Pia put down her pad and pen back on the desk.

“So you think there might have been two bacteria involved,” George said.

“Right at this moment that’s the only thing I can think of. The clinical course was just too fast, especially in the face of two antibiotics given within hours of initial symptoms and known to handle salmonella. I know it’s contrary to recognized diagnostic rules, the major one being that one should look for a single causative agent even with seemingly multiple symptoms. But it’s the only way I can explain what we’ve seen with Rothman and Yamamoto.”

She turned back to her desk and read from her notes.

“We have all the symptoms right here: fever, delirium, prostration, temperature elevation, sweating, low white cell count known to be associated with salmonella, all leading up to abdominal rebound tenderness. From intestinal perforation and finally death.”

George got up from the bed and headed into the bathroom. Pia was overwhelming him. He was amazed she remembered Koch’s postulates from second-year microbiology. He certainly didn’t. He put some of the ice that was melting in her sink into a fresh towel, rolled it up and brought it to her desk. He exchanged it for the first one he’d made. Pia was staring at the paper, her back to him.

“Here’s some more ice,” he said.

Pia swiveled around in her chair, and George winced when he saw her jaw at such close quarters.

“How’s it feel?”

“It’s not too bad. A bit better with the ice.”

Pia took the fresh towel and held it to her face. An image flashed into her mind: Rothman lying on his deathbed, sweating into his pillow, delirious . . . Suddenly she stared directly up into George’s eyes with a fierce intensity that made George look away.

“The hair loss!” Pia said slowly, with emphasis. “What about the hair loss?”

Chapter 40.

40.

COLUMBIA UNIVERSITY MEDICAL CENTER
NEW YORK CITY
MARCH 25, 2011, 12:15 P.M.

Pia got up from her chair, put the ice-filled towel down on the desk, and started pacing her room, circling George. First he’d been unnerved by the intensity of Pia’s stare when she had her epiphany, whatever it was; now she was stalking around the room like a cat closing in on a mouse.

“What hair loss?” George questioned.

“Rothman’s! Remember I saw there was some hair on his pillow before we found the rebound tenderness.”

“Yes, I remember. You pointed it out to the resident, and, as I remember, she suggested it might have been due to the chloramphenicol.”

“Exactly,” Pia said.

She stood still. “Can I use your computer?” Pia’s laptop was old and slow; the year before George had invested in a new Dell with a much faster processor.