They followed him to the counter. Alan held up a culture plate, which looked like a flat brown dessert plate with a clear top. Lopez knew the sealed plate posed no risk to handlers.

Alan held the plate closer for his visitors. “This is typical group-A strep. Grown from a young man in the ER with strep throat.” Several round grayish blobs appeared on the plate’s brown surface. In the center of each blob, a tiny white disc sat surrounded by a ring of brown where the gray had receded.

Alan pointed to the gray areas. “These are colonies of G.A.S. The white discs are various antibiotic preparations—penicillin, erythromycin, and so on. As you can see by the gaps in the gray surrounding each disc, the bacteria are sensitive to all the antibiotics we tested it against. Very typical for G.A.S.”

Alan put his hand in the top drawer and pulled out another similar looking plate. It had the same gray blobs and white discs, but on this plate, each of the gray blobs extended to the edges of the white discs without any brown gap between. “This is the Culture and Sensitivity plate grown from the sputum of Tonya Jackson.” He held it out for the others to see. “As you can tell, the G.A.S. has not responded to any of the antibiotics we’ve tried against it.”

Lopez took the plate from his hand. She held it up and tilted it back and forth, hoping against reason that she could alter the results with a different angle of light. Though the plate was physically light, she felt the metaphorical weight of its significance.

“No chance of a mistake, Phil?” Warmack asked.

Alan shook his head. “Not after three cultures.”

Lopez’s stomach churned. She tasted acid at the back of her throat. It was one thing to read a series of initials on her smartphone’s screen, but to see the actual menace growing unchecked on the culture plate in her hand brought the reality home with a visceral pang.

She put the plate down on the countertop. “So, no antibiotic you know of is effective against this organism?” she asked.

Alan paused. “Essentially … yes.”

They fell into silence. All eyes were fixed on the plate.

Alan slipped his hand back into the drawer. He pulled out a second culture plate and placed it beside the first. Lopez studied the plate, recognizing that the two were almost identical. “Is this one of the confirmation cultures?” she asked.

Alan shook his head slowly. “We plated this thirty-six hours ago,” he paused. “It’s from a different patient. An elderly man who has been in hospital for some time. He was staying in the room next to Tonya Jackson’s.”

“Oh, crap!” Lopez glanced from one veteran physician to the other and recognized the worry in both their eyes. “It’s spreading … .”

14 - Philadelphia, Pennsylvania

14

Philadelphia, Pennsylvania