While waiting for her to call back, he again considered where Tom Mallek could have acquired his resistant group-A strep. Neither the police nor Social Services had tracked down Angelica “Angie” Fischer, the ER patient whose pus had sprayed Mallek. Unless they found the HIV-positive drug user, they would never be able to confirm the link to Mallek because the swabs from Angie’s original wound were never sent to the lab. But even if Fischer were the source of his infection, where did she pick it up? He racked his brain. It made no sense.

The phone rang. He reached for it warily. “Graham, it’s Melanie Wong,” the plastic surgeon said in her rapid staccato tone.

“Hi, Melanie.” Kilburn pictured the petite workaholic surgeon, dressed always in scrubs and usually rushing to the clinic, the ER, or the OR—often all three.

“I operated on a twenty-year-old yesterday with necrotizing fasciitis of her entire forearm,” she said in a clipped clinical tone.

“An IV-drug user?” he asked.

“Not at all,” Wong said. “A previously healthy East Indian woman. A new mom. Developed the flesh-eating disease at an IV site just above her wrist.”

Kilburn’s temples pounded. He felt a sinking feeling in his chest. “Did she get the original IV put in at St. Michael’s?”

“Yeah,” she said with surprise. “At our ER. She had come for three days of outpatient antibiotics for an unrelated breast abscess.”

His temples beat like a drum. How many others? he thought without voicing it. “How bad is it, Melanie?”

“We got it early, Graham. We spared her limb, but she lost a lot of skin and muscle on the dorsum of her forearm.”

Kilburn ran a hand down the back of his own arm as she described it. “But?” he said.

“She was doing well yesterday post-op. We have her on high-dose intravenous clindamycin, but this morning when I checked her preliminary culture results—”

“She was growing group-A streptococcus resistant to all antibiotics,” he cut in.

“How did you know?”

“We had another case.” He rubbed his temples with his free hand. The sense of defeat returned as strongly as those final moments in Mallek’s ICU room.

“How did you treat it?” she demanded.

“That’s the whole problem, Melanie. We couldn’t. Nothing worked. He died with me standing by and watching.”

“I see,” she said stiffly.

“Your patient might have picked it up from the same ER patient who infected mine. It’s an ultraresistant form of group-A strep. The latest superbug.”

Wong took a long breath before speaking. “What do I do for her, Graham?”

“She needs to be isolated.”

“Already done. Is my staff at risk?” Wong asked. Then added softly, “Am I?”