Cold Plague

by Daniel Kalla

  Standing at the check-in desk, Noah consulted his watch. “If we want to catch Dr. Charron, we should get moving,” he said to Duncan.

  They left their bags with the teenaged bellboy and headed back out to the street. Noah was glad not to see their airport driver. Instead, a beat-up yellow Renault with taxi markings idled at the curb. They climbed in the back. Either the heater was broken or the emaciated cabbie liked the cold, because it wasn’t any warmer inside, but getting out of the wind brought some relief.

  After navigating the narrow downtown streets, the taxi turned onto a road that ran along the riverbank. While some of the bridges crisscrossing the river were old and pretty, Noah was underwhelmed by the Vienne itself, with its colorless black water and blandly landscaped banks. The driver turned north, away from the river, and a few blocks later, a large complex loomed around them. Duncan whistled. “Didn’t expect to see that in a one-horse town.”

  Noah was equally impressed by the extent of the sprawling complex of the Centre Hospitalier Régional Universitaire, or CHRU, as the signs everywhere abbreviated the university hospital’s name.

  The driver dropped them off in front of the modern round entryway. In the rotunda, a heavyset receptionist directed them to the elevators down the hallway. A moment later, they walked out onto the sixth floor and passed under a sign identifying the Centre de Maladie Neuromusculaire. Noah had worked in the research world long enough to realize from the signage and the plaques alone that the CHRU had an academically important neurology department. At the end of the hallway, they reached the office of the department head, Dr. Louis Charron.

  The neurologist was waiting for the WHO doctors at the door. Gaunt and with a slight stoop, Charron looked well over sixty to Noah. He had hollow cheeks and penetrating hazel eyes, and his thinning white hair complemented his long lab coat. A lit cigarette dangled from the corner of his thin lips. The sight surprised Noah, who was unaccustomed to seeing anyone smoke inside a hospital.

  Charron held out a bony hand to them. “You’ve come from Geneva, yes?” he said in a clipped tone laced with only a trace of French accent. “I am Dr. Louis Charron. You must be Drs. Haldane and McLeod.” He even pronounced Duncan’s name correctly.

  Noah slipped his hand into Charron’s cold dry grip. “Jean Nantal told me of you,” Charron said. He led them into his corner office, which had a commanding view of the Vienne as it meandered through the center of Limoges.

  “So you know Jean?” Noah asked.

  Charron took a long puff of his cigarette. “For years,” he said in a tone that didn’t clarify whether he liked the man. He walked around his desk and sank into the substantial black leather chair behind it. “Sit, please.”

  Noah and Duncan pulled up two chairs across from the neurologist. Charron fussed with an ashtray on the desk. “You’ve come about our cases.”

  Noah nodded. “You’ve had three atypical variant Creutzfeldt-Jakob patients in the past few months, right?”

  “Perhaps.”

  Duncan rubbed a hand through his beard thoughtfully. “Jean sounded more definite.”

  Charron held his palms open in front of him. “No question, we’ve had three cases of accelerated dementia in young adults…”

  “You’re not convinced it was vCJD?” Noah asked, suddenly more on edge.

  Charron took another puff and then shrugged. “If nothing else, it is a close relative.”

  “Did you examine the patients yourself?” Duncan asked.

  “Of course,” Charron snapped. “I myself made the diagnosis in the first patient. Even before I knew anything of the outbreak in the animals.”

  “Dr. Charron, can you give us more specifics on the victims?” Noah asked.

  Charron crushed his cigarette in the ashtray, reached for the three charts stacked on his desk, and flipped open the first one. Without looking up from the chart he said, “Benoît Gagnon. Thirty-two years old. He was admitted to the psychiatric ward twelve weeks ago.”

  “The diagnosis?” Noah asked.

  “Paranoid psychosis,” Charron said. “The psychiatrists originally diagnosed him with schizophrenia. Very guarded and hostile. However, after he had a series of seizures, they turned to me.” He closed the chart. “I immediately ordered an MRI as part of the workup. The changes in his brain’s white matter were subtle, but I noticed that without question he had organic brain damage of some kind.”

  Noah leaned forward in his seat. “What happened next?”

  “He died,” Charron said matter-of-factly.

  Duncan frowned. “From subtle white matter changes?”

  “By the time of his death, there was nothing subtle about the brain damage,” Charron sighed. He reached for the pack of smokes on the desk and tapped out another one. “We were able to control his seizures, but in the days that followed he deteriorated rapidly.”

  “From a psychiatric or neurological point of view?” Noah asked.

  “Both,” Charron said, cupping his hand around the lighter. He inhaled a long puff of smoke and then pointed with the cigarette. “You see, he became mute. Totally. Would not speak. Or perhaps…could not speak.”

  Noah tried to picture in his mind the young and unresponsive man, but still couldn’t get a feel for him. “How did you diagnose him before you had a brain tissue sample?”

  “With my forty years of clinical experience,” he said with a slight cough. “Also, I performed a spinal tap. The fourteen-three-three protein in his spinal fluid was positive.”

  During the flight in, Noah had read an article on the fourteen-three-three protein, one of the few blood tests useful in vCJD cases. “I understand that the test is far from foolproof,” he said.

  “Perhaps, but the autopsy was conclusive. His brain showed the classic spongiform changes of vCJD.”

  “And the other cases?” Duncan asked, fixing his gaze on the desk.

  Charron reshuffled the charts on his desk and opened the second one. “Giselle Tremblay from Saint Junien. Twenty-six. I wasn’t involved in her care, but she was originally thought to suffer from psychosis. I suppose it was understandable. She had a history of being manic-depressive. But by the time she reached us, she was essentially catatonic. Practically no movement. She died within days. Again, the autopsy was unequivocal.”

  Noah’s unease rose. Even beyond the aggressiveness of the disease, something in Charron’s description was eating at him, but he couldn’t put a finger on it. “And the third patient?” he asked.

  “Ah, yes.” Charron blew a ring of smoke in the air. “Philippe Manet. Thirty. A civil engineer from Lac Noir,” he said without consulting the final chart on his desk. “He also presented with a psychotic episode. Threatened someone with a knife. Very paranoid. Full of conspiracy theories. This time our psychiatrists picked up on it right away.”

  “Picked up on what?” Duncan asked.

  “The tremor in his right hand.” Charron sighed. “That was the only feature that suggested it wasn’t pure psychosis. They consulted me, and of course, I made the diagnosis.”

  “How long did he survive?”

  Charron crushed another cigarette. “He was with us only two weeks before being discharged.”

  Noah sat up in his seat, astounded. “Discharged?”

  “The family insisted,” Charron said. “They knew he was dying. And they wanted him closer to home in Lac Noir. They found him a bed at a private hospital.”

  “But the lad died in a fire, right?” Duncan pointed out.

  “Apparently,” Charron said. “As I understand it, another patient in the hospital gave him a cigarette. Predictably, he set the whole building on fire. Two others died, too, including a staff member.”

  “Amazing.” Noah shook his head, trying to make sense of Philippe’s bizarre death and the unsettling cluster of patients. “Earlier you referred to it as an ‘accelerated dementia’ and a possible relative of vCJD. You think it might be something different?” He paused. “Some new entity?”

 
; Charron leaned back in his chair and studied the ceiling. “They died from some form of CJD-like illness. And considering the outbreak in cattle, it must be a prion-based disease. But with the English vCJD epidemic, the progression was so much slower.” He drew thoughtfully on his cigarette. “Our cases behaved more like an overwhelming infection.”

  Noah’s gut churned at the neurologist’s choice of terms. “And you have no live cases?”

  “Not at my hospital.” Charron pointed to the window with his fresh cigarette. “God knows what is out there.”

  “Shite,” Duncan muttered. “Would have helped to see the victims with our own eyes.”

  “D’accord. I will show you.” Charron pulled open a drawer in his desk and extracted a DVD. He walked over to the TV in the corner of the room, loaded the disc into the player below it, and then returned holding a remote control in his hand.

  Noah and Duncan turned their chairs to face the screen, which filled with the image of a hospital room. “This is Giselle Tremblay,” Charron said.

  The camera zoomed in on a woman in a yellow pajama top lying propped up in her bed, wrapped in a blanket from her chest down. With short brown hair, she had a pleasant round face and full cheeks, but the chain of drool hanging from her chin and the way her wide brown eyes deviated up and to the right dampened her otherwise attractive features.

  “Giselle?” A soft female voice spoke from off-screen. “Giselle? C’est Marianne. Répondez, s’il vous plaît.”

  But Giselle didn’t respond. She just continued to stare up at the sky with her eyes so far back in her head it appeared she was trying to look over her shoulder without moving her head. Noah felt slightly voyeuristic watching the shell of a woman who was only days from death, but her empty doll-like presence viscerally conveyed the consequence of this brain-eating prion.

  “She stayed catatonic like that for her entire stay,” Charron said. “Now let me introduce Philippe Manet.”

  The image on the TV screen suddenly switched to an interview room. A man in jeans and a black T-shirt sat in a chair. He was young with a slim bearded face distinguished by an aquiline nose. His gray eyes darted around the room constantly. The cigarette rarely left his lips. And Noah saw that his right hand trembled on his lap.

  “This was filmed on the first day of Philippe’s admission,” Charron said.

  “Philippe, comment ça va?” asked the same female voice that had spoken to Giselle.

  He shook the cigarette at the camera. “Ça va mal!” he spat, and then launched into rapid-fire French that Noah had trouble following.

  “‘They know I’m here, you know,’” Charron translated for them in a flowing tone that was the antithesis of Manet’s panicky, choppy words. “‘They will come for you just as they have come for me.’”

  Noah understood the interviewer when she asked “Who are ‘they’?” but Philippe’s finger-waving rant was too rapid for him to follow.

  “‘They are the demons who visit us,’” Charron translated. “‘They are the people who possess us. Georges knows. Sylvie does, too. The water, it worms its way into your mind. It gets into your soul. They possess me already. They will come for you!’”

  The interviewer began another question, but Philippe screamed something unintelligible. He shot up out of his chair so quickly that it toppled over. Then he ran forward and out of camera range. The screen’s picture seesawed from side to side as two other male voices yelled out over the commotion of a loud crash. A pair of hulking men in white hospital uniforms appeared on the screen as they wrestled Philippe back into the camera’s view. One of the men righted the chair, and together they forced Philippe to sit down. Eyes wide with panic, he looked beyond the men and cried out as if speaking directly to the camera.

  “‘Don’t you understand?’” Charron translated the words, doing no justice to Philippe’s frantic tone. “‘The fire. The water. They will come for you. They will come. And you will be dead, too!’”

  As a medical student, Noah had seen several paranoid and delusional patients, but he never remembered a psychotic patient looking as terrified as Philippe Manet. The man’s fear was so palpable it was contagious.

  Charron clicked a button on the remote, and the screen changed back to the hospital room setting. Now Philippe lay in a bed similar to Giselle’s and wore a similar yellow pajama top. “This is Philippe thirteen days later,” Charron said nonchalantly. “The day he was sent back to Lac Noir.”

  “Shite,” Duncan grumbled. “That’s a hard thirteen days!”

  Philippe’s face was now gaunt to the point of skin and bones, his beard and hair wild. His hands shook uncontrollably on top of the bedcovers. His eyes gazed out at nothing, and he muttered continuously to himself in a voice that had become incomprehensibly slurred.

  Noah could pick out only a few words—l’eau for “water” and tête for “head”—from the garbled speech, but he suspected that language wasn’t the problem. “He’s not making any sense, is he?” Noah asked.

  Charron sighed. “None whatsoever. Just random words and phrases. And as you can hear, he is losing control over the ability to even form words.”

  “Thirteen days,” Duncan repeated quietly.

  Noah had a sudden mental image of hospital wards full of similarly brain-dead zombies, victims of this ultra-aggressive prion. He shook off the image and swallowed away the lump in his throat.

  We can’t let this thing spread.

  5

  Montmagnon, France. January 15

  Pauline Lamaire had once prided herself on how neat and uncluttered she kept her home. Now chaos reigned. Plates, dishes, newspapers, and clothes were scattered everywhere. Her herbal remedies and other bottles were spread across the room; many toppled over with pills spilling onto the furniture and floors. The stench of spoiled milk—from a bottle left out for days—and urine—from the cat whose litter was days overdue for changing—permeated the room.

  Pauline was only vaguely cognizant of the state of her house. She rarely remembered her medications, but whenever she found a bottle, she popped another dose, having no idea when was the last time she had taken one. She was, however, aware enough to know that something was desperately wrong. Her once ironclad memory grew more unreliable each day. She left notepads around the room, where she would scribble notes to herself—most of which went unread—in a script that had gone from precise and neat to barely legible.

  One note beside her chair asked, WHERE IS POPO? But she had no idea what happened to her cat or even whether he was still missing. CALL DR. TANIER, another note instructed. But she didn’t know his phone number and couldn’t figure out where to find it. Besides, for reasons Pauline couldn’t fathom, she didn’t trust that Dr. Tanier or any medical doctor could help her.

  “You are useless, Pauline!” a German-accented voice barked inside her head.

  For days, the same voice had been nagging at her incessantly. Even in her woolly-headed state, she recognized it as belonging to her former violin teacher, Herr Strieber. The harsh Austrian had taught her from age eleven until sixteen (when Pauline had sworn to her parents that she would quit violin rather than remain his student). No matter what she did, the young Pauline could never please Herr Strieber. And she fared no better now. “You are crippled,” his voice spat in her head. “And you are losing your mind. You should have listened to me. Now you are nothing. Nothing!”

  Her cat whined again, but Pauline ignored it. And again. Or was it the doorbell?

  “Answer it, little fool!” Herr Strieber shrieked in her head.

  She rose to her feet and staggered toward the door, feeling as if she were walking across a ship’s deck in the midst of a gale. At the door, she struggled with the knob before finally pulling it open. The sunlight streamed in, temporarily blinding her.

  When her eyes adjusted, she saw a woman standing on the doorstep. The attractive woman looked familiar. She was the one who brought Pauline more treatment every few weeks. Or maybe not. Everything in he
r head was so muddled. Still, the woman’s sympathetic smile and understanding eyes eased Pauline’s panic.

  “You see, Pauline?” the woman said in a silky-soft voice. “I’m here now, just like I promised.”

  “For me?”

  The woman reached out and laid a hand tenderly on Pauline’s elbow. “For you.”

  Tears welled in Pauline’s eyes. “Thank you,” she sputtered.

  The grip tightened around her elbow until it hurt. “I am going to take care of you now, Pauline,” the woman said.

  6

  Limoges, France. January 16

  As he sat in the dining room of the Grand Hotel Doré and stared at the breakfast menu, Noah vacillated between the fruit-and-yogurt plate and the strawberry crêpes. Though he had been active his entire life and had never deviated more than a few pounds from his college weight, Noah had inherited his father’s high cholesterol level. His doctor had been threatening him with cholesterol-lowering drugs for the past few years, but Noah had resisted, insisting he could tackle the problem with a healthy diet alone. He knew his attitude was born from foolish pride: Starting on those lifelong medications struck him as conceding his youth, something the forty-year-old hadn’t been prepared to do. But recent blood tests showed he was losing the battle. Anna was right—gambling with his coronary arteries was not fair to Chloe. Silently committing to accepting the prescription, he decided to reward himself with the crêpes.

  Movement caught the corner of his eye, and he looked up to see Elise Renard, dressed in a black business suit and white blouse, striding toward him. He smiled at her, but the gesture went unreciprocated.

  “Morning, Elise,” he said. “Did you just fly in?”

  “I drove in last night,” the E.U. envoy said frostily.