Plague

CHAPTER 4

Dr. Samantha Bower looked up from her textbook and at the clock on the wall of the cafeteria at the Centers for Disease Control in Atlanta. It was nearly one in the morning and her back was beginning to ache from an old soccer injury she’d incurred in high school. The fact that she had gone skydiving earlier that morning and landed hard on a steeply inclined hill didn’t help the old injury.

She stretched from side to side and checked her iPhone. Her boss, the director of the National Center for Emerging and Zoonotic Diseases within the CDC, had decided to take a three-week European vacation. The task of finishing the report on a rare strand of influenza infections in Mongolia-that the deputy director of Infectious Diseases wanted right away for no reason at all-fell on her shoulders. It’d been ten days of eight hours in her actual work, fielding calls, drafting research memos, and filing reports, and then eight hours on her own time, fielding calls, drafting research memos, and filing reports.

She decided she’d had enough for today and stood up, picking up her book, Kann’s DNA Virus Replication, and headed out the doors to the parking lot. It was warm and the moon was up in the dark sky. The lighting over the lot was dim, as many of the bulbs were out. Few things in the building were maintained well but no one that worked there seemed to mind. As the director had said in a recent speech, they were at the forefront of medicine and microbiology. Using theories to predict outcomes in real-life scenarios. It was, as far as she could tell, the most exciting place for a physician or microbiologist to work, though few of her colleagues from medical school would think so.

She hopped onto Interstate 75 and headed home in her silver Jeep Grand Cherokee. She rolled down the windows and let the air flow over her face and through the car, rustling some papers in the back. Atlanta at this time of night was no place for her to be out but she had never been afraid. Her father had warned her that Atlanta had more car-jackings per capita than any other major American city. But she saw instances, like car-jackings, as statistical probabilities not real threats. By driving at night she had increased her probability of being car-jacked but the chance was still so remote that she wasn’t worried. Then again, lightning had to strike somewhere.

It took her thirty-five minutes to reach her brownstone in a quiet suburb just near Sandy Springs. She parked in the driveway, too tired to open the garage, and set the alarm to her car before deactivating the alarm to her house.

The house was cool and the air conditioner clicked off as she entered. It was decorated modestly with little extravagance other than a few photographs and paintings related to music, a career as a violinist being her first choice since she was a child. Sam kicked off her shoes, set her alarm, and crawled into bed without brushing her teeth or changing.

Sam awoke at ten in the morning. It was Saturday and the sun was streaming through the windows, lighting up the open spaces in her home. She considered calling her sister Jane in San Francisco and then decided to shower first.

After showering and changing into denim shorts and a black Calvin Klein shirt, she turned on her iPhone and grabbed a protein shake out of the fridge. She stepped outside and wondered whether she should take a quick walk around the park that was located a few minutes up the block.

Jane didn’t answer and Sam left a message asking her to give her a call back when she got up. Three houses down was a small bungalow with an American flag up over the porch, a carving up on the door of marines putting up the flag at Iwo Jima. Sam took out a key and unlocked the door before entering.

The house was decorated in a style that belonged to decades past; she had always guessed the sixties but had no evidence for that other than a black velvet painting of Elvis. She walked through the house and shouted, “Hello?” There was no reply.

Making her way to the north side of the house, she entered the master bedroom. An elderly woman lay in bed, staring at a television that had the sound turned down all the way. Sam pulled up a stool and sat down next to her.

“How are you, Ma?”

“Your uncle Johnny needs to get into the house. Don’t forget to leave your key above the door frame.”

Sam reached over and began to straighten her sheets. “Uncle Johnny’s been dead for over twenty years, Ma. Remember, we talked about this yesterday.”

“He needs the key so that he can get his albums. Oh, him and those albums. I swear he loves those things more than he loves me.”

Sam looked at her a moment; the innocence in her eyes penetrated her. “No, he loves you more than anything.” Sam cleared her throat, choking back the emotion that bubbled inside her. “Where’s your nurse, Ma?”

“Oh that one, that’s another one. The Mexican.”

“Rosa’s very nice. She really likes working here.”

Her mother shrugged. It was confusing for Sam at first: the moments of lucidness coupled with the immediate comment or question that revealed her mother did not know where she was or what time she was in. But Sam was used to it now, as much as someone could be, and she tried to ignore it as much as possible.

“Do you know where Rosa is?”

“She went out for some milk of magnesia. We’re all out. She’s a nice girl to get my milk of magnesia.”

Samantha saw a bowl of cereal on the side table. “Let’s finish the cereal,” she said, taking the bowl and spooning some cereal gently into her mother’s mouth.

She stayed with her mother, rubbing her head until she fell asleep. Rosa got home shortly after. Sam spoke a few minutes with her about the medication situation and told her she would be back tonight to take her mother on a walk in her wheelchair.

Sam stepped outside and had to lean against the door for a moment. She remembered when her mother stood at the oven, stirring delicious stews or baking cakes with generic ingredients bought in bulk because they could only afford to get groceries every other week. Though Sam could afford expensive restaurants now, somehow the cheap cupcakes and beef stroganoff her mother made were the best things she had ever eaten.

After her father’s death late in life, her mother seemed invincible raising four children on her own. To see her shrink away to nearly nothing and not even know who Sam was most of the time tore her guts out, but she couldn’t stop coming. Her mother had been there when she needed her and she was going to return the favor no matter what.

Sam called her sister again but again there was no answer. As she pulled the phone away from her ear, she saw that the voicemail icon had a one next to it. She clicked on it and listened to the message:

This is Gale with CDC dispatch. Please call Dr. Ralph Wilson immediately.

The time display on the message said she had received it at 3:17 a.m.

Sam called the CDC mainline as she leisurely strolled down the sidewalk. It was going to be hot today but for now the temperature was perfect in a cloudless sky. She could see the park no more than two blocks away and throngs of children were already there. Occasionally, she would sit on the benches and watch them for long periods of time.

“CDC dispatch, this is Monique.”

“Hi, Monique, this is Samantha.”

“Oh, hi, Dr. Bower. How are you?”

“Good. I got a message from Gale that Ralph needed to speak to me.”

“Yup. I’ll put you through.”

After a click, Dr. Ralph Wilson, one of the most influential men in public health, sneezed, swore under his breath, and said, “My wife doesn’t return my calls either,” by way of greeting.

“Sorry, I was up until one in the morning working on something for Nancy.”

“Yeah, she’ll do that to you. What was it for?”

“The report you wanted on the influenza outbreak in Khovd.”

“Shelve that. I got something I want you to look in to.”

“What is it?”

“Could be nothing, but could be something. I know it’s Saturday but you’re the agent on call right now I think.”

“I am. We alternate weeks.”

“It’s an emergency room physician in Honolulu. Gerald Amoy. Goes by Jerry. Do you have a pen?”

“No.”

“I’ll text you his information. Give him a call. He’s put in a request for help so I took the liberty of booking your flight for two this afternoon. You okay with that?”

“Sure, I didn’t have any plans for today,” she said calmly, hiding her excitement for a free trip to Hawaii.

“I figured you wouldn’t mind. I’ll send his information over now.”

Sam got to the park and sat on a bench in front of the swing set. A young girl was being pushed by her mother and Sam watched the young girl’s smile and the way she would squeal when she got pushed just a bit too high. Sam didn’t notice that her phone had vibrated with an incoming text and when she glanced down at it she saw that ten minutes had passed.

She clicked on the number displayed in the text.

“Queen’s Medical Center Emergency.”

“Hi, this is Dr. Samantha Bower with the Centers for Disease Control. I need to speak with a Dr. Gerald Amoy. I’m returning his call.”

“Let me page him.”

She was put on hold and heard a ukulele with a soft voice singing over it. The lyrics were in Hawaiian and it excited her even more. She hadn’t been on a real vacation…well, ever. She had worked her way through medical school at the University of Arizona and had no time off during her surgical residency.

Just thinking of the hours she put into her residency in a busy hospital in the suburbs of Chicago sent a chill up her back. As a matter of course she would be in the hospital over a hundred hours a week, leaving no more than six hours a day to eat, sleep, drive, shower, spend time exercising, reading, talking with her family, and anything else she might have had to do. Within the first two weeks, she knew she no longer wanted to be a surgeon.

Luckily, she had met the chief of infectious disease research at the University of Chicago’s Department of Biology at a CME course for physicians. He’d shown up half-drunk and hit on her and then, seemingly to impress her, indicated he was looking to replace one of the physicians on his staff that was leaving the program due to substance abuse issues. She jumped at the opportunity. She applied and got the position after just one interview. The fact that it paid half what the average medical school graduate could expect to earn didn’t hurt, as there were only seven other applicants.

The nine-to-five research schedule made her feel as if she had been freed from prison. She completed three years and was going to take a position with a prestigious clinic in her hometown of San Francisco when she discovered the world of epidemiology on the job, and, almost without any effort, received an offer from the CDC through her connections at the University of Chicago.

“This is Amoy.”

“This is Samantha Bower from the Centers for Disease Control. I’m just responding to a request we received.”

“Oh, I’m glad you called. Just a second.” There was some shuffling and she could hear him give instructions to somebody. “Sorry about that.”

“No problem. So what can we do for you, Dr. Amoy?”

“I have two patients here that are displaying symptoms of an unknown viral infection. One of them is in critical care-I don’t think he’s going to last much longer. The other has just started displaying symptoms. We have them both in isolation here in the hospital.”

“What are their symptoms?”

“The first victim had a rash that’s now displaying on the second. The first victim is hemorrhaging sub-dermally. In the last ten hours or so the skin has begun falling off in sheets. There’s been dark hemorrhaging from the eyes, ears, penis, and anus. We’ve had him on almost constant blood transfusion but it’s not affecting him anymore. Infection is spreading through his body on the portions where the skin has come off. I called because I didn’t think he’d survive more than another day or two and thought you might want to look at him.”

“I won’t be there until tonight. Can I call you when I land?”

“Sure, I’m heading out right now but I’m on a twenty-four-hour shift starting at eleven. Just leave a message if I don’t answer right away.”

“Okay, thanks, Doctor.”

“No, thank you.”

Sam hung up and took a deep breath as she put her phone away. The symptomology of the victims indicated a severe viral infection. There were any number of known viruses that could cause those symptoms, and many more that science hadn’t discovered yet. Of course, she’d seen similar symptoms before and it had been a false alarm. The patient displayed Marburg virus type symptoms and it turned out that they had smoked a bad batch of methamphetamine, cut with dozens of poisonous substances, over the course of a week. An actual unknown viral infection that could cause those symptoms was extremely rare and the likelihood was that this was something else.

Still, her belly tingled with excitement and anticipation, and also fear. This was why she had gone into epidemiology in the first place. She looked at the young girl and smiled at her before rising and heading back to her house to pack.