nodded and sat up straighter in bed in preparation for Allison’s exam.
First, the doctor used the flashlight and one of the tongue depressors from a jar sitting on Rachel’s bedside table. “Not so much exudate,” she said, “but the throat’s still pretty red—maybe a bit redder than before. And there seems to be a bit more swelling back there. Any problem breathing or swallowing?”
“Not really,” Rachel replied.
Allison picked up the stethoscope that hung at the foot of Rachel’s bed. “Let’s have a listen to your chest.”
Rachel went through the routine she knew so well—except she usually was standing by to assist the doctor instead of being the person following commands to take deep breaths. She watched the doctor’s eyes, which were about all Rachel could see of Allison’s expression over the mask, but there was no clue there.
“It’s probably too early to expect much change,” Allison said after hanging the stethoscope on the foot of Rachel’s bed again. “I’m troubled that your fever’s still hovering around a hundred and four. Every time we give you something to knock it down, it climbs right back up within a few hours.” She frowned—that expression was easy for Rachel to see. “But so far, even with increasing swelling in the throat, your airway seems okay. Let’s see if the diphtheria antitoxin makes some difference today.”
“How long will I have to be in isolation?” Rachel asked.
“Conventional wisdom is to isolate patients with diphtheria until they’ve been on antibiotics for at least two days.” Allison shrugged again. “I’ll see if Dr. Pearson agrees. If he does, maybe we can discontinue the precautions tomorrow.” She made a half-turn toward the door. “Any other questions?”
Rachel felt foolish for asking, but the question had been niggling at her since the doctor came in. “Just one,” she said. “What’s the name of the diphtheria organism? I can’t remember it, and it’s driving me crazy.”
***
“Mr. Madison, how do you feel?” Josh asked as he entered the ex-president’s hospital room.
Madison managed a smile, but it was evident to Josh it was a politician’s gesture, with no real emotion behind it. “I’m still here, so I guess that’s something.”
Josh moved quickly to the side of his patient. The main IV continued to drip at a “keep open” rate, but the smaller bag that had delivered the diphtheria antitoxin was empty and its line was turned off. “Let’s have a look at you.”
After the exam, Josh said, “I’m sorry to say I don’t see much progress, but it’s still early. Let’s see how the diphtheria antitoxin affects you today.”
“Do I get another dose?” Madison asked.
“No, everything I’ve been able to find says one dose is all that’s necessary. We’ll continue the antibiotics to kill out any residual organisms. And if your temperature comes down and there’s less redness and swelling of your throat tomorrow, I’ll think about discontinuing the isolation precautions.”
“Good,” Madison said. “The rest of the group that went to South America with me should be on their way back soon, and I want to confer with them. It’ll be a lot easier if they don’t have to go through this silly mask/face shield/gown/gloves drill.”
“I don’t like it any better than you do, Mr. Madison, but that’s the routine that’s called for.”
After a few more words, Josh stepped outside and began to divest himself of the isolation garb. He scrubbed his hands a little longer than usual, although there was really no reason to do so. Josh hoped he could discontinue the isolation precautions soon. Madison had been on antibiotics for twenty-four hours, which was probably long enough to destroy all but the hardiest of the Corynebacterium diphtheriae in the average patient’s body.
Josh pondered whether he should look in on Rachel, but decided he’d have to delay that until he checked out what the bacteriology technician had found. And, after all, even though Rachel was his girlfriend, Josh couldn’t escape the knowledge that his primary allegiance was to his most important patient
. . . the one he’d just left.
He headed toward the lab, wondering if his unease was related to guilt at not being attentive to Rachel or to the news he was afraid he would receive from the lab technician. As Josh punched the elevator button, he decided he’d know soon enough.
***
Ethan Grant looked up as the lab door opened and Dr. Josh Pearson walked in. He’s not going to like what I have to show him.
“Okay, I’m here,” the doctor said. “What’s this I need to see?”
Dr. Pearson, unshaven, his clothes wrinkled, showed evidence of long hours with no sleep. The lab tech felt sorry for him. What he had to show him wasn’t going to make Pearson any happier, either.
Ethan rose from the counter where he’d been using a binocular microscope to scan a Gram-stained slide. “Let me show you,” he said. He moved to a large cabinet with glass doors, opened one of them, and removed a petri dish.
Pearson made no move to take the shallow, covered glass dish Ethan held out. Instead, he bent until his face was a foot from it and studied its contents. Finally, he straightened and said, “I’m afraid it’s been too long since I had bacteriology. It looks like this is a blood agar plate, and it’s almost completely covered with bacterial colonies. What about it?”
“To begin with, it’s totally unusual for Corynebacterium diphtheriae to grow this rapidly. I would normally wait twenty-four hours, then inoculate tellurite-enriched agar with some of the material from the original culture. That would further enhance colony growth. I’d eventually do a stain, basing the final identification on colony characteristics and microscopic morphology of the bacteria.”
“Didn’t we already confirm a diagnosis of diphtheria?” Pearson asked.
“True, the morphology of the bacteria we saw on the slide from the original throat swab are Gram-positive bacilli with clubbing at one end. That, combined with the clinical picture, is generally enough to justify starting treatment for diphtheria. But I don’t stop there. I keep going until I have the diagnosis nailed down. That’s why I’m still working on this.”
“And have you found something more?” Pearson asked.
Ethan put down the plate and picked up another, this one with perhaps a dozen filter paper discs scattered around its surface. “We know that the diphtheria bacillus should respond to penicillin and erythromycin, sometimes to a few other antibiotics, although that varies, but ‘should’ isn’t always dependable, so I do sensitivity studies, seeing how various antibiotics prevent bacterial growth.”
Grant held out the new petri dish for Pearson’s inspection. “This one was plated less than twenty-four hours ago, and as you can see, the colonies have already grown so rapidly they almost fill the dish.” He used his pen to point. “Each of those white filter paper discs is impregnated with a different antibiotic. Normally, a sensitivity study isn’t ready to be read this early, but this one’s unusual.”
Pearson looked at the petri dish, then he took it from Ethan’s hand and studied it more closely.
