Saint Francis Hospital
Chicago

Dr. Claire Antonelli arrived early for her morning rounds, though she had left the hospital only six hours ago, just enough time to take a nap, change clothes and kiss her sleeping teenage son, who groaned a protest. But then he smiled—still without opening his eyes—and asked if she had eaten anything.

“Who’s looking after who?” she had asked.

He smiled again, eyes still closed, and turned over, mumbling something about a slice of pizza he had saved for her.

She’d grabbed the pizza and had eaten it cold during her commute back to the hospital, washing it down with her morning Diet Pepsi.

Now she marched down the sterile hallways, the exhaustion of the week lingering, but she felt vaguely refreshed, like a worn rag that had been wrung out and left to dry, ragged around the edges but ready to get back to work. Still, she was glad she had exchanged her fashionable heels for a comfortable pair of flats.

She had already checked in on her newest patient, a three-pound, seven-ounce little guy in the NICU, the Newborn Intensive Care Unit, currently known only as the Haney baby boy but called “bellow” by the staff because that’s all he had done since he had come out into this world. He was asleep finally with all the connecting monitors taped to his tiny body. The monitors continued to register exactly where Claire wanted them to be. He was doing good for coming into the world much too early.

The patient Claire had gotten here early to see would not be as easy to stabilize and make comfortable. Markus Schroder had allowed Claire to admit him into the hospital two days ago, though “allowed” was even pushing it. The truth was, his wife, Vera, had threatened and coerced him. In less than twenty-four hours he grew too weak and incoherent to argue with either his wife or his doctor. And what was most frustrating for Claire was that after a battery of tests she still had no clue what was wrong with the forty-five-year-old man who, up until a week ago, had been, in his own words, “as healthy as a buck half his age.”

Getting here early she hoped to talk to Markus alone, before his wife arrived. Vera had only good intentions but she also had the annoying habit of answering for her husband even when he was healthy and lucid. Claire needed some answers and she hoped Markus might be able to provide them.

She stopped at the nursing station and pulled the file, checking to see if any of the lab results were in. Before she could flip through everything a petite nurse in green-flowered scrubs came around the corner.

“The rash is worse,” Amanda Corey said.

“What about his fever?”

“Spiked to 106. We have him on an IV but he’s still been vomiting.” The nurse pointed to a plastic container with a red twist cap. “I saved you some.”

Claire examined the container’s contents, a black-red liquid with a few floaters, though Claire knew the man didn’t have anything left in his stomach. This didn’t look good. She was relieved to see Nurse Corey had double-bagged the container and already labeled it for the lab.

“Anything from the lab last night?”

Corey held up a finger and walked to the other side of the counter. “I saw Jasper drop off some stuff about an hour ago.” She grabbed a stack of documents from an in-tray behind the counter. “Let’s see if your guy’s in here.” Halfway through she pulled out three sheets and handed them to Claire.

She didn’t have to look closely. Claire could see the check marks, all of them in the “negative” column. Ordinarily she would be pleased, relieved. No doctor wanted to know that her patient tested positive for jaundice, gallstones, malaria or liver abscess. But in this case it felt like a lead weight had been dropped on her shoulders. She dragged her fingers through her short, dark hair, though she didn’t let Amanda Corey see her total frustration.

“Thanks,” she simply said and then turned and walked down the hall, flipping pages and searching for something, anything she may have missed.

Her patient had a dangerous infection that didn’t respond to any antibiotics. She couldn’t find the source of the infection. Now he was vomiting up pieces of his stomach lining, an educated guess from the looks of the container. Claire was running out of ideas. Hopefully Markus could help her find a clue, because not only was she running out of ideas, she knew she was running out of time.

She found him lying flat on his back, head lopped to the side, watching the door though he didn’t seem to be expecting anyone. He barely acknowledged her entry with a slow blink, eyelids drooping, eyes bloodred. His lips were swollen, his yellowish skin almost swallowed by purple swatches, as though his entire body was starting to turn black-and-blue. It was the red eyes first, then the fever and yellow-tinged skin, that made her think of malaria. Although she couldn’t place Markus Schroder close to anywhere that would have put him in contact with the disease. The Chicago area might feel like the tropics in the summer, but an outbreak of malaria wouldn’t go unnoticed.

Fortunately, Saint Francis was a teaching and research hospital so Claire had access to quick lab results, but she couldn’t keep guessing. She was a family practitioner whose private practice brought her to the hospital to deliver babies, suture the occasional minor scrape and diagnose early signs of common ailments. Whatever was playing havoc with Markus Schroder’s immune system was outside her everyday realm.

“Good morning, Markus.” She came to his bedside and laid a hand on his shoulder. Long ago she had learned her patients appreciated even the slightest touch, some small and gentle contact outside the cold jabs and pats that usually ensued in a doctor/patient relationship.

He reached out a purple-splotched hand to her, but before he could respond, his body jerked forward. The vomit that splattered the white bedding and the front of Claire’s white lab coat was speckled black and red with something that reminded her of wet, used coffee grounds. But it was the smell that set off a panic inside Dr. Claire Antonelli. Markus Schroder’s vomit smelled like slaughterhouse waste.