Outbreak

Outbreak

Robin Cook

Prologue

Zaire, Africa

September 7, 1976

A TWENTY-ONE-YEAR-OLD Yale biology student by the name of John Nordyke woke up at dawn at the edge of a village north of Bumba, Zaire. Rolling over in his sweat-drenched sleeping bag, he stared out through the mesh flap of his nylon mountain tent, hearing the sounds of the tropical rain forest mixed with the noises of the awakening village. A slight breeze brought the warm, pungent odor of cow dung permeated with the acrid aroma of cooking fires. High above him he caught glimpses of monkeys skittering through the lush vegetation that shielded the sky from his view.

He had slept fitfully, and as he pulled himself upright, he was unsteady and weak. He felt distinctly worse than he had the night before, when he’d been hit by chills and fever an hour or so after dinner. He guessed he had malaria even though he’d been careful to take his chloroquine phosphate as prophylaxis against it. The problem was that it had been impossible to avoid the clouds of mosquitoe5 that emanated each evening from the hidden pools in the swampy jungle.

With a hesitant gait, he made his way into the village and inquired about the nearest clinic. An itinerant priest told him that there was Belgian mission hospital in Yambuku, a small town located a few kilometers to the east. Sick and frightened, John quickly broke camp

stuffed his tent and sleeping bag into his backpack and set out for Yambuku.

John had taken a six-month leave from college to photograph African animals, such as the highland gorilla, which were threatened by extinction. It had been his boyhood dream to emulate the famous nineteenth-century explorers who had originally opened the Dark Continent.

Yambuku was scarcely larger than the village he’d just left, and the mission hospital did not inspire confidence. It was no more than a meager collection of cinder-block buildings, all in dire need of repair. The roofs were either rusting corrugated metal or thatched like the native huts, and there seemed no signs of electricity.

After checking in with a nun, swathed in traditional attire, who spoke only French, John was sent to wait among a throng of natives in all states of debility and disease. Looking at the other patients, he wondered if he wasn’t likely to catch something worse than what he already had. Finally he was seen by a harried Belgian doctor who could speak a little English, though not much. The examination was rapid, and as John had already surmised, the diagnosis was a “touch” of malaria. The doctor ordered an injection of chloroquine and advised John to return if he didn’t feel better within the next day or so.

The examination over, John was sent into the treatment room to wait in line for his injection. It was at that point that he noticed the lack of aseptic technique. The nurse did not have disposable needles but merely rotated one of three syringes. John was certain that their short stay in the sterilizing solution was not nearly long enough to render them germ-free. Besides, the nurse fished them out of the fluid with her fingers. When it became his turn, he was tempted to say something, but his French was not fluent enough, and he knew he needed the medicine.

During the next few days, John was glad that he’d been silent since he soon was feeling better. He stayed in the Yambuku area, occupying himself by photographing the Budza tribesmen. They were avid hunters and eager to demonstrate their prowess to the blond foreigner. By the third day John was preparing to recommence his journey up the Zaire River, following Henry Stanley’s footsteps, when his health took a rapid turn for the worse. The first thing he noticed was a violent headache, followed in rapid succession by chills, fever, nausea and diarrhea. Hoping it would pass, he took to his tent and shivered through the night, dreaming of home with clean sheets and a bathroom down the hail. By morning he felt weak and dehydrated, having vomited several times in the darkness. With

great difficulty, he got his things together and made his way slowly to the mission hospital. When he arrived in the compound, he vomited bright red blood and collapsed on the clinic floor.

An hour later he woke in a room occupied by two other patients, both suffering from drug-resistant malaria.

The doctor, the same man who’d examined John on his previous visit, was alarmed by the severity of John’s condition and noted some curious additional symptoms: a strange rash over his chest and small surface hemorrhages in his eyes. Although the doctor’s diagnosis was still malaria, he was troubled. It was not a typical case. As an added precaution, he decided to include a course of chloramphenicol in case the boy had typhoid fever.

September 16, 1976

Dr. Lugasa, District Health Commissioner for the Bumba region, glanced out the open window of his office at the expanse of the Zaire River as it shimmered in the morning sunlight. He wished it was still called the Congo with all the mystery and excitement that name invoked. Then, forcing his mind back to work, he looked again at the letter he’d just received from the Yambuku Mission Hospital concerning the deaths of an American male, one John Nordyke, and of a visiting farmer from a plantation near the Ebola River. The mission doctor claimed that their deaths had been caused by an unknown infection that spread rapidly; two patients housed with the American, four members of the planter’s household who’d been caring for the farmer, and ten of the clinic’s outpatients had come down with severe cases of the same illness.

Dr. Lugasa knew that he had two choices. First, he could do nothing, which was undoubtedly the wisest choice. God knew what kind of rampant endemic diseases there were out there in the bush. His second option was to fill out the bewildering array of official forms reporting the incident to Kinshasa where someone like himself, but higher on the bureaucratic ladder, would probably decide it was prudent to do nothing. Of course Dr. Lugasa knew that if he elected to fill out the forms, he would then be obligated to journey up to Yambuku, an idea that was particularly odious to him at that particularly damp, hot time of year.

With a twinge of guilt, Dr. Lugasa let the onionskin letter slip into the wastebasket.

September 23, 1976

A week later Dr. Lugasa was nervously shifting his weight from one foot to the other as he watched the aged DC-3 aircraft land at the Bumba airport. First out was Dr. Bouchard, Dr. Lugasa’s superior from Kinshasa. The day before, Dr. Lugasa had telephoned Dr. Bouchard to inform him that he’d just received word that a serious outbreak of an unknown disease was in progress in the area around the Yambuku Mission Hospital. It was affecting not only the local inhabitants, but the hospital staff as well. He had not mentioned the letter he’d received some seven days before.

The two doctors greeted each other on the tarmac and then climbed into Dr. Lugasa’s Toyota Corolla. Dr. Bouchard asked if there was any more news from Yambuku. Dr. Lugasa cleared his throat, still upset about what he’d learned that morning from the wireless. Apparently eleven of the medical staff of seventeen were already dead, along with one hundred and fourteen villagers. The hospital was closed since there was no one well enough to run it.

Dr. Bouchard decided that the entire Bumba region had to be quarantined. He quickly made the necessary calls to Kinshasa and then told the reluctant Dr. Lugasa to arrange transportation for the next morning so they could visit Yambuku and assess the situation firsthand.

September 24, 1976

The following day when the two doctors pulled into the deserted courtyard of the Yambuku Mission Hospital they were greeted by an eerie stillness. A rat scampered along the balustrade of an empty porch, and a putrid odor assaulted their senses. Holding cotton handkerchiefs over their noses, they reluctantly got out of the Land Rover and gingerly looked into the nearest building. It contained two corpses, both beginning to decay in the heat. It wasn’t until they’d peered into the third building that they found someone still alive, a nurse delirious with fever. The doctors went into the deserted operating room and put on gloves, gowns and masks in a belated attempt to protect themselves. Still fearful for their own health, they tended to the sick nurse and then searched for more of the staff. Among nearly thirty dead, they found four other patients barely clinging to life.

Dr. Bouchard radioed Kinshasa and requested emergency aid from the Zairean Air Force to airlift several patients from the mission hospital back to the capital. But by the time the infectious disease department at the university hospital was consulted about how to isolate the patients during transport, only the nurse still lived. Isolation techniques would have to be excellent, Bouchard pointed out, because they were obviously dealing with a highly contagious and very deadly disease.

September 30, 1976

The Belgian nurse airlifted to Kinshasa died at 3:00 A.M. despite six days of massive supportive therapy. No diagnosis was made, but after the autopsy, samples of her blood, liver, spleen and brain were sent to the Institut de Medicine Tropical in Antwerp, Belgium; to the Centers for Disease Control in Atlanta, U.S.A.; and to the Microbiological Research Establishment in Porton Down, England. In the Yambuku area there were now two hundred ninety-four known cases of the illness, with a fatality rate of approximately ninety percent.

October 13, 1976

The Yambuku virus was isolated almost simultaneously at the three international laboratories. It was noted to be structurally similar to the Marburg virus, first seen in 1967 in a fatal outbreak in laboratory workers handling green monkeys from Uganda. The new virus, considerably more virulent than Marburg, was named Ebola after the Ebola River north of Bumba. It was thought to be the most deadly microorganism seen since the bubonic plague.

November 16, 1976

Two months after the initial outbreak, the unknown disease in Yambuku was considered successfully contained since no new cases had been reported in the area for several weeks.

December 3, 1976

The quarantine of the Bumba region was lifted and air service reinstated. The Ebola virus had evidently returned to its original

source. Where that source was remained a complete mystery. An international team of professionals, including Dr. Cyrill Dubchek of the Centers for Disease Control who had played a big role in localizing the Lassa Fever virus, had scoured the area, searching for a reservoir for the Ebola virus within mammals, birds, and insects. The virologists had no success whatsoever. Not even a clue.

Los Angeles, California

January 14

Present Day

Dr. Rudolph Richter, a tall, dignified ophthalmologist originally from West Germany, and cofounder of the Richter Clinic in Los Angeles, adjusted his glasses and looked over the advertising proofs laid out on the circular table in the clinic’s conference room. To his right was his brother and partner, William, a business-school graduate, who was examining the proofs with equal attention. The material was for the next quarter’s drive for new prepaid subscribers to the clinic’s health-care plan. It was aimed at young people, who as a group were relatively healthy. That was where the real money was in the prepaid health-care business, William had been quick to point out.

Rudolph liked the proofs. It was the first good thing that had happened to him that day. It was a day that had begun badly with a fender-bender on the entrance to the San Diego freeway, resulting in a nasty dent in his new BMW. Then there was the emergency surgery that had backed up the clinic. Then there was the tragic AIDS patient with some weird complication who’d coughed in his face while he tried to examine the man’s retinas. And on top of everything else, he’d been bitten by one of the monkeys used in his ocular herpes project. What a day!

Rudolph picked up an ad scheduled for the L.A. Times Sunday Magazine. It was perfect. He nodded at William, who motioned for the ad man to continue. The next part of the presentation was a slick thirty-second TV spot slotted for the evening news. It portrayed carefree bikini-clad girls on a Malibu beach, playing volley ball with some handsome young men. It reminded Rudolph of an expensive Pepsi ad, though it extolled the concept of prepaid health maintenance as delivered by an organization like the Richter Clinic in contrast to conventional fee-for-service medicine.

Along with Rudolph and William were a handful of other staff

doctors, including Dr. Navarre, Chief of Medicine. They were all directors of the clinic and held small amounts of stock.

William cleared his throat and asked if there were any questions from the staff. There were none. After the advertising people had departed, the group voiced unanimous approval of what had been presented. Then, after a brief discussion about the construction of a new satellite clinic to deal with the increase in subscribers from the Newport Beach area, the meeting was adjourned.

Dr. Richter returned to his office and cheerfully tossed the advertising proofs into his briefcase. It was a sumptuous room, considering the relatively low professional salary he drew as a physician in the group. But his salary was just incidental remuneration compared to the profits from his percentage of the outstanding stock. Both the Richter Clinic and Dr. Rudolph Richter were in sound financial shape.

After catching up on his calls, Dr. Richter made rounds on his own postoperative inpatients: two retinal detachments with difficult medical histories. Both were doing well. On his way back to his office, he thought about how little surgery he was doing as the sole ophthalmologist of the clinic. It was disturbing, but with all the ophthalmologists in town, he was lucky to have what he did. He was thankful that his brother had talked him into the clinic idea eight years ago.

Changing his white coat for a blue blazer and picking up his briefcase, Dr. Richter left the clinic. It was after 9:00 P.M., and the two-tiered parking garage was almost empty. During the day it was always full, and William was already talking about the need to expand it, not only for the spaces but for the depreciation; issues like that Rudolph didn’t truly understand, nor did he want to.

Musing about the economics of the clinic, Dr. Richter was unaware of two men who had been waiting in the shadows of the garage. He remained unaware even after they fell in step behind him. The men were dressed in dark business suits. The taller of the two had an arm that seemed permanently frozen into a flexed position. In his hand was a fat briefcase that he held high due to the immobility of the elbow joint.

Nearing his car, Dr. Richter sensed the footsteps behind him as they quickened in pace. An uncomfortable sensation gripped his throat. He swallowed hard and cast a nervous glance over his shoulder. He caught sight of the two men, who seemed to be coming directly toward him. As they passed beneath an overhead light, Dr. Richter could appreciate that they were carefully dressed, with fresh shirts and silk ties. That made him feel a little better. Even so, he

p.

moved more quickly, rounding the back end of his car. Fumbling for the keys, he unlocked the driver’s-side door, tossed in his briefcase, and slid into the welcome smell of coach leather. He started to close the door, when a hand stopped him. Dr. Richter reluctantly raised his eyes to what turned out to be the calm, blank face of one of the men who had followed him. The suggestion of a smile crossed the man’s countenance as Dr. Richter looked at him inquiringly.

Dr. Richter tried again to pull his door shut, but the man held it firmly from the outside.

“Could you tell me the time, doctor?” asked the man politely.

“Certainly,” said Richter, glad to have a safe explanation for the man’s presence. He glanced at his watch, but before he had a chance to speak, he felt himself rudely pulled from the car. He made a halfhearted effort to struggle, but he was quickly overwhelmed and stunned by an open-handed blow to the side of his face that knocked him to the ground. Hands roughly searched for his wallet, and he heard fabric tear. One of the men said “businessman,” in what sounded like a disparaging tone, while the other said, “Get the briefcase.” Dr. Richter felt his watch yanked from his wrist.

It was over as quickly as it had begun. Dr. Richter heard footsteps recede and a car door slam, then the screech of tires on the smooth concrete. For a few moments he lay without moving, glad to be alive. He found his glasses and put them on, noting that the left lens was cracked. As a surgeon, his primary concern was for his hands; they were the first thing he checked, even before he picked himself up off the ground. Getting to his feet, he began to examine the rest of himself. His white shirt and his tie were smeared with grease. A button was missing from the front of his blazer, and in its place was a small horseshoe-shaped tear. His pants were torn from the right front pocket all the way down to his knee.

“God, what a day!” he voiced to himself, thinking that being mugged made the morning’s fender-bender seem trivial by comparison. After a moment’s hesitation, he recovered his keys and returned to the clinic, going back to his office. He called security, then debated whether to call the L.A. police. The idea of bad publicity for the clinic made him hesitate, and really, what would the police have done? While he argued with himself, he called his wife to explain that he’d be a little later than expected. Then he went into the lavatory to examine his face in the mirror. There was an abrasion over the right cheekbone that was sprinkled with bits of parking-garage grit. As he gingerly blotted it with antiseptic, he tried to estimate how much he had contributed to the muggers’ welfare. He guessed he’d had about

a hundred dollars in his wallet as well as all his credit cards and identification, including his California medical license. But it was the watch that he most hated to lose; it had been a gift from his wife. Well, he could replace it, he thought, as he heard a knock on his outer door.

The security man was fawningly apologetic, saying that such a problem had never happened before, and that he wished he’d been in the area. He told Dr. Richter that he’d been through the garage only a half-hour before, on his normal rounds. Dr. Richter assured the man that he was not to blame and that his, Richter’s, only concern was that steps be taken to make certain that such an incident did not reoccur. The doctor then explained his reasons for not calling the police.

The following day, Dr. Richter did not feel well but he attributed the symptoms to shock and the fact that he’d slept poorly. By five-thirty, though, he felt ill enough to consider canceling a rendezvous he had with his mistress, a secretary in the medical records department. In the end, he went to her apartment but left early to get some rest, only to spend the night tossing restlessly in his bed.

The next day, Dr. Richter was really ill. When he stood up from the slit lamp, he was light-headed and dizzy. He tried not to think about the monkey bite or being coughed on by the AIDS patient. He was well aware that AIDS was not transmitted by such casual contact: it was the undiagnosed superinfection that worried him. By three-thirty he had a chill and the beginnings of a headache of migraine intensity. Thinking he had developed a fever, he canceled the rest of the afternoon’s appointments and left the clinic. By then he was quite certain he had the flu. When he arrived home, his wife took one look at his pale face and red-rimmed eyes, and sent him to bed. By eight o’clock, his headache was so bad that he took a Percodan. By nine, he had violent stomach cramps and diarrhea. His wife wanted to call Dr. Navarre, but Dr. Richter told her that she was being an alarmist and that he’d be fine. He took some Dalmane and fell asleep. At four o’clock he woke up and dragged himself into the bathroom, where he vomited blood. His terrified wife left him long enough to call an ambulance to take him to the clinic. He did not complain. He didn’t have the strength to complain. He knew that he was sicker than he’d ever been in his life.

1

January 20

SOMETHING DISTURBED MARISSA Blumenthal. Whether the stimulus came from within her own mind, or from some minor external change, she did not know. Nonetheless her concentration was broken. As she raised her eyes from the book in her lap she realized that the light outside the window had changed from its pale wintery white to inky blackness. She glanced at her watch. No wonder. It was nearly seven.

“Holy Toledo,” muttered Marissa, using one of her expressions left over from childhood. She stood up quickly and felt momentarily dizzy. She had been sprawled out on two low slung vinyl-covered chairs in a corner of the library of the Centers for Disease Control (CDC) in Atlanta for more hours than she cared to think about. She had made a date for that evening and had planned on being home by six-thirty to get ready.

Hefting Fields’ ponderous Virology textbook, she made her way over to the reserve shelf, stretching her cramped leg muscles en route. She’d run that morning, but had only put in two miles, not her usual four.

“Need help getting that monster on the shelf?” teased Mrs. Campbell, the motherly librarian, buttoning her omnipresent gray cardigan. It was none too warm in the library.

As in all good humor, there was some basis in truth for Mrs. Campbell’s whispered comment. The virology textbook weighed ten

pounds-one-tenth as much as Marissa’s hundred-pound frame. She was only five feet tall, although when people asked, she said she was five-two, though that was only in heels. To return the book, she had to swing it back and then almost toss it into place.

“The kind of help I need with this book,” said Marissa, “is to get the contents into my brain.”

Mrs. Campbell laughed in her subdued fashion. She was a warm, friendly person, like most everyone at CDC. As far as Marissa was concerned, the organization had more the feeling of an academic institution than a federal agency, which it had officially become in 1973. There was a pervading atmosphere of dedication and commitment. Although the secretaries and maintenance personnel left at four-thirty, the professional staff invariably stayed on, often working into the wee hours of the morning. People believed in what they were doing.

Marissa walked out of the library, which was hopelessly inadequate in terms of space. Half the Center’s books and periodicals were stored haphazardly in rooms all over the complex. In that sense the CDC was very much a federally regulated health agency, forced to scrounge for funding in an atmosphere of budget cutting. Marissa noted it also looked like a federal agency. The hall was painted a drab, institutional green, and the floor was covered in a gray vinyl that had been worn thin down the middle. By the elevator was the inevitable photograph of a smiling Ronald Reagan. Just beneath the picture someone had irreverently tacked up an index card that said: “If you don’t like this year’s appropriation, just wait until next year!”

Marissa took the stairs up one flight. Her office-it was generous to call it that; it was more cubbyhole than office-was on the floor above the library. It was a windowless storage area that might have been a broom closet at one time. The walls were painted cinder block, and there was just enough room for a metal desk, file cabinet, light and swivel chair. But she was lucky to have it. Competition for space at the Center was intense.

Yet despite the handicaps, Marissa was well aware that the CDC worked. It had delivered phenomenal medical service over the years, not only in the U.S., but in foreign countries as well. She remembered vividly how the Center had solved the Legionnaires Disease mystery a number of years back. There had been hundreds of such cases since the organization had been started in 1942 as the Office of Malaria Control to wipe out that disease in the American South. In 1946 it had been renamed the Communicable Disease Center, with separate labs set up for bacteria, fungi, parasites, viruses

and rickettsiae. The following year a lab was added for zoonoses, diseases that are animal ailments but that can be transmitted to man, like plague, rabies and anthrax. In 1970 the organization was renamed again, this time the Centers for Disease Control.

As Marissa arranged some articles in her government-issue briefcase, she thought about the past successes of the CDC, knowing that its history had been one of the prime reasons for her considering coming to the Center. After completing a pediatric residency in Boston, she had applied and had been accepted into the Epidemiology Intelligence Service (EIS) for a two-year hitch as an Epidemiology Intelligence Service Officer. It was like being a medical detective. Only three and a half weeks previously, just before Christmas, she’d completed her introductory course, which supposedly trained her for her new role. The course was in public-health administration, biostatistics and epidemiology-the study and control of health and disease in a given population.

A wry smile appeared on Marissa’s face as she pulled on her dark blue overcoat. She’d taken the introductory course, all right, but as had happened so often in her medical training, she felt totally unequipped to handle a real emergency. It was going to be an enormous leap from the classroom to the field if and when she was sent out on an assignment. Knowing how to relate to cases of a specific disease in a coherent narrative that would reveal cause, transmission and host factors was a far cry from deciding how to control a real outbreak involving real people and a real disease. Actually, it wasn’t a question of “if,” it was only a question of “when.”

Picking up her briefcase, Marissa turned off the light and headed back down the hall to the elevators. She’d taken the introductory epidemiology course with forty-eight other men and women, most of whom, like herself, were trained physicians. There were a few microbiologists, a few nurses, even one dentist. She wondered if they all shared her current crisis of confidence. In medicine, people generally didn’t talk about such things; it was contrary to the “image.”

At the completion of the training, she’d been assigned to the Department of Virology, Special Pathogens Branch, her first choice among the positions available. She had been granted her request because she’d ranked number one in the class. Although Marissa had little background in virology, which was the reason she’d been spending so much time in the library, she’d asked to be assigned to the department because the current epidemic of AIDS had catapulted virology into the forefront of research. Previously it had

always played second fiddle to bacteriology. Now virology was where the “action” was, and Marissa wanted to be a part of it.

At the elevators, Marissa said hello to the small group of people who were waiting. She’d met some of them, mostly those from the Department of Virology, whose administrative office was just down the hail from her cubicle. Others were strangers, but everyone acknowledged her. She might have been experiencing a crisis of confidence in her professional competence, but at least she felt welcome.

On the main floor Marissa stood in line to sign out, a requirement after 5:00 P.M., then headed to the parking area. Although it was winter, it was nothing like what she’d endured in Boston for the previous four years, and she didn’t bother to button her coat. Her sporty red Honda Prelude was as she’d left it that morning: dusty, dirty and neglected. It still had Massachusetts license plates; replacing them was one of the many errands that Marissa had not yet found time to do.

It was a short drive from the CDC to Marissa’s rented house. The area around the Center was dominated by Emory University, which had donated the land to the CDC in the early ‘40s. A number of pleasant residential neighborhoods surrounded the university, running the gamut from lower middle class to conspicuously rich. It was in one of the former neighborhoods, in the Druid Hills section, that Marissa had found a house to rent. It was owned by a couple who’d been transferred to Mali, Africa, to work on an extended birth-control project.

Marissa turned onto Peachtree Place. It seemed to her that everything in Atlanta was named “peachtree.” She passed her house on the left. It was a small two-story wood-frame building, reasonably maintained except for the grounds. The architectural style was in-determinant, except for two Ionic columns on the front porch. The windows all had fake shutters, each with a heart-shaped area cut out in the center. Marissa had used the term “cute” to describe it to her parents.

She turned left at the next street and then left again. The property on which the house sat went all the way through the block, and in order for Marissa to get to the garage, she had to approach from the rear. There was a circular drive in front of the house, but it didn’t connect with the rear driveway and the garage. Apparently in the past the two driveways had been connected, but someone had built a tennis court, and that had ended the connection. Now, the tennis court was so overgrown with weeds it was barely discernible.

Knowing that she was going out that evening, Marissa did not put

her car in the garage, but just swung around and backed it up. As she ran up the back steps, she heard the cocker spaniel, given to her by one of her pediatric colleagues, barking welcome.

Marissa had never planned on having a dog, but six months previously a long-term romantic relationship that she had assumed was leading to marriage had suddenly ended. The man, Roger Shulman, a neurosurgical resident at Mass. General, had shocked Marissa with the news that he had accepted a fellowship at UCLA and that he wanted to go by himself. Up until that time, they had agreed that Marissa would go wherever Roger went to finish his training, and indeed Marissa had applied for pediatric positions in San Francisco and Houston. Roger had never even mentioned UCLA.

As the baby in the family, with three older brothers and a cold and dominating neurosurgeon for a father, Marissa had never had much self-confidence. She took the breakup with Roger very badly and had been barely able to drag herself out of bed each morning to get to the hospital. In the midst of her resultant depression, her friend Nancy had presented her with the dog. At first Marissa had been irritated, but Taffy-the puppy had worn the cloyingly sweet name on a large bow tied around its neck-soon won Marissa’s heart, and, as Nancy had judged, it helped Marissa to focus on something besides her hurt. Now Marissa was crazy about the dog, enjoying having “life” in her home, an object to receive and return her love. Coming to the CDC, Marissa’s only worry had been what to do with Taffy when she was sent out in the field. The issue weighed heavily on her until the Judsons, her neighbors on the right, fell in love with the dog and offered-no, demanded-to take Taffy any time Marissa had to go out of town. It was like a godsend.

Opening the door, Marissa had to fend off Taffy’s excited jumps until she could turn off the alarm. When the owners had first explained the system to Marissa, she’d listened with only half an ear. But now she was glad she had it. Even though the suburbs were much safer than the city, she felt much more isolated at night than she had in Boston. She even appreciated the “panic button” that she carried in her coat pocket and which she could use to set off the alarm from the driveway if she saw unexpected lights or movement inside the house.

While Marissa looked over her mail, she let Taffy expend some of her pent-up energy racing in large circles around the blue spruce in the front yard. Without fail, the Judsons let the dog out around noon; still from then until Marissa got home in the evening was a long time for an eight-month-old puppy to be cooped up in the kitchen.

Unfortunately, Marissa had to cut Taffy’s exuberant exercise short. It was already after seven, and she was expected at dinner at eight. Ralph Hempston, a successful ophthalmologist, had taken her out several times, and though she still had not gotten over Roger, she enjoyed Ralph’s sophisticated company and the fact that he seemed content to take her to dinner, the theater, a concert without pressuring her to go to bed. In fact, tonight was the first time he’d invited her to his house, and he’d made it clear it was to be a large party, not just the two of them.

He seemed content to let the relationship grow at its own pace, and Marissa was grateful, even if she suspected the reason might be the twenty-two-year difference in their ages; she was thirty-one and he was fifty-three.

Oddly enough the only other man Marissa was dating in Atlanta was four years younger than she. Tad Schockley, a microbiologist Ph.D. who worked in the same department she ultimately had been assigned to, had been smitten by her the moment he’d spied her in the cafeteria during her first week at the Center. He was the exact opposite of Ralph Henipston: socially painfully shy, even when he’d only asked her to a movie. They’d gone out a half dozen times, and thankfully he, like Ralph, had not been pushy in a physical sense.

Showering quickly, Marissa then dried herself off and put on makeup almost automatically. Racing against time, she went through her closet, rapidly dismissing various combinations. She was no fashion plate but liked to look her best. She settled on a silk skirt and a sweater she’d gotten for Christmas. The sweater came down to midthigh, and she thought that it made her look taller. Slipping on a pair

of black pumps, she eyed herself in the full-length mirror.

Except for her height, Marissa was reasonably happy with her looks. Her features were small but delicate, and her father had actually used the term “exquisite” years ago when she’d asked him if he thought she was pretty. Her eyes were dark brown and thickly lashed, and her thick, wavy hair was the color of expensive sherry. She wore it as she had since she was sixteen: shoulder length, and pulled back from her forehead with a tortoiseshell barrette.

It was only a five-minute drive to Ralph’s, but the neighborhood changed significantly for the better. The houses grew larger and were set back on well-manicured lawns. Ralph’s house was situated on a large piece of property, with the driveway curving gracefully up from the street. The drive was lined with azaleas and rhododendrons that in the spring had to be seen to be believed, according to Ralph.

The house itself was a three-story Victorian affair with an octagonal

tower dominating the right front corner. A large porch, defined by complicated gingerbread trim, started at the tower, extended along the front of the house and swept around the left side. Above the double-doored front entrance and resting on the roof of the porch was a circular balcony roofed with a cone that complemented the one on top of the tower.

The scene looked festive enough. Every window in the house blazed with light. Marissa drove around to the left, following Ralph’s instructions. She thought that she was a little late, but there were no other cars.

As she passed the house, she glanced up at the fire escape coming down from the third floor. She’d noticed it one night when Ralph had stopped to pick up his forgotten beeper. He’d explained that the previous owner had made servants’ quarters up there, and the city building department had forced him to add the fire escape. The black iron stood out grotesquely against the white wood.

Marissa parked in front of the garage, whose complicated trim matched that of the house. She knocked on the back door, which was in a modern wing that could not be seen from the front. No one seemed to hear her. Looking through the window, she could see a lot of activity in the kitchen. Deciding against trying the door to see if it was unlocked, she walked around to the front of the house and rang the bell. Ralph opened the door immediately and greeted her with a big hug.

“Thanks for coming over early,” he said, helping her off with her coat.

“Early? I thought I was late.”

“No, not at all,” said Ralph. “The guests aren’t supposed to be here until eight-thirty.” He hung her coat in the hail closet.

Marissa was surprised to see that Ralph was dressed in a tuxedo. Although she’d acknowledged how handsome he looked, she was disconcerted.

“I hope I’m dressed appropriately,” she said. “You didn’t mention that this was a formal affair.”

“You look stunning, as always. I just like an excuse to wear my tux. Come, let me show you around.”

Marissa followed, thinking again that Ralph looked the quintessential physician: strong, sympathetic features and hair graying in just the right places. The two walked into the parlor, Ralph leading the way. The decor was attractive but somewhat sterile. A maid in a black uniform was putting out hors d’oeuvres. “We’ll begin in here. The drinks will be made at the bar in the living room,” Ralph said.

He opened a pair of sliding-panel doors, and they stepped into the living room. A bar was to the left. A young man in a red vest was busily polishing the glassware. Beyond the living room, through an arch, was the formal dining room. Marissa could see that the table was laid for at least a dozen people.

She followed Ralph through the dining room and out into the new wing, which contained a family room and a large modern kitchen. The dinner party was being catered, and three or four people were busy with the preparations.

After being reassured that everything was under control, Ralph led Marissa back to the parlor and explained that he’d asked her to come over early in hopes that she’d act as hostess. A little surprised-after all, she’d only been out with Ralph five or six times-Marissa agreed.

The doorbell rang. The first guests had arrived.

Unfortunately, Marissa had never been good at keeping track of people’s names, but she remembered a Dr. and Mrs. Hayward because of his astonishingly silver hair. Then there was a Dr. and Mrs. Jackson, she sporting a diamond the size of a golf ball. The only other names Marissa recalled afterward were Dr. and Dr. Sandberg, both psychiatrists.

Making an attempt at small talk, Marissa was awed by the furs and jewels. These people were not small-town practitioners.

When almost everyone was standing in the living room with a

drink in hand, the doorbell sounded again. Ralph was not in sight, so

Marissa opened the door. To her utter surprise she recognized Dr.

Cyrill Dubchek, her boss at the Special Pathogens Branch of the

Department of Virology.

“Hello, Dr. Blumenthal,” said Dubchek comfortably, taking Manssa’s presence in stride.

Marissa was visibly flustered. She’d not expected anyone from the CDC. Dubchek handed his coat to the maid, revealing a dark blue Italian-tailored suit. He was a striking man with coal black, intelligent eyes and an olive complexion. His features were sharp and aristocratic. Running a hand through his hair, which was brushed straight back from his forehead, he smiled. “We meet again.”

Marissa weakly returned the smile and nodded toward the living room. “The bar is in there.”

“Where’s Ralph?” asked Dubchek, glancing into the crowded living room.

“Probably in the kitchen,” said Marissa.

Dubchek nodded, and moved off as the doorbell rang again. This

time Marissa was even more flabbergasted. Standing before her was Tad Schockley!

“Marissa!” said Tad, genuinely surprised.

Marissa recovered and allowed Tad to enter. While she took his coat, she asked, “How do you know Dr. Hempston?”

“Just from meetings. I was surprised when I got an invitation in the mail.” Tad smiled. “But who am I to turn down a free meal, on my salary?”

“Did you know that Dubchek was coming?” asked Manissa. Her tone was almost accusing.

Tad shook his head. “But what difference does it make?” He looked into the dining room and then up the main staircase. “Beautiful house. Wow!”

Marissa grinned in spite of herself. Tad, with his short sandy hair and fresh complexion, looked too young to be Ph.D. He was dressed in a corduroy jacket, a woven tie and gray flannels so worn, they might as well have been jeans.

“Hey,” he said. “How do you know Dr. Hempston?”

“He’s just a friend,” said Marissa evasively, gesturing for Tad to head into the living room for a drink.

Once all the guests had arrived, Marissa felt free to move away from the front door. At the bar, she got herself a glass of white wine and tried to mingle. Just before the group was summoned into the dining room, she found herself in a conversation with Dr. Sandberg and Dr. and Mrs. Jackson.

“Welcome to Atlanta, young lady,” said Dr. Sandberg.

“Thank you,” said Marissa, trying not to gawk at Mrs. Jackson’s ring.

“How is it you happened to come to the CDC?” asked Dr. Jackson. His voice was deep and resonant. He not only looked like Charlton Heston; he actually sounded as if he could play Ben Hur.

Looking into the man’s deep blue eyes, she wondered how to answer his seemingly sincere question. She certainly wasn’t going to mention anything about her former lover’s flight to L.A. and her need for a change. That wasn’t the kind of commitment people expected at the CDC. “I’ve always had an interest in public health.” That was a little white lie. “I’ve always been fascinated by stories of medical detective work.” She smiled. At least that was the truth. “I guess I got tired of looking up runny noses and into draining ears.”

“Trained in pediatrics,” said Dr. Sandberg. It was a statement, not a question.

“Children’s Hospital in Boston,” said Marissa. She always felt a

little ill at ease talking with psychiatrists. She couldn’t help but wonder if they could analyze her motives better than she could herself. She knew that part of the reason she had gone into medicine was to enable her to compete with her brothers in their relationships with their father.

“How do you feel about clinical medicine?” asked Dr. Jackson. “Were you ever interested in practicing?”

“Well, certainly,” replied Marissa.

“How?” continued Dr. Jackson, unknowingly making Marissa feel progressively uneasy. “Did you see yourself solo, in a group, or in a clinic?”

“Dinner is served,” called Ralph over the din of conversation.

Manissa felt relieved as Dr. Jackson and Dr. Sandberg turned to find their wives. For a moment she had felt as if she were being interrogated.

In the dining room Marissa discovered that Ralph had seated himself at one end of the table and had placed her at the other. To her immediate right was Dr. Jackson, who thankfully forgot about his questions concerning clinical medicine. To her left was the silver-haired Dr. Hayward.

As the meal progressed, it became even clearer that Marissa was dining with the cream of Atlanta’s medical community. These were not just doctors; they were the most successful private practitioners in the city. The only exceptions to this were Cyrill Dubchek, Tad and herself.

After several glasses of good wine, Marissa was more talkative than normal. She felt a twinge of embarrassment when she realized that the entire table was listening to her description of her childhood in Virginia. She told herself to shut up and smile, and she was pleased when the conversation switched to the sorry state of American medicine and how prepaid health-care groups were eroding the foundations of private practice. Remembering the furs and jewels, Marissa didn’t feel that those present were suffering too much.

“How about the CDC?” asked Dr. Hayward, looking across at Cyrill. “Have you been experiencing budgetary constraints?”

Cyrill laughed cynically, his smile forming deep creases in his cheeks. “Every year we have to do battle with the Office of Management and Budget as well as the House Appropriations Committee. We’ve lost five hundred positions due to budgetary cuts.”

Dr. Jackson cleared his throat: “What if there were a serious outbreak of influenza like the pandemic of 1917-1918. Assuming your

r

department would be involved, do you have the manpower for such an eventuality?”

Cyrill shrugged. “It depends on a lot of variables. If the strain doesn’t mutate its surface antigens and we can grow it readily in tissue culture, we could develop a vaccine quite quickly. How quickly, I’m not sure. Tad?”

“A month or so,” said Tad, “if we were lucky. More time to produce enough to make a significant difference.”

“Reminds me of the swine flu fiasco a few years ago,” interjected Dr. Hayward.

“That wasn’t the CDC’s fault,” said Cyrill defensively. “There was no doubt about the strain that appeared at Fort Dix. Why it didn’t spread is anybody’s guess.”

Marissa felt a hand on her shoulder. Turning, she found herself looking at one of the black-dressed waitresses.

“Dr. Blumenthal?” whispered the girl.

“Yes.”

“There is a phone call for you.”

Marissa glanced down the table at Ralph, but he was busy talking with Mrs. Jackson. She excused herself and followed the girl to the kitchen. Then it dawned on her, and she felt a stirring of fear, like the first time she had been called at night as an intern: It had to be the CDC. After all, she was on call and she’d dutifully left Ralph’s number. No one else knew she was there.

“Dr. Blumenthal?” asked the CDC operator, when Marissa picked up the phone.

The call was switched to the duty officer. “Congratulations,” he said jovially. “There has been an epidemic aid request. We had a call from the California State Epidemiologist, who would like CDC help on a problem in L.A. It’s an outbreak of unknown but apparently serious illness in a hospital called the Richter Clinic. We’ve gone ahead and made a reservation for you on Delta’s flight to the coast that leaves at 1:10 A.M. We’ve arranged hotel accommodations at a place called the Tropic Motel. Sounds divine. Anyway, good luck!”

Replacing the receiver, Marissa left her hand on the phone for a moment while she caught her breath. She didn’t feel prepared at all. Those poor, unsuspecting people in California had called the CDC expecting to get an epidemiologic expert, and instead, they were going to get her, Marissa Blumenthal. All five feet of her. She made her way back to the dining room to excuse herself and say good-bye.

2

January 21

BY THE TIME MARISSA had gotten her suitcase from the baggage carousel, waited for the rent-a-car van, gotten the rent-a-car (the first one wouldn’t start), and had somehow managed to find the Tropic Motel, the sky had begun to lighten.

As she signed in, she couldn’t help thinking of Roger. But she wouldn’t call. She’d promised herself that much several times on the flight.

The motel was depressing, but it didn’t matter. Marissa didn’t think she’d be spending much time there. She washed her hands and face, combed her hair and replaced her barrette. With no other plausible reason for delay, she returned to the rent-a-car and set out for the Richter Clinic. The palms of her hands were damp against the steering wheel.

The clinic was conveniently situated on a wide thoroughfare. There were few cars at that time of morning. Marissa pulled into a parking garage, took a ticket and found a spot near the entrance. The entire structure was modern, including the garage, the clinic, and what Marissa guessed was the hospital, which appeared to be seven stories tall. Getting out of the car, she stretched, then lifted out her briefcase. In it were her class notes from the epidemiology portion of the introductory course-as if that would be any help-a note pad, pencils, a small textbook on diagnostic virology, an extra lipstick and a pack of chewing gum. What a joke.

Once inside, Marissa noted the familiar hospital odor of disinfectant-a smell that somehow calmed her and made her feel instantly at home. There was an information booth, but it was empty. She asked a maintenance man mopping the floor how to get to the hospital wing, and he pointed to a red stripe on the floor. Marissa followed it to the emergency room. There was little activity there, with few patients in the waiting room and only two nurses behind the main desk. Marissa sought out the on-call doctor and explained who she was.

“Oh, great!” said the ER doctor enthusiastically. “Are we glad you’re here! Dr. Navarre has been waiting all night for you. Let me get him.”

Marissa absentmindedly played with some paper clips. When she looked up, she realized the two nurses were staring at her. She smiled and they smiled back.

“Can I get you some coffee?” asked the taller of the two.

“That would be nice,” said Marissa. In addition to her basic anxiety, she was feeling the effects of only two hours of fitful sleep on the flight from Atlanta.

Sipping the hot liquid, Marissa recalled the Berton Roueche medical detective stories in The New Yorker. She wished that she could be involved in a case like the one solved by John Snow, the father of modern epidemiology: A London cholera epidemic was aborted when Snow deductively isolated the problem to a particular London water pump. The real beauty of Snow’s work was that he did it before the germ theory of disease was accepted. Wouldn’t it be wonderful to be involved in such a clear-cut situation?

The door to the on-call room opened, and a handsome, black-haired man appeared. Blinking in the bright ER light, he came directly toward Marissa. The corners of his mouth pulled up in a big smile. “Dr. Blumenthal, we are so glad to see you. You have no idea.”

As they shook hands, Dr. Navarre gazed down at Marissa. Standing next to her, he was momentarily taken aback by her diminutive size and youthful appearance. To be polite, he inquired about her flight and asked if she was hungry.

“I think it would be best to get right down to business,” said Marissa.

Dr. Navarre readily agreed. As he led Marissa to the hospital conference room, he introduced himself as chief of the department of medicine. This news didn’t help Marissa’s confidence. She recognized that Dr. Navarre undoubtedly knew a hundred times more than she about infectious disease.

Motioning for Marissa to sit at the round conference table, Dr. Navarre picked up the phone and dialed. While the call was going through, he explained that Dr. Spenser Cox, the State Epidemiologist was extremely eager to talk to Marissa the moment she’d arrived.

Wonderful, thought Marissa, forcing a weak smile.

Dr. Cox sounded equally as happy as Dr. Navarre that Marissa was there. He explained to her that unfortunately he was currently embroiled in a problem in the San Francisco Bay area involving an outbreak of hepatitis B that they thought could be related to AIDS.

“I assume,” continued Dr. Cox, “that Dr. Navarre has told you that the problem at the Richter Clinic currently involves only seven patients.”

“He hasn’t told me anything yet,” said Marissa.

“I’m sure he is just about to,” said Dr. Cox. “Up here, we have almost five hundred cases of hepatitis B, so you can understand why I can’t come down there immediately.”

“Of course,” said Marissa.

“Good luck,” said Dr. Cox. “By the way, how long have you been with the CDC?”

“Not that long,” admitted Marissa.

There was a short pause. “Well, keep me informed,” said Dr. Cox.

Marissa handed the receiver back to Dr. Navarre, who hung up. “Let me bring you up to date,” he said, switching to a standard medical monotone as he pulled some three-by-five cards from his pocket. “We have seven cases of an undiagnosed, but obviously severe, febrile illness characterized by prostration and multi-system involvement. The first patient to be hospitalized happens to be one of the cofounders of the clinic, Dr. Richter himself. The next, a woman from the medical records department.” Dr. Navarre began placing his three-by-five cards on the table. Each one represented a patient. He organized them in the order in which the cases had presented themselves.

Discreetly snapping open her briefcase without allowing Dr. Navarre to see what it contained, Marissa extracted her note pad and a pencil. Her mind raced back to the courses she’d recently completed, remembering that she needed to break the information down into understandable categories. First the illness: Was it really something new? Did a problem really exist? That was the province of the simple 2 x 2 table and some rudimentary statistics. Marissa knew she had to characterize the illness even if she couldn’t make a specific diagnosis. The next step would be to determine host factors of the victims, such as age, sex, health, eating habits, hobbies, etc., then to

determine time, place and circumstances in which each patient displayed initial symptoms, in order to learn what elements of commonality existed. Then there would be the question of transmission of the illness, which might lead to the infectious agent. Finally, the host or reservoir would have to be erradicated. It sounded so easy, but Marissa knew it would be a difficult problem, even for someone as experienced as Dubchek.

Marissa wiped her moist hand on her skirt, then picked up her pencil once more. “So,” she said, staring at the blank page. “Since no diagnosis has been made, what’s being considered?”

“Everything,” said Dr. Navarre.

“Influenza?” asked Marissa, hoping she wasn’t sounding overly simplistic.

“Not likely,” said Dr. Navarre. “The patients have respiratory symptoms but they do not predominate. Besides, serological testing has been negative for influenza virus in all seven patients. We don’t know what they have, but it is not influenza.”

“Any ideas?” asked Marissa.

“Mostly negatives,” said Dr. Navarre. “Everything we’ve tested has been negative: blood cultures, urine cultures, sputum cultures, stool cultures, even cerebrospinal fluid cultures. We thought about malaria and actually treated for it, though the blood smears were negative for the parasites. We even treated for typhoid, with either tetracycline or chloramphenicol, despite the negative cultures. But, just like with the antimalarials, there was no effect whatsoever. The patients are all going downhill no matter what we do.”

“You must have some kind of differential diagnosis,” said Marissa. “Of course,” responded Dr. Navarre. “We’ve had a number of infectious disease consults. The consensus is that it is a viral problem, although leptospirosis is still a weak contender.” Dr. Navarre searched through his index cards, then held one up. “Ah, here are the current differential diagnoses: leptospirosis, as I mentioned; yellow fever; dengue; mononucleosis; or, just to cover the bases, some other enteroviral, arboviral or adenoviral infection. Needless to say, we’ve made about as much progress in the diagnostic realm as the therapeutic.”

“How long has Dr. Richter been hospitalized?” asked Marissa.

“This is his fifth day. I think you should see the patients to have an idea of what we are dealing with.” Dr. Navarre stood up without waiting for Marissa’s response. She found she had to trot to keep up with him. They went through swinging doors and entered the hospital proper. Nervous as she was, Marissa could not help being impressed by the luxurious carpeting and almost hotellike decor.

She got on the elevator behind Dr. Navarre, who introduced her to an anesthesiologist. Marissa returned the man’s greeting, but her thoughts were elsewhere. She was certain that her seeing the patients at that moment was not going to accomplish anything except to make her feel “exposed.” This issue had not occurred to her while taking the introductory course back in Atlanta. Suddenly it seemed like a big problem. Yet what could she say?

They arrived at the nurses’ station on the fifth floor. Dr. Navarre took the time to introduce Marissa to the night staff, who were making their initial preparations to change shifts.

“All seven patients are on this floor,” said Dr. Navarre. “It has some of our most experienced personnel. The two in critical condition are in separate cubicles in the medical intensive-care unit just across the hall. The rest are in private rooms. Here are the charts.” With an open palm, he thumped a pile stacked on the corner of the counter top. “I assume you’d like to see Dr. Richter first.” Dr. Navarre handed Richter’s chart to Marissa.

The first thing she looked at was the “vital-sign” sheet. Beginning his fifth hospital day, she noticed that the doctor’s blood pressure was falling and his temperature was rising. Not a good omen. Rapidly she perused the chart. She knew that she’d have to go over it carefully later. But even a cursory glance convinced her that the workup had been superb, better than she could have done herself. The laboratory work had been exhaustive. Again she wondered what in God’s name she was doing there pretending to be an authority.

Going back to the beginning of the chart, Marissa read the section entitled “history of the present illness.” Something jumped out at her right away. Six weeks previous to the onset of symptoms Dr. Richter had attended an ophthalmological convention in Nairobi, Kenya.

She read on, her interest piqued. One week prior to his illness, Dr. Richter had attended an eyelid surgery conference in San Diego. Two days prior to admission he’d been bitten by a Cercopitheceus aethiops, whatever the hell that was. She showed it to Dr. Navarre.

“It’s a type of monkey,” said Dr. Navarre. “Dr. Richter always has a few of them on hand for his ocular herpes research.”

Marissa nodded. She glanced again at the laboratory values and noted that the patient had a low white count, a low ESR and low thrombocytes. Other lab values indicated liver and kidney malfunction. Even the EKG showed mild abnormalities. This guy was virulently sick.

Marissa laid the chart down on the counter.

“Ready?” questioned Dr. Navarre.

Although Marissa nodded that she was, she would have preferred to put off confronting the patients. She had no delusions of grandeur that she would uncover some heretofore missed, but significant, physical sign, and thereby solve the mystery. Her seeing the patients at that point was pure theater and, unfortunately, risky business. She followed Dr. Navarre reluctantly.

They entered the intensive-care unit, with its familiar backdrop of complicated electronic machinery. The patients were immobile victims, secured with tangles of wires and plastic tubing. There was the smell of alcohol, the sound of respirators and cardiac monitors. There was also the usual high level of nursing activity.

“We’ve isolated Dr. Richter in this side room,” said Dr. Navarre, stopping at the closed doorway. To the left of the door was a window, and inside the room Marissa could make out the patient. Like the others in the unit, he was stretched out beneath a canopy of intravenous bottles. Behind him was a cathode-ray tube with a continuous EKG tracing flashing across its screen.

“I think you’d better put on a mask and gown,” said Dr. Navarre. “We’re observing isolation precautions on all the patients for obvious reasons.”

“By all means,” said Marissa, trying not to sound too eager. If she had her way, she’d climb into a plastic bubble. She slipped on the gown and helped herself to a hat, mask, booties, and even rubber gloves. Dr. Navarre did likewise.

Unaware she was doing it, Marissa breathed shallowly as she looked down at the patient, who, in irreverent vernacular, looked as if he was about to “check out.” His color was ashen, his eyes sunken, his skin slack. There was a bruise over his right cheekbone; his lips were dry, and dried blood was caked on his front teeth.

As Marissa stared down at the stricken man, she didn’t know what to do; yet she self-consciously felt obliged to do something, with Dr. Navarre hanging over her, watching her every move. “How do you feel?” asked Marissa. She knew it was a stupid, self-evident question the moment it escaped from her lips. Nonetheless Richter’s eyes fluttered open. Marissa noticed some hemorrhages in the whites.

“Not good,” admitted Dr. Richter, his voice a hoarse whisper.

“Is it true you were in Africa a month ago?” she asked. She had to lean over to hear the man, and her heart went out to him.

“Six weeks ago,” said Dr. Richter.

“Did you come in contact with any animals?” asked Marissa.

“No,” managed Dr. Richter after a pause. “I saw a lot but didn’t handle any.”

“Did you attend anyone who was ill?”

Dr. Richter shook his head. Speaking was obviously difficult for him.

Marissa straightened up and pointed to the abrasion under the patient’s right eye. “Any idea what this is?” she asked Dr. Navarre.

Dr. Navarre nodded. “He was mugged two days before he got sick. He hit his cheek on the pavement.”

“Poor guy,” said Marissa, wincing at Dr. Richter’s misfortune. Then, after a moment, she added, “I think I’ve seen enough for now.”

Just inside the door leading back to the ICU proper, there was a large frame holding a plastic bag. Both Marissa and Dr. Navarre peeled off their isolation apparel and returned to the fifth-floor nurses’ station. Compulsively, Marissa washed her hands in the sink.

“What about the monkey that bit Dr. Richter?” she asked.

“We have him quarantined,” said Dr. Navarre. “We’ve also cultured him in every way possible. He appears to be healthy.”

They seemed to have thought of everything. Marissa picked up Dr. Richter’s chart to see if his conjunctival hemorrhages had been noted. They had.

Marissa took a deep breath and looked over at Dr. Navarre, who was watching her expectantly. “Well,” she said vaguely, “I’ve got a lot of work to do with these charts.” Suddenly she remembered reading about a category of disease called “viral hemorrhagic fever.” They were extremely rare, but deadly, and a number of them came from Africa. Hoping to add something to the tentative diagnoses already listed by the clinic doctors, she mentioned the possibility.

“VHF was already brought up,” said Dr. Navarre. “That was one of the reasons we called the CDC so quickly.”

So much for that “zebra” diagnosis, thought Marissa, referring to a medical maxim that when you hear hoofbeats, think of horses, not zebras.

To her great relief, Dr. Navarre was paged for an emergency. “I’m terribly sorry,” he said, “but I’m needed in the ER. Is there anything I can do before I go?”

“Well, I think it would be better to improve the isolation of the patients. You’ve already moved them to the same general area of the hospital. But I think you should place them in a completely isolated wing and begin complete barrier nursing, at least until we have some idea as to the communicability of the disease.”

Dr. Navarre stared at Marissa. For a moment she wondered what he was thinking. Then he said, “You’re absolutely right.”

Marissa took the seven charts into a small room behind the nurses’ station. Opening each, she learned that, besides Dr. Richter, there were four women and two men who presumably had the same illness. Somehow, they all had to have had direct contact with each other or been exposed to the same source of contamination. Marissa kept reminding herself that her method of attack on a field assignment, particularly her first, was to gather as much information as she could and then relay it to Atlanta. Going back to Dr. Richter’s chart, Marissa read everything, including the nurses’ notes. On a separate sheet in her notebook, she listed every bit of information that could possibly have significance, including the fact that the man had presented with an episode of hematemesis, vomiting blood. That certainly didn’t sound like influenza. The whole time she was working her mind kept returning to the fact that Dr. Richter had been in Africa six weeks previously. That had to be significant even though a month’s incubation was unlikely, given the symptomology, unless he had malaria, which apparently he did not. Of course there were viral diseases like AIDS with longer incubation periods, but AIDS was not an acute viral infectious disease. The incubation period for such a disease was usually about a week, give or take a few days. Marissa painstakingly went through all the charts amassing diverse data on age, sex, life-style, occupation and living environment, and recording her findings on a separate page in her notebook for each of the patients. Rather quickly, she realized that she was dealing with a diverse group of people. In addition to Dr. Richter, there was a secretary, a woman who worked in medical records at the Richter Clinic; two housewives; a plumber; an insurance salesman and a real estate broker. Opportunity for commonality seemed remote with a group this diverse, yet all of them must have been exposed to the same source.

Reading the charts also gave Marissa a better clinical picture of the illness she was dealing with. Apparently it began rather suddenly, with severe headaches, muscle pain and high fever. Then the patients experienced some combination of abdominal pain, diarrhea, vomiting, sore throat, cough and chest pain. A shiver went down Marissa’s spine as she thought about having been exposed to the disease.

Marissa rubbed her eyes. They felt gritty from lack of sleep. It was time to visit the rest of the patients whether she wanted to or not.

There were a lot of gaps, particularly in activities of each patient in the days directly preceding their illness.

She started with the medical secretary, who was located in a room next to Dr. Richter’s in the ICU, and then worked her way through to the last patient to be admitted. Before seeing each case, she carefully dressed in full protective clothing. All the patients were seriously ill, and none felt much like talking. Still, Marissa went through her list of questions, concentrating on whether each patient was acquainted with any of the other people who were di. The answer was always no, except that each one knew Dr. Richter, and all were members of the Richter Clinic health plan! The answer was so obvious she was surprised that no one seemed to have spotted it. Dr. Richter might have spread the disease himself since he might even have been in contact with the medical secretary. She asked the ward clerk to call for all the patients’ clinic outpatient records.

While she was waiting, Dr. Navarre called. “I’m afraid we have another case,” he said. “He’s one of the lab techs here at the clinic. He’s in the emergency room. Do you want to come down?”

“Is he isolated?” asked Marissa.

“As well as we can do it down here,” said Dr. Navarre. “We’re preparing an isolation wing upstairs on the fifth floor. We will move all the cases there the moment it is ready.”

“The sooner the better,” said Marissa. “For the time being, I recommend that all nonessential lab work be postponed.”

“That’s okay by me,” said Dr. Navarre. “What about this boy down here? Do you want to see him?”

“I’m on my way,” said Marissa.

En route to the ER, Marissa could not shake the feeling that they were on the brink of a major epidemic. Concerning the lab tech, there were two equally disturbing possibilities: the first was that the fellow had contracted the illness in the same fashion as the others, i.e., from some active source of deadly virus in the Richter Clinic; the second, more probable in Marissa’s estimation, was that the lab tech had been exposed to the agent from handling infected material from the existing cases.

The ER personnel had placed the new patient in one of the psychiatric cubicles. There was a Do Not Enter sign on the door. Marissa read the technician’s chart. He was a twenty-four-year-old male by the name of Alan Moyers. His temperature was 103.4. After donning protective gown, mask, hat, gloves and booties, Marissa entered the tiny room. The patient stared at her with glazed eyes.

“I understand you’re not feeling too well,” said Marissa.

“I feel like I’ve been run over by a truck,” said Alan. “I’ve never felt this bad, even when I had the flu last year.”

“What was the first thing you noticed?”

“The headache,” said Alan. He tapped his fingers against the sides of his forehead. “Right here is where I feel the pain. It’s awful. Can you give me something for it?”

“What about chills?”

“Yeah, after the headache began, I started to get them.”

“Has anything abnormal happened to you in the lab in the last week or so?”

“Like what?” asked Alan, closing his eyes. “I did win the pool on the last Lakers game.”

“I’m more interested in something professional. Were you bitten by any animals?”

“Nope. I never handle any animals. What’s wrong with me?”

“How about Dr. Richter? Do you know him?”

“Sure. Everybody knows Dr. Richter. Oh, I remember something. I stuck myself with a vacu-container needle. That never happened to me before.”

“Do you remember the patient’s name on the vacu-container?”

“No. All I remember is that the guy didn’t have AIDS. I was worried about that, so I looked up his diagnosis.”

“What was it?”

“Didn’t say. But it always says AIDS if it is AIDS. I don’t have AIDS, do I?”

“No, Alan, you don’t have AIDS,” said Marissa.

“Thank God,” said Alan. “For a moment there, I was scared.”

Marissa went out to find Dr. Navarre, but he was occupied with a cardiac arrest that had just been brought in by ambulance. Marissa asked the nurse to tell him that she was going back to the fifth floor. Returning to the elevators, Marissa began organizing her thoughts to call Dr. Dubchek.

“Excuse me.”

Marissa felt a tap on her arm and turned to face a stocky man with a beard and wire-rimmed glasses. “Are you Dr. Blumenthal from the CDC?” asked the man.

Nonplussed at being recognized, Marissa nodded. The man stood blocking her entrance to the elevator. “I’m Clarence Hems, with the L.A. Times. My wife works the night shift up in the medical ICU. She told me that you were here to see Dr. Richter. What is it the man has?”

“At this point, no one knows,” said Marissa.

“Is it serious?”

“I imagine your wife can answer that as well as I.”

“She says the man is dying and that there are six other similar cases, including a secretary from medical records. Sounds to me like the beginnings of an epidemic.”

“I’m not sure that ‘epidemic’ is the right word. There does seem to be one more case today, but that’s the only one for two days. I hope it will be the last, but no one knows.”

“Sounds scary,” said the reporter.

“I agree,” said Marissa. “But I can’t talk longer. I’m in a hurry.” Dodging the insistent Mr. Hems, Marissa boarded the next elevator and returned to the cubicle behind the fifth-floor nurses’ station and put through a collect call to Dr. Dubchek. It was quarter-to-three in Atlanta, and she got Dubchek immediately.

“So, how’s your first field assignment?” he asked.

“It’s a bit overwhelming,” said Marissa. Then, as succinctly as she could, she described the seven cases she’d seen, admitting that she had not learned anything that the Richter Clinic doctors didn’t already know.

“That shouldn’t bother you,” said Dubchek. “You have to keep in mind that an epidemiologist looks at data differently than a clinician, so the same data can mean different things. The clinician is looking at each case in particular, whereas you are looking at the whole picture. Tell me about the illness.”

Marissa described the clinical syndrome, referring frequently to her note pad. She sensed that Dubchek was particularly interested in the fact that two of the patients had vomited blood, that another had passed bloody diarrhea and that three had conjunctival hemorrhages in their eyes. When Marissa said that Dr. Richter had been to an ophthalmology meeting in Africa, Dubchek exclaimed, “My God, do you know what you are describing?”

“Not exactly,” said Marissa. It was an old medical-school ploy: try to stay on neutral ground rather than make a fool of yourself.

“Viral hemorrhagic fever,” said Dubchek, “… and if it came from Africa, it would be Lassa Fever. Unless it was Marburg or Ebola. Jesus Christ!”

“But Richter’s visit was over six weeks ago.”

“Darn,” said Dubchek, almost angrily. “The longest incubation period for that kind of fulminating illness is about two weeks. Even for quarantine purposes, twenty days is considered adequate.”

“The doctor was also bitten by a monkey two days before he became di,” offered Marissa.,

“And that’s too short an incubation period. It should be five or six days. Where’s the monkey now?”

“Quarantined,” said Marissa.

“Good. Don’t let anything happen to that animal, particularly if it dies. We’ve got to test it for virus. If the animal is involved, we have to consider the Marburg virus. In any case, the illness certainly sounds like a viral hemorrhagic fever, and until proven otherwise, we’d better consider it as such. We’ve worried about something like this happening for some time; the problem is that there’s no vaccine and no treatment.”

“What about the mortality rate?” asked Marissa.

“High. Tell me, does Dr. Richter have a skin rash?”

Marissa couldn’t remember. “I’ll check.”

“The first thing I want you to do is draw bloods, obtain urine samples, and do throat swabs for viral culture on all seven cases, and have them rushed to the CDC. Use Delta’s small-package service. That will be the fastest way. I want you personally to draw the blood, and for Christ’s sake be careful. From the monkey, too, if you can. Pack the samples in dry ice before shipping them.”

“I’ve just seen what might be another case,” said Marissa. “One of the clinic’s lab techs.”

“Include him, too, It sounds increasingly serious. Make sure that all the patients are totally isolated with complete barrier nursing. And tell whoever is in charge not to do any lab work until I get there.”

“I have,” said Marissa. “You’re coming yourself?”

“You bet I am,” said Dubchek. “This could be a national emergency. But it is going to take some time to prepare the Vickers Mobile Lab. Meanwhile, start setting up a quarantine for contacts, and try to get in touch with the people who sponsored that eye meeting in Africa and see if any of the other doctors who went are di. And one other thing: don’t say anything to the press. With all the publicity about AIDS, I don’t think the public could deal with the threat of another fatal viral disease. There could be widespread panic. And Marissa, I want you to wear full protective clothing, including goggles, when you see the patients. The pathology department should have them if no one else does. I’ll be there as soon as possible.”

Hanging up, Marissa experienced a rush of anxiety. She wondered if she’d already exposed herself to the virus. Then she worried about having already talked to Clarence Hems from the L.A. Times. Well, what was done was done. She was glad that Dubchek was coming.

She knew she’d been in over her head from the moment she’d arrived in L.A.

After putting in a call for Dr. Navarre, Marissa had one of the nurses help her get the materials ready to draw blood from the patients. She needed vacu-containers with anticoagulants, plastic bags, and sodium hypochlorite to decontaminate the outside of the bags. She also needed urine containers and throat swabs. Then she phoned the micro lab and asked to have containers of viral transport media sent up, along with shipment containers and dry ice. When Dr. Navarre called, she related what Dubchek had said about complete barrier nursing and about no lab tests until he’d arrived with a special facility. She also mentioned that they had better get together to talk about systematically quarantining all contacts. Dr. Navarre agreed, shocked to hear that Dubchek thought they might be dealing with viral hemorrhagic fever.

Following Dubchek’s advice, Marissa got goggles from pathology. She’d never thought about catching an illness through her eyes, but she was aware that their surface was a mucous membrane and was obviously as available to viral assault as her nasal mucosa. When she was fully attired in hood, goggles, mask, gown, gloves and booties, she went to Dr. Richter’s cubicle to begin her sampling.

Before she started, she examined him for a skin rash. His arms were clear, but he did have a curious red area about the size of a quarter on his right thigh. Lifting up his hospital gown, Marissa noted a fine, but definite, maculopapular eruption covering most of his trunk. She was impressed that Dubchek had anticipated it.

She drew the blood first, then filled the urine container from the catheter bag. After each was sealed, she washed its exterior with sodium hypochlorite, then put it in a second bag. After the exterior of the second bag was washed in the disinfectant, she allowed it to be removed from the room.

Disposing of the hood, mask, gown, gloves and booties, and then donning new ones, Marissa went on to the next patient, the medical secretary, whose name was Helen Townsend. Marissa repeated the same procedures she’d done on Dr. Richter, including looking for skin eruptions. Helen also had a faint rash on her trunk, but no red circle on her thigh or elsewhere. She seemed less ill than Richter, but none of the patients appeared well enough to question Marissa much as she went about her sampling. Only Alan Moyers could muster the strength to offer some objections. At first he refused to allow Marissa to draw blood unless she told him what his diagnosis was. He was terrified. When Marissa told him the truth, that she did not know

what he had and that that was why she needed the samples, he finally gave in.

As for the monkey, Marissa didn’t even attempt to get a blood sample. The animal keeper was out for the day, and she had no intention of trying to handle the animal alone. The monkey looked healthy enough, but was not friendly. He threw feces at Marissa through the mesh of his cage.

Once Marissa completed the packing, making certain that all the screw caps were tightly in place so that carbon dioxide from the dry ice could not penetrate the samples, she personally rode out to the airport and sent the boxes on their way to Atlanta. Luckily she got them on a convenient nonstop.

Back at the Richter Clinic, Marissa made a detour to the small clinic library. There were a few standard texts there that included sections on viral diseases. She quickly scanned the entries for Lassa Fever, Marburg and Ebola virus. Then she understood Dubchek’s excited reaction on the telephone. These were the most deadly viruses known to man.

Arriving back on the fifth floor, Marissa found that all eight patients had been isolated in a separate wing. She also found that the clinic outpatient records she’d ordered had arrived. After putting in a call for Dr. Navarre, Marissa sat down and began to study the charts.

The first belonged to Harold Stevens, the real estate broker. She started from the back and immediately discovered that the last outpatient entry was a visit to Dr. Richter: Harold Stevens had chronic open-angle glaucoma and saw Dr. Richter on a regular basis. His last checkup had been on January 15, four days before he was admitted to the hospital.

With a sense of growing certainty Marissa looked at the last entry on each chart. There it was. Each patient had seen Dr. Richter on either the fifteenth or the sixteenth of January. All except Helen Townsend, the secretary from medical records, and Alan, the lab tech. The last entry in Ms. Townsend’s outpatient file recorded a visit to an OB-CYN man for cystitis. Alan had seen an orthopod the previous year for a sprained ankle he’d suffered in a hospital basketball league. Except for the medical secretary and the lab tech, there was the strong suggestion that Dr. Richter was the source of the illness. The fact that he’d seen five of the patients just before he developed symptoms had to be significant.

Marissa could explain the lab tech getting the illness by his sticking himself with a contaminated needle, but she couldn’t immediately explain Helen Townsend. Marissa had to assume that Helen had seen Dr. Richter sometime earlier in the week. She had come down with the illness just forty-eight hours after the doctor. Maybe he had spent a lot of time in medical records earlier that week.

Marissa’s musings were interrupted by the ward clerk, who said that Dr. Navarre had called to ask if Marissa would kindly come down to the hospital conference room.

Returning to the room where she’d started the day reminded Marissa of how long she’d been working. She felt bone weary as Dr. Navarre closed the door and introduced the other person who was present. He was William Richter, Dr. Richter’s brother.

“I wanted to thank you personally for being here,” said William. Although he was impeccably dressed in a pinstriped suit, his haggard face was mute testimony to his lack of sleep. “Dr. Navarre has told me your tentative diagnosis. I want to assure you that we will support your effort to contain this illness to the limits of our resources. But we are also concerned about the negative impact the situation could have on our clinic. I hope that you agree that no publicity would be the best publicity.”

Marissa felt mildly outraged, when so many lives were at stake, but Dubchek himself had said essentially the same thing.

“I understand your concern,” she said, uncomfortably aware that she had already spoken to a reporter. “But I think we have to initiate further quarantine measures.” Marissa went on to explain that they would have to separate the possible contacts into primary and secondary contacts. Primary contacts would be those people who had spoken with or touched one of the current eight patients. Secondary contacts would be anyone who had had contact with a primary contact.

“My God,” said Dr. Navarre. “We’re talking about thousands of people.”

“I’m afraid so,” said Marissa. “We’re going to need all the manpower the clinic can spare. We’ll also tap the resources of the State Health Department.”

“We’ll provide the manpower,” said Mr. Richter. “I’d prefer to keep this ‘in-house.’ But shouldn’t we wait until we actually have a diagnosis?”

“If we wait, it may be too late,” said Marissa. “We can always call off the quarantine if it is unnecessary.”

“There’s no way we’ll keep this from the press,” moaned Mr. Richter.

“To be truthful,” said Marissa, “I think the press can play a positive role by helping us reach all the contacts. Primary contacts must be

instructed to stay as isolated as possible for a week and to take their temperatures twice a day. If they run a fever of 1010 or over, they’ll have to come to the clinic. Secondary contacts can go about their business but should still take their temperatures once a day.

Marissa stood up and stretched. “When Dr. Dubchek arrives he may have some suggestions. But I believe what I’ve outlined is standard CDC procedure. I’ll leave its implementation up to the Richter Clinic. My job is to try to find out where the virus originated.”

Leaving two stunned men in her wake, Marissa left the conference room. Passing from the hospital to the clinic building, she approached the clinic information booth, asking directions to Dr. Richter’s office. It was on the second floor, and Marissa went directly up.

The door was closed but unlocked. Marissa knocked and entered. Dr. Richter’s receptionist was dutifully behind her desk. Apparently she hadn’t expected company, because she quickly stubbed out a cigarette and put the ashtray in one of the desk drawers.

“Can I help you?” she asked. She was fiftyish with silver-gray, tightly permed hair. Her name tag said Miss Cavanagh. Reading glasses perched on the very end of her nose, their temple pieces connected by a gold chain that went around her neck.

Marissa explained who she was, adding, “It’s important that I try to determine how Dr. Richter contracted his illness. To do that, I want to reconstruct his schedule for a week or two prior to his getting sick. Could you do that for me? I’m going to ask his wife to do the same.”

“I suppose I could,” said Miss Cavanagh.

“Did anything out of the ordinary happen that you can recall?”

“Like what?” asked Miss Cavanagh, with a blank face.

“Like his being bitten by a monkey or getting mugged in the parking garage!” Marissa’s voice had a sharp edge to it.

“Those things did happen,” said Miss Cavanagh.

“I realize that,” said Marissa. “How about anything else odd or different.”

“I can’t think of anything at the moment. Wait, he did dent his car.

“Okay, that’s the idea,” encouraged Marissa. “Keep thinking. And by the way, did you make the arrangements for his African medical meeting?”

“Yes.”

“How about the San Diego meeting?”

“That too.”

“I would like to have the phone numbers of the sponsoring organizations. If you could look them up for me, I’d appreciate it. Also I’d like to have a list of all the patients Dr. Richter saw during the two weeks before his illness. And finally: do you know Helen Townsend?”

Miss Cavanagh took her glasses off her nose and let them hang on their chain. She sighed disapprovingly. “Does Helen Townsend have the same illness as Dr. Richter?”

“We believe she does,” said Marissa, watching Miss Cavanagh’s face. The receptionist knew something about Helen Townsend, but she seemed reluctant to speak, toying with the keys of her typewriter. “Was Helen Townsend a patient of Dr. Richter’s?” Marissa prodded.

Miss Cavanagh looked up. “No, she was his mistress. I warned him about her. And there: she gave him some disease. He should have listened to me.”

“Do you know if he saw her just before he got sick?”

“Yes, the day before.”

Marissa stared at the woman. Helen Townsend didn’t give Dr. Richter the disease; it was the other way around. But she didn’t say anything. It all fit into place. She could now relate all the known cases to Dr. Richter. Epidemiologically, that was extremely important. It meant that Dr. Richter was an index case and that he, and only he, had been exposed to the unknown reservoir of the virus. Now it was even more important for her to reconstruct the man’s schedule in minute detail.

Marissa asked Miss Cavanagh to start working on an outline of Dr. Richter’s schedule for the last two weeks. She told the woman that she’d be back, but if needed, she could be paged through the hospital operator.

“Can I ask you a question?” said Miss Cavanagh timidly.

“Of course,” said Marissa, with a hand on the door.

“Is there a chance I might get ill?”

Marissa had been suppressing the thought because she didn’t want to frighten the woman, but she could not lie. After all, the secretary would have to be considered a primary contact.

“It’s possible,” said Marissa. “We will be asking you to restrict some of your activities during the next week or so, and I’d advise you to check your temperature twice a day. Personally, however, I think you will be fine since you haven’t experienced any symptoms so far.”

Back at the hospital, Marissa fought off her own fears and her developing fatigue. She had too much to do. She had to go over the clinic charts in detail. She hoped to find a reason why some of Dr. Richter’s patients had gotten the disease and others hadn’t. Also

Marissa wanted to call Dr. Richter’s wife. Between the wife and the secretary, she hoped she could construct a reasonably complete diary of the man’s activities during the two weeks before he became di.

Returning to the fifth floor, Marissa ran into Dr. Navarre. He looked as tired as Marissa felt. “Dr. Richter’s condition is deteriorating,” he said. “He’s bleeding from everywhere: injection sites, gums, CI tract. He’s on the brink of kidney failure, and his blood pressure is way down. The interferon we gave him had no effect whatsoever, and none of us knows what else to try.”

“What about Helen Townsend?” asked Marissa.

“She’s worse, too,” said Dr. Navarre. “She’s also starting to bleed.” He sat down heavily.

Marissa hesitated for a minute and then reached for the phone. She placed another collect call to Atlanta, hoping Dubchek was already on his way. Unfortunately, he wasn’t. He came on the line.

“Things are pretty bad here,” reported Marissa. “Two patients are experiencing significant hemorrhagic symptoms. Clinically, it is looking more and more like viral hemorrhagic fever, and no one knows what to do for these people.”

“There’s little that can be done,” said Dubchek. “They can try heparinization. Otherwise, supportive therapy-that’s about it. When we make a specific diagnosis we may be able to use hyperimmune serum, if it is available. On that track, we’ve already got your samples, and Tad has begun processing them.”

“When will you be coming?” asked Marissa.

“Shortly,” said Dubchek. “We’ve got the Vickers Mobile Isolation Lab all packed.

Manssa woke up with a start. Thankfully, no one had come into the little room behind the nurses’ station. She looked at her watch. It was ten-fifteen at night. She’d only been asleep for five or ten minutes.

Getting to her feet, she felt dizzy. Her head ached and she had the beginnings of a sore throat. She prayed that her symptoms were a product of exhaustion and not the beginnings of viral hemorrhagic fever.

It had been a busy evening. Four more cases had presented themselves in the ER, all complaining of severe headache, high fever and vomiting. One already had hemorrhagic signs. The patients were all family members of the previous victims, underlining the need for strict quarantine. The virus was already into the third generation. Marissa had prepared viral samples and had them shipped to Atlanta by an overnight carrier.

Recognizing that she was at the limit of her strength, Marissa decided to go back to her motel. She was just leaving when the floor nurse said Dr. Richter’s wife was able to see her. Realizing it would be cruel to put her off, Marissa met her in the visitors’ lounge. Anna Richter, a well-dressed, attractive woman in her late thirties, did her best to fill in her husband’s schedule over the past two weeks, but she was desperately upset, not just alarmed about her husband but fearful for their two young children as well. Marissa was reluctant to press her for too much detail. Mrs. Richter promised to provide a more complete chronology the next day. Marissa walked her to the doctor’s BMW. Then she found her own car and drove to the Tropic Motel where she fell directly into bed.

3

January 22

ARRIVING AT THE CLINIC the next morning, Marissa was surprised to see a number of TV trucks pulled up to the hospital entrance, with their transmission antennae raised against the morning sky. When she tried to enter through the parking garage, she was stopped by a policeman and had to show her CDC identification.

“Quarantine,” the policeman explained, and told her to enter the clinic through the main hospital entrance where the TV trucks were located.

Marissa obeyed, wondering what had been happening during the six-plus hours she’d been away. TV cables snaked their way along the floor to the conference room, and she was amazed at the level of activity in the main corridor. Spotting Dr. Navarre, she asked him what was going on.

“Your people have scheduled a news conference,” he explained. His face was haggard and unshaven, and it seemed obvious he had not been to bed. He took a newspaper from under his arm and showed it to Marissa: A NEW AIDS EPIDEMIC, shouted the headline. The article was illustrated with a photo of Marissa talking with Clarence Hems.

“Dr. Dubchek felt that such a misconception could not be allowed to continue,” said Dr. Navarre.

Marissa groaned. “The reporter approached me right after I’d arrived. I really didn’t tell him anything.”

“It doesn’t matter,” said Dr. Navarre, patting her gently on the shoulder. “Dr. Richter died during the night, and with the four new cases, there was no way this could have been kept from the media.”

“When did Dr. Dubehek arrive?” asked Marissa, getting out of the way of a camera crew headed into the conference room.

“A little after midnight,” said Dr. Navarre.

“Why the police?” asked Marissa, noticing a second uniformed officer standing by the doors leading to the hospital.

“After Dr. Richter died, patients started signing themselves out of the hospital, until the State Commissioner of Health issued an order placing the whole building under quarantine.”

Marissa excused herself and made her way through a throng of press and TV people outside the conference room. She was glad Dubchek had arrived to take charge but wondered why he hadn’t gotten in touch with her. When she entered the room, Dubchek was just about to start speaking.

He handled himself well. His calm no-nonsense manner quieted the room immediately. He began by introducing himself and the other doctors from the CDC. There was Dr. Mark Vreeland, Chief of Medical Epidemiology; Dr. Pierce Abbott, Director of the Department of Virology; Dr. Clark Layne, Director of the Hospital Infectious Disease Program; and Dr. Paul Eckenstein, Director of the Center for Infectious Disease.

Dubchek then went on to downplay the incident, saying that the problem was not “A New AIDS Epidemic” by any stretch of the imagination. He said that the California State Epidemiologist had requested help from the CDC to look into a few cases of unexplained illness thought to be of viral origin.

Looking at reporters eager for copy, Marissa could tell they were not buying Dubchek’s calm assessment. The idea of a new, unknown and frightening viral illness made for exciting news.

Dubchek continued by saying that there had only been a total of sixteen cases and that he thought the problem was under control. He pointed to Dr. Layne and announced that he would be overseeing the quarantine efforts and added that experience proved this kind of illness could be controlled by strict hospital isolation.

At this, Clarence Hems jumped up, asking, “Did Dr. Richter bring this virus back from his African conference?”

“We don’t know,” said Dubchek. “It is a possibility, but doubtful. The incubation period would be too long, since Dr. Richter returned from Africa over a month ago. The incubation period for this kind of illness is usually about a week.”

Another reporter got to her feet: “If the incubation period for AIDS can be five years, how can you limit it here to less than a month?”

“That’s exactly the point,” said Dubchek, his patience wearing thin. “The AIDS virus is totally different from our current problem. It is essential that the media understand this point and communicate it to the public.”

“Have you isolated the new virus?” asked another reporter.

“Not yet,” admitted Dubchek. “But we do not expect to have any difficulty. Again, that’s because it is a very different virus from AIDS. It should only take a week or so to culture it.”

“If the virus has not been isolated,” continued the same reporter, “how can you say that it is different from the AIDS virus?”

Dubchek stared at the man. Marissa could sense the doctor’s frustration. Calmly he said, “Over the years we’ve come to realize that totally different clinical syndromes are caused by totally different microorganisms. Now that is all for today, but we will keep you informed. Thank you for coming at this early hour.”

The conference room erupted as each reporter tried to get one more question answered. Dubchek ignored them as he and the other doctors made their exit. Marissa tried to push through the crowd but couldn’t. Outside the conference room the uniformed policeman kept the reporters from entering the hospital proper. After showing her CDC identity card, Marissa was allowed to pass. She caught up to Dubchek at the elevators.

“There you are!” said Dubchek, his dark eyes lighting up. His voice was friendly as he introduced Marissa to the other men.

“I didn’t know so many of you were coming,” she said as they boarded the elevator.

“We didn’t have much choice,” said Dr. Layne.

Dr. Abbott nodded. “Despite Cyrill’s comments at the news conference, this outbreak is extraordinarily serious. An appearance of African viral hemorrhagic fever in the developed world has been a nightmare we’ve lived with since the illness first surfaced.

“If it proves to be African viral hemorrhagic fever,” added Dr. Eckenstein.

“I’m convinced,” said Dr. Vreeland. “And I think the monkey will turn out to be the culprit.”

“I didn’t get samples from the monkey,” admitted Marissa quickly. “That’s okay,” said Dubchek. “We sacrificed the animal last night and sent specimens back to the Center. Liver and spleen sections will be far better than blood.”

They arrived on the fifth floor, where two technicians from the CDC were busy running samples in the Vickers Mobile Isolation Lab.

“I’m sorry about that L.A. Times article,” said Marissa when she could speak to Dubchek alone. “The reporter approached me when I first entered the hospital.”

“No matter,” said Dubchek. “Just don’t let it happen again.” He smiled and winked.

Marissa had no idea what the wink meant, nor the smile, for that matter. “Why didn’t you call me when you arrived?” she asked.

“I knew you’d be exhausted,” explained Dubchek. “There really wasn’t any need. We spent most of the night getting the lab set up, autopsying the monkey, and just getting oriented. We also improved the isolation situation by having fans installed. Nonetheless, you are to be congratulated. I think you did a fine job getting this affair underway.

“For the moment, I’m buried in administrative detail,” continued Dubchek, “but I do want to hear what you’ve learned. Maybe you and I could have dinner tonight. I’ve gotten you a room at the hotel where we are staying. I’m sure it’s better than the Tropic Motel.”

“There’s nothing wrong with the Tropic,” said Marissa. She felt an odd twinge of discomfort, as if her intuition were trying to tell her something.

Marissa went back to her small room behind the nurses’ station and began to catch up on her own paperwork. First she phoned the sponsoring organizations for the two medical meetings Dr. Richter had attended. She told them that she needed to know if any of the other attendees had become ill with a viral disease. Then, gritting her teeth at the cruelty of her next call, she dialed Dr. Richter’s home number and asked if she could pick up the diary Mrs. Richter had promised her the night before.

The neighbor who answered the phone seemed appalled by her request, but, after checking with the widow, told Marissa to come over in half an hour.

Marissa drove up to the beautifully landscaped house and nervously rang the bell. The same neighbor answered and rather angrily directed Marissa to the living room. Anna Richter appeared a few minutes later. She seemed to have aged ten years overnight. Her face was pale, and her hair, which had been so carefully curled the night before, hung about her face in lank strands.

The neighbor helped her to a chair, and Marissa was amazed to see that she was anxiously folding and unfolding some lined papers that

seemed to contain the requested list of her husband’s activities over the last weeks. Knowing what a strain the woman must have been under, Marissa didn’t know what to say, but Anna simply handed her the sheets saying, “I couldn’t sleep last night anyway, and maybe this will help some other poor family.” Her eyes filled with tears. “He was such a good man… a good father… my poor children.”

Despite knowing of his affair with Helen Townsend, Marissa decided that Dr. Richter must have been a pretty good husband. Anna’s grief seemed real, and Marissa left her as soon as she politely could.

The notes that she read before starting the car were surprisingly detailed. Put together with a further interview with Miss Cavanagh and the doctor’s appointment book, Marissa felt they would give her as good a picture of Richter’s last few weeks as anyone could get.

Back at the hospital, Marissa made a separate sheet of paper for each day of January and listed Richter’s activities. One fact she discovered was that he had complained to Miss Cavanagh about an AIDS patient named Meterko who was suffering from an undiagnosed retinal disorder. It sounded like something Marissa should look into.

In the afternoon, the phone in Marissa’s cubicle rang. Picking it up, she was startled to hear Tad Schockley’s voice. The connection was so good that for a moment she thought he was there in L.A.

“Nope,” said Tad, responding to her question. “I’m still here in Atlanta. But I need to speak to Dubchek. The hospital operator seemed to think that you might know where he was.”

“If he’s not in the CDC room, then I guess he’s gone to his hotel. Apparently they were up all last night.”

“Well, I’ll try the hotel, but in case I don’t get him, could you give him a message?”

“Of course,” said Marissa.

“It’s not good news.”

Straightening up, Marissa pressed the phone to her ear. “Is it personal?”

“No,” said Tad with a short laugh. “It’s about the virus you people are dealing with. The samples you sent were great, especially Dr. Richter’s. His blood was loaded with virus-more than a billion per milliliter. All I had to do was spin it down, fix it and look at it with the electron microscope.”

“Could you tell what it was?” asked Marissa.

“Absolutely,” said Tad excitedly. “There are only two viruses that look like this, and it tested positive with indirect fluorescene antibody for Ebola. Dr. Richter has Ebola Hemorrhagic Fever.”

S

“Had,” said Marissa, mildly offended by Tad’s callous enthusiasm.

“Did the man die?” asked Tad.

“Last night,” said Marissa.

“It’s not surprising. The illness has a ninety percent plus fatality rate.”

“My God!” exclaimed Marissa. “That must make it the deadliest virus known.”

“Some people might give rabies that dubious honor,” said Tad. “But personally I think it is Ebola. One of the problems is that almost nothing is known about this illness because there has been so little experience. Except for a couple of outbreaks in Africa, it’s an unknown entity. You’re going to have your work cut out for you trying to explain how it popped up in Los Angeles.”

“Maybe not,” said Marissa. “Dr. Richter had been bitten just prior to his illness by a monkey that had come from Africa. Dr. Vreeland is pretty sure the monkey was the source.”

“He’s probably right,” agreed Tad. “Monkeys were responsible for an outbreak of hemorrhagic fever in ‘67. The virus was named Marburg after the town in Germany where it occurred. The virus looks a lot like Ebola.”

“We’ll soon know,” said Marissa. “Now it’s up to you. Hepatic and splenic sections from the monkey are on the way. I’d appreciate it if you’d check them right away and let me know.”

“My pleasure,” said Tad. “Meanwhile, I’m going to start work on the Ebola virus and see how easily I can culture it. I want to figure out what strain it is. Let Dubchek and the others know they’re dealing with Ebola. If nothing else, it will make them super careful. I’ll talk with you soon. Take care.”

Leaving the cubicle, Marissa stepped across the hall and peered into the CDC room. It was deserted. Going into the neighboring room, she asked the technicians where everyone was. They told her that some of the doctors were down in pathology, since two more of the patients had died, and some were in the ER admitting several new cases. Dr. Dubchek had gone back to the hotel. Marissa told the technicians that they were dealing with Ebola. She left it to them to pass the bad news to the others. Then she went back to her paperwork.

The Beverly Hilton was just as Dubchek had described. It was certainly nicer than the seedy Tropic Motel, and it was closer to the Richter Clinic. But it still seemed like unnecessary effort to Marissa as she plodded after the bellman down the eighth-floor corridor to her

room. The bellman turned on all the lights while she waited at the door. She gave him a dollar, and he left.

She’d never unpacked at the Tropic, so the move wasn’t difficult. Yet she wouldn’t have made it if Dubchek hadn’t insisted. He’d called her that afternoon, several hours after she’d talked with Tad. She’d been afraid to call him, thinking that she’d awaken him. As soon as he was on the line, she told him Tad’s news about the outbreak being Ebola Hemorrhagic Fever, but he took it in stride, almost as if he’d expected it. He then had given her directions to the hotel and told her that she merely had to pick up the key for 805, since she was already registered. And he had told her that they’d eat at seven-thirty, if that was all right with her, and that she should just come to his room, which was conveniently located a few doors from hers. He said he’d order up so they could go over her notes while they ate.

As she eyed the bed, Marissa’s exhaustion cried for attention, but it was already after seven. Getting her cosmetics bag from her suitcase, she went into the bathroom. After washing, brushing out her hair and touching up her makeup, Marissa was ready. From her briefcase, she removed the sheets of information concerning Dr. Richter’s activities before he’d become LU. Clutching them to her, she walked down to Dubchek’s door and knocked.

He answered her knock and, smiling, motioned for her to come in. He was on the phone, apparently talking to Tad. Marissa sat down and tried to follow the conversation. It seemed the samples from the monkey had arrived and they had tested clear.

“You mean the electron microscopy showed no virus at all?” said Dubchek.

There was a long silence as Tad relayed the details of the outcomes of the various tests. Looking at her watch, Marissa calculated that it was almost eleven in Atlanta. Tad was certainly putting in overtime. She watched Dubchek, realizing the man had a disturbing effect on her. She recalled how unnerved she’d been when he’d turned up at Ralph’s dinner party and was upset to find herself inexplicably attracted to him now. From time to time he looked up, and her glance was trapped by an unexpected glint in his dark eyes. He’d removed his jacket and tie, and a V of tanned skin was visible at the base of his neck.

Finally he hung up the phone and walked over to her, gazing down at her. “You’re certainly the best-looking thing I’ve seen today. And I gather your friend Tad would agree. He seemed very concerned that you don’t put yourself at risk.”

“Certainly I’m in no more danger than anyone else involved in

this,” she said, vaguely annoyed at the turn the conversation was taking.

Dubchek grinned. “I guess Tad doesn’t feel the rest of the staff is as cute.”

Trying to turn the talk to professional matters, Marissa asked about the monkey’s liver and spleen sections.

“Clean so far,” said Dubchek, with a wave of his hand. “But that was only by electron microscopy. Tad has also planted the usual viral cultures. We’ll know more in a week.”

“In the meantime,” said Marissa, “we’d better look elsewhere.”

“I suppose so,” said Dubchek. He seemed distracted. He ran a hand over his eyes as he sat down across from her.

Leaning forward, Marissa handed over her notes. “I thought that you might be interested in looking at these.” Dubchek accepted the papers and glanced through them while Marissa talked.

In a chronological fashion, Marissa described what she’d been doing since her arrival in L.A. She made a convincing argument that Dr. Richter was the index case and that he was the source of the Ebola, spreading the disease to some of his patients. She explained his relationship to Helen Townsend and then described the two medical meetings that Dr. Richter had attended. The sponsoring organizations were sending complete lists of the attendees, with their addresses and phone numbers, she added.

Throughout her monologue Dubchek nodded to indicate that he was listening, but somehow he seemed distracted, concentrating more on her face than on what she was saying. With so little feedback, Marissa trailed off and stopped speaking, wondering if she were making some fundamental professional error. After a sigh, Dubchek smiled. “Good job,” he said simply. “It’s hard to believe that this is your first field assignment.” He stood up at the sound of a knock on the door. “Thank goodness. That must be dinner. I’m starved.”

The meal itself was mediocre; the meat and vegetables Dubchek had ordered were lukewarm. Marissa wondered why they couldn’t have gone down to the dining room. She’d thought that he’d intended to talk business, but as they ate, the conversation ranged from Ralph’s dinner party and how she came to know him, to the CDC and whether or not she was enjoying her assignment. Toward the end of the meal Dubchek suddenly said, “I wanted to tell you that I am a widower.”

“I’m sorry to hear that,” said Marissa sincerely, wondering why the man was bothering to inform her about his personal life.

“I just thought you should know,” he added, as if reading her mind. “My wife died two years ago in an auto accident.”

Marissa nodded, once again uncertain how to reply.

“What about you?” asked Dubchek. “Are you seeing anyone?”

Marissa paused, toying with the handle of her coffee cup. She had no intention of discussing her breakup with Roger. “No, not at the moment,” she managed to tell him. She wondered if Dubchek knew that she had been dating Tad. It had not been a secret, but it wasn’t public knowledge either. Neither of them had told people at the lab. Suddenly Marissa felt even more uncomfortable. Her policy of not mixing her personal and professional lives was being violated, she felt. Looking over at Dubchek, she couldn’t help but acknowledge that she found him attractive. Perhaps that was why he made her feel so uncomfortable. But there was no way she was interested in a more personal relationship with him, if that was what this was leading up to. All at once she wanted to get out of his room and return to her work.

Dubchek pushed back his chair and stood up. “If we’re going back to the clinic maybe we should be on our way.”

That sounded good to Marissa. She stood up and went over to the coffee table to pick up her papers. As she straightened up, she realized that Dubchek had come up behind her. Before she could react, he put his hands on her shoulders and turned her around. The action so surprised her that she stood frozen. For a brief moment their lips met. Then she pulled away, her papers dropping to the floor.

“I’m sorry,” he said. “I wasn’t planning that at all, but ever since you arrived at CDC I’ve been tempted to do that. God knows I don’t believe in dating anyone I work with, but it’s the first time since my wife died that I’ve really been interested in a woman. You don’t look like her at all-Jane was tall and blond-but you have that same enthusiasm for your work. She was a musician, and when she played well, she had the same excited expression I’ve seen you get.”

Marissa was silent. She knew she was being mean, that Dubchek certainly had not been harassing her, but she felt embarrassed and awkward and was unwilling to say something to ease over the incident.

“Marissa,” he said gently, “I’m telling you that I’d like to take you out when we get back to Atlanta, but if you’re involved with Ralph or just don’t want to…” his voice trailed off.

Marissa bent down and gathered up her notes. “If we’re going back to the hospital, we’d better go now,” she said curtly.

He stiffly followed her out the door to the elevator. Later, sitting silently in her rent-a-car, Marissa berated herself. Cyrill was the most attractive man she’d met since Roger. Why had she behaved so unreasonably?

r

/

4

February 27

ALMOST FIVE WEEKS LATER, as the taxi bringing her home from the airport turned onto Peachtree Place, Marissa was wondering if she would be able to reestablish a pleasant, professional relationship with Dubchek now that they were both back in Atlanta. He had left a few days after their exchange at the Beverly Hilton, and the few meetings they’d had at the Richter Clinic had been curt and awkward.

Watching the lighted windows as the cab drove down her street, seeing the warm family scenes inside, she was overcome with a wave of loneliness.

After paying the driver and turning off the alarm, Marissa hustled over to the Judsons’ and retrieved Taffy and five weeks’ worth of mail. The dog was ecstatic to see her, and the Judsons couldn’t have been nicer. Rather than making Marissa feel guilty about being gone for so long, they acted truly sad to see Taffy leave.

Back in her own house, Marissa turned up the heat to a comfortable level. Having a puppy there made all the difference in the world. The dog wouldn’t leave her side and demanded almost constant attention.

Thinking about supper, she opened the refrigerator only to discover that some food had gone bad. She shut the door, deciding to tackle the job of cleaning it out the next day. She dined on Fig Newtons and Coke as she leafed through her mail. Aside from a card

from one of her brothers and a letter from her parents, it was mostly pharmaceutical junk.

Manssa was startled when the phone rang, but when she picked up the receiver, she was pleased to hear Tad’s voice welcoming her home to Atlanta. “How about going out for a drink?” he asked. “I can pop over and pick you up.”

“Marissa’s first response was to say that she was exhausted after her trip, but then she remembered on her last call from L.A. he’d told her he had finished his current AIDS project and was hard at work on what he called Marissa’s Ebola virus. Suddenly feeling less tired, she asked how those tests were going.

“Fine!” said Tad. “The stuff grows like wildfire in the Vero 98 tissue cultures. The morphology portion of the study is already complete, and I’ve started the protein analysis.”

“I’m really interested in seeing what you’re doing,” said Marissa.

“I’ll be happy to show you what I can,” said Tad. “Unfortunately, a majority of the work is done inside the maximum containment lab.”

“I’d assumed as much,” said Marissa. She knew that the only way such a deadly virus could be handled was in a facility that did just what its name suggested-contained the microorganisms. As far as Marissa knew, there were only four such facilities in the world-one at the CDC, one in England, one in Belgium and one in the Soviet Union. She didn’t know if the Pasteur Institute in Paris had one or not. For safety reasons entry was restricted to a few authorized individuals. At that time, Marissa was not one of them. Yet, having witnessed Ebola’s devastating potential, she told Tad that she was really eager to see his studies.

“You don’t have clearance,” said Tad, surprised by what seemed to him her naiveté.

“I know,” said Marissa, “but what could be so terrible about showing me what you’re doing with the Ebola in the lab right now and then going out for a drink. After all, it’s late. No one will know if you take me now.”

There was a pause. “But entry is restricted,” said Tad plaintively. Marissa was fully aware that she was being manipulative, but there was certainly no danger to anyone if she were to go in with Tad. “Who’s to know?” she asked coaxingly. “Besides, I am part of the team.”

“I guess so,” Tad agreed reluctantly.

It was obvious that he was wavering. The fact that Marissa would only see him if he took her into the lab seemed to force his decision.

He told her that he’d pick her up in half an hour and that she wasn’t to breathe a word to anyone else.

Marissa readily agreed.

“I’m not so sure about this,” admitted Tad, as he and Marissa drove toward the CDC.

“Relax,” said Marissa. “I’m an EIS officer assigned to Special Pathogens for goodness sakes.” Purposefully, Marissa pretended to be a little irritated.

“But we could ask for your clearance tomorrow,” suggested Tad. Marissa turned toward her friend. “Are you chickening out?” she demanded. It was true that Dubchek was due back from a trip to Washington the next day and that a formal request could be made. But Marissa had her doubts about what his response would be. She felt that Dubchek had been unreasonably cold over the last few weeks, even if her own stupidity had been the cause. Why she hadn’t had the nerve to apologize or even say she’d like to see him one evening, she didn’t know. But with every day that passed the coolness between them, particularly on his side, increased.

Tad pulled into the parking lot, and they walked in silence to the main entrance. Marissa mused about men’s egos and how much trouble they caused.

They signed in under the watchful eyes of the security guard and dutifully displayed their CDC identity cards. Under the heading “Destination,” Marissa wrote “office.” They waited for the elevator and went up three floors. After walking the length of the main building, they went through an outside door to a wire-enclosed catwalk that connected the main building to the virology labs. All the buildings of the Center were connected on most floors by similar walkways.

“Security is tight for the maximum containment lab,” said Tad as he opened the door to the virology building. “We store every pathological virus known to man.”

“All of them?” asked Marissa, obviously awed.

“Just about,” said Tad like a proud father.

“What about Ebola?” she asked.

“We have Ebola samples from every one of the previous outbreaks. We’ve got Marburg; smallpox, which otherwise is extinct; polio; yellow fever; dengue; AIDS. You name it; we’ve got it.”

“God!” exclaimed Marissa. “A menagerie of horrors.”

“I guess you could say that.”

“How are they stored?” she asked.

“Frozen with liquid nitrogen.”

“Are they infective?” asked Marissa.

“Just have to thaw them out.”

They were walking down an ordinary hall past a myriad of small, dark offices. Marissa had previously been in this portion of the building when she’d come to Dubchek’s office.

Tad stopped in front of a walk-in freezer like the kind seen in a butcher shop.

“You might find this interesting,” he said, as he pulled open the heavy door. A light was on inside.

Timidly Marissa stepped over the threshold into the cold, moist air. Tad was behind her. She felt a thrill of fear as the door swung shut and latched with a click.

The interior of the freezer was lined with shelves holding tiny vials, hundreds of thousands of them. “What is this?” asked Marissa.

“Frozen sera,” said Tad, picking up one of the vials, which had a number and a date written on it. “Samples from patients all over the world with every known viral disease and a lot of unknown ones. They’re here for immunological study and obviously are not infective.”

Marissa was still glad when they returned to the hallway.

About fifty feet beyond the walk-in freezer the hail turned sharply to the right, and as they rounded the corner, they were confronted by a massive steel door. Just above the doorknob was a grid of push buttons similar to Marissa’s alarm system. Below that was a slot like the opening for a credit card at an automatic bank teller. Tad showed Marissa a card that he had around his neck on a leather thong. He inserted it into the slot.

“The computer is recording the entry,” he said. Then he tapped out his code number on the push-button plate: 43-23-39. “Good measurements,” he quipped.

“Thank you,” said Marissa, laughing. Tad joined in. Since the virology building had been deserted, he seemed more relaxed. After a short delay, there was a mechanical click as the bolt released. Tad pulled open the door. Marissa felt as if she had entered another world. Instead of the drab, cluttered hallway in the outer part of the building, she found herself surrounded by a recently constructed complex of color-coded pipes, gauges and other futuristic paraphernalia. The lighting was dim until Tad opened a cabinet door, exposing a row of circuit breakers. He threw them in order. The first turned on the lights in the room in which they were standing. It was almost two stories tall and was filled with all sorts of equipment. There was a slight odor of phenolic disinfectant, a smell that reminded Marissa of the autopsy room at her medical school.

The next circuit breaker lit up a row of portholelike windows that lined the sides of a ten-foot-high cylinder that protruded into the room. At the end of the cylinder was an oval door like the watertight hatch on a submarine.

The final circuit breaker caused a whirring noise as some kind of large electrical machinery went into gear. “Compressors,” said Tad in response to Marissa’s questioning look. He didn’t elaborate. Instead, with a sweep of his hand he said: “This is the control and staging area for the maximum containment lab. From here we can monitor all the fans and filters. Even the gamma-ray generators. Notice all the green lights. That means that everything is working as it is supposed to be. At least hopefully!”

“What do you mean, ‘hopefully’?” asked Marissa, somewhat alarmed. Then she saw Tad’s smile and knew he was teasing her. Still, she suddenly wasn’t one hundred percent sure she wanted to go through with the visit. It had seemed like such a good idea when she’d been in the safety of her home. Now, surrounded by all this alien equipment and knowing what kinds of viruses were inside, she wasn’t so certain. But Tad didn’t give her time to change her mind. He opened the airtight door and motioned for Marissa to go inside. Marissa had to duck her head slightly while stepping over the six-inch-high threshold. Tad followed her, then closed and bolted the door. A feeling of claustrophobia almost overwhelmed her, especially when she had to swallow to clear her ears due to the pressure change.

The cylinder was lined with the portholelike windows Marissa had seen from the outer room. Along both sides were benches and upright lockers. At the far end were shelves and another oval airtight door.

“Surprise!” said Tad as he tossed Marissa some cotton suits. “No street clothes allowed.”

After a moment’s hesitation during which time Marissa vainly glanced around for a modicum of privacy, she began unbuttoning her blouse. As embarrassed as she was to be stripping down to her underwear in front of Tad, he seemed more self-conscious than she. He made a big production of facing away from her while she changed.

They then went through a second door. “Each room that we enter as we go into the lab is more negative in terms of pressure than the last. That ensures that the only movement of air will be into the lab, not out.”

The second room was about the size of the first but with no windows. The smell of the phenolic disinfectant was more pronounced. A number of large, blue plastic suits hung on pegs. Tad searched until he found one he thought would fit Marissa. She took it from his outstretched hand. It was like a space suit without a backpack or a heavy bubble helmet. Like a space suit, it covered the entire body, complete with gloves and booties. The part that covered the head was faced with clear plastic. The suit sealed with a zipper that ran from the pubic area to the base of the throat. Issuing from the back, like a long tail, was an air hose.

Tad pointed out green piping that ran along the sides of the room at chest height, saying that the entire lab was laced with such pipes. At frequent intervals were rectangular lime green manifolds with adapters to take the air hoses from the suits. Tad explained that the suits were filled with clean, positive-pressure air so that the air in the lab itself was never breathed. He rehearsed with Marissa the process of attaching and detaching the air hose until he was convinced she felt secure.

“Okay, time to suit up,” said Tad, as he showed Marissa how to start working her way into the bulky garment. The process was complicated, particularly getting her head inside the closed hood. As she looked out through the clear plastic face mask, it fogged immediately.

Tad told her to attach her air hose, and instantly Marissa felt the fresh air cool her body and clear the face piece. Tad zipped up the front of her suit and with practiced moves, climbed into his own. He inflated his suit, then detached his air hose, and carrying it in his hand, moved down to the far door. Marissa did the same. She had to waddle to walk.

To the right of the door was a panel. “Interior lights for the lab,” explained Tad as he threw the switches. His voice was muffled by the suits; it was difficult for her to understand, especially with the hiss of the incoming air in the background. They went through another airtight door, which Tad closed behind them.

The next room was half again smaller than the first two, with walls and piping all covered with a white chalky substance. The floor was covered with a plastic grate.

They attached their air hoses for a moment. Then they moved through a final door into the lab itself. Marissa followed close behind Tad, moving her air hose and connecting it where he did.

Marissa was confronted by a large rectangular room with a central island of lab benches surmounted by protective exhaust hoods. The

walls were lined with all sorts of equipment-centrifuges, incubators, various microscopes, computer terminals, and a host of things Marissa did not recognize. To the left there was also a bolted insulated door.

Tad took Marissa directly to one of the incubators and opened up the glass doors. The tissue culture tubes were fitted into a slowly revolving tray. Tad lifted out one and handed it to Marissa. “Here’s your Ebola,” he said.

In addition to the small amount of fluid the tube contained, it was coated (on one side) with a thin film-a layer of living cells infected with the virus. Inside the cells, the virus was forcing its own replication. As innocent as the contents looked, Marissa understood that there was probably enough infectious virus to kill everyone in Atlanta, perhaps the United States. Marissa shuddered, gripping the glass tube more tightly.

Taking the tube, Tad walked over to one of the microscopes. He positioned the airtight specimen, adjusted the focus, then stepped back so Marissa could look.

“See those darkened clumps in the cytoplasm?” he asked.

Marissa nodded. Even through the plastic face mask, it was easy to see the inclusion bodies Tad described, as well as the irregular cell nuclei.

“That’s the first sign of infestation,” said Tad. “I just planted these cultures. That virus is unbelievably potent.”

After Marissa straightened up from the microscope, Tad returned the tube to the incubator. Then he began to explain his complicated research, pointing out some of the sophisticated equipment he was using and detailing his various experiments. Marissa had trouble concentrating. She hadn’t come to the lab that night to discuss Tad’s work, but she couldn’t tell him that.

Finally he led her down a passageway to a maze of animal cages that reached almost to the ceiling. There were monkeys, rabbits, guinea pigs, rats and mice. Marissa could see hundreds of eyes staring at her: some listless, some with fevered hatred. In a far section of the room, Tad pulled out a tray of what he called Swiss ice mice. He was going to show them to Marissa, but he stopped. “My word!” he said. “I just inoculated these guys this afternoon, and most have already died.” He looked at Marissa. “Your Ebola is really deadly-as bad as the Zaire ‘76 strain.”

Marissa reluctantly glanced in at the dead mice. “Is there some way to compare the various strains?”

“Absolutely,” said Tad, removing the dead mice. They went back

to the main lab where Tad searched for a tray for the tiny corpses. He spoke while he moved, responding to Marissa’s question. She found it hard to understand him when he wasn’t standing directly in front of her. The plastic suit gave his voice a hollow quality, like Darth Vader’s. “Now that I’ve started to characterize your Ebola,” he said, “it will be easy to compare it with the previous strains. In fact I’ve begun with these mice, but the results will have to wait for a statistical evaluation.”

Once he had the mice arranged on a dissecting tray, Tad stopped in front of the bolted insulated door. “I don’t think you want to come in here.” Without waiting for a response, he opened the door and went inside with the dead mice. A mist drifted out as the door swung back against his air hose.

Marissa eyed the small opening, steeling herself to follow, but before she could act, Tad reappeared, hastily shutting the door behind him. “You know, I’m also planning to compare the structural polypeptides and viral RNA of your virus against the previous Ebola strains,” he said.

“That’s enough!” laughed Marissa. “You’re making me feel dumb. I’ve got to get back to my virology textbook before making sense of all this. Why don’t we call it a night and get that drink you promised me?”

“You’re on,” said Tad eagerly.

There was one surprise on the way out. When they had returned to the room with chalky walls, they were drenched by a shower of phenolic disinfectant. Looking at Marissa’s shocked face, Tad grinned. “Now you know what a toilet bowl feels like.”

When they were changing into their street clothes, Marissa asked what was in the room where he’d taken the dead mice.

“Just a large freezer,” he said, waving off the question.

Over the next four days, Marissa readjusted to life in Atlanta, enjoying her home and her dog. On the day after her return, she’d tackled all the difficult jobs, like cleaning out the rotten vegetables from the refrigerator and catching up on her overdue bills. At work, she threw herself into the study of viral hemorrhagic fever, Ebola in particular. Making use of the CDC library, she obtained detailed material about the previous outbreaks of Ebola: Zaire ‘76, Sudan ‘76, Zaire ‘77 and Sudan ‘79. During each outbreak, the virus appeared out of nowhere and then disappeared. A great deal of effort was expended trying to determine what organism served as the reservoir for the virus. Over two hundred separate species of animals and

insects were studied as potential hosts. All were negative. The only positive finding was some antibodies in an occasional domestic guinea pig.

Marissa found the description of the first Zairean outbreak particularly interesting. Transmission of the illness had been linked to a health-care facility called the Yambuku Mission Hospital. She wondered what possible points of similarity existed between the Yambuku Mission and the Richter Clinic, or for that matter, between Yambuku and Los Angeles. There couldn’t be very many.

She was sitting at a back table in the library, reading again from Fields’ Virology. She was studying up on tissue cultures as an aid to further practical work in the main virology lab. Tad had been helpful in setting her up with some relatively harmless viruses so that she could familiarize herself with the latest virology equipment.

Marissa checked her watch. It was a little after two. At three-fifteen she had an appointment with Dr. Dubchek. The day before, she’d given his secretary a formal request for permission to use the maximum containment lab, outlining the experimental work she wanted to do on the communicability of the Ebola virus. Marissa was not particularly sanguine about Dubchek’s response. He’d all but ignored her since her return from Los Angeles.

A shadow fell across her page, and Marissa automatically glanced up. “Well! Well! She is still alive!” said a familiar voice.

“Ralph,” whispered Marissa, shocked both by his unexpected presence in the CDC library and the loudness of his voice. A number of heads turned toward them.

“There were rumors she was alive but I had to see for myself,” continued Ralph, oblivious of Mrs. Campbell’s glare.

Marissa motioned for Ralph to be silent, then took his hand and led him into the hallway where they could talk. She felt a surge of affection as she looked up at his welcoming smile.

“It’s good to see you,” said Marissa, giving him a hug. She felt a twinge of guilt for not having contacted him since returning to Atlanta. They’d talked on the phone about once a week during her stay in L.A.

As if reading her mind, Ralph said, “Why haven’t you called me? Dubchek told me you’ve been back for four days.”

“I was going to call tonight,” she said lamely, upset that Ralph was getting information about her from Dubchek.

They went down to the CDC cafeteria for coffee. At that time of the afternoon the room was almost deserted, and they sat by the window overlooking the courtyard. Ralph said he was en route between the hospital and his office and that he had wanted to catch her before the evening. “How about dinner?” he asked, leaning forward and putting a hand on Marissa’s. “I’m dying to hear the details of your triumph over Ebola in L.A.”

“I’m not sure that twenty-one deaths can be considered a triumph,” said Marissa. “Worse still from an epidemiologic point of view, we failed. We never found out where the virus came from. There’s got to be some kind of reservoir. Just imagine the media reaction if the CDC had been unable to trace the Legionnaires bacteria to the air-conditioning system.”

“I think you are being hard on yourself,” said Ralph.

“But we have no idea if and when Ebola will appear again,” said Marissa. “Unfortunately, I have a feeling it will. And it is so unbelievably deadly.” Marissa could remember too well its devastating course.

“They couldn’t figure out where Ebola came from in Africa either,” said Ralph, still trying to make her feel better.

Marissa was impressed that Ralph was aware of the fact and told him so.

“TV,” he explained. “Watching the nightly news these days gives one a medical education.” He squeezed Marissa’s hand. “The reason you should consider your time in L.A. successful is because you were able to contain what could have been an epidemic of horrible proportions.”

Marissa smiled. She realized that Ralph was trying to make her feel good and she appreciated the effort. “Thank you,” she said. “You’re right. The outbreak could have been much worse, and for a time we thought that it would be. Thank God it responded to the quarantine. It’s a good thing, because it carried better than a ninety-four percent fatality rate, with only two apparent survivors. Even the Richter Clinic seems to have become a victim. It now has as bad a reputation because of Ebola as the San Francisco bathhouses have because of AIDS.”

Marissa glanced at the clock over the steam table. It was after three. “I have a meeting in a few minutes,” she apologized. “You are a dear for stopping by, and dinner tonight sounds wonderful.”

“Dinner it will be,” said Ralph, picking up the tray with their empty cups.

Marissa hurried up three flights of stairs and crossed to the virology building. It didn’t appear nearly as threatening in the daylight as it had at night. Turning toward Dubchek’s office, Marissa knew that just around the bend in the hallway was the steel door that led to the maximum containment lab. It was seventeen after three when she stood in front of Dubchek’s secretary.

It was silly for her to have rushed. As she sat across from the secretary, flipping through Virology Times with its virus-of-the-month centerfold, Marissa realized that of course Dubchek would keep her waiting. She glanced at her watch again: twenty of four. Beyond the door she could hear Dubchek on the telephone. And from the telephone console on the secretary’s desk, she could see the little lights blink when he’d hang up and make another call. It was five of four when the door opened and Dubchek motioned for Marissa to come into his office.

The room was small, and cluttered with reprinted articles stacked on the desk, on the file cabinet and on the floor. Dubchek was in his shirt-sleeves, his tie tucked out of the way between the second and third button of his shirt. There was no apology or explanation of why she’d been kept waiting. In fact there was a suggestion of a grin on his face that particularly galled Marissa.

“I trust that you received my letter,” she said, studiously keeping her voice businesslike.

“I did indeed,” said Dubchek.

“And…?” said Marissa after a pause.

“A few days’ lab experience is not enough to work in the maximum containment lab,” said Dubchek.

“What do you suggest?” asked Marissa.

“Exactly what you are presently doing,” said Dubchek. “Continue working with less-pathogenic viruses until you gain sufficient experience.”

“How will I know when I’ve had enough experience?” Marissa realized that Cyrill had a point, but she wondered if his answer would have been different had they been dating. It bothered her even more that she didn’t have the nerve to withdraw her earlier rebuff. He was a handsome man, one who attracted her far more than Ralph, whom she was happy enough to see for dinner.

“I believe I will know when you have had adequate experience,” said Dubchek interrupting her thoughts, “… or Tad Schockley will.”

Marissa felt cheered. If it were up to Tad, she was certain that she would eventually get the necessary authorization.

“Meanwhile,” said Dubchek, stepping around his desk and sitting down, “I’ve got something more important to talk with you about. I’ve just been on the phone with a number of people, including the Missouri State Epidemiologist. They have a single case of a severe

viral illness in St. Louis that they think might be Ebola. I want you to leave immediately, assess the situation clinically, send Tad samples and report back. Here’s your flight reservation.” He handed Marissa a sheet of paper. On it was written Delta, flight 1083, departure 5:34 P.M., arrival 6:06 P.M.

Marissa was stunned. With rush-hour traffic, it was going to be a near thing. She knew that as an EIS officer she should always have a bag packed, but she didn’t, and there was Taffy to think of, too.

“We’ll have the mobile lab ready if it is needed,” Cyrill was saying, “but let’s hope it’s not.” He extended his hand to wish her good luck, but Marissa was so preoccupied with the thought of possibly facing the deadly Ebola virus in less than four hours, that she walked out without noticing. She felt dazed. She’d gone in hoping for permission to use the maximum containment lab and was leaving with orders to fly to St. Louis! Glancing at her watch, she broke into a run. It was going to be close.

5

March 3

IT WAS ONLY AS the plane taxied onto the runway that Marissa remembered her date with Ralph. Well, she should touch down in time to catch him as soon as he got home. Her one small consolation was that she felt more comfortable professionally than she had en route to L.A. At least she had some idea of what would be demanded of her. Personally, however, knowing this time how deadly the virus could be, if indeed it was Ebola, Marissa was more frightened at the thought of her own exposure. Although she hadn’t mentioned it to anyone, she still worried about contracting the disease from the first outbreak. Each day that passed without the appearance of suspicious symptoms had been a relief. But the fear had never completely disappeared.

The other thought that troubled Marissa was the idea of another Ebola case appearing so quickly. If it was Ebola, how did it get to St. Louis? Was it a separate outbreak from L.A. or merely an extension of that one? Could a contact have brought it from L.A., or could there be an “Ebola Mary” like the infamous “Typhoid Mary”? There were many questions, none of which made Marissa cheerful.

“Will you want dinner tonight?” asked a cabin attendant, breaking Marissa’s train of thought.

“Sure,” said Marissa dropping her tray table. She’d better eat, whether she was hungry or not. She knew that once she got to St. Louis she might not get the time.

As Marissa climbed out of the taxi that had taken her from the St. Louis airport to the Greater St. Louis Community Health Plan Hospital, she was thankful for the elaborate concrete porte cochere. It was pouring outside. Even with the overhead protection, she pulled up the lapels of her coat to avoid wind-driven rain as she ran for the revolving door. She was carrying her suitcase as well as her briefcase, since she’d not taken the time to stop in her hotel.

The hospital appeared an impressive affair even on a dark, rainy night. It was constructed in a modern style, with travertine-marble facing, and fronted by a three-stories-tall replica of the Gateway Arch. The interior was mostly blond oak and bright red carpeting. A pert receptionist directed Marissa to the administration offices, located through a pair of swinging doors.

“Dr. Blumenthal!” cried a diminutive oriental man, jumping up from his desk. She took a step backward as the man relieved her of her suitcase and enthusiastically pumped her freed hand. “I’m Dr. Harold Taboso,” he said. “I’m the medical director here. And this is Dr. Peter Austin, the Missouri State Epidemiologist. We’ve been waiting for you.”

Marissa shook hands with Dr. Austin, a tall, thin man with a ruddy complexion.

“We are thankful that you could come so quickly,” said Dr. Taboso. “Can we get you something to eat or drink?”

Marissa shook her head, thanking him for his hospitality. “I ate on the plane,” she explained. “Besides, I’d like to get directly to business.”

“Of course, of course,” said Dr. Taboso. For a moment he looked confused. Dr. Austin took advantage of his silence to take over.

“We’re well aware of what happened in L.A. and we’re concerned that we might be dealing with the same problem here. As you know, we admitted one suspicious case this morning, and two more have arrived while you were en route.”

Marissa bit her lip. She had been hoping that this would turn out to be a false alarm, but with two more potential cases, it was difficult to sustain such optimism. She sank into the chair that Dr. Taboso proffered and said, “You’d better tell me what you have learned so far.”

“Not much, I’m afraid,” said Dr. Austin. “There has been little time. The first case was admitted around 4:00 A.M. Dr. Taboso deserves credit for sounding the alarm as soon as he did. The patient was immediately isolated, hopefully minimizing contacts here at the hospital.”.

Marissa glanced at Dr. Taboso. He smiled nervously, accepting the compliment.

“That was fortunate,” said Marissa. “Was any lab work done?”

“Of course,” said Dr. Taboso.

“That could be a problem,” said Marissa.

“We understand,” said Dr. Austin. “But it was ordered immediately on admittance, before we had any suspicion of the diagnosis. The moment my office was alerted we called the CDC.”

“Have you been able to make any association with the L.A. outbreak? Did any of the patients come from L.A.?”

“No,” said Dr. Austin. “We have inquired about such a possibility, but there has been no connection that we could find.”

“Well,” said Marissa, reluctantly getting to her feet. “Let’s see the patients. I assume that you have full protective gear available.”

“Of course,” said Dr. Taboso as they filed out of the room.

They crossed the hospital lobby to the elevators. Riding up in the car, Marissa asked, “Have any of the patients been to Africa recently?”

The other two doctors looked at each other. Dr. Taboso spoke: “I don’t believe so.”

Marissa had not expected a positive answer. That would have been too easy. She watched the floor indicator. The elevator stopped on eight.

As they walked down the corridor, Marissa realized that none of the rooms they were passing were occupied. When she looked closer, she realized that most weren’t even fully furnished. And the walls of the hall had only been primed, not painted.

Dr. Taboso noticed Marissa’s expression. “Sorry,” he said. “I should have explained. When the hospital was built, too many beds were planned. Consequently, the eighth floor was never completed. But we decided to use it for this emergency. Good for isolation, don’t you agree?”

They arrived at the nurses’ station, which seemed complete except for the cabinetry. Marissa took the first patient’s chart. She sat down at the desk and opened the metal cover, noting the man’s name:

Zabriski. The vital-sign page showed the familiar complex of high fever and low blood pressure. The next page contained the patient’s history. As Marissa’s eyes ran down the sheet, she caught the man’s full name: Dr. Carl M. Zabriski. Raising her eyes to Dr. Taboso, she asked incredulously, “Is the patient a physician?”

“I’m afraid so,” answered Taboso. “He’s an ophthalmologist here at the hospital.”

Turning to Dr. Austin, she asked, “Did you know the index case in L.A. was also a doctor? In fact he was an ophthalmologist!”

“I was aware of the coincidence,” said Dr. Austin, frowning.

“Does Dr. Zabriski do any research with monkeys?” asked Marissa. “Not that I know of,” answered Dr. Taboso. “Certainly not here at the hospital.”

“No other physicians were involved in the L.A. outbreak that I can recall,” said Dr. Austin.

“No,” said Marissa. “Just the index case. There were three lab techs and one nurse, but no other doctors.”

Redirecting her attention to the chart, Marissa went through it rapidly. The history was not nearly as complete as that done on Dr. Richter at the Richter Clinic. There were no references to recent travel or animal contact. But the lab workup was impressive, and although not all the tests were back, those that were suggested severe liver and kidney involvement. So far everything was consistent with Ebola Hemorrhagic Fever.

After Marissa finished with the chart, she got together the materials necessary for drawing and packing viral samples. When all was ready, she went down the hall with one of the nurses to the isolation area. There she donned hood, mask, gloves, goggles and booties.

Inside Zabriski’s room, two other women were similarly attired. One was a nurse, the other a doctor.

“How is the patient doing?” asked Marissa as she moved alongside the bed. It was a rhetorical question. The patient’s condition was apparent. The first thing Marissa noticed was the rash over the man’s trunk. The second thing was signs of hemorrhage; a nasogastric tube snaked out of the man’s nostril and was filled with bright red blood. Dr. Zabriski was conscious, but just barely. He certainly couldn’t answer any questions.

A short conversation with the attending physician confirmed Marissa’s impressions. The patient had been deteriorating throughout the day, particularly during the last hour, when they began to see a progressive fall in the blood pressure.

Marissa had seen enough. Clinically, the patient resembled Dr. Richter to a horrifying degree. Until proven otherwise, it had to be assumed that Dr. Zabriski and the other two subsequent admissions had Ebola Hemorrhagic Fever.

The nurse helped Marissa obtain a nasal swab as well as blood and urine samples. Marissa handled them as she’d done in L.A., double bagging the material and disinfecting the outsides of the bags with sodium hypochlorite. After removing her protective clothing and

washing her hands, she returned to the nurses’ station to call Dubchek.

The phone conversation was short and to the point. Marissa said that it was her clinical impression that they were dealing with another Ebola outbreak.

“What about isolation?”

“They’ve done a good job in that regard,” reported Marissa.

“We’ll be there as soon as possible,” said Dubchek. “Probably tonight. Meanwhile, I want you to stop all further lab work and supervise a thorough disinfection. Also have them set up the same kind of quarantine of contacts that we used in L.A.”

Marissa was about to reply when she realized that Dubchek had hung up. She sighed as she replaced the receiver; such a wonderful working relationship!

“Well,” said Marissa to Drs. Taboso and Austin, “let’s get to work.” They quickly set the quarantine measures in motion, arranging for the sterilization of the lab and assuring Marissa that her samples would be sent overnight to the CDC.

As they left to attend to their tasks, Marissa asked for the charts on the other two patients. The nurse, whose name was Pat, handed them to her, saying, “I don’t know if Dr. Taboso mentioned this, but Mrs. Zabriski is downstairs.”

“Is she a patient?” asked Marissa with alarm.

“Oh, no,” said Pat. “She’s just insisting on staying at the hospital. She wanted to be up here, but Dr. Taboso didn’t think it was a good idea. He told her to stay in the first-floor lounge.”

Marissa put down the two new charts, debating what she should do next. She decided to see Mrs. Zabriski, since she had very few details with regard to the doctor’s recent schedule. Besides, she had to stop by the lab to check the sterilization. Asking directions from Pat, Marissa rode down to the second floor on the elevator. En route she looked at the faces of the people next to her and guessed what their responses would be when they heard that there had been an Ebola outbreak in the hospital. When the doors opened on the second floor, she was the only one who got off.

Marissa expected to find the evening shift in the lab and was surprised to see that the director, a pathologist by the name of Dr. Arthur Rand, was still in his office, even though it was after 8:00 P.M. He was a pompous older man, dressed in a plaid vest complete with a gold fob protruding from one of the pockets. He was unimpressed that Marissa had been sent by the CDC, and his facial expression did

not change when Marissa said it was her clinical opinion that there was an outbreak of Ebola in his hospital.

“I was aware that was in the differential diagnosis.”

“The CDC has requested that no more lab tests be done on the involved patients.” Marissa could tell that the man was not going to make it easy for her. “We’ll be bringing in an isolation lab sometime tonight.”

“I suggest you communicate this to Dr. Taboso,” said Dr. Rand.

“I have,” said Marissa. “It’s also our opinion that the lab here should be disinfected. In the outbreak in L.A. three cases were traced to the lab. I’d be willing to help, if you’d like.”

“I believe that we can handle our own cleanup,” said Dr. Rand with a look that seemed to say, Do you think I was born yesterday?

“I’m available if you need me,” said Marissa as she turned and left. She’d done what she could.

On the first floor she made her way to a pleasant lounge with its own connecting chapel. She was unsure how she would recognize Mrs. Zabriski, but it turned out she was the only person in the room.

“Mrs. Zabriski,” said Marissa softly. The woman raised her head. She was in her late forties or early fifties, with gray-streaked hair. Her eyes were red rimmed; it was obvious she had been crying.

“I’m Doctor Blumenthal,” said Marissa gently. “I’m sorry to bother you, but I need to ask you some questions.”

Panic clouded the woman’s eyes. “Is Carl dead?”

“No,” said Marissa.

“He’s going to die, isn’t he?”

“Mrs. Zabriski,” said Marissa, wanting to avoid such a sensitive issue, especially since she believed the woman’s intuition was correct. Marissa sat down next to her. “I’m not one of your husband’s doctors. I’m here to help find out what kind of illness he has and how he got it. Has he done any traveling over the last-” Marissa was going to say three weeks, but remembering Dr. Richter’s trip to Africa, she said instead, “-the last two months?”

“Yes,” Mrs. Zabriski said wearily. “He went to a medical meeting in San Diego last month, and about a week ago he went to Boston.”

“San Diego” made Marissa sit up straighter. “Was that an eyelid surgery conference in San Diego?”

“I believe so,” said Mrs. Zabriski. “But Judith, Carl’s secretary, would know for sure.”

Marissa’s mind whirled. Zabriski had attended the same meeting as Dr. Richter! Another coincidence? The only problem was that the conference in question had been about six weeks previous, about the

same interval of time as from Dr. Richter’s African trip to the appearance of his symptoms. “Do you know what hotel your husband stayed in while he was in San Diego?” asked Marissa. “Could it have been the Coronado Hotel?”

“I believe it was,” said Mrs. Zabriski.

While Marissa’s mind was busy recalling the central role played by a certain hotel in Philadelphia during the Legionnaires Disease outbreak, she asked about Dr. Zabriski’s trip to Boston. But his wife did not know why he’d gone. Instead, she gave Marissa her husband’s secretary’s phone number, saying again that Judith would know that kind of thing.

Marissa took the number and asked whether Dr. Zabriski had been bitten by, or had been around, any monkeys recently.

“No, no,” said Mrs. Zabriski. At least none that she knew of.

Marissa thanked the woman and apologized for bothering her. Armed with the secretary’s home phone number, she went to call Judith.

Marissa had to explain twice who she was and why she was calling so late before the secretary would cooperate. Judith then confirmed what Mrs. Zabriski had told her: namely, that the doctor had stayed at the Coronado Hotel while in San Diego, that Dr. Zabriski had not been bitten recently by any animal, and, as far as she knew, that he’d not been around any monkeys. When Marissa asked if Dr. Zabriski knew Dr. Richter, the answer was that the name had never appeared on any correspondence or on his phone list. Judith said the reason that Dr. Zabriski had gone to Boston was to help plan the Massachusetts Eye and Ear Infirmary’s upcoming alumni meeting. She gave Marissa the name and phone number of Dr. Zabriski’s colleague there. As Marissa wrote it down, she wondered if Zabriski had unknowingly transferred the virus to the Boston area. She decided that she’d have to discuss that possibility with Dubchek.

As she hung up, Marissa suddenly remembered that she hadn’t called Ralph from the airport. He answered sleepily, and Marissa apologized both for waking him and for not getting in touch with him before she left Atlanta. After she explained what had happened, Ralph said that he would forgive her only if she promised to call him every couple of days to let him know what was going on. Marissa agreed.

Returning to the isolation ward, Marissa went back to the charts. The two later admissions were a Carol Montgomery and a Dr. Brian Cester. Both had come down with high fevers, splitting headaches and violent abdominal cramps. Although the symptoms sounded

nonspecific, their intensity gave sufficient cause for alarm. There was no reference to travel or animal contact in either chart.

After gathering the material necessary for taking viral samples, Marissa dressed in protective gear and visited Carol Montgomery. The patient was a woman one year older than Marissa. Marissa found it hard not to identify with her. She was a lawyer who worked for one of the city’s large corporate firms. Although she was lucid and able to talk, it was apparent that she was gravely ill.

Marissa asked if she had done any recent traveling. The answer was no. Marissa asked if she knew Dr. Zabriski. Carol said that she did. Dr. Zabriski was her ophthalmologist. Had she seen him recently? The answer was yes: she’d gone to him four days ago.

Marissa obtained the viral samples and left the room with a heavy heart. She hated making a diagnosis of a disease with no available treatment. The fact that she’d been able to uncover information that mirrored the earlier outbreak was small compensation. Yet the information reminded her of a question that had troubled her in L.A.:

Why did some of Dr. Richter’s patients catch the disease and others not?

After changing into fresh protective clothing, Marissa visited Dr. Brian Cester. She asked the same questions and got the same replies, except when she asked if he was one of Dr. Zabriski’s patients.

“No,” said Dr. Cester after a spasm of abdominal pain subsided. “I’ve never been to an ophthalmologist.”

“Do you work with him?” asked Marissa.

“I occasionally give anesthesia for him,” said Dr. Cester. His face contorted again in pain. When he recovered, he said, “I play tennis with him more often than I work with him. In fact I played with him just four days ago.”

After obtaining her samples, Marissa left the man, more confused than ever. She had begun to think that fairly close contact-particularly with a mucous membrane-was needed to communicate the disease. Playing tennis with someone did not seem to fit that mold.

After sending off the second set of viral samples, Marissa went back to Dr. Zabriski’s chart. She read over the history in minute detail and began the same type of diary she’d drawn up for Dr. Richter. She added what material she’d learned from Mrs. Zabriski and the secretary, knowing that she would have to go back to both of them. Although such work had not resulted in determining the reservoir of the virus in the L.A. outbreak, Marissa had hopes that by following the same procedure with Dr. Zabriski she might find some common

element in addition to both doctors having been to the same eye conference in San Diego.

It was after twelve when Dubchek, Vreeland and Layne arrived. Marissa was relieved to see them, particularly because Dr. Zabriski’s clinical condition had continued to deteriorate. The doctor taking care of him had demanded some routine blood work be done to determine the state of the patient’s hydration, and Marissa had been caught between the conflicting demands of treating the patient and protecting the hospital. She finally allowed those tests that could be done in the patient’s room.

After a cursory greeting, the CDC doctors all but ignored Marissa as they struggled to get the mobile isolation laboratory functioning and improve the isolation of the patients. Dr. Layne had some large exhaust fans brought in, while Dr. Vreeland immediately went down to the administration area to discuss improving the quarantine.

Marissa went back to her charts but soon exhausted the information they could supply. Getting up, she wandered to the isolation lab. Dubchek had removed his jacket and had rolled up his sleeves while he labored with the two CDC technicians. Some kind of electrical bug had developed in the automatic chemistry portion of the apparatus.

“Anything I can do?” called Marissa.

“Not that I can think of,” said Dubchek without looking up. He immediately began conversing with one of the technicians, suggesting they change the sensing electrodes.

“I would like a minute to go over my findings with you,” called Marissa, eager to discuss the fact that Dr. Zabriski had attended the same San Diego medical meeting as Dr. Richter had.

“It will have to wait,” said Dubchek coolly. “Getting this lab functioning takes precedence over epidemiologic theories.”

Going back to the nurses’ station, Marissa seethed. She did not expect or deserve Dubchek’s sarcasm. If he’d wanted to minimize her contribution, he had succeeded. Sitting down at the desk, Marissa considered her options. She could stay, hoping he might allow her ten minutes, at his convenience, or she could go and get some sleep. Sleep won out. She put her papers in her briefcase and went down to the first floor to rescue her suitcase.

The operator woke Marissa at seven o’clock. As she showered and dressed, she realized that her anger toward Dubchek had dissipated. After all, he was under a lot of stress. If Ebola raged out of control, it was his neck on the line, not hers.

When she arrived back at the isolation ward, one of the CDC lab techs told her that Dubchek had gone back to the hotel at 5:00 A.M. He didn’t know where either Vreeland or Layne was.

At the nurses’ station things were a bit chaotic. Five more patients had been admitted during the night with a presumptive diagnosis of Ebola Hemorrhagic Fever. Marissa collected the charts, but as she stacked them in order, she realized that Zabriski’s was missing. She asked the day nurse where it was.

“Dr. Zabriski died just after four this morning.”

Although she’d expected it, Marissa was still upset. Unconsciously, she had been hoping for a miracle. She sat down and put her face in her hands. After a moment she forced herself to go over the new charts. It was easier to keep busy. Without meaning to, she caught herself touching her neck for swelling. There was an area of tenderness. Could it be a swollen lymph node?

She was pleased to be interrupted by Dr. Layne, the Director of the CDC’s Hospital Infectious Disease Program. It was obvious from the dark circles under his eyes, his drawn face and the stubble on his chin that he had pulled an “all-nighter.” She smiled, liking his slightly heavyset, rumpled looks. He reminded her of a retired football player. He sat down wearily, massaging his temples.

“Looks like this is going to be just as bad as L.A.,” he said. “We have another patient on the way up and another in the ER.”

“I’ve just started looking at the new charts,” said Marissa, suddenly feeling guilty for having left the night before.

“Well, I can tell you one thing,” said Dr. Layne. “All the new patients seem to have gotten their disease from the hospital. That’s what bothers me so much.”

“Are they all patients of Dr. Zabriski’s?” asked Marissa.

“Those are,” said Dr. Layne, pointing at the charts in front of Marissa. “They all saw Zabriski recently. He apparently inoculated them during his examinations. The new cases are both Dr. Cester’s patients. He’d been the anesthesiologist when they had surgery during the last ten days.

“What about Dr. Cester?” asked Marissa. “Do you think that he contracted the disease the same way that Dr. Zabriski did?”

Dr. Layne shook his head. “Nope. I talked at length with the man, and I found out that he and Zabriski were tennis partners.”

Marissa nodded. “But would such contact count?”

“About three days before Dr. Zabriski became ill, Dr. Cester borrowed his towel between sets. I think that’s what did it. Transmission seems to depend on actual contact with body fluids. I think Zabriski is another index case, just like Dr. Richter.”

Marissa felt stupid. She had stopped questioning Dr. Cester just one question short of learning a crucial fact. She hoped that she wouldn’t make the same mistake again.

“If we only knew how the Ebola got into the hospital in the first place,” said Dr. Layne rhetorically.

Dubchek, looking tired but clean-shaven and as carefully dressed as always, arrived at the nurses’ station. Marissa was surprised to see him. If he’d left at five, he’d hardly had time to shower and change, much less get any sleep.

Before Dubchek could get involved in a conversation with Layne, Marissa quickly told both doctors that Zabriski had attended the same San Diego medical conference as Richter had and that they had stayed in the same hotel.

“It’s too long ago to be significant,” Dubchek said dogmatically. “That conference was over six weeks ago.”

“But it appears to be the only association between the two doctors,” protested Marissa. “I think I should follow up on it.”

“Suit yourself,” said Dubchek. “Meanwhile, I’d like you to go down to pathology and make sure they take every precaution when they post Zabriski this morning. And tell them that we want quick-frozen samples of liver, heart, brain and spleen for viral isolation.”

“What about kidney?” interjected Layne.

“Yeah, kidney, too,” said Dubchek.

Marissa went off feeling like an errand girl. She wondered if she would ever regain Dubchek’s respect, then remembering why she’d lost it, her depression was wiped out by a surge of anger.

In pathology, a busy place at that time of day, Marissa was directed to the autopsy rooms, where she knew she’d find Dr. Rand. Remembering his pompous, overbearing manner, she was not looking forward to talking with him.

The autopsy rooms were constructed of white tile and gleaming stainless steel. There was a pervading aroma of formalin that made Marissa’s eyes water. One of the technicians told her that Zabriski’s post was scheduled for room three. “If you intend to go, you have to suit up. It’s a dirty case.”

With her general fear of catching Ebola, Marissa was more than happy to comply. When she entered the room, she found Dr. Rand just about to begin. He looked up from the table of horrific tools. Dr.

Zabriski’s body was still enclosed in a large, clear plastic bag. His body was a pasty white on the top, a livid purple on the bottom.

“Hi!” said Marissa brightly. She decided that she might as well be cheerful. Receiving no answer, she conveyed the CDC’s requests to the pathologist, who agreed to supply the samples. Marissa then suggested the use of goggles. “A number of cases both here and in L.A. were apparently infected through the conjunctival membrane,” she explained.

Dr. Rand grunted, then disappeared. When he returned he was wearing a pair of plastic goggles. Without saying anything he handed a pair to Marissa.

“One other thing,” Marissa added. “The CDC recommends avoiding power saws on this kind of case because they cause significant aerosol formation.”

“I was not planning to use any power tools,” said Dr. Rand. “Although you may find this surprising, I have handled infectious cases during my career.”

“Then I suppose I don’t have to warn you about not cutting your fingers,” said Marissa. “A pathologist died of viral hemorrhagic fever after doing just that.”

“I recall,” said Dr. Rand. “Lassa Fever. Are you about to favor us with any further suggestions?”

“No,” said Marissa. The pathologist cut into the plastic bag and exposed Zabriski’s body to the air. Marissa debated whether she should go or stay. Indecision resulted in inaction; she stayed.

Speaking into an overhead microphone activated by a foot pedal, Dr. Rand began his description of the external markings of the body. His voice had assumed that peculiar monotone Marissa remembered from her medical school days. She was startled back to the present when she heard Rand describe a sutured scalp laceration. That was something new. It hadn’t been in the chart, nor had the cut on the right elbow or the circular bruise on the right thigh, a bruise about the size of a quarter.

“Did these abrasions happen before or after death?”

“Before,” he answered, making no attempt to conceal his irritation at the interruption.

“How old do you think they are?” said Marissa, ignoring his tone. She bent over to look at them more carefully.

“About a week old, I’d say,” Dr. Rand replied. “Give or take a couple of days. We’d be able to tell if we did microscopic sections. However, in view of the patient’s condition, I hardly think they are important. Now, if you don’t mind, I’d like to get back to work.”

Forced to step back, Marissa thought about this evidence of trauma. There was probably some simple explanation; perhaps Dr. Zabriski had fallen playing tennis. What bothered Marissa was that the abrasion and the laceration were not mentioned on the man’s chart. Where Marissa had trained, every physical finding went into the record.

As soon as Rand had finished and Marissa had seen that the tissue samples were correctly done, she decided to track down the cause of the injuries.

Using the phone in pathology, Marissa tried Zabriski’s secretary, Judith. She let the phone ring twenty times. No answer. Reluctant to bother Mrs. Zabriski, Marissa thought about looking for Dr. Taboso, but instead decided to check Dr. Zabriski’s office, realizing it had to be right there in the hospital. She walked over and found Judith back at her desk.

Judith was a frail young woman in her mid-twenties. Mascara smudged her cheeks; Marissa could tell that she’d been crying. But she was more than sad; she was also terrified.

“Mrs. Zabriski is sick,” she blurted out as soon as Marissa introduced herself. “I talked with her a little while ago. She’s downstairs in the emergency room but she is going to be admitted to the hospital. They think she has the same thing that her husband had. My God, am I going to get it too? What are the symptoms?”

With some difficulty, Marissa calmed the woman enough to explain that in the L.A. outbreak the doctor’s secretary had not come down with the illness.

“I’m still getting out of here,” said Judith, opening a side drawer of her desk and taking out a sweater. She tossed it into a cardboard box. She’d obviously been packing. “And I’m not the only one who wants to go,” she added. “I’ve talked with a number of the staff and they are leaving, too.”

“I understand how you feel,” said Marissa. She wondered if the entire hospital would have to be quarantined. At the Richter Clinic, it had been a logistical nightmare.

“I came here to ask you a question,” said Marissa.

“So ask,” said Judith. She continued to empty her desk drawers.

“Dr. Zabriski had some abrasions and a cut on his head, as if he’d fallen. Do you know anything about that?”

“That was nothing,” said Judith, making a gesture of dismissal with her hand. “He was mugged about a week ago, in a local mall while he was shopping for a birthday gift for his wife. He lost his wallet and his gold Rolex. I think they hit him on the head.”

So much for the mysterious question of trauma, thought Marissa. For a few minutes she stood watching Judith throw her things into the box, trying to think if she had any further questions. She couldn’t think of any just then, so she said good-bye, then left, heading for the isolation ward. In many ways she felt as scared as Judith did.

The isolation ward had lost its previous tranquility. With all the new patients, it was fully staffed with overworked nurses. She found Dr. Layne writing in several of the charts.

“Welcome to Bedlam,” he said. “We’ve got five more admissions, including Mrs. Zabriski.”

“So I’ve heard,” said Marissa, sitting down next to Dr. Layne. If only Dubchek would treat her as he did: like a colleague.

“Tad Schockley called earlier. It is Ebola.”

A shiver ran down Marissa’s spine.

“We’re expecting the State Commissioner of Health to arrive any minute to impose quarantine,” continued Dr. Layne. “Seems that a number of hospital personnel are abandoning the place: nurses, technicians, even some doctors. Dr. Taboso had a hell of a time staffing this ward. Have you seen the local paper?”

Marissa shook her head, indicating that she had not. She was tempted to say that she didn’t want to stay either, if it meant being exposed.

“The headline is ‘Plague Returns!’ “Dr. Layne made an expression of disgust. “The media can be so goddamned irresponsible. Dubchek doesn’t want anyone to talk with the press. He wants all questions directed to him.”

The sound of the patient-elevator doors opening caught Marissa’s attention. She watched as a gurney emerged, covered by a clear plastic isolation tent. As it went by, Marissa recognized Mrs. Zabriski. She shivered again, wondering if the local paper really had been exaggerating in their headline.

6

April 10

MARISSA TOOK ANOTHER FORKFUL of the kind of dessert that she allowed herself only on rare occasions. It was her second night back in Atlanta, and Ralph had taken her to an intimate French restaurant. After five weeks with little sleep, gulping down meals in a hospital cafeteria, the gourmet meal had been a true delight. She noticed that, not having had a drink since she’d left Atlanta, the wine had gone right to her head. She knew she was being very talkative, but Ralph seemed content to sit back and listen.

Winding down, Marissa apologized for chattering on about her work, pointing to her empty glass as the excuse.

“No need to apologize,” Ralph insisted. “I could listen all night. I’m fascinated by what you have accomplished, both in L.A. and in St. Louis.”

“But I’ve filled you in while I was away,” protested Marissa, referring to their frequent phone conversations. While she’d been in St. Louis, Marissa had gotten into the habit of calling every few days. Talking with Ralph had provided a sounding board for her theories as well as a way to relieve her frustration at Dubchek’s continued insistence on ignoring her. In both cases, Ralph had been understanding and supportive.

“I wish you’d tell me more about the community reaction,” he said. “How did the administrators and medical staff of the hospital try

to control the panic, considering that this time there were thirty-seven deaths?”

Taking him at his word, Marissa tried to describe the turmoil at the St. Louis hospital. The staff and patients were furious at the enforced quarantine, and Dr. Taboso had sadly told her he expected the hospital to close when it was lifted.

“You know, I’m still worried about getting sick myself,” admitted Marissa with a self-conscious laugh. “Every time I get a headache I think ‘this is it.’ And though we still have no idea where the virus came from, Dubchek’s position is that the virus reservoir is somehow associated with medical personnel, which doesn’t make me any more comfortable.”

“Do you believe it?” asked Ralph.

Marissa laughed. “I’m supposed to,” she said. “And if it is true, then you should consider yourself particularly at risk. Both index cases were ophthalmologists.”

“Don’t say that,” laughed Ralph. “I’m superstitious.”

Marissa leaned back as the waiter served a second round of coffee. It tasted wonderful, but she suspected she’d be sorry later on when she tried to sleep.

After the waiter left with the dessert dishes, Marissa continued: “If Dubchek’s position is correct, then somehow both eye doctors came into contact with the mysterious reservoir. I’ve puzzled over this for weeks without coming up with a single explanation. Dr. Richter came in contact with monkeys; in fact he’d been bitten a week before he became ill, and monkeys have been associated with a related virus called Marburg. But Dr. Zabriski had no contact with any animals at all.”

“I thought you told me that Dr. Richter had been to Africa,” said Ralph. “It seems to me that is the crucial fact. After all, Africa is where this virus is endemic.”

“True,” said Marissa. “But the time frame is all wrong. His incubation period would have been six weeks, when all the other cases averaged only two to five days. Then consider the problem of relating the two outbreaks. Dr. Zabriski hadn’t been to Africa, but the only point of connection was that the two doctors attended the same medical conference in San Diego. And again, that was six weeks before Dr. Zabriski got sick. It’s crazy.” Marissa waved her hand as if she were giving up.

“At least be happy you controlled the outbreaks as well as you did. I understand that it was worse when this virus appeared in Africa.”

“That’s true,” agreed Marissa. “In the Zaire outbreak in 1976, whose index case may have been an American college student, there were three hundred eighteen cases and two hundred eighty deaths.”

“There you go,” said Ralph, feeling that the statistics should cheer Marissa. He folded his napkin and put it on the table. “How about stopping at my house for an after-dinner drink?”

Marissa looked at Ralph, amazed at how comfortable she’d become with him. The surprising thing was that the relationship had developed on the telephone. “An after-dinner drink sounds fine,” she said with a smile.

On the way out of the restaurant, Marissa took Ralph’s arm. When they got to his car, he opened the door for her. She thought that she could get used to such treatment.

Ralph was proud of his car. It was obvious in the loving way he touched the instruments and the steering wheel. The car was a new 300 SDL Mercedes. Marissa appreciated its luxuriousness as she settled back in the leather seat, but cars had never meant much to her. She also couldn’t understand why people bought diesels since they had an uncomfortable rattle when they started and idled. “They are economical,” said Ralph. Marissa looked around at the appointments. She marveled that someone could delude himself that an expensive Mercedes was economical.

They didn’t speak for a while, and Marissa wondered if going to Ralph’s house at that time of night was a good idea. But she trusted Ralph and was willing to let their relationship develop a little further. She turned to look at him in the half-light. He had a strong profile, with a prominent nose like her father’s.

After they had settled on the couch in the parlor, with brandy snifters in hand, Marissa mentioned something she had been afraid to point out to Dubchek in his current patronizing mood. “There is one thing about the two index cases that I find curious. Both men were mugged just a few days before they got sick.” Marissa waited for a response.

“Very suspicious,” said Ralph with a wink. “Are you suggesting that there is an ‘Ebola Mary’ who robs people and spreads the disease?”

Marissa laughed. “I know it sounds stupid. That’s why I haven’t said anything to anyone else.”

“But you have to think of everything,” added Ralph. “The old medical-school training that taught you to ask everything, including what the maternal great-grandfather did for a living in the old country.”

Deliberately, Marissa switched the conversation to Ralph’s work and his house, his two favorite subjects. As the time passed, she noted

that he did not make any moves toward her. She wondered if it were something about herself, like the fact that she’d been exposed to Ebola. Then, to make matters worse, he invited her to spend the night in the guest room.

Marissa was insulted. Perhaps just as insulted as if he’d tried to drag her dress over her head the moment they walked in the front door. She told him thank you, but she did not want to spend the night in his guest room; she wanted to spend the night in her own house with her dog. The last part was meant to be an affront, but it sailed over Ralph’s head. He just kept on talking about redecorating plans he had for the first floor of the house, now that he’d lived there long enough to know what he wanted.

In truth, Marissa did not know what she would have done if Ralph had made any physical advances. He was a good friend, but she still didn’t find him romantically attractive. In that respect, she thought Dubchek’s looks distinctly more exciting.

Thinking of Cyrill reminded her of something. “How do you and Dr. Dubchek know each other?”

“I met him when he addressed the ophthalmology residents at the University Hospital,” said Ralph. “Some of the rare viruses like Ebola and even the AIDS virus have been localized in tears and the aqueous humor. Some of them even cause anterior uveitis.”

“Oh,” said Marissa, nodding as if she understood. Actually she had no idea what anterior uveitis was, but she decided it was as good a point as any to ask Ralph to drive her home.

Over the next few days, Marissa adapted to a more normal life, although every time the phone rang, she half expected to be called out for another Ebola disaster. Remembering her resolve, she did pack a suitcase and kept it open in her closet, ready for her to toss in her cosmetics case. She could be out of her house in a matter of minutes, if the need arose.

At work, things were looking up. Tad helped her perfect her viral laboratory skills and worked with her to write up a research proposal on Ebola. Unable to come up with a working hypothesis for a possible reservoir for Ebola, Marissa concentrated instead on the issue of transmission. From the enormous amount of data that she’d amassed in L.A. and St. Louis, she had constructed elaborate case maps to show the spread of the illness from one person to another. At the same time, she’d compiled detailed profiles on the people who had been primary contacts but who had not come down with the disease. As Dr. Layne had suggested, close personal contact was needed,

presumably viral contact with a mucous membrane, though, unlike AIDS, sexual transmission had only been a factor between Dr. Richter and the medical secretary and Dr. Zabriski and his wife. Given the fact that hemorrhagic fever could spread between strangers who shared a towel, or by the most casual close touch, Ebola made the AIDS scare seem like a tempest in a teapot.

What Marissa wanted to do was to validate her hypothesis by using guinea pigs. Of course such work required the use of the maximum containment lab, and she still had not obtained permission.

“Amazing!” exclaimed Tad, one afternoon when Marissa demonstrated a technique she’d devised to salvage bacteria-contaminated viral cultures. “I can’t imagine Dubchek turning down your proposal now.”

“I can,” answered Marissa. She debated telling Tad about what had happened in the L.A. hotel, but once again she decided not to do so. It wouldn’t accomplish anything and might cause problems in Tad’s relationship with Cyrill.

She followed her friend into his office. As they relaxed over coffee, Marissa said, “Tad, you told me when we went into the maximum containment lab that there were all sorts of viruses stored in there, including Ebola.”

“We have samples from every outbreak. There are even samples frozen and stored from your two outbreaks.”

Marissa wasn’t at all sure how she felt about people referring to the recent epidemics as “hers.” But she kept that thought to herself, saying instead, “Is there any place else that the Ebola virus is stored, other than here at the CDC?”

Tad thought for a moment. “I’m not sure. Do you mean here in the

U.S.?”

Marissa nodded.

“The army probably has some in Ft. Detrick at the Center for Biological Warfare. The fellow that runs the place used to be here at the CDC and he had an interest in viral hemorrhagic fevers.”

“Does the army have a maximum containment lab?”

Tad whistled. “Man, they’ve got everything.”

“And you say the man in charge at Ft. Detrick has an interest in viral hemorrhagic fever?”

“He was one of the people along with Dubchek who had been sent out to cover the initial Ebola outbreak in Zaire.”

Marissa sipped her coffee, thinking that was an interesting coincidence. She was also beginning to get a germ of an idea, one so unpleasant that she knew she could not consider it a reasonable hypothesis.

“One moment, ma’am,” said the uniformed sentry with a heavy Southern accent.

Marissa was stopped at the main gate to Ft. Detrick. Despite several days of trying to argue herself out of the suspicion that the army might have somehow been responsible for Ebola being loosened on an unsuspecting public, she had finally decided to use her day off to investigate for herself. Those two muggings continued to nag at her.

It had only been an hour-and-a-half flight to Maryland and a short drive in a rent-a-car. Marissa had pleaded her field experience with Ebola as an excuse to talk to anyone else familiar with the rare virus, and Colonel Woolbert had responded to her request with enthusiasm.

The sentry returned to Marissa’s car. “You are expected at building number eighteen.” He handed her a pass that she had to wear on the lapel of her blazer, then startled her with a crisp salute. Ahead of her, the black-and-white gate tipped up, and she drove onto the base.

Building #18 was a windowless concrete structure with a flat roof. A middle-aged man in civilian clothes waved as Marissa got out of her car. It was Colonel Kenneth Woolbert.

To Marissa, he looked more like a university professor than an army officer. He was friendly, even humorous, and was unabashedly pleased about Marissa’s visit. He told her right off that she was the prettiest and the smallest EIS officer he’d ever met. Marissa took the good with the bad.

The building felt like a bunker. Entry was obtained through a series of sliding steel doors activated by remote control. Small TV cameras were mounted above each door. The laboratory itself, however, appeared like any other modern hospital facility, complete with the omnipresent coffeepot over the Bunsen burner. The only difference was the lack of windows.

After a quick tour, during which the presence of a maximum containment lab was not mentioned, Colonel Woolbert took Marissa to their snack shop, which was nothing more than a series of vending machines. He got her a donut and Pepsi, and they sat down at a small table.

Without any prompting, Colonel Woolbert explained that he’d started at the CDC as an EIS officer in the late fifties and had become increasingly interested in microbiology and ultimately virology. In

the seventies, he’d gone back to school, at government expense, to get a Ph.D.

“It’s been a hell of a lot better than looking at sore throats and clogged ears,” said the Colonel.

“Don’t tell me you were in pediatrics!” exclaimed Marissa. They laughed when they realized they had both trained at Boston’s Children’s Hospital. Colonel Woolbert went on to explain how he’d ended up at Ft. Detrick. He told Marissa that there had been a history of movement between Detrick and the CDC and that the army had come to him with an offer he couldn’t refuse. He said that the lab and the equipment were superb, and best of all, he didn’t have to grovel for funds.

“Doesn’t the ultimate goal bother you?” asked Marissa. “No,” said Colonel Woolbert. “You have to understand that three-quarters of the work here involves defending the U.S. against biological attack, so most of my efforts are directed at neutralizing viruses like Ebola.”

Marissa nodded. She’d not thought of that.

“Besides,” continued Colonel Woolbert, “I’m given complete latitude. I can work on whatever I want to.”

“And what is that just now?” asked Marissa innocently. There was a pause. The colonel’s light-blue eyes twinkled.

“I suppose I’m not violating the confidentiality of the military by telling you, since I’ve been publishing a string of articles on my results. For the last three years my interest has been influenza virus.”

“Not Ebola?” asked Marissa.

Colonel Woolbert shook his head. “No, my last research on Ebola was years ago.”

“Is anyone here at the center working on Ebola?” asked Marissa. Colonel Woolbert hesitated. Then he said, “I guess I can tell you, since there was a Pentagon policy paper published on it in Strategic Studies last year. The answer is no. No one is working on Ebola, including the Soviets, mainly because there is no vaccine or treatment for it. Once started, it was generally felt that Ebola Hemorrhagic Fever would spread like wildfire to both friendly and hostile forces.”

“But it hasn’t,” said Marissa.

“I know,” said Colonel Woolbert with a sigh. “I’ve read with great interest about the last two outbreaks. Someday we’ll have to review our assessment of the organism.”

“Please, not on my account,” said Marissa. The last thing she wanted to do was encourage the army to work with Ebola. At the same time she was relieved to learn that the army was not fooling around with the virus just then.

“I understand you were part of the international team that was sent to Yambuku in 1976,” she said.

“Which makes me appreciate what you’re doing. I can tell you, when I was in Africa I was scared shitless.”

Marissa grinned. She liked and trusted the man. “You are the first person to admit being afraid,” she said. “I’ve been struggling with my fear from the first day I was sent to L.A.”

“And for good reason,” said Colonel Woolbert. “Ebola’s a strange bug. Even though it seems it can be inactivated quite easily, it is extraordinarily infective, meaning that only a couple of organisms have to make entry to produce the disease. That’s in marked contrast to something like AIDS, where billions of the virus have to be introduced, and even then there is only a low statistical chance that the individual will be infected.”

“What about the reservoir?” asked Marissa. “I know the official position is that no reservoir was discovered in Africa. But did you have an opinion?”