by Fuyumi Ono
On the night of August the twenty third, Seishin and Toshio called Ishida to the temple and explained the situation. At first Ishida seemed to be in half doubt but upon receiving Toshio's explanation, his pallor changed.
"Last summer, four people died. Two in June, one in August and September each. To be precise, those are all the dead that I personally oversaw. The death in August was from a heart attack. For a year, well, that's about normal. On the other hand this year all at once, seven. August isn't even over yet but a in simple comparison of the dead up until now with last year's one, we have a surplus of seven or six people."
"Surplus..."
Toshio nodded. "Not the best wording but the numbers are clearly too high for a normal death toll is what I'm saying. Now, looking at the raw numbers of the situation and that we have six more than last year wouldn't be anything to make a fuss over. Without a statistical analysis there's no way I can say anything definitive but all the same six people is enough to certainly call abnormal."
That's right, said Ishida with a dumbfounded nod.
"This August, it's certain something's happening in the village. It's causing the abnormal surplus of deaths. Sotoba's an incredibly tiny place, but just the same in one season alone there've been seven. On top of that, most of them were unexpected sudden death by some internal cause. Since it's come to this, it shouldn't be by any means unreasonable to suspect we have a mass outbreak of some kind of disease or another."
Yes, said Ishida wiping at his sweat with his handkerchief. It was an abnormally sultry night. The air was thick and stagnant, the tepid humidity rising. The glass of beer sat in front of Ishida was beaded with drops of water, the foam completely gone.
"But at the same time we're far off from being anywhere near knowing what's actually happening. All I can say about where we are now is that it starts with trivial symptoms, symptoms that while they aren't even aware of it themselves takes a dramatic turn for the worst into sudden death, is what it comes down to. And that it has a trend of spreading like fire to those nearby. If nothing else, I think it's certain it's spreading."
Ishida stared at Toshio with dependent eyes.
"It isn't yet a certainty that it's an epidemic, right?"
"I can't say anything definitive. But, if we cling to wishful thinking, then in the one in a million chance it is an epidemic, we won't get that lost time back. I think it's better to be vigilant as if assuming it is an epidemic."
"But, you know." Ishida patted his forehead with his handkerchief. "If you carelessly throw around the word epidemic..."
"That's the problem," Toshio sighed. "It's gonna be the worst. If rumor of a contagion spreads there the village there'll be a panic. The initial symptoms are too trivial and common, if they lose their cool, then the hospital's functionally paralyzed. It's not definitely a contagious disease but in the case that it is, if the patients march in on the hospital when we don't know the illness or the infection route, it's not just a bother it's a danger. I'd like to minimize that possibility as much as we can, if possible."
Ishida nodded. Sotoba was dependent on the Ozaki Hospital. In a mountain village of merely 1,319 people, having a proper hospital at all in itself was a rarity. Sotoba had been blessed with such all this time, so that was all the more reason that their faith in the Ozaki Hospital was so high. The people in the village had a certain sense of duty practically taken on through osmosis that they wouldn't go to another hospital without a referral by Ozaki, so all the more reason that if rumors started of a plague, the villagers would mostly flood the Ozaki Hospital without a doubt.
"But.... But then, what should we...."
Seeing Ishida's dismay, Seishin explained.
"Could not a notice be passed about through you, Ishida-san, as the public health official? Phrased as if lately there have been many suffering summer fatigue and to be cautious."
"Circulating a notice is simple enough but..."
"If you think that someone has become fatigued, do not rely on a layperson's judgement and go to the doctor, it would say."
Toshio nodded.
"In the first place in the summer there're plenty who just take in drinks and lose their appetites. Couldn't you say the summer heat's still pretty stringent, so for the time being take in three square meals a day, don't diet excessively? Even a simple 'mind your health''ll be fine. If we do that then at least as much as it'll actually protect against simple ailments, it'll be useful in sieving out a few patients."
"Yes, yes, ---that's true." Ishida wiped at his sun burnt neck. "But, will just that be enough? If we don't take some concrete measures to stop the spread of the infection..."
"Even if we try to take some concrete measures at our current level we don't have any measures to take. At best, all we'd have is don't drink well water, try to bring a canteen with you when going into the mountains, and mind what you're washing your hands and gargling with. Make too loud of a fuss and that'll just be poking the bush with a stick."
"Haa..."
"That's why for the time being the only way we can start is with gathering data. The bunch in the village won't let you touch a corpse. Forget doing a pathological autopsy, they disapprove of even drawing blood after death. If they don't come into the hospital before they become a corpse, we can't even get a grasp on what's happening in the village."
"Yes--yes, that's right."
"There's no choice but to collect the data this way, compile it, then have the administration act on it. It's true enough that if it really does turn out to be an epidemic, it's going to be too much for us."
"Wouldn't it be better for me to pass this report up to the prefecture health department or the city health center?"
"You can try it I guess. But right now without a name to put to the disease, the government won't move. What those guys call an epidemic isn't something spreading around to the people; for them it's a word for an existing contagious disease written into the protocol or manuals. Unless the situation really gets huge, we probably can't count on any support. They can't do anything themselves. If you wanted to hurry it, there's the possibility of saying for example that food poisoning or hepatitis is spreading, but if I get an inquiry from the public office, I can't exactly give fake disease report."
"Th, that's indeed true."
"Anyway I'll collect the data. All we can do is get solid proof if something is spreading, then leave it to Kanemasa to get things moving," Toshio said, his face scrunching. "So I say but while the predecessor was one thing, I dunno if it's all right to rely on that old guy that much or not, but...."
Ishida nodded without really thinking. The previous generation of the Kanemasas, as well as the one before that had served as the village headmen and had been experienced, influential people. That predecessor died last year, and now his son was a member of the Diet but compared to the vigor of his predecessor, he was hopelessly flaky.
"It'd have been better if the predecessor were alive for us." Ishida murmured, then suddenly: "Come to think of it, the Kanemasa predecessor also died suddenly, didn't it?"
Toshio suddenly made a complicated expression as if something bitter had been tossed into his mouth.
"Yeah, but----. No matter how you stretch it, that's probably not related, right? We're talking last July, I'm sure. That was a year ago."
"There is that but. Well, I mean, you know."
"Anyway, in order to collect data first we need patients to come to the hospital."
"Yes, indeed. I understand."
"In the mean time, Ishida-san, this summer's---yeah, since July, I want the list of those who've died since then. There might've been deaths amongst those who weren't my patients, too. If there were, I'd like copies of their death certificates too, but."
Ishida nodded.
"I'll see what I can do tomorrow. At the latest I will have them prepared by the day after tomorrow. My jurisdiction is over demographics but I'll see what I can do about compiling them quickly for that period."
"The day after tomorrow's fine. But, definitely by the day after tomorrow."
"Yes, sir."
3
The day after Toshio met with Ishida, it was abnormally sultry. Of the patients who came into the hospital, all of them were conspicuously weary. At any rate, it seemed like a shower was approaching. In the midsts of that, from the Monzen Yasumori family came Nao. The instant Nao entered the examining room, Toshio had a feeling.
What is it, Toshio asked as a formality, though Nao's complexion was clearly poor, and indeed she looked worn down. Even if the fatigue was the same, there was something different from the patients suffering from the heat and the humidity. Nao moved her lips faintly as if to answer but even that seemed to be too much and stopped.
"What's up? You look tired." While pushing her again for a response, Toshio took Nao's hand. She was powerless and felt cool to the touch. Her pulse was pretty fast but not enough to qualify as tachycardia. Peering at her face up close, those eyes of hers had the impression of someone somehow possessed. It was the way her conjunctiva was so blueish.
"I'm tired... My mother-in-law said I had to go to the hospital no matter what, so."
"I see. Doesn't look like you have a fever, does it? So with that, it probably isn't a cold. When did you start feeling like this?"
"Yesterday... No, this morning."
"Which one?"
"This morning, as soon as I woke up I was very tired. It was hot at night so I didn't sleep well... But, my mother-in-law asked me I don't know how many times since yesterday if I was all right."
Toshio tilted his head. She was talking strangely.
"And Nao-san yourself, you didn't think you felt particularly sluggish at any point yesterday?"
"...I don't know. If I have to say it one way or another I think I had the feeling I was tired. ... Like, my head was heavy. I was dazed."
"Looks like it," Toshio nodded. "Any shortness of breath or palpitations?"
While asking he took her pulse. Her blood pressure was a little weak, so he couldn't get it clearly by touch.
"No, yes,.... I don't really know."
"Did you eat?"
Her voice answering that she hadn't seemed to die out. Lifting up her eyelid to look at the membrane, the color was faint. Her nails were white, and just to be sure he had her open her mouth to confirm that her oral cavity too had lost its healthy reddish color. It was similar---to Megumi's.
"Dizziness when you stand?"
"Yes, some."
"Your period's been regular, right? Are you menstruating now?"
Yes, Nao nodded.
"That's good. Looks like you have a case of anemia," Toshio said, then added on. "Just in case let's do a full examination. Do you have any other pains anywhere?"
"No... not really."
Really, Toshio murmured, telling Nao to head into the other examining room and strip. He instructed the nurse Kiyomi to take her height, weight, pulse, blood pressure and temperature.
While he was seeing other patients, Kiyomi finished taking the measurements. Her blood pressure was pretty low, her pulse pretty high. There was a slight fever but, at any rate nothing abnormal.
At a glance her skin was losing its healthy glow but she wasn't particularly jaundiced and had no particular purple spots. Her nails and tongue seemed normal, and there was nothing abnormal about her hair.
"Raise both your knees if you could. ---Any problems going to the bathroom or difficulties passing urine?"
"No..."
Nodding, he felt the lower region of her liver. Nothing felt abnormal.
"Nothing unusual about the color? A brownish color or a reddish color or..."
"...I don't think so."
Nao's responses sounded incredibly labored. While asking her medical, life and family history, he performed palpations. There were no particular signs of a swollen spleen, the lymph nodes at her neck and underarm were slightly swollen. Listening with a stethoscope, there were no particular disruptive sounds in her heart or veins. ---As expected, it looked like simple anemia.
"I think it's anemia, but," Toshio stated while instructing her to put her clothes on. "Still, since anemia can occur due to internal bleeds, I'd like to do an X-ray, is that all right?"
Nao nodded, so he gave instructions to Kiyomi.
"An X-ray of the chest and abdomen. Also, run a blood and urine test. Take enough for us to run an analysis here. And a bone marrow sample."
"Bone marrow? From the sternum?" Kiyomi blinked.
"Mm. And then take a sample for a peripheral smear too." Bearing the questioning gaze of Kiyomi, Toshio gave a smile to Nao. "I'll be taking a little bone marrow sample. It might hurt a little, but it's not really a scary test or anything. Anyway, for today we'll run the labs and prescribe some vitamins, so come back in three days. But," Toshio added on firmly. "If tomorrow morning, you feel more tired than today or you have a fever or you feel anything's going wrong, come in tomorrow. Got that?"
Nao nodded but her face was indifferent. She looked like it was somebody else's business. It seemed like she wasn't feeling any distress at all but maybe it was weighing on her.
Watching over Nao as she was urged into the treatment room by Kiyomi, Yasuyo quietly called to him.
"Doctor--is it something bad?"
Nah, Toshio shrugged his shoulders. "If it was bad, I'd refer her to the national hospital. This's just in case."
"But."
He waved a hand to stop what Yasuyo was going to say. "If it was just a cold or just nephritis, I wouldn't be watching it this close. It looks like Nao-san is showing signs of anemia. And 'just anemia' at that. If that's the case it's nothing to get neurotic about. ---But, Megumi-chan was like that."
Yasuyo nodded, with an understanding look. "You don't want to have any regrets."
"That is correct."
"Tanaka-san, I'm sorry but could I ask a favor of you?"
Tanaka Yoshikazu blinked as the health department's Ishida asked of him. Ishida suddenly said he'd wanted to know the deaths that had come in since July. It wasn't the right time of year for a demographic survey, and the time for the month's census was long past. When he tried to ask the reason, his words were unclear and not very satisfying but at any rate he nodded.
"You'd like me to prepare the names of the deceased and make copies of their death notices, then. In secret?"
"It isn't anything especially suspicious. There was something bothering me that I wanted to investigate is all. It isn't something to make a fuss over so if you could do it without drawing attention to it."
Tanaka nodded and during the lunch break when the branch office staff were all out, at his own discretion he took the death notices out of the binders. With a dry sound, a water droplet splattered against the public office's window. The moisture that had been building all morning at last passed the saturation point and fell as drops of water---that was the impression Tanaka had. Large drops of rain scattered, soon changing into a shower that sounded like water in the bottom of a bucket. It was shaping up to be the rain they were long overdue. The public office devoid of any signs of anyone else quickly grew dark.
Tanaka brought the binder back to his own desk. The one in the top binder was Shimizu Ryuuji. Tanaka didn't know that man. Fourty one years old, his death certificate was issued from Mizobe's General Hospital. Before that was an old woman named Gotouda Fuki. Before that was Ohtsuka Yasuyuki.
Without thinking much of it, Tanaka gazed at the face. It was the Ohtsuka sawmill's son. He was in a different mourning group but as he lived right next door to him, Tanaka himself had attended his service.
(Come to think of it, this year there have been serial funerals...)
Before Otsuka Yasuyuki, Shimizu Megumi had died. The one beneath the death certificate of the old woman man who died in Monzen was Megumi's. She was his daughter's childhood friend, a year older, just a tenth grader. He had sympathies for the Shimizu household for their despondency but his daughter's grief over losing her friend
was terrible, too.
Before that the three people in Yamairi died, which had been a big fuss. Three old people died---.
Tanaka's hands stopped over the binder. What Ishida said he had wanted to investigate was this, he thought. Yes, it was clear there were too many deaths.
Before Shimizu Megumi was the young man in Naka-Sotoba, and the three old people in Yamairi. Before that somebody in Kami-Sotoba had died. This was all since August started.
(...This many?)
Tanaka was in charge of the family register and certificates of residency but in practice whoever was free manned the front window to take any report for processing. The Sotoba office was small. In all it was a six person organization. Even if their areas of duty were defined, that was how things were, so he hadn't noticed. But, for just coming into August, these numbers were abnormal.
