by Matt Richtel
“I got it.” Jerry turned and unfurled a rope and, with some ceremony, tied a fancy knot and flung the rope down into the breach. Jerry clearly had his attributes. He pulled the rope, testing it. “Okay.”
Lyle pulled out the plastic gloves, making a show of it himself, and snapped them on. It echoed a sound he associated with “game on.” The gloves always were the last thing he’d done before he walked into a disease scene. He stuffed the flashlight into his back pocket. He swung his legs into the hole. With his right hand, he grasped the rope handle the makeshift ladder was tied onto. Then he changed his mind. He reached down and felt the dangling rope with his right hand. He extended his left to Jerry. The first officer took it.
After a few seconds of wrangling, he found the position he wanted; his legs wrapped around the rope. He lowered himself, feeling with his right hand and letting Jerry hang tight to his left arm.
“Good,” said Lyle.
Jerry let go.
Lyle slid down the rope. He lost his grip. The flashlight flew from his pocket. He heard it slam to the ground right before he did. Ankle, he thought, just twisted. Just twisted. He winced. He suspected it was worse than that. Nothing broken. But contusions and scrapes.
“Dr. Martin.”
“I’m . . . I’m okay.”
Holy shit, it was cold. And dark. The only immediate light came from above, Jerry’s flashlight. Some other ambient light shone to the right, distant, a building Lyle couldn’t make out. Lyle tested his left ankle. Definitely a sprain. He decided to give it a rest and sat on the ground. Frozen ground met his ass. He jammed his hand into his right pocket and pulled out a bottle. His brain crackled happily when the vodka hit the back of his throat. He wiped his mouth on his sleeve and decided not to have another one.
“Dr. Martin?”
“Just getting my bearings.”
He pawed for the pieces of the flashlight. But he knew it was hopeless. Brittle plastic had collided with frozen ground. He remembered his phone and pulled it out and ignited the flashlight feature. It would drain the battery. The alternative was to ask Jerry for his flashlight and that just meant more complications.
Lit by his phone, he stood and walked toward the man in the orange jumpsuit.
Seven
Eleanor and Alex saw edges of light peek from around Lyle as he appeared beyond the nose of the plane. The slightest phone light framed him.
“Do you think they’re okay? Back home?” Alex asked. “Are they . . .”
“Hmm,” Eleanor said, focused on Lyle.
“Why not use the big light?” Alex mumbled, referring to the Boeing’s external lights.
“I don’t want to bring attention.” Eleanor clenched her teeth. She even wanted to whisper to Lyle: Turn off the light. It brings attention.
Lyle got within five feet of the orange lump on the ground. He turned off the light. He must’ve been having the same thought as Eleanor. But from the flight deck, who the hell knew what he was doing?
They could see Lyle suddenly pause. He bent at the waist, to about seventy degrees.
“What’s he doing?” Alex said.
“He’s looking for blood.”
Lyle marveled at the silence. It was so quiet as to be distracting. Just him and an unseen power, overwhelming silence as its emblem.
He waited for his eyes to adjust. Five feet away from the body, he concluded there was no bullet or shrapnel that had felled this body. That was evident from the way the man—it was a man, right?—had fallen. Not ripped from the ground, not propelled. But toppled, on his side, more or less, face flat. The man fell as Lyle had seen other bodies fall naturally. In Tanzania, one of the adolescent sons of a tribal elder had taken his last step in the direction of a water tank. His foot sunk into the soft dirt and he fell to the side, midstep, a recently deceased statue in perfect human form.
He took two steps forward and stopped again. Now he was sure it was a man, the jawline gave that away. Caucasian. Stringy long hair appeared from the edge of a wool cap. His hairstyle made Lyle think the man was youngish, twenties or early thirties, maybe someone who snowboarded, though that extraneous observation faded. The man’s right arm stretched forward onto the ground. Did that mean he’d had a second to brace himself for the fall?
Lyle took two steps forward and knelt at the body.
Eleanor tasted blood. She’d bitten her lip. She wanted to call Lyle back. Her gut told her this wasn’t right. She shouldn’t be sending a passenger out there, and, was that motion there, over to the right of the airplane, by the hangar? “Jerry!” she yelled.
Lyle was twenty feet, she guessed, from the tip of the plane. It was too dark to distinguish shapes. His lump of black melded into anything else. “Jerry. Get him back in here!”
Calm overcame Lyle. He put his left hand on the man’s cheek. It was cold. That didn’t tell him a thing, and Lyle quietly cursed the lack of light and tools. That could be solved. He turned on the light on his phone. He shone it on the man’s face, the left eye, the one he could see. Yes, Caucasian, and long hair. Face rosy. That was worth noting. Blood had flowed there, either recently or before death. Lyle put the light beneath the man’s nose, looking for breath. If it was there, it couldn’t be seen in this light or was too faint.
Lyle put his hand on the carotid artery. Where are you, pulse? Nothing. Lyle repositioned his hand. A blip. Was it a blip? He lost it. He repositioned again. He couldn’t tell.
He scooted over and took the man’s right wrist. Same thing. He thought he’d found a pulse, then it seemed he couldn’t. His freezing hands weren’t helping. He blew on them through the rubber gloves.
He heard a scuffling sound.
Lyle turned off the light.
He looked in the direction of the hangar. Nothing. What could he possibly see? He closed his eyes and listened. Whatever scuffling he’d heard, or imagined, was gone. He could hear the distant hum of machinery. A generator, he guessed. Otherwise, the air filled with the silence of falling snow.
Lyle turned on the light again.
He looked at the man’s angular nose. A droplet of moisture hung on the right nostril. Mucus. Maybe useful. An immune response or a response to cold. In either case, the body had responded at some point, relatively recently. Be alive, Lyle heard himself think.
Lyle heard a sound behind him, a voice. He assumed it was Jerry looking for an update. Lyle put up his thumb without looking back.
He pulled back the light to get some context. The orange jumpsuit looked puffy, indicating clothing worn underneath. Good news, thought Lyle; if the man’s alive, his layers may have saved him. He was at least six feet tall, thin, sinewy with muscle. Lyle scanned upward along the body and saw the blood.
It was near the back side of the man’s head. Just a trickle. Must have come when the man hit the ground, Lyle surmised. Only one way to find out.
Lyle set the phone down and slid his hands under the body. He tried to feel for heartbeat and warmth but knew he couldn’t cheat this. He’d have to have the body turned over and get a good look, really confront this man. The thought jarred him. He tipped the body gently, trying not to injure a vertebrae. Gently, again, he lowered the body down.
He lifted the light. The man wore a name tag. Don.
“Hello, Don,” Lyle said. “Let’s see what’s going on with you.”
He looked at the temple where the blood originated. As Lyle had suspected, Don had scraped his head when he’d fallen. It indeed looked more like a scrape than a massive contusion. It was further evidence that the man had been able to brace himself, felt himself falling, perhaps, rather than hitting like a stone.
Lyle brushed the hair away from the man’s scalp. It was time to look into the man’s eyes. Peel back the eyelids and look for signs of life. He reached for his face.
Don’s body jerked upright.
Part II
Three Years Earlier
Eight
“Dr. Martin.”
“Dean Thomas, what
a pleasant coincidence.”
Lyle Martin nodded with a tight smile and kept up the slick steps at a trot, passing by the pantsuited woman under the umbrella.
“Dr. Martin,” Dean Jane Thomas called after him. Mix of plaintive and displeased. A tone no one likes to hear but she clearly liked to use. Next to her stood a man in a purple-checked gingham shirt and a blue suit a quarter size too small, the fabric tugging at his back and shoulders. The dean, exhaling audibly, walked after Lyle. In her non-umbrella hand, a phone cocked like a weapon. “I need to talk to you.”
“You know I cherish our meetings,” Lyle said without turning. “I’ve got lecture.”
“It started ten minutes ago, Dr. Martin.”
Now, reaching the tall glass doors of Genentech Hall, he turned. He looked at her, then the man in the suit, seemed to consider saying something about the dean’s cheap shot, half smiled, and turned back to the door. On the other side, Lyle’s assistant held a gray cardboard coffee tray, watching the scene unfold. “It’s cold,” she said to Lyle. “They’re lining up outside.”
“Lyle!” Dean Thomas called.
“Emily, can you arrange for me to chat with the dean,” Lyle said, taking the coffee too briskly, a wave spilling over the side and cascading onto the beach of his tan sweater. This completed the picture, the contrast between Dr. Martin, hair matted by sleep and drizzle, and the majesty of the nearly half-million square feet of marble and glass science hall at the University of California, San Francisco medical school. One of the world’s gems.
“Let this be a lesson to you, Emily. If you’re late for class, the dean will show up brandishing an umbrella.”
“I think she’s here for a different reason,” the young lady said, and then, realizing that Lyle knew that, reddened, a look that measured on the dial beyond humiliation and well into schoolgirl crush.
At the door, the dean lowered her chin, shook her head.
“You warned me,” said the man in the suit. His firm tone was a touch undone by the singsong of a southern Tanzanian accent, the mixed influence of Swahili, Portuguese, and military training. Hand at his side, he involuntarily made a fist and then unclenched it. “How long is this class?”
“Asshole,” the dean muttered, referring to Lyle, and followed the scientist and his intern. She had given up on catching him. She turned to the man. “Michael, I think I’d like to hook you up with Dr. Sanchez instead. She’s not . . .”
“An asshole?” Michael said.
The dean, in spite of herself, laughed bitterly. “Dr. Martin is not . . . He’s, how do I describe it?”
“Someone who drinks himself to sleep?”
This paused the dean in her tracks. “Actually, I don’t think so—the drinking part. I’m not sure where you got that information.”
“In any case, my government is not negotiable on this one. He’s the best and it’s got to be him. And soon. How do you say it: yesterday? This can’t get across the border.” Michael paused. “Or into the news.”
Half a hallway away, wet shoes squeaking on smudgy tile, Lyle arrived at the auditorium entrance. “Good morning,” he said to the handful of students standing outside. “I’m sorry I’m late. I wrestled my alarm clock to the death, and I won.”
It got an adoring laugh that Lyle didn’t seem to be asking for, or even particularly notice. “Dr. Martin,” called a med student in the clump, clutching a biology tome to his chest. “Will you hold office hours today?”
“He’s got an hour scheduled,” responded Emily.
She trailed him through the wooden doors of the spacious auditorium, clamoring with small talk, clacking of keys on gadgets, and, as Lyle made his way down the aisle, the brushing of backs on chairs. A capacity crowd filled the 268 seats, with a handful of others plopped on the ground in front of the stage. The popularity of these twice monthly lectures owed in no small part to Lyle’s little rivaled capacity for mixing war story with substance. Some academics come off like orchestra conductors, prim and distant, others like the Beatles, brilliant but singular and unapproachable. Lyle more like Keith Richards, an everyman with serious licks. Or maybe a thirty something, Harrison Ford, the disheveled version, but hunting for disease and not treasure. The kind of things students loved—but some colleagues resented because it didn’t fit their scholarly mold.
“If it makes them feel any better, you’re totally inaccessible emotionally,” Melanie had told him in the previous night’s version of toe to toe.
No response from Lyle on that.
“At the risk of repeating myself, you weren’t always like this, Peño.” That was her nickname for Lyle, “Peño,” short for Jalapeño, reflecting the sizzle nature of their relationship the first few years.
Lyle hiked the four stairs on the right side, strode to the podium, looked up and then . . . full stop. He gazed out at the audience, now come almost fully to attention, and he seemed to have lost all momentum. Many onlookers assumed he was centering himself, and the place. The ones near the front of the room, though, they wondered if it was something else. Were those tears in Lyle’s eyes?
It crystallized into such a particular moment that it was impossible to ignore the pop when someone near the left side of the auditorium broke a gum bubble. This yanked Lyle back from wherever he was visiting in his mind. He cleared his throat, reached into his back pocket, and pulled out notes. Unfolded them onto the lectern.
“Where were we?” His voice projected over the microphone. A piercing screech followed from the microphone. Lyle tapped it, and the interference receded. He glanced at his notes.
From the audience, a woman shouted, “Saudi Arabia!” The voice rang just at the same moment Emily was saying the same thing—“Saudi Arabia”—from behind the curtain to Lyle’s left.
“Saudi Arabia,” Lyle said. “That’s right. Hickam’s dictum.”
He looked up.
“Hickam’s dictum,” he repeated. “We’ve talked about Occam’s razor.”
Occam’s razor, a key principle in medicine, says that when there are competing theories to explain a medical condition, the doctor should favor the simpler one. Or, as Sir Isaac Newton restated the fourteenth-century logic: “We are to admit no more causes of natural things than such as are both true and sufficient to explain their appearances.”
Lyle glanced at the group. “It can be tempting to look for complex causes and diagnosis. But that often is a form of self-deception, the seeds of imagination, vain hope. Often, things are just as simple as they might appear, much as we are inclined to dupe ourselves.”
Again, he paused, something odd. Where exactly was he going with this?
Dr. Martin, Emily mouthed inaudibly, wishing she could whisper in his ear.
The silent admonition seemed to make its way to him through the ether, or maybe he realized he was getting off track. “As a clinician, it is not necessary to overcomplicate things, Occam’s razor. Much as we’d like to discover something extraordinary, it’s usually, I’m sorry to say, just a head cold.” Some laughter. “Bed rest and fluids will do the trick.
“But then, along came Dr. John Hickam. He gave us permission to get our money’s worth out of medical school.” Lyle explained that Hickam’s principle allows that multiple symptoms often can be explained only by multiple diagnoses—not just a single disease or pathology but, in fact, several. This comes into play, in particular, when you have a patient with a compromised immune system.
Lyle scanned the auditorium. “There’s a great phrase to describe Dr. Hickam’s dictum. It goes like this: the patient may have as many diagnoses as he damn well pleases.” Laughter. “Which brings us to Saudi Arabia.” He told them previously that he’d done some early training in the Epidemiology Outbreak Office for the Centers for Disease Control. After doing a stint like that, the government would occasionally ask Lyle, or others in the program, to visit a place or person in need of a specialized medical consult.
“A guy in the State Department called and asked me if I’
d go visit a government minister in Riyadh,” Lyle told the audience. He said the State Department officer told him that the guy had MERS and wasn’t responding to treatment. First class ticket, three-day turnaround, Lyle could stay at a palace.
Lyle seemed not to notice how much he had his audience rapt. He did, though, notice the dean, standing in the aisle near the back, and, more than her, he noticed the man next to her, wearing the too-tight suit. The man stood solidly, not rocking back and forth impatiently like the dean, watching Lyle, studying him.
“I’m sure you’ve read up on MERS,” Lyle addressed the students. “But as a refresher . . .” He told them about Middle East respiratory syndrome coronavirus. It reared its head in 2012 in Saudi Arabia, thought to originate in camels. Symptoms include severe cough, gastrointestinal issues, kidney failure. It can be fatal. Lyle flew to King Khalid airport in Riyadh, got whisked past to a midlevel palace and an opulent bedroom turned medical suite with a man in his seventies prone in a gold-posted bed under a canopy. The minister.
Next to the bed stood a bodyguard in telltale fatigues, and a nurse with ice for the old man’s lips and, cross-armed, his doctor, looking grave. The doctor gave Lyle an update: a CT scan showed a nodule on the lung, consistent with a MERS diagnosis, diarrhea, mostly consistent with it, and also stiff neck, light sensitivity, bouts of confusion.
“What’s lesson number one?” Lyle asked his audience.
Voices from the audience in dystonic harmony: “Take a history.”
So much of infectious disease diagnosis comes from taking a careful patient history. That was the thing Lyle told this class, and every class, on day one. Get a pet history, food history, sexual history, ancient history, and new history. Frontline doctors, in the emergency room or even at clinic, can see symptoms consistent with a pathology, make a fairly reached conclusion about diagnosis but one that is at odds with history.
