The Blood Artists

The Strange Case of Dr. Peter Maryk

Everything that begins, begins with blood.

We were at work in a B1 blood laboratory on the third floor of the seventh building of the Centers for Disease Control and Prevention, a network of industrial-looking brick-and-mortar structures located just outside the city limits of Atlanta, Georgia. We were both junior virologists on staff at the CDC, myself and Peter Maryk, and both thirty-one years of age. This was the final week of December 2010.

Peter worked across the lab table from me, standing over a whir-ring centrifuge, spinning down blood serum. His hair was pearl-white and had been since college, and he kept it short and straight, his angular face and slate gray eyes set in a mask of severity. He switched off the centrifuge and like a roulette wheel it slowed, ticking to a stop, silence returning to the lab. He crooked his head at a tinny scratching behind him.

“Thirty-seven’s going down,” he said.

I looked across at the wire cages. Thirty-seven, a large, white, pink-eyed rat, was digging repetitively at the metal floor and shifting back and forth. His hind legs buckled beneath him, and at once he slumped over onto his side.

I crossed to the cage. Thirty-seven kicked sideways at the air, his small-toothed mouth opening and closing. Blood dappled his sugar-white chin. His pink eyes fixed on my face as his body twitched, his tail lashing at the cage floor, pang, pang. The jerking became less and less frequent, and Thirty-seven expired staring at me.

There was still a chill. Death made failure real, something I wished not to repeat.

Peter appeared at my side. He opened the top door of the cage with a gloved hand and lifted Thirty-seven out by the tail, sealing him inside a numbered plastic bag.

“It should work,” I said. “We’ve watched it under slides. We know it works. It’s just too potent for rats.”

Peter said nothing. He returned to his station and set the bag down on the table with a light,thump.

“We can’t go to primates,” I continued. “If we go to chimps we’ll have to declare our research, and I’m not ready for that.”

Peter and I distinguished each other in our fields of specialization, mine being straight laboratory science, Peter’s being field pathology and investigation. I was most at home in a laboratory setting, but Peter was growing restless, and beginning to show his disdain for the project.

Clean human blood was a precious commodity as the first decade of the twenty-first century drew to a close. An onslaught of viral and bacterial disease had depleted the reliable source pool, and patients around the world were dying, stuck on long lists waiting for transfusions of untainted blood. Lucrative black markets had sprung up in every major population center, from New York to Beijing to Cairo, where illicit blood traded at fifteen to twenty times its weight in gold.

Like many medical scientists of the day, Peter and I had dedicated ourselves to the great challenge of developing a safe, synthetic human blood substitute. Yet that achievement alone would not have satisfied me. I was seeking to improve on organic human blood by deriving not merely a perfect substitute, but one infused with enhanced virus- and cancer-fighting properties. Peter was questioning the propriety of our work, and fully half my time now was spent appeasing him. His participation in the project was essential. Peter Maryk’s immune system was infallible. He possessed innate immunological qualities beyond the natural ability of any human being known to medical science. When Peter Maryk claimed never to have been sick a day in his life, he meant it as fact. His gifted blood provided the essence of our project. At that time, my goal of conferring some degree of Peter’s enhanced immune system to the ill seemed in reach. The potential benefit to medical science and worldwide human health would be inestimable.

We returned to our stations on opposite sides of the wide stainless steel table, Peter to his centrifuge and I to my binocular microscope. I bent over it and looked down upon a small, bustling, crystalline city.

There was a thick popping splash, and I shot back reflexively. Peter was rising from the table, arms out at his sides, blood splattered over his fleshy latex gloves and paper smock and the small beige refrigerator humming behind him.

Peter glowered at me, and I stood. It was a scare, but fortunately the blood was our own. He picked up the dripping plastic pack labeled MARYK and examined the torn eyelet. The rest of the pocketed units of blood labeled either PEARSE or MARYK hung from a steel rack over the table. My blood was the project’s control. Four small vials labeled PEAMAR4 were the product, to date, of the fourth generation of our efforts.

Peter’s spilled blood was inordinately rich in color, oozing over the steel table top and seeping in dark parabolas down the walls of the sink. He turned on the faucet and ran water over his gloved hands, then wiped down the sink and counter and untied his bloodied smock, stripping off his gloves. He started toward the door with such intensity that I believed he would walk out and keep going, never to return to the lab or the project, but he merely disposed of his soiled gloves in a red biohazard box set into the wall. He was on his way back for a fresh pair when he slowed to read the flip-up screen of his tablet, a portable notebook computer, recharging in a wall socket and therefore wired into the CDc’s central net.

“Stephen,” he said.

Every sentence Peter Maryk spoke, even the most benign of phrases, was infused with urgency. His voice was clear and deep, compelling. I went around the table and joined him, struck by the scent of baby powder coming off his bared hands. Peter’s hands were never without protective gloves, in or outside the lab. They were pallid and smooth-knuckled, and he held them upturned as though awaiting a towel.

The monitor was flashing an EPI-AID mail message. The epidemic assistance request had been posted over the CDC-maintained LifeLink web from a Dr. André Dieudonné Kaunda in the central African Congo for vaccine to treat one unconfirmed case of “variola major,” or smallpox. I reviewed the symptoms detailed in French beneath the description of the patient, a nine-year-old Congolese girl said to be in the poring stage.

“Buboes,” Peter translated, fancying the antiquated term.

“Can’t be.”

“The symptoms match. But no request for assistance. Or investigation.”

“He’s just uncertain,” I said. “As well he should be.”

But Peter was pulling on a fresh pair of gloves and already heading for the door. I followed him out, across to adjoining Building Six via one of the outdoor wire encased catwalks linking each building of the CDC. The center was understaffed that week due to the year-end holidays, and our shoe heels scuffed loudly along the well-worn tile steps to the first floor.

Room 161 in Building Six was, considering its duties, an office of modest size. The three desks inside, and the computers they supported, made up a virtual clearinghouse for rare drug and inoculation requests received from around the world. It was in Room 161 in the early 1980s that a CDC doctor first noted a surge in requests for pentamidine, a drug used to treat a rare pneumonia, from physicians in the Los Angeles and San Francisco areas perplexed by an unusual wasting disease afflicting several young, male, homosexual patients.

The door was open. Dr. Carla Smethy stood in relief as I entered. “Stephen,” she said, surprised. “I was beginning to think there was no one here at all.”

Carla Smethy was in her mid-thirties, black-haired, round-cheeked, and smart. She nudged a curl off her forehead. The Christmas carols jingling out of her desktop computer were an unsuccessful attempt to alleviate the gloom of the rare drug request office.

Peter entered behind me, and Dr. Smethy’s smile flickered. In fact, she took one small step back.

“What do you make of it?” I said.

She shook her head. “A first for me. You’re the bug experts.” She looked to me in an interested way. “How did you get stuck working the holiday?”

Peter sat at her computer. “May I?” he said.

She appeared startled. “Yes — sure.”

He ran his gloved hands over the keyboard, first switching off the tinny carols. I kept one eye on the monitor.

“We wanted some lab time,” I said in answer to her question. “Thought it would be nice and quiet around here.”

She plucked a piece of paper off her desk and showed it to me. “Seen this?”

It was a proof of the cover of Morbidity and Mortality Weekly Report, the centers’ weekly periodical, featuring the new letterhead logo and initials “BDC.” Following public outcry in the wake of emerging and reemerging diseases worldwide, an act of Congress had redrawn the CDc’s policy mandates and enhanced its federal powers. As of January 1, 2011, the preeminent health agency in the United States and the world leader in disease prevention would be rechristened the Bureau for Disease Control.

“The end of an era,” she said.

Peter had brought up the complete bulletin on the monitor. Delivery of the smallpox vaccine was requested by airdrop west of the city of Dongou on the Ubangi River. A relay trace sourced the sender’s tablet coordinates to a location just a row degrees above the central African equator. Peter pulled up a grid map. The coordinates cross-haired into northern Congo, stopping there and pulsing faintly. The bulletin had been dispatched from deep within the rain forests south of the Sangha Wildlife Reserve, west of the Bumba Zone.

“The Congo,” Peter said, his strange voice leavened with something like romance. He had worked a year in Dares Salaam, the port capital of Tanzania, while I had elected to spend my foreign field residency in Calcutta, in a floating pediatrics hospital on the Hooghly River. Acquaintances since our third year at Yale, roommates in med school at Johns Hopkins and rivals in our virology class at Emory, we were now colleagues and research partners at the CDC; it was the only period of time during the preceding decade in which we had worked apart.

“Must be a mistake,” she said, looking at the screen. “The wrong request class, it has to be.”

I said, “Do we have any variola vaccine in stock?”

“We do, actually. But only because first-year vaccinologists cook it up as part of their training. Otherwise, who cares?”

“But why no medical support?” Peter turned in the chair. He trained his silvery eyes on her. “A call for variola vaccine, but no support?”

She looked stunned. “There’s blood on your shirt,” she said.

I tried to intervene. “It’s all right—”

“It’s mine,” Peter said. He examined the florid stain.

Peter Maryk was different, innately different, apart from his imposing physical presence. People sensed this. Conversations trailed off when he approached. Rooms changed whenever he entered them. Some people even claimed they could feel him walking behind them in the halls. He was in many ways an irregular human being, which at one time had been a source of great consternation for him. I was the politician of the two, and had taken on the role of social intermediary for him since college, explaining him to some, defending him to others, even apologizing to a few. But every attempt to introduce him into the broader culture of the CDC had failed. Increasingly he seemed uninterested in fitting in anywhere.

Dr. Smethy looked again to me. “What do you think, Stephen?”

I looked at the monitor screen. Laboratory space at the CDC was at a premium, and I had been looking forward to Christmas time and the changeover as an opportunity to push ahead on our PeaMar research without interruption.

“We have the lab free and clear for an entire week,” I said.

It was part of the alchemy of our relationship that I would temper Peter’s morbid enthusiasm. Peter had often questioned smallpox’s untimely fate, distrustful as he was of most of mankind’s triumphs, a distrust that now included our PeaMar research. My reluctance here — as there was no question that the distress call required further investigation — was simply an attempt to leverage his renewed participation in the project upon our return.

“Worst case,” I said, “it’s an orphan,” a virus whose symptoms resemble another, more prevalent disease.

“Even so,” Peter said, “there’s a very sick little girl out there.”

I was stunned. The abject insincerity of his words, known only to me, was shocking. Peter’s interest lay exclusively in hunting viruses, and to that end healing people was something of a by-product, the perfume that sweetened and further profited the whale kill. These clumsy words of concern were meant to manipulate me. This was the branch height to which our relationship had evolved.

“How badly do you want this to be smallpox?” I said.

He paged through airline schedules and clicked on a red-eye to Paris. “Our flight leaves in three hours.”

In the mid-1760s, a young apprentice surgeon named Edward Jenner was examining a milkmaid suffering from cowpox, an occupational febrile illness characterized by nausea and painful pustular sores on the forearms, when the milkmaid proclaimed that, according to lore, she was now no longer at risk for the dread smallpox. Intrigued, Jenner pursued the milkmaid’s agrarian remedy, and on May 14, 1796, came to perform mankind’s first vaccination, lancing a sore on the wrist of a milkmaid named Sarah Nelmes and subsequently scratching the arm of eight-year-old James Phipps with the same instrument. The mild case of cowpox this produced in Phipps successfully rendered him immune to future smallpox exposures.

But smallpox continued its wrath, killing sixty million people that century, disfiguring and blinding many millions more. Into the 1950s, the scourge still claimed more than two million deaths each year, a testament to the extraordinary virulence of the microbe, which was transmitted by respiration as well as casual contact. Inspired by the virus’s seeming preference for young children and the availability of a secure vaccine, an ambitious multinational campaign to eradicate smallpox was launched in 1967. In September 1976, a three-year-old Bangladeshi girl named Rahima Banu was cured of the last naturally occurring case of variola major, the more severe strain. A twenty-three-year-old Somalian cook, All Maow MaaIin, cast off the final case of variola minor on October 26, 1977.

Smallpox is the only virus ever to succumb to the efforts of mankind. The sole extant strain remains frozen and archived among tens of thousands of high-risk biological agents in the security containment vault of BDC Building Thirteen.

Edward Jenner deservedly achieved the eminence to which all medical scientists aspire. His contribution to the human species was significant, and in 1823 Jenner died arguably the first global hero.

I, certainly, would not die the last.

I spent our brief Paris layover out on the tarmac at de Gaulle, wrapped in a borrowed orange parka, overseeing the transfer of a hundred pounds of equipment and supplies onto a Swissair jet. The flight to Gabon passed uneventfully. I drifted in and out of sleep while Peter busied himself with his tablet, most likely tapping out some obscure virological missive that would never see publication. We changed planes again and split four matches of computer chess during the final leg of the journey, from Libreville, Gabon, to the sprawling RECI reserve east of Bomassa.

The head of the Rainforest Ecology Conservation International camp was a rangy ex-Californian named Todd. He sported a floppy bush hat and greeted us at the plane with a surfer’s smile and a strange look at Peter. “Merry Christmas,” he said.

I shook his hand, but Peter was busy watching our Cameroonian pilot, a hajji, kneeling beside the T-tail of the eighteen-seat turboprop, praying his salat. The orange light of the dawning sun warmed the pilot’s face and felled a shadow of reverence on the runway behind him.

We declined their offer of breakfast, and four other bright-eyed conservationists helped with the gear transfer into a waiting Pinzgauer Turbo. They argued with one another over the directions, eventually producing a hand drawn map of cross-outs and jagged arrows.

“Good time to be here,” said Todd, his unlaced boot resting on the towing loop of the all-terrain Pinzgauer. “Neat little window on the rainy season right around Christmas time, these next two weeks. Roads should hold. This is Pygmy territory. You two okay with that?”

Peter, tying a white cotton headwrap around his shining white hair, nodded.

“You’ll run into them if you’re lucky,” said Todd. “This is their backyard. And they take francs.”

Peter said, “I like your hat.”

Todd’s eyebrows rose in response. He pulled the hat off his head and inspected it. “Imitation snakeskin,” he said, touching the band, as though accused of something. Todd looked a decade older without the hat, strings of brown hair drawn across his sweat-soaked pate. He seemed to consider making a gift of the hat, then instead replaced it firmly on his head and squinted into the risen sun. “We got some teams camping out there, entomologists, botanists. Should I be calling them in?”

“No need,” I said. I pulled down an Emory University ball cap snugly over my brow and climbed into the green Pinzgauer. “We should be back to you in a day or so.”

Peter drove us out. The road deteriorated immediately from hard dirt and sandy shoulders to soft gray dirt and no shoulders to encroaching jungle walls and emerald vines sweeping like pennants over the windshield. A light, wavy mist became a driving rain that pattered the massive, thickly veined tree leaves, sloughing rivulets of water into the softening road, and our speed dropped to five kilometers per hour. The road faded and reappeared but the map read true.

I marveled. The vegetation spilled over us as though from a perpetual green fountain, reducing the Pinzgauer to little more than a sturdy beetle scuttling over the ground. We drove like that for hours, and my thoughts returned, as always, to work back home, to PeaMar4.

Peter stopped for the first Pygmy we saw. He was an elderly man with rich brown skin and a short, dusty beard, wearing only a battered navy blue suit jacket and a sheath that covered his groin, holding a whittled staff by the side of the road. Peter got out and approached and exchanged les salutations with the diminutive man, whereupon the rest of the tribe emerged from the vegetation behind him, as one. I had remained a few yards back, near the car.

The old man, standing not much taller than one meter, next to Peter who stood just under two, cast a dark eye upon Peter’s gloved hands.

“Médecins Sans Frontières?” he said.

Peter shook his head. He spelled out “C-D-C.”

Some among the tribe nodded. They were used to intrusions by doctors and scientists. As a race Pygmies possessed extraordinary natural immunities, including a seeming resistance to certain clades, or distinguishing strains, of the human immunodeficiency virus, HIV. Although they had lived for millennia in the remote rain forest region that was the epicenter of the virus that caused AIDS, in the three active decades of the disease no infections had yet been reported among their tribes. This revelation in the early part of this century had led to a resurgence of interest from immunologists hoping to penetrate the mystery of the coevolution of virus and man.

The old gentleman reassured Peter that we were nearing “the settlement,” as he called it. Then at once he grasped Peter’s oversized hands and regarded them through their latex shields. “As young as your hands,” he said in French, “or as wise as your hair?”

The question seemed to amuse Peter. He glanced back, then looked out at the tribe.

“Le chapeau,” he said. One of the tribesmen was wearing a bush hat similar to Todd’s, fixed atop a traditional African toque for balance and fit. The snakeskin band appeared authentic.

Peter relieved him of the hat with four hundred of the five thousand francs he had withdrawn on account from the CDC currency office — somehow he had known where to locate the keys — and presented the old man with an appropriate tribute of four blue pouches of Drum rolling tobacco, procured at de Gaulle airport for just such an occasion.

Peter fitted the hat onto his wrapped head as the old man raised his tobacco pouches in appreciation. His tribesmen followed, all raising their hands and whatever tools they held in them. It was something to see, this race of immunologically advanced people saluting Peter Maryk, who was in fact immunologically nearly a race of people unto himself.

I remained behind. In the jungle our roles were reversed, and for one of the few times in my life, I smiled the empty smile of the outsider.

The pitted, sunken road was a courtesy the jungle soon withdrew.

The twists and turns of the RECI map led us out beyond the eastern border of the conservation lands, the Pinzgauer surfing a collapsing tsunami of mighty vegetation. The land rose and fell and we rose and fell with it. Roadside bursts of beauty — waterfalls, lagoons — became routine, a whispering palette of emerald and black and olive. In time the rains returned to crash against the steel grille and overmatch the windshield wipers of the Pinzgauer, a fresh sheen of mud slicking the jagged road. The path before us flickered but never quite went out.

The rain pecked at the immense leaves, giving them fitting life as we rolled past. The jungle now seemed antagonistic; my earlier wonder was eclipsed by a mix of respect and fear. In no other place on earth does man feel more like the intruder that he is. Tamed or chased out of the megacities of the world, here resided the fugitive Nature, the artist in exile, stripped of her canvases and finer oils, now hurling paint.

The rain tapered off again and the swirl of the windshield cleared, wipers slowing in relief, the roar of the storm subsiding to a thumping on the steel hood of the Pinzgauer like small rubber mallets pressing out tin. I eased off the grab handle before me and settled back into my seat, and Peter popped his hat back onto his wrapped head. I rolled down my window and the vehicle filled with the dank sweat of the troposphere.

Another thirty minutes and the path began to widen again. Dirt shoulders appeared and the road surface ran smooth. We passed a fallen tree neatly quartered beside the road, and it was a relief to see something touched by the hand of man.

Misty sunlight streamed through gashes in the high canopy ahead, and suddenly the jungle opened on a plot of wet dirt cleared around a large, one-story plantation style house.

The house was constructed of whitewashed stone. Its clay tile roof glistened from the sunny rain, as did twin pairs of shuttered French windows in front. A fat path of crushed rock led like a white mat to the door. Another muddy car, a Japanese 4x4, was parked near the walk. Above the door hung a sopping flag fashioned waist-to-hem from a tattered, yolk-yellow skirt. It was a homemade flag of quarantine.

We stepped out into light rain and swung out the spare tire hinge to open the rear door. Peter removed his hat and broke the tape seal on a CDC-stamped carton, and we stripped off our gloves, dropping them into a cubic repository emblazoned with the international biohazard symbol. We pulled on two fresh pairs each, first standard latex surgical, then dull green contact issue extending beyond the wrist, sealing them against our skin with adhesive tape. Neither of us had much hair left on his forearms. Peter pulled blue cotton surgical scrubs on over his clothes and I did the same, forsaking the thicker, safer contact suits, selecting for mobility and comfort in the seething clime. It occurred to me at the time that it was always nice to have one higher level of protection to fall back to.

Respirators went on last. I swept my hair in under a surgical cap, then pulled the flexible harness down over the back of my head, adjusting the belt so that the customized black rubber face piece set flush across my brow, behind my ears, and below my chin — again creating a seal. The stubby inhalation valves, extending like insect mandibles forty-five degrees off each side of the chin piece, decontaminated incoming air by exposure to ultraviolet light. UV light destroyed viruses by shattering their genetic material, and was radiation-safe to three hundred and fifty nanometers. A smaller black exhalation valve was set in between.

Raindrops picked at my Plexiglas view. We powered up our respirators, hearing the dull whine emitted by the light source, and lifted the emergency aid kits out of the cargo hold, starting for the house.

The door beneath the dripping flag of quarantine was garnished with a childlike weaving of vines, stems, and berries. An African man answered my knock. He was in his sixties, wearing an agricultural mouth and nose shield tied around his head, his eyes baggy and blinking above it. His open shirt collar exposed pearls of sweat. His gloved hands, one hanging at his side and the other holding the door, were streaked with blood.

“Dr. Kaunda,” Peter said through his mask.

The doctor looked from respirator to respirator, then focused on our scrub shirts and the letters stenciled there, CDC. He looked out at the Pinzgauer in the rain beyond us, a dazed expression in his eyes.

“Parlez-vous français?” he said.

I nodded, feeling the muzzle like awkwardness of my respirator.

“Le vaccin?” said Kaunda.

Peter held up a small plastic box.

“Par ici.” This way.

We entered. A woven mat ran the length of the hallway inside. Dr. Kaunda shut the door behind us and at once the trapped heat of the shuttered house raised pops of sweat on my exposed upper arms. The respirator and twin layers of gloves dulled most of the senses. Taste was lost and touch and smell were well cloaked, though sight remained strong — I could see a light flickering through an opening at the end of the hall — and sounds were muffled but audible over the ultraviolet whine. I discerned a faint cough somewhere within.

Kaunda led us slowly down the hall. The windows were shut in accordance with the rules of quarantine, protecting against the possible introduction of a vector — an insect or rodent or some other conduit of microbial transmission — even though smallpox was passed directly from person to person. A pall of sweat shaded the back of Dr. Kaunda’s pink cotton shirt. He felt his way along the wall, moving more like a parent than a doctor.

We turned into a small, flickering bedroom. A fat candle hung unswinging in a ceiling lantern over a stripped bed upon which a nine-year-old girl lay twisted upon a patchwork of towels. She was nude, her arms out at her sides, the swell of her stomach sinking and filling as breath huffed out of her small, blistered mouth. Bulbous pox sores speckled her inflamed flesh, most prominently on her neck and arms, although common also to her torso, upper legs, and groin. The largest ulcerations were swollen to more than a centimeter.

“Elle ne peut pas supporter être touchée,” Dr. Kaunda said. She cannot bear to be touched. He stood with the underside of his left forearm pressed against his brow.

Some of the sores were broken and discharging pus, the sand-colored towels under the girl’s back showing mixed stains of yellow and red. A rash imbued the unblemished patches of her dark skin with a ruddy glow.

Her right eye was swollen shut, the bloated lid pored and crusting over. Her left eye remained open, and was bursting with veins.

“En feu,” she hissed. Burning.

Shed hair lay in wiry, doll-like strands atop her undressed pillow. The bed was soiled with waste and flakes of dead skin.

Peter moved quickly around the foot of the bed. There were trinkets and carved gourds on a wooden night stand, cleared back from a basin of reddened water. He slid his case onto the table and swiped the gourds and trinkets noisily to the unmatted floor.

Dr. Kaunda said behind us, “Elle ne peut pas supporter même la pression d’un drap.” She cannot bear even the pressure of a bed sheet.

I said sharply, “She can hear you.”

“Maman,” said the girl with a cluck of her blistered tongue, shivering, straining up off the bed.

I knelt and set the aid kit down on the floor and fumbled open the clasps. I admit that I did not know what to reach for first.

“Her name,” I said behind me.

Kaunda had found a child’s wooden rocking chair in the far corner. He was squeezing himself into it.

“Her name,” I said again.

“Jacqueline,” he answered.

I rose empty-handed and moved to her. The new rubber smell of my respirator had been replaced by the stench of human decay, seeping like a gas down my throat. I fought the odor as I stood over the writhing body of the girl. Peter was preparing an injection across the bed.

“Jacqueline,” I said in French. “My name is Dr. Pearse. We have come for you.”

Her open eye flickered and fixed overhead. “La bougie,” she insisted. The candle.

Peter straightened with the syringe. “Delirious,” he said. “Get clear.”

Peter popped off the plastic tip protector and readied the needle above the blistered pocket of her left elbow. He located the median cephalic vein and entered it.

She arched and thrust out a low-pitched groan of pain. I kept talking to her in French, partly in order to calm myself.

“It is all right,” I said many times.

Her venous left eye bulged as though straining to see through the ceiling. Peter remained over the syringe and the girl’s tensed arm. I realized then that he was not vaccinating her, but was instead drawing out blood. “Peter!”

He straightened, holding a full red barrel. “We need a clean sample for PCR,” he said, never stopping his work, chucking off the needle hub and discarding it, setting aside the full barrel and reaching for a proper hypodermic. He braced her arm at the biceps and stuck her a second time, easing down on the plunger, voiding the barrel and shooting the inoculant into her system. She arched again and cried out shrilly, a cry without human precedent.

He discarded the hypodermic, and we met at the foot of the small bed.

“Abscesses match,” I said, mumbling. “The rash, the languor. Odor.”

Peter was excited. I suppose we both were. “I don’t recall hypotoxicity,” he said — the inability to absorb inhaled oxygen, likely the cause of her hyper-sensitized nerve endings. He listed the classic diagnoses, recalled from text. “If the sores do not touch: recovery probable. If sores cluster: fifty-fifty. If bleeding erupts beneath the skin: death likely.”

The girl’s sores were clustered. I nodded just to nod. She lay trembling on the stained towels beside us.

“I’ll run the blood sample,” Peter said. A PCR assay would provide us with a genetic fingerprint of the virus and demonstrate conclusively whether or not it was indeed variola. Before he left, something in the room darkened Peter’s expression, and he turned to Kaunda.

The aged doctor was slumped in the girl’s rocking chair, his bloodied gloves dangling to the floor. Peter asked him where the parents were.

“Dead,” Kaunda said in French, making no effort to lower his voice. “Two days ago. I buried them next to the house.”

Peter exited the room without the blood sample. I heard him in the hallway, and he was throwing open doors.

I returned to the girl’s side. Her half-open eye was again focused on the candle above the bed. I reached for her small hand and took it in my own, lightly, aware of the rubbery strangeness of her fingers even through my thick gloves, monitoring her eye for distress.

“Jacqueline,” I said. “Jacqueline.”

Her head rolled slightly and the dark pupil inside her raw red eye settled on me. I warmed my eyes and put forward the smile of a confident doctor. I nodded. Her unwavering stare was one of apparent amazement.

“Je flotte,” she whispered. I am floating.

It would be a minimum of six hours before she could be safely evacuated. Six hours before the Pasteur Institute could assemble and fly in a biohazard team with an isolation stretcher — assuming no reluctance on the part of the French government in granting a visa to an African national racked with an unidentified contagion that was perhaps smallpox, a single case of which would, by definition, represent an epidemic. At that point I hoped that it was just that, mere smallpox, the reemergence of the worst scourge in human history, but an entity known and imminently curable.

I was staring at the girl, waiting for her to tell me what to do, as Peter reappeared at my side. “A man’s study in the front room,” he said. “Mural of a lion hunt on the wall. A rolltop desk full of French pens and empty file hangers. A laser printer. Two unused business ledgers in a drawer, tablet chargers, and a rotary file on the desk stripped to the brackets, even the alphabet dividers. The stove in the kitchen is full of burned paper.”

He turned from me to face Kaunda and spoke bitingly, in French.

“Where does the back road lead?”

Kaunda appeared quite aged as he looked up at Peter from the small chair in the corner of the room. He did not immediately answer.

“You are a camp doctor,” Peter said.

Kaunda’s eyes above his blood-dappled mask showed a prisoner’s expression of weary defiance, as that of a man so broken and exhausted that he existed beyond fear. I was still very much in the dark as to what Peter was getting at.

“That is why you requested vaccine only, and not support,” Peter said. “You didn’t want us here at all.” Anger burned brightly in his gray eyes, glowing with each flicker of the candle. “What are you bringing out of the jungle? It can’t be ivory. Diamonds?”

Kaunda’s latex hands rotated slightly at the ends of his arms in a truncated shrug, and his sad eyes pleaded. “Monsieur Moutouari ordered that help be called only if his daughter became ill,” he said in French.

Peter said flatly, “How many more cases like this one?”

“None,” Kaunda said. He blinked profoundly, many times. “The others are much, much worse.”

The girl’s hand slipped from my grip.

Peter told him, “You bring the girl,” then picked up my emergency kit and moved out of the room.

I remained, awaiting an explanation from Dr. Kaunda, but the old doctor just sat looking at the dark floor, his head shaking weakly.

The girl was trying to speak. Her tiny, blistered throat was working, but not well. I leaned close and lowered my masked head to her lips as she managed a hoarse whisper.

“C’est la mort,” she said fiercely. It is death.

I wondered at the extent of the girl’s agony as we crawled along behind Kaunda’s muddied 4x4. I chided myself for being too accustomed to life in comfortable, metropolitan Atlanta, having overlooked the significance of the improved jungle road, and failing to question the logistics of constructing such a house in the depths of the African rain forest. And then there was the original EPI-AID alert, broadcast by a general practitioner in the middle of the jungle with a state-of-the-art digital uplink. Peter had suspected treachery from the beginning.

On the way out of the house I had looked in through one of the doors opened along the hallway and saw the parents’ bed, stripped bare and stained with blood, vomitus, excrement. Outside, a plot of freshly spaded dirt lay on the far side of the house, patted smooth by two days of rain.

The road ran two kilometers longer to a wide opening. We parked behind Kaunda and pulled off our respirators, unpacking the contact suits: bright red-orange rubber jumpsuits with attached hoods and flexible UV face pieces. We stepped into them and pulled them up over our shoulders, sealing them across our chests, waist-to-neck, like the zipper of a plastic bag.

My head throbbed with the danger and the heat. I tugged at the cuff gaskets on my sleeves and the thick black rubber gloves attached, an additional layer of protection for the most vulnerable area of a physician’s body. Peter came before me and took hold of my sleeves and coolly double-checked the seal. His thin lips inside his face piece faintly grinned at my distress. “Nobody should be enjoying this,” I said. “Not even you.”

Kaunda spread a heavy sheet out on the grass. The girl remained curled up inside the back seat, moaning, quaking, nude. I reached in and lifted her out, feeling the fragile puffing of her immature lungs in my arms, and she was lighter even than I had, imagined. I lowered her onto the sheet and she doubled in pain, breath pushing through her torn lips like choked laughter. I straightened, immediately drenched in sweat and miserable in spirit.

Behind us, two lanes of shanties constructed of corrugated metal faced off across a wide, sun-bleached band of beaten grass. Heavy stones secured the flat shanty roofs, cooled by leafy tree limbs from the encroaching jungle. This would later become known to us as the heart of the camp town: a kitchen cafeteria, public latrine, small liquor store and bar, general store, Dr. Kaunda’s dispensary, and a wide, unwalled market. Farther away, two rows of smaller thatch huts continued around a rightward bend into the trees.

We saw only one person outside. A man was squatting beneath a large woven mat strung up on bamboo stalks near the first of the huts, his shoulders resting against his knees and his hands flat on the burned grass beside his feet. Gourds and pots lay scattered and overturned on a mat before him. He saw us and rose to stand, wearing only a shin-length pair of custard-colored pants, then abruptly turned and disappeared into one of the huts.

A distant wail startled us, and as I turned my head within the hood, a second figure burst from one of the shanties, racing across the grass mall toward the huts. She was a tall, woolly-haired woman unused to running, her slender arms flapping over abrupt strides, wearing a bright, shin-length floral skirt, a tight headdress of the same fabric, and a faded pink T-shirt. Halfway across the grass mall, she saw us, cried out and turned. Her sandals flopped as she raced toward us.

She reached me first and grabbed my rubber arm, bursting out something in a Bantu dialect that I did not understand and pulling at me to follow her. I loosed her fingers from my sleeve and for a moment held fast on to her wrist, examining her face. There were no sores and her eyes were bloodshot from crying but otherwise clear. I nodded to the woman and started away, but by then she had seen Kaunda. She shouted at him and spat with precision at his feet, and then at the wrinkled sheet of the shivering girl.

I followed inside my bulky suit. The woman clasped her hands as she moved, raising a doubled fist to the dusky carmine sky, leading me past the hanging straw mat and around an old-fashioned, pedal-driven Singer sewing machine set on a table and a ring of stones that was a cooking fireplace, to a hut on the left. She prayed to me to go inside. Sweat ran down my brow into my eyes, which I could not reach to wipe away. I set down the aid kit and motioned to her to be calm, then ducked inside, under neatly trimmed reeds.

A human figure lay still on a small cot mattress. It was a man weighing no more than eighty pounds. His limbs were wasted down to the skeletal architecture of his body, such that each knobby articulation — the ball of the humerus within the scapular cavity of the shoulder, the carpal bones like loose rocks within the fleshy pouch of his wrist — was plainly described. His skin itself was rotting off his body in a fetid stink, marble-sized boils and violet tumorous ulcerations marking the dark map of his flesh. It was less than flesh, a fungus that had grown up over a skeleton. He respired in slow, shallow breaths.

Worst of all was the man’s face. His lips were curled back from cracked teeth and dissolving gums in a mummy like sneer, and wrinkled folds of unbound skin were gathered in darkly layered sags beneath his drooping ears. Most expressively, his eyes had found something horrible in the ceiling. They were distended, blood red and fully exposed from their widened orbits, the pupils dilated and floating like compass heads fixed in scarlet spheres — as of a pair of eyeballs plucked from a jar of bloody preserve.

I backed out of the hut. I stood staring at the open black doorway I had retreated through and heard the woman pleading or praying behind me, and I backed away some more. I pointed Peter inside. “Soyez calme,” I said to the woman automatically, Be calm, not hearing the words myself until well after they had been spoken.

A figure moved in front of me. It was the man who had been squatting under the mat. He said something in a dialect I did not understand, though it was clearly gibberish. His eyes were sad and scarlet beneath drooping lids, half-open, half-dead, drunk with blood. He made a reaching motion behind him which at first I did not comprehend, and the woman screamed anew.

He produced nothing, and stared at his empty hand in confusion. Peter stood behind him, holding a large unsheathed machete he had pulled from the back of the man’s pants. There was blood encrusted on the flat of the blade. The man let out a cry of despair and fell weeping to the ground.

Peter and I looked at each other through our masks. We looked at the machete.

“Christ,” I said finally.

Peter flung it deep into the trees. He said, “Come on.”

We left the woman. We looked in at each of the more than twenty huts set along the curling pathway. Camp conditions were such that each small dwelling housed as many as six workers, and each hut now contained at least one bedridden infected person, though many contained more. Kaunda rejoined us and led the way to a hastily cleared burial ground in the back trees. At his insistence, the camp workers had dispensed with the traditional washing of corpses. An animal bone yard was similarly arranged nearby.

Kaunda explained that the disease had a peculiar and dramatic effect upon the brain; a few of the infected camp workers had set upon the others with knives, hammers, whatever was handy. The man with the machete was a sorcier aux crabes, the camp sorcerer who divined fortunes and, once the deaths had begun in earnest, dispensed buti tokens to ward off the fever. Kaunda departed the camp once the sorcerer became ill, in fear of his life.

We crossed a sturdy vine-and-grass bridge hanging over a swift river to a second grouping of smaller huts beyond. The huts were lined around a wide quadrangle of clay-tinged dirt where the afflicted were laid out on woven mats at odd angles, staring with uninterested eyes. Other obviously ill people knelt in grief at the side of loved ones, and still others shuffled about the square in a fevered funk. The recent dead were laid out in rows, their faces fixed in grimace, limbs and torsos emaciated, eyes bloated.

Raindrops bled through the high, dense canopy as Kaunda led us back toward the bridge. He paused near the quiet river, hooking his hand on a low, curved tree branch and blotting his forehead with a handkerchief from his back pocket. “Four days, start to finish,” he said in French. “First the headache. Flulike symptoms, a general malaise. Then spasms, chills, and onward.” He rumbled a light cough into the dirty handkerchief. He was facing the river. “Four to five days, fever to fulmination. Three weeks now. It set upon the camp like an eclipse.”

Peter went around in front of Kaunda. Under his scrutiny, the wizened doctor straightened off the low branch. He swiped at his face with the cloth, standing on short, uncertain legs, but ultimately wilted under Peter’s intent, silvery gaze.

“You’re sick,” Peter said.

Kaunda gestured dismissively with the damp cloth. “Malaria,” he said. “It returns now and then—”

Peter shook his head. “You’re sick,” he said again.

Kaunda looked wearily back at me, a pleading smile, and then again at Peter, appealingly. “A touch of the fever,” he explained. “I have quinine in my office.”

He tried to move toward the bridge but Peter stood in his way. “Sick doctors,” he said.

Kaunda shook his head. “Non, Monsieur—”

Peter regarded Kaunda with disgust. “Denying their own disease as they spread it.”

“Monsieur.” He was indignant now, rubbing at his face with the cloth as though trying to erase it, his balance wavering, “I can assure you—”

Peter turned his back on the man and faced me. “We’re on our own here,” he said.

For a long time after that I forgot about the heat inside my suit. We unpacked the equipment and immediately began treating people. The metal-roofed marketplace shanty was the only structure large enough to accommodate all of the sick. I drafted the healthier camp survivors — falteringly, in glove-pantomimed French — to help me clear out baskets of grains and meal and burlap bags of spoiled produce, to make room for a trauma center. Peter isolated the area by dividing the camp lengthwise along the center mall, symptornatics to the right, asymptomatics to the left. A dotted row of stones became the borderline between sickness and health. They were all term laborers trucked in from the depressed cities of Kinshasa, Brazzaville, and Yaoundé, recruited by agents of the same illicit concern that had hired Kaunda, lured by high wages too attractive to refuse. Of the roughly one hundred and fifty surviving workers, the two populations at that time were nearly balanced.

After a round of preliminary examinations Peter set up his tablet and bulletined two nurses and seven investigators from the Special Pathogens Section, a division of the CDC that dealt specifically with the epidemiology and etiology of unknown emerging viruses. The aid message read, in part:

There was no international alert, as we agreed that the outbreak was adequately isolated, at least for now. In any event, it was always preferable to establish the disease etiology first, rather than face unanswerable questions that could lead to misinformation and public panic later. Fear was the most virulent disease of all.

Peter backed the Pinzgauer out of the clearing into what became our retreat, abandoning Kaunda’s infected 4x4 inside the camp and pocketing the keys. I designated a barrier zone between the two areas, setting out for us a large biohazard box, packets of sterile gloves, and pans and brushes and jugs of Pheno virucidal disinfectant.

We refit Kaunda’s dispensary inside the camp, fashioning an operating theater out of an examining table and pump sink that would service autopsies as well. Then we set up shop in the market shanty and began prioritizing the afflicted. The asymptomatic population assembled behind us in a desultory line along the quarantine border, watching us administer to their sick.

Peter broke away around midnight to do the PCR work, and ran the genetic fingerprint of Jacqueline Moutouari’s virus through the database at the CDC. It came back exactly as we had feared: UNK, or Unknown. Whatever was eating Jacqueline Moutouari, it was not the smallpox virus. It was something not yet encountered by human medicine.

I visited her later. She was lying on an air mattress in Kaunda’s personal hut, behind the dispensary, feverishly reciting what sounded like a child’s prayer. The suppurating pustules had merged upon her chest and legs. I could only wait for more antivirals to arrive, in the vain hope that one might click.

I returned exhausted to Peter under the roof of the marketplace.

“The sores have merged,” I said. “She’s dying.”

He immersed his instruments in a pan and ceded the patient to me. “I’m finding tumors in post,” he said, meaning postmortem examinations. “It’s a retrovirus.”

I slid my gloved hands into a bowl of cleansing formalin. Retroviruses were RNA viruses, more complicated than regular DNA viruses, and responsible for a rogue’s gallery of diseases including various viral cancers, leukemia, and immune-deficiency afflictions such as AIDS.

“The girl’s is different,” I said. “Hypotaxia. Range of sores. The symptoms vary victim to victim. There’s something to that.”

Peter nodded. As he started back to the dispensary I heard again what I had previously taken to be the pounding of my own pulse inside my head. I called after him. “The drums,” I said.

Peter looked to the high trees, listening. “Pygmies,” he said before continuing on.

The CDC team arrived by Ford Explorer and Peugeot station wagon at noon the next day. They wore full biohazard regalia and brought with them nearly five hundred pounds of equipment, including surgical supplies and diagnostic apparatus, body bags, nylon restraints, a thirty liter autoclave, generators, refrigerators, and small transport freezers. The expression in their eyes as they stood among the dying reimpressed upon me the macabre rage of the disease.

Following a short briefing, we left them to string up IV feeds and hang mosquito nets around the trauma center while Peter and I retreated to the barrier point on the edge of camp. We disinfected our suits with a painstakingly thorough Pheno scrub bath, before ripping them open and pushing back the hoods. The pores of my cheeks tingled, exposed to the free-flowing air. We disposed of the suits in biohazard and changed gloves and proceeded to the Pinzgauer outside camp. I broke open a waxed box of distilled water and downed half of it, pouring the rest into a bowl and splashing it on my needy face. Peter, a claustrophobic, strode in wide, relieved circles around the vehicle, happy to be out of his suit. I sat in the open side door of the Pinzgauer and savored the muggy air.

Neither of us had ever seen a virus so devastating as this one was. No one had. A virus with such a high degree of pathogenicity traditionally lacked virulence, just as, conversely, a less debilitating virus achieved wider penetration by virtue of its having a greater number of living, functioning carriers. This African bug would likely burn through the camp inhabitants within one week’s time.

All of this went without saying. We still did not know what the virus was or, more important, exactly how it was transmitted. After the meal, Peter waved a mosquito away from his head, and both of us looked at each other with a surly alertness. Silently we withdrew into fresh contact suits.

At dusk anything that could be used as a weapon was confiscated in a hut-by-hut search. The virally induced psychosis had manifested itself in varying degrees among the afflicted, from mere confusion, to stupor, to outright dementia. Only a few became violent and had to be restrained. Psychotic episodes were staggered with brief periods of lucidity, marked by despair and expressions of terror, leading invariably to the final, catastrophic stage of the disease.

That night Peter completed a field assay involving a T cell survey of ten patients in the prodrome, or preliminary, phase of the disease. T cells are the white blood cells that make up the vanguard of the human immune system response. Peter’s field test — a simple tally of cells on a microscope slide — found the highest T cell count of the ten prodrome cases to be thirty-four, which was demonstrably low, in fact well below the CDC criteria for establishing a diagnosis of AIDS.

By the end of the second day, thirty-seven more were dead, fifty-one suffered advanced cases, and thirty-two were entering the prodrome phase with severe flulike symptoms. PCR analysis had revealed significant differences in the genetic sequences of the viral strains infecting the population. We were dealing with something unusual, a virus possessed with extraordinary mutative properties.

The CDC team submitted lymphatic samples once daily for PCR screening and adopted a buddy system in order to monitor one another for disease symptoms or fatigue. The virus was almost certainly airborne, and a slipped scalpel or torn glove compromising a suit could lead to a fatal contamination.

Later that evening I began to hyperventilate inside my suit and had to be relieved. A few minutes away from trauma I regained my composure, and on my way out of camp I checked in again on Jacqueline Moutouari. Bleeding had erupted beneath her skin. The sores were now most profound upon her face and torso, many broken open and draining a mustard-yellow discharge. Her decaying body was ridding itself of nutrients and fluids faster than could be replenished. Any attempt at dressing her wounds resulted in cries of pain. The nine-year-old was in agony. I stood over her, daubing some garamycin into her half-open, blood-filled left eye and gently holding her hand. There was no response now, no squeeze or gurgle or twitch of the eye. Nothing had worked. I wandered out to Kaunda’s car on the edge of camp and lay back on the passenger seat. I could not fathom the life that was going along blithely back in Atlanta, throughout America and all the world. It was as though the airports we had passed through on the way to this virus had, upon our takeoff, turned to dust. I slept there, fully suited, for two hours.

Peter woke me before dawn and handed me a flashlight. I accompanied him down the dark road, past the camp, ending around a long curve at a natural cave opening in the center of a steep, grassy rise. He approached the cave’s wide, dark mouth and stepped inside.

I followed. The walls and the ceiling had been widened and reinforced, our flashlights illuminating work grids painted onto the surface, continuing deep into the dark earthen belly. A fine dust swirled in the bright cones of our beams.

A four-wheeled wooden cart rested on twin rails to the right, containing hand tools and mining implements, pickaxes, hammers. The inside walls of the cart were dented and stained black.

We withdrew from the cave at once. Further exploration was never considered. The chance of compromising our suits was too great, the floating dust itself a formidable potential vector.

We followed the rails along a well-trod path to a long, flat-roofed, pale brick building to the right of the rise. Severed treetops were spaced in large pots atop the roof, and camouflage netting hung halfway down each of the high walls.

The wooden double doors were not secured. Inside, Peter’s beam found four more wheeled carts on alternate rails, one filled with broken chunks of brownish-black ore still encrusted with dirt. The main track fed directly into what appeared to be a small refinery. We moved along the length of the left wall, past ovens, stone crushers, smelting vats, and piping, to the end of the line, where beneath a short, iron flume stood a sealed twenty-gallon drum painted sugar white. Peter found a steel rod and pried off the cover, which popped and fell with a clamor against four more barrels behind. It was full of sand packed chunks of clean, dark, lustrous ore laced with quartz. Peter picked up a small piece and turned it over in the light of his beam.

“Pitchblende,” he said. “Uranium ore.”

Radioactive material. I backed away from the barrel, and brushed something with my boot. My light found a small bat lying dead in a dried streak of blood. Its brown wing membrane was curled and spattered with sores. I turned my torch up toward the ceiling, pipes leading like steel vines to exhaust portals in the grimy roof. The vent windows along the high side walls were unscreened and open to pest and rodent intrusion. I looked back at the floor; it was fouled with guano.

We exited the infested building and crossed the road to a smaller structure fashioned of the same corrugated metal as the camp shanties, but twice the dimension, and bolted edge to edge. Rats and mice lay twisted along the roadside at our feet, as though having crawled out of the underbrush to die. Peter opened the door on the darkness, and we heard a rodent like scattering. His flashlight beam swept a long wooden counter where the miners had evidently been served lunch and dinner. We moved behind it to a cramped cafeteria-style kitchen, and there he illuminated four objects set along a high shelf next to a stack of tin food trays. They were flowering plants of some sort, well-dead now, cauliflower like eruptions of bunched petals spilling off a broad stalk around medusan strands of horny stigma. The pots holding them were cracked where the root system had burst through the clay and forced out dirt and leggy spindles. The color had since faded off the wrinkled petals, like a comic book bleached by the sun, leaving only shadows where apparently garish streaks of color once rioted.

Peter turned to me, his flashlight hanging down, fallen leaves and crumbs of dirt shining in its puddle of light.

“Four weeks ago the miners broke through the dry gallery wall they thought was the rear of the cave,” he said. “They followed a quartz vein of uranite down into a wide cavern running beneath most of the camp, beneath us now. It was a rich deposit. They held an impromptu celebration dinner that night, and some of them brought up a few of the strange plants discovered below. The cavern dips into the water table down there; they had to have waded through it. The ceiling is lower than two meters in places, the stalagmites and stalactites pointed and sharp. They reported large, strange-sounding flying insects. The soil in there hadn’t been disturbed for centuries, perhaps never.”

“How do you know all this?”

“Kaunda’s tablet. He was a camp doctor hired to hand out quinine and Praziquantel tablets to keep the workers working, and got in way over his head. The glass cabinet in his dispensary, stocked with bottles: half are routine medical, peroxide, alcohol; the other half bourbon bottles with the labels soaked off. I found it tucked in there. He began charting the spread after the fifth or sixth incidence. It originated simultaneously in two cave workers and a female cook. The cooks were unmarried women who also accommodated the miners as prostitutes. A fourth case occurred in Kaunda’s nurse; the virus spread quickly from there. Animals too. Pigs, sheep, and goats all crashed or had to be put down within days of the first human case.”

I took a moment to digest this. “What about the girl?”

“She never came into camp. Neither did her mother. Mr. Moutouari was in charge of the mine and came and went regularly back and forth by bicycle. He led the first expedition down into the cavern after it was discovered. Maybe he brought up one of the more exotic flowers as a present.”

I envisioned Jacqueline outside her front door, thrilled with her father’s gift of a fantastically queer wildflower, placing it into a small porcelain vase and raising the petals to her nose for a deep breath.

Peter continued, “In any event, someone fronted this excavation. The camp was set up to bring out the pitchblende and clean it off to be packaged and shipped out where it could be milled for uranium. Whoever it is, they’ve abandoned this place now. The disease scared them off. Moutouari must have warned them. There haven’t been any food shipments in more than a week.”

“Radioactive ore,” I said. “With whatever ancient microbes are sealed in down there. A closed system, mutating, slow-cooking the RNA, selecting and reselecting over time.”

Peter agreed. “Over the millennia. A magma chamber of viruses. These people go down there and break the seal, disrupt the ecosystem. That’s phase one.”

“Then carry it back up here.” I nodded. “Whatever they brushed up against, or whatever is in these plants, whatever they breathed, it surfaces and they are infected.”

“The cave is clearly the epicenter. The surrounding camp is densely populated. From the incident group to their families, and the nurse to her patients. Then to non-mine workers, the bar owner, the tailor. The far camp was the last to get it.”

“Casual contact, then. And aerosol delivery, but with limited capacity. It burns through the camp. Phase two.”

“And now phase three,” Peter said. “Opportunity for secondary spread must exist. The insect census is a wash for vectors — more species of bug in this tiny camp than in the entire state of Georgia. The river tests clean, no fish washing up yet. But mammals carry it.”

Peter saved words by moving his light beam back and forth between us.

“Someone could become infected and vector this virus back to the U.S.” I agreed. “There’s no physical boundary here, no safe wall we can put up between us and the bug. The sunlight is killing it in the clearing, and keeping it off the trees. But not for long.”

Peter nodded meaningfully, looking into the darkness of the diseased kitchen.

I said, “If this has gotten out already, and is showing up anywhere else, we need to know. An international alert. We need entomologists, zoologists.”

Peter shook his head distractedly. “Too hot,” he said. “Containment is most imperative now. Kaunda’s log said there hadn’t been any ore shipments out in almost a month — they thought the cave had run dry. We’re contained now. More people here means only more meat for the bug.”

“But we need support. I’m seeing only limited success in trauma. Fluid management is only marginally effective in slowing the process.”

Peter snapped off his light. “Or prolonging the agony,” he said. “It’s going to burn right through this camp, nine doctors or nine hundred.”

He was right, of course. As we left the kitchen I found myself feeling oddly reinvigorated, anxious to get back to trauma. Our challenge had finally taken shape. Peter opened the metal door and we emerged into the apricot dawn of our third day in the jungle.

“A massive cleanup,” I said, thinking ahead.

Peter looked around at the cave and the road and the morning trees. A wild plant was growing in the shadow of the cafeteria, its leaves spindly and fevered with overripe color. He uprooted it with his booted heel, and kicked it into the killing light. He said, “Leave that to me.”

In the afternoon of the third day I was called away from the marketplace trauma by a young girl in her mid-teens on the healthy side of the quarantine line. She was attractive, even remarkably so, with expressive eyes and a chestnut face almost more sculpted than functional, but inside the charnel house this was just another detail among details, an identifying trait I might have listed along with size and weight on her chart, and in truth a feature not nearly as remarkable as the spectacular disfiguring qualities of the disease. What did distinguish the girl were the stains of vitiligo over her neck and arms, and what I could see of her shins below the hem of her banana-yellow skirt, dappled with depigmented, strikingly pale pink flesh that, in my haze, I first mistook for symptoms of the scourge, and which brought me to her. The young woman’s eyes, however, were white and clear.

She began begging me, in quiet, controlled French, to take her away. Save me from this death, she said, her fingers plying at the red-orange fabric of my chest. Her entreaties became more desperate as I continued to decline, but she pleaded and pleaded, even offering herself to me, anything, grabbing on to my suit, until finally I had to wrest her hands and thrust her away. She dropped to her knees in the grass on the healthy side of quarantine, and continued calling after me.

Later that day, one of the nurses brought me Dr. Kaunda. His eyes were bloodshot and glazed, and small lesions had appeared over his body, and he complained of prostrating lower back and abdominal pain. He was still muttering something about quinine. The muscles of his face were lax and formless. The depersonalization phase had begun. I dosed him with Seconal to allow him some sleep, and moved on.

That evening, as I walked in on Peter in the dispensary, working over a corpse, I saw that his head was exposed. He had severed his rubber contact suit at the neck and removed the hood in favor of a respirator and a simple cotton surgical cap. The suit was taped sealed to his thick neck, while the decapitated hood piece lay on its side on the floor across the room.

He saw me in the doorway, looking up from his corpse. There was no explanation, no regret. No apology nor even defiance.

Though I strove to return a similarly cool expression, I certainly failed, and finally left without saying a word, proceeding to the hut behind the dispensary.

Jacqueline Moutouari’s face was no longer distinguishable. I had seen decomposed bodies before and that was what she looked like now. She was breathing in short, feral breaths with extended pauses in between. Each one seemed her last.

Peter appeared next to me. He was rubbing something sticky off his gloves and looking at her. She clutched at her chest with tiny, crooked fingers.

“End it,” Peter said.

The Seconal kit was in my gloved hands. I felt its weight and wondered, as though it were the greatest question in the universe, whether or not I had intended to bring it there. Seconal was a powerful barbiturate sedative, and when administered in significant dosages, was considered a humane instrument of physician-assisted death.

Peter grew impatient. “Give me the kit,” he said. He did it himself. Her pulse rate began to fade and, in less than thirty minutes, stopped.

I buried her myself. It was backbreaking work. I buried her behind the dispensary, away from the others.

Peter later abandoned the autopsy room and joined me out in the makeshift hospital, having capped and chilled many more biological samples than we would ever need. His protective gear had changed again, and now consisted merely of a lighter half mask that provided not much more protection than a simple surgical shield, goggles, and half-arm gloves taped to bloody cotton surgical scrubs. He had covered only the vulnerable membranes of his eyes, nose, ears, and mouth. The contact suit was gone. A nurse next to me saw him and gasped but I kept right on working. Peter was able to move more easily than the rest of us, and flaunted this advantage, rotating from patient to patient with breezy dispatch, like a barber inspecting haircuts. Later that evening I asked him for 2 cc of his blood. It came back negative for viral infection. Peter was clean.

When I was first getting to know my third-year roommate at Yale, I ignored Peter’s boasting of never having been sick. I was myself descended from a long line of New York Episcopalians who claimed the same, my grandfather having “never missed a day of work in his life,” simply by going to meetings ill and routinely infecting half of Wall Street. This was the starched white underpinning of my Protestant Yankee work ethic.

But as I came to know Peter, I watched as he immersed himself in the petri dish of university life without forfeiting a single class to illness; without contracting the case of mononucleosis that kept me, his finals study partner, from participating in the graduation ceremonies; without ever catching so much as a sniffle. I witnessed more of the same as we continued together through medical school: a defiance toward illness that went beyond the bragging of an extraordinarily hardy constitution. In our second year at Emory, in the CDC virology track, each candidate had to submit to a battery of inoculations before being allowed access to the most dangerous biological agents. Peter was the only one to smile through the endless vaccinations — yellow fever, Q fever, Rift Valley, tularemia, anthrax, hepatitis A and B, typhoid, meningitis A type and C type, and multiple flu and encephalitis strains — tolerating each of these and more without any side effects, without developing even the slightest rash or headache.

The clincher came a few months later, when Peter was contact-traced by the CDc’s own Crimes of Infection branch as having been seated on a recent flight from Seattle to Atlanta two rows in front of a man infected with multidrug-resistant tuberculosis. Untreatable MDR-TB was the second most prevalent infectious disease in the world, and in the United States it was illegal for carriers to fly on commercial airlines. Contact tracing had turned up all 221 passengers and members of the flight crew, and all were found to have contracted the incurable disease during the five-hour flight, and all went on to secure enormous financial compensation from the airline. All except Peter Maryk. He was the only passenger who did not collect. He had been exposed with the others, and yet somehow had thrown off the incurable disease. A battery of tests proved this. The only sensation of discomfort he recalled was one of exhaustion shortly after landing, which he slept off lying across three chairs inside the airport terminal.

I set to work, initiating a series of laboratory tests exposing samples of Peter’s blood to infectious agents both viral and bacterial. He demonstrated resistance to each, and in time and in secret, Peter began exposing himself to some of the more exotic, non-lethal viruses. He cast each one aside without manifesting a single symptom, and with only one unusual side effect.

The more serious exposures were followed by a period of mononucleoticlike languor, the duration of which varied according to the pathogenicity of the infectious agent, ranging from brief periods of sluggishness to deep re-energizing sleep. The effort required to expel invaders from his system prompted an overall energy drain, which Peter termed a “cascade.” This typically meant his slumping in a corner chair following an exposure, as though dawn had found him the last survivor of a wild party with no ride home. When it compelled him to sleep, which was rare, he slept soundly, nearly unconscious. Given his imposing physical appearance and his superhuman immunological strength, these cascades were the only times he ever appeared vulnerable.

Our co-authored findings were published to acclaim in The New England Journal of Medicine and entitled, “Noninduced Superimmunoresponse and the Search for the Survival Mechanism: The Strange Case of Dr. Peter Christian.” Peter’s pseudonymous identity and reputation were however generally known within the CDC and the greater medical and scientific community, and the professional acclaim he enjoyed only exacerbated his alienation from his peers.

The origin of Peter’s enhanced immune system could be explained only as an accident of genetics, although a six-generation family history had yielded no clues. His body somehow recognized and isolated unhealthy intruders with alacrity, overwhelming and disabling them profoundly, and dispatching them without any trace of infection — including the production of antibodies. While this latter condition seemed to preclude any direct therapeutic application of his gifts, Peter’s blood serum did evince certain benefits in laboratory tests. I determined the reactive process to be CMI, or “cell-mediated immunity,” a little-known function of the immune system distinct from the classic antibody response. With CMI, patrolling killer T cells destroy not merely the invading virus, but the infected cell itself, simultaneously ending the virus’s bid for reproduction and ridding the body of the threat.

Transfusions of his blood, however, wreaked havoc on laboratory animals. The problem was that Peter’s killer Ts attacked without restraint in non-primates, not stopping at pathogens but going on to devour healthy body cells and eventually whole organs and the blood itself. Still, the prospect of a blood serum enhanced with disease fighting properties sustained my laboratory efforts over many more months.

Before that day in Africa, I had never seen him be anything but scrupulously careful, or otherwise dare to tax his system in an uncontrolled setting. Peter had the so-called doctor’s disease, the compulsion of many twenty-first-century physicians and scientists acquainted with contagion prevalence and modes of transmission to wear latex gloves at all times, even socially. In fact I assumed that Peter went to bed with a pair on. He was conscientious to the point of compulsion regardless of his incredible natural gifts and had never before been one to take any unnecessary health risks. Direct transmission from an unknown virus like this one, such as infective matter gaining entrance into his body through membranes, or a direct blood exposure, such as from a needle stick, still posed a threat. I kept an eye on him throughout that long, hot night, and at one point noticed him working in a vaguely rhythmic fashion, moving in time to the patient drumbeat of the distant Pygmies.

I was being followed. Whenever I started out to the vehicles for supplies, or went to a quarantined hut to isolate an advanced case from their family, or carried a body to the morgue, the girl with vitiligo shadowed me along the quarantine border. As I worked over patients she sat on the grass across the dividing line, hugging her pink dappled legs, watching me. There were by then only seventeen people remaining on the healthy side. Her time was running out.

At midday I found that I could no longer ignore her, and left trauma suddenly, crossing to the center of the mall. She stood as I started to move, hesitated when I began in her general direction, then rushed to meet me at the quarantine line. I pulled her groping hands from my suit and examined her eyes with a penlight. I inspected her mottled arms and legs, which she displayed proudly, following my gaze with rapt anticipation. She exhibited no signs of the illness. I called upon a nurse to run PCR tests on the remaining seventeen asymptomatics, then wrested myself away again. The girl struggled against me, lunging at my shoulders as I twisted free, stopping only at the quarantine threshold, calling after me as I walked away, “Docteur! Docteur!”

By the middle of the fourth day, I knew that all our efforts were in vain. Working in the stifling heat, my body weeping dollops of sweat — I had already lost more than ten pounds — treating patients who only days before had carried me their brothers, their mothers, their children, I struggled to retain some facade of humanity, to make contact with these masklike faces before passing them down the line to Peter to be taken apart and studied. Preventive therapy had failed and supportive therapy was inadequate, and worse, unable to keep up with demand. We had reached the limits of our medical expertise with the resources available.

We were not the cause of this, I reminded myself. But neither were we the cure. We were merely the facilitators.

PCR tests comparing the virus in Jacqueline Moutouari to samples taken just that day showed dramatic changes in the genetic architecture of the virus. The pathogen was incredibly labile, which we attributed to the virus’s aeonian radioactive exposure.

The cries came at midafternoon and lasted for several minutes, a feral bellowing somewhere north of camp that halted relief work and commanded our attention, myself and the two nurses, all looking in the same direction as though expecting something to charge out at us through the trees. The sick listened distractedly to the animal screams as though receiving long-delayed news, and a few, such as the strapped-down, wasting figure of Dr. Kaunda, emulated the wild baying, pearls of foam drying at the corners of his broken lips.

Peter left to investigate and later returned to lead me out across the grass bridge, along a macheted path to a high spot outside the camp. It was a ridge overlooking the jungle terrain rolling out to the west. The largest of a thick grove of ancient black trees there had been ravaged, the bottom meter of trunk bark rent to the bare wood and scored with blood and bits of greenish-gray fur. A green monkey lay dead atop a bed of shavings. Its fur was burst with pustules, and black, blood-sodden eyes stared out of its small, drawn, side-turned face. One long arm lay across its belly, the leathery black fingers of both forepaws broken and bloodied. A few paces away, a baboon lay ripped to shreds. The infected monkey had savaged the larger animal before turning its attack upon the tree trunk, then bled to death from its subsequent injuries.

“My God,” I said.

Peter opened up the disinfectant pack he had brought along and uncapped a gallon bottle of industrial bleach. He began sloshing it on the monkey carcass.

“A quarter mile outside camp,” he said, dousing the tree wound. “The virus is making its move.”

Peter often spoke of viruses as though they had motives, as though they were forward-thinking, free-will life forms with plans and hopes for a deviant future.

“Flies are already visiting the kill,” he continued. “Whether arthropods can vector this is anybody’s guess, but we have to assume for the purposes of containment that they can. It’s starting to break.”

I looked out over the ridge into the virgin land below. The camp river continued there, a sparkling blue stripe, eventually pooling into a soft clearing that floated hazily, like a mirage, in the emerald distance. Birds arced in slow, careless circles over pink flamingos high-stepping in the shallows.

“We can’t quarantine the entire jungle,” I said.

Peter nodded his agreement. “That is exactly what I told Krebs.”

I turned back and took a step toward him, then stopped. Dr. Martin Krebs was the director of the CDC. “When did you—”

“Earlier today. Reached him in Washington. I told him what we had. It’s over, Stephen. We’re out of here in four hours.”

The caustic smell of the bleach just then began to drift into my suit hood. “What do you mean?” I said. “These people.”

“Are dying.” His voice was flat, yet urgent as always. “The relief effort has failed. Fifteen minutes after we’re airborne, air force jets will fly in and take out everything within five square kilometers.”

“Jets?” I moved closer toward him in my suit, as though running underwater. “The Congo government would never allow—”

“The prime minister and the president have already been briefed on the outbreak. They signed off on anything that would avoid the panic of an Ebola-like winter.”

“But that kind of disruption would whack out the cave’s ecology. We’d only be escalating it.”

Peter calmly shook his head. “A few strategic strikes on the top of the rise to reseal the cave for good. The rest, a surface exfoliation. Plants, bugs, animals: every living thing.”

“But the camp people. The asymptomatics. How do you propose evacuating them?”

Peter moved on to the baboon, bleach glugging out of the upturned bottle. In the heat and sweat of my contact suit, I felt a bracing chill.

“This is the hottest thing we’ve ever seen, Stephen. You know that. It’s only a matter of time before someone slips up and draws a contamination. This bug could burn through every living thing on this planet if it gets out. That cave is simply too hot to preserve. It is the tumor of the world, never meant to be found. So we bury it. We sea] it back up, and work with the samples we have.”

“And the asymptomatics?”

He looked at me over his half mask. “You’d bring them back into the U.S.?”

“Murder,” I said. “Don’t pretend this is humane. It’s preemptive, and misguided, and premature. Murder.”

“Our job is to protect humans as a species from an extinction event such as this.”

“By slaughtering a few? Offering up the remaining healthy ones as sacrifices to the viral god?” I battled to control my breathing. “Going to Krebs without me. Without even consulting me.” Peter’s betrayal shocked me most of all.

“I knew what your position would be.”

“And so you ignored it? Went around me? Never even considered that you might be wrong and I right?”

“If you have an alternate plan,” he said, shaking out the last drops of bleach over the dead baboon, “now is the time.”

“We wait.”

“We can’t wait.”

“Let it run its course. Let it burn out. For God’s sake, Peter.”

He sounded strangely disappointed. “This is Andromeda, Stephen. The Holocaust paradigm: bombing the rail yards to cut the transport lines, martyring those already in the cattle cars to the millions who would die in the gas chambers. That’s what disease control is all about: trading the dead for the living. This is no laboratory, Stephen. Categorical imperatives are fine; it’s all right to be contemplative on the front porch some warm summer evenings. We’re facing world genocide here. Krebs understands that. I am sorry these people are sick. But I am even sorrier they are contagious. De mortuis nil nisi bonum.” Of the dead say nothing but good.

I watched him recap his bottle of bleach. “What’s happening to you?”

“You can’t save everyone, Stephen. Not even you. Mercy was right enough for the girl.”

It was all I could do to keep from ripping off my suit, as though only my self-destruction would change his mind. “She was dying.”

He was kneeling before me now, repacking his disinfectant kit. “If we don’t stop it here, cauterize it, now, it’s going to slip out of the jungle and march across this continent and the planet.”

I saw it all then, the bulletining of Special Pathogens black-baggers, his reluctance to issue an international alert. “You were going to bury this from the beginning.”

“No,” he said. “Not from the beginning. But early on.”

“I’m calling Krebs.”

“I told him to expect you. But the jets won’t be called back. The uranium mine is in violation of international treaties and the Department of Defense will strike whether we remain here or not.”

“Peter,” I said. “Listen to me. Burning these people alive...”

He snapped the kit shut and stood. “We don’t have the supplies to euthanatize everyone. But if you have a favorite or two, be my guest.”

He started away with his plastic kit like a salesman moving on to his next call, leaving me standing with the two animal carcasses. Vapor waves of bleach, formerly the essence of cleanliness, of household chores and gym socks in the wash, of pale grout and a gleaming bathroom floor — now and forever the effluvium of disease containment, of ablution.

At once I started after him. The girl with the vitiligo was watching for me at the huts, but I brushed past her grabbing arms to search the camp for Peter. I passed the trauma area and a patient cried out, and I stopped only long enough to treat him. Soon there were others calling for my attention, more than the nurses could handle. After a while I stopped looking over my shoulder. I began treating the doomed as fast as I could.

Steaming rain rang off the shanty roof and pelted into the mud. I had received no satisfaction from my terse conversation with the expedient Krebs, and the rest of the team had been informed of the evacuation and were hurriedly packing up supplies and samples.

Peter reappeared at dusk with jerricans of gasoline from the Pinzgauer and went around burning the huts. With the camp in flames, he joined me in the failed enterprise that was trauma. His head was now completely bare. No mask or shield or goggles, his mouth, nose, ears, and eyes daringly exposed, his white hair glowing under the argent rain-light of the rising moon. Only the latex gloves remained, poreless, wrinkle-free sheaths protecting his vulnerable surgeon’s hands.

Fury and despair had synergized into fatalistic resolve, and though my head pounded without mercy, my hands were steady as I worked. I was fighting the clock to treat the untreatable. Death was coming to these people either by nature’s hand or by man’s, and I was trying to provide some small measure of comfort in place of hope.

Peter was performing agonal biopsies, rapid sampling of the tissues of those closest to death. Heavy rain crashed after nightfall, but no drums, and I understood then where he had disappeared to earlier. He had gone to warn the Pygmies away.

In retrospect, Peter’s divestment now seems inevitable. But it was not his claustrophobia — a simple psychological condition, separate from his cascades — that triggered it, as I had then thought. Nor was it Africa itself that drove him to this Kurtz-ian breakdown. I learned its source as Peter worked over the carcass of a middle-aged woman, drawing bloody slush out of her brain where clear cerebrospinal fluid should have been.

“Life, Stephen,” he called across trauma, rainfall crashing outside the mosquito net hanging behind him. He set his instruments aside and crossed the corpses toward me. “Eating. Feeding. Consuming, and being consumed. The beauty of decay. All here, Stephen, all the secrets. All the questions and answers, here for the touching but for this thin membrane—” He flexed his fingers inside his gloves. “Warm, stewy. Consumption.” He nodded, stopping on the other side of my patient, smiling. “The viscera of our existence. The slime we crawled out of, claiming us back. Creation; destruction. Our end game peeking out at us from inside a cave — and you and I facing it down. Life, Stephen. In our hands alone. We are the boundary. Death. Life.”

Blood dripped from his gloves as his hands formed enthusiastic fists. I was terrified.

The girl with vitiligo dogged me through sheets of rain as I rushed along the far shanties to the vehicles. She had been at me all night. “You are leaving,” she said, alarmed by all the movement inside the camp. “We will go away now, Docteur. You will not leave me here to die.”

I stopped finally, the rain smashing at my hood. I turned to her and set my feet in the mud of the narrow walkway, and heard her plead once more. “La pluie, ça pue la mort.” The rain, it stinks of death. I then grabbed her suddenly with both gloved hands, one on her neck, the other covering her mouth. Her eyes fluttered wide with surprise and I propelled her around to the shaded rear of a shanty, thrusting her up against the metal wall. She was squirming in my grasp, trying to speak. She was trying to breathe. I saw the rain falling in the inches between our faces, smearing my mask and breaking like bits of glass over her nose and lips — and then returned to my senses, and at once let her go.

I stepped back. I looked at my suit gloves and they were clean; I had just come from a formalin soaking. If not for that I would certainly have infected her. “Murder,” I mumbled, huffing inside my stale suit, mad with despair and frustration and the unforgiving rain. She regained her breath and came at me undaunted, begging to be saved, her pink-stained hands pulling at my wet rubber chest. “No,” I told her, each time with less conviction.

“Stop,” I said finally, seizing her thin wrists and holding her arms fast. The downpour rang off the metal roof of the shanty as I scrutinized her clear, desperate eyes. She looked so small and young in the rain. “Wait,” I said. “Wait here.”

I moved under the branches behind the shanties to the road barrier and quickly disinfected. The seventeen asymptomatics’ blood samples had come back dirty — all except hers. Remarkably, for someone living in the tropics of central Africa, she had been demonstrably free of any viral infection as of noon that day. I was beginning to think that perhaps I had stumbled upon Peter Maryk’s immunological equal.

In my duffel bag in the trunk of the Pinzgauer I dug out my blue thermos and unscrewed the jar top. Dry ice steamed out. I had included with my provisions one 2-cc ampule of PeaMar4, just to have on hand, just in case.

The glass ampule containing the golden sera slid into my hand. The bottle was small and cool and smoking in the heat. I took one of the last remaining clean hypodermics and hurried back.

She met me as I approached. I showed her the hypo and instructed her to make a fist with her left hand and clench her left biceps — “Like this” — with her right. Fumblingly I drew the immunoserum into the barrel.

“The cure,” she said brightly.

“No,” I said. “But this will help to protect you.”

I braced her arm at the shoulder, then paused with the needle just over her skin. I looked again into her eyes. They were clear, and the trust I saw in them was overwhelming.

I jabbed the needle into her biceps. She looked away but did not grimace or call out in pain, and when it was over she released her fist, slowly, and then her hand. She smiled and flexed her arm, gently rubbing the puncture spot. She looked eager and thankful and suddenly quite lovely, and it thrilled me, and I knew then beyond any doubt that I had made the correct decision.

“Now run,” I said. “Down along the river, beyond the lake. And never come back here.”

She touched the fabric of my chest. “But I am going with you.”

I grabbed her other arm beneath the shoulder. “No,” I said. Her strewn, dripping hair made her look petulant, and I shook her roughly, once. “If you want to live, go now. If you want to die — stay.”

I released her, and after a moment she smiled at me admiringly, and again I hated her. She was like a stray that followed closest when kicked. “If you tell me to do it,” she said proudly, “I will.” It was as though her blind trust in me were her thanks. I turned and started back toward the mall. “I will go now, Docteur,” I heard her say behind me, her proud voice drowning in the rain. “I will go.”

I went around the corner of the shanty and kept walking.

Their sunken faces stared up at us through the rain, a silent, staring chorus. It was too late for anger and too early yet for regret. I tried to imagine the cymbal crash of immolation and the waves of orange flame, and their drawn faces flaring up, the diseased skin blackening and melting back, and their final revelation: “This is why the doctors abandoned us.”

The air force helicopter rose out over the river and the waterfall beyond, pulling away from the hazy clearing and the shrinking pink forms of the flamingos, higher and higher. I looked hard for the girl with vitiligo, as though I might see her there, waving good-bye.

The window was cool against my bared forehead. PCR lymphatic tests had confirmed each of us infection-free, and we seven sat strapped into our seats: malnourished, clinically exhausted, rocking lifelessly with the motion of the military helicopter climbing through the rain. We had shed our contact suits, leaving them collapsed on the mud road with the vehicles and contaminated equipment like so much trash awaiting incineration. We were all finally free of the suits and yet no one could bring him- or herself to celebrate. My own skin felt just as constricting.

Viruses traditionally are named for their place of origin. Ebola River, Democratic Republic of the Congo. Marburg, Germany. Lhasa, Nigeria. Machupo River, Bolivia. Lyme, Connecticut, and Muerto Canyon, Navajo Nation, USA. I wondered what exception would be made when the place of origin no longer existed.

Peter was strapped in across from me, and I saw that the first stage of his cascade had begun. His sluggish half eyes watched me, his chest emptying and filling deeply. He roused himself awake like a drunk coming to in a strange chair, blinking lazily and licking his thin, red lips.

“Twenty-one days of quarantine on an aircraft carrier,” he mumbled. “Doesn’t seem so bad right about now.”

I saw then something in him that I had never seen before, or perhaps had seen but ignored as I tried to shape his deviance for the benefit of humanity: the monstrous aberrance of Peter’s genetic superiority. My eyes opened to his utter inhumanity.

He tipped forward and slurred a few parting words before succumbing to the cascade slumber. “The tumor of the world,” he said. “You know I was right.”

This was to be his apology. There are chapters to every life, though seldom are we aware at the time of a page being thumbed and turned. This was one of those uncommon occasions.

Zero

I wish my tale of Africa ended there. There is however one more incident I must relate, a brief sequence of events to which, at the time, I was not privy. Even now, with the keenness of hindsight and every fact of consequence available before me, this singular event remains the most strange.

Seven days following the razing of the camp, the rainy season resumed in earnest. Oren Ridgeway, a botanist with Rainforest Ecology Conservation International, was out on the last night of a five-day field expedition into the rain forests of northern Congo, having circled back to within thirty kilometers of the RECI reserve. The night jungle is a haunted place, as I had found, where no man should venture alone. I can picture Ridgeway stretched out on his back, the rain spattering against the roof of his narrow nylon tent, listening to a BBC World Service broadcast on his radio, reporting on the current political climate in the United States, his home.

The pioneering enthusiasm he had arrived with eight months before was by then gone. He had journeyed to the central African rain forest in order to archive and preserve specimens of the tens of millions of uncharacterized species of tropical flora, before population demands and the big boot of human development stamped them out forever. But that night he was facing the futility of his efforts; millions of rare life forms were being willfully exterminated around him, and he was reexamining the merits of his crusade. What was the use, after all, of trying to salvage a representative sample of a species not strong enough to survive on its own? How much should be left to nature? And what of the senselessness of naming something just as it ceased to exist?

The fact that he was even deigning to entertain these questions must have depressed young Ridgeway all the more. The earth was suffocating worldwide under the weight of advancing Homo sapiens, and that night, as he lay alone in the pounding rain of the jungle, he must have felt himself its only witness.

Case in point: the jets he had heard streaking across the jungle sky seven nights before; he had reported them. And the black rain, which he at first thought was volcanic ash cycling back through the biosphere; he had reported that too. His reports went out over the airwaves among a million bursts of static, answered by no one, slipping the earth’s orbit and pulsing into the galaxies, a lone human voice of protest.

The system had since purged itself, and the rain that night fell again sweet and clear. I see him reaching up and unzipping the tent fold, letting in some of the perfumed forest air, the scent of his smothered cooking fire, its lingering smoke. There would have been faint light from above, threads of silver angling off the waxing moon through the jeweled rain. Perhaps by the light of one of those lunar strands did he notice the branches bobbing in the trees across from his tent. There was nothing unusual about a creature moving through the night jungle — until the creature emerged from the trees on two legs, walking erect. Ridgeway then sat up, repositioning himself to peer through the zipper folds and through the rain.

It was a human figure, too large to be a Pygmy, slipping from the cover of the trees and moving across a muddy path to a tree of surfboard-sized leaves.

Maybe Ridgeway thought it was someone trying to steal something from his camp. Did he turn up the volume on his radio, in hopes of scaring off the intruder? Or did he simply struggle into a plastic poncho and step out into the rain?

“Yes?” he called out. “Hello?”

Not until the silhouette emerged from the cover of the leaves would he have known that it was a female. Ridgeway knew little of the local dialects, and no French, but he was a trusting soul, with plenty of food to share, and would have welcomed friendly company of any sort.

She started across the camp toward him, striding through the strands of silver light, and Ridgeway saw then that she was nude. Her body was young and firm, with branch scratches and other irregular marks covering much of her dark flesh. She walked right up to him, breaching even that radius of personal space generally respected by strangers, breathing deeply, as though after a long run. Her dark nipples brushed against the chest of his poncho with each gust. He opened his mouth to speak then, to ask her what she wanted, and her lips closed on, his in a firm kiss. She kissed him full-mouthed and sensually, without otherwise touching his body, and after the initial shock, Ridgeway’s neck and back relaxed and he accommodated her passion without resistance. Perhaps he opened his eyes just once, buoyed by his raging pulse, and found her eyes were open too, but dark, her pupils flat and staring. Her tongue then swished the enamel of his front teeth — strangely cold, in his limited experience, colder than any other tongue he had ever tasted — and their lips parted and she stood facing him as before.

He saw more clearly then the dull glow behind her eyes, the thick drops of rain breaking upon her nose and cheeks, and the vague discoloration of her flesh. It was vitiligo, though this meant nothing to Ridgeway. And then at once she turned and started away. She walked not quickly, not even purposefully, the bright glints of moonlight illuminating her buttocks, the sheen of her shoulder blades, and the dimpled small of her curved back, crossing through the rain back into the trees.

She would wander the jungle in this same stupor for some ten more hours before sitting down to rest against a dead tree in the middle of a wide clearing and succumbing to a series of swift, violent, massive strokes. Creatures of the jungle came forward to nibble on her corpse, but did not like what they tasted, and none of them made it back out of the clearing before failing dead. The insects that fed upon the dead creatures also died, so many carcasses cooking under the bright, virus-killing sun. The animals deemed it a sacred place, and all stayed away. The girl’s skeleton still sits there, partially intact, slumped next to the rotted tree, its skull fixed in an empty, meaningless grin.

As for Ridgeway, he ran after her that night, but no deeper than the first few forbidding trees. He returned and found her footprints in the soft mud of his camp, small and faint and disappearing in the hard rain — then gasped out a nervous laugh. She had been real enough, though there was precious little consolation in that. A beautiful woman of the jungle, exotic and nude, had walked out of the trees and kissed him once, as though delivering a passionate message dispatched from the heart of the rain forest, then disappeared again without a word. He shook his head underneath his poncho hood, and smiled.

He looked up and found the swelling moon above the thinning canopy. The warm rain washed his face, smelling of the sky and of the fleeting bare feet of summer, and he stood there, the blood rush still tingling in his veins, perhaps dreaming of home.

This was Patient Zero.

My Own Story, Half-Told

Another page turned.

Stockholm, six years later. December tenth, the anniversary of Alfred Nobel’s death, and traditionally the inauguration of Nobel Week, the end of a day that should have been the brightest yet of my thirty-seven years. The diploma and solid gold medal presented me by His Majesty the king of Sweden at the award ceremony at the Stockholms Konserthus lay securely in the safe behind the reception desk in the hotel lobby, while I lay seven floors above, deep in a strange bed like a heavy stone set upon a soft pillow. And for the first time in a long time, I was not alone.

Following clinical trials of varying degrees of success, and in light of Peter Maryk’s increasing disdain for the project, I eventually directed our PeaMar research exclusively toward manufacturing a pure, whole blood alternative. The result, PeaMar23, was a certified disease-free, hemoglobin-based, synthetic blood substitute with a storage shelf life of nearly three times the forty-two-day limit of organic human blood.

Coming at a time when worldwide inventories of clean blood were reaching a critical level, news of the discovery was hailed internationally as a triumph on the level of Salk’s polio vaccine and, unexpectedly, made me something of a celebrity. PeaMar23 was currently in use in every health clinic in every province of every country in the world, all mass-produced in a plant in Chamblee, north of Atlanta, known as BDC Building Twenty, the Blood Services Section.

For this Peter Maryk and I shared the 2016 Nobel Prize for Physiology or Medicine. My acceptance speech at that day’s ceremony had been well received (The governing principle of my professional life has been that we at the BDC must never let technology overshadow basic human care... that we continue to reach out to the afflicted, if only with a gloved hand... that we be scientists second, doctors first...), though as I returned to my seat, flushed with relief amid the applause filling the concert hall, I felt that something was missing.

It was not the ignominy of Peter Maryk’s vacant seat next to me. That I could have expected. The breach that first formed between us in Africa had widened during the development of the PeaMar sera, and culminated in the dissolution of our partnership following the unveiling of PeaMar23 four years before. Since our abrupt falling out, Peter had become something of an outlaw among the medical science community, while my professional career had moved in a diametrically opposite direction. For the past thirty months, I had held the dual federal posts of U.S. Surgeon General and Director of the Bureau for Disease Control. Though we both still worked for the BDC, Peter Maryk and I had not spoken to each other for almost four years.

So it was not Peter I was missing as I glanced around at my fellow laureates on the concert hall stage, in chemistry, literature, and economics, all joined on that milestone day by their families. I was unmarried and unattached. Both my parents had passed away that same year, and I found myself alone. When the ceremony ended and I stepped down off the concert stage with one hand in the pocket of my tuxedo pants, making polite conversation with His Majesty who, in an imperial gesture of pity, had seen fit to escort the lone bachelor to the floor, the only familiar face waiting there was Peri Fields’s, head of the BDc’s Public Affairs Section and my public relations liaison. Her congratulatory kiss as she pressed it into my cheek felt genuine rather than perfunctory, and raised my spirits a bit. Even this spin-weary sorceress of worldwide media was swayed by the authenticity of the Nobel.

Following the royal banquet, Peri and I repaired to the hotel bar for a champagne nightcap, the electricity of the day still coursing through us. My excitement I understood, but hers surprised me, and interested me. For two years in Atlanta, we had shared nothing more than a working relationship. I heard her shoes fall to the floor beneath the table, and watched her mouth as she laughed. I had not been drunk in years. The steady, interested blue of her eyes, moistened by the champagne, caught some of the magic of the chandelier. The clumsy embrace that began in the mirrored elevator on the ride up to the top floor continued more gracefully behind the door to my top-floor suite. There was at first the revelatory exhilaration of intimacy with a close associate, like a hunger choking us both, followed by the fumbling of zippers and buttons and the culminate unveiling of each to the other as we stood beside the high bed. My hands found her warm hair, her neck, her crotch. The preliminary sacredness of touch accelerated to bold groping and grasping, and the sheets tangled around us, twisted and grew warm.

Afterward, I had found the release of orgasm to be rousing rather than narcotizing and lay staring at the thickly papered walls by the light of the city, diffuse through the lace-veiled window, as synapses fired within the charged nebula of my brain. The events of the day came flooding back, but the accolades felt empty again, the honor a cheat. It was Africa, still haunting me. Within every doctor’s psyche resides that patient from early in his career, the one who touched him and whom ultimately he failed, and who becomes the secret source of all his healing efforts. I lay there on that strange Nobel night not with Peri Fields, not in a hotel suite, and not even in Stockholm, but a world away, in a camp shanty in deepest Africa, next to the writhing form of a nine-year-old girl corrupted by a pitiless disease.

After a time I did sleep, and awoke to the sound of the door closing. Peri’s clothes were gone from the floor, and I sank back against the pillow as remorse seized me all at once. That night seemed a terrible mistake suddenly, a selfish stab at my own loneliness that had perhaps sabotaged a perfect working relationship.

I arose and showered automatically, due that morning at a Nobel symposium arranged early to accommodate my schedule. I dressed alone in the solitude of the hotel suite, the tableau of bedsheets creased and tugged. out from beneath the mattress resembling the scene of some passionate crime, to be repaired by the proper authorities in the form of a humming chambermaid.

The symposium concerned the alarming spread of infectious disease around the globe. Before the question-and-answer period, a video program was played on the large screen behind me, entitled The Disease Dilemma, a one-hour documentary concerning recent health scares around the world and the Bureau for Disease Control’s vanguard role in managing and preventing them. The program had been Peri’s brainchild, having debuted on one of the global satellite networks that previous Monday and been available on-demand for downloading since. It was the highest-rated worldwide prime-time broadcast of that week, with tens of millions of viewer hits since, and I was the host.

It had been Peri’s strategy, which I had agreed to and signed off on, that as director of the world’s preeminent health organization, I was to be promoted to the public as a spokesman for good health and clean living. This was done most expressly in the bureau’s numerous Health Promotion campaigns for children, but The Disease Dilemma represented a quantum leap forward in terms of popular exposure, and at the time had struck me as a unique opportunity to educate the world about disease prevention. But now, as my voice carried over the heads of the luminaries assembled in the Royal Caroline Medico-Chirurgical Institute auditorium, the program felt dishonest. The role of health messiah seemed to me now a cheap part we could have hired an actor for, or even commissioned a cartoon mascot. I looked down at the day-old Nobel weighing heavily in my lap — it had been suggested that I wear it around my neck, in the manner of an Olympic athlete, which I had respectfully declined — and felt suddenly nothing, which was wrong. It was a significant award, conferred for advancements made in the interests of humanity; for me, there could be no higher praise. Yet the ghost of Africa, like a creeping stain, corrupted all. I was a fraud who had violated my oath by having been complicit in the expedient murders of dozens of camp workers, and though no one ever learned of the firebombing — Peter had seen to that — I felt somehow certain that the more accolades I received, the worse my ultimate retribution would be.

Part of the reason for this was the dark shadow that had followed us back from Africa. The lethal camp virus had inexplicably emerged in the United States fifteen months after our return, achieving worldwide infamy with a massive outbreak in the small town of Plainville, Massachusetts. The Plainville plague was a catastrophe unrivaled in the modern era of disease control, such that the term itself, “Plainville,” not only came to denote the name of the virus, but entered the popular lexicon as a site of mass disaster, such as Chernobyl, or Bhopal. Plainville claimed more than twenty thousand human casualties, including entire neighborhoods of nearby towns — though, as far as the public knew, that had been the end of it. In fact there had been four subsequent isolated outbreaks. None was as devastating nor nearly as widespread as Plainville, thanks to the efforts of the BDC in containing the spread of the raging virus, and therefore, with no immediate threat to the public at large, the outbreaks were covered up in order to avoid hysteria and undue media scrutiny. The secret was closely held; even Peri Fields was not aware of the post-Plainville reemergences. Six times since Africa, the Plainville virus had materialized, poisoning every living thing it touched before vanishing without a trace, only to rise up again some months later in another state, with no discernible link between events. Enigmatically, there had been no connecting outbreaks — no other victims of the disease — between the uranium camp in the Congo and Plainville, USA. Its incursion into North America remained a mystery.

Now the program was ending. I listened to myself embellishing the extent of my actual field participation, furthering the superhero image — and cringed, ashamed to know that my hubris had crossed the line into a lie. The truth was, I had not attended the site of any outbreak in the thirty months since I had become director. I had never even gone to Plainville.

The lights came back on and hands went up among the international press assembled in the hall. A British accent: “Dr. Pearse, simply put: Why are so many becoming so sick?”

I nodded, though the question itself was unanswerable. “One of the lessons of what we now call the ‘antibiotic era’ of the previous century was that as weaker microbes fall away, more resilient ones survive and emerge, and sometimes with a vengeance. We will never eradicate viruses or bacteria from the earth, nor should we. What we as a people must do is to seek to control viruses, as man has learned to control fire, as we control and continue to legislate against crime.”

Another question. “Do you agree with your president’s statement that ‘America is no longer the world’s policeman, it is its doctor’?”

“I do, but not as a slight to the other world international-disease-fighting organizations. Our world is shrinking, and the bureau has, for better or for worse — I think for the better — stepped to the forefront of global disease control.”

“What do you think it means that your co-recipient, Dr. Peter Maryk, did not attend the award ceremony? Do you consider it a snub to the Nobel Foundation?”

“I can’t speak for Dr. Maryk,” I said, trying to move along. “You’ll have to ask him that yourself.”

I recalled The Disease Dilemma and its retelling of the Syn-Bank dedication at the White House four years before. Peter and I had both decided that we could not in good conscience profiteer from PeaMar23 and jointly signed over all patents and monetary claims to the BDC. It was perhaps the last thing we ever agreed upon. The revenue filled the bureau’s coffers, and in what was known as the “blood dividend” the Bureau for Disease Control became, while still functioning as an arm of the government, a self-supporting philanthropy not funded by tax dollars. The reason I had accepted the more decorative position of surgeon general was to ensure the integrity of the cash-rich BDC, and to preserve its political autonomy.

The news footage of the White House ceremony had shown me at the podium in the Rose Garden, holding forth on my vision of the future of medicine and disease control. Peter, seated in a chair behind me, folding and refolding the event’s program repeatedly in his gloved hands, his white hair glowing in the morning sun, declined to speak that day, and each day that followed. After Krebs was forced out, and I was appointed BDC director almost by acclamation, Peter, who could have had-anything he wanted, asked only to head the small Special Pathogens Section, with the proviso that he be well left alone.

Another question. “What can you tell us about Dr. Maryk? What is the ‘Special Pathogens Section’ and why is its work so secretive?”

“Special Path is a separate unit of the BDC,” I said, “dealing primarily in disease detective work involving unknown or emerging viruses. There is nothing secretive about that.”

“What would you say to those who claim you are putting your own personal agenda ahead of that of the BDC?”

“I would say, ‘What personal agenda?’ I want to see the world healthy. That’s all.”

“Where do you go from here, Dr. Pearse?” This particular accent was American. “What’s next?”

“Next?” A smile passed over my face. For some reason, the question tickled me, perhaps because of the bad taste left in my mouth from my performance on The Disease Dilemma. “Perhaps my resignation as surgeon general,” I said, as much for the charm of hearing myself say it aloud as anything else. I hadn’t given this any serious thought.

There was a stirring within the press corps. A buzz started throughout the room, and a camera light or two. came on, and questions began overlapping — all of which only further provoked me.

“The directorship also,” I said. “It may be time for me to get back to research. The Nobel has reminded me of why I got into medical science in the first place, before I got caught up in the parenting of PeaMar23. But only if I can first set up a smooth transition of power at the BDC.”

More commotion. I was entertained anyway, and oddly relieved; the announcement seemed to ease some of the pressure that had been building up inside of me that strange night and morning. It was as though my career fever had suddenly broken, and I was waking up, looking around the room with new eyes.

A signal tone sounded above the fray, and I looked off to the side of the dais. There was Peri, looking back at me, troubled by my candor. After some confusion as to whose tablet was going off, she opened her own and then held it for me to see. It could have been an inelegant ploy to get me off the stage, but something in her manner compelled me to stand. She met me at the step, her quick blue eyes anticipating my suspicion.

“It’s real,” she said. “Dr. Chiles.”

Reporters were surging toward us now, and to get away we withdrew through a pair of rear doors into the auditorium control room. Two women looked up disinterestedly from a computer station, then resumed their work. Pen turned her tablet around for me and held it, patiently, as I scanned the header.

It was indeed from Bobby Chiles, my deputy director at the bureau, forwarding an EPI-AID alert originating in a federal hospital in Orangeburg, South Carolina. The disease class caught my attention, listed as UNK, or Unknown.

I pulled the headset out of the tablet and dialed Bobby’s office in Atlanta. A window opened in the lower left corner of the screen and Bobby’s face, jowly and brown-skinned with a bush of rusty hair on top, appeared.

“Stephen,” he said. I saw the familiar black vinyl headrest of his chair behind him. His Georgia accent was strong in my ear, concerned. “No confirmation yet, but it looks like Plainville.”

I stared at the screen. The letters “UNK” stood out to me in bold blue pica. “South Carolina?”

Bobby read from a piece of paper. “A tuberculosis ward inside a hospital, burning fast. Eleven down already and we’re just now pulling up curbside.”

My pulse quickened. “No link to the last outbreak?”

“Nothing so far. Looks like the same deal as the others. Maryk’s out in Nevada, chasing down a low-grade hemorrhagic dengue. Protocol’s the only reason I’m bothering you. You are both still down as case agents on this thing. Just need your say-so before I call him in.”

I was nervous but, moreover, excited. “No,” I told him. “I’m taking this one, Bobby. I’m leaving here right now.”

Peri said over the top of the tablet, “You are?”

Bobby looked at me across thousands of miles, through the screen. “Come again?”

Peter and his Special Pathogens group had managed the original Plainville outbreak and each subsequent recurrence, shielding the operation from the public eye and, more important, containing the spread. But I remembered my claim on The Disease Dilemma broadcast, and thought that now would be a good time to begin living up to it.

“I can be there in a few hours,” I said. “They should have the pathogen properly typed by the time I arrive.”

I pulled down the headset and signed off, and Peri took back her tablet. “South Carolina?” she said.

“We’re heading back. You’ll need to clear my calendar for the next few days.”

“But the London speech...” She broke off, and did not persist. She must have sensed my determination. “I’ll extend all apologies,” she said.

Her smile brought back some of the night, and in her face I saw again that thing I had glimpsed under the chandelier, that had endeared her to me: Behind the learned cynicism of her profession lingered, like a smattering of character freckles just visible beneath camouflaging cream, the bright liveliness of a small-town girl.

Our shared silence was, rather than uncomfortable, thoughtful. Even encouraging.

“I panicked this morning,” she said. “It was stupid. I’m sorry I ran out.”

I smiled and shook my head. “Good morning,” I said.

I blushed. She didn’t.

“Good morning.”

Later we returned to the States together, conversing over meals in first class like any other couple, and the time passed pleasantly, but too quickly. After a small kiss inside the main terminal at Dulles International Airport, we departed for separate airplanes, hers back to Atlanta and mine on to South Carolina, that dread feeling in the pit of my stomach returning.

But for now she reached up to swipe a wayward lock of hair off my forehead, then nodded back at the door. “By the way,” she said. “Did you actually mean any of that in there?”

The medal weighed heavily in my hand like a gilded ashtray. “All of it, I think.”

The chief resident of the Orangeburg Federal Hospital waited anxiously to be introduced. “An honor, Dr. Pearse,” he said, and we shook gloved hands, under the ambulance entrance overhang. I was being sealed into a biohazard contact suit, its design much improved in the years since Africa, a lighter, saffron-colored, tear-resistant polymer jumper that was cooler inside and allowed greater mobility of the head and shoulders.

“We’ve isolated the green zone,” he said, “and evacuated all nonexposed patients, support staff, personnel.”

“Leaving how many infected?”

The chief resident took a dramatically deep breath. “Sixty-four. Eleven dead already and as many as twenty in the late stages. We would have picked it up sooner, but with the TB patients, it was difficult to tell.”

The hood came down over my head. There were many people moving around me.

“The catatonics, Dr. Pearse.”

They were pulling tape around my ankles, knees, and elbows, sashing the slack suit material. I nodded my hood at the doctor, prompting him to continue.

“Clinical catatonia, nonresponsive to medication. None of them has spoken or moved in at least the past ten years. They were in the room next to the TB ward, undergoing neurological tests. Dr. Pearse — they’re speaking. The infected catatonics. They’re waking up, asking questions.”

The suit hood smelled of plastic inside, with a lingering coolness like that of a Halloween mask. A Velcro tag labeled S. PEARSE was affixed to my breast, beneath the black BDC logo. I thumbs-upped the Biohazard Containment Unit without enthusiasm and looked again to the doctor.

“The virus we suspect here has been known to have a pronounced effect on the brain,” I said. “Now, if you’ll excuse me.”

I walked alone to the nylon-tunneled entrance way, known as “the umbilical,” its pale blue wails rippling in the Carolina breeze. The advance BioCon team had removed the automatic doors to the hospital and installed air locks and negative pressure doorways. I stopped at a steel door papered with safety stickers, checklists, and red warnings, placing my triple-sealed hand upon it. It had been a long time since I’d been inside a suit. I took three deep, filtered breaths, loud inside the hood, then entered.

The second door opened on a hospital corridor and whooshing gusts of air accompanied me inside. The building was sealed under negative pressure so that no microbes could escape to the outside environment; whenever the control doors were opened, air was made to rush inward. The gloomy admitting room and hospital lobby were empty, the talking head on a high monitor still automatically welcoming visitors and issuing paperwork instructions. Hospitals were no longer places where the sick went to be cured. All surgeries, diagnostic tests, and physical examinations were performed at neighborhood-based “parish” clinics under the auspices of the national health care system, at a flat rate surcharge. Federal hospitals had become “managed care facilities,” or sanitariums for long-term care of the chronically and terminally ill.

The walls and ceilings were all coated with a white, meringuelike viricidal foam. Eight colored bands ran along the center of the clean corridor floor. I followed apple green where it veered off from the rest.

Around the first corner, other BDC personnel moved about in yellow suits like astronauts burdened by gravity, backs emblazoned with the cardinal red, three-petaled biohazard symbol. One stepped out and approached me, calling to the others in a muffled voice, “Dr. Pearse is on-site.” A second suit holding a glassine-shielded tablet, the administrator of the situation log, called out the time in response: “Mr. Director on-site, thirteen-oh-two.”

The approaching scientist strode out to meet me, her arms and legs moving naturally inside the baglike suit, the cap lining her forehead and the frame of the Plexiglas shield giving her face a pronounced V shape of dark eyes and slanting cheeks, a sharply tapered chin. The woman’s face was striking, but like a sculpture made of glass, her beauty was cold and fixed. Two thin auburn eyebrows arched smartly into an uncreased forehead. Her name tag read U. FREELEY.

Freeley was Peter Maryk’s number two in Special Pathogens. She joined me and strode confidently at my side, following the green stripe ninety degrees around another corner. “PCR typing confirms the pathogen,” she said. Her voice lowered commensurate with the privileged nature of the information. “It’s a confirmed Plainville drift.”

“We’re absolutely certain?”

“Oligonucleotide mapping will take a day or two, but it’s here, and it’s hot.”

An antigenic “drift” described a slight change in the makeup of a virus. A virus that has “drifted” has undergone a subtle genetic mutation, and can elude previously produced antibodies to successfully reinfect an immunized host. An antigenic “shift” is a wholesale recasting of the virus. Plainville’s frequent shifts were as alarming as they were unexplained.

She said, “It originated with the catatonics.”

That was meant to surprise me, which it did. “Not the TB ward?”

“Catatonics first. Then immediately jumped to the lungers down the hall.”

“No amplification outside the hospital?”

“None yet. Again, a nice, tight environment for containment. We have the hospital logs for all visitors and contact tracing is under way. Quarantine Services should have everyone rounded up within the hour.”

“Good. The hospital is locked down?”

“FEMA Biohazard is settled in. Epidemiology is represented by General Investigation, Identification, Host Factors, Pathogenesis—”

“Fine.” I cut short the roll call. We had arrived at another air lock bolted to the wall and sealed with drying epoxy, the removed door leaning next to it. The tiles beneath our feet were entirely green.

“Trauma,” Freeley said. “We grouped the catatonics here to facilitate treatment.”

I nodded and reached for the door handle. I wanted to pick up the old feeling before proceeding with the investigation.

“Just patients inside,” she said. “Serology can handle the blood sampling.”

“I want to take a look around for myself.”

Freeley stepped back, her eyes narrow and steely, like Peter’s, and humorless. Her deference to me was forced; she either disliked or distrusted me, or both. I attributed it to Maryk’s influence and left her there in the hallway, moving through the portal alone.

The forced air washed me inside the trauma unit. Curtains printed with pharmaceutical advertisements segregated the patient bays, numbered two to twenty-nine around the room. Yellow suits conferred in the central nurses’ station, stocking trays and updating computer charts. One nodded to me as he passed, the laminated pages of a small book held in his rubber-gloved hands; the Velcro tag upon his chest read CHAPLAIN.

The fact that the outbreak had not originated with the hospital staff was in itself remarkable. In epidemiological terms, it was the hound that did not bark. The catatonics’ incapacitated state seemed to be, at that point, our first solid lead in establishing the epidemiology of the Plainville strain: The disease could have been communicated to them only by a visitor. Thus the vital importance of contact tracing.

An attending serologist passed me wheeling an instrument cart. “Director Pearse,” he said, recognizing me, slowing, straightening.

His awed greeting reminded me just how remarkable my presence there was. “I’m here to help,” I said.

He gestured to his cart. He was young and thin inside the tightly sashed suit, wearing black-rimmed glasses. “We’re just pulling blood,” he said.

“Dangerous work,” I reminded him, reading his name tag, “Dr. Tenney.”

“Yessir. Of course.”

“Okay if I accompany you on your rounds?”

“Yessir,” he said brightly, and we started across the room.

I discerned the hazy forms of patients through the plastic tent walls, lying supine or sitting up against pillows, doctors and scientists and nurses in yellow suits at their sides. The bays themselves were each roughly the size of an average parking space, and each contained one bed sealed inside an opaque plastic oxygen tent hanging from the ceiling to the green floor. Tenney led the way to a bed near the door, number twenty-five.

He peeled open the tent fold on his side and entered, and I did the same opposite him. Resealed, it was quiet inside but for the hiss of oxygen.

The patient was a woman in her late thirties. The wrinkled sag of her biceps over the bedsheet indicated years of atrophy, though overall the condition of her face and hands evinced care. Her head rolled slightly on her withered neck, illustrating the benefits of dedicated physical therapy.

Her eyes were open and blinking and blushed faintly with hemorrhaged blood. She was early stage, the skin on her face dark and blotchy, her tongue — she was attempting to speak — scarlet and swollen. She looked up at the roof of the opaque plastic tent as though she were falling through the room rather than lying in it.

When she spoke, her unused jaw moved side to side rather than up and down, and her throat rasped hoarsely. “What is happening?” she said.

Tenney was punching up her chart on the bed rail console. “Negative for motor activity and speech functions for eighteen years,” he told me. A moment to do the math, then excitement in his eyes. “Since 1998.”

“What are you?” she said.

I released and collapsed the railing and sat on the mattress next to her. My suit bunched beneath me, but she was small on the bed and there was plenty of room. Tenney said revelatorily, “She’s never seen a contact suit.”

I nodded to quiet him. “My name is Dr. Stephen Pearse,” I told her. “You are in a federal hospital in South Carolina.”

I had to strain to hear her. “Why?”

“Well, you’ve been asleep for a while.”

She swallowed clumsily and raised her quivering right forearm off the bed, high enough that the orange hospital bracelet slid down to her elbow. “See?”

Soft, russet-colored lesions blemished her neck and face, but a bedsheet covered her body from the chest down, and her hands and arms were as yet free of any Plainville sores. I realized she was in fact directing my attention to her wrinkles.

She said, “Old.”

I watched her face as its features, fixed for two decades, shifted slightly with the effect of breaking apart, like ice cracking in warm liquid. They re-formed again in an awkward, lopsided, plaintive expression, and I recognized a teenager’s fear in an adult woman’s face.

I took her shaking hand and eased it back down onto the bed, and she gazed up at me, patient to doctor. “Parents,” she rasped.

“We’ll check,” I said, and the veneer of her face broke again into another long-unused expression. She wept tearlessly with the fragile eyes of a young girl. I squeezed her hand again. “We’re going to need to draw some blood. Then we’ll see about getting in touch with your folks.”

I motioned for the apparatus and Tenney handed it to me across the bed.

It had been a while. I swabbed her elbow and tied and released the rubber tourniquet, drawing out 4 cc as she moaned in pain. Her blood was dark and sludgy. I withdrew and broke off the needle and disposed of it in a biohazard box behind the bed, capping and sealing the syringe barrel. The motions were familiar to me, comfortable. Tenney printed a label from the bedside chart, and we met outside.

“Take care of the blood,” I told him, “then see what you can do about her parents.”

He appeared confused. “I’ve got rounds to do, sir.”

“Find them,” I said. “The hospital will have records. Leave your cart for me.”

He went away and I proceeded to a standing pan of Pheno disinfectant — green-hued, like a bowl of antifreeze — to immerse my gloved hands in the sterilizing solution between patients.

Plainville held tightly to its secrets. We could study it in only the most secure laboratory setting, and we could not work with it at all. The virus ate through laboratory animals, fetal tissue, Vero cells, and blood products — any living matter placed in front of it. Only through due diligence on the part of the bureau, as well as some extraordinary good fortune, had the bug failed to achieve amplification beyond the isolated microbreaks since Plainville.

As I was shaking out my gloves over the pan, I heard a muffled voice call my name. I was startled, but not unnerved, and looked around expecting to see another hopeful face inside a suit hood. There were no suits near me. I saw then a small, thin arm moving within a plastic tent, in bay number twenty-six. I went there, unzipping the tent and drawing Tenney’s instrument cart in behind me.

Patient Twenty-six was a younger man with a gaunt, collapsing face. I guessed he was in his late twenties, although the disease had aged him significantly. He was mostly bald, with a few patches of wispy silver hair streaming off his pate, as light and thin as spider’s thread. Overall, even as compared to the woman in twenty-five, Twenty-six’s convalescent care had been superlative. Only his sclera, the whites of his eyes, which were a bright firehouse red, indicated any significant illness. He bore no observable sores, save his badly scabbed, lips, which were nearly chewed away, as though he had been gnawing at them throughout his prolonged slumber.

But this man had been in a catatonic state for at least ten years. It was inconceivable that he should know my name.

“Do you know me?” I said to no response or change of expression. Just a hollow stare. The wasting man looked at me across a great distance, as though the center of the hospital bed were quite removed from the sides. I felt no recognition myself. I broke from the man’s stare and turned to the chart on his bed rail.

The screen read “Unoccupied.” I checked his thin wrists for an admittance bracelet, not finding one. His left arm was as light as a cardboard tube and I rotated it in search of a needle stick from a previous blood draw. The man did not otherwise move.

“What is your name?” I asked.

“Pearse,” he whispered again, in a garbled voice. He was staring at my chest, and I realized that my name tag was there. I turned and surveyed the outer room through the thick plastic tent, where yellow suits moved about hazily. He could not have read my name tag from that distance, and only barely could have made out my face.

“Who are you?” I said again, but his eyes had retreated into a faraway, blood-sodden gaze. I gave up and printed out an Unoccupied label, then proceeded to swab the man’s elbow with alcohol. I was still a bit rusty, and it took me three attempts to locate a viable vein for a blood sample. I released the tourniquet and watched the plastic barrel slowly fill with blood.

It happened in an instant. One moment I was finishing off the blood draw; the next, the syringe was falling from my hand, and there was a stinging in the center of my left palm. A shudder or a jerk, that by the laws of atrophy the patient should never have been able to make — and somehow his hand had come up and struck mine just as I was withdrawing the needle from his arm.

Afterward I stood for some time staring at the man beneath me. He had settled back into the mattress, the blood-filled syringe lying alongside his leg. His face was fixed and phlegmatic, his half-open eyes regarding me as though with a blithe red wisdom. All I kept thinking was He should not have been able to move like that.

Finally I left the staring patient and broke away from twenty-six. I threw aside the curtain and rounded the crowded nurses’ station, entering the air lock leading back out to the corridor. Lamps of deep blue light came on inside the chamber, and doors on either side of me bolted automatically. I had forgotten about the ultraviolet light shower. I tried the second door anyway with my right hand, a wasted effort. It was locked fast. I drew my left hand into a tight fist, and it felt inconceivably warm and heavy; I imagined my glove filling with blood. I closed my eyes and stood for 120 seconds as the blue light cooked the viruses on my suit.

Down the corridor and away from the others I found an examining room with a scrub room inside. I locked the inside door and the light over the sink blinked on, harsh and suddenly blue to my eyes. I turned on the sink faucet. I broke open my warmed suit one-handedly and shrugged off the shoulders and hood, freeing my left arm. There was no blood visible through the gloves. I snapped off the first layer, then the second, and withheld my bare left hand. Still no blood, and no visible breach. I gripped it by the wrist, palm up under the light, and searched for a hole, close enough to see the faint mound of beating pulse in the center of the scoop of my palm. With growing relief, I pressed down on the area with the thumb of my right hand. A single drop of blood squeezed out.

I shoved my hand under the water. It was cold. I needed it hot. Friction was imperative and I rubbed and squeezed at my hand as the water scalded and the sink began to smoke. I forced my hand to bleed. I pulled and prodded at my flesh, trying to open up the meat of the wound in order to irrigate it. I found a bottle of soap and pumped some clear gel into my palm. There was a low-grade antiseptic cleanser on the countertop and I pulled the sink trap and sloshed the green solution into the steel bowl. I thrust my hand into it and expected it to burn, hoped that it would burn. But it did not. I found a scrub brush and scraped at my palm until it was raw.

I pulled out my hand. I slicked away the excess liquid and again held the dripping, reddened palm to the light. In doing so, I caught the reflection of my face in the steamed mirror and was stunned by its look of terror. I moved closer and examined my staring eyes. Wide and unblinking, a thin orbit of blue circling the dilated black. I knew exactly what was happening. The locus ceruleus, a cluster of nerve cells that is the control center of the brain, responds to stress by releasing hormones that activate the hypothalamus, which in turn triggers the pituitary gland to release adrenocorticotrophic hormones into the bloodstream, which then make their way into the kidneys, which respond by spewing out adrenaline — all of which causes the eyes to dilate, the blood vessels to open wider for increased blood flow, and the heart to pump faster.

It gets into your palm; you could cut off your hand but it’s already in your arm; you could cut off your arm but it’s already pumping through your shoulder and circulating down into your heart, flooding into the spleen, the liver, the brain. My own body was facilitating the infective process and revolting against me. I felt a gag deep in my throat as though a hand had reached up from my stomach and pulled. I pitched forward with an awful groan and vomited into the sink.

I cleared the trap with my right hand and the sink basin drained. I straightened, choking, one hand gripping the sink edge, the other flat against the wall beside the mirror, holding me up. But then a cooling sensation spread from my spine outward, a sudden, bracing chill of realization, the muscles of my back softening as I faced myself again in the glass of the mirror. I was well acquainted with the horror stories of doctors who imagined themselves into getting sick, and immediately I regained my breath, coughing up a burst of nervous laughter. That passed, and I was sober once again. I washed my face, blotting the sweat from my brow with a paper towel, then wrapped my bleeding hand in a tight gauze cushion. I looked down at the four gloves lying discarded on the floor like pate, strangled birds, and at once disposed of them in biohazard, pulling on two fresh pairs, gathering my suit up around me from the waist and sealing myself back inside. I cleaned the floor and the sink, replaced the soap bottle and the empty jug of antiseptic cleanser, then unlocked the scrub room door and emerged.

I returned to the green zone. The second door opened onto the trauma unit, and my anxiety began again immediately. I needed to see the patient in bay twenty-six. I needed to speak with him, for my own sanity, feeling somehow that he had something to say to me. I found the gaudy curtain pulled aside as I had left it, the tent zipper undone, the Unoccupied sticker peeking out from the bed rail chart.

The bed was empty. The patient was gone. I felt panic welling up, and whirled around to check the adjoining bays.

“Dr. Pearse.”

It was Tenney approaching, carrying a printout. “Have they taken any patients out of here?” I asked him.

He was startled. “I wouldn’t know, Dr. Pearse—”

“How long was I gone just now?”

“I wouldn’t know, sir. You sent me out.”

I noticed two patients laid out on gurneys in front of the air lock and hurried over to them. One was an advanced case inside an oxygen tent, a middle-aged woman, her palsied face locked in agony. A black rubber body bag lay on the other gurney. I seized the zipper, pausing a moment for confidence, then quickly drew it down. The seam opened on the wasted, staring corpse of an elderly black man.

I backed away. “How many others have you taken out?” I said to the woman who was attending them.

“None, sir,” she said through her hood. “None myself.”

“Then there were others?”

“Maybe, Dr. Pearse. A few.”

I returned to twenty-six. I drew the hanging curtain around the bay, closing myself off from the prying eyes of Tenney and the rest, and looked at the shrouded bed. I tore aside the plastic tent opening near the cart The bed linen had been shucked down to the foot of the mattress and I gathered the sheet and blanket in my hands, but my rubber gloves prevented me from feeling any warmth. I shook each out separately, looking for the blood-filled syringe I had dropped there, then pulled up the mattress. I searched beneath the bed and broke apart the plastic biohazard box. I checked the sheet, the blanket, the mattress, the apple green floor for drops of blood. Nothing.

He had disappeared. I backed away to the curtain, stopping there to regroup.

The patient had just awoke from long-term catatonia. He would have had little if any manual coordination, and therefore simply could not have bumped my arm with the intention of infecting me. The entire event was beyond reason. The absence of any admittance records was another mystifying piece of evidence. I had seen people go to pieces inside a contact suit before. Maybe I had imagined the entire thing.

I managed to convince myself of this, even as I knew it was not true. I was trusting that the patient in bay twenty-six was just that, a patient, and not an assassin dispatched in the same way a killer T cell is dispatched to an invading force. Only later would the greater irony be revealed: that this assassin had in fact collected two debts that day, one for Africa, and the other, unwittingly, for himself.

But for now I turned and drew the curtain open again, baring the bay to the rest of the room, telling myself that there was nothing to hide. I crossed the trauma unit back to the air lock with all eyes on me until the bolts clicked again and I was alone, the blue lamps humming brightly and easing the echoes of panic left in my head. Relieved, concerned, mystified: I didn’t know what I felt. All I knew was that I was getting away. I stood waiting with my head hung low in the sterile chamber between death and life.

The rest is shameful but I shall tell it anyway.

I returned to Atlanta that evening, traveling home from the airport by taxi. I owned a house in Sandy Springs, just north of the city, a stately five-bedroom brick colonial set upon an incline, overlooking a labyrinthine community of variations upon the same brick colonial. I disarmed the alarm and went upstairs without switching on any of the lights, sitting down at the foot of my bed, relieved and happy to be finally home. Outside the window, trees shifted against the blue-black sky.

I had been among the first to buy into the planned community, named Diver Bridge, a family subdivision of swimming pools and tennis courts, two managed lakes, a shopping center, a Montessori preschool, and twenty-four-hour gated security. The glossy brochure had reminded me of a time and place I was eager to get back to, my parents’ seaside retreat in Amagansett and the Long Island summers of my youth, a world away from the fortress of Manhattan. I had bought the house as something to grow into, but three years later remained the only bachelor in a gated neighborhood of families. I had played exactly one set of tennis on the Diver Bridge courts, on a bright Saturday morning two years earlier, and could only recall the pock pock of the soft yellow balls being volleyed on the surrounding courts, back and forth. The bureau was my true home.

I stood tiredly and went to the bathroom to change the bandage on my throbbing palm, casually, so as to preclude any examination. Afterward I snapped off the light and stood in the second floor hallway, in the silence and the darkness of the half-empty house.

I forced myself to cook dinner, then sat down to face it. My chagrin and embarrassment at my actions at Orangeburg were peaking. The entire incident now seemed a blur. I knew that the risk of infection from a needle stick exposure was statistically less than two tenths of one percent.

My food was still untouched when I stood again and brought the dishes to the sink. I returned to snuff the candle I had lit, and left my sunken thumbprint in the soft white scoop of wax. That night I slept poorly, thrashing beneath the sheets, dreaming repetitively of soft yellow tennis balls being endlessly volleyed.

Clifton Road began as a leftward fork at Dusty’s BBQ restaurant. It was a country road like any other outside the city limits of Atlanta, winding lazily and buffeted with leafy trees and founded upon a clay dirt tinged red as though mixed with rust or Tabasco or old blood. Emory University climbs out of the roadside like a city growing out of sand, a sprawling southern school of old homes and towering white stone buildings. It was the university’s donation of fifteen acres in the early 1940s for the establishment of a government agency to battle malaria that planted the seed of what was now the Bureau for Disease Control.

The main BDC campus sloped down from the roadside halfway along Clifton like a fortress founded upon one square block. Old Building One, the brick-and-mortar former entrance, was dwarfed on the right by the bureau’s flagship, Building Sixteen, formed of smooth concrete and mirrored glass, its six-story face broadly curved and sky-reflecting. A jumble of smaller, ill-fitting buildings led down to the rear perimeter fence and its posted warnings U.S. GOVERNMENT PROPERTY, NO TRESPASSING abutting the pristine university playing fields and exhausted southern houses of Emory’s fraternity row.

Sixteen was the main administrative building of the BDC. Its twenty-first-century face, the horizontal bands of sky-reflecting windows familiar to news viewers, stood out along winding rural Clifton Road like a temple materializing in a field of wheat. Just across the street from Sixteen was the small DeKalb County Firehouse, which was how I always thought of us at the bureau, as firefighters, responding to alarms from around the world and dousing incipient threats.

The BDC had for years been the largest federal agency headquartered outside greater Washington, D.C and Building Sixteen was its executive seat. Its laboratories were conference rooms, its remedies financial and political. Attaches from other international disease-fighting organizations such as Parton Down, the Pasteur Institute, the Tropeninstitut in Germany, and the University of Anvers in Belgium, convened there regularly.

The office of the director was the largest in the building, a corner suite, second-floor rear, with a sweeping view across miles of treetops — a lazy current of green leaves in summertime — to the downtown Atlanta skyline. The push of a button activated vertical blinds, and a shadow, like a theater curtain rising, crawled across the room.

It was from there that I oversaw the Orangeburg investigation. Every scrap of information generated on-site was routed through the notebook tablet on my desk, from individual patient case histories and specific treatments prescribed, to hospital ventilation contractor’s records and regional disease statistics going back twenty years. All my regular duties were postponed as I consumed each scrap of information, hungrily, drawn in by the devastation of the outbreak as well as its peculiarities. Such as:

An asterisk from a footnoted chart on page seventeen of a poorly written thirty-page report, noting that four of the early-stage afflicted catatonics were on different treatment protocols from the rest. Each had been receiving five hundred milliliters every eight hours of one of three different types of blood sera, code-named, and therefore still in the research stage, MILKMAID, BLOSSOM, and LANCET, with MILKMAID being administered to two patients simultaneously. The names were strange but meant nothing to me, and I posted inquiries on the codes and ran an open search of the BDC net, yielding no answers. None of the sera was registered with the Laboratory Branch, and therefore none had been submitted to or approved by the FDA. This was irregular. I began with Special Pathogens and traced the code names to its Epidemic Intelligence Service under development by a “Dr. Christian,” the same pseudonym we had used in the medical journal article detailing the attributes of Peter’s immune system nearly a decade ago. Whether he had anticipated my investigation and was flaunting his disregard for procedure, or simply thought I would not bother to pursue the matter, I took his derisive alias for an insult. The case scientist for these irregular blood serum projects was none other than Peter Maryk.

I punched up Bobby Chiles’s office down the hall. Bobby was that rare breed of public servant, the brilliant bureaucrat. He had come into the BDC relatively late in his medical career following a brief period of specialization in the family practice of podiatry. He loved medicine and loved science, but was better suited to administration than administering. Bobby was a trusted confidant.

“The Special Pathogens budget,” I said. “Did you ever break through those numbers?”

He shrugged a shrug that was a nonanswer. “They balanced.”

I did not like what Special Path had become. It was a clandestine service operating within and yet apart from the bureau, accountable to no one except Peter Maryk. Peter did A the hiring and firing and captained every investigation himself, and the loyalty of his people, such as Freeley, was fierce. I had allowed him too much free rein.

Bobby was typing. “I’ll punch up the budget numbers and shoot them on over to you.”

“Good. Let’s meet for lunch, see what we come up with.”

Bobby looked out from my screen. “Lunch?” he said. “Stephen, it’s after six.”

So it was. It had grown dark outside, and my office lights had compensated, coming on dimly without my noticing. The work day had gotten away from me.

I went home and opened the Special Path budget on my tablet, but as intense as my concentration had been at the BDC, I found it nearly impossible to focus at home. I got up and wandered throughout the downstairs area, the dim kitchen, the media room, and then, remembering the exuberance of that night in Stockholm, went to the bar and poured myself a drink. I found my way upstairs and patrolled the empty bedrooms of my unfinished house, pausing before one of the southwest-facing windows overlooking Diver Bridge to Atlanta. Darkness blanketed the glowing halo of the distant city.

Moving lights brightened the tree branches outside the window and directed shadows across the ceiling. Headlights in my driveway, though I expected no one. I left my glass on the sill and walked to my bedroom window for a better view, arriving just in time to see a car back out and pull away.

That second night was longer than the first. Sleep teased but never fully embraced me.

The next day’s situation log noted that Peter Maryk had returned from Nevada and assumed on-site command of the Orangeburg investigation. Neither one of us initiated communication with the other. I continued my own multipronged investigation, immersing myself in all aspects of Orangeburg, while simultaneously pursuing the code names and the Special Pathogens budget — which I found to be padded with overruns and blind outlays exceeding $17 million.

I left the office only once that morning, to drop in on Lab Safety in Building Four under some pretense in order to procure a Postprick Kit. In the toilet stall of a nearby washroom, hiding like a junkie in a train station, I administered the preventive HIV and hepatitis series. I was counting on this to relax my mind.

Peri Fields was waiting outside my office door when I returned.

“Hi,” she said, and I stopped near. Her light brown hair was done up lightly in a loose bun, run through expertly with a pencil. “You weren’t answering my pages, so I thought I’d just drop by.”

“Orangeburg,” I told her. I was having a difficult time meeting her eyes.

“Were you just out for lunch? We could have—”

“No. Just getting some air.”

It was her turn to nod. She crossed one heeled shoe over the other and held her tablet in both hands at her waist. “You know I’m not asking for anything,” she said, still smiling. “We can go as fast or as slow as you want.”

“I know,” I said. “But right now I need to give this investigation everything I...”

My words trailed off. She was studying me. She was looking at my hands.

“You’re wearing gloves,” she said.

I looked at them myself, a worm of guilt starting up my back. “And?”

“Nothing. Except that — you’re one of the few here who didn’t.”

“My image.” I nodded.

These words wounded her more deeply than I expected. They warranted an apology which, for some reason, I did not give.

“I’m fine,” I said. She reached out to me as I started past her for my door, her hand brushing my bare forearm, just below my shirtsleeve. I jerked away.

She turned and stood in the doorway, stunned, as I shut the door.

I did not leave my office the rest of the day. Updates from Orangeburg continued tonguing out of my printer. The White House press secretary had left three messages since my on-camera comments in Stockholm, but I did not respond. Everything else paled next to the outbreak.

My search under the “Dr. Christian” pseudonym led me to case reports corresponding to the mystery code names, buried in an unlabeled Special Pathogens file of year-old interdepartmental performance reviews. The files were encrypted for confidentiality, but all BDC documents were accessible to the director at his discretion.

Downloaded, the case reports contained detailed medical histories of the three apparently healthy subjects, BLOSSOM, LANCET, and MELKMAID, but going back only three years and listing only addresses, no names: Two of the subjects resided in the Atlanta area, the third outside Boston. My thirst for more information, coupled with a reluctance to return to my empty house, compelled me to pursue the matter, without further success, long into the evening.

That night back at Diver Bridge, I paced. My palms and the creases of my knuckles remained cloyingly moist; repetitively, I washed and dried my hands. The bruises on my stuck hand, the ones caused by my first scrubbing out the wound, were not going away. I wandered upstairs, dreading the night that was already upon me.

I discovered an empty bar glass on the windowsill in one of the bedrooms, and for a few frantic minutes believed a stranger was inside the house with me. Headlights appeared in my driveway again, and I rushed down the hallway to my bedroom to look. I watched a car slow nearly to a stop at the bottom of the drive, then strangely pull away.

I remembered my behavior toward Peri, and tried to call her, but had some difficulty using my tablet. A vague sense of uneasiness overcame me like a chill.

I went to bed, and watched the ceiling for headlights. I rolled the Orangeburg investigation over and over in my head, but could not get it straight; fragments from my own life kept intruding, as though like electrical wires the two concerns had somehow become crossed.

I dozed briefly, on and off, each time awakening to the shaded room as though summoned by name. In the dark corners of my bedroom and the furls of the curtains hanging off my windows, faces appeared, watching me, trying to speak. They were the faces of the camp workers. Something terrible was happening to me.

The next day I took care to encounter no one, arriving at work well before seven. Rescheduled appointments were stacking up, jamming my calendar into the weeks and months ahead, but without consequence, as my future now was clear: Once free of Orangeburg, I would tender my resignation to the president. There was relief in this decision — the impending resumption of my life’s work, a return to the sterile safety of the BDC labs — which freed me to further indulge the worm of my consuming obsession with Orangeburg, poring over the scores of updates and summaries flowing hourly from South Carolina.

The outbreak once again, by hard work, a miracle, or a combination of both, had been successfully contained. Only two cases had been reported outside the hospital, and both were discovered through contact tracing of recent visitors and duty isolated. Hopes soared, but neither visitor was found to be the source of the outbreak, and rather each had become infected inside the hospital like all the rest. The disease was running its course, and there was still no indication of how Plainville had reemerged among a bedridden group of catatonics.

The virus confounded me. My notes from that morning, scribbled shakingly in black felt pen on the back of a hard copy of an autopsy photograph:

The only bright points of the outbreak were the prognoses of two of the four patients, the ones receiving the MILKMAID sera protocol. Astonishingly, each appeared to be successfully staving off the effects of full-blown Plainville. Equally provocative was the attention paid this development in the reporting materials generated by the Special Pathogens Section: none. I established a new file on my personal tablet, “Investigation.Maryk,” and copied into it all information relevant to the mystery sera, including the budget discrepancies and Peter’s dummied reports.

At midmorning, a blistering headache overtook me. I medicated myself with caffeine and vitamins and successive half liters of water from my office kitchen suite. It was lack of sleep, certainly; I was exhausted but unable to nap or even sit still. This deficit also seemed to affect my thinking. It was as though time were unraveling. The pain soon faded and I felt much improved; in truth, I felt relieved.

An hour later I experienced a sensation like ice water being poured down the back of my neck. The chills that followed straightened me in my office chair and held me rigid through deepening waves of nausea as papers slipped from my grasp to the floor and my gloved hands began to quiver, the trembling soon spreading to my arms and legs. My neck muscles cramped until I could no longer move my head, and I began to panic. I was tipped back and could only see the ceiling lights, quaking and bluffing in my view. I tried to yell for help but the sound was trapped in my throat. Eventually the spasms subsided, releasing me, my tendons aching as though run through with needles. I used my desk to stand. Crushing head pain lingered as I reached for my tablet. At the door I righted myself I practiced speaking in the event that I encountered anyone, then exited unseen and unmet down a fire stairwell to the parking lot.

I rode out in search of the highway. Steering was difficult but manageable and I sustained a kind of equilibrium by keeping my arms low in my lap and my timorous hands light on the wheel. The joints in my elbows and knees and ankles felt like eggshells slowly breaking open. But overall the driving seemed to help. It was as though I were seated just behind myself, my arms and hands pushed through the empty shirtsleeves; of a puppet operating a car. Cruise control was set at sixty miles per hour, and I can remember a red lap-belt light winking at me from the instrument panel. I remained on the highway, not heading home, instead turning north onto Interstate 85 and finding myself soon leaving Georgia, pushing ahead through South Carolina and into North Carolina. I drove on and on, trapped in a dream. I concentrated on the road lines flowing past and found it oddly soothing to be in the middle lane of the great American highway, flowing forth as though on a raft, the cars on either side of me passing and receding, passing and receding.

At one point my tablet chirped on the seat next to me, but rather than answer it, I managed to open the screen and deactivate the Hailing function so that it would not bother me again. I needed only to drive, and not to think.

I slowed only for tolls, which detected the government vehicle and debited the appropriate fee. I feared stopping, certain that it would kill my momentum, but the drive was longer than I could bear. Somewhere in Maryland I pulled off into a service area, parked in the last space, turned off the engine and lay a while sideways across the front seats. I do not believe I slept. After a while I sat up again, feeling watched. I refueled at the service station but did not get out of the car or even roll down my window.

The pain in my head expanded with a force that was nearly crippling, until all at once it was gone, replaced only by a dull ringing tone. The veins in my extremities all throbbed; it had been some time since I had actually felt the wheel beneath my hands. Still, on I drove. I piloted the last leg of the journey slumped against the armrest, too weak to sit up on my own.

Finally I was off the highway and circling Manhattan, its towers looming in my window. I turned off and continued on the road toward Long Island, knowing then that I was heading home.

I reached the familiar town of Amagansett and drifted along the old streets out to the shore. The mailbox and the driveway. Flagstones curling to the brick steps. The door with the golden horse head knocker, and at once I was inside the great house: cavernous, dreamlike, dark. The chandelier was gone from the foyer, a chain and bare copper wire hanging insolently from the high cathedral ceiling. Pale dust outlines of removed frames marked the walls, the remaining furniture draped in thick plastic — all things I should have taken care of after my mother’s funeral. I felt my way along the walls to the kitchen, empty and quiet. In the cabinet over the sink, four or five glasses stood mouths-down, orphans of mismatched sets. I reached for a plastic tumbler of swirling colors, which to me signified summertime in the late 1980s, Hawaiian Punch and television laughter from the back porch, sand in my sandwiches and fireflies winking at night. The faucet spat pockets of air, then garbled brown water, then flowed clear. It hurt very much to swallow. There was something wrong with the mechanics of my throat.

I gripped my tablet to my chest and took the tumbler of water and started up the stairs. The task was daunting and I rested frequently, slumping with one knee against the next highest step, the handrail always seeming to twist just out of reach. I gripped the side wall and water shook out of the tumbler and over my gloved hand down to my forearm.

I mounted the top landing and sat there sweating, huffing, leaning on my elbow on the familiar beige carpet. The tumbler was empty now and I let it go. Fatigue overcame me. Something told me that if I did not move now, I might never move again.

I found the railing and hauled myself up, legs bandy and reluctant to respond. I felt sick to my stomach. Bathroom or bedroom: a choice. I lurched toward my old bedroom, striking the doorjamb with my shoulder and knee, and feeling neither. My view of the room faded, a strange pressure behind my eyes sparking silver phosphenes that showered and bloomed. I stumbled inside, fumbling the tablet onto a small writing desk and falling across the twin bed, sizzling against the cold plastic wrap beneath me. I shrugged and pulled and eventually dumped the sheeting out onto the floor, and lay on my back on the bare mattress as the room filled with viscous glitter. The room smelled exactly as I remembered. It smelled of the sea.

Later I awoke to a roaring noise in a room of bare walls, a bureau, an empty bookcase, a child’s desk: my old summer room in Amagansett. Three trophies, small golden boys standing poised to dive, remained atop the low bureau, swimming awards, the smallest for holding my breath underwater the longest.

I looked through the skylight in the ceiling above. This was a wonderfully clear dream with no queer subconscious filters, no anomalous intrusions from other places, or other times. I was a boy again, back in my room at the old summer house, and life was bright and new. Everything lay ahead of me; nothing behind. I closed my eyes and rode out the sensation of somersault after somersault, backward, feet following head, and then changed direction at will, rolling forward and deeper, forward and deeper.

Shooting pain through my thighs, arms, abdomen, neck, thorax, feet, calves, shoulder blades, back. Rockets of pain. I was afire. Thrashing atop the bed, being consumed.

Awake again. Vomit, mainly water coughed from my groaning throat, puddled on the stripped mattress beneath my head. Total apathy at the loss of control over my bodily functions. No embarrassment. No thought to it even. Such extraordinary lethargy, such leadenness, stuporous muscles and sandbag limbs. A wholesale letting-go. Idly I watched as my feet twitched at the end of the bed — watched without the slightest concern. Hours were slipping away, and I knew it, and did not know it.

Night again: or still. My parents huddling outside the door. Mother holding a Dixie cup full of tap water. They were going out. The room and the hallway were dark but my parents were painted with light and faintly glowing. Dressed formally.

“So proud,” she said. Over me now, her face before the skylight, smiling down. “Feeling better?”

“A little,” I said.

“Just rest. Raisin toast and tea in the morning.”

And glasses of flat ginger ale; an uncapped bottle of Canada Dry set out overnight on the kitchen counter. And later, chicken soup.

My father remained on the landing in his tweed overcoat, fixing his collar, waiting to go. Flickering out.

Sunlight struck the trophies on the bureau. I was still in my summer room in Amagansett. Burning up and meaning to do something about it. Open a window maybe. I was going to get up, soon. It hurt to swallow. It hurt to be lying down.

Peri came to me later. She appeared in the middle of the room with her eyes closed and her arms out at her side, nude. I was terrified she would open her eyes and see me lying there, helpless, but I hadn’t the strength to hide. When she did open her eyes, her orbits were hollow and black, and tears of toxic blood poured down her cheeks to her breasts and over her stomach and legs, burning through her spoiling flesh to the meat and bone beneath. She was rotting with her own blood and howling at me as, standing there, she decomposed.

Then she was gone. The bed was trembling.

Vaccine? This way.

She cannot bear to be touched.

Burning

She cannot bear even the pressure of a bedsheet.

Maman

Her name.

The candle

Vaccine. A cure.

Two days ago. I buried them next to the house.

I am floating

You are a camp doctor.

The others are much worse.

It is death

You’re sick.

The rain it stinks of death

This will protect you.

I am going with you

If you tell me to do it I will I will go

I looked out at the small writing desk next to my bed and saw the patient from bay twenty-six. Rather than junk the outgrown desk, my parents had moved it to the summer house, and now this wasted phantom sat large in the young child’s chair, his flat legs tucked snugly under the desk, gnawing on his lips with destructive precision as he typed. Sideways I watched the ghoulish little man as he keyed through pages on my tablet. The file he stopped at looked familiar. It appeared to be the title page of “Investigation.Maryk.” When he turned his head toward me, his red eyes were kindled by the faint light of the screen and the night glow from the skylight above.

“Pearse,” he said, his ragged lips twisted into something like a smile.

Something about this apparition differed from the others, in that something about it was true. The man moved about the room, preternaturally well, dressed in street clothes now and a colorful, brimless cap, his shirt and pants hanging formlessly off his slim hips. He mumbled to himself as he paced, chewing his lips, thinking. Deciding something.

He crossed to the bed, and I heard the plastic sheeting crumpling underfoot. I had forgotten about the sheeting, and the sudden memory of it, an icy splash of reality among the humidity of my dreams, commanded my attention. He leaned over me — his face was cheekless almost to the sinewy muscles beneath, eyes wet and large and boiling red — and I realized I was terrified. He looked me up and down with a flat, sluggish grin, like a deranged artist amused by the incoherence of his own incoherent work.

“Mine now,” he told me. “You are mine.”

He was right.

Then the room was empty again, and I was waiting for Jacqueline Moutouari. The bed was floating: I was floating. Blackness shone through the skylight as I burned.

The horse head knocker clanked as the front door was opened downstairs. Footsteps wandered somewhere on the first floor, and I imagined she was coming to me now, to take my hand and lead me to the others. The room was beginning to drift again, but I held on, I held on.

A creak on the stairs: I knew the exact spot: fifth step, right side: and the creak again as the foot was lifted. The doorway slid away along the wall, circling the room, everything starting to spin and collapse.

The figure rose onto the dark landing outside my door. There was no disappointment on my part, no feelings either way; acceptance was all. His shadow filled the bedroom doorway, and I saw the zinc shock of hair under the skylight and recalled how in school behind his back they used to call him “Pearse’s Lab Rat.” Tight pale gloves glowed on his oversized hands. He was like a thing I had created, an ill-considered experiment gone awry and unleashed upon an unsuspecting, unprepared world, now returned to exact revenge upon its master. But like those of the patient from bay twenty-six, Peter Maryk’s actions also seemed true, not what I might have fancied or hoped for or feared, but exactly what I might have expected had he actually walked into the room. There was nothing at all like compassion in the severity of his shadowed face, the heat of his bright, gray eyes, the contemptuous slant of his lips. Only absolute, unforgiving disgust.

“You’re sick,” he said.