A heavy pall had settled over Boston’s White Memorial Hospital.
Becca Seabury’s condition was deteriorating.
The hospital grapevine was operating at warp speed, sending the latest rumors through the wards and offices of the iconic institution, chosen two years in a row as the number-one general hospital in the country. This morning, in all likelihood, the decision would be made—a decision that almost everyone associated with White Memorial, from housekeeping to the laboratories to the administration, was taking personally.
Before long, the team of specialists—orthopedic, medical, and infectious disease, would either choose to continue battling the bacteria that the press and others had begun calling the Doomsday Germ, or they would opt to capitulate and amputate the teen’s right arm just below the shoulder.
In room 837 of the Landrew Building, a group of carefully selected physicians and nurses had been assembled. At the doorway to the room, as well as at every elevator and stairway, security was keeping the media at bay, along with any but essential personnel.
From the day, more than two weeks ago, when Becca was operated on to clean out infection from the site of her elbow repair, she had been front-page news.
FLESH-EATING BACTERIA COMPLICATING CHEERLEADER’S HEALING
The seventeen-year-old, captain of her school’s championship team, had shattered her elbow in a spectacular fall during the state finals. The violent injury was chronicled on YouTube and immediately went viral, making Becca something of a household name around the globe. A successful reconstruction by Dr. Chandler Beebe, the chief of orthopedics, followed by several days of IV antibiotics, and the conservative decision was made to wait one more day and discharge.
That was when Becca Seabury’s fevers began.
The Landrew Building, less than two years old, was the latest jewel in the expanding crown of White Memorial. The eighth floor featured four negative pressure isolation rooms—airtight spaces except for a gap beneath the door, with a ventilation system that brought more air into the room than it allowed out. By the time a nurse escorted Becca’s family to the waiting area, there were seven in gloves, gowns, and hoods in the spacious room.
Chandler Beebe, six-foot-six, towered over the rest.
Nearly lost among them, motionless on her back, was a pale, fair-skinned young woman, with hair the color of spun gold. Her lips were dry and cracked and the flush in her cheeks looked anything but healthy. An IV with a piggybacked plastic bag of meds was draining into her good arm. The temperature reading on her chart was 102.5 degrees. It had been as high as 104. Her blood pressure was 85/50.
Chandler Beebe, once a guard for the Harvard University basketball team, was generally unflappable. Now, beneath his mask and hood, he was nearly as pale as his patient. It was the smell, he knew, that was getting to him. Despite his years operating in war zones and medical missions to third-world countries, he had never been fully able to accustom himself to the odor of pus and of rotting flesh. Glancing at the monitor, with a nurse holding up Becca’s arm, he began unwrapping the gauze he had placed around it eight hours before. Beebe had two teenagers himself, a boy and a girl, both athletes and excellent students, and as brave and well-adjusted as this girl. But he couldn’t get his mind around the image of either of them being at the crossroads of decisions like this one.
The progressive layers of bandage as they were removed were first damp with bloody drainage, then soaked. The ooze, from eight inches of filleted incision, reeked of untreated bacterial growth. The color of the flesh darkened. Twelve days before, Beebe and a surgical colleague had reopened the incision he had made when he did the initial, meticulous reconstruction. The infection had come on with the speed and ferocity of a Panzer attack. Fever, shaking chills, new swelling, intense pain, dehydration, blood pressure drop. Signs of infection in an enclosed space. There was no choice that day. The incision had to be opened, debrided, irrigated, and drained.
Now, it was time for another decision.
Becca Seabury’s antecubital space—the inside of her elbow—looked like ground beef that had been left in the sun. Muscle fibers, tendons, ligaments, all basted in thick, greenish purulence, glinted beneath the portable saucer light overhead. Beebe heard his brilliant chief resident inhale sharply, and vowed to reprimand her for the audible reaction as soon as it was appropriate. In the next moment, he decided not to mention it.
“Becca, it’s Dr. Beebe. Can you hear me?”
There was little response except a fitful moan. Beebe, his jaw set, looked across the bed at the chief of infectious disease.
“Sid?” he asked
Sidney Fleishman shrugged and shook his head. “As you can see, she’s still toxic. No change in the bug, and no effect from every antibiotic in our arsenal. Her white count has dipped a bit, but there are no other signs that we’re winning. We’ve gotten permission to try one of the most promising experimental drugs that is being tested on strep and MRSA, but this Doomsday G—this bacteria—is like nothing we’ve seen. Strep, but not really strep, resistant to methicillin and vancomycin, and carbapenem.”
“I think we have some time. Not much, but some—especially with the infection still limited to her elbow.”
Beebe inhaled deeply and exhaled slowly. Fleishman, as bright as anyone at White Memorial, was advocating a continued conservative approach with the addition of a new, experimental drug, which was showing effectiveness against methicillin-resistent staph aureus.
How much time do you think? Beebe was about to ask when Jennifer Lowe, Becca’s nurse, standing at the foot of the bed, cleared her throat by way of interruption. She had been massaging lotion onto Becca’s left foot and now had turned her attention to the right one.
“Dr. Beebe, I think you’d better have a look at this,” she said. “I didn’t see anything here an hour ago.”
She gently folded back the sheet and gestured to the foot. All five toes were reddened, and swelling extended two inches toward the ankle.
Beebe stepped to his right and inspected this new development—first with his eyes, then with his gloved hands.
Fleishman studied the foot, then checked for swollen lymph nodes in their patient’s right groin—often a sign of expanding infection.
“Nothing yet,” he said, “but this is clearly new infection, probably seeded from her arm.”
Chandler Beebe ran his tongue across his lips and took one more breath.
“Jennifer, is the OR ready?” he asked.
“Call to tell them we’re bringing Rebecca Seabury down for removal of a septic right arm. I’ll speak to her family. Thank you for your efforts, everyone. My team, go ahead. I’ll meet you in the OR. Oh, and Jennifer, call pathology, please, and tell them we’ll be sending down a specimen.”
The room emptied quickly and silently. These were medical professionals—the best of the best. But every one of them was badly shaken.
Jennifer Lowe, thirty, and a veteran of half a dozen missions to villages in the Congo, bent over her patient. Lowe’s marriage to a physical therapist was just six months away. She was a sparkplug of a woman, the daughter and granddaughter of nurses.
“Be strong, baby,” she whispered. “We’re going to get through this. Just be strong.”
It was at that moment she felt an irritation—an itch—between the middle and ring fingers of her left hand. While she was at work, her modest engagement ring hung on a sturdy chain around her neck. She had eczema, but never bad and never in that particular spot.