Alan E. Nourse - The Fourth Horseman

by Alan Edward Nourse

  A chill went up his back and he took the notebook over to a desk, sat down where the light was good, began reading it closely, word for word. Three dead ground squirrels on the trail, one below Nada, one right at the lake, one on the approach to the Snow Lakes. Something weird about a dirty barefoot kid going up the trail; she'd tried to stop him and he vanished. Thought maybe she dreamed him. Dreamed him? Trail work at Upper Snow all day, headache and cough by evening. Nasty crowd across the lake with three camping violations, man armed with a .38 pistol. They started squaring away when she threatened citations, but with ugly grace. But she thought maybe she gave the big guy the flu, at least, with all of her coughing. . . .

  Three dead ground squirrels.

  The next day was a terrible scrawl, he could barely make it out at all. Written at Lancelot—that was where the Super said they'd found her. Sick all day, chills and fever, coughing, violent headache. Four hours to make it up to Vivian, another two to Lancelot—Christ, she must have been sick. The rest of the afternoon making camp. Handwriting even more scribbly. And then, before it all degenerated into delirium, there was something written to him, as surely as if she had been writing him the letter she had never written, and he read the words, and all the held-back grief finally caught up with him, and tears were pouring down his cheeks, and he buried his face in his hands and sobbed.

  After a while it eased up, and he pushed himself back away from the desk and stared stupidly around him. The answer had come while he was weeping. He knew now what had killed Pam Tate.

  The job now was to prove it, and then figure out what to do about it. He went back to her pack again, dug out the little personal bag, found her medicine bottle. He knew what she carried there. Some ampicillin gone, maybe three or four doses, and a few aspirin. He picked up the citation book, found the smudged carbon of a ticket she had written, somebody Comstock from Canon City, Colorado. He dialed for long-distance information, got a number to match the name, direct-dialed it. The distant phone rang and rang, but nobody answered.

  He turned the lights out, sat back in the chair, rubbing his forehead in the darkness for a long while. The question was: what to do now? Call the Super and tell him what he was thinking? Sure, and get treated like you were some kind of nut. A dangerous nut—you don't wave that flag around unless you have solid, inarguable medical proof, and all he had to go on was a gut-deep hunch. And that's not good enough, man. You've got to build a case. All you '11 have is panic and bad trouble if you don't. You need proof. Support of some kind, real support. . .

  Support. He thought about that for a long while. There was something poking up from the bottom of his mind, something down in Oregon months and months ago—what was it? He knew Shel Sieglerdown in Deschutes National Forest; Shel had been his boss for a while up here when he had first.joined the Forest Service, working trails, after the medical-school thing had fallen apart. A great joker, Shel, but very sharp. Suddenly something jelled in Frank's mind, the right question to be asking, and he sat up straight. He checked a number in Bend, Oregon, and dialed the phone. Moments later he heard Shel Siegler's nasal Brooklyn voice on the line. "Frank, you old son of a bitch! Long time no hear. How they hangin'?" .

  "Pretty low, right now," Frank said.

  "Oh, yeah? Well, you don't want to let 'em drag in the dust. The Super handin' you a heap of shit or something?"

  "No, no, it's personal. But Shel, I've got a funny question to ask you."

  "Yeah, that's all I get these days, is funny questions. You'd think I was Henry Youngman or somethin'. So what's your funny question?"

  Frank braced himself. "I wonder if you guys down there have taken a dead rodent count in Deschutes lately."

  There was a long, long silence. When Shel finally spoke there was no trace of humor in his voice. "Odd that you should ask," he said. "Why?"

  "I need to know, Shel."

  "Okay, Frank, this is off the record, you got that? Okay. We've been doing dead rodent counts every week for the last six months. The counts have been high, and getting higher every week. Frankly, some of us are scared, and we don't quite know what to do about it."

  "Have you had any actual plague?"

  "Three cases, down in Sisters, about six months ago. First cases in Oregon in years. All three of them died before we had time to get a diagnosis."

  "What kind of plague?"

  "Pneumonic. All we could do was send sputum samples and a couple of dead squirrels—talk about a nightmare, baggin' them up—down to Atlanta, Centers for Disease Control. They pinned the diagnosis, very much post-mortem. I mean, those people went like a brush fire. So CDC sent a guy named Quin-tana up here, Mexican chap, and he looked around a bit and said, 'Very interesting, don't pat any ground squirrels,' and caught a plane back to Atlanta. Of course, like he said, he didn't have anything to work with, the cases were all six feet under long before he got here, and we didn't have any tissue samples for him. Our medical people wrote it off as some weird kind of pneumonia at first and didn't even take cultures, since the people were dead, and no new cases were turning up, and Quintana was a busy man, so you couldn't blame him going back to Atlanta. Nice guy, in fact, but he was just in and out. Suggested we start doing dead rodent counts, so we did." Siegler paused. "Now, why all the questions? You got some cases up there?"

  "Just one," Frank said. "So far."

  "What does the Super have to say?"

  "He doesn't even know. I'm not so damned sure / know, not sure enough to get the whole state of Washington stirred up. What I need is some hard data about what's going on in the woods."

  "Well, shit, man," Shel Siegler said. "Don't just talk to me. Get hold of—what's his name?—Kessler in the Humboldt in northern Nevada and Tad Okito down in the Big Sur. Then there's Murph Miller over in the Salmon in Idaho, and Don Whitney up in the Kootenai. Get on the horn and find out what's going on in the woods. It may be pretty raw data, but if we've got dead rodents down here and you've got a funny case up there, even just one, somebody better find out what's happening. Keep me posted, and if you need any help, any way at all, give me a buzz, okay? And Frank . . ." The man paused. "Did you have any contact with that case up there?"

  Frank sighed. "You might say so."

  "Then take some medicine. Don't wait to get hit in the head."

  Frank set the phone down and found that his hand was shaking. Dead rodents in Deschutes, lots of them, and three cases of plague. Nobody had done a rodent count up here since that rabbit hunter from Ellensburg died eight years ago. Everybody had thought it was tularemia and only confirmed bubonic plague on autopsy later. They'd counted dead rodents like mad then, for a while, and found nothing. AH of the Forest Service had plague shots and ate a lot of some antibiotic that was supposed to stop it, and the press—he flinched. Talk about whipping a dead horse. From the press reports, you'd have thought the Forest Service deliberately planted that case of plague just to spite the tourist industry.

  The fact was that isolated cases of plague had been turning up in the West for years, and more in the last decade or so—a dozen or more cases a year scattered here and there, mostly in the Southwest. The disease was kept alive by flea-ridden wild rodents—squirrels, chipmunks, ground squirrels, marmots, even prairie dogs and gophers. A tiny percentage of those creatures were always infected, dying, passing the infected fleas on to other rodents, ever since the plague had turned up in San Francisco in 1900, transported from Hong Kong by way of Hawaii. Endemic was the word they used for it, a quiet ground fire of infection smoldering in the wilderness, never moving very fast or very far, just waiting. And the only humans ever infected were those rare, unfortunate individuals unlucky enough to happen to be bitten by an infected flea. . . .

  And Pam? Was that what she had been? One of those twenty million-to-one victims of sheer, blind bad luck? His Pam? Frank stared into the darkness, refusing to accept it. There had to be something more. So fast, so incredibly fast. To cut down a superbly healthy girl in less than forty-eight hours ? T
oo terribly fast to believe. No infection known to man moves that fast. What ghastly kind of plague could do that?

  He got on the phone again, working on the names Shel

  Siegler had suggested, adding some others that he could think of. Every call he made was met with caution, great hesitation— why did he want to know? Cautious himself now, he evolved a cover story: no cause for alarm, but he'd run into some high dead rodent counts up here in the Wenatchee. He just wondered if maybe others had too. It was flimsy, but it had to do. Very guarded responses from half a dozen. But from those who answered at all, a sort of consensus: there were dead rodents around, more than normal. At one place in California and another in Colorado, quite a few more.

  Frank walked into the bathroom and found the old shoe box of pill bottles he kept on a linen shelf. What was that stuff they handed out to us when that rabbit hunter died? Chioro something. Great big bottle. Chloramphenicol. He still had half a bottle full of the white capsules with the gray-blue bands around them. The typing on the yellowed label said Take two four times a day, with a double dose to start with. Probably way outdated, he thought, but maybe better than nothing. He looked at the tent in the bathtub and took four capsules with a glass of water.

  He found a piece of cold chicken in the refrigerator and ate it with some milk. Then, back at the desk, he tried the Colorado number again. There was still no answer. He sat in the darkened room staring at the wall for a long, long time, his mind racing. Twenty people or more in the camping party—where are they now? In what mortal danger? He felt as if his mind would explode with the thing he was considering. Moment by moment the pressure became more unbearable.

  Finally he stirred. He knew he could not sit there a moment longer—he had to move, do something. He couldn't bear the thought of facing the Super or Doc Edmonds again just now. They knew what had happened, they could put things together with just a nudge from him. But none of those Colorado people know. . . .

  His decision finally made, he dialed a Seattle phone number. Then he took a pad and pencil out and wrote a brief note to the Super, i think pam tate died of plague, check

  with doc edmonds about those cultures. dead rodent counts high throughout west. pam was sick when she came in contact with those colorado campers. am flying down to check them out. will phone in two or three days.

  He sealed the note in an envelope with the Super's name, locked the house and fired up his old pickup. It was 2:00 a.m. He stopped by the Forest Service office and stuck the envelope in the mail slot. Then he turned the car north toward Stevens Pass and the road to Sea-Tac airport.

  BRUSH FIRES

  It was 2:00 a.m. when Dr. Ed O'Hara jolted awake and groped for the ringing telephone. He recognized the young, anxious voice instantly. "Ed? I've got a guy down here in the emergency room with something funny going on with his chest. I'd sure like you to come take a look at him."

  "What kind of 'something funny'?" Ed growled.

  "Well, it looks like pneumonia."

  "That's funny?"

  "No, but I think he's got heart failure too."

  Ed sighed. "A lot of old geezers get heart failure with their pneumonia," he said.

  "Yeah, but this guy's only seventeen. Can you come take a look?"

  The older doctor got dressed and started driving down toward the Rampart Valley Community Hospital. Damnation, he thought-as he stopped at the town's only stoplight, invariably red. / knew I should never have left that kid alone in the ER until I'd seen him in action a little bit more. Some of these Family Practice residents were dynamite in a crisis, he reflected, and some of them just fell apart. Pete Whitehead was showing signs of being the falling-apart kind.

  Ed pulled into the ambulance entrance of the hospital, a handsome modern structure, fifty patient beds, including an eight-bed maternity ward and birthing rooms in an adjacent building, a fully equipped emergency room, intensive-care facilities and a good basic lab with twenty-four-hour coverage. The building was about the only handsome thing there was in

  Rampart Valley, Colorado, he reflected, what with the lead mines, the zjnc mines, the uranium mines, and every hill in sight scarred and ravaged by years of mining operations. It had taken Ed O'Hara years of prodding to get the other doctors and the people of the town galvanized into building this hospital, and it was a pearl of its kind, saving the local people hundreds of eighty-mile round trips down to Colorado Springs for medical care each year. To Ed O'Hara it was the most beautiful structure in the world.

  Pete Whitehead met him at the emergency-room door, looking veiy young and very nervous. Quite the picture of the proper young doctor, Ed thought, with his crisp white knee-length clinical coat and the stethoscope tucked into a side pocket on that hot summer night, but the illusion faded as he kept tugging uncertainly at his wispy mustache and looking back over his shoulder. As Ed walked in, wearing his "Here today, Gone to Maui" T-shirt and a pair of shorts and sandals, he heard somebody coughing up a storm in one of the draped cubicles to the rear of the ER. "Okay," he said to the young doctor. "Now what the hell's going on that you've got to call me out at two in the morning?"

  "Well, this kid came in just before dinnertime this evening, and I didn't know whether to believe his story or not." Dr. Whitehead tugged at his mustache. "He was just a drop-in, said he was driving down from the airport in Denver to Canon City and couldn't go any farther because he was coughing so much and his head ached so bad. Said he could hardly see to drive. Seems like he'd been up north somewhere with a big crowd on a camping trip this past week, and then all of a sudden everybody started getting sick. Three of them died—"

  "Died!" Suddenly Ed O'Hara blinked awake.

  "That's what he said."

  "Died of what?"

  "I'm not just sure. Pneumonia, it sounded like. They'd begun packing down the mountain when they started getting sick, and they tried to get the three worst ones to some hospital in Seattle, but all three were dead on arrival. At least I think that's what he said, the story was getting pretty garbled. I gather that he was getting sick too, and somehow lost contact with the rest of the party and just took a cab to the airport and flew back to

  Denver on the ticket he had in his pocket. Stopped here because he couldn't go any farther."

  "So what did you do?"

  The young doctor took a deep breath. "Well, I examined him and took a chest X ray—he had consolidation in both lungs, looked like double lobar pneumonia, but he wasn't cyanotic yet, just coughing like mad, so I took a culture and smear of his sputum and ran a fast gram's stain on the smear, but the bug sure wasn't pneumococcus or anything else gram-positive. All I could see was gram-negative rods. Of course, I plated out the culture and put it in the incubator, but he was getting worse in a hurry, coughing more than ever, getting up some blood, and I didn't think we had time to wait around for a culture, so I started him on gentamycin and clindocin."

  Ed nodded. "On the premise that it was some kind of atypical E. coli, I suppose."

  "Right. I hoped the antibiotic might hit it, but it hasn't done anything yet that I can see. And then about an hour ago he started bringing up lots of blood and getting very short of breath and cyanotic, so I had Miss Towne and a couple of the LPNs help me get him on the respirator back there—his temp had gone up from 101 to 105 in three hours—and that was when I found out he had a pulse of 240 and damned little blood pressure at all, and 1 decided I'd better call you."

  "Good thinking," Ed said sourly. "Well, let's take a look at him."

  They took a look. The youth was coughing weakly in the respirator; otherwise he was barely responding at all. When Ed stopped the machine and bent to listen to his chest, the patient burst into an explosive paroxysm of coughing, spraying Ed's face and T-shirt with blood and splattering Peter Whitehead's white lab coat with red-streaked sputum. Ed wrinkled his nose. "God, what a stench. You don't suppose he's got a lung abscess, do you? Ho—wait a minute."

  The doctor had been stripping down the youth's gown when he
saw the purple hemorrhagic welts on the arms and chest. He felt under the armpits. "Did you feel these lumps?"

  "Uh, lumps?"

  "Yeah, under his arms. Groin, too. Did he have these welts when you first saw him?" "Uh, not like that."

  Ed O'Hara's face was gray when he came out of the cubicle. "Let me see those slides you made."

  The young doctor tagged along behind as Ed headed for the little emergency-room lab. "I'm afraid they aren't the greatest slides, Ed. They just didn't seem to take the stain worth a darn ..."

  "Don't worry, just show me the slides." Ed adjusted the microscope and stared down through the, oil-immersion lens, a muddy-looking field filled with pus cells and red cells and debris, rod-shaped bacteria all over the place, but barely pink and barely visible, certainly not the sharp red-staining appearance of E. coli organisms.

  "I hope I didn't do something wrong," Whitehead said nervously, tugging his mustache.

  Ed looked up. "Son, you did everything you knew how to do and did it just exactly right. Now I need to know if you did one other thing. Did you save the original sputum specimen?"

  "Yes. It's in the incubator."

  "Great. Have we got any Wilson's stain around here?"

  "Wilson's stain? There's Wright's and Giemsa . . ."

  "Giemsa might do, but Wilson's would be better." Ed rooted around on a shelf. "Yeah, Wilson's. You heat-fixed that first slide?"

  "Yes."

  "Then make another just like it and I'll stain it."

  Moments later he was staring down at a newly stained slide, filled with bacteria, far more distinct and sharply defined. "Take a good look."

  Peter looked and looked. "They're rods, all right, but they've got a little spot of chromatin in each end. They sort of look like closed safety pins ..."

  "Right," Ed said. "They're the murderer."

  "What do you mean?"

  "I mean we've got a dead man back there on that cot. He was probably beyond help before he even walked in here. He's got a couple of hours left, no more. And we're liable to be dead men, too, if we don't move fast.'' Ed looked at the bloody smear on his T-shirt and the brown splattering on Pete's white coat and swallowed hard. "First of all, get those nurses down here, the ones who helped you with the respirator. Get them off the hospital floor and get a list of every patient they've been near since they were down here—or anyone else they've contacted. Tell Miss Towne to open up the pharmacy and bring down ail the streptomycin and chloramphenicol we've got, and I hope to Christ we've got quite a lot. Meanwhile, lock the doors to this place and don't let anybody in until we can get some help-God! You, me, the whole emergency room, the respirator, those nurses, the patients, all contaminated. We're going to have to close this place down. A whole fine modern hospital turned into a pesthole in eight hours flat by that little bug that looks like a safety pin . . ."