“You go, George, I’m not leaving. Not yet.” From working with Rothman, Pia had learned a great deal about typhoid fever and its cause, salmonella typhi. She knew the danger signs of the illness and the fact that the disease attacked the small bowel, concentrating in lymphoid tissue in the small intestine called Peyer’s patches. Rothman’s gown was pulled over to one side, and Pia exposed Rothman’s abdomen a little more. She slowly pushed in on his upper abdomen, and Rothman squirmed and moved his head from side to side.

“He’s definitely showing signs of discomfort, maybe pain in his abdomen,” Pia said. “This is not a good sign.”

George was beside himself. He could see a few people passing by in the outer hall through the wire-embedded windows in the two doors of the isolation room. He walked over and closed the blinds, hoping to buy Pia some time. When Pia suddenly let up on the pressure she was exerting, Rothman reacted slightly, to Pia’s surprise, as if that caused more discomfort.

“Did you see that? He recoiled. Would you say he recoiled?”

Pia repeated the maneuver and got the same result.

“He definitely recoiled.”

“Whatever it is you’re doing, it’s going to get both of us kicked out of school if we don’t leave right now. We’re pushing the limits on a couple of celebrity patients.”

“It’s rebound tenderness,” she said. “It’s a sign of peritonitis, inflammation of the lining of the abdominal cavity. It means the bacteria have penetrated the lining of the small intestine.”

Pia reached over and punched the intercom button. The nurse at the station picked up.

“Is Dr. De Silva available? If she is, get her in here stat. The patient has developed rebound tenderness.”

George was hopping from one foot to the other. Now she’s really done it, he thought.

At once, Dr. De Silva came in the room, palpated Dr. Rothman’s abdomen and confirmed Pia’s finding.

“And look, he’s losing some hair,” Pia said.

“That could be the chloramphenicol. But regardless, the rebound tenderness suggests the chloramphenicol is not controlling the infection. We’ll have to change the antibiotic. I’ll call Springer and get his suggestion. Thanks for your help.”

Dr. De Silva ducked out of the room.

“He’s getting worse,” Pia said, looking at Rothman forlornly.

“Rebound tenderness isn’t a good sign, I know that,” George said. “But you’ve done all you can do. Let’s go. You heard her, she’s calling Springer.”

By the time George and Pia took off their gear and got back to the nurses’ station, Dr. De Silva was on the phone with Springer. Pia stood where she could hear Dr. De Silva’s half of the conversation. It sounded like Springer was doing most of the talking.