Page 2 of Outbreak Protocol

CHAPTER TWO

Day One

FELIX

I've been on my feet for nine hours straight when the doors to the emergency department burst open again. The paramedics wheel in an elderly woman, her face contorted in pain, oxygen mask fogging with each laboured breath.

"Seventy-eight-year-old female, crushing chest pain radiating to left arm, began forty minutes ago," the paramedic reports, already connecting monitoring leads. "Nitro administered en route with minimal relief. BP 165/95, pulse 112, oxygen 91% on four litres.”

I place my stethoscope on her chest, glancing at her name on the nearby medical chart. "Frau Weber, I'm Dr. Müller. We're going to take good care of you."

Her eyes find mine, wide with fear. I place my hand over hers and squeeze gently. "I know you're scared. That's normal. But you're exactly where you need to be right now."

The monitors spring to life, displaying the telltale ST elevation on her ECG .

"Call cardiology for immediate catheterization," I tell the nurse while I quickly examine the patient. "Frau Weber, you're having a heart attack. We need to open the blocked vessel quickly. The cardiologist will thread a tiny tube through your wrist to fix the blockage."

"Am I going to die?" Her voice trembles.

I lean closer. "Not if I have anything to say about it. My mother had the same procedure last year. She's back to tending her garden and complaining about my father's snoring."

A ghost of a smile crosses her lips as the cardiology team arrives.

"STEMI, anterior wall, pain began forty minutes ago. She's prepped and ready," I report, helping transfer her to their gurney.

"Thanks, Felix," Dr. Reiner says. "Good catch."

I nod and move immediately to the next cubicle, where a six-year-old boy sits clutching a teddy bear, tears streaming down his flushed cheeks.

"Hey there, buddy." I crouch to his eye level. "I'm Felix. What's your bear's name?"

"Bruno," he whispers, clutching the stuffed animal tighter.

"Is Bruno feeling sick too?" I ask, pulling out my stethoscope.

The boy nods solemnly.

"Well, I better examine both of you then." I place the stethoscope on the bear's chest first. "Hmm, Bruno's heart sounds perfect. Very strong." I wink at the mother, who watches with grateful exhaustion. "Now your turn."

As I examine the boy—temperature 39.5°C, throat inflamed, no respiratory distress—I chat with him about Bruno's adventures. By the time I've finished my exam, he's stopped crying.

"Good news. You have a nasty throat infection, but we can fix that." I write a prescription for antibiotics. "And Bruno is completely healthy. He's doing a great job taking care of you."

The mother mouths "thank you" as I move to the next patient—a sullen teenager with a suspicious fracture pattern on his wrist x-ray.

"The chart says you fell off your skateboard," I say, studying the films.

"Yeah." He avoids eye contact.

I note the defensive posture, the faded bruises at different healing stages. "Interesting. This break doesn't typically happen from a fall. It's more consistent with someone twisting your arm."

His eyes dart to the door.

"Your father waiting outside?"

A barely perceptible nod.

"I need to set this properly." I pull the privacy curtain closed. "While I work, maybe you can tell me how this really happened."

Twenty minutes and one social services consult later, I'm finally grabbing a sip of water when Anna appears beside me, her scrubs as rumpled as mine.

"Three minutes of peace," she announces, leaning against the counter. "New record for today."

"I was hoping for four." I drain the water cup. "How's bed seven doing?"

"The appendicitis? Surgery just took him up." She checks her watch. "Emma's school play is tonight. If this shift ever ends, I might actually make it."

"You will. I'll cover if things run late."

Anna smiles, the exhaustion momentarily lifting from her face. "You're a good man, Felix Müller. Terrible taste in football teams, but a good man."

"Bayern Munich is objectively superior, and someday you'll admit it." This is our ritual, this banter that makes fourteen-hour shifts bearable.

"Never." She glances at the board. "Looks like you're up. Cubicle four. Flu-like symptoms. "

I groan. "Fifth one today. Didn't anyone get their flu shot this year?"

"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 but with 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."

Back in the emergency department, Anna reads my expression. "Hartmann shot you down?"

"Of course." I check Herr Becker's latest vitals—temperature now 40.5°C despite medication. "He thinks I'm overreacting."

"You're not." Anna's voice is firm. "I've worked with you for four years, Felix. Your instincts are usually right."

"Usually isn't good enough for Hartmann. He wants the patient diagnosed, treated, and discharged in under four hours to keep his precious performance metrics looking good."

She touches my arm. "Do what you think is right. I'll back you up."

In the end, I order the lumbar puncture anyway. The results show elevated protein and a moderate pleocytosis with lymphocytic predominance—consistent with viral meningitis. Not definitive, but enough to justify admission and further testing.

Herr Becker is transferred to the medical ward with isolation precautions, despite Hartmann's visible annoyance at the "unnecessary use of a private room.

" I write detailed notes about the parrot in the chart and request infectious disease consultation, knowing I'll probably get reprimanded tomorrow.

It's nearly midnight when I finally clock out. The emergency department continues its controlled chaos behind me as I walk to the doctors' lounge. My shoulders ache from tension, my mind still churning over Herr Becker's case.

In the quiet of the lounge, I pull up his chart one more time. His condition has deteriorated further—now requiring oxygen, his mental status worsening. The attending physician has ordered an MRI for morning, suspecting encephalitis.

I stare at the screen, that same prickle of unease growing stronger. Something about this case feels ominous, like the distant rumble before a storm breaks. The dead parrot. The rapid progression. The resistance to standard treatments.

This isn't just an unusual flu. It's something else entirely.

I close the chart and lean back, exhaustion settling into my bones. In pathology, my patients were already beyond suffering. Their stories were complete; I simply had to read them correctly. But emergency medicine is different—messy, uncertain, filled with lives hanging in precarious balance.

I chose this path because I needed the connection, needed to matter to the living rather than just interpret the dead. But nights like tonight remind me of the weight of that choice—the nagging worry that follows me home, the faces I can't forget.

I gather my things slowly, reluctant to leave while Herr Becker's condition remains uncertain. But there's nothing more I can do tonight. Tomorrow will bring new patients, new challenges, perhaps answers to today's questions.

As I walk through the parking garage, my phone buzzes with a text from Anna: "Emma says thanks for letting her mom see her play. You're her favourite doctor (after me, of course)."

I smile despite my fatigue. This is why I left pathology—for moments of connection, for the chance to make a difference in lives still unfolding. Even when the cases haunt me, even when bureaucracy frustrates me, this work matters in a way I can feel.

But as I drive home through Hamburg's quiet streets, Herr Becker's feverish face stays with me, along with a growing certainty that we've missed something important—something that might matter beyond just one patient's outcome.