: an acute paralytic disease caused by botulinum toxin especially in food
The intern, young and nervous and living on donuts, coffee and too little sleep, suspected he was not a good doctor. He’d always known that his acceptance into medical school had more to do with his name than his grades. No one had mentioned his father during his interview at UCLA, but he stared out at his son from the picture on the wall behind Dean Fontaine’s desk—taken one summer on his father’s annual fishing trip with his former classmate. Now, four years later and six months into his internship, he knew he was good at some things, his stitches were neater than a Victorian girl’s sampler, and he had a talent for tapping narrow veins and setting broken bones. But symptoms that didn’t come with an easy diagnosis left him teetering at the edge of a steep cliff. There were so many ways to do the wrong thing. So many ways to fall.
When the call came in that evening to the ER that a patient was en route, ETA ten minutes, adult male, abdominal cramps, muscle weakness and respiratory distress, he experienced a few abdominal pains of his own. The attending was busy with a GSW, the senior resident was trying to stabilize the heart attack in trauma two, so this one would be all his. He was already skimming through his pocket reference guide looking for common denominators when he heard “suspected botulism” crackle over the speaker. He hadn’t thought about botulism since first year med school—he never expected to see a case, and he knew damned sure he could never have diagnosed one. At least not in time to save the patient. He had five minutes to become an expert on botulism, so he headed to the men’s room and locked the door behind him. Coming out three minutes later, the guide tucked safely back in the left pocket of his white jacket, he asked the nurse to prepare the first injection of antitoxin (page 23 in the guide), and keep the ventilator on standby (page 24). He could insert a breathing tube faster than anyone in the ER. The edge of the cliff receded. He could do this.
The paramedics put the new arrival—dirty and disheveled—in curtain three. They were followed by a worried looking man who flashed a BCPD badge when the doctor held out one arm to stop him from following.
“Where he goes, I go.” It sounded like an order.
“Just stay out of my way then.”
The man nodded and took a step back from the bed, then started talking. Too fast, like he’d been holding it in for days.
The cop told him how the sick guy—the doctor didn’t bother learning names, he always forgot them anyway—had eaten a can of contaminated clam chowder. He heard the recall notice on the radio, and had spent the last couple days looking for him. Yes, he was sure he’d eaten the soup. And yes, he was sure it was the same soup they talked about on the radio. No, he didn’t know when the patient first started experiencing symptoms. No, the patient wasn’t allergic to horses.
“Horses? What the hell kind of question is that? Just fix what’s wrong with him.”
Within ten minutes, the patient—who looked as bad as he probably felt—was hooked up to IV fluids and antibiotics (not in the guide, but antibiotics were an intern’s best friend), and had given him his first injection of equine antitoxin. He placed him on oxygen and a nurse connected the cardiac monitor. He wasn’t taking any chances. Things had a habit of going south when you least expected it. He watched the monitor and wondered briefly if he could claim the diagnosis as his own. His father would be pleased.
He turned away from the bed and bumped into the cop. “Officer . . .”
“It’s Detective. Or Sergeant. Detective-Sergeant actually,” he said and put out a shaky hand. “Dave Starsky. How’s he doing?”
The intern didn’t shake. “Let’s talk outside.” He watched the detective hesitate, but Starsky followed him out into the hall, glancing back at the man in the bed before the curtain closed behind them.
“We’ve given him the antitoxin and he’ll probably start feeling better in a few hours. He’s lucky. He’s still breathing on his own. We don’t usually see any permanent damage in that case.” He thought usually was a nice touch. Made it sound like botulism was an everyday kind of disease. Made him sound experienced. Competent.
“How long does he have to be here?” The detective wiped a hand across his face and leaned against the wall.
“Two or three days probably. Just to be safe. They’ll move him upstairs as soon as they have a room.” He leaned in. Lowered his voice. “I told the nurse he needed a private room. I imagine there’ll be a police guard.”
Starsky smiled a little at that. “You could say that.” He paused. “Are you really sure we got him here in time?”
“As sure as we ever are.” He’d learned early never to offer guarantees. Just reassurance and comfort when there was time. But this was a cop and his prisoner, there was no room for comfort here. “My name is Dr. Koulis. Someone will find me if there’s any change.”
A nurse interrupted them. “Doctor, we need you in curtain two. Stitches.”
He nodded. Stitches were easy. “In a minute, Debbie.”
Maybe he’d make it through this shift without falling after all.
Dr. Koulis looked up from his stitches. The tired voice on the other side of the curtain was the detective’s voice. Not sounding much like a cop anymore.
That was the other guy. His botulism case. He must have lifted off the mask so he could talk. Stupid.
“Pardee?” Mr. Botulism again.
“Got him. How do you feel?”
The sick guy moaned a little. Guess that was his answer. Dr. Koulis remembered he’d meant to prescribe painkillers. Served him right anyway. He couldn’t be a very smart criminal, eating bad soup and getting arrested all in the same week. Maybe there were worse things than being an intern.
“I want to go home.” Petulant and annoyed. More than a little out of breath.
“You have botulism, you idiot. The clam chowder was contaminated.”
“Good try, Starsk. I don’t have botulism I have the flu.” He paused and Dr. Koulis guessed he’d put the mask back on. “I’m going home,” he said a minute later.
“No, you’re not. You have botulism.”
The intern could hear the impatient edge in the cop’s voice.
“Fine, you win. Let’s say I have botulism. How about I have it at home?”
“For Christ’s sake, Hutch, this isn’t a game anymore. You could’ve died.”
“Are they going to give me your old room? Seeing how quickly you recovered from that pesky gunshot wound. That was a dirty trick, you know.”
“Yeah, well, sorry. But all’s fair in life and death, Hutch.”
He didn’t sound that sorry.
“That’s love and war.”
“I’m going home. Get out of the way.”
Dr. Koulis heard the sound of metal clicking against metal. He wanted to peek but he still had three stitches left and the kid had finally stopped squirming. He waited.
“What the hell are you doing?” His patient. Quiet and angry.
“Arresting you. For stupidity. And since it turns out you aren’t going to die, you ungrateful bastard, I’m going back to the station to write up your damned report and then I’m going home to sleep.”
“Undo the fucking handcuffs. Now!”
More sounds of metal rattling against the bed rail. More swearing. The kid’s mother held her hands over her son’s ears while he tied off the last stitch.
He stepped back into curtain three. Mr. . . . he glanced at the name on the chart . . . Hutchinson was handcuffed by one wrist to the bedrail. The oxygen mask was pushed down and rested against his neck. “Mr. Hutchinson, you have botulism. Not the flu. We’ve given you the antitoxin, but you’re going to be in the hospital for two or three days.”
Hutchinson studiously ignored him. “Where you’d find him, Starsk? He’s good, I’ll give you that.”
Dr. Koulis tried to sound like his father. Stern. Serious. “If you don’t settle down, Mr. Hutchinson, I’ll have to give you a sedative.” He replaced the oxygen mask on the patient’s face to end the discussion.
Hutchinson rattled his handcuffs like a bear in a cage. Swore under the mask. It sounded like motherfucker.
Starsky followed the doctor out. “Don’t mind him. He’s a little high-strung. Next he’ll probably try to convince you he’s a cop.”
“Can I ask you something, Detective?”
“I know it’s none of my business, but what exactly did Mr. Hutchinson do? He’s rather frightening when he’s angry.”
“Pencils, Dr. Koulis.” He shook his head slowly. Regretfully. “Pencils.”
“Yep. Selling them.” He looked around, then lowered his voice to a whisper. “Without a vendor’s license.”
“Oh.” He nodded thoughtfully. Sympathetically. “I see. Pencils.”
He didn’t really see at all. But that was part of being a good intern—looking like you understood all the things you didn’t.
Three hours later, between a case of food poisoning and setting a broken ankle, between his fifth cup of coffee and his third donut, he found the detective sitting alone in the waiting room flipping through an old magazine, his jacket crumpled on the chair beside him. He sat down opposite the detective and sipped his lukewarm coffee and watched him for a minute. Dr. Koulis thought how the man didn’t look much like a cop anymore, he looked just like every exhausted friend and relative who worried away their time in this room. In his six months at Memorial, Dr. Koulis had learned that most people were only as strong as they needed to be. For as long as they needed to be. He’d learned that the hard part often came after the crisis had passed.
“Detective Starsky, Mr. Hutchinson was moved upstairs two hours ago. I thought you were leaving. . .” He knew it was none of his business.
Starsky stood and stretched slowly. “I lied.” He rubbed at his neck. “I’ve been doing that a lot lately.”
“He’s on the fifth floor. The nurse can give you the room number.”
“I know.” A small lift of his shoulders hinted at a shrug. “I had to give her the keys to the handcuffs so they could move him.”
The doctor stood and threw the empty coffee cup in the trash, turned to leave, then stopped and looked back at Starsky, who was staring out the window into the parking lot, his hands buried deep in the pockets of his jeans. “You were right, by the way,” the intern said carefully.
Starsky didn’t turn away from the window. “About what?”
“Before they moved him, he told me he was a cop. Just like you said he would. He claimed you were his partner.”
Now he turned to face him. “He say anything else?”
“Yes. He said I should tell you to go home. That I shouldn’t let you sit up all night worrying. I told him that’s what friends do. They worry.”
Starsky nodded and sat down wearily on one of the small plastic chairs, and bent forward, elbows on his knees, head in his hands. Dr. Koulis rested one hand briefly on Starsky’s shoulder, then walked back to the ER.