Page 4 of Outbreak Protocol
"Apparently not. This one's different though—he looks properly ill."
I find a middle-aged man in cubicle four, dressed in an expensive suit now rumpled and sweat-stained. His face is flushed with fever, eyes glassy.
"Herr..." I check the chart. "Herr Becker. I'm Dr. Müller. What brings you in today?"
"Worst flu of my life," he gasps, each word clearly an effort. "Started yesterday... thought I could push through... important meetings..."
I note his temperature—40.2°C—and the slight tremor in his hands. His pulse races at 124, blood pressure low at 95/60.
"Any recent travel?" I ask, listening to his lungs. Clear, thankfully.
"Business trip... Copenhagen... three days ago."
I perform a thorough neurological exam, finding slight confusion and photosensitivity. "Any exposure to sick people?"
"Don't think so." He winces as I test his neck flexibility. "My parrot died suddenly... yesterday morning... had him for years."
Something prickles at the back of my mind. "Your parrot died?"
"African grey... Imported him... eight years ago... Never sick a day..."
Before I can probe further, he vomits violently. A nurse rushes in to help, and the moment passes as we clean him up and start IV fluids.
"Let's get blood cultures, complete blood count, comprehensive metabolic panel, influenza panel, and a chest x-ray," I order. "And let's start empiric oseltamivir and broad-spectrum antibiotics after we get the cultures."
Two hours later, I'm reviewing Herr Becker's preliminary results with growing concern. His white count is elevated butwith an unusual distribution. Liver enzymes slightly elevated. Influenza rapid test negative.
"His fever's not responding to antipyretics," Anna reports, joining me at the computer. "And he's more confused. Keeps asking about his parrot."
"Something's not adding up." I scroll through the results again. "This presentation... it's not typical influenza. The headache, the photophobia, the rapid onset of neurological symptoms."
"Meningitis?"
"Maybe, but no nuchal rigidity. And why mention the dead parrot?"
Anna raises an eyebrow. "You think it's connected?"
"I don't know." I run a hand through my hair. "But exotic birds, sudden illness... we should consider zoonotic infections."
"You want to consult infectious disease?"
"Yes. And I want a lumbar puncture."
Anna nods. "I'll set it up."
When I approach Dr. Hartmann with my concerns an hour later, he dismisses them with a wave of his manicured hand.
"A businessman with a fever during flu season, and you want to call in ID consult?" He doesn't look up from his computer. "We're already over budget on specialty consults this quarter."
"His presentation is atypical, and there's a potential zoonotic exposure. His parrot died suddenly yesterday."
Hartmann sighs dramatically. "Dr. Müller, when you hear hoofbeats, think horses, not zebras. It's influenza. Admit him for supportive care and move on. We have patients waiting for beds."
"With respect, sir, I believe—"
"Your concern for patients is admirable," he interrupts, his tone suggesting it's anything but. "But your history in pathology doesn't qualify you to diagnose exotic diseases. Treat the obvious and discharge when appropriate. That's how emergency medicine works."
I clench my jaw. "Yes, sir."
