Selena, one of the main acute Chagas symptoms is anorexia, the patient is unwilling to eat and when he/she does, they experience nausea. Anemia is more often linked to chronic Chagas disease.
Nicky, Shari will explain how and why Mr. Robertson got infected in the next chapter, so keep reading! :)))))
And, of course thank you all so much: Selena, Nicky, Deana, Cindy, Kcrane for taking the time to leave your comments. I value them a lot!!!!!
Chapter 5: An accurate diagnosis and a nice chat.After setting things in motion in the lab, Shari went up to the Epidemics area, where she found a small group of people waiting for her. She recognized the two nurses who had been at Mr. Robertson's room; they looked extremely frightened, and she wasn't sure if they feared the disease or her. Then there was a young student, who was desperately trying to put up a brave front (and was failing miserably) and, of course, Matt and Nicholas. She led them all into her office.
" Hi, thank you for coming so soon. So, the six of you have been in touch with Mr. Robertson?" They all nodded and she could sense they were nervous. Yes, even almighty Nicholas looked apprehensive. " Well, as you've probably heard, I have the suspicion he might be suffering from Chagas' disease and since you've treated him, you all must be put on preventive treatment."
" You mean we can be infected?" Asked Matt.
Shari had never seen her friend look so apprehensive and smiled soothingly at him. " It's extremely unlikely, Dr. Slingerland. But if you've been in contact with the patient's body fluids or skin, there's a chance you could be infected. Luckily, it has never happened before."
" It's said that there's a first time for everything. I hope in this case there isn't," he commented, half jokingly, half serious.
She nodded and turned to a medicine cabinet, from where she took out five square boxes in bright yellow. After handing one to everybody and receiving a few questioning looks, she explained. " OK everybody, these boxes I' giving you contain Benznidazole, one of the drugs of choice for Chagas' disease. It's a yellow powder that you have to dissolve in water and drink three times a day after the meals. This drug is rapidly absorbed and distributed through the body tissues. The recommended administration is for a period of sixty days, but we will reduce your treatment up to only ten days."
" Will it be enough?" Questioned one of the nurses, who, according to the nametag was 'Rose'.
" As a preventive treatment, yes. There's really nothing to worry about because, even if you were exposed to the parasite, Benznidazole is claimed to be more than eighty percent effective in curing acute and chronic Chagas' patients. Good results can be seen in early treatment, circulating trypanosomes may disappear, and there may be a remission of chagasic symptoms. Now on to the negative side: the diverse side effects of Benznidazole include vomiting, peripheral neuropathy, and skin reactions that may include erythematous light-sensitive skin rashes. If any of these effects are too severe to tolerate, come see me immediately and we'll put you on another drug, OK?" The room slowly nodded their heads. " Anybody's got any questions?"
No one spoke, so Shari decided to end the 'meeting'. " Good, I'll need a follow-up of each one of you, so we'll be probably seeing each other a lot in the next ten days. Let's see... today is Monday, so come see me on Friday. Now let's get back to work."Before anyone had the chance of saying everything, she promptly left the room and nearly ran to the laboratory. She was dying to start working on the microscopy and incredibly eager to test her skills on such a challenging disease.
Five hours later, she looked up from the microscope with a smile on her lips. She had been right. Shari didn't even notice the soreness of her neck's muscles or the fact that she had been holding her breath since she had finished the Giemsa stain... all she could think about was treatments and drugs to help Mr. Robertson.
And she also prayed that the disease hadn't spread to other patients or to any of the attendings.
" Kym, make sure no one touches this, I'll be right back," she told one of her coworkers and left the lab with the same swiftness she had arrived.
No soon had the elevator doors opened at Presidio's waiting area, when she ran into David Eidenberg.
" Shari, have you got the results?" He asked with great urgency.
" Yes… it is Chagas' disease."
Her boss looked at her without blinking and her mouth hanging open for a whole minute before letting out an " I have to notify the Board of this."
The woman nodded. " OK, David, you go. I'll take care of the patient."
" Yes, who better than you for this?"
***
Less than an hour later, Shari was at the hospital. She and David had agreed on the treatment for Mr. Robertson and she was on the way to administer him his first IV of diluted Benznidazole, when she found Matt and Nicholas standing at his door.
" Here comes the woman of the hour and by all the stuff you have in your hands I'd say you diagnosis was correct," said the first one with a smile that did little to conceal his anxiousness.
" Yes, Matt, it was. Now I have to start Mr. Robertson's medications."
" How can you know for sure it is Chagas?" Asked Nicholas, testing her.
" Demonstration of the causal agent is the diagnostic procedure in acute Chagas disease. It almost always yields positive results, and can be achieved by microscopic examination. Immunodiagnosis is another method of choice for determining whether the patient is infected, by the ELISA test. I have run both of them and the results indicate acute Chagas."
" I would have never even thought of this disease," he confessed.
Shari smiled lightly at him. " Well, it's seldom heard of. Besides, Chagas' disease often goes undiagnosed because its symptoms are associated with heart disease, volulus, achlasia, and constipation."
" So that's why we were so confused, Shari."
" Mislead is a better word."
Before Matt could reply, his beeper went on. " Well, looks like Letty needs me. See you two later," he said and left, only after giving Shari a quick kiss on her cheek.
Nicholas' eyebrows arched and she had to stifle a laugh at his reaction. " Would you like to see the microscopy?" She offered him.
" Yes," was his simple answer.
" Then follow me."
When they entered the lab, things were exactly like Shari had left them. Kym shot her at look which meant ' Who's the hunk?' which she chose to ignore. She then took her seat in front of the impressive microscope and motioned Nicholas to do the same.
" Look at this…" She moved so he could have access to the lens. " Do you see that little blue thing in the center of the field that looks like a worm?"
" Yes."
" That's the T. cruzi," she informed him.
" What method is this?" Nicholas asked, looking up.
" Microscopy of thin and thick blood smears stained with Giemsa for visualization of the parasites," Shari said simply.
" You did this yourself?"
" Why so surprised, Dr. Kokoris? It's not like I've split the atom or anything!"
" I know, but… " he trailed off.
She finished his sentence for him. " You didn't think I was capable of doing this." Shrugging at his killer look, she went on, " Thing is, Dr. Kokoris, I bet you must not like it when people doubt your skills. Well, neither do I."
" I'm sorry. That wasn't fair of me," Nicholas apologized, looking down.
Shari sighed, feeling she had been a bit harsh on him. " Hey, that's OK. Even if people don't acknowledge my work, I like what I do."
" Indeed. You seem to be enjoying this chaotic situation," he commented with a half smile.
" Well, I like controlled chaos. Besides, I've never had a patient before… I've always worked in labs. This is rather refreshing."
" This job... you seem very good at it," acknowledged the surgeon.
" Thank you. I simply love it, which is obvious, since why else would I move across the country?"
" Don't you have any friends or family here?"
Shari suddenly wondered when the conversation had got personal, but decided to go on with it. After all, she didn't mind. " Nope, I'm all alone. Besides, I don't have much time left for socializing or anything like that."
" Except for Dr. Slingerland, of course," he casually said.
" Oh, Matt's been wonderful to me. I don't think I would have made it without a friend like him," she replied with a smile that lit up her eyes.
Before Nicholas could ask her if they were more than just friends, a young secretary interrupted them. " Shari, a man named David Eidenberg would like to see you in his office at Presidio."
" When?"
" I think his exact words were: 'right now'."
She smiled, that was to be expected. " OK, thanks Dana." When the woman left, she turned to Nicholas. " Sorry, Dr. Kokoris, but the boss needs me."
" Please, I would not like to delay you. I think I've taken enough of your time."
" You're welcome here anytime," she said and shot him a smile before leaving the laboratory.
He watched her walk away, admiring her body as she cut through the hall's lights. He remained sitting in the lab for a few minutes longer, hands clenching and unclenching at his sides, before standing up. His mind busy with thoughts of Shari.
He had heard of Presidio Medical Group wanting to hire an expert on epidemics to complete their staff and work in cooperation with the hospital; but he had never expected their expert to be that cocky, maddening, beautiful girl.
' No, not girl, woman. Quite a woman,' his mind corrected.
***
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