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07 – 28 – 1999 | SOUTH SIAM | WEEK 6
The stylet advances slowly, sliding through skin and fat and muscle before burring into fibrous cartilage. You pause for a moment to steady your fingers.
Three more millimeters. A trace of resistance, followed by a faint pop. Clear spinal fluid seeps into a glass ampule.
An eyedropper filled with India Ink reveals what plain eyesight cannot perceive. Under the unmerciful light of a bright-field microscope, tiny dots of bright white resolve against a dark backdrop. You increment the magnification level. The display flickers and the dots resolve into pale halos, drifting placidly in an ocean of jet-black ink.
Cryptococcal meningitis. You were dealing with an encapsulated yeast.
Natcha brings you bags of amphotericin and flucytosine before you finish your medication order. The inpatient transfer slip is already filled with the patient’s information, penned in neat cursive.
“Good work,” you say. “Make sure you get enough rest after we transfer him.”
She half-nods before handing you a printout for the patient’s blood draw. Like you, the dark circles beneath her eyes have begun to gain an unfortunate permanence.
Despite your hopes, the cluster of cases you identified last week had failed to relent. Patients continue to flow into your clinic in twos and threes, presenting with massively disseminated fungal infections. The circumstances were confusing, and the outcomes were consistently bleak. There were few unifying features between the cases – no history that supported a shared source of infection. Some were younger; some were elderly. Most helped manage customs and imports, but others worked in different industries. All of them were recent immigrants, though rarely from the same nation or continent.
