Outbreak

by Robin Cook

  “Certainly,” said Richter, glad to have a safe explanation for the man’s presence. He glanced at his watch, but before he had a chance to speak, he felt himself rudely pulled from the car. He made a half-hearted effort to struggle, but he was quickly overwhelmed and stunned by an open-handed blow to the side of his face that knocked him to the ground. Hands roughly searched for his wallet, and he heard fabric tear. One of the men said “businessman,” in what sounded like a disparaging tone, while the other said, “Get the briefcase.” Dr. Richter felt his watch yanked from his wrist.

  It was over as quickly as it had begun. Dr. Richter heard footsteps recede and a car door slam, then the screech of tires on the smooth concrete. For a few moments he lay without moving, glad to be alive. He found his glasses and put them on, noting that the left lens was cracked. As a surgeon, his primary concern was for his hands; they were the first thing he checked, even before he picked himself up off the ground. Getting to his feet, he began to examine the rest of himself. His white shirt and his tie were smeared with grease. A button was missing from the front of his blazer, and in its place was a small horseshoe-shaped tear. His pants were torn from the right front pocket all the way down to his knee.

  “God, what a day!” he voiced to himself, thinking that being mugged made the morning’s fender-bender seem trivial by comparison. After a moment’s hesitation, he recovered his keys and returned to the clinic, going back to his office. He called security, then debated whether to call the L.A. police. The idea of bad publicity for the clinic made him hesitate, and really, what would the police have done? While he argued with himself, he called his wife to explain that he’d be a little later than expected. Then he went into the lavatory to examine his face in the mirror. There was an abrasion over the right cheekbone that was sprinkled with bits of parking-garage grit. As he gingerly blotted it with antiseptic, he tried to estimate how much he had contributed to the muggers’ welfare. He guessed he’d had about a hundred dollars in his wallet as well as all his credit cards and identification, including his California medical license. But it was the watch that he most hated to lose; it had been a gift from his wife. Well, he could replace it, he thought, as he heard a knock on his outer door.

  The security man was fawningly apologetic, saying that such a problem had never happened before, and that he wished he’d been in the area. He told Dr. Richter that he’d been through the garage only a half-hour before, on his normal rounds. Dr. Richter assured the man that he was not to blame and that his, Richter’s, only concern was that steps be taken to make certain that such an incident did not reoccur. The doctor then explained his reasons for not calling the police.

  The following day, Dr. Richter did not feel well but he attributed the symptoms to shock and the fact that he’d slept poorly. By five-thirty, though, he felt ill enough to consider canceling a rendezvous he had with his mistress, a secretary in the medical records department. In the end, he went to her apartment but left early to get some rest, only to spend the night tossing restlessly in his bed.

  The next day, Dr. Richter was really ill. When he stood up from the slit lamp, he was light-headed and dizzy. He tried not to think about the monkey bite or being coughed on by the AIDS patient. He was well aware that AIDS was not transmitted by such casual contact: it was the undiagnosed superinfection that worried him. By three-thirty he had a chill and the beginnings of a headache of migraine intensity. Thinking he had developed a fever, he canceled the rest of the afternoon’s appointments and left the clinic. By then he was quite certain he had the flu. When he arrived home, his wife took one look at his pale face and red-rimmed eyes, and sent him to bed. By eight o’clock, his headache was so bad that he took a Percodan. By nine, he had violent stomach cramps and diarrhea. His wife wanted to call Dr. Navarre, but Dr. Richter told her that she was being an alarmist and that he’d be fine. He took some Dalmane and fell asleep. At four o’clock he woke up and dragged himself into the bathroom, where he vomited blood. His terrified wife left him long enough to call an ambulance to take him to the clinic. He did not complain. He didn’t have the strength to complain. He knew that he was sicker than he’d ever been in his life.

  1

  January 20

  SOMETHING DISTURBED MARISSA Blumenthal. Whether the stimulus came from within her own mind, or from some minor external change, she did not know. Nonetheless her concentration was broken. As she raised her eyes from the book in her lap she realized that the light outside the window had changed from its pale wintery white to inky blackness. She glanced at her watch. No wonder. It was nearly seven.

  “Holy Toledo,” muttered Marissa, using one of her expressions left over from childhood. She stood up quickly and felt momentarily dizzy. She had been sprawled out on two low slung vinyl-covered chairs in a corner of the library of the Centers for Disease Control (CDC) in Atlanta for more hours than she cared to think about. She had made a date for that evening and had planned on being home by six-thirty to get ready.

  Hefting Fields’ ponderous Virology textbook, she made her way over to the reserve shelf, stretching her cramped leg muscles en route. She’d run that morning, but had only put in two miles, not her usual four.

  “Need help getting that monster on the shelf?” teased Mrs. Campbell, the motherly librarian, buttoning her omnipresent gray cardigan. It was none too warm in the library.

  As in all good humor, there was some basis in truth for Mrs. Campbell’s whispered comment. The virology textbook weighed ten pounds—one-tenth as much as Marissa’s hundred-pound frame. She was only five feet tall, although when people asked, she said she was five-two, though that was only in heels. To return the book, she had to swing it back and then almost toss it into place.

  “The kind of help I need with this book,” said Marissa, “is to get the contents into my brain.”

  Mrs. Campbell laughed in her subdued fashion. She was a warm, friendly person, like most everyone at CDC. As far as Marissa was concerned, the organization had more the feeling of an academic institution than a federal agency, which it had officially become in 1973. There was a pervading atmosphere of dedication and commitment. Although the secretaries and maintenance personnel left at four-thirty, the professional staff invariably stayed on, often working into the wee hours of the morning. People believed in what they were doing.

  Marissa walked out of the library, which was hopelessly inadequate in terms of space. Half the Center’s books and periodicals were stored haphazardly in rooms all over the complex. In that sense the CDC was very much a federally regulated health agency, forced to scrounge for funding in an atmosphere of budget cutting. Marissa noted it also looked like a federal agency. The hall was painted a drab, institutional green, and the floor was covered in a gray vinyl that had been worn thin down the middle. By the elevator was the inevitable photograph of a smiling Ronald Reagan. Just beneath the picture someone had irreverently tacked up an index card that said: “If you don’t like this year’s appropriation, just wait until next year!”

  Marissa took the stairs up one flight. Her office—it was generous to call it that; it was more cubbyhole than office—was on the floor above the library. It was a windowless storage area that might have been a broom closet at one time. The walls were painted cinder block, and there was just enough room for a metal desk, file cabinet, light and swivel chair. But she was lucky to have it. Competition for space at the Center was intense.

  Yet despite the handicaps, Marissa was well aware that the CDC worked. It had delivered phenomenal medical service over the years, not only in the U.S., but in foreign countries as well. She remembered vividly how the Center had solved the Legionnaires Disease mystery a number of years back. There had been hundreds of such cases since the organization had been started in 1942 as the Office of Malaria Control to wipe out that disease in the American South. In 1946 it had been renamed the Communicable Disease Center, with separate labs set up for bacteria, fungi, parasites, viruses and rickettsiae. The following year a lab was a
dded for zoonoses, diseases that are animal ailments but that can be transmitted to man, like plague, rabies and anthrax. In 1970 the organization was renamed again, this time the Centers for Disease Control.

  As Marissa arranged some articles in her government-issue briefcase, she thought about the past successes of the CDC, knowing that its history had been one of the prime reasons for her considering coming to the Center. After completing a pediatric residency in Boston, she had applied and had been accepted into the Epidemiology Intelligence Service (EIS) for a two-year hitch as an Epidemiology Intelligence Service Officer. It was like being a medical detective. Only three and a half weeks previously, just before Christmas, she’d completed her introductory course, which supposedly trained her for her new role. The course was in public-health administration, biostatistics and epidemiology—the study and control of health and disease in a given population.

  A wry smile appeared on Marissa’s face as she pulled on her dark blue overcoat. She’d taken the introductory course, all right, but as had happened so often in her medical training, she felt totally ill-equipped to handle a real emergency. It was going to be an enormous leap from the classroom to the field if and when she was sent out on an assignment. Knowing how to relate to cases of a specific disease in a coherent narrative that would reveal cause, transmission and host factors was a far cry from deciding how to control a real outbreak involving real people and a real disease. Actually, it wasn’t a question of “if,” it was only a question of “when.”

  Picking up her briefcase, Marissa turned off the light and headed back down the hall to the elevators. She’d taken the introductory epidemiology course with forty-eight other men and women, most of whom, like herself, were trained physicians. There were a few microbiologists, a few nurses, even one dentist. She wondered if they all shared her current crisis of confidence. In medicine, people generally didn’t talk about such things; it was contrary to the “image.”

  At the completion of the training, she’d been assigned to the Department of Virology, Special Pathogens Branch, her first choice among the positions available. She had been granted her request because she’d ranked number one in the class. Although Marissa had little background in virology, which was the reason she’d been spending so much time in the library, she’d asked to be assigned to the department because the current epidemic of AIDS had catapulted virology into the forefront of research. Previously it had always played second fiddle to bacteriology. Now virology was where the “action” was, and Marissa wanted to be a part of it.

  At the elevators, Marissa said hello to the small group of people who were waiting. She’d met some of them, mostly those from the Department of Virology, whose administrative office was just down the hall from her cubicle. Others were strangers, but everyone acknowledged her. She might have been experiencing a crisis of confidence in her professional competence, but at least she felt welcome.

  On the main floor Marissa stood in line to sign out, a requirement after 5:00 P.M., then headed to the parking area. Although it was winter, it was nothing like what she’d endured in Boston for the previous four years, and she didn’t bother to button her coat. Her sporty red Honda Prelude was as she’d left it that morning: dusty, dirty and neglected. It still had Massachusetts license plates; replacing them was one of the many errands that Marissa had not yet found time to do.

  It was a short drive from the CDC to Marissa’s rented house. The area around the Center was dominated by Emory University, which had donated the land to the CDC in the early ’40s. A number of pleasant residential neighborhoods surrounded the university, running the gamut from lower middle class to conspicuously rich. It was in one of the former neighborhoods, in the Druid Hills section, that Marissa had found a house to rent. It was owned by a couple who’d been transferred to Mali, Africa, to work on an extended birth-control project.

  Marissa turned onto Peachtree Place. It seemed to her that everything in Atlanta was named “peachtree.” She passed her house on the left. It was a small two-story wood-frame building, reasonably maintained except for the grounds. The architectural style was indeterminant, except for two Ionic columns on the front porch. The windows all had fake shutters, each with a heart-shaped area cut out in the center. Marissa had used the term “cute” to describe it to her parents.

  She turned left at the next street and then left again. The property on which the house sat went all the way through the block, and in order for Marissa to get to the garage, she had to approach from the rear. There was a circular drive in front of the house, but it didn’t connect with the rear driveway and the garage. Apparently in the past the two driveways had been connected, but someone had built a tennis court, and that had ended the connection. Now, the tennis court was so overgrown with weeds it was barely discernible.

  Knowing that she was going out that evening, Marissa did not put her car in the garage, but just swung around and backed it up. As she ran up the back steps, she heard the cocker spaniel, given to her by one of her pediatric colleagues, barking welcome.

  Marissa had never planned on having a dog, but six months previously a long-term romantic relationship that she had assumed was leading to marriage had suddenly ended. The man, Roger Shulman, a neurosurgical resident at Mass. General, had shocked Marissa with the news that he had accepted a fellowship at UCLA and that he wanted to go by himself. Up until that time, they had agreed that Marissa would go wherever Roger went to finish his training, and indeed Marissa had applied for pediatric positions in San Francisco and Houston. Roger had never even mentioned UCLA.

  As the baby in the family, with three older brothers and a cold and dominating neurosurgeon for a father, Marissa had never had much self-confidence. She took the breakup with Roger very badly and had been barely able to drag herself out of bed each morning to get to the hospital. In the midst of her resultant depression, her friend Nancy had presented her with the dog. At first Marissa had been irritated, but Taffy—the puppy had worn the cloyingly sweet name on a large bow tied around its neck—soon won Marissa’s heart, and, as Nancy had judged, it helped Marissa to focus on something besides her hurt. Now Marissa was crazy about the dog, enjoying having “life” in her home, an object to receive and return her love. Coming to the CDC, Marissa’s only worry had been what to do with Taffy when she was sent out in the field. The issue weighed heavily on her until the Judsons, her neighbors on the right, fell in love with the dog and offered—no, demanded—to take Taffy any time Marissa had to go out of town. It was like a godsend.

  Opening the door, Marissa had to fend off Taffy’s excited jumps until she could turn off the alarm. When the owners had first explained the system to Marissa, she’d listened with only half an ear. But now she was glad she had it. Even though the suburbs were much safer than the city, she felt much more isolated at night than she had in Boston. She even appreciated the “panic button” that she carried in her coat pocket and which she could use to set off the alarm from the driveway if she saw unexpected lights or movement inside the house.

  While Marissa looked over her mail, she let Taffy expend some of her pent-up energy racing in large circles around the blue spruce in the front yard. Without fail, the Judsons let the dog out around noon; still from then until Marissa got home in the evening was a long time for an eight-month-old puppy to be cooped up in the kitchen.

  Unfortunately, Marissa had to cut Taffy’s exuberant exercise short. It was already after seven, and she was expected at dinner at eight. Ralph Hempston, a successful ophthalmologist, had taken her out several times, and though she still had not gotten over Roger, she enjoyed Ralph’s sophisticated company and the fact that he seemed content to take her to dinner, the theater, a concert without pressuring her to go to bed. In fact, tonight was the first time he’d invited her to his house, and he’d made it clear it was to be a large party, not just the two of them.

  He seemed content to let the relationship grow at its own pace, and Marissa was grateful, even if she suspected the rea
son might be the twenty-two-year difference in their ages; she was thirty-one and he was fifty-three.

  Oddly enough the only other man Marissa was dating in Atlanta was four years younger than she. Tad Schockley, a microbiologist Ph.D. who worked in the same department she ultimately had been assigned to, had been smitten by her the moment he’d spied her in the cafeteria during her first week at the Center. He was the exact opposite of Ralph Hempston: socially painfully shy, even when he’d only asked her to a movie. They’d gone out a half dozen times, and thankfully he, like Ralph, had not been pushy in a physical sense.

  Showering quickly, Marissa then dried herself off and put on makeup almost automatically. Racing against time, she went through her closet, rapidly dismissing various combinations. She was no fashion plate but liked to look her best. She settled on a silk skirt and a sweater she’d gotten for Christmas. The sweater came down to mid-thigh, and she thought that it made her look taller. Slipping on a pair of black pumps, she eyed herself in the full-length mirror.

  Except for her height, Marissa was reasonably happy with her looks. Her features were small but delicate, and her father had actually used the term “exquisite” years ago when she’d asked him if he thought she was pretty. Her eyes were dark brown and thickly lashed, and her thick, wavy hair was the color of expensive sherry. She wore it as she had since she was sixteen: shoulder length, and pulled back from her forehead with a tortoiseshell barrette.

  It was only a five-minute drive to Ralph’s, but the neighborhood changed significantly for the better. The houses grew larger and were set back on well-manicured lawns. Ralph’s house was situated on a large piece of property, with the driveway curving gracefully up from the street. The drive was lined with azaleas and rhododendrons that in the spring had to be seen to be believed, according to Ralph.