by Robin Cook
Marissa eyed the small opening, steeling herself to follow, but before she could act, Tad reappeared, hastily shutting the door behind him. “You know, I’m also planning to compare the structural polypeptides and viral RNA of your virus against the previous Ebola strains,” he said.
“That’s enough!” laughed Marissa. “You’re making me feel dumb. I’ve got to get back to my virology textbook before making sense of all this. Why don’t we call it a night and get that drink you promised me?”
“You’re on,” said Tad eagerly.
There was one surprise on the way out. When they had returned to the room with chalky walls, they were drenched by a shower of phenolic disinfectant. Looking at Marissa’s shocked face, Tad grinned. “Now you know what a toilet bowl feels like.”
When they were changing into their street clothes, Marissa asked what was in the room where he’d taken the dead mice.
“Just a large freezer,” he said, waving off the question.
Over the next four days, Marissa readjusted to life in Atlanta, enjoying her home and her dog. On the day after her return, she’d tackled all the difficult jobs, like cleaning out the rotten vegetables from the refrigerator and catching up on her overdue bills. At work, she threw herself into the study of viral hemorrhagic fever, Ebola in particular. Making use of the CDC library, she obtained detailed material about the previous outbreaks of Ebola: Zaire ’76, Sudan ’76, Zaire ’77 and Sudan ’79. During each outbreak, the virus appeared out of nowhere and then disappeared. A great deal of effort was expended trying to determine what organism served as the reservoir for the virus. Over two hundred separate species of animals and insects were studied as potential hosts. All were negative. The only positive finding was some antibodies in an occasional domestic guinea pig.
Marissa found the description of the first Zairean outbreak particularly interesting. Transmission of the illness had been linked to a health-care facility called the Yambuku Mission Hospital. She wondered what possible points of similarity existed between the Yambuku Mission and the Richter Clinic, or for that matter, between Yambuku and Los Angeles. There couldn’t be very many.
She was sitting at a back table in the library, reading again from Fields’ Virology. She was studying up on tissue cultures as an aid to further practical work in the main virology lab. Tad had been helpful in setting her up with some relatively harmless viruses so that she could familiarize herself with the latest virology equipment.
Marissa checked her watch. It was a little after two. At three-fifteen she had an appointment with Dr. Dubchek. The day before, she’d given his secretary a formal request for permission to use the maximum containment lab, outlining the experimental work she wanted to do on the communicability of the Ebola virus. Marissa was not particularly sanguine about Dubchek’s response. He’d all but ignored her since her return from Los Angeles.
A shadow fell across her page, and Marissa automatically glanced up. “Well! Well! She is still alive!” said a familiar voice.
“Ralph,” whispered Marissa, shocked both by his unexpected presence in the CDC library and the loudness of his voice. A number of heads turned toward them.
“There were rumors she was alive but I had to see for myself,” continued Ralph, oblivious of Mrs. Campbell’s glare.
Marissa motioned for Ralph to be silent, then took his hand and led him into the hallway where they could talk. She felt a surge of affection as she looked up at his welcoming smile.
“It’s good to see you,” said Marissa, giving him a hug. She felt a twinge of guilt for not having contacted him since returning to Atlanta. They’d talked on the phone about once a week during her stay in L.A.
As if reading her mind, Ralph said, “Why haven’t you called me? Dubchek told me you’ve been back for four days.”
“I was going to call tonight,” she said lamely, upset that Ralph was getting information about her from Dubchek.
They went down to the CDC cafeteria for coffee. At that time of the afternoon the room was almost deserted, and they sat by the window overlooking the courtyard. Ralph said he was en route between the hospital and his office and that he had wanted to catch her before the evening. “How about dinner?” he asked, leaning forward and putting a hand on Marissa’s. “I’m dying to hear the details of your triumph over Ebola in L.A.”
“I’m not sure that twenty-one deaths can be considered a triumph,” said Marissa. “Worse still from an epidemiologic point of view, we failed. We never found out where the virus came from. There’s got to be some kind of reservoir. Just imagine the media reaction if the CDC had been unable to trace the Legionnaires bacteria to the air-conditioning system.”
“I think you are being hard on yourself,” said Ralph.
“But we have no idea if and when Ebola will appear again,” said Marissa. “Unfortunately, I have a feeling it will. And it is so unbelievably deadly.” Marissa could remember too well its devastating course.
“They couldn’t figure out where Ebola came from in Africa either,” said Ralph, still trying to make her feel better.
Marissa was impressed that Ralph was aware of the fact and told him so.
“TV,” he explained. “Watching the nightly news these days gives one a medical education.” He squeezed Marissa’s hand. “The reason you should consider your time in L.A. successful is because you were able to contain what could have been an epidemic of horrible proportions.”
Marissa smiled. She realized that Ralph was trying to make her feel good and she appreciated the effort. “Thank you,” she said. “You’re right. The outbreak could have been much worse, and for a time we thought that it would be. Thank God it responded to the quarantine. It’s a good thing, because it carried better than a ninety-four percent fatality rate, with only two apparent survivors. Even the Richter Clinic seems to have become a victim. It now has as bad a reputation because of Ebola as the San Francisco bathhouses have because of AIDS.”
Marissa glanced at the clock over the steam table. It was after three. “I have a meeting in a few minutes,” she apologized. “You are a dear for stopping by, and dinner tonight sounds wonderful.”
“Dinner it will be,” said Ralph, picking up the tray with their empty cups.
Marissa hurried up three flights of stairs and crossed to the virology building. It didn’t appear nearly as threatening in the daylight as it had at night. Turning toward Dubchek’s office, Marissa knew that just around the bend in the hallway was the steel door that led to the maximum containment lab. It was seventeen after three when she stood in front of Dubchek’s secretary.
It was silly for her to have rushed. As she sat across from the secretary, flipping through Virology Times with its virus-of-the-month centerfold, Marissa realized that of course Dubchek would keep her waiting. She glanced at her watch again: twenty of four. Beyond the door she could hear Dubchek on the telephone. And from the telephone console on the secretary’s desk, she could see the little lights blink when he’d hang up and make another call. It was five of four when the door opened and Dubchek motioned for Marissa to come into his office.
The room was small, and cluttered with reprinted articles stacked on the desk, on the file cabinet and on the floor. Dubchek was in his shirt-sleeves, his tie tucked out of the way between the second and third button of his shirt. There was no apology or explanation of why she’d been kept waiting. In fact there was a suggestion of a grin on his face that particularly galled Marissa.
“I trust that you received my letter,” she said, studiously keeping her voice businesslike.
“I did indeed,” said Dubchek.
“And…?” said Marissa after a pause.
“A few day’s lab experience is not enough to work in the maximum containment lab,” said Dubcheck.
“What do you suggest?” asked Marissa.
“Exactly what you are presently doing,” said Dubchek. “Continue working with less-pathogenic viruses until you gain sufficient experience.”
“How
will I know when I’ve had enough experience?” Marissa realized that Cyrill had a point, but she wondered if his answer would have been different had they been dating. It bothered her even more that she didn’t have the nerve to withdraw her earlier rebuff. He was a handsome man, one who attracted her far more than Ralph, whom she was happy enough to see for dinner.
“I believe I will know when you have had adequate experience,” said Dubchek interrupting her thoughts, “… or Tad Schockley will.”
Marissa felt cheered. If it were up to Tad, she was certain that she would eventually get the necessary authorization.
“Meanwhile,” said Dubchek, stepping around his desk and sitting down, “I’ve got something more important to talk with you about. I’ve just been on the phone with a number of people, including the Missouri State Epidemiologist. They have a single case of a severe viral illness in St. Louis that they think might be Ebola. I want you to leave immediately, assess the situation clinically, send Tad samples and report back. Here’s your flight reservation.” He handed Marissa a sheet of paper. On it was written Delta, flight 1083, departure 5:34 P.M., arrival 6:06 P.M.
Marissa was stunned. With rush-hour traffic, it was going to be a near thing. She knew that as an EIS officer she should always have a bag packed, but she didn’t, and there was Taffy to think of, too.
“We’ll have the mobile lab ready if it is needed,” Cyrill was saying, “but let’s hope it’s not.” He extended his hand to wish her good luck, but Marissa was so preoccupied with the thought of possibly facing the deadly Ebola virus in less than four hours, that she walked out without noticing. She felt dazed. She’d gone in hoping for permission to use the maximum containment lab and was leaving with orders to fly to St. Louis! Glancing at her watch, she broke into a run. It was going to be close.
5
March 3
IT WAS ONLY AS the plane taxied onto the runway that Marissa remembered her date with Ralph. Well, she should touch down in time to catch him as soon as he got home. Her one small consolation was that she felt more comfortable professionally than she had en route to L.A. At least she had some idea of what would be demanded of her. Personally, however, knowing this time how deadly the virus could be, if indeed it was Ebola, Marissa was more frightened at the thought of her own exposure. Although she hadn’t mentioned it to anyone, she still worried about contracting the disease from the first outbreak. Each day that passed without the appearance of suspicious symptoms had been a relief. But the fear had never completely disappeared.
The other thought that troubled Marissa was the idea of another Ebola case appearing so quickly. If it was Ebola, how did it get to St. Louis? Was it a separate outbreak from L.A. or merely an extension of that one? Could a contact have brought it from L.A., or could there be an “Ebola Mary” like the infamous “Typhoid Mary”? There were many questions, none of which made Marissa cheerful.
“Will you want dinner tonight?” asked a cabin attendant, breaking Marissa’s train of thought.
“Sure,” said Marissa dropping her tray table. She’d better eat, whether she was hungry or not. She knew that once she got to St. Louis she might not get the time.
As Marissa climbed out of the taxi that had taken her from the St. Louis airport to the Greater St. Louis Community Health Plan Hospital, she was thankful for the elaborate concrete porte cochere. It was pouring outside. Even with the overhead protection, she pulled up the lapels of her coat to avoid wind-driven rain as she ran for the revolving door. She was carrying her suitcase as well as her briefcase, since she’d not taken the time to stop in her hotel.
The hospital appeared an impressive affair even on a dark, rainy night. It was constructed in a modern style, with travertine-marble facing, and fronted by a three-stories-tall replica of the Gateway Arch. The interior was mostly blond oak and bright red carpeting. A pert receptionist directed Marissa to the administration offices, located through a pair of swinging doors.
“Dr. Blumenthal!” cried a diminutive oriental man, jumping up from his desk. She took a step backward as the man relieved her of her suitcase and enthusiastically pumped her freed hand. “I’m Dr. Harold Taboso,” he said. “I’m the medical director here. And this is Dr. Peter Austin, the Missouri State Epidemiologist. We’ve been waiting for you.”
Marissa shook hands with Dr. Austin, a tall, thin man with a ruddy complexion.
“We are thankful that you could come so quickly,” said Dr. Taboso. “Can we get you something to eat or drink?”
Marissa shook her head, thanking him for his hospitality. “I ate on the plane,” she explained. “Besides, I’d like to get directly to business.”
“Of course, of course,” said Dr. Taboso. For a moment he looked confused. Dr. Austin took advantage of his silence to take over.
“We’re well aware of what happened in L.A. and we’re concerned that we might be dealing with the same problem here. As you know, we admitted one suspicious case this morning, and two more have arrived while you were en route.”
Marissa bit her lip. She had been hoping that this would turn out to be a false alarm, but with two more potential cases, it was difficult to sustain such optimism. She sank into the chair that Dr. Taboso proffered and said, “You’d better tell me what you have learned so far.”
“Not much, I’m afraid,” said Dr. Austin. “There has been little time. The first case was admitted around 4:00 A.M. Dr. Taboso deserves credit for sounding the alarm as soon as he did. The patient was immediately isolated, hopefully minimizing contacts here at the hospital.”
Marissa glanced at Dr. Taboso. He smiled nervously, accepting the compliment.
“That was fortunate,” said Marissa. “Was any lab work done?”
“Of course,” said Dr. Taboso.
“That could be a problem,” said Marissa.
“We understand,” said Dr. Austin. “But it was ordered immediately on admittance, before we had any suspicion of the diagnosis. The moment my office was alerted we called the CDC.”
“Have you been able to make any association with the L.A. outbreak? Did any of the patients come from L.A. ?”
“No,” said Dr. Austin. “We have inquired about such a possibility, but there has been no connection that we could find.”
“Well,” said Marissa, reluctantly getting to her feet. “Let’s see the patients. I assume that you have full protective gear available.”
“Of course,” said Dr. Taboso as they filed out of the room.
They crossed the hospital lobby to the elevators. Riding up in the car, Marissa asked, “Have any of the patients been to Africa recently?”
The other two doctors looked at each other. Dr. Taboso spoke: “I don’t believe so.”
Marissa had not expected a positive answer. That would have been too easy. She watched the floor indicator. The elevator stopped on eight.
As they walked down the corridor, Marissa realized that none of the rooms they were passing were occupied. When she looked closer, she realized that most weren’t even fully furnished. And the walls of the hall had only been primed, not painted.
Dr. Taboso noticed Marissa’s expression. “Sorry,” he said. “I should have explained. When the hospital was built, too many beds were planned. Consequently, the eighth floor was never completed. But we decided to use it for this emergency. Good for isolation, don’t you agree?”
They arrived at the nurses’ station, which seemed complete except for the cabinetry. Marissa took the first patient’s chart. She sat down at the desk and opened the metal cover, noting the man’s name: Zabriski. The vital-sign page showed the familiar complex of high fever and low blood pressure. The next page contained the patient’s history. As Marissa’s eyes ran down the sheet, she caught the man’s full name: Dr. Carl M. Zabriski. Raising her eyes to Dr. Taboso, she asked incredulously, “Is the patient a physician?”
“I’m afraid so,” answered Taboso. “He’s an ophthalmologist here at the hospital.”
Turning to Dr. Austi
n, she asked, “Did you know the index case in L.A. was also a doctor? In fact he was an ophthalmologist!”
“I was aware of the coincidence,” said Dr. Austin, frowning.
“Does Dr. Zabriski do any research with monkeys?” asked Marissa.
“Not that I know of,” answered Dr. Taboso. “Certainly not here at the hospital.”
“No other physicians were involved in the L.A. outbreak that I can recall,” said Dr. Austin.
“No,” said Marissa. “Just the index case. There were three lab techs and one nurse, but no other doctors.”
Redirecting her attention to the chart, Marissa went through it rapidly. The history was not nearly as complete as that done on Dr. Richter at the Richter Clinic. There were no references to recent travel or animal contact. But the lab workup was impressive, and although not all the tests were back, those that were suggested severe liver and kidney involvement. So far everything was consistent with Ebola Hemorrhagic Fever.
After Marissa finished with the chart, she got together the materials necessary for drawing and packing viral samples. When all was ready, she went down the hall with one of the nurses to the isolation area. There she donned hood, mask, gloves, goggles and booties.
Inside Zabriski’s room, two other women were similarly attired. One was a nurse, the other a doctor.
“How is the patient doing?” asked Marissa as she moved alongside the bed. It was a rhetorical question. The patient’s condition was apparent. The first thing Marissa noticed was the rash over the man’s trunk. The second thing was signs of hemorrhage; a nasogastric tube snaked out of the man’s nostril and was filled with bright red blood. Dr. Zabriski was conscious, but just barely. He certainly couldn’t answer any questions.
A short conversation with the attending physician confirmed Marissa’s impressions. The patient had been deteriorating throughout the day, particularly during the last hour, when they began to see a progressive fall in the blood pressure.
