The Deadliest Strain

Chapter Forty-Six

Austyn couldn't have felt more welcome.

After asking him a couple of questions about his background and realizing their visitor's interest in science and research, the physician gave him a complete tour of the hospital. He talked about the staff and their publications. Dr. Mansori had been here since before the Iranian revolution, and his thirty-year tenure gave him the air of a proud parent.

Austyn didn't want to stray too far and for too long away from Fahimah, though, so after a couple of hours they made their way back toward the wing where Rahaf was staying.

There was a nurse outside the door, and she told Austyn that Fahimah was looking for him.

He knocked on the door and Fahimah opened it.

Austyn had to keep from putting his arms immediately around her. She had a look on her face that he could only describe as one of gain and loss. She had found something that she knew she was about to have torn from her.

"I told Rahaf about you," Fahimah said softly. She drew him into the room.

Austyn looked at the bed where Rahaf lay. The absurdity of imagining she could be responsible for the terror in the U.S. would have been comical if it were not for her condition. She was beyond frail. The years and her illnesses had been very hard on her. She looked so much older than her age. Her intelligent green eyes, though, were very much alive.

"Mr. Newman," she said hoarsely.

"Please, call me Austyn," he said, approaching her. The head of the hospital bed had been raised and a couple of pillows were propped up beside her. There were no IVs or any other monitoring devices hooked up to her. His gaze went over the place where her leg should have been.

He saw, pinned to her hospital gown, a gold charm. He recognized it as the one the woman at the clothing store in Erbil had given Fahimah.

"My sister tells me that she owes her freedom to you."

Now he was embarrassed. He looked at Fahimah and shook his head. "All I can say is that I'm sorry, though I know that will never be enough."

"Let's not discuss politics," Rahaf said, wincing. She was sounding very tired and short of breath. "We all are victims… every one of us."

It was obvious that she was in a great deal of pain. Dr. Mansori had mentioned that, other than shots of morphine to ease her suffering, she wouldn't allow treatment that would needlessly prolong her life. She moved slightly and motioned to a chair near the bed.

"Please sit down," Fahimah said, repeating her sister's gesture.

Austyn did as he was told but not before Fahimah brought another chair that was by the window closer to the bed, too, where she could sit.

"Fahimah tells me you are facing an epidemic in America."

Austyn summarized the situation, focusing first on the strain of bacteria they'd never seen before — with the exception of what had been discovered in Rahaf's laboratory. He gave her as much background information as he had on the cases discovered since that first outbreak. He also mentioned the latest suspicion that some kind of cold medication might be infecting the victims.

Rahaf listened to everything he said. Despite her pain and obvious discomfort, Austyn could see she comprehended every word.

"My study initially started on a family of Panton-Valentine leukocidin," she began softly, "which, as you know, is toxic to cells. They can cause leukocyte, or white blood cell destruction, pneumonia and necrotizing fasciitis…."

Austyn pulled out a pen and paper and scribbled her words as fast as he could. She told him the details of the study that she'd been doing prior to the discovery of something unexpected, the mutation of the bacteria into a super-microbe. Despite her illness and physical frailty, her mind was sharp and clear. She had no trouble remembering anything.

"Although MRSA… methicillin-resistant staphylococcus aureus… has traditionally been seen as a hospital-associated infection, MRS A strains have begun to appear outside of hospitals and clinics in recent years. This specific strain is definitely a community-associated one," Rahaf told him.

"As you know," she continued, "MRSA strains are resistant to the usual antibiotics, but a curious interbreeding with community staph has led to the genetic acquisition of a PVL factor, which in turn has produced a series of changes that make these strains particularly invasive, as well as resistant."

"My understanding," Austyn said to her, "is that staphylococcal infections are an issue only when the individual has suffered a skin break or an open wound, but this isn't always the case with these victims."

Rahaf closed her eyes for a moment, and Austyn looked at Fahimah.

"There is no need to do this now," he said. "I don't want to tire—"

"No, Austyn," Rahaf said. "Just give me a moment."

Fahimah kept her eyes on her sister's face, and Austyn could read the sorrow there. Rahaf drew in a deep breath and looked at him.

"What you say is true." She nodded. "My laboratory experiences were in a controlled environment. But my contention is that, in the real world, this strand can colonize in the mouth and the throat. You see, it is in the genetic combination of these three microbes: staphylococcus, carried by thirty percent of healthy adults in their nose, the strep infection that must be present in the throat, and an outside staphylococcal cassette chromosome, introduced separately that forms the basis for the creation of the deadly new strain… you have a name for it."

"We just call it NFI," he said. "Necrotizing Fasciitis Infection."

As she continued to explain, it became clear that outside of a laboratory environment, the victim had to have a strep infection for the NFI microbe to mutate. Austyn thought of all the cold medications they were testing in the U.S. This narrowed the field down to medications relating to a sore throat where the victim actually has strep throat.

Fahimah gave her sister some water.

"If this is too much for you, we can stop and get back to it later," he told her again.

"No," she said adamantly. "You see… I was so frightened of this NFI… that I destroyed everything. Not only what Fahimah did for me at the lab… but any documentation I had outside, too." She touched her head. "What is left is here."

Austyn understood now the need to remove the bacteria through the amputation. "Can you tell me about the remedy you took to survive?"

Rahaf motioned to Fahimah and sipped some more water first. "Most classes of antibiotics were discovered in the 1940s and '50s. You know that they work by blocking synthesis of the cell wall, DNA, and proteins within the bacteria."

Austyn knew this. "And I know that most of today's antibiotics are simply a variation on that original concept."

"Exactly. The fact that they work in similar ways may be one reason why bacteria are developing resistance," Rahaf told him. "Now, this remedy was not something that I discovered. It is a product presently under testing by one of your pharmaceutical companies. The antibiotic was discovered by isolating a certain microorganism from a sample of soil from southern Africa."

Austyn wrote down the information. She told him the name of the company and how successful the product had been so far on mice. She said she heard it might be a decade before it became available for humans. Rahaf had gone to school with one of the lead scientists working on the project at the time, who had given her a sample of the product.

"If the compound passes clinical trials it will become only the third entirely new antibiotic developed in the past four decades."

"Do you know how this antibiotic works differently from the others?" Austyn asked.

"It acts to block enzymes involved in the synthesis of fatty acids, which bacteria need to construct cell membranes."

She had to stop again. Fahimah gave her sister more water. The burst of energy Rahaf had gathered to give him this information was draining from her body. He hoped she would bounce back. But he could see the pain was too much.

"I need the nurse, my love," she told her sister.

Fahimah ran for the door, and Rahaf beckoned to Austyn.

He went to her and held her thin hands. The green eyes met his. "She has suffered."

He nodded.

"You make good on that suffering. You make sure she is taken care of."

"She will be," he promised her.