by Melissa Yi
Them: But what if the mosquito comes here?
Me: It probably won't be until after your pregnancy is finished.
Them: But what if a mosquito comes here, and bites someone, and then bites me, and my baby ends up with microcephaly?
That was the especially vicious effect of the Zisa virus. It attacked neurological tissue. Especially fetal neurological tissue.
This summer, the Center for Disease Control and other agencies had formally announced the link between Zisa and microcephaly.
My eyes dropped to Joan's belly, cradled between her hands.
Chapter 23
I licked my lips. Ryan might not understand what we were talking about, but I didn't dare break eye contact with Joan now. Our rapport was too delicate.
"Is your baby okay?" Her shoulders sagged. Oh, no. Oh, God.
When Zisa started making the news because of the microcephalic babies in Brazil, we assumed that infection during the first trimester was the most dangerous. That's true of most of the TORCH infections (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes), and it makes intuitive sense: an embryo still forming its brain, lungs, heart, and guts can make more devastating errors in cell division compared to a 39-weeker ready to enter the world.
Then we started getting reports of fetal death with Zisa infections. Not limited to miscarriages at six to eight weeks, which we often see in the emergency department, but fetal death right up until birth.
Stillbirth is one of my nightmares. I glanced at Joan's stomach and made a quick prayer. Baby, be okay.
Compared to those better-known diseases, Zisa seemed relatively innocuous. When most Zisa-infected pregnant women gave birth to babies with a normal head circumference, we celebrated until some of those babies developed other abnormalities. They cried all the time. They seized. They had cataracts. They had trouble feeding.
Suddenly, it seemed like nothing could protect you. Not the miracle of conceiving a baby. Not giving birth to a normal skull-sized infant. Nothing. Zisa invaded cells and vessels in the brain not only in utero, but in a newborn.
Now I knew why they'd left Miami.
I asked, "Did you or Lawrence test positive for Zisa?"
Ryan sucked in his breath, but even out of the corner of my eye, I could see that he hadn't shrank away or started screaming. He was a good egg and a rational being. He probably knew that the vast majority of people only get Zisa via a mosquito, though you can also get infected through sex, in utero, or through a blood transfusion, none of which were likely to happen to us at a dinner party.
Joan's lips twisted. "Oh, Doctor Hope, I am the last one to know anything."
That was a strange response. She didn't add anything, but she maintained steady eye contact with me. I decided to change tacks. "Did you have a rash or red eyes or aches and pains?" I was speaking more slowly now, the way I did with patients who didn't speak much English. Joan spoke English, but I wanted to be extra-clear, even if it made me look like a colonialist.
She shook her head. So if she had Zisa, she was one of the eighty percent of people who didn't develop any symptoms. Like I said, it's part of the reason that the disease is spreading so fast. People don't even know they're sick. But she must have had prenatal care in Miami, right? And they would have tested for Zisa, especially since there was such a hullaballoo over the summer. I tried to remember exactly when the first reports hit that Zisa was being spread in the Miami-Dade area by local mosquitoes. August, I decided. I'd barely started my psychiatry rotation.
Even if Joan had been asymptomatic, they must have tested her. Or had they? So many pregnant women had jumped at the free Zisa testing, overwhelming the system, that the Center for Disease Control had to step in and help with the backlog.
But surely, if you worked in a lab, you would figure out a way to have your wife tested for Zisa. Maybe you could even test for it yourself.
I remembered Lawrence's body in the snow, and I shivered. What happened to this couple? How did they end up in Ottawa, and who killed one of them?
Time to back up. "You were tested for Zisa, right?" I said. She nodded.
Okay. That was something. "What did the test say?"
She didn't meet my eyes. At last, she murmured, "It was positive." Ryan set down his cup and pushed it away a few inches.
Right. Zisa was spreading faster than it should have, for a purely mosquito-borne infection. Zisa might be transferred through saliva or tears.
I stared at Joan's tear-stained face, smelled the food she'd prepared for us in her own kitchen, wishing we'd never come.
Chapter 24
Ryan excused himself to go the bathroom, probably so he could discreetly rinse out his mouth.
I pushed the banana juice across the table, out of arm's reach, and tried to figure out when Joan might have gotten infected. Twenty-eight weeks was about seven months along. In mid-August, she would have been three months pregnant. Terrible timing, because even though fetuses can become sick any time, first trimester infections may still be the most dangerous.
"What do you know about your pregnancy so far?" I tried to phrase it delicately, asking if she knew about birth defects.
She placed both hands on her belly. "I'm so worried, Doctor Hope. I feel kicks, and I think, 'How will you stay alive? What are we going to do now that your daddy is with Jesus?'"
"We'll help you," I said. "You're not alone. You saw the group today. We'll band together." Summer wanted to raise some funds; Joan's church was on casserole duty; add in me and Ryan, and that might be enough.
"So many terrible things have happened. I need to know what happened to my husband. You understand, don't you, Doctor Hope?"
"Yes, I do." That feeling throbbed inside me again, that she and I were the same at heart, plunging head-first into danger when everyone else said Stop, Drop and Think. "What do you want to know?"
When Ryan walked back toward us, I could smell the soap on his hands. Poor guy. Now he knew how I felt touching Lawrence—
My breath seized.
Touching Lawrence. I'd already had skin-to-skin contact with him. Zisa is transmitted back and forth between the mother and fetus continuously during pregnancy, maybe through the placenta. We're not sure about the mechanism yet. The mother can't seem to develop antibodies until after she delivers, usually a week post-partum. And Joan had told me she had Zisa.
It's also sexually transmitted. Zisa is a persistent beast. It seems to hide in men's testicles, where the immune system is less likely to find it. They've found Zisa RNA in mouse tears and vaginal fluid.
Couples are supposed to use condoms or abstain from sex during pregnancy so as not to transfer it back and forth, but when was the last time you heard of a pregnant couple using condoms?
Joan had Zisa. Lawrence probably had Zisa. And now I'd been in close contact with both of them.
Breeeeeeeeeeeathe.
There are no guaranteeeeeeeees. I'd touched Lawrence and sipped Joan's food. Still, chances were, I was not infected with Zisa. Yet.
"Where did you find my husband?" Joan was asking.
I opened my mouth, but Ryan was already telling her about Roxy running away and finding Lawrence's body.
"In the ditch beside the road?" Joan said, her eyes alert.
Ryan and I exchanged a look. It sounded so indelicate. Yes, your husband's body was in the ditch.
"I guess that's what you could call it," I said. "We did everything we could, though. I started CPR, which the police took over, and the paramedics got an airway and a monitor—"
Joan pressed her lips together and shook her head. "What was he doing there? He was supposed to come home for supper."
I held my breath. I wanted to piece together what had happened to Lawrence. This was what I'd been waiting for. And I didn't even have to ask.
She began to pick at one of her nails. "He said he had to work that afternoon. I wanted him to come with me to look at a crib, but he said he had to work. He said it was a matter of life and—" H
er face crumpled. Her voice shook, and her hand drifted to her back.
"He was happy about your pregnancy, wasn't he?" I said.
After a moment, Joan said, "We were his family. He said he would do anything to protect us."
That wasn't an answer. I understood about work. Believe me, it's the closest thing my parents have to a religion. Work hard. Look after your family. Are you tired? Work harder.
But if Ryan or Tucker blew me off when our baby and I had motherfucking Zisa, I would stomp on them.
To be fair, Lawrence was a Ph.D. who specialized in virology. He understood the disease better than I did. Hell, maybe that was why he had to go in.
"Was he studying Zisa?" I asked, even though I knew I should let her ask the questions.
She sighed. "He was trying to get funding. The CDC had promised him, but because he moved to Canada … "
Sure. The Center for Disease Control wanted to help Americans, not Canadians. And most cases were in the US instead of here. There was no good reason to move from the epicentre of the disease in the continental U.S., unless your wife was pregnant.
"That's just wrong," said Ryan, and while they commiserated over bureaucracy, I studied her kind, round face and thought, Lawrence must have loved her. I wasn't sure I liked him, based on the little she'd said, but he'd cared about her enough to move her to one of the safest countries in the world, Zisa-wise. Chile doesn't have the mosquito either, but Canada must have more job opportunities and a more solid health care system, although it couldn't protect Lawrence.
How on earth did he end up with a black bag over his head? Why hadn't he pulled the bag off himself ?
You hear about infants suffocating in a bag, but not young, strong adults. I'd vaguely heard of committing suicide that way, but why would he bother bringing his pregnant wife here and killing himself ? Unless he felt like, "My work is done, see ya. Canada will take care of you." But from all indications, Lawrence had been fighting for Zisa funding, not giving up. And suicide by bag, a block away from the hospital? An educated man could come up with a dozen better ways to kill himself.
In medicine, you're supposed to chase down every possibility with the caveat that "When you hear hoof beats, think horses, not zebras."
It made no sense that Lawrence had killed himself in such a stupid way. Therefore, this was a suspicious death. Therefore, the police were right to question me and Ryan. Therefore, I should try and unravel it myself.
"More banana juice?" said Joan, slowly rising to her feet. She pushed her hips forward as she did so, keeping her belly balanced in the air, her right hand supporting her back.
Neither of us had touched our cups after the first toast. We stood up to help her.
Ryan said, "My stomach is a little unsettled."
"Me too!" I sounded too enthusiastic, so I added, "Why don't you rest, and we'll talk instead of worrying about food?"
Joan's lower lip jutted forward. "Food will settle your stomachs. My delicious vegetable curry has been simmering all day."
Ryan winced. He hates the way my parents leave food out all day, even though my family is hardly ever sick, and I tell him we must have really good gut flora.
"Honestly, I'd rather talk," I said, but Joan made her way to the stove, placing each foot as if she were the one with a mildly sprained ankle, not me.
She said, over her shoulder, "The police asked me to come to the station. They have new information for me. I told them I couldn't come, I was cooking for you."
Oh, God. More guilt. I hurried to her side and glanced at Joan's face, shiner than it had been a few seconds before. If I reached out to touch it, I bet her forehead would feel clammy. "Joan? Are you—"
"Excuse me for one second," she said, spacing each word apart and pronouncing each one carefully. She rotated her body to the right like she was redirecting the Titanic.
Ryan and I exchanged a look.
"Joan, I can help you," I said, but she was already eking her way to the teeny bathroom beside the entrance. It was a bit like watching a turtle make its determined way across a beach. You know it has to get there on its own, but you really want to pick it up and make its life ten times easier. It felt like two decades before she breached the entrance and shut the door, vibrating the doorknob as she locked it behind her.
Ryan angled his head at the main door. I nodded and pointed at my watch to indicate that if we waited a few minutes, we'd try and make a graceful exit.
I braced myself for the sound of number one or two hitting the toilet bowl, but aside from a rustle of clothes, everything was quiet.
Ryan's face relaxed until Joan's urine started splashing. Ryan looked like he'd rather fight his way out of a biker bar than sit here and listen to that soundtrack.
"How was your day?" I said, raising my voice to cover the noise. "Not bad. You?"
I shrugged. "I don't feel like they expect too much from me."
"Well, it was only your second day."
Suddenly, Ryan stiffened. A low moan came from the bathroom.
Chapter 25
Ryan stopped breathing.
Joan moaned again, a low, throaty sound that seemed to permeate the room.
The apartment walls seemed to fold in on me. My heart battered my ribs.
The last time I had a pregnant woman in a bathroom, I had to deliver her baby literally at gunpoint. What are the chances of that? Like, one in a million? Ten million?
This wasn't happening.
I heard Joan gasp through the door.
Somehow, I could tell she was trying not to cry. This was happening. No matter how improbably. I sucked air in through my teeth.
I was the only doctor in the room.
(I'm getting Punk'd, right? Is this Denis's new version of therapy? Shock therapy.
#FML.)
If I was getting Punk'd, I'd better put on a good show for Ashton Kutcher or whoever was directing this reboot. I touched Ryan's hip, suddenly calm. This was the world's version of tossing me into the ocean even though I'd forgotten how to swim and had recently developed hydrophobia.
At least no one held a gun to my head. I could handle this.
Ryan reached for his phone, ready to call EMS. They should give us a frequent caller discount.
I held up my finger. I wanted to assess what the problem was. Joan was alive. The baby, I sincerely hoped, was alive. If Joan was in early labour, we could drive her to the hospital and save her the ambulance charge of $200.
I crossed the room and knocked on the door. The wood was so thin, it jounced under my fist, although the lock held. "Joan?"
Even without my ear pressed to the door, I could hear her breathing hard and fast.
Joan was pregnant. I did not want to deliver her baby in the bathroom. Or deliver any baby, period, until I got the PTSD under control. I repeated, my voice higher-pitched than I'd like, "Are you having the baby? You want us to call 911?"
"Noooooooooooo." Another moan, more than a word.
I glanced at my watch. I should be timing these in case these were contractions, but it couldn't be more than two minutes between moans.
Bad sign.
I touched the doorknob. It didn't move. "Immaculate Joan"—it suddenly seemed right to call her by both her first names, to try and lift her out of her pain or panic—"are you having contractions, or not feeling well in general? I might have some Tylenol in my bag." My mother had pressed a giant bottle into my purse. If Joan wasn't vomiting, she could take a tablet. You can also administer it rectally, but it wouldn't be my first choice.
I jiggled the doorknob. It was locked, to my secret relief, backfilled with exasperation. "Joan, if you don't open the door, Ryan is calling for an ambulance. You have a high risk pregnancy, and you won't let me in. I'm a doctor, Joan. I've delivered babies before." Although not premies with Zisa.
She sobbed once, a high note that thrilled the air. Then she was silent. "I'm calling 911," said Ryan, phone in hand.
I nodded.
"No!" Joan s
houted.
Ryan and I stopped. No, she did she not need help, or no, she was too scared to go to a hospital after her husband had died?
"What's happening, Joan?" I said. "I'm okay!"
She sure didn't sound okay a few minutes ago.
On the other hand, she'd said two words, which was better than groaning. Ryan started pushing buttons. I touched his arm.
"I'll go in there," I told Ryan, under my breath. "I'll get her to let me in. I'll take a look first. She might not need the hospital. She might be … having a panic attack, or Braxton-Hicks contractions."
Ryan raised both eyebrows, clearly thinking, And that's better?
"She wouldn't need an ambulance for either of them. Braxton-Hicks are practice contractions."
"That didn't sound like an anxiety attack to me," said Ryan, meeting my eyes head on. Most guys would've already hit the parking lot, but Ryan would always stand by me in a crisis. Always. Even if it had icky girl stuff going on.
Joan called through the door, "NooooOOOOooooo … "
I jangled the doorknob loud enough that she should hear me. "Joan. You're going to have to let me in, or let the paramedics in. One or the other."
Ryan didn't say anything, but his body leaned toward the exit in a way that screamed Paramedics, paramedics.
I reached for my purse hung at the front door. There was only one upside about finding Lawrence's body: ever since, I carried a pair of gloves in my purse at all times. I slid them on, sheathing my hands in an unearthly blue latex-free barrier. I could've used two pairs of gloves. Sometimes we double-glove if there's a high-risk patient. Next time, I'd make sure I had a backup pair for myself and another two sets for Ryan. Just in case.
As I walked back to the bathroom, I thought, You've heard of the dream team. Ryan and I are the death team.
No. Joan was alive. I had two patients to look after now. That's what OB/gyn's say: they're the only ones who have two patients. ER docs have multiple patients, but usually not hanging out within each others' bodies.
