Miracle Drug. Richard L. Mabry, M.D.

less redness and swelling of your throat tomorrow, I’ll think about discontinuing the isolation precautions.”

      “Good,” Madison said. “The rest of the group that went to South America with me should be on their way back soon, and I want to confer with them. It’ll be a lot easier if they don’t have to go through this silly mask/face shield/gown/gloves drill.”

      “I don’t like it any better than you do, Mr. Madison, but that’s the routine that’s called for.”

      After a few more words, Josh stepped outside and began to divest himself of the isolation garb. He scrubbed his hands a little longer than usual, although there was really no reason to do so. Josh hoped he could discontinue the isolation precautions soon. Madison had been on antibiotics for twenty-four hours, which was probably long enough to destroy all but the hardiest of the Corynebacterium diphtheriae in the average patient’s body.

      Josh pondered whether he should look in on Rachel, but decided he’d have to delay that until he checked out what the bacteriology technician had found. And, after all, even though Rachel was his girlfriend, Josh couldn’t escape the knowledge that his primary allegiance was to his most important patient

       . . . the one he’d just left.

      He headed toward the lab, wondering if his unease was related to guilt at not being attentive to Rachel or to the news he was afraid he would receive from the lab technician. As Josh punched the elevator button, he decided he’d know soon enough.

      ***

      Ethan Grant looked up as the lab door opened and Dr. Josh Pearson walked in. He’s not going to like what I have to show him.

      “Okay, I’m here,” the doctor said. “What’s this I need to see?”

      Dr. Pearson, unshaven, his clothes wrinkled, showed evidence of long hours with no sleep. The lab tech felt sorry for him. What he had to show him wasn’t going to make Pearson any happier, either.

      Ethan rose from the counter where he’d been using a binocular microscope to scan a Gram-stained slide. “Let me show you,” he said. He moved to a large cabinet with glass doors, opened one of them, and removed a petri dish.

      Pearson made no move to take the shallow, covered glass dish Ethan held out. Instead, he bent until his face was a foot from it and studied its contents. Finally, he straightened and said, “I’m afraid it’s been too long since I had bacteriology. It looks like this is a blood agar plate, and it’s almost completely covered with bacterial colonies. What about it?”

      “To begin with, it’s totally unusual for Corynebacterium diphtheriae to grow this rapidly. I would normally wait twenty-four hours, then inoculate tellurite-enriched agar with some of the material from the original culture. That would further enhance colony growth. I’d eventually do a stain, basing the final identification on colony characteristics and microscopic morphology of the bacteria.”

      “Didn’t we already confirm a diagnosis of diphtheria?” Pearson asked.

      “True, the morphology of the bacteria we saw on the slide from the original throat swab are Gram-positive bacilli with clubbing at one end. That, combined with the clinical picture, is generally enough to justify starting treatment for diphtheria. But I don’t stop there. I keep going until I have the diagnosis nailed down. That’s why I’m still working on this.”

      “And have you found something more?” Pearson asked.

      Ethan put down the plate and picked up another, this one with perhaps a dozen filter paper discs scattered around its surface. “We know that the diphtheria bacillus should respond to penicillin and erythromycin, sometimes to a few other antibiotics, although that varies, but ‘should’ isn’t always dependable, so I do sensitivity studies, seeing how various antibiotics prevent bacterial growth.”

      Grant held out the new petri dish for Pearson’s inspection. “This one was plated less than twenty-four hours ago, and as you can see, the colonies have already grown so rapidly they almost fill the dish.” He used his pen to point. “Each of those white filter paper discs is impregnated with a different antibiotic. Normally, a sensitivity study isn’t ready to be read this early, but this one’s unusual.”

      Pearson looked at the petri dish, then he took it from Ethan’s hand and studied it more closely. “Where are penicillin and erythromycin?”

      Ethan pointed. “There and there. But it really doesn’t matter, does it? There’s no zone of inhibition anywhere.”

      “So that means—”

      “Yes, sir. That means the organism infecting your patient is growing so much more rapidly than the Corynebacterium diphtheria that it’s covering over that bacteria. And whatever this other organism is, it’s resistant to every antibiotic in our arsenal.”

      ***

      David Madison awoke from a fitful doze when he heard the door of his room open. Despite good eyesight, he couldn’t identify the person who entered. He’d complained to Dr. Pearson about the face shield, mask, and gown all his visitors had to wear, but until now, using height and mannerisms, he’d generally been able to identify the few people cleared to enter his room: two nurses, one orderly, and his chief of security, Jerry Lang. This new visitor was taller and thinner than Lang, and his walk was different from Dr. Pearson’s. Madison didn’t recognize him, and he had a bad feeling about it.

      He felt silly challenging the person like a sentry on post, but then again, he’d learned in his years in the White House to have a high index of suspicion in some situations. This one qualified. Madison cleared his throat and said, “Who are you?”

      The intruder—because that’s what Madison was beginning to think of this person as—didn’t respond, but continued his slow advance across the room. When he was six feet from the foot of the bed, his hand disappeared for a moment beneath the hem of the yellow isolation gown he wore.

      “What are you doing?” Madison asked. He was concerned not only by the visitor’s failure to respond to his question, but by the raspy tone he detected in his own voice. Pearson had warned him to watch for difficulty breathing. Was what he was experiencing now due to fright or to a progression of his disease?

      The man’s hand emerged holding a small pistol with a long, thick barrel. Still without a word, he pointed it at Madison, who thought he could see the man’s finger tighten on the trigger.

      It was probably useless to make a grab at the weapon, but Madison determined to try. He gathered himself for the effort. His left hand was encumbered just enough by the IV in his vein that Madison leaned a bit to the left as he tried to sit up. Then gunfire shattered the relative hush in the hospital room.