Silent Strike

by Francis Bandettini

  Rivera's somber look flashed to a countenance of curiosity and excitement. "What're you thinking, buddy. I like it when you get your ideas."

  "Yes, you are an adrenaline junkie, Rivera. And, this idea may just give one of your constant cravings a fix." Stoker sat up higher in his bed and leaned in a little closer to Rivera. "According to the phlebotomist, the lab here slows down at night. I'm not sure exactly what that means. But, if we can get into the lab and look at specimens and paperwork, I bet we can find out what the dirty little secret is."

  "Either we get into the lab, or we kidnap and torture one of the pathologists," Rivera said with a smirk. "I'm sure we can make a pathologist sing in five minutes or less."

  "Sounds like a fascinating clandestine exercise," Stoker said. "I hope you're joking. Can you imagine the international incident waterboarding a doctor would cause?"

  "The adrenaline rush would be profound," Rivera said. "Your plan to infiltrate the lab is more appropriate. And yes, I was only joking. It amuses me when your shrink skills can't pick up on my sarcasm."

  Stoker became serious. "Listen, Rivera. It amuses me—no it concerns me—how you hide your deep-seated desires behind sarcasm. There's therapy for that. I think I just spared an innocent pathologist a world of hurt."

  "Hey, amigo. I'm cool. Chill out, Señor Paul." Rivera said. "I know I've got some ghosts and goblins in my head. I can't help it sometimes. Instead of all this psychoanalysis, let's spend our time figuring out why all these people are sick with the same symptoms. Now, how should we break into this lab?"

  "How about we wait until there's nobody there?" responded Stoker. "Then, we pick the lock?" Rivera started to respond, but Stoker cut him off. "It's not elegant or badass, but I think it'll work."

  "Truth be told, I like your idea," Rivera said. "But remember, amigo, we're in Mexico. Like most other countries in the world, a little grease money can get us through any door."

  "Touché," Stoker replied. "I often neglect your cosmopolitan solutions when we're out on our worldwide magical mystery tours. Let's find someone to bribe—for the good of dozens of patients in Hospital de Los Santos."

  "Alright," Rivera said. "I'll come back to visit in a few minutes. We can work on getting access to the lab, once the night sets in and the hospital settles down."

  "For the next little while," Stoker said, "I'll do as much observing as I can. I'll give you a sitrep a little later."

  "Sounds good," Rivera said. "Try stretching your legs. Something tells me walking's going to be a prerequisite for tonight's mission." Then Rivera stood up and motioned for Jessica to follow him. "Let's get you out of here, Jessica. If Stoker and I are going to break some rules, I need to get you away from the troublemaking."

  Jessica smiled and followed Rivera from the medical floor. “Bailing my superiors out of a Mexican jail just went on my bucket list.”

  CHAPTER 7

  Black Rock City, Nevada

  The sun was setting over the Nevada desert. Z stood with about a hundred wedding guests on the dry, parched ground. For almost a mile the high desert sand nursed no trees, flowers, birds, or mammals. The uproar from the Burning Man Festival raged to their west.

  Z watched his friend make marriage vows with a stunning woman. The preacher took the groom’s hand and the bride's hand and brought them together. The couple’s chosen vows were powerful in their simplicity.

  As dusk yielded to darkness, the wedding party moved to a large tent. All the guests joined the couple in a celebration and meal. The menu featured fare from the Mediterranean. The earthy, rich flavors pacified a primeval appetite within Z as he dined on vegetables, roast lamb, hummus, and fruit. The caterers provided warm pita bread in abundance. He reached into his pocket and switched off his phone. Setting aside cares he had not abandoned for years, he decided to savor this one moment.

  After the wedding party diminished, Z walked alone over the barren desert back toward the Burning Man Festival. As he approached the outskirts of the temporary metropolis, he absorbed the creativity, energy, and expression. He passed the temporary structure labeled Arctica, where volunteers sold ice. Z realized he needed to hydrate and cool off a little. His training in the Mexican desert had acclimatized him to operating under duress in the heat. But, he still needed to pay attention to his hydration, no matter which desert, jungle, or arid plateau he occupied. So, after buying some ice, he sucked on one piece, while he used another piece to rub on his face, neck, and head. Sublime, he thought.

  Z continued to walk amongst the camps, art installations, parties, villages, and countless other fascinations. There were more than 50,000 people present. He came upon a giant geodesic dome, most of which was covered by white cloth. But, there were a few clear windows. Inside he saw revelers dancing while millions of feathers were blown about by powerful fans. The phenomenon was fascinating to watch from outside the dome. But, Z disliked the idea of stepping into the chaos. He turned and walked in another direction. As he passed a giant statue representing a frog, he felt a gentle mist cross his face. Much like the ice, this mist had been a refreshing contrast to the desert heat. So, he turned a bit to his right and sensed the location of the mist's source. A system of tubing delivered a refreshing vapor to the throngs crowding the thoroughfare. Z walked a few paces and allowed the moist fog to envelop him. He welcomed the cold humidity. And, he was in good company. It was a favorite spot for revelers to linger and cool off.

  As Z breathed, he inhaled minuscule water droplets and hundreds of thousands of Balamuthia mandrillaris amoebas. They were finding a warm, moist home in the mucous membranes of his nose and sinus cavities. Other amoebas moved into his bronchia and lungs. Then some amoebas entered Z's blood stream.

  A few minutes later, thousands of amoebas crossed Z's blood-brain barrier. There they found their hospitable, warm home and began to eat, grow, and infect. In this case, they found an ideal host in Z.

  After a couple of hours of drifting through Burning Man, Z sensed a subtle wind shift. The Sierra Nevada mountains surrendered a cool, mountain-scented wisp, which intermingled with the dry desert currents and triggered contented drowsiness in his soul. Z returned to his tent. But before he fell asleep, he switched his phone back on again. Among his texts, there was a message from Stoker informing him a private jet would pick Z up in the morning. He needed to be at the Black Rock City Municipal Airport at 0700 hours.

  Things must be getting serious in Mexico, Z thought. Then he laid down for the night and fell into a deep sleep. By lunchtime the next day, he would be back in Chihuahua, Mexico, clueless he was incubating the deadly amoebas.

  • • •

  At Sioux Falls Regional Airport, Allie Stoker boarded a non-stop flight to Chicago. She would spend the next two weeks designing the interior of a new high-rise office building. But, she was also excited about running a half marathon this upcoming weekend. In the best shape of her life, Allie was confident she would shatter her personal best time for the thirteen-point-one-mile event.

  As she took her seat aboard the 737, she sat next to a woman who was eager to strike up a conversation. “What takes you to Chicago?” she asked.

  “I’m doing some design work for a construction project there,” Allie answered before asking, “Is Chicago your final destination?”

  “Yes. I’m going home to sleep for twelve to sixteen hours. Then, I’m back to work tomorrow.”

  “Tough travels?” Allie asked.

  “Not really. My fatigue is secondary to the amazing time I had during two days at Burning Man.”

  Allie smiled. “Wow! I’ll have to tell my husband I met a burner. I keep trying to cajole him into taking me—at least for a day or two.”

  “Oh,” responded the woman with enthusiasm. “I bet you’d love it. There’s something for everyone. Unless that something is sleep. There’s very little of that.”

  “I suspect air conditioning is in short supply, too,” Allie joked.

  “Yes, but so is clothing. There is an abun
dance of sunscreen.”

  Allie laughed. She shared a few more minutes of conversation with her fellow passenger about the Burning Man experience before fatigue overtook the woman. Ninety minutes later, Allie Stoker deplaned, claimed her luggage, and walked out to the curb. She caught an Uber to her hotel. When Allie walked up to the registration desk, the smiling clerk greeted her with a warm, "Welcome to downtown Chicago."

  CHAPTER 8

  Chihuahua, Mexico

  Stoker had been walking up and down the main corridor of the medical floor when his dinner tray arrived. The woman delivering the meal did not speak English, so Stoker thanked her in Spanish and began to eat. An aged man in the bed next to him seemed to awaken, as if by instinct, when his meal arrived.

  "Buenas tardes," Stoker greeted him when the man glanced over at him. With a weak voice, the patient returned the greeting. Stoker could tell the man did not have the strength to maintain a conversation. So, he watched the old patient eat. The meal his neighbor had was different. The patient was eating soup at a snail's pace. It consisted of chicken broth and rice. He also had mashed potatoes, pureed chicken, and some yams—an easy-to-swallow meal. In contrast, Stoker's dinner included a chicken drumstick, vegetables, boiled potatoes, and some bread.

  Stoker took a few bites of his meal. Then he decided to make up an excuse to walk around. He wanted to observe the other patients' food. So, Stoker stood. Then he started to make his way down the corridor at a casual pace. As he passed other patients, he noticed about half of the patients had the same meal he just ate. But, the other half of the patients were relegated the easy-to-swallow soup, pureed chicken, mashed potatoes, and yams. During his military years and psychiatry residency, Stoker had walked down hospital wards many times; and this moment evoked emotions of the past. He recalled hundreds of his patients in hospitals in the former Yugoslavia, Jamaica, Guatemala, and other countries. Stoker had treated patients suffering from countless infections, injuries, and syndromes. As a psychiatrist, he also worked to relieve patients when they agonized through fatigue, PTSD, dissociative states, and many other behavioral illnesses exacerbated by stress and their environment. War and strife always introduced tragedy as well as trauma.

  Now here he was in Chihuahua, Mexico. Stoker noticed the people with the easy-to-swallow meals also exhibited signs of muscle weakness and fatigue. As he observed, Dr. Stoker noted how these weary patients also struggled to respond to conversations with the nurses, dietary staff, and other hospital workers.

  "May I help you Señor Paul?" one of the nurses asked. Stoker discerned that she appeared stressed and overworked. "Why are you loitering way down on this end of the floor?"

  "I'm just on my way to the bathroom," Stoker replied as he continued walking down the hospital ward at a languid pace. "Recovering from that snakebite has sucked away all of my energy." She accepted his half-truth.

  Stoker was taking his time, analyzing each patient he passed. By the time he reached the bathroom, he'd observed a few more patients on ventilators. And, most of the patients on this ward had very similar symptoms.

  On Stoker's return trip to his bed, he walked back at a sluggish pace. At one point, he decided to do a little experiment. Stoker identified one of the patients who appeared to suffer from the common illness on the floor. As he walked by the man, he gave his bed a sharp bump. "Lo siento, Señor," Stoker said apologizing for his sham clumsiness. He expected the patient to react with a startled jump. Instead, the man responded by whispering back an inaudible comment. Stoker tried the experiment a few seconds later with another patient. Again, the patient exhibited almost no reaction to the jolt. What's causing this muted central nervous system response? Stoker wondered.

  As he arrived back at his bed, Stoker turned and looked down the corridor again. One of the nurses was instructing a middle-aged woman to take a deep breath and blow into a tube attached to a simple spirometry device. When she exhaled into the machine, her puff would propel a little ball up into a cylinder. The patient exhibited poor results, as her earnest huffs and puffs barely propelled the ball up the cylinder at all. Something was weakening her breathing muscles.

  Stoker watched the nurse administer the spirometry test to about a dozen of the patients. As he ate his dinner, he made a mental note of their poor results and compromised breathing. Now, Stoker felt near perfect confidence many patients on the floor were suffering from the same condition. The evidence screamed epidemic.

  "Hey, Señor Paul." Thanks to his concentration on the patients surrounding him, Stoker failed to notice Rivera walking onto the busy hospital ward. "How's that arm of yours doing?"

  "Now that's an interesting question. I'm so distracted by the spectacle on this floor that I've neglected my own recovery."

  "What did you notice, Stoker?" Rivera asked as he set down a backpack he had in tow. It was full of survival and tactical gear.

  "See the stressed-out nurse over there? She's administered spirometry tests on a bunch of patients."

  "They're worried about pulmonary insufficiency," Rivera commented.

  "Right," Stoker said. "Couple that with a bunch of patients on vents, and that's enough to get a couple of doctors curious."

  "What else should make us curious?"

  "The patients who share this congruency of symptoms also show obvious signs of weakness. I mean, they can use their arms, although with some weakness. But it appears their legs are even weaker than their arms. Nobody's walking around."

  "Now that you mention it, the nurses' aides are going crazy with bedpan duty," Rivera interjected. "Many of these people cannot stand up to go to the bathroom on their own."

  "Bingo, Dr. Rivera," Stoker said. "I knew there was a reason I brought you along on these crazy missions. Let's keep watching."

  A couple of years ago, when Rivera was first getting to know Stoker, he spotted Stoker's remarkable observation skills. His almost superpowers of perception and intuition made Stoker a formidable asset on the Espada Rápida team.

  "It might be time to meet a few of these patients," Rivera said. "Let's get to know our new amigos and memorize a few of their names. Will you watch my backpack?"

  "With that beast of a bag, you're prepared for anything. I'm always happy to support a good Boy Scout."

  Rivera put on a surgical mask and walked toward a man who was struggling to find the strength to feed himself. In his native Spanish, he asked the patient, "Can I get you some water? I just happened to notice the nurses are running around crazy this evening. Are you thirsty?"

  The man nodded and whispered, "Gracias."

  Sit up straight. Put your chin down. Now you're a chicken. When you swallow, move your neck back like a chicken clucking."

  The man made the odd movement as he swallowed. But, his face registered a new level of satisfaction. "My mom always told me not to be chicken," the patient whispered. "This is one time I will disobey her; may she rest in peace."

  "It will be our little secret," Rivera said. A surgical mask covered his mouth, but his smile was evident in his eyes.

  "The man thanked Rivera with a stammer. Who taught you that?" he whispered. "Are you a doctor?"

  Rivera dodged the question. "I've just had to take care of some people I love during challenging times."

  For the next twenty minutes, Rivera went down the hospital ward asking select patients if he could help them drink. Stoker watched his friend, the man who had become a doctor to atone for his barbarous military past in the jungles of Central America. He could see, as he had witnessed dozens of times before, Rivera relished the opportunity to care for people. In an instant, he set aside the tough exterior of a soldier and exercised deep, sincere compassion. Even though this group of patients was suffering from some facial paralysis, the thoughtful Dr. Rivera could still make them smile. He even elicited laughter from a few. Not only had Rivera cared for a dozen strangers in a Mexican hospital today, but he had also comforted their souls.

  Rivera made his way back to Stoker's bed. "Th
e old medical school skill, observational assistance, is such a powerful tool for us doctors. A large percentage of those weakened patients also show dysarthria. I've been hearing Spanish sounds since the moment I emerged from the womb in Cuba. These patients struggle to pronounce every syllable emerging from their lips. So, let's just call this a made-up name, non-running man syndrome. What's our list of symptoms so far for potential differential diagnosis?" Rivera asked.

  "Well, before you go making the list, look at that technician over there. She's performing yet another nerve conduction study—I count at least five so far. I think that's an EMG machine."

  “Look at that,” Rivera said. “You're right. She's got electrodes on the patient's thumb. They're testing nerve reflexes. That’s interesting."

  "She's also doing the needle EMG on the elbow," Stoker interjected.

  "This could be significant for the diagnosis. Let's watch and see who gets nerve conduction studies."

  "We already know the answer," Stoker said. "It will be all the weakened, immobile patients. The ones who fit your non-running man syndrome profile. The same individuals who also got the spirometry tests."

  "Why don't you just eat some of your dinner," Rivera said. "We can pretend to be chatting while we observe what's going on."

  Stoker took a bite. "Even from here, I can see that patient's having a poor response to the nerve conduction study. His fingers aren't twitching as they should be."

  "You're right," Rivera said. "Let's see what happens with the next patient." Stoker and Rivera continued to watch. Stoker ate another bite here and there. Over the next few minutes, the technician administered the study to the patients who fit the profile Stoker and Rivera had observed—the patients who were weak, stoic, and unable to walk.

  "The patients are not doing so well with the EMG study," Stoker pointed out. "It's time for you and me to get back to making that list of symptoms. There's a lot of uniformity here."