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Fort Walton Beach, Florida
Breakfast today was an apple, a bright-red Macintosh, and Dr. Carol Mayer bit into it with the aggrieved attitude of a hungry woman deprived of a decent meal. It made a satisfyingly crunching sound, and tasted delicious and sweet. But it was still an apple, and as such a woefully insufficient substitute for a real meal.
Her jaw working busily, Carol popped another chart from the ready-rack behind the reception counter and scanned it quickly. She frowned, pursing her lips.
Another upper-rez complaint? the young physician said to herself. Third one I’ve fielded this morning.
It was shaping up into a busy day, and the non-physician side of Carol sighed in disappointment. It was a beautiful day outside, and the waters of Choctawatchee Bay —her bay: the expanse of living waters that she had first seen on the incoming flight when she interviewed for the job here, the bay with which she had fallen into thrall from that instant onward— would be blue and inviting.
The emergency room at the Rossini-Evans Clinic was crowded— not unusual for a Tuesday during the summer season, when it seemed that every other tourist, traveler or random visitor to the Emerald Coast ran afoul of the perils of vacation. It might be sunburn, cherry-red on newly arrived flesh unaccustomed to the searing rays of the Redneck Riveria. It might be jellyfish stings, or fishhook impalements. It might be cracked bones or abrasions on visiting skateboarders, whose chronic attitude of terminal teenage boredom was at least temporarily on hold.
But it’s not often summer colds, Carol told herself. At least, not this many.
“Room Three,” LaTonya Ferris said, interrupting the physician’s musings. She was a large black woman in nurse’s garb who ruled the clinic’s immediate care operations with an iron hand. “But when you’re finished there, honey, take a look at the boy in Five. He’s wearing a cast that’s past due the time to come off.” She chuckled. “And the fragrance is something else, I want to tell you.”
Carol Mayer checked to make sure no patients were watching. Then she stuck her tongue out at LaTonya. Both women laughed at the same time, and Carol was still grinning as she strode down the hallway to the examining room. She took a final bite of her apple, dropped it in the side pocket of her lab coat, and knocked once on the closed door.
Carol was all efficiency when she opened the door and stepped in.
Seated on the exam table was a woman who could not have been far out of her teens. She was wearing a multi-colored tubetop and white shorts, and on her feet were bright red canvas Keds. Like so many of the girls who found their way to the sugar-white beaches here, she had long blond hair and the body of a dancer. A seahorse tattoo, acquired recently enough to still look raw on the margins of the inklines, decorated the inside of her left thigh.
A young man in a faded Mississippi State T-shirt and cutoff Levi’s sat on the table beside her, holding her hand and looking uncertain.
“How are we doing today” —Carol glanced at name on the insurance form— “Ms. Atkins, is it?”
Ashley Atkins, whose sophomore year at Ol’ Miss had ended three weeks before she had informed her parents of the plan to summer on the beach, blew her nose in the handkerchief she held. Her eyes were red and puffy.
“Not so good. I truly feel like hell.”
“She’s been throwin’ up all morning, Doctor,” the young man interjected. His voice was worried. “I think she’s running a fever, too.”
“Let’s take a look.” Carol snapped on fresh latex gloves from a box on the countertop. She slipped a plastic sleeve over the sensor of an electronic thermometer and placed the tip in the younger woman’s ear canal.
“Yep. You’re elevated, a bit. I want to look at your throat, please.”
There was inflammation. It was not major, and certainly fit the diagnostic profile Carol was building. Northwest Florida in July was an oven, which meant that air conditioners were working overtime in every motel room, beach house and condo. That kept the inside air dry, which dried out throat and nasal membranes; viruses tend to thrive in that kind of environment. Add to that the closed-circuit recirculated air in movie theaters, restaurants, rave halls and bar rooms— well, Carol reasoned, it’s a wonder everybody isn’t nursing the summer sniffles.
She scribbled a note on the form. “About how long have you been feeling ill, Ms. Atkins?” she asked, without looking up.
“Day ‘fore yesterday, she started sounding all clogged up,” the young man said. “I don’t think she got much sleep last night, either.”
“It wasn’t bad until this morning, Bobby,” Ashley protested. “Doctor, you got something I can take to feel better?” She blew her nose again. “Penicillin or something? I tried Contac, but it didn’t do any good.”
Carol shook her head sympathetically.
“I’m afraid you’ve picked up a bad cold,” she said. “Antibiotics don’t work on a virus. I’m going to take some swabs and have a nurse draw a blood sample —don’t worry, Ms. Atkins, you’ll hardly feel it. We’ll run some tests. There are a few medications that can help with the symptoms, and we’ll write you up a prescription.” She stood, peeled the latex gloves from her hands and tossed them into a wastebasket. “I’ll be back in a minute.”
Carol closed the door behind her. It was a routine case, a summer cold, and Ashley Atkins was an otherwise healthy young woman. Strictly speaking, she could prescribe two antivirals, amantadine and rimantadine, though it was probably too late in the cycle to do much good. In addition, the medical journals were all agog about neuraminidase inhibitors like zanamivir and oseltamivir, though the results were still less than predictable. There were also even newer formulations, most of them still in the pre-brandname stage and tagged only by alphanumeric identifiers; sometimes they worked, usually they did not. Worse, the cost was horrendous; few HMO’s or insurance companies would pay for what they termed such “experimental” treatment.
All you could really do was wait it out. A week, ten days at the most, and Ashley Atkins would be back on the beach without a care in the world. Carol fished the apple from her pocket and nibbled at it.
She was approaching the reception counter to order the tests when she heard a loud hacking from the waiting room. It rose above what suddenly seemed to her a cacophony of lesser coughs and a chorus of snuffling noses.
On a hunch, she walked around the counter and looked out at the waiting room. Of perhaps fifteen people there, she estimated a dozen were exhibiting the sniffling, flushed-face presentation she had already seen three times today.
As she watched, one of the waiting patients began to cough again. It was loud and phlegmy and extended, racking the middle-aged man’s beefy body. It was also evidently painful, bending him forward from the waist as he sat. When the man finally regained control his eyes were watering profusely. He wiped at his mouth with a handful of paper tissues, and Carol saw the bluish cast of his lips.
My God, she realized, he’s cyanotic.
She was just starting forward when the man’s eyes rolled upward and he fell forward. He crashed heavily to the floor and lay motionless. In an instant, Carol was crouched over him, oblivious to the screaming and commotion in the room. Her fingertips were still wet with the juice of the apple now rolling into a far corner, and she pressed them firmly against the man’s carotid. She concentrated hard, only vaguely aware of a figure that was now kneeling beside her. It was one of the nurses, Jerry -something-or-other, who moonlighted at the clinic when not on duty at Eglin Air Force Base hospital.
“There’s no pulse,” she told him, and began chest compressions as Jerry bent to clear the airway. They worked as a team, with Jerry timing his mouth-to-mouth ventilation to Carol’s pace until LaTonya sprinted up with a bag and oxygen mask.
For the next few minutes, the waiting room was chaos. Other physicians and nurses rushed in, some of them herding the waiting room occupants away from the tableaux on the floor. Patients, themselves alarmed by the clamor of the frightened crowd, peered from behind half-opened doors of the treatment rooms; several emerged to better see, adding to the press of humanity in the room.
Carol noticed them only in peripheral, all her attention focused on the medical crisis. The portable electroshock kit was up and charging in seconds, but even repeated hits from the paddles caused no change in the unit’s monitors. She heard somebody, a woman, asking loudly for an ambulance; if Carol had not been so fiercely focused she might have laughed.
Ambulance? This is a clinic, lady. He’s already up to his butt in doctors.
She said nothing, except to call for syringes of adrenaline, bicarbonate, TPF— the full arsenal that modern medicine provides to restimulate cardiac activity.
But not even the most sophisticated treatments can reanimate dead tissue. After almost twenty minutes, Carol waved Jerry away from what was now only a bundle of slowly cooling meat. She looked at her wristwatch, trying to ignore the film of tears that blurred the digital numbers.
“Time of death,” she said in a low voice, “nine-fifty-four A.M.”
Around the room, there was a hushed silence from the medical staff and the patients alike.
But only for a moment.
Then, a woman standing wide-eyed amid the other stunned patients began to cough, loudly and painfully. She was bent forward at the waist when Carol looked up, and had it not been for the fresh seahorse tattoo she would not have known who it was. The paroxysm rocked Ashley Atkins’ body, and she leaned heavily against the young man who held her arm.
There was an instant’s hesitation before one of the clinic staff moved toward her. In that brief moment, the other patients already had begun to shrink back— all but one, whose own sudden racking cough ended in a projectile gush of bright crimson blood.
What the hell? Carol Mayer asked herself. What the hell is going on here?
She felt a shiver pass along her spine, and recognized it as fear.
- ∞ -