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The ID director apparently read her mind. “Critical Care.”
“Brilliant; thank you.” She turned to me. “Come, you can meet Dr. Ambrose as well.”
I swept a hand in front of me in invitation. “Lead on.”
Dr. Okafor stopped at the nearest elevator lobby. “I hadn’t planned on showing you this side of the hospital on your first day,” she murmured.
I appraised the elevator doors. The silver-toned metal was dim with age, but at least they weren’t dirty.
“I promise the rest of the hospital doesn’t look like this,” Dr. Okafor insisted.
Now I was getting concerned. “Like what?”
The elevator doors slid open, revealing wood paneling and linoleum tile that had to be older than either of us. “Brace yourself.” Dr. Okafor murmured, stepping on. “This is the fastest way down to Critical Care.”
The morning after our trip to San Francisco, I faced a virtual stack of catch-up work taller than I was. We had a meeting with the State Health Department in half an hour, but a particularly tricky case had brought Dr. Donaldson and me down to Critical Care along with a clutch of residents.
I tried to put the stress of my day out of my mind as I took the patient’s history, to make it feel less like an interrogation during a medical emergency and more like a conversation. Stressing my patients out never helped, even if I was stressed. We hadn’t found a reason for the patient presenting with fever, skin lesions, and lethargy, which could indicate a deadly infection. I had my suspicions based on those symptoms, but Mr. Ordóñez had no history that might have led to contact with ticks or wild rabbits. We’d ruled out walks, jogs, cycling, hiking, mowing and any other outdoor activity that might involve long grass. Mr. Ordóñez had barely left his house in the seven days before the first symptoms presented.
“Okay, Mr. Ordóñez,” I restarted. “Have you seen any deer flies in the last two weeks?”
“I don’t know what that is.” He shifted, rubbing at a lesion on his hand.
I paused and lowered my tablet. “How’s your fever?”
Mr. Ordóñez merely grunted. His skin was red, but it seemed like his normal, ruddy pigmentation and not fever-related.
“We’ll get the nurse in with something to get it down and make you more comfortable.” I made a note in his chart.
There was another possibility. I did a quick image search and then turned the tablet to Mr. Ordóñez. “This is a deer fly,” I said.
“Ugly sucker.” He shook his head. “Never seen one before.”
“Okay. Any other fly bites?”
“No.”
So much for that.
“How’s it going?” Dr. Ambrose, head of critical care, leaned in the doorway.
“Dr. Croft is doing well,” Dr. Donaldson answered for me. Which was nice of him—we were not any closer to a diagnosis than when we’d started half an hour ago.
Dr. Ambrose accepted Dr. Donaldson’s nonanswer and moved on to the next room. I glanced over what we had so far. “You said you don’t have any pets.”
Mr. Ordóñez nodded.
“Have you been in contact with anyone else’s pets? Birds, rabbits, cats, dogs—sheep, goats?”
“Well.” He swallowed hard. “My sister’s neighbor’s cat.”
I looked up abruptly. “And what kind of contact have you had with the cat?”
“It jumped on my back when I was over there last week.” He huffed out a laugh. “Serves it right—it died two days ago.”
Bingo. Now we were onto something.
“How did it die?” I asked, doing my best to cross check the history. If the cat had been struck by a car coincidentally, we could be on a wild goose chase. Or wild cat chase.
