Outbreak

by Robin Cook

  Recognizing that she was at the limit of her strength, Marissa decided to go back to her motel. She was just leaving when the floor nurse said Dr. Richter’s wife was able to see her. Realizing it would be cruel to put her off, Marissa met her in the visitors’ lounge. Anna Richter, a well-dressed, attractive woman in her late thirties, did her best to fill in her husband’s schedule over the past two weeks, but she was desperately upset, not just alarmed about her husband but fearful for their two young children as well. Marissa was reluctant to press her for too much detail. Mrs. Richter promised to provide a more complete chronology the next day. Marissa walked her to the doctor’s BMW. Then she found her own car and drove to the Tropic Motel where she fell directly into bed.

  3

  January 22

  ARRIVING AT THE CLINIC the next morning, Marissa was surprised to see a number of TV trucks pulled up to the hospital entrance, with their transmission antennae raised against the morning sky. When she tried to enter through the parking garage, she was stopped by a policeman and had to show her CDC identification.

  “Quarantine,” the policeman explained, and told her to enter the clinic through the main hospital entrance where the TV trucks were located.

  Marissa obeyed, wondering what had been happening during the six-plus hours she’d been away. TV cables snaked their way along the floor to the conference room, and she was amazed at the level of activity in the main corridor. Spotting Dr. Navarre, she asked him what was going on.

  “Your people have scheduled a news conference,” he explained. His face was haggard and unshaven, and it seemed obvious he had not been to bed. He took a newspaper from under his arm and showed it to Marissa: A NEW AIDS EPIDEMIC, shouted the headline. The article was illustrated with a photo of Marissa talking with Clarence Herns.

  “Dr. Dubchek felt that such a misconception could not be allowed to continue,” said Dr. Navarre.

  Marissa groaned. “The reporter approached me right after I’d arrived. I really didn’t tell him anything.”

  “It doesn’t matter,” said Dr. Navarre, patting her gently on the shoulder. “Dr. Richter died during the night, and with the four new cases, there was no way this could have been kept from the media.”

  “When did Dr. Dubchek arrive?” asked Marissa, getting out of the way of a camera crew headed into the conference room.

  “A little after midnight,” said Dr. Navarre.

  “Why the police?” asked Marissa, noticing a second uniformed officer standing by the doors leading to the hospital.

  “After Dr. Richter died, patients started signing themselves out of the hospital, until the State Commissioner of Health issued an order placing the whole building under quarantine.”

  Marissa excused herself and made her way through a throng of press and TV people outside the conference room. She was glad Dubchek had arrived to take charge but wondered why he hadn’t gotten in touch with her. When she entered the room, Dubchek was just about to start speaking.

  He handled himself well. His calm no-nonsense manner quieted the room immediately. He began by introducing himself and the other doctors from the CDC. There was Dr. Mark Vreeland, Chief of Medical Epidemiology; Dr. Pierce Abbott, Director of the Department of Virology; Dr. Clark Layne, Director of the Hospital Infectious Disease Program; and Dr. Paul Eckenstein, Director of the Center for Infectious Disease.

  Dubchek then went on to downplay the incident, saying that the problem was not “A New AIDS Epidemic” by any stretch of the imagination. He said that the California State Epidemiologist had requested help from the CDC to look into a few cases of unexplained illness thought to be of viral origin.

  Looking at reporters eager for copy, Marissa could tell they were not buying Dubchek’s calm assessment. The idea of a new, unknown and frightening viral illness made for exciting news.

  Dubchek continued by saying that there had only been a total of sixteen cases and that he thought the problem was under control. He pointed to Dr. Layne and announced that he would be overseeing the quarantine efforts and added that experience proved this kind of illness could be controlled by strict hospital isolation.

  At this, Clarence Herns jumped up, asking, “Did Dr. Richter bring this virus back from his African conference?”

  “We don’t know,” said Dubchek. “It is a possibility, but doubtful. The incubation period would be too long, since Dr. Richter returned from Africa over a month ago. The incubation period for this kind of illness is usually about a week.”

  Another reporter got to her feet: “If the incubation period for AIDS can be five years, how can you limit it here to less than a month?”

  “That’s exactly the point,” said Dubchek, his patience wearing thin. “The AIDS virus is totally different from our current problem. It is essential that the media understand this point and communicate it to the public.”

  “Have you isolated the new virus?” asked another reporter.

  “Not yet,” admitted Dubchek. “But we do not expect to have any difficulty. Again, that’s because it is a very different virus from AIDS. It should only take a week or so to culture it.”

  “If the virus has not been isolated,” continued the same reporter, “how can you say that it is different from the AIDS virus?”

  Dubchek stared at the man. Marissa could sense the doctor’s frustration. Calmly he said, “Over the years we’ve come to realize that totally different clinical syndromes are caused by totally different microorganisms. Now that is all for today, but we will keep you informed. Thank you for coming at this early hour.”

  The conference room erupted as each reporter tried to get one more question answered. Dubchek ignored them as he and the other doctors made their exit. Marissa tried to push through the crowd but couldn’t. Outside the conference room the uniformed policeman kept the reporters from entering the hospital proper. After showing her CDC identity card, Marissa was allowed to pass. She caught up to Dubchek at the elevators.

  “There you are!” said Dubchek, his dark eyes lighting up. His voice was friendly as he introduced Marissa to the other men.

  “I didn’t know so many of you were coming,” she said as they boarded the elevator.

  “We didn’t have much choice,” said Dr. Layne.

  Dr. Abbott nodded. “Despite Cyrill’s comments at the news conference, this outbreak is extraordinarily serious. An appearance of African viral hemorrhagic fever in the developed world has been a nightmare we’ve lived with since the illness first surfaced.

  “If it proves to be African viral hemorrhagic fever,” added Dr. Eckenstein.

  “I’m convinced,” said Dr. Vreeland. “And I think the monkey will turn out to be the culprit.”

  “I didn’t get samples from the monkey,” admitted Marissa quickly.

  “That’s okay,” said Dubchek. “We sacrificed the animal last night and sent specimens back to the Center. Liver and spleen sections will be far better than blood.”

  They arrived on the fifth floor, where two technicians from the CDC were busy running samples in the Vickers Mobile Isolation Lab.

  “I’m sorry about that L.A. Times article,” said Marissa when she could speak to Dubchek alone. “The reporter approached me when I first entered the hospital.”

  “No matter,” said Dubchek. “Just don’t let it happen again.” He smiled and winked.

  Marissa had no idea what the wink meant, nor the smile, for that matter. “Why didn’t you call me when you arrived?” she asked.

  “I knew you’d be exhausted,” explained Dubchek. “There really wasn’t any need. We spent most of the night getting the lab set up, autopsying the monkey, and just getting oriented. We also improved the isolation situation by having fans installed. Nonetheless, you are to be congratulated. I think you did a fine job getting this affair underway.”

  “For the moment, I’m buried in administrative detail,” continued Dubchek, “but I do want to hear what you’ve learned. Maybe you and I could have dinner tonight. I’ve gotten
you a room at the hotel where we are staying. I’m sure it’s better than the Tropic Motel.”

  “There’s nothing wrong with the Tropic,” said Marissa. She felt an odd twinge of discomfort, as if her intuition were trying to tell her something.

  Marissa went back to her small room behind the nurses’ station and began to catch up on her own paperwork. First she phoned the sponsoring organizations for the two medical meetings Dr. Richter had attended. She told them that she needed to know if any of the other attendees had become ill with a viral disease. Then, gritting her teeth at the cruelty of her next call, she dialed Dr. Richter’s home number and asked if she could pick up the diary Mrs. Richter had promised her the night before.

  The neighbor who answered the phone seemed appalled by her request, but, after checking with the widow, told Marissa to come over in half an hour.

  Marissa drove up to the beautifully landscaped house and nervously rang the bell. The same neighbor answered and rather angrily directed Marissa to the living room. Anna Richter appeared a few minutes later. She seemed to have aged ten years overnight. Her face was pale, and her hair, which had been so carefully curled the night before, hung about her face in lank strands.

  The neighbor helped her to a chair, and Marissa was amazed to see that she was anxiously folding and unfolding some lined papers that seemed to contain the requested list of her husband’s activities over the last weeks. Knowing what a strain the woman must have been under, Marissa didn’t know what to say, but Anna simply handed her the sheets saying, “I couldn’t sleep last night anyway, and maybe this will help some other poor family.” Her eyes filled with tears. “He was such a good man . . . a good father . . . my poor children.”

  Despite knowing of his affair with Helen Townsend, Marissa decided that Dr. Richter must have been a pretty good husband. Anna’s grief seemed real, and Marissa left her as soon as she politely could.

  The notes that she read before starting the car were surprisingly detailed. Put together with a further interview with Miss Cavanagh and the doctor’s appointment book, Marissa felt they would give her as good a picture of Richter’s last few weeks as anyone could get.

  Back at the hospital, Marissa made a separate sheet of paper for each day of January and listed Richter’s activities. One fact she discovered was that he had complained to Miss Cavanagh about an AIDS patient named Meterko who was suffering from an undiagnosed retinal disorder. It sounded like something Marissa should look into.

  In the afternoon, the phone in Marissa’s cubicle rang. Picking it up, she was startled to hear Tad Schockley’s voice. The connection was so good that for a moment she thought he was there in L.A.

  “Nope,” said Tad, responding to her question. “I’m still here in Atlanta. But I need to speak to Dubchek. The hospital operator seemed to think that you might know where he was.”

  “If he’s not in the CDC room, then I guess he’s gone to his hotel. Apparently they were up all last night.”

  “Well, I’ll try the hotel, but in case I don’t get him, could you give him a message?”

  “Of course,” said Marissa.

  “It’s not good news.”

  Straightening up, Marissa pressed the phone to her ear. “Is it personal?”

  “No,” said Tad with a short laugh. “It’s about the virus you people are dealing with. The samples you sent were great, especially Dr. Richter’s. His blood was loaded with virus—more than a billion per milliliter. All I had to do was spin it down, fix it and look at it with the electron microscope.”

  “Could you tell what it was?” asked Marissa.

  “Absolutely,” said Tad excitedly. “There are only two viruses that look like this, and it tested positive with indirect fluorescene antibody for Ebola. Dr. Richter has Ebola Hemorrhagic Fever.”

  “Had,” said Marissa, mildly offended by Tad’s callous enthusiasm.

  “Did the man die?” asked Tad.

  “Last night,” said Marissa.

  “It’s not surprising. The illness has a ninety percent plus fatality rate.”

  “My God!” exclaimed Marissa. “That must make it the deadliest virus known.”

  “Some people might give rabies that dubious honor,” said Tad. “But personally I think it is Ebola. One of the problems is that almost nothing is known about this illness because there has been so little experience. Except for a couple of outbreaks in Africa, it’s an unknown entity. You’re going to have your work cut out for you trying to explain how it popped up in Los Angeles.”

  “Maybe not,” said Marissa. “Dr. Richter had been bitten just prior to his illness by a monkey that had come from Africa. Dr. Vreeland is pretty sure the monkey was the source.”

  “He’s probably right,” agreed Tad. “Monkeys were responsible for an outbreak of hemorrhagic fever in ’67. The virus was named Marburg after the town in Germany where it occurred. The virus looks a lot like Ebola.”

  “We’ll soon know,” said Marissa. “Now it’s up to you. Hepatic and splenic sections from the monkey are on the way. I’d appreciate it if you’d check them right away and let me know.”

  “My pleasure,” said Tad. “Meanwhile, I’m going to start work on the Ebola virus and see how easily I can culture it. I want to figure out what strain it is. Let Dubchek and the others know they’re dealing with Ebola. If nothing else, it will make them super careful. I’ll talk with you soon. Take care.”

  Leaving the cubicle, Marissa stepped across the hall and peered into the CDC room. It was deserted. Going into the neighboring room, she asked the technicians where everyone was. They told her that some of the doctors were down in pathology, since two more of the patients had died, and some were in the ER admitting several new cases. Dr. Dubchek had gone back to the hotel. Marissa told the technicians that they were dealing with Ebola. She left it to them to pass the bad news to the others. Then she went back to her paperwork.

  The Beverly Hilton was just as Dubchek had described. It was certainly nicer than the seedy Tropic Motel, and it was closer to the Richter Clinic. But it still seemed like unnecessary effort to Marissa as she plodded after the bellman down the eighth-floor corridor to her room. The bellman turned on all the lights while she waited at the door. She gave him a dollar, and he left.

  She’d never unpacked at the Tropic, so the move wasn’t difficult. Yet she wouldn’t have made it if Dubchek hadn’t insisted. He’d called her that afternoon, several hours after she’d talked with Tad. She’d been afraid to call him, thinking that she’d awaken him. As soon as he was on the line, she told him Tad’s news about the outbreak being Ebola Hemorrhagic Fever, but he took it in stride, almost as if he’d expected it. He then had given her directions to the hotel and told her that she merely had to pick up the key for 805, since she was already registered. And he had told her that they’d eat at seven-thirty, if that was all right with her, and that she should just come to his room, which was conveniently located a few doors from hers. He said he’d order up so they could go over her notes while they ate.

  As she eyed the bed, Marissa’s exhaustion cried for attention, but it was already after seven. Getting her cosmetics bag from her suitcase, she went into the bathroom. After washing, brushing out her hair and touching up her makeup, Marissa was ready. From her briefcase, she removed the sheets of information concerning Dr. Richter’s activities before he’d become ill. Clutching them to her, she walked down to Dubchek’s door and knocked.

  He answered her knock and, smiling, motioned for her to come in. He was on the phone, apparently talking to Tad. Marissa sat down and tried to follow the conversation. It seemed the samples from the monkey had arrived and they had tested clear.

  “You mean the electron microscopy showed no virus at all?” said Dubchek.

  There was a long silence as Tad relayed the details of the outcomes of the various tests. Looking at her watch, Marissa calculated that it was almost eleven in Atlanta. Tad was certainly putting in overtime. She watched Dubchek, realizing the man had
a disturbing effect on her. She recalled how unnerved she’d been when he’d turned up at Ralph’s dinner party and was upset to find herself inexplicably attracted to him now. From time to time he looked up, and her glance was trapped by an unexpected glint in his dark eyes. He’d removed his jacket and tie, and a V of tanned skin was visible at the base of his neck.

  Finally he hung up the phone and walked over to her, gazing down at her. “You’re certainly the best-looking thing I’ve seen today. And I gather your friend Tad would agree. He seemed very concerned that you don’t put yourself at risk.”

  “Certainly I’m in no more danger than anyone else involved in this,” she said, vaguely annoyed at the turn the conversation was taking.

  Dubchek grinned. “I guess Tad doesn’t feel the rest of the staff is as cute.”

  Trying to turn the talk to professional matters, Marissa asked about the monkey’s liver and spleen sections.

  “Clean so far,” said Dubchek, with a wave of his hand. “But that was only by electron microscopy. Tad has also planted the usual viral cultures. We’ll know more in a week.”

  “In the meantime,” said Marissa, “we’d better look elsewhere.”

  “I suppose so,” said Dubchek. He seemed distracted. He ran a hand over his eyes as he sat down across from her.

  Leaning forward, Marissa handed over her notes. “I thought that you might be interested in looking at these.” Dubchek accepted the papers and glanced through them while Marissa talked.

  In a chronological fashion, Marissa described what she’d been doing since her arrival in L.A. She made a convincing argument that Dr. Richter was the index case and that he was the source of the Ebola, spreading the disease to some of his patients. She explained his relationship to Helen Townsend and then described the two medical meetings that Dr. Richter had attended. The sponsoring organizations were sending complete lists of the attendees, with their addresses and phone numbers, she added.