by Edward Ahern
Ingvill Berntsen was the only person in Trinity Lutheran Church. She liked praying alone with her God, liked being able to hear the faint echoes of her whispered prayers. Eventually she braced her three-footed medical cane, stood, and shuffled toward the church doors.
At the arched doorway she dipped her finger in the water font and blessed herself. And cursed herself as well. Staphylococcus aureus drifted in the limpid, clear water. At her touch, bacteria nestled into the minute skin cracks of her chafed hand and began to propagate.
Despite being 84, Ingvill lived alone in her Eau Claire apartment, relying on home deliveries and community services. As she washed her hands that evening, she spread the flesh-eating bacteria from her right hand to her left. The next morning, gnarled fingers on both hands were inflamed, but she assumed that, like many of her ailments, it would eventually pass.
During the next day and night, the infected sites swelled and changed color from angry pink to the shade of rotten rose petals. Her hands hurt badly, but Ingvill, who most people called Inga, was used to pain. The day after that, three of her fingers developed black spots, and she searched her medicine cabinet until she found a container of three-year old penicillin tablets and began swallowing them as prescribed.
The bacterium feasted subcutaneously as they invaded her hands, forming blisters and releasing a dishwater-like fluid. Ingvill lost the use of her hands as toxins coursed through her system and a fever left her incoherent. On the fourth day the frail woman died alone in her apartment.
* * *
“Runa, they’ve found a woman dead of what appears to be necrotizing fasciitis.”
“Yes, Doctor Norberg?”
“It happened less than a mile from here. Incredible. This is Wisconsin, we get frostbite cases, not flesh-eating bacteria.”
“Is it one of our patients?”
“No, thank God, but we need to ramp up our cleaning procedures. And gloves. We don’t want to be spreading this to our patients. And a case traced back to our office would cripple my practice before it even gets going.”
“Yes, doctor.” Runa’s tone was firm, assuring him that nothing would get past her scrutiny. In only three months as his nurse-assistant, Runa Bergdahl, had run a road-grader through his practice, smoothing out the appointments and record-keeping into something navigable. Better still, she was willing to occasionally babysit for the Norberg’s two children.
Anders Norberg was an internist who diagnosed and then usually shuttled his patients on to specialists for treatment. The rest of the morning, he hop-scotched from one exam room to another, so focused on the complaints that the patients themselves were a blur. While he was eating lunch at his desk, he scrolled through messages on his laptop. One message made him put down his sandwich.
From: Eau Claire Health Department
To: Licensed medical practitioners in the city of Eau Claire
Subj: Further incidences of necrotizing fasciitis.
Please be advised that the health department has confirmed two further cases of necrotizing fasciitis, known commonly as flesh-eating disease. Both patients remain alive, although significant portions of an arm and a leg were removed surgically to contain the infections.
As of this writing there is no known common infection vector, but police and medical staffs are investigating both cases, as well as the initial terminal case of an elderly woman.
The Center for Disease Control (CDC) has been notified. Medical professionals are encouraged to practice even more vigilant sanitization procedures, and to report any suspected case immediately to the health department.
“Holy crap!” Anders muttered. “Runa? Runa!” he called out, then remembered that she was shopping at Complete Foods during her lunch hour. Anders mentally reviewed the morning’s cases but couldn’t recall any instances of inflamed or necrotic flesh, and decided that at this point there was nothing else he could do.
When Runa returned he filled her in.
“Our congregation will pray for them on Sunday.”
“I’m surprised, Runa, I don’t think of you as a churchgoer.”
“I keep to the old ways.” She made a face. “But, truth be told, there aren’t very many attending, even on Sunday.”
Anders’ cell phone woke him up at 2:00 a.m. the next morning. There was a message from Eau Claire Public Health.
This is Doctor Ralph Adams with the Eau Claire Public Health Department. This message is for all medical professionals in the greater Eau Claire metropolitan area. Four additional cases of necrotizing fasciitis have been reported since yesterday’s e-mail report. Two of the patients are in critical condition. Doctors, nurses and care givers must immediately report all cases of skin inflammation or infection to this office, and take all epidemiological precautions in treatment.
The cases reported thus far have occurred in the southwestern quarter of the metropolitan area, and the source(s) of infection are suspected to be in that quadrant. Doctors and nurses are requested to confirm receipt of this message.
Anders knew Ralph Adams must still be up and knew him just well enough to call back. “Ralph? Anders Norberg. Anything I can do to help?”
“Hi, Anders. Not right now, but stay ready, because this is ugly. All the cases appear to be a highly contagious strain of Staphylococcus Aureus, resistant to the standard antibiotics. We think we’re going to lose two of the patients. In addition to your own patients, appreciate your keeping a trained eye on the people you encounter outside the office. And I wouldn’t shake hands with strangers.”
Anders woke his wife. “Nellie, keep the kids home from school today.”
“Why? They’re fine.”
“And I want to keep it that way. This skin infection that’s going around is getting much worse. Let’s just be careful until we see what’s happening.”
The local television news programs began at six a.m. that morning and were whipping the disease news into viewer frenzy. The babbling faces threw in the word “plague” several times. Terrific, Anders thought sourly, panic will really help control the infection.
When he reached his office at eight a.m., there was a line of people outside, half of whom Anders didn’t recognize. Runa, uniformed and latex-gloved, stood as a stocky but well-curved bouncer in the doorway, keeping the riffraff at bay.
“We need to get into triage mode, Runa.”
She nodded. “Worst first, patients or not?’
“Yes. Let’s do the initial screening out here so we don’t have to wipe down the exam rooms after every look-see.”
Runa was fearless, ordering those outside the office into groups, and seemingly callous to their complaints about deserved treatment. It’s like she’s done all this before, just another day at the office.
Anders waded into a stream of cuts, bruises, burns, rashes and, in one peculiar case, hemorrhoids. They were all innocuous until he reached Judy.
Judy actually was his patient. Unusually thin, with an admitted cocaine habit and what Anders suspected was a dabbling with heroin. The calves of both her legs had patches of angry red. Anders noticed fine cuts on both legs.
“Judy, did your recently shave your legs?”
“Please describe everything you did yesterday, every little detail.”
“Nothing unusual. Showered and shaved my legs in the morning, went to work, ate lunch at a Gut Brot, more work, worked out a little at the gym, came home, made supper for myself, watched some television and went to bed.”
“Did you shower at the gym? Swim in the pool?”
“Both. I like the pool there; it’s not too heavily chlorinated.”
“Which gym was that, Judy?”
Anders hesitated. “Does somebody else have a key to your place?”
“Judy, you may have a serious infection. I’m going to arrange an ambulance to take you to St. Olaf’s hospital for tests and treatment that I can’t do here. Call your boyfriend and ask him to bring whatever you’ll need.” Anders nodded at Runa. “Ambulance please. Tell them it’s a suspected case of S.A.”
“Dr. Norberg, you’re frightening me. It’s just a rash, right?”
“Let’s hope so, but we’re going to make sure you’re okay.”
Anders got a call from the hospital a few hours later. “Is it S.A.?”
“Yes. We’ve started her on an IV for massive antibiotics, but her immune system is badly compromised. We’ll know more tomorrow.”
“Thanks.” Anders turned to Runa. “She’s got it. Is the exam room clean?”
“Scoured. There’s nothing living left in there.”
“Good. I think it’s going to get worse. Have you ever seen anything like this?”
Runa paused. “No, not like this. Are we done for the day?”
“Yes. Thanks again, you were an incredible help. I need to stop by the nursing home and check on my grandmother; those places are disease hothouses.”
Copyright © 2020 by Edward Ahern