Judgment Day
A deadly disease is spreading through Trenton, New Jersey and the NIH team is called out to investigate. Meva and Nathen romance. There is tragedy for the team both collectively and individually. My first Medical Investigation fic. Please review!
Disclaimer: I do not own Medical Investigation, but I do think that I could write some pretty awesome episodes if I did.
Chapter 3: Diagnosis
Miles sat in the lab, staring intently at the results that were spread over the table. The samples had shown nothing conclusive. There were only a few panels left to run on the samples and Miles' patience was running out. He barely heard the quiet beep from the centrifuge in the background, signaling the end of another set of labs. The results of the labs weren't terribly urgent, but the remaining panels were importunate. Miles decided to go down and see his team. Maybe he could find some answers there.
The members of the team were all sleeping soundly. He walked over to where Eva lay and lightly grasped her hand in his. He stroked the back of her hand with his thumb, gently massaging the IV site. Eva was roused from her sleep by Miles' delicate beckoning. She opened her eyes and blinked sleepily. Miles heart wrenched at the sight of the weakness etched clearly across her features. In all the time they had worked together, he had never seen Eva Rossi in a weak moment. It scared him more than anything else. Eva smiled wearily up at him.
"Hey, what's going on?" She whispered quietly.
The disease was taking her voice. It was something she couldn't do without and Miles worried for her.
"Not too much. There are no new cases; no one else has… given in… I'm just waiting for the last few cultures to come back on the evidence Frank collected," Miles explained.
Eva smiled a little more assuredly. Miles smiled back at her.
"How are you feeling?" Miles inquired.
"I've been better," Eva replied honestly.
Miles glanced at the monitors that betrayed her condition. She was doing as well as was expected and so were the others. Well, Frank's oxygen saturation was a little low, but Miles was determined to find a cure for this thing before anyone got any worse. He looked back down at Eva.
"Is there anything bothering you?" Miles asked.
He could see the pain in her eyes and knew that it was hard for her to be honest when it betrayed her vulnerability.
"My wrists hurt, I can't bend them too well," Eva stated.
Miles nodded and continued to rub the back of her hand gently. He tried to keep her mind off of the thought that this disease might very well be the end of her. Eva began to cough violently and Miles pulled away to grab an oxygen mask. He glanced at the monitor and noted that her oxygen saturation was dropping slowly. It hovered around 89 on 60 percent oxygen. He increased the flow of oxygen to make her more comfortable and was relieved to see her saturation come up to 94 on 65 percent oxygen. Eva eventually stopped coughing and laid her head back in anguish. Tears ran in rivulets down her cheeks and Miles gave her a commiserating smile. He laid one gentle hand against her shoulder as he checked her breath sounds. He felt her shudder as the cold disk touched her feverish skin. Miles was devastated to hear the beginnings of the familiar, deadly crackling in Eva's lungs. He pulled away slowly and took Eva's hand once again.
"You're doing great, just hang in there. I'm going to go check on the others and then I have to get back to the lab, but I'll be back to see you later, I promise," Miles said reassuringly.
"See you," Eva said lightly.
Miles stepped away and watched her tired body collapse into a deep slumber almost immediately. As he checked on the rest of his team, Miles wondered what kind of a person had opened Pandora's box and unleashed this plague on them. He made his way over to Stephen's bed and noticed his superior was awake.
"Dr. Connor, how are you feeling?" Miles asked as he walked up.
"Fine," Stephen said plainly. "How is the research coming along?"
"I'm just waiting on the rest of the panels I've run on the samples to come back. I should know more soon," Miles said.
"Good. How are you doing, Miles?" Stephen inquired.
"What do you mean?" Miles shot back.
"Are you presenting with any symptoms?" Connor asked.
"No," Miles said briskly.
"How about otherwise? How are you handling the case by yourself?" Connor queried.
"It's hard not having the rest of the team to back me up, but I guess it's an opportunity to prove myself," Miles said quietly.
"You don't need to prove yourself, Dr. McCabe. You are a skilled physician and diagnostician and I know that you can handle this case on your own. Don't doubt that, Miles," Stephen said firmly.
Miles nodded and carried on with his brief examination. After he was finished Miles received a reassuring smile from Stephen before leaving the room. He headed back up to the lab at top speed, praying for answers. As he rode in the elevator, Miles thought about Eva. He had given her morphine for the joint pain. The symptoms weren't making sense. Maybe he was dealing with two viruses. Suddenly, Miles had a flashback of a conversation he, Stephen and Natalie had had during a recent case they had worked on. There was a disease that Connor had mentioned that was similar to this one in some of its forms. The name flashed in his mind as Miles raced up to the lab.
The answers were hidden in the families' pets. They had all recently adopted young animals from the pound. Mice were often found in animal holding facilities as such. Mice carried tularemia that could be spread to the animals which could then be spread to humans which would present with symptoms identical to the ones of these patients through varied contact. If the bacteria were inhaled, the symptoms were respiratory. If the bacteria were ingested, the symptoms were gastrointestinal. If the bacteria were absorbed, the symptoms were cutaneous. The pieces of this insane jigsaw were finally coming together. Miles only hoped he was right. The samples would mean sink or swim for his team. Miles finally reached the lab and ran straight over to the cultures he was running on the patient's clothing. He found tufts of cat and dog fur all over the place and hurriedly placed a mask over his face to prevent infection. He quickly placed a slide under the microscope and searched for his answers.
Miles almost whooped for joy when he found the familiar form of the francisella tularensis bacteria in the samples. He thanked God that it wasn't bioterrorism. He quickly ran from the lab and discarded his protective gear. He ran down the stairs to the isolation ward and hailed a number of staff members.
"Nurse, I want you to get these patients started on Streptomycin, 1g IM every twelve hours," Miles ordered.
At that same moment the sound of a monitor signaling supraventricular tachycardia could be heard wailing across the hall. Miles dashed over to where 16 year old Jamie Kurtz was progressing into respiratory and cardiac arrest. A team of nurses joined Miles and worked with him to save the girl.
"Get me a 7.0 ET tube, stat! Give her 1mg of epinephrine, 20mg of atomidate and 100mg of suxamethonium," Miles ordered.
He successfully intubated the girl and moved on to doing compressions. A nurse took over for him as he grabbed the defibrillator.
"Charge to 200, clear! Charge to 300, clear! Charge to 360, clear!" Miles shouted.
The team tried for a long while before the monitor signaled a flat line. Miles stopped CPR and glanced at the clock. He hung his head as he pronounced the girl's passing.
"Time of death, 13:09," Miles stated.
Outside the room he heard a shrill yell and the agonizing sound of mourning as her death registered in Jamie's parents' minds. Miles walked out of the room and joined Jamie's parents in the corridor. He placed a hand lightly on Jamie's father's back as the man comforted the girl's mother. He sympathized with the family for a moment before finding his voice.
"Mr. and Mrs. Kurtz, I'm Dr. McCabe. Jamie was suffering from tularemia. She arrested before we had the chance to give her the antibiotic that could have saved her life. I'm sorry, Mr. and Mrs. Kurtz, Jamie passed away a few minutes ago," Miles explained.
The mother was too shocked to be able to speak but the father intrepidly found his inner strength.
"Was she in pain? Was my baby girl scared, Dr. McCabe?" Mr. Kurtz asked.
"No, I can assure you Jamie died peacefully," Miles said reassuringly.
He stayed with the parents for a moment longer before turning to visit his team. A weak hand on his shoulder stopped him. He turned back to face the Kurtzes and found young Jamie's mother reaching out to him. He looked down into her teary eyes as she spoke.
"Thank you, Dr. McCabe. Thank you for doing your best to save my little girl," Mrs. Kurtz whispered.
"You're welcome," Miles replied.
He swallowed hard as he walked away. Miles had to fight the tears that welled up in his eyes as he headed for his team's room. The girl had only been 16. He had had a few good conversations with her during her short stay in the hospital. Her best friend would be devastated when she found out what had happened. Miles promised himself that he would maintain that human connection and that he would do his best to commiserate the other girl. He walked into the next room and found the nurse injecting the antibiotics into his teammates' tired bodies. They were all awake save for Frank. His condition was still steadily declining. Miles looked around the room and received smiles from each of his coworkers in turn. He came to stand closer to the foot of the bed near Natalie in the centre of the room.
"You've figured out what's happening, I'm guessing," Natalie said plainly.
"Tularemia," Miles replied simply.
"Great work, Dr. McCabe. What have you started us on?" Stephen asked.
"Streptomycin," Miles answered.
"Well done, Miles. You've saved all of the people here today single handedly. How does it feel to be a hero?" Eva asked lightly.
"I'm just glad that I know I can work under pressure," Miles replied.
Suddenly, a gasping could be heard from the other side of the room. Miles spun around on his heels and strode over to where Frank was slipping into respiratory arrest. Again, he was joined by a few nurses and he tried frantically to intubate one of his own. Miles struggled for a minute before decided it was hopeless.
"It's no use, I can't see his cords! Give him 1mg of epinephrine and get me a tracheotomy kit, he's having a damned allergic reaction to the streptomycin!" Miles shouted.
The nurses obeyed as his team watched in horror from all angles. Miles worked carefully to insert the tubing into Frank's trachea without causing any unnecessary damage. After he had successfully gotten the trache in place, Miles started compressions. Frank was rapidly progressing into cardiac arrest. Before many efforts could be had, the monitor that was secured to Frank's chest heralded a flat line. Miles stopped his work and stripped off his gloves. He cried out in anguish as he tossed his gloves angrily into the trash bin.
"Time of death, 14:18," Miles snapped.
He turned on his heels and ran from the room, not once stopping before reaching the courtyard outside the hospital. He collapsed onto a bench under the shade of an oak tree and put his head in his hands. He let tears flow as he recalled Frank's death. It was what Miles had been dreading the most; losing a team member. He could only imagine how angry and disappointed Connor, Natalie and Eva were. He didn't know how he would face them again. At that same moment, Miles was startled by a hand on his shoulder. He turned around quickly and noticed Connor standing above him. Miles' expression softened at the look of sympathy on his superior's face. Connor sat down next to Miles and tried to comfortably rearrange the array of tubes and lines that surrounded his body. He had had one hell of a time trying to convince the nurses to let him go after Miles, but in the end he had seniority and Miles wasn't there to object. Connor grasped Mile's shoulder as firmly as he could muster to try and reassure the young doctor. Miles ran a frustrated hand through his hair and took a deep breath.
"I screwed up," Miles deadpanned.
"No, you didn't. You had no idea that Frank was allergic to Streptomycin, neither did I. He's never been given the drug before, so no one could have known. It wasn't in his records. You did the best you could and you're not to blame. I don't want you to hold this against yourself," Connor said sharply.
"Even if I couldn't have known, I could have treated him with any number of antibiotics; Gentamicin, Doxycycline, Chloramphenicol, Ciprofloxacin…" Miles trailed off.
"You chose the most effective course of treatment and you know it, Miles. Gentamicin isn't approved by the FDA to treat tularemia. Doxycycline, Chloramphenicol and Ciprofloxacin are inferior choices. You did what you knew was the best thing to treat this infection quickly. Don't blame yourself, Dr. McCabe," Stephen said firmly.
Miles exhaled a long, stagnated breath. He still felt responsible for Frank's death. He could have kept a closer eye on him. He could have worked harder to save him. Anything to not have let him die. Connor kept his hand firmly on Miles' shoulder as Miles let out a few frustrated tears. After a few minutes Miles had managed to collect himself and he turned to Connor, as if seeing him there for the first minute.
"Dr. Connor, you should be in bed, resting. Let's get you back upstairs," Miles suggested.
The two men stood and Miles supported Stephen as the walked back up to the isolation ward. They returned to the room to find Frank's body had already been moved to the morgue. Natalie and Eva both had tears in their eyes, but they refused to cry. It would only deepen the guilt that Miles felt. It would make the sense of loss too real to bear.
Miles helped Stephen get back into bed and adjusted his IVs. He checked on Natalie before collapsing into a chair beside Eva. Miles just wondered why he had been the only one who hadn't become infected. His contemplative expression must have said as much because a moment later, Natalie spoke up.
"It was just dumb luck, Miles. Your not getting infected, I mean. Frank was obviously infected in one of the houses. He had direct contact with the animals. Stephen and I likely got infected when we were treating the initial victims, from particles that were in their clothing. We would have disturbed the particles when we had to cut their clothes off of them. Eva's best bet would have been when she was talking to one of the victims' affiliates by the same manner as Stephen and I. Now the only question that remains is why only some of the people from each household got infected," Natalie stated.
"The ones who didn't get infected have pet dander allergies, so they would have stayed away from the animals. I handled the samples, too, why didn't I get infected?" Miles asked.
"You always wore a mask. For one reason or another, you always had a mask on," Stephen said lightly.
With hindsight Miles realized that Stephen was right. With those questions out of the way and Frank dead, the only thing that remained was for Miles to watch his patients as they recovered over the next few days and pray he didn't present with delayed symptoms. After all, the incubation period was up to 14 days, so he wasn't quite in the clear and neither were the victims' families. Miles sat back and said a silent prayer for all of them before putting his head back against the high back of the chair and drifting off to sleep.
It was the first uneventful sleep he would have in a number of days…
A.N.: So, what do you think? It was hard to write in one day, but I did it! The info should all be correct, since I did get it off of the official CDC website. In any case, let me know how this is going! I promise to have the next one up ASAP! Thanks for reading and please review-Julia-