The Blue Death

by Joan Brady

  ‘He pries into things that don’t concern him.’

  ‘I see. I see.’ Sebastian nodded. ‘This nosy fellow’s part of the family, right? Got an inside track? That could be worth a look-see. I sure don’t want to impose or nothing, but could I ask our security guy to give you a call about it? Maybe make an appointment to see you? Would that be okay?’

  Jimmy nodded. ‘It’ll be my pleasure,’ he said.

  As Jimmy eased out of the tower’s bowels and back into the heavy traffic of St Louis streets, he was thinking that Sebastian Slad really was a yokel. How could anybody think David Marion had an inside track on the Freyls of all people?

  But then Jimmy had been born in Massachusetts. The Midwest has a different culture, a different set of priorities, not limited to the growth of corn either. Another old saying – one he’d never heard – comes from Kansas where the Slads had grown up: ‘Beware the yokel when he acts real stupid. He’s lifting your wallet out of your pocket.’

  16

  KNOX COUNTY: A week later

  ‘Over there, Andrew!’ Quack shouted. ‘Bucket!’

  Little Andy scuttled, but he wasn’t quick enough. A thin, grape-coloured fluid shot out from beneath the bed and splashed onto the floor. The prison infirmary held only half a dozen beds. All were full. Quack had persuaded the Warden to add another half dozen that spilled into the hallway beyond. These were full too. Each bed had a hole in the mattress to let the spurts of diarrhoea dump straight into a bucket beneath. Another dozen inmates lay on the ground outside underneath a marquee, no buckets here, only the absorbent earth.

  The main thing was to get water into these men as fast as possible. By rectum? Forget it. They’d only spew it out again. Intravenous hydration? Forget that too. Clear pouches of hydration fluid did hang from makeshift scaffolds above several patients, but it wasn’t feeding into veins. The last thing these men needed was massive infection, and Quack had no sterile needles. He boiled whatever the gang bosses supplied – a motley collection that included one made from the bass string of a guitar – and hydrated just beneath the skin. A couple of sites per man: abdomen, upper arms, thighs. He was expert at this – could get in several litres per man per day. Breast-like swellings arose at each site.

  But he’d never known anybody to be sick like these men, had nothing to compare it to except the outbreak a month earlier. There’d been only four patients then; he himself had watched one of them collapse at the canal site. Their symptoms had been controllable enough to let him feel his way a little and confirm that forcing fluids was the only thing that seemed to help; an hour of hurried research had suggested that the antibiotic tetra-cycline might have an effect. It didn’t. And then he’d been as taken aback at the speed of recovery as at the suddenness of onset. They’d returned to work on the canal within ten days.

  Which left him without any idea why this new batch of patients were so desperately ill or what to do for them – except get water into them.

  He’d spent the time between that outbreak and this one teaching Little Andy how to mitre a sheet, scrub a floor, bathe a patient in bed. Andy was a good student. Tell him once, and that was it. This new outbreak had shown that he wasn’t squeamish either. Not that Quack had expected quivering delicacy in a prison whore so harshly treated that he’d be wearing diapers for weeks to come.

  Quack turned back to the telephone in his hand. ‘I need an ambulance, Miss Pouria, and I need it quick. Some of these men are really sick.’

  ‘Do try to stay calm, Mr Kolb.’ The voice was patient, polite: calls to Medical Services Direct were recorded to judge nurses’ performance. ‘We’re all here to help you. I do think gastroenteritis is your most likely . ’

  Quack decided to let her talk for thirty seconds. Sometimes a wait worked, sometimes not. The trouble was, he knew that Medical Direct nurses could get fired if their average ‘call handle time’ exceeded something like seven minutes, and he knew that they followed elaborate computer protocols tracking symptoms through some algorithm and coming up with a verbatim speech at the end. Before these outbreaks, he’d never spoken to the same nurse twice. During them, he’d spoken only to Miss Pouria, and what she was telling him now was word for word what she’d told him throughout.

  ‘Forgive me, Miss Pouria’ – he couldn’t wait any longer – ‘this isn’t the same as before. Two of these men are dying.’

  That caught her attention. ‘Dying?’

  ‘They’re deeply cyanosed, and their breathing is so shallow that—’

  ‘Cyanosed? Blue? Are you sure?’

  ‘I’ve never seen anything like it. Lips, hands – all blue. Not just pale blue. Deep blue. Bruise blue. The Latino is turning blue-grey – his whole body – right in front of my eyes.’

  There was a pause. Quack knew that pause. It meant she was consulting a not-too-familiar icon on the screen in front of her. ‘An ambulance will be with you as soon as possible, Mr Kolb.’ Not a single change in the tone of her voice. ‘I do know how difficult such patients can be, but from what you’ve told me, we have all the symptoms of gastroenteritis. What about temperature?’

  ‘I have no thermometers. You know that, and you can’t be serious about gastroenteritis. A couple of these guys have blood in their urine.’

  ‘Try to be calm, Mr Kolb. The Service will arrange thermometers for you. Now perhaps a few simple instructions will help . ’

  That meant a pop-up on her screen was telling her that ‘the option of a CCMD’ – Call Center Medical Doctor – was ‘not available’. Quack was to take faecal samples at once, temperatures every two hours, note all changes at twelve hours, twenty-four hours and forty-eight hours, take a second faecal sample after sixty hours.

  ‘. and as before, we’d appreciate all your notes. Gastroenteritis is very common, Mr Kolb. The body usually rights itself within a few days. Fluids, a light diet, common sense.’

  Quack knew he’d get no more.

  ‘No luck?’ said Little Andy, who was washing his hands for the fiftieth time in only a few hours. Quack’s orders had been absolute: if he touched one patient, he needed a thorough cleansing with soap and water before he touched another.

  Quack shrugged. ‘Where’s Monk?’

  ‘Dunno.’

  Quack had appealed to all the South Hams gang leaders, explained that they could lose men themselves for lack of nursing; they’d volunteered as many helpers as he could use. Monk was one of them, two hundred pounds of solid muscle, an albino – and a racist to the core – with swastikas tattooed on his skull, hardworking, tireless if stupid, superlative at keeping patients clean, and these patients desperately needed it.

  ‘Go find him, will you?’

  Quack went back to his measuring spoons. Baking soda, salt, sugar levelled off into a five gallon jug of water is a cheap, simple way to restore a dehydrated body’s chemistry as well as its fluids. Hundreds of ordinary people die in the heat of an Illinois summer, and the South Hams prison block was old and poorly ventilated. Temperatures often rose above a hundred degrees, stayed that way day and night for weeks. This rehydrating solution was one of the first practical remedies Quack had learned as a prison medic.

  That’s what had succeeded the first time around with this illness too. There’d been a quiet period before the second influx, five of them at once. Then two more, then a dozen by twos and threes. He and Andy had come to spend hours churning out his formula, a quart per man per hour. He’d had just enough equipment to get it beneath the skin of the ones who couldn’t take it by mouth.

  He was replenishing a bag of saline solution when the guards brought in another victim. ‘Who’s this?’ he said. The man was a wizened ancient who hung between the two guards.

  ‘Monk?’ said one of the guards.

  ‘No!’

  Quack stared at him. He was a shrunken relic of yesterday’s giant, a bag of bones, clothes glued to him, cheeks sucked in, eyeballs protruding, skin shrivelled on his hands and face. But his colour! This racist of a
white man had turned into a purple dwarf so dark he was almost black. There was no bed for him. Quack eased him down on the ground under the marquee.

  Monk was barely flat when he began to gasp. He clawed at his clothing, body raised up, eyes wild, tendons in his neck standing out like steel rods on a suspension bridge.

  ‘Andrew!’ Quack cried. ‘Left drawer. Syringe in the small box. Now!’ Little Andy came running. ‘Hold him down,’ Quack said, shoving the needle into Monk’s arm. The clawing and gasping went on a moment longer. Monk fell back onto the ground.

  ‘What did you do?’ Little Andy said to Quack a few minutes later.

  ‘His airways collapsed. Not an easy way to go.’

  Little Andy stared at him. ‘Did I just watch you kill this motherfucker?’

  Quack shut Monk’s eyes and nodded.

  ‘If he’s dead, how come his fucking mouth is still open?’

  ‘Because he’s so relaxed.’

  Little Andy looked from Monk to Quack and back again. ‘What’s going on here, Quack? It’s getting worse, isn’t it? I thought it was . ’ He trailed off.

  Quack gave a slight shrug. ‘I’m very much afraid we’re going to lose a couple more – maybe three – but my bet is that Monk is the last of the new cases.’ Quack turned back to him, then gave another slight shrug. ‘Don’t listen to me, Andrew. I don’t know what I’m talking about. Give me a hand with this poor guy, then get some sleep.’

  ‘You’re the guy that needs sleep.’

  The network of fine wrinkles on Quack’s face had come to look like a mat of spiderwebs. ‘I’ll manage,’ he said.

  ‘You can’t go on forever like this.’

  ‘Sure I can. I’ve been at it a long time now.’

  One day all those years ago when Quack had been David’s cellmate, David said to him, ‘You need something to occupy your mind.’

  ‘Mind? Who’s got a mind?’

  ‘You said once you wanted to be a doctor. Maybe it’s time to make a move in that direction.’

  Quack was still Brendan back then, still frightened of David – unsure just how far he could go – and David had that about-to-blow-up look that appeared on his face so frequently and so quickly. Quack began pleading, just as he did with Miss Pouria. ‘It’s too late for me. You know that.’

  ‘Do you want to be a doctor or don’t you?’

  ‘Of course I want to be a doctor,’ Brendan burst out, taken aback by his own passion. ‘I’ve always wanted to be a doctor. I can’t stop myself dreaming about it even now. I know where I want to practise: the eastern townships of Quebec, small villages – agriculture mainly. See, I’d get to know my patients that way. When I’m old and somebody brings little Maggie Pratt to me, I’ll be able to put a stethoscope to her chest and say, “Ah, yes, this is the asthma that her grandfather had.” Or maybe, “That murmur is the bicuspid valve she inherited from her mother.”’

  David was as taken aback by the outburst as Quack was. ‘Let’s get you a job in the prison infirmary.’

  ‘You’re kidding. What for?’

  ‘Start your medical training. We need a contact in there.’

  Prison gangs survive despite draconian measures to quash them, partly because prisoners need protection from each other as well as from the guards. Guards couldn’t do both jobs even if they wanted to, and they don’t want to. Somebody has to keep order. Gangs also survive because a prison’s thriving economy – its drug trafficking, protection, prostitution, smuggling, gambling, liquor – requires cooperation and laws. It needs somebody to regulate the flow of goods and services, and it requires enforcement when cooperation and law fail.

  David’s gang – the Insiders – ran the drug and liquor trade.

  ‘You’re the perfect cover,’ he said to Quack. ‘You know something about medicine.’

  ‘I don’t know a damn thing.’

  ‘Come on. What was it you just said? A “stethoscope”? A “bicuspid valve”? Sounds good enough to me.’

  Quack began his medical training only days later. Even back then, it was a Herculean feat to get a real doctor into a prison; for the most part they worked – as they had entirely for the past five years – by what’s known as ‘telemedicine’. Broken bones went unset. HIV and AIDS went undiagnosed.

  But the neglect gave Quack a free rein, not just to treat his own illness either. It was the hands-on part of treating patients that he loved. Just as with Little Andy – and for the same reasons – blood didn’t bother him. Nor did vomit or shit or gangrene or ulcerated flesh or any other bodily horror. He cleaned the infirmary himself. He scrubbed the floors, laid traps for the rats and the mice, poisoned the roaches. He took the manacles off patients, delivered the linen to the laundry himself, collected it. He learned quickly that few doctors know the generic names of drugs – even for the ones they prescribe regularly – and found that he could place orders for many that David’s gang were grateful to receive.

  In return, David arranged for the delivery of books in anatomy, physiology, urology, cardiology, virology, even gynaecology and obstetrics (these got stolen at once). Quack studied at night. He studied during meals. He studied as he walked in the exercise yard, nodding his head like a rabbinical student at a seminary as he memorized the bones of the wrist and the cranial nerves. Nobody bothered him. Everybody gave him respect.

  ‘He’s the doc,’ they said.

  ‘He be a straight-up dawg,’ they said. ‘Ain’t no sideways shit to him.’

  Quack’s voice was cadenced, unemotional, close to a chant. ‘Slowly . lower . Tracy’s . panties . to . the . curly . hairs,’ he said.

  ‘What the fuck are you talking about?’ said Little Andy.

  ‘Your skeleton, Andrew. Look at the skeleton your mother sent you.’

  The pressure was off. A week had passed since Quack’s call to Miss Pouria. He’d followed instructions, and he’d followed them exactly. Four of the sick men, including Monk, had died; Quack didn’t know what the death certificates said, but he’d have bet anything gastroenteritis figured in there somewhere. Maybe some viral strain: ‘viral’ covers such a multitude of sins. The live ones remained weak and listless, but they were back in their cells if not yet ready for hard labour.

  Little Andy and Quack sat in the cell that Andy shared with the toothless old inmate; Andy’s injuries had healed enough so that he finally could sit, provided he settled gently into the inflated ring Quack had made for him. But the cement walls and cement bunks acted like storage heaters; temperature and humidity were more relentless than ever, a situation made even more dire with the prison’s water supply on the blink. For the last twelve hours there’d been no water for the rusting metal toilet, and human shit stinks worse than any shit on earth. Anybody who’d shaved that morning, had had to shave with only sweat for a lubricant.

  The cardboard skeleton Lillian had sent dangled from one of the bunks. Quack was holding out its arm, but gingerly, using only two fingers so that he wouldn’t perspire on it. ‘We’re trying to remember the bones of the wrist, right?’ he was saying. ‘Scaphoid, lunate, triquetrum, pisiform, etcetera. One way to get them into your head is to match first letters to catchy phrases like Slowly Lower Tracy’s Panties . ‘ Quack laughed at the abrupt smile. ‘A couple of my books used to belong to an Australian medical student. I found lots of these scribbled in the margins.’

  ‘They all like that?’

  ‘Some of them are much more fun. Just wait till you get to the cranial nerves.’

  ‘What was really wrong with those guys, Quack?’

  Quack just shook his head.

  ‘I ain’t swallowing that,’ Little Andy said.

  ‘Andrew, I really don’t know.’

  ‘Not gastroenteritis though, huh?’

  Quack shook his head again. ‘At first I thought it could be cholera. But then—’

  ‘Cholera! Ah, come on. That makes guys turn blue?’ Andy was studying his own pink palms. ‘Nah. You couldn’t have thought that. That’s
what they get in Africa.’

  ‘There’ve been outbreaks here from time to time. It’s one of the reasons they put chlorine in public water supplies. Water supplies do get polluted though. The thing is, at least one of these men died of kidney failure, and cholera doesn’t produce bloody urine. Not that I’ve ever seen a case of cholera before.’ Quack took in a breath. ‘I’ve seen guys with blue lips and fingernails, toenails: heart patients, bad bronchitis, asthma, that kind of thing. Men get so cold in winter here their hands and feet turn blue. But I’ve never seen whole bodies change colour like that.’ He took in another breath. ‘It’s a pretty word: cyanosis. It comes from the Greek for blue: the blue disease – not enough oxygen in the blood.’ Then in a rush: ‘Medical Services Direct has never been openly obstructive before. If somebody’s really sick – or sick in some unexpected way – I’ve always talked to a doctor about it. I thought maybe it’s a little-known communicable disease, and they’d have to notify Public Health. There’d be an investigation. Not a good idea. People might find out what’s going on here. I mean, can you see a call centre setting up a situation where, say, Illinois Prisoners’ Rights might poke its nose in? Maybe even somebody really big like Amnesty International?’

  Little Andy laughed. ‘You telling me a bunch of do-gooders are going to make corporate America quake in its boots?’

  ‘Can’t you just see the headlines, Andrew? “Slave labour in American prisons”? “The Illinois Gulag”? Nobody really gives a damn about hard labour for prisoners – as long as they don’t drop dead on you. Four of these did.’ They’d all died before the ambulance arrived to take them away; Quack himself had shut their eyes. ‘UCAI had to close down a massive pharmaceutical enterprise only a couple of years ago because it got some seriously bad headlines. Markets are jittery. Another major scandal, and even this giant’s stock could collapse.’

  A shrill alarm rang throughout the prison to signal the next shift of workers on the canal, and a rustle along the corridor – men pulling themselves off cement beds – added a brush-drum to the cacophony of radio, singing, clanging, crying, shouting, stamping that never died out in the cell block. Neither Quack nor Little Andy paid attention; just as Quack had promised, infirmary work meant Andy was excused from work on the canal.