Chapter 17: Case 2 - Epidemic
Morning comes with a code blue.
I barely slept—stayed in the NICU through the night, watching monitors, taking notes, trying to find the pattern. Emma Chen's oxygen saturation kept dropping despite the ventilator. The other babies were stable but declining slowly. Something was killing them, and we were running out of time.
At six AM, Baby #1 crashes.
Alarms scream. Nurses flood the room. The tiny body convulses as the heart stops. CPR on an infant is delicate, precise, terrifying. Two minutes of compressions. Epinephrine. Shock.
The heart restarts.
Baby #1 lives. But for how long?
I'm updating Emma's chart when House arrives, followed by Foreman and Cameron. They all look exhausted. Nobody went home either.
"Status?" House demands.
"Baby #1 just coded. Resuscitated successfully but critical." I gesture to the monitors. "Baby #5 developed seizures at four AM. Controlled with medication but concerning. The others are stable but declining. We're losing them."
"Environmental toxin." House isn't asking. "Something in this ward changed recently. What?"
"New cleaning solution." I pull up the maintenance records I accessed overnight. "Hospital switched to an industrial-strength disinfectant two days ago. Quaternary ammonium compound. Administration wanted better infection control after that staph outbreak."
Foreman checks the product specs. "Says it's non-toxic. Safe for use around infants."
"By itself, maybe." I open my notes. "But in combination with other chemicals, quaternary ammonium compounds can create toxic byproducts. I need to test it. See what it's reacting with."
"Test it how?" Cameron asks.
"Direct exposure. Handle the cleaning solution, examine the ventilation system, swab surfaces where it's been applied." I'm already pulling on gloves. "See if there's a reaction with something else in the environment."
"That's dangerous." Cameron's voice is sharp. "If it's toxic enough to harm babies, it could harm you."
"Someone has to do it. And I'm—" I'm the one with enhanced immunity that makes this safer than anyone else. "—the least critical to the team's function. Foreman's the neurologist, you're immunology, House is House. I'm expendable."
House's eyes narrow. "Why are you always volunteering for the risky work?"
Because I can survive it. Because the babies can't.
"Because babies can't volunteer." I meet his gaze. "If there's a risk to take, I'll take it."
"Noble and stupid." But House nods. "Do it. Fast. Before we lose another one."
I don't suit up properly.
Should wear full hazmat gear for chemical testing. Should use proper containment procedures. But that takes time, and time is what these babies don't have.
So I grab basic gloves and a mask and head to the storage room where they keep the new disinfectant.
The bottle is industrial-sized, labeled with chemical warnings. I pour a small amount into a specimen cup and carry it back to the ward. House is watching from the doorway, arms crossed.
"You're not wearing protection," he observes.
"This won't kill me in the next ten minutes. The babies don't have ten minutes." I grab samples from the NICU—swabs from isolette surfaces, dregs from formula bottles, air filter samples from the ventilation system.
One by one, I test combinations.
Disinfectant plus surface residue: No reaction.
Disinfectant plus filtered air particles: No reaction.
Disinfectant plus formula residue: Reaction.
The liquid fizzes slightly. Releases a faint vapor. I lean closer—the smell is subtle but wrong. Chemical. Acrid.
"There." I show House. "Quaternary ammonium compound reacting with proteins in the formula. Creates a toxic byproduct when aerosolized. The ventilation system is spreading it through the ward."
Foreman pulls up the formula records. "Three of the babies are on Brand X formula. Two others are bottle-fed from hospital supply. What brand does the hospital use?"
The nurse checks. "Brand X. We switched suppliers last month."
"So all five babies were exposed." Cameron's piecing it together. "The disinfectant residue on surfaces, aerosolized by the ventilation system, reacting with formula proteins in the air. Babies breathing it in constantly."
"Babies with longer NICU stays get more exposure." I point to Emma's chart. "She's been here two months. Baby #1 three weeks. Baby #4 just arrived two days ago—his symptoms are mildest."
House is already on the phone. "Shut down the NICU ventilation system. Open all windows. Evacuate the babies to clean rooms. And get someone from maintenance to test the air ducts for that compound. Now."
Chaos erupts—organized but urgent. Nurses disconnecting monitors, moving isolettes, parents being notified. The ward transforms into a evacuation zone.
I stay with Emma through the move, monitoring her vitals. The moment we get her into a regular patient room with clean air, her oxygen saturation begins climbing.
From 88% to 91%. Then 93%. Then 95%.
It's working.
House appears beside me. "You handled that chemical without proper protection."
"I was careful."
"You were reckless." He studies me. "Most people would've suited up first. You didn't. Why?"
Because I knew my immune system would handle exposure. Because I heal faster than normal. Because I'm not actually at the risk I pretended to be.
"Time was critical. Suiting up takes fifteen minutes. Those babies didn't have fifteen minutes."
"So you risked yourself for them."
"Yes."
House stares at me for a long moment. "Interesting."
He walks away, but I know he's filing this away. Another data point. Another piece of the puzzle that is me.
Worth it. The babies are safe.
By noon, four of the five babies are improving.
Emma Chen is still struggling.
Her oxygen saturation improved initially but plateaued at 93%. Her respiratory rate is high—seventy breaths per minute when it should be forty. The ventilator settings keep increasing, but she's not responding.
"Why isn't she getting better?" Mrs. Chen's voice breaks. "You fixed the toxin. Why is she still sick?"
I don't have an answer yet. But I will.
The team reconvenes in the conference room while the babies are monitored by NICU staff.
"Toxin removal should have resolved all symptoms within hours," Foreman says. "Four of the babies responded. Why not Emma?"
"Longer exposure?" Cameron suggests. "She's been in the NICU longest. Maybe accumulated more toxin?"
"Or the toxin revealed an underlying condition." I pull up Emma's history on the computer. "She's twenty-eight weeks gestational age. Small for gestational age. Mother had gestational diabetes."
"Relevant how?" House asks.
"I watched her overnight. Her breathing pattern changed around three AM. Not just distress—a specific rhythm. Tachypnea with grunting. That's not toxin response. That's cardiac compensation."
Foreman leans forward. "You think she has a heart condition?"
"Patent ductus arteriosus. The ductus arteriosus is supposed to close after birth, but in premature infants it sometimes stays open. Blood shunts between the aorta and pulmonary artery, reducing oxygen delivery to tissues." I pull up the cardiac anatomy diagram. "Mild PDA can go unnoticed in healthy babies. But the toxin stressed her cardiovascular system enough to reveal it."
House nods slowly. "Makes sense. Toxin caused respiratory distress, heart had to work harder, PDA became symptomatic. Order an echo. If Chase is right, we treat with indomethacin."
Cameron's already calling cardiology. "Echo in thirty minutes."
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