by Mark Kelly
She didn’t look back. She didn’t dare. There was as much pain and suffering in front of her as there was behind. She needed to focus her attention on the patients who had already been seen by the triage team.
As she neared the nurses’s station, a voice called out to her. “Dr. Ling—mandatory staff meeting in a few minutes…the 8N conference room on the 8th floor.” She paused as the nursing shift supervisor ran past with a handful of charts.
“I’ve got patients to see,” she shouted back.
“So does everyone. Surnames A through L at nine—that’s you, Dr. Ling.”
She looked at her watch—8:55 a.m. Enough time to make it.
The conference room was nearly full when she joined the crowd at the door. Everyone wore a mask, most wore gloves. A handful of doctors sat in chairs alongside the table. The remainder, orderlies, and nurses mainly, stood in small groups against the wall. Aside from a few hushed whispers, the room was quiet and absent of chit-chat.
Dr. Thomas Dullet, the hospital's Chief of Medicine, stood at the head of the table. Mei had met him once before during her internship interview. She had found him handsome then, distinguished perhaps. Today he was anything but. His blue shirt was wrinkled and untucked on one side. The dark circles under his eyes hinted at a long night of meetings and desperate decisions.
He raised his arms and the room went silent as he began to speak.
“Thank you all for coming on such short notice. I apologize for the chaos downstairs in admitting. We’ll have some more help from the NYPD and possibly the National Guard shortly. I won’t keep you long today, I know you have patients to treat and work to do,” he said. There was a raspy tiredness in his voice. “As you probably know, the city’s crisis response network has been completely overwhelmed by the surge in CDI cases. We’ve had to make some tough decisions.”
“First, all elective surgery and non-essential treatment has been canceled.”
“Second, all staff leave has been put on hold and mandatory double-shifts implemented.”
A handful of grumbling voices interrupted him but quickly died out. He looked around the room. “Those of you that are able, please consider staying at the hospital, at least for a few days until we get the situation under control.”
She scanned the crowd. She could tell from the look on their faces who would stay and who wouldn’t. About half, she thought. I will.
“Third—I’m sure you’ve heard the rumors but let me allay your concerns, the hospital is not under a general quarantine. However, we will stop taking new cases—of any kind—at noon today”
“What about critical pediatric ER?” a voice from the back of the room shouted.
The chorus of objections grew and he raised his hands, motioning the crowd to be quiet. “Look, I understand your concerns and I share them, but we can’t operate on a business as usual basis.”
He swept his eyes sternly from one side of the room to the other. “We’re in crisis mode. That should be clear to everyone by now. We’re missing nearly a quarter of our staff and every available bed in the hospital is full.”
The shouting started again. Mei felt herself being jostled from one side to the other. They were scared, looking for answers. She was too. Tony’s email had sat, unread, on her phone until this morning. She didn’t know when he had sent it, access was spotty—on for a couple of minutes and then off for hours. The message was from his student but the writing was his. Hundreds of deaths had already occurred worldwide. He was convinced the bacteria was man-made.
She looked at Dullet as he raised his hands to quieten the crowd and wondered what he knew.
The Chief of Medicine began to speak, shouting over the crowd. “Please…Ladies and Gentlemen, let me finish.” Others followed his lead and raised their hands in the air, pleading with those around them to stop and listen. The shouting quieted to a level where he could be heard.
He began again. “The CDI outbreak is bad, worse than anything I’ve ever seen but we will persevere. This hospital has served the people of New York for nearly three hundred years. We won’t abandon them in their moment of need—Thank you.”
He paused as a smattering of applause broke out. It died just as quickly. She watched him push through the crowd to the door, ignoring the questions directed his way.
“Mei...Mei...over here.”
Unsure if she had imagined her name being called, she pivoted her head. The voice called again and she saw Grant, the intern she had helped a few days earlier.
Damn it. He’s nice enough, but needy. It was too late to pretend she hadn’t seen him. She offered a half-smile as he approached.
“Did you hear about Robinson?” he asked, his fleshy cheeks flush from the exertion of pushing through the crowd.
She shook her head, fearing the worst. Robinson secretary hadn’t been able to reach him and there was no one at his house when the ambulance they had sent arrived.
“Dead,“ he whispered.
Her heart sunk. “When?”
“I don’t know. He was in the parking garage—in his car. They found him this morning.”
Grant’s face went white. “I touched him too you know when I helped Robinson.”
She knew he was talking about the British patient.
“That was four days ago,” she said, calming him. “If you had been infected, there would be signs by now. It’s about one day before symptoms and then—“
“—then what?” he asked.
“A few more until death,” she said bluntly.
“What are you going to do?”
“Do?” she frowned and tilted her head.
“You know…“ He stopped, expecting her to fill in the blanks and then started again when she didn’t. “A few of us are thinking about leaving…what about you?”
She stared at him in disbelief, astonished by the mere idea. Leaving the hospital was the last thing on her mind. There’s too much to do…too many people to help.
“I have to go now,” she said, brushing past him. “I have patients to see.”
BUT SHE DIDN’T GO to check on a patient, she rode the elevator to the sixteenth floor. She walked past Robinsons’s office. The door was shut, barricaded by yellow biohazard tape that ran in a criss-cross from one corner to the other. That was the procedure now when a room had been occupied by a person infected with the bacteria. The tape would remain until the room was disinfected.
Two doors down, Thomas Dullet’s office door was half-open. She knocked on it. He glanced up for a second before returning his attention to whatever it was he had been doing.
“Dr. Ling, I’m very busy. What can I do for you?”
“I want to know what’s going on.”
He looked up. “Going on?”
“With the outbreak. It’s a pandemic isn’t it?”
He blinked and looked away.
He knows something. “Is this a terrorist attack, bioterrorism?”
She saw the briefest flash of surprise in his eyes before his poker face returned. “Why would you think that?”
She took her phone from her pocket and found the email from Tony. She placed the phone on Dullet’s desk. He leaned forward and read it.
“Who is Emma Rice?”
“A student of the man who wrote the email,” she answered. “His name is at the bottom. He’s a professor at Stanford University, an expert on bacterial genetics. You can look him up if you want.”
Dullet’s eyes stayed on her. The email was short. There was no need to re-read it. “Shut the door, Dr. Ling.”
When she had, he answered her question. “I don’t know what caused the outbreak and if the CDC does, they aren’t sharing that information. What I do know is that every hospital in the United States has been told to prepare for more cases. The Federal Emergency Preparedness Plan has been activated.”
“What does that mean for us?”
“Nothing good at this point,” he said. His voice was heavy with resignation.
“I don
’t understand.”
“The framework is all encompassing. In many ways, it’s like the medical triage system. There are five stages, a few weeks ago, before this all started, Bellevue was at stage one—normal operations. We’re at stage four now—closed to new patients and functioning with reduced staff.”
“What’s stage five?”
“Quarantine.”
“Can they do that?”
“I asked that very same question. The CDC has always had the right to quarantine for international and inter-state travel. Yesterday, the president signed an executive order extending that authority to include intrastate movement.”
“Would they do it?”
He nodded. “Yes, Dr. Ling, I think they would.”
They stared at each other for a few long seconds and then she spoke. “You know some of the staff are talking about leaving, right?”
“Some already have. I’ve seen the duty rosters—What about you?” He cocked his head and waited for her answer.
She bit her bottom lip and turned to leave. “Not anytime soon. I have patients to see.”
TWENTY MINUTES LATER, she stood in the doorway of the ICU. She watched Lucia Sanchez thread a string of rosary beads through her fingers while she looked down at her daughter.
The young girl was oblivious to the noise and pain that surrounded her. The sound of her breathing was labored. The movement of her chest imperceptible. An intravenous tube dripped fluids into her body.
The girl’s brother sat in a chair. He had been by his mother’s side the last three days. The ugly dark lines beneath his eyes were from lack of sleep, but the pallid yellow color of his face was something else.
He coughed a deep hacking sound. His mother turned to look at him. She placed a hand on his forehead. “You’re burning up. I’ll get a nurse.”
He cracked open his mouth to speak but lurched forward instead. Vomit filled his mask and dripped onto the front of his yellow plastic gown.
As his mother yanked the mask off, Mei ran towards them. She searched desperately for something to clean him with. The box of tissues on the counter was nearly empty. She used the few that remained to wipe his face.
The boy’s mother grabbed her arm with a force that nearly yanked it out of its socket. “Alejandro is sick. Please help him.”
Before she could reply, the haunting sound of a flat-line came from the heart monitor. Mei turned and ran to the bed. The little girl was still, her eyes closed. She slammed the code-blue button on the wall and began CPR.
1…2…3—28…29…30—breathe, breathe—1…2…3—28…29…30—breathe, breathe.
After ten minutes of desperate effort and no crash cart, she placed her stethoscope on the young girl’s chest one final time.
Nothing.
The girl’s mother uttered a soul-destroying cry and ran to the bed. Her face was contorted with grief. She pushed Mei away and dropped to her knees. She lay her head on the girl’s body and sobbed with great gasping breaths that caused her chest to heave up and down.
Mei watched with a deep emptiness. It was only a few minutes earlier she had told Dullet she would continue to look after the patients.
But what good am I, if I can’t help them?
She turned off the droning heart monitor. The room went quiet aside from the mother’s sobbing.
“I'm so sorry, Mrs. Sanchez. Should I call a chaplain?”
The woman lifted her head and glared at her with an anger so fierce it frightened her.
“There is nothing a priest can do,“ she spat. “God has taken my daughter.”
She watched the woman stand and walk to the garbage pail where she took the string of rosary beads and snapped the thread. The beads tumbled into the pail, one after another.
The boy, who had been forgotten during the turmoil, coughed and climbed to his feet. He lost his balance and stumbled into the door. Mei rushed to support him. He had seen everything but didn't appear to understand any of it.
“I’ll call for a chaplain anyway,” she said to the mother as she struggled to support the boy who weighed as much as she did. “I’m going to take your son to an examining room.”
She half-walked, half-dragged him down the hallway until she could no longer carry him. I’m not going to be able to make it. She leaned him against the wall and looked for an empty wheelchair. There was one in the room next to them. She eased the boy into it and continued down the hallway.
The examining rooms they passed were all full. Even without tests, she was certain he had the same bacterial infection as the others. She left him in the hallway beside the nurses station and ran to the hospital pharmacy.
“I need ten days of Vancomycin for an eleven-year-old male.”
“Can't do it, we're out,” the pharmacist replied sympathetically from behind the counter. “No Metronidazole either—won't be any until tomorrow morning.”
“What the hell can I prescribe then?” Her frustration boiled over and she glared at him.
“Don’t shoot the messenger. The whole damn city is running low. Fidaxomicin…that’s about it—but I can only give you five days worth.” He shrugged his shoulders.
She’d take it. It was better than nothing.
“What about FMT approval, any word yet?” she asked as he filled the prescription.
“FDA waived the paperwork requirements and New York-Presbyterian Hospital is running some trials,” he said as he scooped a handful of pills into a small container. “But the results haven’t been great—marginally better than antibiotics.”
Her shoulders sagged. What then?
She took the pills and ran back to the nurses’s station where she gave the boy his first dose. She hid the remainder in the back of a drawer. She didn’t trust that the scarce drug would remain if she left it in the open.
She remembered the girl and picked up the desk phone to call for the chaplain. It rang unanswered. I’ll call again when I’m back.
She returned the boy to his sister’s room, his mother was on her knees by the side of the bed huddled over her dead daughter’s body. She quietly pushed the boy’s wheelchair to the end of the bed and left without speaking. There was nothing more she could do here.
16
IN THE LAB
March 27th, 15h45 GMT : Fort Detrick, Maryland
Damn suit…The itch had started as a tickle in the space between his shoulder blades. At first it was just annoying, but soon became relentless, a distraction he couldn't ignore no matter how hard he tried. The thick blue suit was constrictive and the itch just beyond the reach of his gloves. Finally, he walked to the corner of the lab's workbench, turned and squatted. As he moved up and down, he could feel the rounded corner of the bench rubbing against the suit.
“Tony, what are you doing?"
Embarrassed, he stood quickly with a sheepish grin on his face. "I had an itch I couldn’t reach.”
Dr. Mayer gave him a chastising look and shook her head. He imagined the tsk-tsk sound that could have but didn't come out of her mouth.
“Watch you don't rip that suit, that would be much worse than an itch.” She lifted her air hose and walked around to his side of the workbench.
“What are you working on?”
He turned the monitor so she could see the screen. “I’ve been comparing the antibiotic resistance regions in the bacteria’s genetic material to other samples that are on file. I wasn’t able to make much progress at the university—not enough computing power—but here?” he waved his hands around. “With all the equipment and computers, it’s like a geneticist’s wet dream.”
She frowned at his analogy and he continued excitedly. “The strain has exactly the same fluoroquinolone resistance mutation in it’s DNA gyrase genes as the RT027 strain I studied two years ago, but it also has resistance genes from a host of other bacteria—resistance to Metronidazole from a strain that was grown in a Canadian university lab, Fidaxomicin resistance that looks like it was acquired from the Rifamycin family of antibioti
cs and most surprisingly of all, genes from Vancomycin-resistant Enterococci.”
He turned away from the monitor and spoke with a measure of awe. “Other than being deadly, it’s a spectacular piece of genetic engineering. With all these resistance genes, there’s no possible way that treating patients with antibiotics will have any affect at all.”
“It just seems impossible,“ he added after a pause.
"What does?”
“That it’s North Korean.”
“How does a country barely able to feed its people and not exactly known as a hotbed of genetics, come up with something as deadly as this?”
”Perhaps they have capabilities we don’t know about.”
Surprised, he stared at her and thought, You don’t believe that.
She turned away from his gaze, motioned to a chair and changed the subject. “Sit down. I’ll fill you in on how the research teams have been organized.”
He rolled the chair out from under the lab table and carefully backed into it. The process was cumbersome with the suit, not only did he have to ensure the air hose didn’t jam up against the back of the chair, but he had to line his butt up with the seat so he didn’t miss and land on his ass.
Mission accomplished, he thought as his bum hit the seat. He balanced precariously on the chair like an oversized balloon and leaned forward to force a small amount of air out of the suit. It made it easier to move. Mayer did the same with a practiced ease. She had taught him that trick years before.
“Okay, I’m all ears,” he said when he had finished the maneuver.
“There are three separate teams—one in the UK at Porton Down, one in Winnipeg, Canada and of course, the team here at Fort Detrick. The Canadians are focused on spore neutralization, the Brits on antibiotics and we’re working on developing a vaccine.”
“What about other countries—the Russians, Chinese?”
“We’re sharing our research with some countries but…” Her voice trailed off and she shrugged, the motion mostly hidden by the bulky suit she wore.
He didn’t need her to finish. He could put two and two together. Somethings never change.
