Plague

CHAPTER 5

The layover at LAX took two hours and Sam perused the magazines and books in the gift shop. She had her iPad with her and refused to read any book in paper form that could be found electronically, but there was something relaxing about the actual feel of a book in her hands, the smell of the pages as she flipped through them.

She got a salad with extra cheese and an apple juice from a café at the airport and spent her time reading the New England Journal of Medicine near a window, glancing over occasionally as a plane landed or took off. They called her flight and then delayed it another twenty minutes before she was finally let on the plane.

It wasn’t until past midnight that she stepped onto the tarmac of Honolulu International. Traveling over the ocean at night had been an experience she hadn’t expected. The moon lit the water a dim white and it looked like a flashlight shining in a pool of black oil. A ship was on the sea underneath the plane and she watched it until it disappeared into the murk of the Pacific at night.

She grabbed her two bags and went to the curb to hail a cab. Rather than finding a hotel, she went straight to the hospital.

Honolulu struck her as a resort town created specifically to cater to tourists. The restaurants, bars, shopping malls, and even convenience stores looked uniquely islander. The air had the salty taste of the ocean and it was humid, but pleasant. She kept her window rolled down on the cab ride over and tipped the driver well before getting out.

She stood, staring up at Queen’s Medical Center. It too appeared like a resort rather than a hospital. The valet area was lit with the soft glow of tiki torches and the building itself resembled an upscale hotel. She had read about it on the plane and knew that, with over five hundred rooms, it was the largest hospital in the state.

As she walked through the ER’s sliding glass doors, she was struck by the familiar smell of hospital antiseptic. Rather than a nostalgic, warm feeling as many physicians had upon entering a hospital when they had not been practicing in the profession, it brought up images of being so exhausted she couldn’t keep her eyes open and would fall asleep at a cafeteria table. Or of being yelled at by the attending or the chief for minor errors brought about by the exhaustion, or of turning down dates because there simply wasn’t enough time to sit down for dinner at a restaurant without being called in.

She went to the reception and asked for Dr. Amoy. While waiting, she set her bags down on one of the waiting room chairs and stretched her arms over her head and rolled her neck. She had missed her run today and it was a ritual that, if ignored, would throw off her entire rhythm and cause insomnia at night.

“Dr. Bower?”

She turned to see a man in blue scrubs and a white coat approach her. He was tall and lean. Clearly of Hawaiian decent but with light skin and sandy hair. They shook hands and she picked up her bags.

“I’m Jerry. Nice to meet you.”

“Nice to meet you,” she said.

“I take it you haven’t checked into a hotel yet?”

“No, not yet.”

“You can leave your bags behind the reception desk. The first patient isn’t doing well. We’d better head up there as soon as we can.”

She dropped her bags off but took out a legal pad and pen. It was what she always used for notes on field assignments because she could copy them into her iPad before leaving the scene and then throw away the notebook in case it had been exposed to any pathogens. Such a risk was minimal but it helped her feel better and was certainly worth the two-dollar price tag for a pack of legal pads every few months.

Dr. Amoy took her up the plush elevators to the third floor where there were women’s locker rooms. She changed into scrubs and was given a facemask, gloves, and booties. After changing, she looked at herself in the mirror. Sometimes it struck her how odd a job she really had. She was like a fireman that ran into a burning building when everyone else was running out. It was counter-intuitive and certainly anti-evolutionary. Biologically, humans were not set up to expose themselves willingly to disease. If she didn’t control her thoughts and her breathing, panic could strike her as easily as it would anyone.

When she came out of the locker room she saw Dr. Amoy speaking on his cell phone. “I have to go…love you too.” He looked to her. “Ready?”

“I’d like to see their charts first if I could.”

“Certainly.”

They went back to the elevators and up to the top floor. They walked down a long corridor where there was only one reception desk, which was left unattended. She noticed more offices than hospital rooms and also a kitchen and lounge area.

“They’re converting this floor but this used to be our psychiatric unit,” Amoy said.

“I gotta tell you, this is one of the nicest hospitals I’ve ever been in.”

“You’re preaching to the choir. My residency was done in St. Catherine’s in Detroit. You ever been?”

“No.”

“It’s like a cheap office building with an OR. We’d get a dozen gunshot victims a weekend and it would take the staff days just to clean up the blood. We were underfunded and they contracted the janitors out-it’s just up here to the right.”

They turned down another empty corridor and walked past some construction that was taking place. No workers were there at this hour but Sam saw half-empty Gatorade bottles and burrito wrappers lying out.

Once they were in a small conference room with a fridge, Amoy went in and pulled two charts off a wall hanger. He sat down at the table and Sam did the same.

“Clifford Lane, resident of Honolulu, twenty-nine and in perfect health before this. Second victim is an Erin Simon from Los Angeles. She was here on vacation.”

He passed the charts to her and she began reading. She took notes on her pad of the patients’ statistics: height, weight, occupation, marital status, sexual orientation, etc.

“I’ll need their medical records,” she said.

“We can get that afterward when you’ve signed the HIPPA release. I really think we should see them now and do the paperwork later.”

They rose and Sam checked her gloves and mask for any tears or holes. Amoy did the same and they walked out to the corridor and down to the room at the end of the hall. Two adjoining rooms were connected by a thick door and Sam saw a woman of thirty-six lying on her back, her eyes closed, a morphine drip attached to her arm.

“Hello, Erin,” Amoy said, approaching the bed. “How we feeling today?”

Sam stood by the foot of the bed, bending as close as she dared to get a good look at her exposed arms and neck. Her skin appeared smooth, no pustules, but splotches of black and dark purple appeared underneath. It didn’t cover her entirely but it occurred frequently enough that she could tell instantly it wasn’t bruising. It was blood that was flooding out of her body just underneath the skin.

Sam looked to the woman’s mouth. Crusted, dried blood lined her nostrils and her lips. Her teeth were stained with it and her mouth was completely dry and hanging open as if she were struggling to suck in air.

She heard something out of the patient that sounded like a groan but caused Dr. Amoy to respond and Sam realized the woman was speaking.

“I want to go for a walk,” she gasped. “I’ve been in this bed for five days. I want to go for a walk.”

“Soon,” Amoy said, checking the morphine. “We just gotta make sure we’re dotting our I’s and crossing our T’s before we take you for a spin. We want to get you home to your family as soon as we can, darling. Would you like anything else right now?”

There was no response and Sam saw that the woman had dazed off into sleep or unconsciousness. Amoy lightly touched the bed, running his fingers over the sheets. Sam could tell he wished to touch the patient; human contact was important to the best doctors, the ones that went into medicine to actually heal patients rather than for money or prestige. Instead, he had to settle for the sheets behind a rubber glove.

“I’d like to see the first patient,” she said, not taking her eyes off Erin.

Amoy walked to the door and opened it to reveal another room identical to the first but set up diametrically opposite. The bed was against the wall, facing them, and Sam stopped at the doorway when she saw the patient.

He looked as if he’d been burned in a fire. His skin was black and large portions of it were covered with antiseptic gel used for burn patients when the skin had peeled off. Bandages covered his legs. He opened his eyes briefly, flashing a feverish anger from confusion, and she could see a bright red conjunctivitis, the whites of his eyes soaked in blood. His eyes closed and he let out a long, raspy whisper.

“He’s unresponsive at this point,” Amoy whispered so the patient couldn’t hear. “We’ve spoken with the family and they’re upset that they can’t see him but I figured I’d wait for the OK from you guys first, in case this is something serious and dangerous to the public health.”

“We shouldn’t be in this room,” Sam said. “We need to set up full-barrier nursing for both of them. You need to make sure no one has access to this room except nurses who know how to handle the barrier and won’t have a problem with it.”

“Why would they have a problem?”

“Nurses can get brave around illness over time. They may feel it’s not a big deal.”

Amoy took a deep breath. “You’re right. I should have done that from the beginning.”

“I understand why you didn’t. I’ll need tissue and blood samples to send to the labs in Atlanta. Until we find out what this is, nobody can be up here.”