Becca Seabury’s antecubital space—the inside of her elbow—looked like ground beef that had been left in the sun. Muscle fibers, tendons, ligaments, all basted in thick, greenish purulence, glinted beneath the portable saucer light overhead. Beebe heard his brilliant chief resident inhale sharply, and vowed to reprimand her for the audible reaction as soon as it was appropriate. In the next moment, he decided not to mention it.

“Becca, it’s Dr. Beebe. Can you hear me?”

There was little response except a fitful moan. Beebe, his jaw set, looked across the bed at the chief of infectious disease.

“Sid?” he asked

Sidney Fleishman shrugged and shook his head. “As you can see, she’s still toxic. No change in the bug, and no effect from every antibiotic in our arsenal. Her white count has dipped a bit, but there are no other signs that we’re winning. We’ve gotten permission to try one of the most promising experimental drugs that is being tested on strep and MRSA, but this Doomsday G—this bacteria—is like nothing we’ve seen. Strep, but not really strep, resistant to methicillin and vancomycin, and carbapenem.”

“Conclusion?”

“I think we have some time. Not much, but some—especially with the infection still limited to her elbow.”

Beebe inhaled deeply and exhaled slowly. Fleishman, as bright as anyone at White Memorial, was advocating a continued conservative approach with the addition of a new, experimental drug, which was showing effectiveness against methicillin-resistent staph aureus.

How much time do you think? Beebe was about to ask when Jennifer Lowe, Becca’s nurse, standing at the foot of the bed, cleared her throat by way of interruption. She had been massaging lotion onto Becca’s left foot and now had turned her attention to the right one.

“Dr. Beebe, I think you’d better have a look at this,” she said. “I didn’t see anything here an hour ago.”

She gently folded back the sheet and gestured to the foot. All five toes were reddened, and swelling extended two inches toward the ankle.

Beebe stepped to his right and inspected this new development—first with his eyes, then with his gloved hands.

“Sid?”

Fleishman studied the foot, then checked for swollen lymph nodes in their patient’s right groin—often a sign of expanding infection.

“Nothing yet,” he said, “but this is clearly new infection, probably seeded from her arm.”

Chandler Beebe ran his tongue across his lips and took one more breath.

“Jennifer, is the OR ready?” he asked.

“It is.”

“Call to tell them we’re bringing Rebecca Seabury down for removal of a septic right arm. I’ll speak to her family. Thank you for your efforts, everyone. My team, go ahead. I’ll meet you in the OR. Oh, and Jennifer, call pathology, please, and tell them we’ll be sending down a specimen.”