Dead on Arrival

Eight

“Dr. Martin.”

“Dean Thomas, what a pleasant coincidence.”

Lyle Martin nodded with a tight smile and kept up the slick steps at a trot, passing by the pantsuited woman under the umbrella.

“Dr. Martin,” Dean Jane Thomas called after him. Mix of plaintive and displeased. A tone no one likes to hear but she clearly liked to use. Next to her stood a man in a purple-checked gingham shirt and a blue suit a quarter size too small, the fabric tugging at his back and shoulders. The dean, exhaling audibly, walked after Lyle. In her non-umbrella hand, a phone cocked like a weapon. “I need to talk to you.”

“You know I cherish our meetings,” Lyle said without turning. “I’ve got lecture.”

“It started ten minutes ago, Dr. Martin.”

Now, reaching the tall glass doors of Genentech Hall, he turned. He looked at her, then the man in the suit, seemed to consider saying something about the dean’s cheap shot, half smiled, and turned back to the door. On the other side, Lyle’s assistant held a gray cardboard coffee tray, watching the scene unfold. “It’s cold,” she said to Lyle. “They’re lining up outside.”

“Lyle!” Dean Thomas called.

“Emily, can you arrange for me to chat with the dean,” Lyle said, taking the coffee too briskly, a wave spilling over the side and cascading onto the beach of his tan sweater. This completed the picture, the contrast between Dr. Martin, hair matted by sleep and drizzle, and the majesty of the nearly half-million square feet of marble and glass science hall at the University of California, San Francisco medical school. One of the world’s gems.

“Let this be a lesson to you, Emily. If you’re late for class, the dean will show up brandishing an umbrella.”

“I think she’s here for a different reason,” the young lady said, and then, realizing that Lyle knew that, reddened, a look that measured on the dial beyond humiliation and well into schoolgirl crush.

At the door, the dean lowered her chin, shook her head.

“You warned me,” said the man in the suit. His firm tone was a touch undone by the singsong of a southern Tanzanian accent, the mixed influence of Swahili, Portuguese, and military training. Hand at his side, he involuntarily made a fist and then unclenched it. “How long is this class?”

“Asshole,” the dean muttered, referring to Lyle, and followed the scientist and his intern. She had given up on catching him. She turned to the man. “Michael, I think I’d like to hook you up with Dr. Sanchez instead. She’s not…”

“An asshole?” Michael said.

The dean, in spite of herself, laughed bitterly. “Dr. Martin is not… He’s, how do I describe it?”

“Someone who drinks himself to sleep?”

This paused the dean in her tracks. “Actually, I don’t think so—the drinking part. I’m not sure where you got that information.”

“In any case, my government is not negotiable on this one. He’s the best and it’s got to be him. And soon. How do you say it: yesterday? This can’t get across the border.” Michael paused. “Or into the news.”

Half a hallway away, wet shoes squeaking on smudgy tile, Lyle arrived at the auditorium entrance. “Good morning,” he said to the handful of students standing outside. “I’m sorry I’m late. I wrestled my alarm clock to the death, and I won.”

It got an adoring laugh that Lyle didn’t seem to be asking for, or even particularly notice. “Dr. Martin,” called a med student in the clump, clutching a biology tome to his chest. “Will you hold office hours today?”

“He’s got an hour scheduled,” responded Emily.

She trailed him through the wooden doors of the spacious auditorium, clamoring with small talk, clacking of keys on gadgets, and, as Lyle made his way down the aisle, the brushing of backs on chairs. A capacity crowd filled the 268 seats, with a handful of others plopped on the ground in front of the stage. The popularity of these twice monthly lectures owed in no small part to Lyle’s little rivaled capacity for mixing war story with substance. Some academics come off like orchestra conductors, prim and distant, others like the Beatles, brilliant but singular and unapproachable. Lyle more like Keith Richards, an everyman with serious licks. Or maybe a thirty something, Harrison Ford, the disheveled version, but hunting for disease and not treasure. The kind of things students loved—but some colleagues resented because it didn’t fit their scholarly mold.

“If it makes them feel any better, you’re totally inaccessible emotionally,” Melanie had told him in the previous night’s version of toe to toe.

No response from Lyle on that.

“At the risk of repeating myself, you weren’t always like this, Peño.” That was her nickname for Lyle, “Peño,” short for Jalapeño, reflecting the sizzle nature of their relationship the first few years.

Lyle hiked the four stairs on the right side, strode to the podium, looked up and then… full stop. He gazed out at the audience, now come almost fully to attention, and he seemed to have lost all momentum. Many onlookers assumed he was centering himself, and the place. The ones near the front of the room, though, they wondered if it was something else. Were those tears in Lyle’s eyes?

It crystallized into such a particular moment that it was impossible to ignore the pop when someone near the left side of the auditorium broke a gum bubble. This yanked Lyle back from wherever he was visiting in his mind. He cleared his throat, reached into his back pocket, and pulled out notes. Unfolded them onto the lectern.

“Where were we?” His voice projected over the microphone. A piercing screech followed from the microphone. Lyle tapped it, and the interference receded. He glanced at his notes.

From the audience, a woman shouted, “Saudi Arabia!” The voice rang just at the same moment Emily was saying the same thing—“Saudi Arabia”—from behind the curtain to Lyle’s left.

“Saudi Arabia,” Lyle said. “That’s right. Hickam’s dictum.”

He looked up.

“Hickam’s dictum,” he repeated. “We’ve talked about Occam’s razor.”

Occam’s razor, a key principle in medicine, says that when there are competing theories to explain a medical condition, the doctor should favor the simpler one. Or, as Sir Isaac Newton restated the fourteenth-century logic: “We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances.”

Lyle glanced at the group. “It can be tempting to look for complex causes and diagnosis. But that often is a form of self-deception, the seeds of imagination, vain hope. Often, things are just as simple as they might appear, much as we are inclined to dupe ourselves.”

Again, he paused, something odd. Where exactly was he going with this?

Dr. Martin, Emily mouthed inaudibly, wishing she could whisper in his ear.

The silent admonition seemed to make its way to him through the ether, or maybe he realized he was getting off track. “As a clinician, it is not necessary to overcomplicate things, Occam’s razor. Much as we’d like to discover something extraordinary, it’s usually, I’m sorry to say, just a head cold.” Some laughter. “Bed rest and fluids will do the trick.

“But then, along came Dr. John Hickam. He gave us permission to get our money’s worth out of medical school.” Lyle explained that Hickam’s principle allows that multiple symptoms often can be explained only by multiple diagnoses—not just a single disease or pathology but, in fact, several. This comes into play, in particular, when you have a patient with a compromised immune system.

Lyle scanned the auditorium. “There’s a great phrase to describe Dr. Hickam’s dictum. It goes like this: the patient may have as many diagnoses as he damn well pleases.” Laughter. “Which brings us to Saudi Arabia.” He told them previously that he’d done some early training in the Epidemiology Outbreak Office for the Centers for Disease Control. After doing a stint like that, the government would occasionally ask Lyle, or others in the program, to visit a place or person in need of a specialized medical consult.

“A guy in the State Department called and asked me if I’d go visit a government minister in Riyadh,” Lyle told the audience. He said the State Department officer told him that the guy had MERS and wasn’t responding to treatment. First class ticket, three-day turnaround, Lyle could stay at a palace.

Lyle seemed not to notice how much he had his audience rapt. He did, though, notice the dean, standing in the aisle near the back, and, more than her, he noticed the man next to her, wearing the too-tight suit. The man stood solidly, not rocking back and forth impatiently like the dean, watching Lyle, studying him.

“I’m sure you’ve read up on MERS,” Lyle addressed the students. “But as a refresher…” He told them about Middle East respiratory syndrome coronavirus. It reared its head in 2012 in Saudi Arabia, thought to originate in camels. Symptoms include severe cough, gastrointestinal issues, kidney failure. It can be fatal. Lyle flew to King Khalid airport in Riyadh, got whisked past to a midlevel palace and an opulent bedroom turned medical suite with a man in his seventies prone in a gold-posted bed under a canopy. The minister.

Next to the bed stood a bodyguard in telltale fatigues, and a nurse with ice for the old man’s lips and, cross-armed, his doctor, looking grave. The doctor gave Lyle an update: a CT scan showed a nodule on the lung, consistent with a MERS diagnosis, diarrhea, mostly consistent with it, and also stiff neck, light sensitivity, bouts of confusion.

“What’s lesson number one?” Lyle asked his audience.

Voices from the audience in dystonic harmony: “Take a history.”

So much of infectious disease diagnosis comes from taking a careful patient history. That was the thing Lyle told this class, and every class, on day one. Get a pet history, food history, sexual history, ancient history, and new history. Frontline doctors, in the emergency room or even at clinic, can see symptoms consistent with a pathology, make a fairly reached conclusion about diagnosis but one that is at odds with history.

“I pulled up a chair next to the minister. People need to feel you are the same level that they are on. Never forget the power of your white coat to unnerve; there’s almost nothing you can do to diminish it. So find the humblest place you can. The less arrogance you communicate, the more likely that most patients will share a real history with you. In the case of the minister, the second that I sat down, he dismissed everyone in the room with a wave of his hand. The bodyguard didn’t move and then the minister swatted him out as well.” Lyle then explained that he had asked the minister basic questions to establish a baseline of communication and gauge cognition. How old was he (seventy-one); where was he born (outside Medina); what was he a minster of (domestic police); did he have a family (yes, wife, two sons, and a daughter); did he have much interaction with animals (no); what was his diet like?

“Are you a doctor?” the minister asked Lyle.

“Yes.”

“Then get on with the doctoring,” the man said. He had a white beard and he had been heavy once. Sleeplessness tore at his eyes and left cracked skin at each corner of his mouth. Fear and inner ugliness trickled out in his voice, the sound of a powerful person unaccustomed to feeling helpless.

“The minister’s comment that I should get on with the doctoring was an important moment,” Lyle explained to the students. “It told me that this might be one of those people who actually preferred me to be in a position of authority, rather than one of mere expertise. I don’t want to make more of bedside style than necessary, but I also want to tell you how essential the role of listening, really listening, is. In this case, he was telling me I didn’t need to be so humble after all.” He paused. “So I could just go ahead and be the arrogant jerk my wife tells me that I am.”

There was a smattering of laughter but not so much. Lyle continued with the story. Next to the minister’s bed, Lyle cleared his throat.

“May I examine you?”

The man struggled to pull himself up on his bed.

“Just turn over,” Lyle told him. “Please, pull off your shirt.”

The minister removed the body-length nightshirt, his back exposed. Lyle ran his hand along wrinkled skin over depleted back muscles. He spent some time moving the skin around on the man’s neck.

“Right-handed, played a sport. You have slightly more developed muscles and scar tissue on the right.”

“Hound hunting.”

“You’ve had some hearing loss.”

“Yes.”

“Did the hunting cause your hearing loss?”

“No. How can you tell about my hearing?”

“Small mark on the skin around your ear. Sometimes, that area can get itchy if the nerves get irritated from a hearing aid. Behaves like dry skin.”

“My hearing loss is a state secret. I have to pretend I’m listening to the king.”

“Of course. Doctor/client privilege. How long have you been married?”

“Sixty-one years.” The minister was starting to relax. That was the goal. Yes, Lyle was looking for any unusual external markings, bites or lesions, signs of infection. Mostly, he was getting the man to relax. This was a veritable backrub.

“You are monogamous—with your wife?”

“The only woman for sixty-one years.”

An hour later, Lyle had been over the man head to toe. He’d looked at the chart, read the CT scan. He’d looked in the man’s eyes, causing the minister to recoil, confirming the light sensitivity. He cocked his head back and forth, like a metronome, lost in rhythmic thought.

Back in the auditorium at UCSF, the audience hung on his story, much like Lyle had the minister caught up in the examination. It had been an act of trust building.

“I explained to the minister that I thought we needed one more test,” Lyle told his audience of med students. “Would anyone like to guess what that test was?”

Lots of looks down by students at their laps. Even in an audience this big, many students felt like they’d not like to let down Dr. Martin with a flier, a wrong guess. From the back, a hand rose.

“Yes,” Lyle said. “No hands needed here. Just let ’er rip.”

“An MRI of his brain,” said a woman’s voice. “With contrast, I’d guess.”

“Very good.” Lyle nodded approvingly. “Just what I told the minister. Almost my exact words.”

The minister said, “Sure, yes. If you say so. What will that tell us, Dr. Martin?”

“The MRI is going to show us your brain. I suspect, strongly, it will show us a fungal infection. Crypto meningitis.”

“So that’s what I have? Meningitis?” The minister pushed himself up on his bed, his gown back on, his face strained with pain he struggled to hide.

“Yes and no.”

“Which is it: Yes or no?”

“The fungus is a by-product.”

“Of what? Of the MERS?”

Lyle felt it had gone on long enough. “I’d like to talk about your sexual history.”

“I told you already. I’m married.”

“And you’ve never been with another woman.”

“You are testing me?”

“You’ve been with a man.”

“Excuse me?”

“I believe you’ve got HIV, on top of MERS. It would be simple enough to give you an HIV test to prove it. But I bet your doctor wouldn’t even allow himself to think about such a test. It would insult you and even be dangerous. I hear they flog people here for that sort of behavior.”

“What sort of behavior.”

“Homosexual.”

“I flog people for that sort of behavior.”

“Well, Minister, I think you’re going to want to change your policy or your own practices.”

“You’re a quack!” His words exploded in a hacking cough. He doubled over.

“Minister, let me add it up for you. You haven’t responded fully to MERS treatment. You’ve got cognition issues and light sensitivity. Pronounced stomach issues, a lung nodule. All of that says to me that your immune system is compromised. On top of that, you sent your people out of the room when it was time to talk to me—”

“So.”

“Maybe nothing. Maybe that you wanted privacy. And I can see why, given the marks.”

“What marks?”

“You’ve got several areas of light purple skin on the back of your neck.”

“I’m getting older. It’s my skin.”

“You know the term quack, Minister, so I’m guessing you are also familiar with the term ‘hickey’?”

The minister glared at him. “This is a joke. Are you the best that the United States has to offer me?”

“I’m definitely not the best. But I have had my share of hickeys, and I’ve given a few too. I know what they look like. And I have seen my share of men die terrible deaths from HIV. Most of them contracted it through sex with other men.”

The minister clenched his jaw, now seemingly to calculate.

Back in the auditorium, Lyle leaned on the lectern. “Nothing special about the diagnosis. In fact, I suspect his personal doctor knew what it was and was looking for someone from the outside to take the fall. In the end, they left the official diagnosis as meningitis and gave the minister an antiviral cocktail that just happened to be the same thing they give for HIV.

“The minister died nine months ago. His condition wound up being widely speculated about. He also spent the last few years of his life intensifying his attacks on homosexual behavior. His rage at his own condition, his hypocrisy, amplified. I mention this, and the story, to impart a particular idea about pathologies, diseases. They are, in their own way, straightforward. They aim to kill an otherwise healthy body. They have a deadly agenda but they don’t hide it. Pathology is not duplicitous. It does not discriminate. It doesn’t choose. It is precisely what it represents itself to be. The same cannot always be said of people.”

At the edge of the stage, Emily, Lyle’s intern, tensed. Dr. Martin was out on that Dr. Martin ledge again, heading to parts unknown. In the back of the room, Dean Thomas had a similar but less generous version of the thought: The asshole is going to get rave reviews again, and for what, storytelling?

“Hickam’s dictum,” Lyle continued. “Patients can have as many diseases as they damn well please. Implicit in the phrasing is that people choose illness. This, of course, is utterly false on its face. They don’t choose. But they can reveal. Even inadvertently, often, in fact, inadvertently. I urge you, when you sit at the bedside, to think about the person, the individual. Consider his or her history, habits, as well as the larger context of culture, constituency, demographic. Think about what makes a person tick. What separates a good doctor from a great doctor, in my opinion, happens outside the pages of the book.”

In the back of the room, the man in the too-tight suit smiled. He thought, Dr. Martin is brilliant, just as advertised.

“Dr. Martin,” Emily called quietly. He turned to the side. She pointed to her watch. He nodded and turned back to the stage.

“Having said all that about going beyond the book, I’d like if everyone could read the next three chapters of infectious disease principles and practices. If there are any questions, I think we’ve got some office hours set up in the lounge.” A smattering of applause accompanied the sound of students standing, packing up, hustling on. Lyle could feel his heart working double time with the pulse of dehydration and still metabolizing sleep drugs, and from stress toxins left over from his fight with Melanie. He let his eyes wander to the dean and her guest. Whatever they wanted to talk to him about, he’d seen enough to know. Someone was dying.

Nine

Dean Thomas marched up the aisle, looking ever the headmistress. She made a beeline for Lyle. Trailing her, a foot behind, more measured, walked Michael Swateli, a Tanzanian attaché to the CDC. Lyle ignored the both of them and followed Emily to an adjoining conference room they sometimes used for office hours. It was antiseptic, just a rectangular table made of cheap wood and, on the wall, a whiteboard. A yellow sheet of paper tacked inside the door indicated the place was not to be used for study.

Nearly two dozen students showed up. Lyle sat on the edge of the table and the students mostly stood, a few taking the nearest chairs. The dean stood near the door, resigned that Lyle appeared to be going through with his office hours. She was in a bit of a tough spot in that she had just a few weeks earlier urged him to show up for all his obligations (by which she mostly meant his faculty obligations) and couldn’t now easily yank him from his scheduled office hours. Even though a foreign governmental official stood nearby with an urgent request.

“Mr. Swateli,” she said in a low voice, “I do think Dr. Sanchez could be a great alternative for you.”

“We had this conversation, Dean Thomas.”

“She’s respected without peer for her broad-based understanding of—”

“I’m happy to wait,” Michael said, putting it to bed.

In pushing Dr. Sanchez, the dean was genuinely suggesting a terrific clinician. But she had a low-level ulterior motive: the dean knew such a consultation might well irk Dr. Martin. Dr. Sanchez was by the book, the sort of scholar who privately blanched at some of Lyle’s more “creative” methods, and he, the dean guessed, was just as unimpressed by her. It would be nice to see something get under Dr. Martin’s skin.

On the other hand, as the dean stood there, she managed a feeling of genuine pride as the students asked Lyle their questions. This group, like all the graduate students at the UCSF medical school, were not just among the best and the brightest but were arguably the best, a pick of the litter that matched Harvard, Stanford, and the rest. One student, seated at the table, pulled from his backpack a white mask. He described it to Lyle as a new version of an N-95 respirator, which, generically, was one of a handful of field air-purifying respirators. But the student said his version, which he’d made in his spare time, did a better job at resisting degradation from industrial oils. Would Dr. Martin take a look?

“Not exactly my expertise—product design. But I’m happy to glance,” Dr. Martin said, turning the mask over in his hands. “Check with me next week. If I’m still alive, it worked.” Laughs. “Okay, anything else? I can see that if I keep Dean Thomas waiting any longer, I may be killed anyway.”

He looked around the room. It seemed the meeting was over when his eye fell on a student whose arm was half raised, as if she couldn’t decide whether to ask a question.

“What’s on your mind,” he encouraged.

“What about doctor-patient privilege?” Her voice sounded familiar.

“Sorry, I’m not sure I know what you’re asking,” Lyle said.

“You shared the story of the minister—in Saudi Arabia. What about privacy?”

Now Lyle placed the voice’s familiarity; it was the woman seated in the back of his lecture who had correctly shouted out “CT scan with contrast” in answer to a question Lyle had asked the audience: What procedure did the minister need?

Lyle studied the face belonging to the voice. Dark blue eyes and short hair, glasses with edgy frames.

“The minister is dead,” Lyle said.

“Does that matter?” Her tone seemed equally curious as pointed.

Lyle took it in. “It can. Societal concerns factor in. When weighing what to describe publicly about any medical issue, I ask myself: Does the disclosure serve a larger health-related purpose? Anything else, gang? As you can see the dean awaits.”

“That’s what the AMA says.” It was the woman’s voice again.

“Pardon?”

One of the other students said, “Sheesh.”

But the young lady, seeming to have found the full of her voice, continued undaunted. “The American Medical Association says doctors can disclose patient information following death if there is a societal benefit.”

“Right. Okay, so we’re on the same page…”

“Isn’t there another wrinkle?”

“I’m not following, Ms. …”

“Obviously your work is so much about the societal good, the big picture, and it requires you in some cases to divulge personal information. Y’know, to make a larger point. To, say, prevent an outbreak. I’m just wondering if that is truly necessary or if it can be done without…” She paused.

“Go on.”

She cleared her throat. “Bringing notoriety to yourself.”

“Oh, come on,” another student said.

“No, hold on. You know what?” Lyle smiled. He could feel a touch on his arm. Emily, his intern. Instinctively, she was trying to hold him back from saying something untoward. But he had no such thing in mind. “That’s a damn good question, you’re asking, Ms.-I-didn’t-catch-your-name, and a fair one. My answer is that the patient comes first and, then, would-be patients and, in the case of the story I told you, then the doctors who would serve them. I felt it was valuable to impart the story as a way to inform the doctors of the future. I sincerely hope I’ve made the right call in this case but I am never beyond reproach.” He had been looking around the group but, near the end of his explanation, let his eyes meet the woman’s glasses-obscured gaze. She blinked, losing her nerve.

“I… I think you did,” she stammered. “Thank you.”

“Keep asking good questions,” Lyle said. “You all could learn something from her.”

The students quickly departed. Dean Thomas, watching them walk out, could only shake her head at how Lyle had managed to turn yet another situation in his favor. Now the students would imbue Lyle with the characteristic of humility, of all things. In her view, he was humble like frozen yogurt was nonfattening—it’s what everyone let themselves believe but she knew better.

“Okay, Dean Thomas, you can see that I’m warmed up for your skewering,” Lyle said, turning to her. “Emily, thank you for everything today. Let’s chat over the next few days.” In this way, he dismissed his intern.

The dean made sure everyone had left the room.

“Lyle, this is—”

“Michael Swateli.” The man extended a beefy mitt. Lyle took it and shook. “Impressive lecture. Your reputation as a clinician proceeds you, but I had no idea about your capacities as a presenter.”

Lyle studied the man’s eyes, the faintly lighter skin where his sunglasses had been, a residue of brown dirt beneath his thumbnail. “You were just there. How many days ago, or was it mere hours?”

“I beg your pardon?”

“Wherever you want me to go. You were in the midst of it. You had to borrow someone’s suit. A family member or someone formerly in your unit?”

Michael laughed. “Wrong about that one, Dr. Sherlock Holmes. It is mine or, rather, it was. I wore it for my own college graduation and I have since had much more food. But you are correct that I was there not very long ago. It is bad. Very bad. I only had time to race home to get this old suit and get on an airplane.”

“Tanzania?”

“You’ve been, I think.”

“Years ago with the CDC. Has high rates of albinism, twelve times greater, I think, than does virtually any other population.”

“Yes, yes. My green eyes. It is in here somewhere, as you can see,” Michael said. He looked down and Lyle understood why: time was wasting.

“Look, Mr. Swateli, I want to hear what’s going on. I also want to let you know that it’s a very busy time. Class and grant reports due and, chiefly, my wife and I have just gotten settled and—”

“Please, Dr. Martin,” Michael cut him off. He reached for the inside breast pocket of his too-tight suit and pulled out several pieces of paper. “Just look.” He unfolded the papers on the table. The pictures printed on them were grainy but clear enough. Bodies ravaged by disease. One showed a woman who looked like life had literally oozed out of her.

The dean cringed.

Lyle looked down and gritted his teeth. “I’m not sure that I can—”

“Dr. Martin,” the dean cut him off. “How can you look at this and not say yes. What’s going on with you?”

Lyle studied her. He tried to hold back his thoughts but he couldn’t. “Don’t pretend you give a damn, Jane. You’re only here because, what, there’s foreign grant money on the line, or who knows what.”

“You have no right.”

“Oh, Jane, you’d give your mother TB if it would lead to matching funds. Just own up to your motives for once.” He said it with a shrug, making it more funny than mean. And Michael chuckled.

Across the room, through the far doorway, the slight woman who had asked the question about doctor-patient privilege—the same one who had talked during the lecture—watched rapt. Then, just as Lyle looked her direction, she spun out of view.

A few minutes later, Lyle came barreling out of the room and she stood not a few feet away, pretending to glance at a corkboard with various school announcements. She couldn’t help but turn and look at him. They caught eyes. She smiled.

“Sorry you had to overhear that,” Lyle said.

“I didn—”

“Anyhow, no biggie.” He was talking in an offhanded way, but he looked so sad to her.

“Everything all right, Dr. Martin?”

“Fine. Thank you for asking,” he said without enthusiasm. “Nice job today. You…” He cocked his head to the side. “Are you a med student?”

She flushed. “No.” She wanted to ask how he intuited it. “I’m in tech. I work at Google. They encourage us to develop outside areas of interest so I’m auditing—”

“Well, regardless, well done. I’m not sure most med students would’ve been as willing as you were to put themselves out like that. Whatever you do, you’ve got a bright future.”

He turned away, started to, when she cleared her throat.

“Do you recognize me?” She couldn’t stop the words from tumbling out, though they did so at a whisper, a veritable mumble.

“Pardon?” he said.

“I said: thank you.”

“Okay, great, good luck to you.”

He turned and she was glad that he couldn’t see her face. It was a jigsaw of embarrassment and doubt. She willed it into conviction. She had impressed a man who was an embodiment of action, who didn’t shrink, and, more than any of that, a man who once had saved her life.

Ten

The ceilings at Google reached to the sky. The open-air offices and workspace of one of Silicon Valley’s most respected and envied companies could feel like a military air hangar. A vast cubicle den that could fit a 747. As Jackie entered, a voice echoed through the cavern.

“Hey, this isn’t gluten free. Look at this, Jackie, this isn’t gluten free! How can we possibly concentrate when there are only ten free energy bars and fully 10 percent aren’t gluten free? Eh, waif like you probably doesn’t even eat. Oopsy, I’m gonna get sued! You won’t sue me, will ya?”

Jackie Badger shook her head and half smiled at the sarcastic rant of fellow Googler Adam Stile. The geeks ran deep here, the brightest young minds in the world figuring out how to serve Internet users and make sure they stayed attuned to their screens. Some of the engineers were so geeky they redefined the concept. Adam fit the bill. If Google had a vote for most-likely-to-be-not-so-funny-as-he-thinks, he would win it.

Jackie set down her backpack in her cubicle and caught Denny’s eye. He was standing a few desks away in the vast cubicle den, clearly feeling the same way about Adam. Denny Watkins ran the department. Much more than that: he ran the Basement. That’s what Denny told Jackie he called it the first time he’d invited her down there, after several lunches and drinks. Just telling her about the Basement was an admission she’d been vetted. That she now knew.

Denny jerked his head to the side. She understood what it meant: Meet me downstairs.

Jackie sat at her desk and unzipped her backpack. She grabbed two clementines and put the tiny oranges next to a framed picture of her dog, Sadie. She reached into the backpack and started to pull out the big medical text. Then she thought better of it. Why bring any attention?

She felt a pang of frustration that the lecture had been canceled this morning. Now, they said, he was “on assignment.” There was a lot of speculation about what that meant, chatter in an online group of class members. He’s battling a seventy-foot microbe with just his stethoscope and flip-flops.

She knew better. Dr. Martin was heading to Tanzania. She’d overheard it through the doorway. Then she’d done a little harmless hacking to track his whereabouts. Greater good and all that. He’d said so himself when she’d asked about the ethics of disclosing the Saudi minister’s cause of death. She couldn’t wait for his next class and then his after-hours.

You’ve got a bright future. Clichéd, sure. But he even took time to single her out when he was fighting with that wretched dean. Jackie had risked putting herself out, asking him about patient privacy, and he’d perceived her as real, not as some showy kiss-ass med student trying to prove she was as smart as the teacher. She’d vacillated later whether she should’ve thanked him more clearly for what happened in Nepal and decided that would have come off as insincere. She’d rather be seen now as a full-bodied, able person than a self-doubting supplicant.

“I know when you’re this lost in thought we might have a patent coming,” said Denny, startling her. He was standing over her shoulder. “What gives, genius?”

“Wondering if we can patent your stealth gait. Who can walk that quietly?”

“You mean at two hundred thirty pounds?” Denny smiled jovially.

“Have a gluten-free bar.”

Nobody else would talk to Denny like that. Everyone in the department wondered about it—how Jackie talked so casually to the big Russian bear. It was hard not to see the warmth between them, less like friends or siblings, more like doting father and precocious daughter.

“How’s your audit class going? What is it again: remember-to-wash-your-hands 101?”

“It’s infectious disease…” Of course he knew. “Jackass.”

He laughed. “Can I talk with you about the protocol on that search tool?” he said.

It was thinly veiled code. Nothing specific. Just nonsense. When he said a nonsense sentence to her, it meant they were headed to the lab over at Google X. Sometimes, he said the most comically inane stuff, like Let’s optimize that engine, or Can I speak to you about the spreadsheet database? This time, Jackie could see from Denny’s eyes that, despite his innocuous code, he had something significant on his mind.

“Catch you in a bit,” Denny said.

Jackie snagged one of the shared bicycles outside Lemon-Lyme, the name of the three-story glass-plated building at Planet Google where she worked. It was hard not to feel a little excited by the prospect that they had some new data. For six months she’d been going over the same incremental reports on a handful of projects, one about Internet use habits, another about reaction times of Internet users. It was also hard for her not to feel a little used. Story of her life on some level: always with the extraordinary talent and often feeling like others were using it for their ends. It took a lot for her to trust the rare individual who now made it through her screening.

One such person was Denny. At Stanford, he plucked her from an engineering class where he’d lectured a single day, and, from the back of the room, she drilled him with a question that contorted his face into wonder and then laughter. After class, he beelined for her, took her to coffee at Peet’s, asked her to come work for Google. Less than a year later, he invited her to join on as a consultant for Project X, which was a catchall name for big, speculative ideas at Google that may or may not pan out, like the driverless car, clean water projects, interstellar communications technology. Her job, he told her, “was to use that overly developed antenna to ask the questions others don’t think about or are too haughty to ask.

“Jackie, I like you, but that’s beside the point. What’s important is that you see patterns other people don’t see. I’ll ignore the fact you’re not sure whether you like me.”

Jackie liked Denny’s candor and the fact that he seemed to put things in the right context. He was real. He always had food crumbs somewhere on his shirt or beard and he sometimes just stopped in the middle of a conversation and stood silently until he thought through what he wanted to say. He could live with taking his time, however awkward that might appear. It had taken her a long time to find someone she could invest in, and who she felt invested in her; three months after she joined Project X, Denny told her he trusted her enough to show her what was really going on. Not Project X, but the experiments in the Basement, the ones that didn’t get discussed in the media, or anywhere. Her confidence grew, and her willingness to insert herself, like in Dr. Martin’s class.

She rode her yellow bicycle off the campus sidewalk and onto the street. The move prompted her to glance in the rearview mirror, which is where she saw Adam Stile, the goofy punster from her engineering pod. He was seemingly riding in her path, following. When she glanced back, he put his head down. Then took a sharp right that landed him in a planter. Jackie, lost in the stupidity, nearly tipped over herself when slipping against a curb. She righted herself and accelerated. Something about Adam threw her off.

Or maybe, she thought, looking back, Adam, ever the gadfly, was following to see where she was going. But so what? It was no secret she worked with Denny at Project X. And there was no way Adam would get into the Project X building, let alone the lower offices. That would mean passing the human security upstairs, then taking the elevator using a key card and voice recognition protection to get to the floor, then the retinal scanner and the other stuff below that Denny said was “just best practices these days.”

Google, she often thought, was a multibillion-dollar labyrinth, an overflowing font of money, and power. And secrecy. It was insinuated in every facet of people’s lives, from work and driving, music, television, every form of communications. In the mazes of projects here, a collection of brilliant engineers who tinkered with, fine-tuned, intensified that power click by click.

She looked back. No sign of Adam. She pulled outside the Project X building and slipped the bike into an empty slot in the rack. She marveled at the line of electric cars in the lot. She had little doubt it forecast a future filled with battery-powered vehicles piloted by algorithms not humans. The line of cars reminded her of one of her prouder intellectual moments. Early on at Google, she’d suggested developing a program for Google Maps that entailed recommending driving routes to motorists that minimized the number of left turns and maximized right turns. It turns out that such a route can reduce global warming because drivers who take left turns have to wait before turning, thus burning more gas. On an individual basis, that is meaningless. In the aggregate, it adds up to tons of carbon emissions. Google eventually took up her idea, allowing drivers to opt for “eco” map mode.

At the door to the Project X building, Jackie, sensing something, turned to look behind her at the bike rack. There stood Adam wearing his yellow slicker. As soon as he saw her, he looked down. Then he peered back up and gave her a look she interpreted as a challenge of some sort. She looked one more time at Adam, found her better angels, cleared her throat, and turned inside. After passing security, she walked through the cavernous hall with scattered pods of desks and sixty-foot ceilings. It couldn’t possibly feel cramped in here, even with a dozen driverless cars on mounts, their wheels spinning as engineers put them through various simulations. Easy to get lost in here, which was fine with Jackie. She walked by unnoticed, not that she really knew anyone here, then behind the well-stocked kitchen, into the foyer that protected Denny’s office, where she was let through by a receptionist to the elevators. Key card, voice recognition to “B,” and a retinal scan and she let herself into the “lab.”

Anyone at Google who asked was told this room kept some internal servers, redundancies cooled by an alternate generator system, blah, blah, blah. Nonsense that fell on deaf ears. Not that the term “lab” was any more appropriate or accurate. The room downstairs was rectangular with built-in desk counters lined against the walls, computers at every second seat. A floor-to-ceiling screen hung on the far wall, receiving a bland Google logo from a projector mounted on the ceiling. Any accountant would be proud to work here. Denny sat in a chair at a conference table in the middle sipping tea. Jackie glanced at crumbs next to the button of his plaid shirt. She pulled out the chair where she usually sat. A blue folder sat in front of her.

“Take a look,” he said. “New formatting but same idea; AI mode on the X-axis, varied by its response time, and then on the bottom are individual responses. The dotted lines map response by key word and the bars by duration of interaction.”

So today they were doing the AI project. The idea was to develop and tweak new artificial intelligence modes and then map them against human response intensity and duration of interaction. They’d learned that certain words and fluidity of responses by humans could indicate the extent to which people thought the programs were “real.” Over the months, Jackie had found some interesting patterns but, on the whole, she couldn’t understand why this merited secrecy or was considered particularly valuable. Maybe the AI was that profound. She looked at the first piece of paper.

It caught her attention.

Could this be right?

She looked at the second, and the third. All similar results. She flipped through the pages again. Duration had spiked, the rhetorical measures were off the charts. But with some heavy zigzags. Her first thought was that something marked had changed in people’s responses to the computer. She wondered whether the study subjects had, for the first time, started to really be convinced that the program was another human being, not an algorithm. But the zigzags threw her off. Maybe people felt the computer was alive, then got confused, then felt connected again. Or maybe that was how people—

Too many questions. She looked up at Denny, who was studying her. She felt a flutter of uncertainty, tinged with anger.

“What do you need me for, Denny?”

“What am I missing?” he asked.

She looked back at the pages.

“What do you see?” he asked.

It was how he always asked her about patterns. The answer hit her hard, finally. She swallowed. She put her hands underneath the table and she gripped her legs. It kept her from screaming.

She stared down at the pages. They had nothing to do with artificial intelligence or human response time and rhetorical measures. Denny had been lying to her the whole time.

What the hell was this project about?

She looked down, forced herself to count to ten and fought to find a smile. It wouldn’t come. Before she knew it, her legs took over: she stood up and made for the door.

Eleven

“Jackie. Stop.”

She kept walking to her bike. Her stomach ached. Where had Denny appeared from? She’d seen the numbers on the paper, the bullshit diagram he’d tried to pass off as related to their artificial intelligence program. She indulged him with a few platitudes and then said that she was feeling ill, which was true but also owed entirely to the fact she was almost sure he was lying. Denny, Christ, even Denny. No, count, Jackie.

“Jackie,” Denny said, lowering his voice, “I can tell that you know. I was hoping you’d figured it out.”

She turned. “I trusted you.”

The virulence in her voice caused him to step back.

“You have to come back inside. I’m not purposely…” He bowed his head in her direction and he spoke even more quietly. “Please, come back inside. I’m glad we’re at this point.” Now at a genuine whisper. “I can justify the clearances. We need you. Come inside.”

She stared at him blankly. Denny assumed she was thoughtfully calculating. She felt a rush of the distrust that pervaded her thinking, her cross to bear.

Jackie first noticed it in elementary school, this pattern. At first, she got attention. Wow, Jackie, how did you divide those numbers? Where did you learn that? Or: Did you see that little girl, clearing the entire memory board? There was the time she talked two boys out of a fistfight over an orange-and-blue Nerf football by pointing out some or another common interest, and another time where she realized her little sister was in the other room eating the whole jar of Flintstones vitamins and called 911 on her own because her parents were too busy fighting to pay attention. Nice job, young lady. Bit by bit, she saw a different side to these remarks. They implied some responsibility. Was she supposed to be something great, or do something great? Her gifts felt like liabilities. That’s what she once told her drunken father.

Impressive, Jackie, where did you learn that word?

Fuck you, Dad, you somnambulating bottom feeder.

Well, look, another pseudointellectual dipshit! Don’t you ever—

Shut your mouth, Alan. She’s not one of your whores! Jackie’s mother had gripped a vase from the table like it was a baseball.

As years had passed, Jackie tried to stay beneath the radar. She took every effort to not be noticed so she wouldn’t have to be misunderstood, underestimated, overestimated, estimated at all. No platitudes, and no expectations. She wore dark knit hats and baggy clothes to make herself indistinguishable. It was hard because she not only was so smart but attractive, with doll-like features. Delicate, a beautiful petite, if she’d have allowed it.

“Jackie?”

She settled on a wry smile.

She nodded. She thought about Dr. Martin, both flexible and firm, ultimately a model of how to be decisive, how to challenge, and be challenged, without being thrown off course. In Nepal, in that moment that could’ve gone either way, he’d saved her life, physically, even spiritually; absent his treatment, she’d not only have died, but even embraced it.

She felt light wind blowing through campus. It carried with it the feeling of uncertainty.

“Okay,” she muttered.

Downstairs, he set out two cups of coffee.

“Lantern,” he said.

Her small hands wrapped around the warm mug.

“Yes, another terrible code name from the company that brought you Project X,” Denny said. He hoped she’d smile but she wasn’t there yet.

“Bottom line, Jackie, we’re studying memory.”

She met his eye and saw truth there. He let her gaze at his sincerity until she looked down.

“What makes one image or memory stick? What causes it to fade? If you want to be blunt about it”—he was gaining steam—“we’re trying to get people to remember better and share more of the things they see on the Internet.”

“Things?”

“Advertisements. Video, banner, click-thrus, YouTube videos, et cetera. It’s all about recall and sharing, whether they’re taking something viral, like a song or a sell-crafted Nike ad, or remembering the narrative or image of a Lego set, car, washer and dryer. No one liked my idea of calling this project Hippocampus, and then we’d name our headquarters the Hippo Campus.”

Hippocampus, the memory center of the brain.

“Lantern, Jesus.” He shook his head.

Despite herself, she smiled.

“Look, Jackie, it’s not that novel. It’s a neuroscience twist on the basic Silicon Valley business model.”

He stated the obvious: the entire Silicon Valley business model was built on getting people to see and respond to advertisements. Services like Google, Facebook, Instagram—go down the list. They were “free” and, in exchange, they sought attention. Fairly, this was the attention economy, the eyeball economy. And, more recently, the sharing economy; brands, whether corporate or individual, created things to be tweeted, liked, commented on, a fluid, amorphous river filled with baited fishing poles, bobs and flies and lures to be swallowed. Denny glossed over this stuff because it was simply understood.

“What’s new is we figured out how to do it,” he said. “Or we’re figuring out how to do it.”

“That’s the data you’ve had me looking at.”

“I can’t say this strongly enough: I’m not sure we can do this without you. You filter information in a way other people don’t, or can’t. You have an unusually creative way of synthesizing data.”

She studied his face for contradictions and transgressions like a child deciding whether there was still such a thing as unconditional love. She knew how Dr. Martin must have felt sometimes; used. Somehow, he seemed able to navigate it. He dug for truth on his own terms and figured out exactly the right thing to say and do. She could dig, too.

“Why didn’t you tell me before?” No sooner had Jackie said it than she hated having done so; it showed her vulnerability. So she added, “I deserve a hell of a lot better than that.”

“You do, Jackie. But we’re playing around in a gray area of”—he looked for the word—“ethics. I didn’t want to…” Another long pause.

“What?”

“I didn’t want to compromise you or put you in a bad position, or make anyone more vulnerable than they need to be.”

“I don’t need your protection.”

“Come to the desert,” Denny said. “See for yourself.”

“What’s in the desert?”

“You really do have to see it to believe it. Will you just trust me?”

“Just to be clear”—she tilted her head to the side, looking virtually coquettish—“you want me to trust you, despite having lied to me, and to trust a secret project spawned by a multibillion-dollar company more powerful than the government and that only subverts its ‘do no harm’ motto when it suits the stock price?”

“When you put it that way,” he said, smiling, “yes.”

Twelve

“What’ll it be?” a bartender at a cheesy Irish pub in JFK’s international terminal asked. He had a fresh tattoo on his beefy forearm of a New York Giants helmet that looked red around the edges. Melanie put a hand on Lyle’s shoulder, silently urging him not to get into the man’s diabetes or possible tattoo infection. Lyle flinched.

“Patrón, double, straight,” he said.

“My man,” said the bartender. “Silver, okay?”

Lyle nodded absently; sure.

“Peño…” Melanie said.

“He’s paying,” Lyle responded, gesturing with a jerk of his neck to Michael, the Tanzanian representative who stood near the front of the pub looking at a menu on a stand, giving Lyle and Melanie a wide berth. Michael had thought it would be a grand gesture to invite Melanie, particularly after Lyle had said that a chief reason he didn’t want to make the trip is because he’d just gotten settled in a new place with Melanie.

But the pair had been bickering since San Francisco. Michael was starting to wonder whether Dean Thomas had been right that Lyle was unstable to an extent that outweighed his tremendous value. Michael, standing at the menu, snuck a peek at the picture he’d taken to keeping in his right front slacks pocket. Even though it was a still shot, Michael could picture the man on the ground, panting, as if a dog gasping for breath.

“Make it two?” the bartender asked Melanie as he poured Lyle’s drink.

“I’ll have two. She’s fine,” Lyle said.

“What the hell has gotten into you, Peño?”

Lyle stared at his glass. Melanie exhaled. “I’ll have a seltzer”—she looked at Lyle—“because I want to sleep on the plane, not because I’m taking your shit.”

“Lemon?” the bartender asked.

“Sure.”

The bartender sent a flash of anger at Lyle. This guy had no idea how good he had it. His wife was a knockout. Not like cheerleader knockout, which in the bartender’s simplistic female taxonomy was the top of the food chain, but wife knockout. Her red hair was pulled back in a ponytail and she wore a baggy maroon V-neck sweater that, by contrast, gave her skin a pale tint. Originally, she’d purchased the sweater for Lyle but he’d shrunk it enough in the dryer that it no longer fit in the shoulders.

Lyle drained his shots in two drags. Held the glass up to the bartender.

“Are you still serving food?” Melanie asked.

The bartender pulled a menu from under the counter and slid it forward. “The au jus gets raves. Comes with fries.”

“Perfect. We’ll have two. I’m ravenous,” she said. “Can you put them in before we have another round?” To Lyle: “Like you said, Peño; Michael’s paying. We might as well have a last decent meal.”

“Go home, Melanie.”

“Peño! What the fuck!”

“It’s not safe for you where we’re going.”

“So, Lyle, this is new, this is fascinating.”

“What’s that?”

“You’ve got all kinds of psychological flaws, but being bossy isn’t one of them.”

“There you go, that’s the spirit, Melanie.”

“Jesus.” She’d never heard him like this, not quite. But she had felt it building. For well more than a year, he’d been changing. She just assumed it was because he’d been to one tragedy after the next, one more village, one more filthy apartment building with stricken children; such things would take their toll on anyone. She’d tried to be sympathetic. She knew in her heart what Lyle confessed to her with his eyes: love, real connection, genuine passion—it made up for everything else. Nothing could be more trite but, simply, true, this physician healed himself by feeling connected. Those weren’t words he’d have used. But she knew and he knew she knew. And yet, for all her efforts, he became increasingly beyond reach. She stared at him staring at his glass. “I’d chalk this up to whatever horror is on those pictures Michael’s carrying around in his jacket but you’ve been like this for… weeks.”

“Is that all?”

“No. No, Lyle, you’re right. For six months.”

“Like what?”

“Um, reserved, distant, surly, angry, sullen, terse. Ring a bell?”

Lyle grimaced. Maybe it had been after he returned from that well poisoning in South Korea, an ugly bacteria caused by a local official who had embezzled money intended for sewage treatment and invested it into ounces of gold. A week of sullen behavior followed, then two, then halfway through the third, Melanie, sick of it, went dancing with her friends until 3 a.m. on a Thursday.

“Nice outfit,” was Lyle’s single rejoinder in the morning, looking at her skirt next to the bed.

“I have a right to defend myself,” Melanie responded, the sympathy squeezed out of her voice.

“Against what?”

“Invasion of the body snatchers. I want to help you. I’m here to help you. But I have a life and I won’t let you take my hand and yank me over a cliff.”

In the months that followed, she’d vacillate between trying to reach him and making sure she continued to exist. She indulged an entrepreneurial bug and signed up for an evening class at Berkeley’s Haas School of Business. Things at home didn’t feel hostile, more like that proverbial frog in simmering water that would eventually boil.

Lyle looked at Melanie over his empty shot glass.

“So why are you here, Mel?”

“Because I’m looking for you.”

It was a striking thing to say, especially the plaintive way she said it. He turned to her, even though doing so meant he was abandoning his stubborn self-imprisonment.

“I can’t find you in our home, our bed, not in our conversations, not at the lab,” Melanie said. “I’m going to see if I can find you… I don’t know… in Africa, in a tent, surrounded by…” She had tears in her eyes. Lyle cleared his throat. She was softening him and he was fighting it.

“By… all that sickness.” She chose the word over disease. “You shine there, you are magnificent, when you are called upon. I don’t think you can hide from me there.”

She put her hand on his knee. Lyle felt warmth course up his thigh. He looked for the bartender, a lifeline. Melanie squeezed his leg. The bartender appeared with two heaping plates of French dip and fries.

He wanted to beg her to go home. She shouldn’t be going, not now, and not on this one. He looked at her, desperate to say something, and, yes, God, she was beautiful, particularly with this pink hue to her skin, and even with a slight puffiness around her blue eyes. Lyle tried to get words out—don’t go—and instead took his last gulp of booze and felt defeat.

Fourteen hours later, they landed in Amsterdam for a brief layover before flying to Arusha. Before touchdown, Lyle had awakened with his head on Melanie’s shoulder and seemed to have forgotten whatever was fueling his mood. Until he got his bearings. Then, fully awake, he withdrew from Melanie, smiled thinly, asked Michael to hand him the briefing folder. He looked at the pictures and the medical reports. He immediately homed in on the anomaly, the thing he’d noticed when Michael had first told him what was happening near the border. This wasn’t ordinary, this situation. He pushed his reading glasses back on his nose and let himself dive into the folder.

And Melanie let him get away with it even though she sensed he was retreating into the work as much as embracing it. This was, she thought, a legitimate excuse, to let things settle down. Maybe she’d discover him again.

Not likely. Not with the secret he was keeping from her.

Thirteen

“Are those two giraffes…” Melanie’s voice trailed off.

“It’s a wonder the first time you see it,” Michael said. “Now you understand men.”

They traveled south through the plains in a yellow Land Cruiser, open top, the size of a small bus. It was an angular thing, exposed metal bars, a safari vehicle but without any of the fancy signs or branding of a commercial company. Government issue. To the left, under an acacia tree, two giraffes held the bizarre pose. One had mounted the other.

“Men? They’re not mating,” Melanie said.

“Nope. Guess again.”

She shrugged.

“The one on top just beat the other in a fight. His reward is this expression of dominance.”

“Prison rules,” Melanie said. “You see that, Peño?”

He sat in a seat across the aisle, reading from a file. He glanced at Melanie. “I think you should go back to the hotel.”

She looked away.

“Dr. Martin. Tsetse,” Michael said. Lyle didn’t even notice the fly on his wide-brim beige hat gunning ultimately for his cheek. Michael stood and swatted the air, sending the fly on its way.

“Lost when he’s working,” Melanie said. But she was making excuses—for him, and for herself. They’d had a brief layover in the Arusha Hotel after that exquisite landing near Kilimanjaro. Lyle had sat on the bed, eyes half closed. By that point, Melanie had given up trying to coddle him into conversation. But at one point she came out of the bathroom determined to confront him, bring her nuclear weapon and clear the air. Couldn’t do it. She’d been having trouble sleeping and felt like she might be getting a cold.

The landscape was changing quickly. The dusty steppe took on high grass. Denser trees appeared. In the distance, it looked practically lush.

“We’re not that far from the Selous Reserve. It’s where we’ve set up the perimeter,” Michael said to Lyle. Now Lyle looked up. A man in green fatigues stood beside a yellow police barrier. It looked like he was completely in the middle of nowhere, an oasis amid the brown grass and a felled evergreen. Hardly. Everyone in the truck knew that he was the last stop before death. The truck pulled beside him and slowed. Michael waved.

“Jambo. This is the doctor,” he said. It was a formality. The man in fatigues was too young to have any say-so about anything. His mere presence intended as deterrence. Who would come out here anyway? “Have some more coffee,” Michael said to the soldier as they passed.

Ahead, a small rock formation that would qualify in these parts as a landmark. Melanie watched a lizard scatter at the base of the rocks.

“It’s going to sneak up on you on the other side,” Michael said. He was saying: Brace yourself.

Lyle looked at the late-afternoon sky, pinky blue, yellows bent through the prism of wispy clouds. He scanned the rocks. Muddy water pooled at the bottom right. Maybe someone had washed there. Or people had used it for a restroom. One of the problems he often saw was that sick people did what they had to do where they had to do it—like pissing and shitting—and disease fed on it.

They rounded the corner. A small village emerged, thatched huts bisected by a footworn orange-colored dust road, more like a path. They saw the man in the middle of it. He was on all fours, crawling their direction, trying to, breathing like a dog hit by a car. An aid worker or nurse in a white suit tried to help him by the arm.

“He’s the one I need to see,” Lyle said.

The stake in the far right corner of the medical tent had loosened. Other than that, the setup was reasonable, nothing profound, as might be expected. Six victims in beds, four along one wall, two along another, getting saline drip. Two empty beds betrayed the fate of their most recent inhabitants; sweat and bowel stains, the bodies’ last expressions. It irked Lyle that there still was insufficient manpower here six days after the first patient showed up.

Michael, an edge in his voice, said something in Swahili. A nurse who looked like a beekeeper in all his garb quickly cleaned up one of the empty beds by tossing the sheets and pillow into a plastic bag. A few minutes later, the moaning man Lyle had seen outside became the makeshift hospital’s latest inhabitant.

By then, Lyle had already scrubbed in a bowl of soapy water and gloved and put on a respirator. Melanie remained in the truck. She was a nurse by training, but the risks here outweighed any help she might offer, especially before Lyle got a grasp. Besides, he’d practically begged her to stay put. In the tent, he leaned down and felt the faint pulse of a woman of truly indeterminate age; he figured her between thirty-five and sixty. Disease and sun mottled her skin, bleached her night-dark pallor near pale, obscured the truths her face might tell.

“How many days?” he asked the nurse.

“Four hours.”

Lyle blanched.

A straw rested by her lips. She lacked the strength to suck or move it. A red-and-yellow scarf tied around her forehead hung damp with sweat it couldn’t absorb. The Iraqw people, Lyle had read in his file, typically lived farther north. This was among their southernmost tributaries. He could see from the slightly narrowed shape of the woman’s eyes the Asiatic genetics shared eons ago. Spittle on her chin suggested she’d been coughing. He picked up the chart by her bed and could make out the numbers even if he couldn’t read the words. Last her temperature was taken, it had been 103.8. Another number stood out: 51. Must be her age. He patted her arm and she briefly opened her eyes and he smiled.

He stood from his bench and turned to the man from the road. He kept trying to stand up. With each tiny effort, he violently coughed. You didn’t need an x-ray. Lyle could practically see the fluid in the guy’s lungs. The nurse struggled with him for a second to put on a mask and the man finally succumbed, lacking the strength to fight.

The nurse said something and Michael interpreted. “The son of the local chieftain.”

His smooth round head shone with perspiration. He leered at Lyle and set loose with coughing. Lyle understood. This man wasn’t accustomed to being defeated. Lyle lowered his eyes and gestured to the side of the bed. May I sit? He took the nonanswer as an okay. He sat. He took the man’s long arm and felt for a pulse at the wrist. Ordinarily, ill-advised, not a good place to test. But Lyle didn’t want to reach for the man’s neck. He got what he needed: 185.

“Saline, please,” Lyle said to no one. He would bet that this man’s pulse didn’t get that high facing a mother lion. With Michael’s help, he asked questions and learned the man had been sick for a day. And didn’t want help. Lyle said he understood; he wanted to help the older folks, he said, and the children. He listened and watched and thought. Not Ebola. Maybe Lassa fever.

“You have many mice?”

“This is Africa,” Michael said.

“Sir, how many dead—like you?” Lyle asked.

“Like him?” Michael asked.

“Young?”

Four. Out of a village of only sixty.

Lyle pushed the sheet up and saw the swelling in the man’s legs. The man tried to withdraw but he coughed. Then he shouted, tried to, his words swallowed by coughing.

“What’s he say?”

“The pure breeds did it.”

“What does that mean?”

An exchange followed between Michael and the nurse. Michael explained to Lyle that a new theory had emerged among the locals that had to do, of course, with religion. The Iraqw borrowed each from Islam and Christianity. In recent months, Muslim proselytizers had visited and called them heathens, promised plague. Lyle pressed the interpreter. What had the men looked like? What had they said—exactly? These visitors called the Iraqw an abomination—chukizo, in Swahili. Hell’s plague would befall them, inshallah, God willing.

Lyle saw Melanie standing in the doorway. “Go back to the truck,” he said. She had tears in her eyes.

“Go back to the truck,” he insisted.

“Don’t tell me what to do.” But she turned and left.

Outside, Lyle asked Michael if he had Internet. Yes. On Michael’s big-screen phone, Lyle pulled up an article in Nature. The article was a controversial publication, to say the least. A rare piece of truth that almost didn’t see the light of day; too dangerous. Before delving in, he walked the empty streets of the village. A dozen thatched huts, wood booths, empty, that must’ve served as some kind of market. He asked to see the well and observed it to be clean. He asked Michael about these Muslim proselytizers. Michael said it was the first he’d heard of it. When had they last come? Michael didn’t know. Why?

Lyle, leaning against a hut, was too lost in the article to answer.

“Show me the man’s hut, please.”

There was not much to see. That was the point, Lyle said, without elaborating. A broom in the corner told Lyle much of what he needed to know. The only sign of disarray owed to a glass shattered on the ground near the bed. Where the man must’ve spilled it reaching in his febrile state.

“What are you thinking, Dr. Martin?”

No response.

“You’re frightening me.”

“Looks like Coxsackie B.” True but he didn’t really believe it.

They returned to the makeshift hospital hut.

“When was the last time they were here?” Lyle asked the chieftain’s son. “The pure breeds?”

“What are you asking?” Michael said.

“Ask him, please.”

He doesn’t remember.

“A few weeks?”

“Yes.”

“What did they wear?”

Lyle listened to the translation of Swahili to the Cushitic tongue and back, then to English.

“Suits, like he said.”

“Dark skin?”

“Not this dark.”

“Did they leave you anything? A way to get in touch.”

No.

Just the warning.

“Peño, what are you doing?”

“Taking a nap.”

“In the truck.”

“Good a place as any.”

She stared at him.

“I’ve never in my life seen you act like this,” she said.

He half smiled at her, distant. “Lyle,” she said, “say something.”

He was sitting in the last row of the safari truck. He stared at her. He shook his head, and she could tell he’d traveled to some distant place in his head. He reached behind his head and pulled out a white shirt he’d used as a pillow. He lifted it into the air, like a flag, and he waved it. Surrender.

A day later, their airplane landed from JFK. Michael had gotten off in New York hardly able to hide his frustration. Lyle had given him nothing, bubkes, well, other than his personal symptoms of emotional withdrawal. Just turned into a fucking log. Except when he shrugged and asked for a beer. Before he’d gone totally dark, he’d also told Michael, cryptically, that the villagers didn’t need a doctor but a better police force.

“I’m realizing I don’t speak Dr. Martin,” Michael said to Melanie, trying to be as diplomatic as possible.

She didn’t share Michael’s sense of decorum. “I don’t speak asshole, either,” she said, right in front of Lyle as a taxi driver spitting chew out the window spirited them past looming Kilimanjaro in swirling winds to the airport. “If you want my interpretation, I think Lyle thinks this wasn’t caused organically.”

“Meaning what?”

“He thinks it’s a man-made virulence. Someone poisoned these people.”

It was exactly what Lyle thought. This was chemical warfare. Someone had come in here and given this tribe an intensified flu, maybe something even using CRISPR, genetically hacked viruses meant to do an end around immune systems and traditional treatments. It would explain the attack of young, strong members of the tribe, the threat by outside forces, the visitation of this virus absent any clear catalyst or patient zero and in a fairly clean community, well kept. It would explain, most of all, Lyle’s gut feeling. Maybe even some government had supported this experimentation. It would be revelatory, of course, also solvable. He scribbled down several courses of action, one of which would almost surely confine this and put it to rest.

“It’s absurd,” Michael said before he left Melanie and Lyle in their Air France seats to take his own. “He sounds like one of those nuts in Brazil with Zika.” Conspiracy theorists in Latin America had spread rumors nearly as virulent as the virus itself that the Zika-carrying mosquitoes had been planted by angry British colonialists or one-worlders. “The dean was right,” Michael concluded. He didn’t finish the thought but it was clear enough: he should’ve sought someone else’s counsel. Lyle hadn’t really tried; he’d mailed it. Lyle was just a good storyteller more interested in applause than answers, or maybe something more insidious than that—a malicious fraud. How had he gotten such a reputation? On the flight, Melanie willed herself to go to sleep. She talked again to Lyle when the landing gear came down to touch down in San Francisco.

“Counseling, Lyle. You’re in or I’m out.”

He studied her face. The water retained in her rosy cheeks.

“You’re pregnant, Melanie.”

“Shut up, Lyle.”

He looked down so he couldn’t watch the wave of revelation spread over her face. He’d suspected for a week or more. He suspected she didn’t know. How could he know before her? How did he ever understand these things? It started with a sensation, like an itch, and it made its way from his body to his brain to his consciousness.

“No, Lyle, it’s not…” She stopped and her blue eyes turned steely. “I’m pregnant? I’m pregnant!” Her utter disbelief transformed quickly into wonder. Lyle so often was right about things like this. Could he see it before she knew? “Why did you let me go?” she demanded. No words to capture her betrayal.

“Maybe the better question is why you went.”

The tears leaked from her crimson-tinged eyes and one dripped off her chin. She had no strength to wipe them away.

“What’s happened to you, Lyle?”

Fourteen

Jackie and Denny hit the Nevada border just after two on a bright Saturday afternoon in Denny’s Tesla. They’d taken the “scenic” route, Denny joked, which meant driving the flatlands east of the Bay Area, skirting the more populated route to the north, and taking two-lane highways where Denny got to test out the “autonomous driver” mode on his Tesla. The car’s new software drove itself while Denny told Jackie more about Lantern, the project they were studying in the desert. With his hands free, he could even show her slides on the seventeen-inch touch screen in the Tesla, which he’d hooked up to his iPad.

At the Nevada border and truck weigh station, they slowed at the request of a soldier who waved them to the side.

“An army checkpoint?” Jackie asked.

“I assume because of what happened last month.”

Three weeks earlier, the army had raided the home of a family in the Big Smoky Valley to the east. The family’s ranch was on federal land to be used for military exercises, but the parents had refused multiple requests and legal maneuverings to get them to move. They holed up on the property with a veritable cache of munitions, including a grenade launcher, and declared themselves sovereign. On Instagram, they posted a sign of their twin nine-year-olds, a boy and a girl, draped in the American flag, holding AK-47s. The army assault, pressed by manifold interests, including concerns about the children, used nonlethal gases and took back the house.

Three days later, in retaliation, two men attacked the guard post at the military base in Hawthorne. They killed a soldier and injured three others, before they were killed.

At the border, the grim-looking soldier looked into the Tesla’s trunk and waved on Denny and Jackie.

Martial law, Jackie thought. She said, “You never said why here—in Hawthorne.”

He explained how Nevada was about the most business-friendly place in the world. Low taxes, lax regulations. Totally hassle free, he said, sounding mostly kidding, but not totally. “In Silicon Valley, we spend more for an hour of a lawyer’s time than we do to rent an office for the month.”

Jackie listened to Denny on two different levels: on one, she was getting basic information, and on the other she was assessing whether he was being straight with her, if she could still have faith in him, follow his direction. The lines beneath her eyes told how much sleep she’d lost, some nights making lists of the evidence in his favor and against. She’d let him lead her from wilderness, pull her from two decades in shadows—and what if she’d been wrong to do that all along?

“Jackie?”

“Huh?”

“You look like you’ve got something on your mind.”

“Not really.”

Another long stretch of road and silence.

“You spent much time in the hinterlands?” Denny asked.

“Did some backpacking, after college.”

“Yeah.”

“Nepal.” She gritted her teeth. Almost didn’t come back.

“You grew up in…”

“Ohio.”

“Really?”

“No, but why’d you ask if you already knew?”

“Trying not to be presumptuous.”

“Salt Lake,” she said. How much did he actually know? Who was she kidding; Google knew everything.

“Family?”

“Sister.”

“Oh, yeah, what’s her name?”

Jackie gripped the leather seat next to her right leg. “Marissa.”

“Beautiful name. What’s she up—”

“I’d rather not talk about it, Denny.”

He nodded. “Were you trekking—when you went to Nepal?”

She wondered if he knew about that, too.

“Finding myself, I guess.”

“What did you find?”

“A near-death experience—rabies.”

“Say what again.”

“I got scratched by a monkey. Not that common, the monkey part. But there are lots of rabies attacks there, mostly from dogs’ bites. You know much about rabies?”

“I know you don’t want it.”

“We’ve got a winner. It is a hundred percent fatal once the symptoms set in. The good news is, it’s also preventable during the incubation period if you get the vaccine. The trick is getting it in time.”

“Which you obviously did or you’d be salivating even more than you already are.”

She laughed. “The vaccine is available there, if you get to a clinic. And I was on my way to one when there was an earthquake.”

His eyebrows raised, like Holy shit.

“Flights canceled, trains down, chaos. Long story short, I was in deep trouble when I was essentially rescued by an American doctor who was over there dealing with a cholera outbreak. He saw me waiting at an airstrip that had ground to a halt due to the earthquake. I’d never have gotten to Kathmandu in time. If not for him, I’m not here to experience”—she focused out the window—“lovely Hawthorne.”

The town now loomed, just three miles across the border. It was the kind of small highway town where the low-slung building with the red word “Motel” stood out like the Leaning Tower of Pisa. And it seemed even to lean. Another business sign read classic car, which probably meant “Old.” And another, which made Jackie laugh, said wash and referred to a Laundromat but the sign was encrusted in filth.

“That’s a remarkable story,” Denny said. “Does it explain your interest in infectious disease—that class you’re taking?”

The insightful nature of the question startled her. She hadn’t even told the whole of it to Denny, and how it really had been the turning point in her life. Truth is, had it not been for the heroism of Dr. Martin—Lyle—she well might’ve let herself just die. Sitting on the ground outside the airstrip, she had actually gotten peaceful with the idea. After so much bullshit in her life, so little faith in herself and people around her, it felt in the moment like a blessing to curl up there on the ground and let the hot wind carry her away.

“The guy who teaches it is a genius,” Jackie said.

“High praise coming from you.”

“I mean the real McCoy, Denny. You ever really want someone to figure something out, Dr. Lyle Martin is the guy…”

“I’m starting to feel jealous,” Denny said, as he slowed at a stoplight. “Okay, it’s decision time. I figured we’d stop at the restaurant, unless you want to go straight to the shop.”

“The restaurant?”

“I guess there’s more than one. I’ve never tested the theory.”

They got turkey sandwiches with canned cranberry chunks on white bread to go and Denny drove them a half mile east of town and down a dirt road. Jackie noticed the preponderance of army trucks driving both directions. The army base here was a large munitions storage facility, located outside of town, and essentially was this place’s raison d’être. The Rocky Mountains loomed to the east. Two miles down a dirt road, and then a few serpentine turns later Denny parked his Tesla in front of a place that looked, appropriately, like a scientific outpost but one you might find in a frozen tundra. Two corrugated metal buildings with a generator by the side and a horizontal unit Jackie recognized as housing cooling equipment.

“Not much to look at,” Jackie said.

And, simultaneously, she and Denny said, “I guess that’s the idea.” The idea being: don’t draw attention to this operation.

Denny smiled. “Great minds…”

“What about that?” Jackie said. She was looking out the left side of the Tesla window, noticing that farther down the road sat another building, this one concrete, almost bunker-looking. Next to it a long stretch of paved road, like a runway. And looming over the whole thing a giant metal dish, very clearly a powerful antenna.

“Have you ever seen anything so subtle?” Denny said, and laughed. “The supersecret Google space project. Not so supersecret, right?”

It was well known that Google was playing around with low-cost ways to get into space. They weren’t alone in this respect. Amazon, too, was getting into the act, and Facebook, Elon Musk, Richard Branson. The stated reason was that these companies wanted to explore the future of space travel, even for tourists. But Jackie was no dope; she and others who liked to read tea leaves suspected it had more to do with the future of much more immediate businesses, like telecommunications and even Internet commerce. If the companies could get low-cost, high-power satellites into orbit, they could become hubs to control Internet access, information, drones, who knew what else.

“Are they launching rockets?” she asked Denny.

“Satellites, I suspect,” he said. “Most of that is done in Florida.”

“But you’re not sure.”

“Yeah, I’m sure. Keep it between us. That’s not my area; this is, and I try to keep my nose out of stuff that could fuck with my ability to cash in my stock options.”

She felt relieved again. She’d asked about the rockets as a test, hoping he’d be frank with her. Opening the car door, she brushed bread crumbs off her lap onto the dusty ground and felt a wave of satisfaction. She was getting let into the inner sanctum at Google, though that was secondary to the bond she was solidifying with Denny.

She stepped out of the car and felt a gust of desert wind and she shivered. She hated wind. It reminded her of uncertainty, self-doubt, the feeling that little things could throw you off if you weren’t anchored. She pictured an invasive memory: her mother shouting at her father, her father shouting back, the pair nose to nose on the balcony, little Jackie sitting on the couch, looking over its back, feeling the breeze through the sliding door. Marissa sucking on a bottle Jackie had made for her. Wind brought memories, guilt. Wind smelled like sweat and shampoo, it sounded like anger. Jackie put her hand to her face and wiped.

For an instant, she thought about the fateful day in Nepal, nearly dying, being saved, becoming determined to live a more directed life, to not just do the right thing but figure out how to do the right thing. She thought of these moments as the yin and yang of her life: her terror, paralysis, impotence in dealing with her parents, years of self-doubt, and then a salvation and a determination to figure it out.

“Everything okay?” Denny asked.

“Bad cranberry burp.”

“Let’s go inside.”

Denny used a card key to gain them entrance to the larger of the two metal-framed buildings. Cool air greeted them, the refrigerated feel of a server farm. Inside, not racks of powerful computers. Just a few desks and a Ping-Pong table. A dartboard hung against a far wall. To Jackie’s right, a kitchenette. An industrial-size case of Red Bull still in the Costco shrink wrap sat on top of the refrigerator. It all looked like Silicon Valley lite.

Only two of the cubicles were occupied. From one of them, a man looked up. He had a scruffy goatee poking out from his hoodie. From the other cubicle stood a petite woman in a too-tight white shirt and dark pants and short-cropped hair. She looked to Jackie like a waiter—in the marines.

“These are our two Alexes,” Denny said. “Alex 1 and Alex 2, say hello to Jackie.”

“Hello, Jackie,” they simultaneously drawled but seemed mostly disinterested. Then the female Alex said: “And then there were three.”

“That’s right, three now,” Denny said. “So one of you geniuses will have to figure out how to divide the Red Bulls by thirds.”

“I only work with imaginary numbers,” cracked the male Alex.

“You’ll love it here,” Denny said and took a sharp angle to the right. Jackie followed him through the building to a staircase with metal railings and cement stairs. “Where the action happens,” Denny said in a low voice.

“They’re really both named Alex?”

“What’re the odds, but, yep.”

Denny had also explained in the Tesla what happened below. Below, testing rooms where Google sought to dial in this Lantern discovery it had made. The discovery, in essence, was that Internet users experienced sharply improved rates of memory recall depending on the speed, frame rate, and also the frequency of the delivery of information.

“Like subliminal messages?” Jackie had mused. “What Alfred Hitchcock did in Psycho.”

“Much more sophisticated and less well understood. We just know it seems to work.”

He had pulled up four images on the Tesla screen of the hippocampus, a crescent-shaped part of the brain central to memory recall. The images were taken from real-time magnetic imaging scans of a twenty-two-year-old female study subject. During the tests, the woman had been using her phone or an iPad. The tests were complex because the study subject had to look at and interact with the devices while situated in an MRI machine. The images that Denny displayed in the Tesla were similar except that some images were shaded more than others. The greater the shading, Denny explained, the more of the young woman’s hippocampus had been engaged at the time that the imaging had taken place. Where it was less shaded, less of the woman’s brain was engaged.

Jackie could see where this was all headed. “So during some of her online interactions, she remembered more than she did in some other cases.”

“That too,” Denny said. The images, he explained, didn’t necessarily mean that the subject remembered less, or more—because images can lie. But in this particular case, the images hadn’t lied at all. Far from it. After the study subject was removed from the machine, she had taken tests to see how much of her online interactions she remembered. In the same conditions in which her hippocampus had lit up most, she had the strongest recall.

“Amazing, actually,” Denny said. “Like she had eidetic memory.”

“Photographic.”

“Right.”

“So what made the difference on what she remembered?”

Denny shook his head. “We’re not sure. We were playing with placement of information, streams, also speeds and frame rates. We can’t quite get a handle on it. Enter the inimitable Jackie Badger.”

It was why they brought her here. Still, she couldn’t figure out why it was such a secret. Of course, Google would be working on getting users to remember and share more information. It was in the damn annual report, their entire raison d’être, if you knew how to read the thing.

At the bottom of the stairs, Denny used his key and did a retinal scan and a door clicked open. On the other side, a long hallway, much more nicely appointed than the upstairs, even bespoke floor runners and wood trim near the bottom. Odd, Jackie thought. A doorway marked each side every ten feet or so with keypads beside each one. The quiet rectitude of the place reminded Jackie of the psychiatrist’s offices her parents wanted her to see after she got caught hacking into the junior high school computer system to send a fake e-mail on behalf of an instructor who Jackie felt had been rude to students. It had been that confusing, interim period in Jackie’s life where she was playing with boundaries: What was the right thing to do? When should she intervene or participate in the world, and how? She thought maybe she was looking for a moral compass. But, later, she discovered a different term for what she was seeking: situational awareness. It was a term of art she read about in a psychology class that applied to how people pay attention to their surroundings. Some had terrific situational awareness, like pilots. People who had to be aware, think fast, make good decisions. She still wasn’t sure she had it but she was getting there.

“Individual lab areas,” Denny said. He stopped midway down the hall. He kept his voice low. “I wanted you to see some of the current work. It’s less focused on the imaging right now and more so on recall and behaviors. What kinds of conditions lead to more social behavior, sharing, liking, endorsing, and remembering. Basically, you’ll see people using their gadgets through a two-way mirror.”

“The study subjects?”

“Local folks. There’s actually a pretty good pool from wives and girlfriends of military personnel, along with folks we draw from surrounding communities. Low income in Nevada, sadly, leaves us with people who will do experiments for what is pretty low pay, at least by our standards.”

Jackie heard a voice behind her and the female Alex appeared with a tablet.

“Door number five, boss,” she said to Denny. “Good time. We’re just finishing up.”

Alex led them inside the fifth doorway on the left. Behind a two-way mirror a woman sat in a comfortable office chair in the middle of a room, staring at her own tablet. Jackie watched to the point of gawking and now she, at last, understood why this project was a secret one.

The woman behind the two-way mirror looked so engrossed as to be catatonic.

For a long time, Jackie and Denny stared. Suddenly, the woman bolted upright.