by Nancy Kress
“Oh, Judy,” he said helplessly, overwhelmed with love, and guilt, and wariness, and the desire to change the subject. Inspiration suddenly seized him. “Honey, I know I’ve been distant, but I have a lot on my—there’s something at work that I really need your help with!”
“My help?”
“Yes! You’re the science writer. You know how to really work the Internet, and you have so many contacts in the scientific world. Here’s the situation …”
He shouldn’t do this, he knew. Bureau cases weren’t supposed to be discussed outside the Bureau, not even with spouses, which Judy wasn’t. But this stroke thing could hardly be called a case as yet—there wasn’t a suspicion of any foul play. And Judy really did have solid groundings in the scientific community. And if it would divert her from the idea of marriage … Of course, Cavanaugh had also put an analyst on it at Headquarters. Jim Neymeier, Cavanaugh’s favorite intelligence analyst, who loved data—especially computerized data—the way moths loved porch lights. Not that Cavanaugh was going to tell Judy about Neymeier.
“Blacks and Indians,” Judy said thoughtfully, when he’d finished telling her about Nurse Pafford, Dellridge, and Soldiers and Sailors Memorial. “And you think it’s some genetic brain difference, something in the cerebral chemistry—”
“That’s only a hypothesis,” Cavanaugh said. “But can you check it out for me?”
“Yes,” Judy said. She sounded happy again. Almost shyly, she touched his arm in the darkness. “I’m glad you asked me to help, Robert. I like being useful to you.”
Her words barely registered. But her touch did. Suddenly, to his own surprise, he had a mammoth erection. He got up from his deck chair, pulled Judy to her feet and kissed her deeply.
“Well,” she said. “And what’s all this?” He could feel her grin against his shirt.
“Let’s go inside, honey.”
“I’m willing,” she said huskily, and kissed him again.
So that was all it took! Some affection, some lust … sex was the answer then. Or, at least, an interim answer. It distracted her from thinking about marriage. Sex was his best ally.
Pleased with himself, Robert led her inside the house.
ZAP! went the purple light behind him.
Melanie Anderson looked around the table at the other three members of the newly formed CDC team: Gary Pershing, the top laboratory man in malaria; Susan Muscato, experienced veteran of disease outbreaks in the United States—she’d done some good sleuthing with hantavirus; Joe Krovetz, very young, an unknown quantity, whom Jim Farlow was probably giving a chance to do his EPI-AID, Epidemic Assistance Detail, necessary to becoming a full-fledged epidemic intelligence officer. And Farlow himself, who was supposed to be administrating the CDC Special Pathogens Branch but could never bear to be left out while anything hot was breaking. Melanie took Farlow’s inclusion as a sign that the implications of the Senator Reading blood samples were being taken seriously. The team was a good one.
It was also, except for her, all white.
“All right,” Farlow summarized, “we have the lab results. We have the stroke data, in rough form, in the weekly morbidity reports for the last month. We have—”
“There’s something I don’t get,” Joe Krovetz said. He was heavyset, with a neck thick and strong as a bulldog’s. Everybody at the table, except apparently Joe himself, noted that he didn’t hesitate to interrupt Farlow.
“What don’t you get?” Farlow said.
“The Anopheles is infected, right?” This was a safe assumption; Anopheles quadrimaculatus was the only mosquito found east of the Rockies that could carry malaria. “Anopheles bites a victim; the parasite enters the bloodstream and goes straight to the liver. All normal so far.”
Normal. Young Joe Krovetz had never seen a village devastated by an outbreak of lethal tertiary malaria. Never seen people shivering through bone-shattering chills, followed abruptly by fevers so high that they hallucinated. Never seen mothers too weak and dazed to feed their children, men too sick to reach for the water they craved, while more mosquitoes fed on their burning skin. Never seen a fetal death rate of 50 percent among pregnant women whose bodies could not support both Plasmodium parasites and a fetal one. Normal.
Joe went on. “The data so far show that the Plasmodium parasites leave the liver on schedule, enter the bloodstream, and invade the sickled cells. But when the first batch breaks out of the red blood cells to infect another bunch of cells, the host should start to show signs of malaria, right? Fever, chills, all the rest of it. But Reading didn’t, and neither did the others. So that means the sickle cells form a fatal clot almost as soon as Plasmodium enters them, before there’s even an hour or two for the victim to start feeling sick. Right?”
“Right,” Farlow said, smiling faintly. Melanie saw that he knew where Joe was taking this. He was giving the kid a chance to work it out for himself.
“So the victim has a stroke and dies. Most of them, anyway. But that means the parasites die, too—before they can be sucked back up into another mosquito and passed on to somebody else. So how is the disease spreading from person to person and mosquito to mosquito?”
Susan Muscato said, “Maybe it’s not. Maybe there’s only one batch of infected mosquitoes somewhere, and once we get out in the field we’ll find that all twenty victims so far were in the same place—a park or something—and got it at the same time. And when they die, the outbreak will die with them.”
“Could be,” Farlow said.
Joe said stubbornly, “I don’t think that’s what’s happening.”
“I don’t think so, either,” Farlow said. “Joe, what do you think is happening?”
“I think that the new strain doesn’t infect only people carrying sickle-cell trait. It infects everyone. But in people with normal hemoglobin, the parasite can’t flourish. So those people get a very mild case of malaria—possibly so mild they don’t even know they have it. Maybe just a slight fever, headache, little bit of a sore throat. After a few days it’s gone, and then they’re immune to reinfection. It’s the exact reverse of how sickle-cell trait protects against the usual strains of malaria. Except that with Plasmodium reading—”
“What did you call it?” Gary Pershing interrupted.
“Plasmodium reading. You know, after the senator.”
There was a little silence. Usually diseases were named after either the place it first appeared, such as all the Ebola strains, or after the person who discovered it. A National Institutes of Health researcher named Don Eyeles had been the source for Plasmodium eylesi. But as far as Melanie knew, no malaria had ever before been named after its first identified victim. What a memorial to the man who might have been the next president of the United States.
Farlow said, “Joe’s theory about universal infection with Plasmodium reading is certainly plausible. We need to check blood samples from victims’ family members, neighbors, associates. But there’s also another possibility: a second host to sustain the parasite between Anopheles’s breeding cycles.”
“Well, maybe,” Susan Muscato said thoughtfully. In her midforties, she still looked like an athlete: strongly built, pared down, not weighted by anything to slow her down. “Transspecies parasite migration has happened before, but only among primates, and never with any variant of P. falciparum. Besides, apes and gibbons are rare in Manhattan, where Reading collapsed.”
“It wouldn’t have to be gibbons,” Joe said—Melanie saw that he was both persistent and humorless: one plus as a team member, one minus—“or any other primate. But I suppose there could be another host.”
Gary Pershing, the lab man, said suddenly, “The DNA homology of P. falciparum is closer to the malaria parasites of birds than of monkeys.”
Farlow said, “Only one way to tell. When we’re in Maryland we need to collect blood samples from people without sickle-cell trait who have been in the same locales as the victims. And do interview follow-ups on both.”
Gary said, “But
if that doesn’t play out, we should look at birds. God, Maryland is so species-rich …”
Melanie couldn’t help herself. She had planned on saying nothing, just listening, until the end of this meeting. But the word just burst out, “Birds.”
“No, I don’t see how it could use birds as an alternate host,” Susan agreed, or thought she did. “Bird malarias use Culex mosquitoes as vector, not Anopheles. Cattle or pigs or something are more usual.”
“Let’s not be premature here. About anything,” Farlow said, looking directly at Melanie. “One step at a time. Gary, you’ve had two days with the senator’s samples. What can you tell us?”
Pershing shook his head. Melanie could have sworn the gesture was admiration. “It’s quite a piece of work. This is just preliminary, of course, but there seem to be three changes from standard P. falciparum. First, the merozoites have a surface peptide that attaches itself only to a receptor on the surface of a cell with hemoglobin S. I haven’t found the peptide or the receptor yet, but I’m almost positive that’s what’s happening. The surface of sickle cells already differs in so many ways from normal cell surfaces: in stickiness, in oxygen acquisition and release rates, all kinds of ways.
“Second, once they’re inside the cell, the altered parasites make attaching knobs that prefer the vascular endothelium of cerebral blood vessels rather than any old vessel walls. So the infected blood cells migrate to the brain.
“Third, once they’re there, they excrete something, or do something, that makes the blood vessel constrict and the blood clot. My guess is a protein that binds to the nitric oxide that’s supposed to act as vasodilator, but I haven’t verified that yet. But anyway, the result is a fast, big blood clot in constricted blood vessels in the brain.”
“And a fatal stroke,” Susan said.
“And a fatal stroke,” Gary agreed. “But only in people with sickle cells in their blood. Some Mediterranean peoples, some Indians. But mostly blacks.”
There it was, out on the table. Nobody spoke until young Joe Krovetz said, “There’s something else I don’t get.”
“Yes?” Farlow said.
“If only blacks are in danger from this disease, what’s Melanie doing on the team? I mean, no offense, Melanie, but you’re at risk in a way none of us is.”
Melanie saw now the value of Joe Krovetz, despite his inexperience. He would say aloud what everybody else was only thinking.
She said evenly, “No, I’m not at risk. I’m negative for sickle-cell trait.”
“And we’re all grateful for that,” Susan Muscato said, too quickly. They were embarrassed, Melanie knew. Here, in one of the most advanced scientific establishments in the world, in one of the most democratic countries in the world, her colleagues were embarrassed to discuss racial differences. Enlightened America was supposed to be color-blind.
She put both palms flat on the table. “There’s something I don’t get.” It came out harsher than she intended, not an echo of young Joe but a sarcastic mockery. Joe didn’t react. Chalk up another plus for the kid: He didn’t take things personally.
Farlow said, “What’s that, Melanie?”
“I don’t get why we’re not discussing whether this P. falciparum strain was deliberately engineered to kill carriers of sickle-cell hemoglobin, which means mostly African Americans.”
Farlow said instantly, “Premature. And that’s our official stand on this, people. I talked to the director this morning. He’s setting up a meeting for early next week. It’ll be us, the Public Health Service, the FBI, and a team from the Army Medical Research Institute at Fort Detrick. We’ll get in several good days’ work on site before the meeting and go in prepared to make recommendations. Until then, the official word is to keep this away from the press until we have more information. If asked, we just say that all theories are premature.”
“Which is true,” Susan said. “Especially your theory, Melanie. There’s no evidence at all that P. reading is any kind of plot against African Americans. It could just be a natural mutation. You know it could.”
Everyone looked awkward. Susan was right, Melanie knew. Melanie had no hard evidence that P. reading was anything other than a natural mutation. Unless, of course, you counted the statistical chances of three entirely different genetic mechanisms all mutating at exactly the same time, in the same parasite, to produce a disease fatal only to a population subgroup that just incidentally happened to have been oppressed and discriminated against for three hundred years. Yeah, right.
She said, “Right now the official death toll from P. reading is one. We may find a lot more once we start field work. My question is, if we don’t alert the press, how many more people out there will die who could have been saved by being told about the problem? Radio and TV should carry instructions on using insecticides, using mosquito netting, destroying or staying away from breeding grounds—”
“They will be, Melanie,” Farlow said, “they will be. That’s on next week’s meeting agenda. But first we have to be sure there really is a problem. There’s no use in causing a panic if it turns out we haven’t got an epidemic, just a local pocket of morbidity that disappears with a single batch of mosquitoes. After all, Anopheles can’t pass on parasites to larvae.”
Melanie said, “Jim, tell me we’re not going to sit on this very long. Not when lives could be at stake!”
“No, of course not. Not if lives really are at stake. But give it at least a few days of initial field work, Melanie. Don’t cry wolf if all we’ve got is one cub dying from natural causes.”
“If you really believe Senator Reading’s death was an isolated ‘natural cause,’ then why is the FBI coming to tomorrow’s meeting?”
“I don’t know,” Farlow said. “Maybe because Reading was a senator and a presidential candidate. We’ll find out more tomorrow.”
Melanie subsided. She had no choice, really. Yet.
The team began to plan the painstaking interviewing of medical personnel and next-of-kin. That was the first step in finding the patterns of who got infected, where, and how. An indispensable step, Melanie told herself. They needed the data to trace this thing to its source.
But, meanwhile, more people might die. Black people, mostly.
That was the trade-off.
Four
Nature does not proceed by leaps.
—Carolus Linnaeus, Philosopha Botanica, 1751
* * *
C
avanaugh sat in his office, filling out expense forms. This task always made him feel vaguely guilty. On the one hand, it was clearly necessary; agents needed reimbursement for legitimate expenses, and the Bureau needed a record of where and how it was spending its funds. Also, it gave Cavanaugh a sense of satisfaction to complete the neat rows of figures in his small, precise handwriting. On the other hand, this satisfaction was tainted because filling out expense vouchers didn’t, after all, lead to the apprehension of any criminals. Every hour spent on paperwork was one hour less spent on real law enforcement.
“Anybody calls, I’ll be out till tomorrow,” Seton said.
Cavanaugh looked up from his forms. “Anywhere in particular?”
“Out developing informants for the naval complex,” Seton said, and winked.
“Those informants sure take a lot of developing,” Cavanaugh said evenly. “Why is that, Don?”
“Well, Bob—”
“Robert.”
“It’s like this. A lot of them aren’t too bright. They need to be asked the same questions over and over before they remember the answers. And that takes a lot of time.”
“I’ll bet.”
“Sign me out for six P.M.,” Seton said. “That’s how long it’ll probably take.” He winked again and lumbered out the door.
Cavanaugh was just as glad; the very sight of Seton was beginning to make his skin crawl. Seton was a canker sore, a smiling treacherous boil on the ass of law enforcement, a … The phone rang.
“Robert? Jerry Dunbar. Listen, I’ve go
t something for you.”
Cavanaugh’s hand tightened on the phone. Oh, God, at last … “What, Jerry?”
“Probably not anything real. But it’s connected with that report you gave me last week on the high incidence of strokes among African-American patients at Dellridge and at Sailors and Soldiers.”
“Connected how? Somebody willing to talk about civil rights infringements? Somebody at one of the hospitals?”
“It’s not about civil rights infringements. It’s … something else.”
What else could a difference in the ways blacks and whites received medical care be except a civil rights infringement? Cavanaugh waited.
Dunbar said, “I’m not even sure it is connected. But they are. The CDC has formed a task force to investigate the stroke rate.”
“The CDC?” Now Cavanaugh was more bewildered. The CDC kept statistics on various health problems, of course. Cavanaugh had even seen copies of its journal of record, the Morbidity and Mortality Weekly Report, lying around the house. Judy sometimes used it in writing her science articles. But what did a CDC task force have to do with the FBI?
Dunbar said, “The task force thinks the strokes might not be accidental. Or maybe the USPHS thinks that—you know, the Public Health Service. They made the actual contact with the Bureau. Apparently the USPHS thinks that there’s a possibility the strokes could be the result of some sort of selective biological warfare toxin. Something that … Robert, are you still there?”
“Yes,” Cavanaugh said. He forced himself to relax his grip on the phone. “What sort of toxin? Spread by whom?”
“Unknown. Frankly, I think the whole thing sounds wild-eyed. For one thing, they’re dragging in malaria.”
“Malaria?”
“Yes. And there’s been no malaria in the United States since the end of World War II, except for the odd isolated case coming in from overseas. I looked it up. For another, they’ve got nothing hard. The CDC guy I talked to even said that the most likely probability is that malaria mutated by itself. But the USPHS requested we supply FBI presence, and so that’s you. Unless Don wants to take it. Is he there?”
