Assignment:
Part I-Trouble in the Nursery
"Flesh eating bacteria? You're kidding, right?" Dr. Mark Maddison winced as he tried to understand the alarmed nurse at the other end of the phone. "Slow down and tell me again what's happening." Mark knew that he needed to stay calm and try to buy time to understand the problem. It was the fi rst time he had been left as the sole physician in charge of the struggling Black Rock Clinic. Dr. Jullie Elridge, the seasoned senior physician in their partnership, had left for Nepal two weeks earlier on a three-week expedition to climb Mount Everest.
The nurse, Jill Benoit, continued, "All I know is that I have three really sick babies down here. The Willis twins started to go bad yesterday. They have a strange rash on their thighs and they're running a fever. I thought it was just ordinary diaper rash, but this evening when I was rubbing some ointment on it, the skin started coming off in sheets! Now the Levi baby looks like she has the same thing under her arms."
"You haven't started using some new lotion or soap on them, have you?" asked Mark, hoping that he wasn't going to have to resurrect his knowledge of infectious diseases. "Perhaps you're using something that's too harsh for the skin of neonates."
"No, no," Jill answered impatiently. "I've been working in neonatal nurseries for 25 years. I think I know a thing or two about washing babies. Can you reach Dr. Elridge? She knows how to handle these sorts of things."
Mark resisted the urge to snap back at her. If he had to call Jullie in Nepal he'd never live it down. "No need to call her. She left me in charge. I just need to take a look at the little guys. I'll be right up."
Mark took the stairs up to the nursery two steps at a time. Turning down the hallway he could see a small cluster of visitors cooing and waving at a small red-faced infant being displayed through the nursery's large plate glass window. Behind them Nurse Benoit was hovering over an isolette. Mark hurriedly washed his hands and walked over to the isolette to examine the baby.
Jill didn't look up when he arrived but simply murmured "Dr. Maddison" under her breath as if his name were something distasteful. The Levi baby was wearing a tiny knit cap and was wrapped tightly in a hospital blanket. Mark gently unwrapped the blanket and lifted up the baby's white undershirt to examine her skin. He could see some small vesicular lesions on the inside of her upper arm. Farther up, in the axillary area, there was a moist red area about the size of a quarter. The baby girl seemed warm to the touch, and she began to fuss and wave her fi sts in response to his probing. He replaced the blanket and walked over to the isolette that held the fi rst of the Willis twins.
"Baby Boy A is worse than his brother," Jill called from across the nursery. Mark undressed Baby Boy A and removed his diaper to look at the affected area. The entire area of the tiny baby's groin appeared to be involved, demonstrating the same strange skin infection. Maybe Jill was right-perhaps this was the beginning of necrotizing fasciitis, the famed "fl esh eating bacteria" of tabloid lore. No Marker what it was, he needed to act quickly to avoid any kind of negative publicity.
Mark looked up in time to see Bill Alkin, the clinic administrator, enter the nursery wearing a grey pinstripe suit that seemed oddly out of place in the antiseptic and starched white surroundings of the "The Case of the Newborn Nightmare" by Andrea Wade Page 2 nursery. "Dr. Maddison," Bill said curtly. "Nurse Benoit has notifi ed me that we have a potential situation here in the nursery. It looks as though we need to give Dr. Elridge a call." Mark shot Jill a withering glance, but she studiously ignored it. "No, no," he replied. "I'm sure I can handle this. Besides, Jullie has probably already started up the mountain. She's undoubtedly out of contact with everyone, except perhaps her Sherpa guides."
"For your sake, I hope you're right about being able to handle this," Bill countered. "We can't afford to have an epidemic in the news. You know that Whitley Memorial Hospital has been looking for an excuse to shut us down. I'm sorry, but I can't risk losing this clinic just so that you can pursue some idea of being a hero. I'll give you 24 hours-after that I'm quarantining the nursery and calling in the county health department. If there is any negative publicity about delaying even a day, I'm holding you personally responsible." With that, Bill turned abruptly and headed out of the nursery.
Mark looked down at the mewling infant and soberly rewrapped him in his powder blue blanket. "Well, Dr. Maddison?" Jill inquired, her voice tinged with sarcasm. "What are your instructions?"
"I'll have them written out for you as soon as I check on a few details," Mark responded. He was going to have to read up on infectious agents that could cause this kind of a skin disorder-and fast. Mark wished he had been a better student of infectious diseases. He hated to admit it but he had just barely passed that part of his education. The reference collection in the clinic library was a bit sparse and somewhat outdated, but at least it was a place to start.
Questions
1. What are the challenges Dr. Maddison is facing?
2. What information does he have so far about the infection?
3. What are some possible causes of skin infections? List at least five different organisms.
4. What should Dr. Maddison's next move be in determining the cause of the babies' infection?
Readings:
The Case of the Newborn Nightmare
By Andrea Wade