Mystery Pneumonia (1)
This was the Stanford Hospital Cancer Ward. I'd come back one last time to see the patient before his discharge.
A particularly dangerous subtype of lung cancer. Radiation and chemotherapy. Experimental treatments for this era. Paraneoplastic syndrome from the lung cancer, complicated by encephalitis. It had been a long, grueling process. But the patient was heading home able to speak and walk, so I figured that counted as a success.
"Aigoo, Doctor."
The lung cancer patient I'd seen before was sitting there in his street clothes, discharge preparations complete. He reached out for a handshake the moment he spotted me. He looked far healthier than I'd expected. His hair had thinned out from the chemo, but that was unavoidable. Compared to when he'd been lying there with impaired consciousness last time, he was downright robust.
"You look great."
There was a cane leaning nearby. No neurological sequelae at all, then? Unavoidable, really. Reality isn't a story, and the world isn't that straightforward. These were such severe illnesses. Expecting a perfect recovery without issues was unrealistic, even with proper treatment.
"Thank you so much. Dr. Kaplan explained everything—how you investigated everything thoroughly enough to write a whole new paper on it."
"Aw, it wasn't that much."
I hadn't written it yet.
"And the hospital bill being waived—that's thanks to you too, isn't it? Without you, I don't even want to think... Thank you from the bottom of my heart."
His life must have gotten a lot tougher. Autoimmune encephalitis isn't something you survive without treatment.
I nodded slowly.
"All set for discharge?"
"All done."
"Get well completely. Take care of yourself."
The patient stood with his cane, chuckling a bit. He still seemed sore here and there. Might need rehab? Getting rehab in America wasn't easy.
"My kid says he wants to grow up to be a doctor, just like the man who saved his dad."
Not easy, was my first thought.
One of the kids sitting quietly by the bed looked up at me.
Wonder if he can do it.
"Work hard at it..."
"Haha, that's still a long way off."
The patient laughed again. I bowed in farewell and left the cancer ward room.
At least it ended well. Really.
Behind me, the noisy chatter of the patient's family faded away.
Ice cream sandwich! As promised last time.
Alice and I were sitting on a sunny outdoor terrace, eating ice cream sandwiches. It had been a peaceful day for once. The sun really shone year-round here.
The past few months had flown by like a war. Even if it was just a short paper, compressing years of research into months was no small feat.
"Good ice cream, right?"
"Delicious..."
The ice cream sandwich was chocolate cookies with vanilla ice cream. On Alice's recommendation, it exceeded expectations.
"You've been so busy lately, but it's nice to have some breathing room this week. I'm thinking of raising fish on my desk—"
I squinted.
"What kind?"
"Still deciding. I was looking into keeping a shark at home, but that seems unrealistic."
I listened to Alice ramble on. Who keeps a shark at home, logically?
"Well... logically, yeah."
"How about a sturgeon?"
I scratched my head.
"Isn't that the fish with the expensive caviar eggs? Never raised one, so no idea."
Alice kept saying incomprehensible things. But she was a good friend, at least.
With fewer patients on the ward, maybe I could wrap up the encephalitis paper and take it easy for a bit. At least for now.
Time to submit the new paper soon, too.
Peace didn't last.
Dean Rich summoned me to his office. I was waiting outside with his secretary. First time being called in.
The secretary stared at me like I'd wandered out of a zoo. I'd never spoken to her before, but her face seemed oddly familiar. She was a neatly dressed woman, a bit older than a student.
"You're that Asian doctor?"
"Uh? Yeah."
"The dean praises you a lot. Yesterday he was yelling and throwing something, demanding to bring that resident here quick."
Yelling? Not like him.
Something serious must have happened. I scratched my head.
"Oh. Why?"
"Didn't hear details. Something about community-acquired pneumonia. I asked, 'How's a resident supposed to handle cases coming in from all over California?' and he just yelled to bring you fast."
Ah, got it. The secretary had some bite, talking back like that to the dean.
But if she didn't say it straight, who would?
I pondered. Community-acquired pneumonia—to me? What now...
No clue what was going on.
"Brought him?"
"Yes, Dean."
"Come in."
The secretary opened the door, and I entered the dean's study. A space filled with antique 1970s-style furniture. Cigar smoke hit me immediately. Gray ash mountains piled in the ashtray. He'd been chain-smoking in here.
I coughed and greeted him.
"Cough, cough—Hello, sir."
Dean Rich nodded.
"Heard your encephalitis case paper got published in The Lancet. Good work. The most ingenious clinical research I've seen personally."
"Not The Lancet—Science. It was physiologically significant."
"Right, that one. Neurology stuck it up on the wall, page by page."
"Why?"
"For reflection on why they couldn't write something like that. Neurology attracts a lot of those types—neurotic folks."
Department discrimination now, huh. I nodded vaguely.
Anyway, not why he'd called me.
The dean rubbed his temples, reached for a nonexistent cigar on the ashtray, then set his hand down on the desk with a deep sigh.
"Not for that. There's a problem only you can solve."
"A unique case?"
He shook his head.
"Pneumonia's bad lately. Lots of patients coming in, but no allergies, no bacteria, not even parasites. No cause."
"Really?"
He nodded. Not enough info yet.
"It's crazy. Local hospitals and other facilities can't find the cause, treatments fail, so they're shipping everyone here. Figured a research institution like us could crack it."
"What kind of pneumonia?"
"No idea. Coordinating with hospitals statewide, but seems like dozens piling up, centered on LA."
"And... I solve it?"
Even for me, that seemed off. But he nodded.
"Go solve it. Do your usual—read patients' faces, find treatments, spin weird logic."
"I'll start with the charts."
"Good. Thanks."
"No known treatment yet?"
He nodded.
"Called it mystery pneumonia for now. Cleared a ward for them—move 'em all there. Go check it out."
Even in the 1970s, simple pneumonia shouldn't kill people. Had to figure out what it was. Fungal? Tough to treat, but unlikely for dozens of cases.
Would see soon enough.
Meanwhile, at Stanford Respiratory Medicine Ward.
Second patient dead already. What was this disease? Treatment? Transmission? Nothing clear. Just guessing it was some pneumonia-like illness.
Only silver lining: no staff infected yet.
"Tried antibiotics, antifungals—patients' lungs and kidneys are failing. James. Any hypotheses?"
James's eyes lit up.
"New virus? Localized to one area, lymphocytes dominant in white cells."
Who knew. Bizarre pneumonia unresponsive to antibiotics.
If no quick answer, more deaths among current patients.
"What pneumonia ignores antibiotics? Cultures and microscopes show nothing?"
"Nothing."
"Still?"
James nodded.
One person came to mind. The junior who could diagnose unsolved diseases just by looking at patients.