"Do I have a tumor? What do you mean a lesion?" Z asked.
"While I doubt it's a tumor, we're not sure what your lesion is. But we need to find out."
"Hey, Z. You're lucky it's not in your frontal lobe," Rivera said.
"Yes, really lucky," Z replied with lots of sarcasm.
Rivera explained. "You're unlucky to have a lesion like this. But, if this lesion were situated a couple inches closer to the front of your skull, it would really affect your behavior. You would have severe impulse control problems.
"I am having impulse control problems," Z said. "I want to tell you to shut up. I want to just grab my clothes and run out of here. I just found out a lesion is occupying some valuable real estate inside my head.”
The ER doctor started to speak. "There's a minimal procedure we need to do, Z. It's called a biopsy. We have to find out precisely what this lesion is. It's about the most straightforward procedure a neurosurgeon performs. We take you to the O.R. and put you under general anesthesia.
"It's also very techie," Stoker said realizing how the presence of technology would reassure Z thanks to his faith in technology. "A robot does a lot of the work."
"I'm having brain surgery?" Z asked in shock and disbelief. "Within the last few hours, I've gone from wondering if I'm allergic to tangerine juice to having brain surgery?"
"Yes," Stoker said firmly. "It's the best course. And it really is a very small brain surgery. Your pain will be minimal."
Z stood up and started to pull on his pants. When the hospital gown he was wearing got in the way of zipping up his fly, he ripped off the shroud. "This is bogus!" Z tossed the gown to the foot of the exam table. "I don't want anyone cutting into my brain. It's a brain filled with music, computer programming code, foreign languages, a knowledge of the world, and a love for the simplicity of warm pita bread." Z thought back to his time in the Nevada desert a few weeks ago. He longed to be in that place. He ached to feel free of burdens as he had, for just a few hours in the middle of the chaos of the Burning Man Festival. "Stoker, you've been teaching me to analyze people and read body language. I don't want to lose what I've been learning. How can I be sure Farsi will continue to roll off my tongue?"
"Did you say Farsi?" the ER doctor asked.
Two hours later, Z sat in front of Dr. Hosseini. Stoker and Rivera were there. And his girlfriend Jessica had found her way there, too. It was the first time Z had ever seen her worried.
The Iranian neurosurgeon was explaining the procedure, first in Farsi and then in English. Z asked a question in the doctor's native tongue. The doctor answered in Farsi and Z translated it into English. "The procedure takes about twenty minutes, and you use the x, y, z matrices to tell the robot where to remove a small piece of my brain tissue."
"I don't think you need to worry about your intellect, Mr. Z," the neurosurgeon said in perfect English. "The location of your lesion is not involved in your memory, cognition, or thought processing. It is more likely to affect your motor control, probably your left leg."
"Let's do this," Z responded. "Before the charm of language and robots using x,y,z matrices to operate on me wears off."
"In that case, we'll wheel you into the OR," the doctor said.
"No way is anyone pushing me around like a sick guy," Z said. Then he got up from his chair, kissed a teary-eyed Jessica, and walked toward the double doors that led to the operating room. He stopped right next to a sign that read "Operating Room." Z removed his phone which he had hidden held in place by his underwear's elastic band next to his hip. He put his head next to the operating room sign, pointed to the spot on his head where he would have the procedure and shot a Snapchat. "Hi, all. It looks like I'm having a little spontaneous neurosurgery. Pray for me."
After he sent the Snapchat, he hid the phone on his hip, held in place by his underwear’s elastic band. Then he pushed the door open and entered the operating room under his own power.
• • •
While Z was in surgery, Stoker and Rivera made some quick phone calls. They each identified ten high-volume emergency rooms, in different cities across the country. Rivera connected first with an emergency room physician on duty at Montefiore Hospital in the Bronx, in New York City. "Hello. My name is Dr. Errol Rivera. I'm calling from Chicago. As you know, there have been more Guillain-Barre cases in the United States. How have your Guillain-Barre volumes been?"
"We've admitted nine cases in the last two weeks, which is abnormally high" the doctor responded. "We usually see about two cases per year. Most of those patients are in our ICU right now."
"That matches what we're seeing," Rivera said. He captured the doctor's email and promised to share the results of their informal study. After phone calls to hospitals in Orlando, Houston, Denver, San Francisco, Seattle, and fourteen other hospitals, Stoker and Rivera had some preliminary data suggesting cases of Guillain-Barre syndrome were skyrocketing all over the country. There were seventeen cases at a hospital in Atlanta, right in the CDC's backyard.
"This is just the very beginning," Stoker said. "In two weeks, each of these hospitals will have a hundred cases. In a month, they'll have thousands."
Then Stoker's phone rang, and he looked at the display. "If Z weren't in surgery, I would think he was spoofing me."
"What do you mean?" Rivera asked.
"My caller ID says this call's from the White House. It's a 202 area code and everything." Stoker answered the call.
"Is this Dr. Stoker?" a voice said.
"Yes. This is Dr. Stoker."
"This is Secretary Karin Danielsen from the Department of Homeland Security."
"Hello Madame Secretary," Stoker said. "Are you calling to talk about the Campylobacter jejuni bacteria and Guillain-Barre syndrome?
"Yes. More specifically I'm calling to arrange a meeting with you and Dr. Rivera to brief the President and select members of his cabinet."
"With respect, Madame Secretary. We're fighting a battle, and we cannot leave the front lines. Could we arrange a teleconference? We are prepared to brief you immediately."
"Dr. Stoker, you're being summoned by the President of the United States. It’s rare that someone attempts to decline this invitation."
"I understand," Stoker replied. “But the issue is where can we be best utilized?"
"You need to tell us all you know. We need to talk about how to best deal with this crisis. We need to put together a battle plan, and nobody sees the battlefield as well as you and Dr. Rivera."
"And, Rivera and I can describe our battlefield very concisely from right here in Chicago via secure teleconference from the FBI field office. Delaying this meeting because of travel time will cost lives."
"I agree," the secretary said. "I'm not asking you to fly to Washington D.C. I'm aboard Air Force One with the president. I'm asking you and Dr. Rivera to meet us on the tarmac at O'Hare International Airport in 30 minutes. The Marines will send a helicopter to pick you up. Where in Chicago are you?"
"Northwestern Memorial Medical Center," Stoker said. "I'm sure they have a helipad."
Secretary Danielsen's voice was stern. "Doctors, find the helipad and be there in fifteen minutes."
Thirty minutes later, Stoker and Rivera climbed the mobile stairway up to Air Force One.
CHAPTER 24
Chicago, Illinois
In her room at the LTAC hospital, Allie Stoker was alarmed by her weakness. She had always been so strong. And, her strength had helped her push through virtually any pain and discomfort in her life. Just months ago, she had amplified her patience, endurance, wits, and pain tolerance to survive a kidnapping ordeal. But now, her own immune system was attacking her nerves. And those nerves were losing control of her well-toned muscles. Her strength was zapped, and she was weak. And being weak made her scared. And, her fear produced anxiety.
She knew a fair amount about anxiety. Being married to a psychiatrist gave her insight into anxiety and dozens of other conditions that profoundly affected the human p
syche. And now, her psychological fortitude crumbled as her immune system had kicked out the crutch of physical strength from under her. Was it all a facade? Was my physical strength the only quality making me feel emotionally strong for all these years?
Breathing. It was so hard. Am I struggling to breathe because of the Guillain-Barre, or is this anxiety talking? Is this what a panic attack feels like? And which came first, the chicken or the egg?
A white-haired doctor walked into her room. He introduced himself to Allie, her parents, and her sister. "I'm Doctor Paulson." He paused for a minute. He noticed profound worry in Allie's eyes. "I'm an expert at keeping people breathing, a pulmonologist. And, I'm sorry you have a disease, Mrs. Stoker—"
"Allie. Please call me Allie."
Dr. Paulson observed how Allie was biting her lip, playing with her necklace, and blinking more frequent than usual. "Allie. I'm sorry you feel alarm bells going off in your head as your ability to breathe slips away." The doctor paused for a moment and looked at Allie's family. "Between your parents, your sister, and our staff here, we'll keep you breathing strong. We'll also have the help of this machine right here." He pointed at the ventilator. "Over the next few minutes, our team will start to prepare you."
• • •
"Okay. You're all done," came a nurse's sing-song voice. Indeed, this nurse had been trained to use happy and optimistic tones to welcome patients out of anesthesia.
To Z, she sounded like an amusement park ride attendant at Disneyland saying something like, “We hope you enjoyed the ride.”
"Everything went very well," the nurse said. "Z struggled to open his eyes for a moment. He felt different. He felt great. He felt much too cheerful and energetic to be coming out of surgery.
"Is waking up from anesthesia supposed to be such a rush?"
"Um, no," the nurse replied.
"I know. I was just making sure the neurosurgeon didn't jack up my ability to speak or be funny!"
"Well, your speech is fine. But we'll have to see if your sense of humor returns."
"Hah. But, I bet you don't know who killed Jack Kennedy!"
"I don't know. But, I bet you do."
"I know all their names. It was a well-orchestrated hit."
"Okay, I think the anesthesiologist may have been a little generous with his potions. But, besides high and appearing a bit manic, how are you feeling?"
"Remarkably well for someone who just had a section of brain bored out of his head."
"It was a tiny sliver," the nurse said. "Here, let me check your vitals and this minimal incision. Your doctor will be here shortly." She started to probe the spot on his head where the neurosurgeon had worked.
"And Rivera and Stoker?" Z asked "They're doctors. Are they allowed into the recovery room?"
"No, and neither is your girlfriend, for now. But the doctors did leave you a note," the nurse said as she handed a folded over piece of paper to Z.
Sorry to not be there when you woke up. We were asked to talk to the president of the company.
Z smiled. He knew immediately. Stoker and Rivera finally had the ear of the president of the United States.
Now he was tethered to an IV bag supplying miltefosine, fluconazole, albendazole, and clarithromycin into his bloodstream. And, he was confined to a recovery room in Chicago. Z remembered his smartphone he snuck in, and he removed it from his underwear's elastic band next to his hip. A Snapchat had arrived from his newlywed friends who had been married at the Burning Man Festival a few weeks ago. On the short video, they wished Z well. Then the couple shared a selfie while the bride complained, "Too bad we're sharing our two-month anniversary as sickos."
About ten minutes later, Z saw another Snapchat arrive. One of the people he remembered from the wedding chimed in. "Something must be going around. I've been really sick for three days, and it's not getting any better. Time to call the doctor."
Within thirty seconds, another person responded. "It is going around. I'm vomiting, any amount of light gives me a horrible headache. What is this stuff? Ugh!"
On the heels of that message another Snapchat arrived. This person had been to the emergency room a few days back. The doctor told her to drink more liquids, take ibuprofen, and rest. But now, she felt even worse.
Z instant messaged all of them.
What are your symptoms? I had similar symptoms, and now I'm in the hospital with four different drugs being pumped into me. Not to mention the brain biopsy.
Twenty minutes later, Z was in communication with twenty people who had been at Burning Man and who were experiencing the same symptoms. "Get your butts to the emergency room," he told them. "But, let us know what you learn."
Dr. Hosseini walked into the recovery room. "Salâm!"
"Salâm, chetori, Z. It looks like you've emerged from anesthesia feeling perhaps a little too good."
"I feel great. A little thirsty. But other than that, I feel great."
"I'm sorry I was not here when you woke up. I personally delivered your sample to the pathology lab. The pathologist and I took turns looking at a small piece of your brain tissue under the microscope. We can see some damage from a parasite of some type, but we don't have the tools at this hospital to distinguish which parasite it is. So, we're sending your sample to the Centers for Disease Control. It should be there within hours. I hope to have specific results very soon."
"So, what's going on with me? Is this something rare? Am I going to be okay?"
"We're not sure if your situation is unique, but my hunch tells me it is. You may have a rare germ. It could be one of many pathogens. We'll just have to wait and see."
"What do I do while we're waiting?" Z asked. "Can I go back to my hotel room?"
"I don't think so," Dr. Hosseini said. "Until we hear from the CDC, I need you to stay here. We're already administering drugs through your IV that kill bacteria, amoebas, and fungi. That will give us a head start regardless of what this turns out to be. One of them, called miltefosine, is actually an orphan drug. It was recently approved by the FDA. We're using it as a precaution."
"Okay. Hopefully, I can go home in a day or two?"
"I think you're going to be in the hospital for longer than that. You may feel good now, but you arrived here after an alarmingly quick onset of some serious symptoms. Let's see how you’re feeling in a few days."
"Okay. I guess I'll be checking into a room here."
The doctor smiled. "Let me go talk with your doctor friends."
"They had to leave. It was an emergency."
"With doctors it always is," Dr. Hosseini said.
Z smiled and blinked three times, in quick succession. "I've got some other information I want to share with you. It's a bit of a wild theory."
"What's that?" asked the doctor.
"A couple of months ago, my friend got married at the Burning Man Festival in Nevada. Have you heard of it?"
"Yes. I've heard about it, read about it."
"I went to support my friend. I was there for less than twenty-four hours. But, on social media, I'm seeing a lot of people who attended have my symptoms. I'm counting twenty so far."
"Please, keep talking with these people," Dr. Hosseini said. "You may be onto something. Usually, when we see emerging clusters of symptoms like you're seeing in a specific population, our theories end up evaporating. But occasionally, vigilance and early detection pay off, and we find an epidemic. Please let me know if anyone else is diagnosed with a growth or infection in their brain. It's worth watching."
• • •
As Stoker and Rivera entered Air Force One, they were greeted by Ethan Musgrove the surgeon general as well as the head of president James Riddell's Secret Service detail. After a brief security check, Surgeon General Musgrove asked them, "Doctors, have either of you been exposed to the Campylobacter jejuni bacteria?"
"We cannot be sure," Stoker said. "But, we're both asymptomatic and have been for weeks."
"Have you walked under any mist machines? H
ave you eaten at any Little Italy sandwich shops?"
"We haven't," Rivera said.
"I'm going to ask both of you to wash your hands and wear gloves while you meet with President Riddell. Also, please do not shake anyone's hand during our meetings here today, because of the infections, especially the president."
Rivera rolled his eyes. And then they walked to a bathroom, where they washed their hands and donned disposable exam gloves. Then they were accompanied into the Air Force One conference room. The president and Secretary Danielson stood up immediately. Surgeon General Musgrove introduced Stoker and Rivera to Danielson and the president.
"It feels strange not to shake your hands, Doctors,” President Riddell said. “I’m sorry for the abundance of caution.” The president gestured toward the chairs in the conference room and instructed everyone to take a seat. “First, Dr. Stoker let me say how sorry I am that your wife is a victim of this horrible attack."
"Thank you, Mr. President. She's in good hands."
"I want to thank you both for all you have done to get ahead of this terrorist epidemic. Frankly, you two were ahead of two major government agencies in uncovering this plot. We owe you a debt of gratitude for the tens of thousands of infections you’ve prevented and numerous lives you’ve saved." The president pointed to a large color monitor hanging against a wall. "I'm conferencing with Glenn Brookfield, the Secretary of Defense, and Albert Bostock the Secretary of Health and Human Services. We're familiar with the basics of your story."
The Homeland Security secretary spoke. "We know you found a cluster of this infection in Mexico. You also followed some Iranian agents to Chicago, uncovered this Nikolas person at his hotel in Chicago, and then found the lab instrumental in distributing Campylobacter jejuni. We want your input on our strategy going forward."
Silent Strike Page 26
