Medical Investigation (2004) s01e07 Episode Script

You won't be wearing that long.
Sarah, you're not a little girl.
Thanks, Melanie.
You're the best.
You know you have to try it on.
- What? - Come on, model it for us.
- Please, you guys.
- It's not a request.
It's a demand.
Don't be nervous, honey.
It's just marriage.
All right! - We're waiting.
- How's it look? I'm coming.
Darling, if you are in there shaving your legs Don't even bother, because nothing can ruin romance like fresh razor burns.
You guys, I need We're still waiting.
Sarah, are you all right? Hello? Sarah? Oh, my god.
Just Just stay calm, Sarah.
Ashley, get some help.
Please.
Miles.
You know, you'd think with a $28 billion budget we'd be able to get a decent cup of coffee.
Let's go.
Maybe some cream.
All right, everybody, Listen up.
Two days ago Sarah Doyle lost consciousness at her bridal shower with flu-like symptoms.
24 hours later five other patients were admitted with the same symptoms, fever, chills, chest pains and confusion.
- Three of them are now dead.
- Any initial commonalties? All six were female, and they lived in the same suburb outside of Philadelphia.
The flu doesn't usually lead to confusion.
Yeah, not even the spanish flu.
We might be looking at something neurological.
The respiratory distress could be cutting off oxygen to the brain.
We should also look for some sort of toxicity or chemical abuse.
Six stoned suburbanites.
It wouldn't be the first time.
We go to Philadelphia.
Do any of these three patients have a medical history? Minimal.
One has a history of hypertension.
And all three are non-smokers.
How about the three that've died? The coroner hasn't released the autopsy results.
Eva, contact the coroner's office.
Have him send those results as soon as possible.
Dr.
Eckhart, where are you in initial testing? We've started testing for viral and bacterial pneumonia.
What about fungal? If it's even a cousin of pneumonia, we're testing for it, doctor.
Whatever this is irritates the lungs.
It may be an aerosolized pathogen.
Houses in the burbs are always being rebuilt, repainted, fumigated.
I'll start with toxicity tests and blood cultures.
These are the three surviving patients.
Sarah Doyle, 27, fell at her bridal shower.
Kathy Owens, 42, Mary Johnson, 55.
Sarah Doyle was the first reported victim? That's right.
Her fiance, Alex has not left her side.
McCabe, I want you attending on this one.
Thank you, Dr.
Connor.
Dr.
Connor and I are gonna need some substantial lab time while we're here.
Of course, it's this way.
Sarah's in great shape.
She even ran a 5k for charity a week ago.
Ever hear her complain of fatigue, chest pain, fever? She said she's never felt better.
What about the other patients, does she know any of them? You're sure? / Look, we've been together for three years.
I know all of her friends.
She knows all of mine.
What does she do for a living? She's an art teacher.
She paint? / Yeah.
She works in oils, mostly.
Does that mean something? It may.
It may not.
Was she taking any medication? She had a cold a few days ago.
Uh, sniffles, a minor cough.
Why is that important? Alex, I know that this is difficult, but if we're gonna help Sarah, we need to know everything about her.
Nothing is insignificant, including her state of mind.
The only thing on her mind was the wedding, where we were gonna live.
After fighting about it for awhile, I decided I was gonna sell my place and move into hers.
We're going to need access to her home.
I'm guessing you have your own set of keys.
Yeah.
Whatever killed the first three victims is slowly killing the other three.
The initial autopsy reports Eva received confirmed all three died when the cells in their lungs were destroyed, impairing their ability to breathe.
- That's a tough way to go.
- Which X-ray is Sarah Doyle's? - Here.
- Well, she's lucky.
Her lungs appear to be in better shape than the others.
It's not luck.
There's no way of knowing her level of exposure to whatever this is, or predisposition compared to other patients.
What else can you tell us? Uh, she is an artist, so she may have been overexposed to fumes from her oil painting.
Makes toxic gas exposure worth looking into.
How does that play into the blood cultures you're running? There's no growth.
They're still pending.
Okay.
Miles, you stay bedside.
If there are any visitors, ask questions.
I want to know what connects Sarah Doyle to Kathy Owens to Mary Johnson.
I'll keep a watch on the cultures and compare our results against Dr.
Eckhart's.
Great.
Powell, you're with me.
Let's go.
Looks like nothing's been touched since the bridal shower.
Even the cake's still here.
You smell that? Paint fumes.
Miles said she's an artist.
Toxic paint fumes wouldn't explain why the unrelated women got sick.
Unless some of the others are artists.
Bag some samples.
Whatever caused her sickness is here.
I want to find it.
McCabe.
Miles, I want you to check the dextromethorphan levels of all the patients and the victims.
Are you thinking possible DXM overdose? That could be the toxic exposure.
The symptoms match.
Blurred vision, hallucinations, loss of consciousness.
With the right amount, the reaction to the ingredients in cough medicine can have the same effect as PCP.
Okay.
Looks like Sarah Doyle has a lot of bridesmaids.
Sarah must get sick before she gotta hand out her gifts.
What do these go for, a couple hundred a pop? You're asking me? Right.
Connor.
You've gotta come back and see this.
What do you got? I checked it five times, to be sure.
Boxcar-shaped gram-positive rods are present in all the patients.
Are you absolutely positive? I've already called Eva.
She's going to be busy on this one.
I'm on my way.
What is it? Anthrax.
Anthrax? Should I put out a health alert? No, put out an EI-exchange, since it only goes out to the state's department of health.
There's no reason to incite a panic.
Well, I'll talk to the family members of the patients.
And keep the press two steps behind us.
That's what I do.
- Miles.
/ - Thank you.
- Where do we start? We need to know if the source of the anthrax is from something they ate, touched or inhaled.
I'll check for acute inflammation on the intestinal tract to rule out gastrointestinal anthrax.
Any black lesions on Sarah Doyle? None so far.
All right, then most likely it isn't something they've touched, or we would've already seen the open sores, but check again.
If it's inhalational exposure, what's the fatality estimate? 75 percent.
Why is Sarah being moved? Her fiance asked for a private room.
He said if these are her last days, he'd like to spend them alone with her.
Okay.
How are we doing with the other two of them? I'm pushing two million units of penicillin G-IV every three hours and added cipro.
I want our team and the staff treating these patients given the anthrax vaccine, and put on cipro as well.
Stephen, I know the vaccine isn't available to the general public, but what about the patients' families? As soon as the vaccine arrives safe from NIH, administer it to the families.
But they may have already been exposed.
I'll take care of it.
Connor.
I'll be right there.
Agent Borman.
Stephen.
Good to see you again.
Didn't take the FBI long this time.
So, what kind of anthrax are we dealing with? Well, we're narrowing down the possibilities.
Is there any indication whether it's naturally acquired anthrax or weapons grade? Well, right now, we can't rule out anything.
So we can't rule out bioterrorism? Remember the slaughterhouse? Three farmers infected with anthrax simply by petting their cattle.
They were back to good health in a week.
Let's just hope we have the same thing here.
Ah, let's hope.
How much longer till this is taken out of my hands? I can't promise anything.
That doesn't change my question.
You keep us in the loop.
When we find anything, you'll be the first to know.
How are you doing? It's been a long day.
I can only imagine.
but she's in good hands.
Anything that can be done is being done.
Alex, there's never a good time to bring this up.
God knows you've been through enough already, but I just want to make sure you understand the confidential nature of what we do.
What I'm saying is no one has to know that Sarah's been exposed to anthrax.
You're going through enough.
I wouldn't want reporters beating down your door.
If they hear about anthrax, they will.
Do you understand? Sure.
I've checked all three patients.
None have any lesions.
That helps rule out cutaneous anthrax.
According to the coroner, there was no inflammation of the gastrointestinal tract in any of the victims.
Okay, we can eliminate anthrax contamination through touch or ingestion.
That just leaves inhalation.
Are there any side effects of this vaccine I should know about? Very mild headaches, itching or fatigue in one out of five.
Oh, and a very sore arm.
One, two, three, four.
Oh, yeah, right.
Eva makes five.
Natalie, where are you with testing? The cough medicine came back negative for any traces of anthrax, and Sarah's blood work showed no signs of toxic gas poisoning from the paint fumes.
I just got a hit on the EI-exchange.
- How many? - Five more cases.
They're being transferred here now.
This is a different crowd.
They're all African-american men.
Miles, start by taking a patient.
Powell, start by asking questions.
- If anything stands out - I know where to find you.
- Natalie? - I'll start with an antibiotic push.
Check all their cultures for gram-positive bacilli.
Eva, tell NIH the amount of anthrax vaccine needed just doubled.
Dr.
Connor? Ian, this is Dr.
Connor.
It is my pleasure to meet you.
Oh, the pleasure's mine.
How long have you had this? - Just a few days.
- Does it hurt to touch? I don't feel anything.
Any idea what may have caused this? I've seen spider bites like this many times in Nigeria.
It's going to heal okay, am I right? I'm sure you're gonna be fine.
Right now, I need to know everything that you've done, who you've seen, where've you been, what you may have touched.
What do you do for a living? I am a college student.
A junior.
Where do you work? Where do I work? Uh, for a job.
You work on campus, off campus? What are you going to do with that? This will help us confirm that the patients here at the hospital have the same symptoms that you do.
Dr.
Durant.
Are you saying there are more sick people than those I have come in with? Yeah, I'm afraid so.
Would you excuse us just for a second? Cutaneous lesion.
He came in direct contact with the anthrax.
I don't think he even knows he's been exposed.
But he might help us find the source.
I'll start with his culture first.
/ Good.
Miles, take his chest X rays.
I want to know exactly how much contact he's had with anthrax.
Okay.
Hi.
Could I use your fax machine? That's fine.
/ Thanks.
You with NIH? That's cool.
Do you know that gentleman? No.
Never seen him before.
Do you have change for a dollar? Get what you want.
It's on me.
You must not be from around here.
Sure I am.
I was born and bred in the city of brotherly love.
I love it.
You could teach a few men I know a thing or two.
I'll take the granola bar.
Watching your weight? No.
Should I? Don't change a thing.
Thanks.
So, uh, are you here visiting a patient? Yeah.
You? Uh, just in for a physical.
How'd it go? My physical? Yes.
It went well.
How was your visit? Good.
Very good.
I got what I needed.
Okay, let's cut the crap.
Who do you work for? Philadelphia chronicle.
You must be Eva Rossi.
You look shorter in person.
I read your bio on the NIH web site.
Oh, a reporter who does his homework.
What a new twist.
So Why don't you tell me what you know.
So you can deny it? No problem.
Three people are dead of anthrax.
The citizens of Philadelphia should be the first to know there's bioterrorism running rampant in their city.
The citizens, or just your readers? Well, that will be a win-win.
Tell me who your misinformed source is, before they make our investigation any more difficult, and I'll give you an exclusive on the real story.
I'm not revealing my sources to NIH or anyone else.
The fallout of publishing this story too early will risk the lives of the same people you're trying to inform.
Too early? That's a curious choice of words.
Don't get in my way, Mr.
Hodge.
Stephen, we have a problem.
Someone's been talking to the press.
Someone? A reporter from the Philadelphia chronicle has the story.
My best bet, is that "bioterrorism hits Philadelphia" is gonna be the top story in the late edition.
Which means you only have a few hours to do damage control.
Natalie, have you been able to identify the strain of anthrax? The good news is, None of the patients have the strain used in the bioterrorist attacks of 2001.
The aames strain.
/ Right.
However, the strain I did identify resembles moz-1, an African isolate found in Mozambique that usually comes from farm animals or animal products.
- Animal products.
- Wool, leather, fur Wait a minute.
Africa.
- One of them is from there.
- Ian Adoti.
Right.
What've you got from his culture? I confirmed his wound is due to cutaneous anthrax exposure.
Which means he was infected through a cut or incision.
I also ran an X-ray on him.
He shows signs of mediastinal widening in his chest, just like the first three patients.
So what do Ian and these new patients have in common with Sarah Doyle and the others? - How are they connected? - I'll talk to her fiance? You know, in cities like Philadelphia, people may not cross over that invisible line that separates them, but bacterial agents do.
We have to find out how.
Everything I know, Dr.
Connor.
Are you sure about that? Yes, I am sure.
We haven't told you everything.
Ian, you've been exposed to anthrax in two different ways.
Cutaneous and inhalational.
We've already started medicating you and we're doing everything that we can, but we still need to know how you came in contact with anthrax.
But I don't know.
Have you recently come in contact with imported wool items leather, animal products Such as meat? Yes.
My hands work with meat.
You're a butcher.
Yes.
With my friends.
We work part-time.
We sell meat from a shop.
Where exactly is that shop? In the Nigerian community.
And the shop owner's name is Mr.
Ndulu.
North Phil Please, what have I done wrong? I can fix it.
You haven't done anything wrong, Mr.
Ndulu.
One of your employees, Ian Adoti, is very sick.
We think the source of that sickness came from right here inside this market.
In my establishment? Not possible.
I've been here for 20 years.
Mr.
Ndulu, we're gonna need to test your meat and send it to our lab.
But I have a family to feed, employees.
What are my customers going to think of me? We're gonna do everything we can to make this as easy as possible.
Mr.
Ndulu, this way.
Why are they, why are you doing this to me? Miles was right.
I'm going vegetarian.
If Ian cut his hand on this machine, then came in contact with contaminated meat, that's how it may have entered.
Through a crack in the skin.
But that doesn't explain his inhalational exposure.
Maybe the meat aerosolized.
/ How? Through the cutting process.
Particles of aerosolized meat may have traveled through the ventilation system to the front where the customers were.
No.
That's not likely.
And it's not likely Sarah Doyle bought meat from a butcher 30 miles from her house.
- McCabe.
- Ask Sarah's fiance if she ever bought meat from Ndulu's quality meats.
What part of town is it in? - North Philly.
- Well, then the answer's no.
Miles, just ask.
Dr.
Connor, I already have.
I talked to him about where Sarah works, where she shops, where she spends her time.
He told me she doesn't cross that invisible line we talked about.
- How's she doing? - The treatment's kicking in.
Her lungs are clearing, breathing is stabilizing.
And the others? - The same.
- Keep me posted.
Powell! - We're here to help.
- Hold on, hold on.
- Relax, relax.
- Hey, hey, hey.
Why are you running? You're sweating.
How long you been like this? Quiet.
Please.
It's solid.
His lungs are consolidated.
He's been exposed.
Let's get him to a hospital soon as we can.
Eva.
/ Hey.
Stephen wants you to start working on broadening the search for other patients.
I'll do it as soon as I finish the press conference.
I'm on my way there now.
Since the anthrax isn't a threat, why is the press conference still a priority? Because Randall Hodge is gonna run with a bioterror angle for the sake of a sexy headline, and the potential public hysteria caused by an erroneous leak from a sleazy source is only gonna make our jobs more difficult.
Give them hell.
We're taking every prudent measure to protect the city.
That is why the CRI, the cities readiness initiative, is prepared to deploy antibiotics, if necessary.
I will be able to answer your questions in more detail as soon as our investigation is complete.
In the meantime, there's absolutely no reason to create fear.
The people of Philadelphia should go about their daily lives as usual.
I have time for one last question.
Yes, sir.
Ms.
Rossi, regardless of your opening statement, my source reports that, in fact, this is bioterrorism and whether it's naturally acquired anthrax or weapons grade, three people have died, and as far as their families are concerned, they've been terrorized.
What's your response to that? Mr.
Hodge, your source is wrong.
This is not bioterror.
If it were, you all would have been medically screened before coming on the premises.
If this were a biological attack, a high-level suit-and-glasses type from homeland security would be addressing you, not me.
Our team is in control and doing its very best to come to a resolution.
Thank you.
Ms.
Rossi! Ms.
Rossi! McCabe.
A guy named Wali Tunde who works with Ian at the butcher shop is on his way to the hospital.
Is he another anthrax case? I believe so, but he doesn't speak English.
Get Ian to help us.
How long have you been in the states? Eight months and four days.
Did you arrive alone? My brother was supposed to join me, and he got cold feet and stayed in Nigeria.
I have not heard from him.
How long have you been a meatpacker? That is only my job.
I am not a meatpacker.
You're right.
How long have you worked at Ndulu's? Four weeks.
The work is hard, but when I am well enough, I will return.
What are you doing? Giving you more oxygen and medication.
Help your breathing.
I should have known that.
We went over it in physiology class.
Are you pre-med? I have wanted to be a doctor ever since I can remember.
No sleep, no friends, no dating, ever.
You ready for that? Yes.
All those things.
Wali? That is my friend.
What is he doing here? Your friend's very ill, Ian.
Unless we can talk to him, we can't help him.
We need your help.
Me? What can I do? You can talk for us.
Think of him as your first patient.
Whatever you need of me.
We need to know if someone was taking care of him before he became sick.
Does Wali Tunde have a doctor? I only gave Mr.
Tunde medication for his condition.
That is all.
Wali is very ill, Dr.
Onyiuke.
He inhaled the anthrax bacterium into his lungs, possibly damaging his alveoli.
You know as well as I do that leads to respiratory arrest, even death.
He's telling you the truth.
We need your help so that others don't follow.
What is it you want to know? Have you had any patients with anthrax symptoms? If so, did they talk about how they may have been contaminated? Did you hear me, doctor? I will need certain assurances.
Assurances? I need to know that you will not contact immigration.
We're here for answers, doctor.
We're not interested in deporting anybody.
Do I have your word? You have my word.
And yours? You do.
Come.
You must take good care of them.
Ndulu's meat market tested negative for anthrax.
How are the men? Three have a severe case of cutaneous and inhalational exposure.
- And the others? - Inhalational only.
Natalie's making them as comfortable as she can but the three with cutaneous exposure, they're not likely to make it.
You know, they come to this country illegally for a better life, but without papers, they're afraid to ask for help.
How can dying in America be better than returning to Nigeria? Maybe you're asking yourself the wrong question.
Once they're here, why do we turn our backs on them? The sick men all share this apartment.
They all moved here from Nigeria three weeks ago.
Whenever they entered the country, they may have brought a from of naturally acquired anthrax with them.
Glove up.
The landlord paid two of them to work around the building.
The others, they did odd jobs around town.
Maybe it's the work that connects them to Sarah and the others.
Musicians.
There's nothing here.
The landlord also said something about selling products at a flea market.
Here's cologne clothes Different food, different social circles, different part of town, but something links them with Sarah Doyle and the other anthrax victims.
Whatever it is.
Check this out.
That's the same bag we found at Sarah Doyle's.
Bridesmaids' gifts.
McCabe.
- Is Sarah Doyle conscious? - She's in and out.
Ask her where she bought the designer handbags for her bridesmaids.
Dr.
Connor, she's not fully recovered.
McCabe, just ask her.
Sarah, can you hear me? We need to know where you bought the designer handbags for your bridesmaids.
They're fake She says they're fake.
She bought them at an African street market in North philly.
That's where we are now.
Good job.
Well, I am glad to see you're feeling better.
So am I, Dr.
McCabe.
Come on in.
Love philly.
How many people do you suppose pass through this intersection on a given day? In this part of town, hundreds, maybe a thousand.
All right, up to a thousand possible contacts with anthrax in this intersection, and only 17 reported cases? How could that happen? I don't know.
Anthrax is transferred by contact with infected animals.
If people bought infected clothing or ate infected meat that would cause at least a hundred cases, not 17.
It has to be something more specific.
We're looking for a mode of anthrax transfer that is both tactile and breathable.
- Excuse me.
- I have a license.
That's not why I'm here.
Do you usually perform with five other musicians? No.
We don't.
They usually grab a spot over there.
But I haven't seem them with their drums all day.
Thanks, man.
Sarah Doyle came here to buy handbags for her bridesmaids.
Knockoffs.
She heard the music being played.
And we know that at least one of them was playing a drum.
How were they all exposed? Drums The surface of the drums is made of stretched animal hide.
If the animal hide were infected with naturally acquired anthrax the pounding of the drums would've aerosolized the spores, infecting anyone playing or getting too close to the drums.
The answer isn't here.
It's back at their apartment.
We found it.
An African drum.
Seems so harmless.
If anthrax can live on its surface for years, it's not so harmless.
It's the same African strain found in Mozambique we identified in the lungs of all the patients.
As well as the cutaneous lesion on Ian's hand.
The spore encapsulates the bacteria with a protective shell.
Of course, it can't hurt you unless you touch it or inhale it.
In this case, pound the crap out of it.
You know, remind me to keep my bongos in the closet at the next NIH party, huh? The risk of naturally contracting anthrax is very low in the U.
S.
You definitely broke the mold.
When can I go home? A few more days, then in a couple of months, you'll be back to your old self.
It doesn't matter, Dr.
McCabe, because the vows say "in sickness and in health," so he's stuck with me either way.
I'll be right back.
Okay, great.
Thank you.
Excuse me.
It was me.
I'm sorry? Mr.
Hodge, the reporter.
I called him.
Why? Why would you get in the way of us trying to help? Don't you realize that You weren't my priority, Ms.
Rossi.
Sarah was.
Before you got here, three people died.
No one knew about it, nothing was being done, I mean What would you have done? If I had what you and Sarah have, not only would I have called the press, I would have called the national guard.
Your O2 sats are above 80% on room air.
What does that mean? It means there's room for improvement.
And the others? We're doing everything we can.
I mean, will they be deported? It's unlikely they'll be able to stay.
But you did everything you could for them, Ian.
Thank you for you help.
Join me? Step right in.
Long day.
Since when have we ever had a short one? Miles tells me that Sarah's wedding is planned for the end of the month and that two other women are well on the road to recovery.
Powell has tracked down the last of the drums, including the one that Wali sold to Ian.
The other owners have been vaccinated and given a prophylactic dose of cipro.
You beat a drum, celebrate life, and You come close to dying.
Three of them did.
Three more might.
We saved a community today.
That's worth something.
What? You know, the fifth and sixth plagues in the book of exodus could've been the outbreak of anthrax in cattle and humans.
No plagues today.
No.
No plagues today.
You want me to close your door? I'm going for a little walk.
You do good work, Natalie.
We do good work.