A/N: Hi guys! It's time for another chapter. Definite science alert from now on. Let me know if I don't make things clear enough. Please let me know what you think. Thank you all for reading! =)
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Chapter 7
Morning dawned mysteriously, a light rain casting a ghost-like mist into the air and reducing visibility. Oh, how Rachel would have loved to have stayed curled up in bed with a good book. Alas it was not to be and so, groaning, Rachel rolled out of her bed and headed for the hotel's coffee stand. She got herself a gigantic mocha (she had always had a sweet tooth) and she bought Hood a latte. Back in the room, sipping her coffee, she calmly holstered her gun and clipped her badge to her belt. She moved into Hood's room next and found him slumped over the desk, the lamplight still flickering dimly on his pale face. Rachel set the coffee down on the desk and pulled the curtains open, increasing the light in the room and rousing Hood with the steely noise of the curtain rings skirting over the rod. He shuddered, blinking owlishly and, spotting the coffee, nodded to Rachel in thanks before grasping it with a desperation born of his sleepless night. He knew he would drink much more coffee than this today.
He rose sluggishly from the desk chair and stretched the kinks out of his back. Rachel scrunched her nose in disgusted sympathy as Hood's neck and back popped. His stretch finished, Hood bent briefly to gather the case notes together and returned them to his file, keeping out his notepad and pen. In the car, he tossed the notepad on the center console. One phrase had been circled in red ink, its near illegibility a testament to the weariness of the author. It read: 'many victims appear to own animals'. It was a tenuous connection at best, but all such connections must be investigated if they had any hope of finding the source of the infection. At any rate, they needed to return to the hospital to find the answers they sought.
Shortly after arriving at the hospital, Hood and Rachel spotted Dr. Wilkinson who was coming out of the isolation ward. The doctor pulled his disposable gown off arms first, breaking the ties. Next, he carefully removed his gloves, grasping the palm of one glove with the fingers of the other to remove that glove first and finishing by hooking one finger under the cuff of the other and turning it inside out over the first. He finished by pulling off his mask and dumping the whole mess into the biohazard bin and favoring them with a rather weary smile. "We did those nerve conduction studies that you suggested in your note," he told Hood. Hood leaned forward, gaze sharpening with interest, "Yes?" he prompted. "We saw no decrease in nerve conduction. However, we were unable to elicit any muscle contractions."
Hood looked away for a moment, his eyes thoughtful, "have you tried edrophonium?" he asked at last. He barely registered the sarcastic clacking of heels and a scornful huff of disapproval as Nurse Alma stalked by, but Dr. Wilkinson's eyes showed his interest, "Hmm...you're thinking it might be myasthenia gravis aren't you." Another explosion of contempt could be heard faintly from the direction of the disappearing nurse, but neither man noticed. Hood nodded, "It's a possibility. In our witness interviews, one commonality was that they all stated that the victims' eyes were drooping shut. Additionally, Mara told us that Vivian Maxwell's face lost all muscle tone and that she dropped her coffee before she collapsed."
Dr. Wilkinson seemed intrigued. The more he thought about it, the more that he became convinced that the mysterious illness could be a type of myasthenic syndrome. He nodded once, "We haven't conducted an edrophonium test yet. Would you like to observe?" Hood quickly agreed, but pulled Rachel aside for a hurried discussion. "Rachel," he said earnestly, "I need you to talk to the friends and relatives of the victims and ask them anything that you can think of regarding the victim's pets." In a different situation, Hood might laughed at the completely dumbfounded expression that crossed Rachel's face, but now he hurried to explain himself. "Last night as I was going through the detailed interviews, it occurred to me that almost all of the victims have pets and another victim works at an animal hospital." Rachel nodded, "I'll do that, but you are going to explain to me later what that myassthingy is." Hood's eyebrows shot up in amusement and he chuckled softly, but before he could frame an answer, Rachel was already walking purposefully toward the waiting room.
Hood and Dr. Wilkinson decided to test the drug on a middle aged man named Ed Thompson. Both men knew of edrophonium as a drug classically used to test for myasthenia gravis. In certain cases of myasthenia gravis, edrophonium would briefly decrease muscle weakness and/or reverse paralysis and as such could be a useful diagnostic tool. Dr. Wilkinson found himself hoping that this would be one of those cases. If not, even should the illness prove to be a myasthenic syndrome, they would need to sequence a number of different genes to find the source - and that, unless they were very lucky, would take time. He shook his head anxiously - time was a luxury that his patients were fast running out of.
He and Hood headed into the isolation ward, ready for their crucial test, but Hood froze in the doorway, his face blanching. "Oh...oh God," he managed finally, "how many?" Dr. Wilkinson froze as well, having forgotten the scientist didn't know that more patients had come in during the night. He motioned apologetically at Hood, "seventeen more cases were discovered during the night. We've had to start redirecting them to another hospital" He watched unhappily as Hood's whole body tensed, rigid in alarm. Hood stared blankly for a few seconds before slapping his fist into his palm determinedly, "Well, we don't have any time to waste then." They shared a glance, both hoping desperately that the edrophonium test would work.
"The medication is going in now," Dr. Wilkinson told Hood. "If there is no reaction in 30 seconds, I'll give him the rest." Hood nodded, but appeared troubled, frequently glancing back and forth between the patient and something on the other side of the room that Dr. Wilkinson did not take the time to register. Dr. Wilkinson shook his head softly, "No response to muscle stimulation. I'm pushing the rest of the edrophonium." More time passed and there was again no response. "Son of a BITCH," Dr. Wilkinson swore acidly. "No response to..."
"Dr. Wilkinson!" a voice vibrating with alarm froze him in his tracks. He turned to find the scientist shining a pen light into the eyes of Simon Morris. Hood's eyes snapped up to find Dr. Wilkinson's, his fingers ticking off each point as he said it, "pupil dilation accompanied by rising systolic blood pressure, falling diastolic pressure, and a drop in heart rate." Hood's words had the doctor rushing to his side, where he quickly confirmed his findings. "Shit!" Simon was tanking fast and Dr. Wilkinson pressed the clearly marked button to signal a code blue. Rapidly the room began to fill with personnel, a crash cart was wheeled over beside the bed, and Hood retreated to the far side of the room. "Janet - get a surgery suite ready now and have them send a team! This guy is exhibiting Cushing's triad." The designated nurse sprinted over to the wall and snatched up the phone, speaking urgently to someone on the other end.
Everyone in the room knew that time was of the essence now. Cushing's triad was indicative of an increased intracranial pressure. With increased pressure in the brain, vital structures, such as those regulating pulse and blood pressure begin to be crushed and deprived of blood. Should the pressure increase too much, Simon's brain would herniate out of the hole at the base of his skull and death would occur instantly. Simon was surrounded by a flurry of activity. One nurse worked to put in a secondary line. Another was drawing drugs out of a vial with a syringe. A doctor worked to unhook Simon from the ventilator, while a nurse waited, ready with an Ambu bag. In minutes, the surgical team arrived and Simon was smoothly transferred to their care, one nurse riding on the gurney and rhythmically squeezing the Ambu bag. They sprinted down the hall and into an elevator that was being held for them by another nurse and then they were gone.
The remaining doctors and nurses filtered quietly out of the room, faces grim. Dr. Wilkinson stood staring at the empty space against the wall for a moment longer before shaking his head and leaving the room. Hood followed him out, eager to remove the stifling mask for a few minutes. He gladly disposed of his protective gear just as Rachel reappeared. She immediately noted the shift in the atmosphere, "What happened?" she asked, touching Hoods arm to get his attention. "It's Simon," he told her, "he is showing signs of increased pressure in the brain. I'm guessing that this is due swelling in the brain caused by a hypoxic brain injury."
Behind him Dr. Wilkinson only just remembered to pull off his gloves before he passed one hand wearily over his face. "Damn," he said softly to himself, "I sure hope that they can save that kid." He glanced over at Hood and Rachel and shook his head sadly. The good doctor wasn't voicing anything beyond a natural human concern, but Rachel thought that she detected an additional note of strain in his voice - a leaden conviction; she shot him a questioning glance as he looked her way. Dr. Wilkinson sighed heavily and allowed his shoulders to drop fractionally, "Mr. Morris is a farmer from Iowa. He was planning on visiting his son once he settled into his new apartment. He was supposed to arrive two days ago, but he canceled at the last minute because one of his most valuable brood mares was foaling." Hood and Rachel glanced at each other, beginning to understand the situation. Dr. Wilkinson nodded sadly, "When Simon collapsed, no one was with him. A neighbor called the landlord to complain about Simon's dog howling and it was the landlord who found him. He called 911 and began CPR immediately, but when the ambulance arrived, Simon was DOA. The paramedics managed to jump start him, but clearly the damage had already been done."
Dr. Wilkinson and Hood knew that the possibility of Simon's death wasn't even the worst thing. The edrophonium test had failed and now, they were flying blind. While each of them suspected that the patients were exhibiting some form of myasthenic syndrome, there were numerous mutations found in several genes that could be responsible. Dr. Wilkinson straightened himself and turned once again to Hood, "I'll have muscle biopsies done on every patient and I'll tell our geneticist to start sequencing known causative genes. In the meantime, we have already started trying to culture the virus in primary cells. We should be able to pinpoint the causative gene more quickly if we can grow the virus well enough to sequence its genome." He started to turn away, but Hood gestured for him to wait, "Have your geneticist start off by checking the sequence of both the acetylcholine receptor and the voltage-gated sodium channel." Dr. Wilkinson nodded affirmatively, "I'll do that." He then turned and walked swiftly down the hall.
Rachel stood watching Hood quietly for a moment. His shoulders stooped slightly and his face was gray with exhaustion. "Hood," she said, simultaneously shaking the scientist's shoulder. He raised his gaze from where it rested on the floor to make eye contact. "Let's go get some coffee," she suggested. Hood opened his mouth to protest and Rachel held up one finger to stop him. "Let's go get some coffee and maybe a bite to eat and I'll tell you about my interviews this morning." Hood shrugged, knowing that he would not win this particular argument and together they trudged off to the cafeteria.
They returned half an hour later, both carrying steaming cups of coffee. Hood was intrigued by one point in particular that seemed to stand out in Rachel's interviews. Many of the victims had recently taken their pets to a veterinary clinic in the area called the Merriter Lane Animal Hospital. Moreover, another of the patients had worked in that same clinic. Hood was all in favor of going over to the animal clinic now and looking for anything unusual, however, he wanted to check back in with Dr. Wilkinson first. Hood and Rachel didn't have far to look. On arriving on the intensive care floor, they were rapidly approached by a grim looking Dr. Wilkinson.
"I've just been informed that Simon Morris died in surgery," he told them, sighing and throwing his hands out helplessly. Hood's head bowed slightly and Rachel grimaced. Dr. Wilkinson sighed softly and slouched, hands in his pockets, "I've recently come back from tissue culture and they tell me that they have managed to culture what appears to be the virus of interest. They are setting up slides for an electron microscope now and they have already sent samples of the viral DNA over to the genetics lab. I am told that our geneticist has begun PCR amplification and she hopes to have at least partial sequencing done by tomorrow." "Thank you Dr. Wilkinson," Hood told him, smiling fractionally. "Those slides will be ready in an hour or so," Dr. Wilkinson said, glancing at the clock, "I'll be sure to find you when they are ready for viewing." Hood nodded in appreciation as the other man walked off down the hall and decided to hold off on investigating the veterinary clinic until after he had seen the slides. "Hood," Rachel said softly "I'm going to go sit down for a few minutes. Do you need anything?" Hood shook his head negatively and Rachel moved off in search of a soft chair. She only hoped that he could stay out of trouble for half an hour or so.
Hood was standing next to the one unoccupied bed in the isolation ward when he heard the quiet whoosh of the door opening and the sound of footsteps approaching. He turned and spotted Mr. Morris staring from the center of the room at the empty bed. He looked desperately at Hood who moved carefully toward the other man. "Dr. Hood," he said, his voice frightened, "where's my boy? Where's Simon? Please..." he trailed off breathlessly. The skin around Hood's eyes pinched slightly as if in pain and he hesitated briefly, "I'm so sorry Mr. Morris, " he began. The older man began shaking his head frantically, breathing raggedly. "I'm so sorry, but your son passed away earlier today." The little that could be seen of Mr. Morris's face crumpled in agony and he unconsciously bent forward, reeling as though from a physical blow. Both men were oblivious to the door opening for a second time and to Rachel's presence as she stood, observing quietly from near the door. "My fault," Mr. Morris said softly, "oh God, my fault."
Hood stepped closer, his hand twitching as if he had started to reach for the other man's shoulder but had stopped the motion partway through. He hesitated for a couple of seconds and came to some sort of decision, "Your son contracted meningitis while in the hospital and this caused swelling in his brain. The doctors operated to try to relieve the pressure, but it was already too late. I'm sorry we didn't catch things earlier."
With barely any warning at all, Mr. Morris hauled off and punched Hood in the face, sending the scientist sprawling to the floor. Then he turned and practically bolted for the door. Rachel made a move as if to grab him but Hood's voice, muffled as it was from behind the hand he held to his nose, stopped her where she was. "Let him go." He pulled his hand away, blood already beginning to seep through his mask, "Just let him go," he breathed, half to himself. Rachel watched Mr. Morris disappear down the hall and then went to help Hood off of the floor. They left the room and Hood removed his mask, dabbing at his nose with a handkerchief. "Hood," she said exasperatedly once she was certain that he wasn't going to fall over again, "why did you lie to him." "Because," Hood said simply, allowing the hand he had been holding to his nose to drop, "things are going to be hard enough on him without the addition of the two worst words in the English language..." He shifted his stance slightly forward, eyes blazing with conviction, "What If."
