“I can tell you that Rachel related this same story to me last night. One of the other clinic doctors is examining her this morning. And, before you ask, I’m sure we can trust Dr. Neeves to be discreet.” Josh rolled his stool forward a bit. “Now let’s talk about you. After that incident, what kind of symptoms have you developed?”
“I didn’t say I had symptoms,” Madison said. He coughed again. “Well, I might have picked up a little respiratory infection while I was gone.”
“I noticed that. You have to be honest with me.”
“Even if it’s nothing serious?” Madison asked.
“Yes. Because you’re used to being invulnerable. I suspect chiefs of state, even those no longer in the limelight, feel that way.” When Madison started to speak, Josh stopped him with an upraised hand. “Don’t worry. It’s the same with doctors.”
Madison gave a wry grin. “You got me. All right. I had a raw throat a few days ago—probably two days after the incident with the native woman. A day or two later I developed a mild cough. I still have it. And I might have a bit of a fever.”
Josh nodded. “Well, let’s have a look at you.” When he’d finished, he stowed his stethoscope in the pocket of his lab coat. “I’m going to take a swab from your throat and ask our lab to culture the material and also to make a slide, stain it, and look for bacteria. I want to get a chest X-ray and some blood work. The nurse will assist you and bring you back here when you’re done.”
“What do you think?”
“It may be nothing more than a routine viral or bacterial respiratory infection, but I want to be certain.” He smiled.
“Sounds like you’re being extra thorough, but you’re the doctor,” Madison said. “I can see why Ben Lambert thought so highly of you.”
As Josh exited the exam room, he wondered if that confidence was misplaced. Was he overreacting? He hoped not. But the incident with the woman flinging liquid at Madison troubled him. It could be that she was just someone angry with the Americans who’d come to their small town. But perhaps there was more to it than that.
Meanwhile, he wanted to double-check something in Madison’s medical records. And maybe he could catch Allison Neeves and see what she thought about Rachel.
He’d asked Allison to see Rachel because, of the half-dozen internal medicine specialists at Preston Medical Clinic, she was probably the sharpest. Besides, she was female and something told Josh that Rachel might prefer a doctor of the same sex.
He and Allison had done their residency at different facilities, so much of what he knew about her he’d learned after she came to Preston Medical Clinic. Allison had always been hesitant to reveal details of her personal life, but Josh finally learned that she’d married during her first year in medical school. However, she and her husband had been divorced about the time of her graduation. Allison’s natural beauty plus her bare ring finger had quickly made her a target for most of the single doctors at the clinic as well as a couple of the married ones. She’d gently rebuffed these approaches, some more gently than others, but had never been anything but cordial to Josh.
Allison was closing the door to the exam room when Josh rounded the corner heading down the hall toward her. She ran her fingers through her short blonde hair and smiled at him. “Josh, I was going to see if I could find you, but you found me first.”
Josh nodded. “I’m concerned about Rachel.”
“I saw her a few minutes ago. Now she’s gone for some lab work and a chest film.”
“And . . .”
“My philosophy is to expect the common diagnoses but check for the worst-case scenarios, too. That’s what I’m doing here.”
A nurse, escorting an older woman, came down the hall toward them. Josh was itching to continue his conversation, but waited until they passed by and entered one of the several exam rooms that lined the hall. Then he said, “Rachel and President Madison were on the same trip to South America. I presume she told you about the incident—”
“With the woman who showered them with an unknown liquid? Yes. Ordinarily, I might not be too concerned, but when I look in her throat—”
“You see not just redness but a few tiny patches of exudate. Right?”
Allison nodded. “And she has cervical lymph nodes that are more prominent than you’d see with a run-of-the-mill pharyngitis. So I’m getting a throat culture and smear.”
Josh grimaced. “I’m doing the same thing. And while we wait, I’m going to go over the list of immunizations the group received again.”
As Josh walked away, he tried to ignore the ominous thought that kept popping up. Surely this wasn’t— No, it couldn’t be.
***
Josh sat before the computer in his office and scrolled through David Madison’s medical records until he came to the visit before the former president left for his South American trip. Madison had undergone a complete physical, even though his previous one had been only nine months earlier. That included a cardiac stress test, which he passed with flying colors. Josh pulled a notepad toward him and jotted down a reminder to recheck Ben Lambert’s cardiograms. Maybe there’d been something there that had been missed.
What about immunizations? Before the trip, Madison had received multiple immunizations, including a tetanus-
diphtheria booster and preventive shots against hepatitis A, typhoid, and yellow fever. That made what Josh was concerned about less likely, but then again, no immunization is 100 percent effective. And there was always the possibility of a rare type of infection, not covered in the routine spectrum of immunization. He’d double check that—another note to himself.
Dr. Ben Lambert hadn’t provided the ex-president with any prophylactic antibiotics at the time of that visit, but since Lambert was part of the group that would be traveling, he might have planned to give those out to everyone at the time of departure or even while on the plane. Josh would have to look into that. Rachel or Madison should be able to tell him. He scratched out another reminder.
His intercom buzzed. Josh pulled his eyes away from the screen long enough to hit the button. “Yes?”
“Doctor, Ethan Grant at the lab just called. He’s made a smear of the throat swab you took and thinks perhaps you should look at it yourself.”
“Tell him I’ll be right there,” Josh said. For reasons of security, the specimen had been sent with a code instead of a name, but he figured it wouldn’t take long for word to get around that it belonged to David Madison. Josh closed down the open medical record on his computer—he’d have to get used to the extra layers of security in place for this special patient—and headed out the door of his office.
In a few moments, he was seated before a binocular microscope in the lab with Ethan Grant, the chief lab tech in the bacteriology section, standing behind him. Grant rubbed his shaved head nervously. “I think you’ll see what I mean,” he said.
Josh focused the microscope on the glass slide prepared from a swab from David Madison’s throat. There was the usual trash: mucosal cells, white blood cells, but in among it all were dark rods. Their cell walls had absorbed the Gram stain—that is, they were Gram positive—and the organisms were elongated, with a few showing the characteristic clubbing at one end that confirmed the diagnosis Josh had feared.
“This is the best slide you have?” he asked Grant. He knew it was, but he had to ask.
“I made three, and they’re all like that.” Grant leaned closer and almost whispered. “Doctor, I know who your patient is, but don’t worry. I’ll keep it quiet. I also know that Dr. Neeves is seeing Rachel Moore this morning. We got her throat swab at almost the same time as this one came in.”
“And?”
“It shows