Sam noticed a handwritten note on the edge of a sheet of paper on his chart. It said, “Patient does not know Erin or Clifford.”
Sam read through the rest of the chart. It had been thrown together hastily by the nurse and Amoy. It was subtle, and unless you had read several hundred charts, you wouldn’t have noticed it. But fear was creeping in. The nurses did not take the time to fill out the chart properly and ask all the questions that needed to be asked. They wanted less and less to do with these patients.
“Would you mind sitting up?” Sam said. “I’d like to take a look at the rashes on your back.”
Amoy helped her as she lifted Jake up to a sitting position on the bed. She saw his abdominal muscles and the striations in his shoulders and concluded that he was perhaps some sort of athlete or at the very least a gym rat. But she could already see the gray, sagging skin on his face and body, and the way it took two people to even help him sit up indicated that the disease, whatever it was, was multiplying at an enormously quick pace. He had displayed symptoms and almost immediately had to be admitted to the ER. Sam ran through a list of viral infections that could cause such a quick change. She could think of several, along with a host of their mutations: smallpox, influenza, meningitis, and Ebola…the list could go on and on.
The rash on his back was fading and she didn’t notice any pustules, but she did see a slight discoloration just over the lungs. His skin appeared shiny and black in jagged splotches. It seemed like a dark purple bruise covered his whole body. It was blood, just underneath the skin. His lungs were bleeding.
“Okay,” she said, gently helping him back down. “You let us know if you need anything. We’re gonna have someone come take your blood in a minute and run some tests.”
“What is it, you think?”
“Viral infection of some sort. Did Dr. Amoy tell you there’re three other patients here with the same symptoms?”
“Yeah.”
“Well, we’re working as fast as we can to figure it out. In the meantime, you’re not going to be going anywhere, so if there’s anyone you’d like to call please buzz the nurse and she can do it for you. We have speaker phones and you’re free to use them.”
“Thanks.” He closed his eyes. “I feel like I’m getting hotter.”
“We’ll get you something cold to drink.”
Sam walked out of the room and Amoy followed. He appeared nervous and she wondered whether it was from the disease or the fact that it was his hospital that would be in all the newspapers.
She heard the ding of the elevators and two men in suits stepped off. One of them was pasty white with a slightly pink, balding head and orange hair just above the ears. He turned to Sam and Amoy and began walking toward them as the second man followed.
“Dr. Bower,” he said, stopping before her as she removed her facemask and gloves and threw them in a biohazard bin. “I’m Dr. Terry Whitman. I’m the director of Queen’s Medical.”
“Nice to meet you.”
He smiled widely. “You as well. Ah, do you mind if we talk for a bit? Maybe grab a soda in the cafeteria?”
“Sure. I just need to change.”
It took Sam less than ten minutes to change. She didn’t feel she had to, but she took a quick shower and scrubbed herself twice with a bar of soap she had brought.
When she stepped out into the corridor, she saw Whitman turn to the man behind him and nod. He then offered her the elevator first and she got on, noticing that Amoy and the other man stayed behind.
“Have you been to the island before?” he said on the ride down.
“No, first time.”
“Well,” he said, turning to her, a smile on his face, “it’s a fun island…if you have the proper guide. I’d be happy to show you around when we’re done with today.”
Sam looked down and noticed the wedding ring on his finger. He immediately curled his hand so it was out of view.
“I would appreciate that, Doctor, but I’m on a strict timeline. I don’t leave the hospital much.”
“Understood,” he said, the smile disappearing from his face as he looked forward.
The elevator opened and they walked across the first floor down a long corridor with island art up on the walls. A group of young men and women in green scrubs were standing around, talking, and as they saw Whitman, they straightened up and exchanged a few more words before disbursing. One wasn’t quick enough and remained leaning against the wall. Whitman stared him down as they passed.
“Medical students,” he said to Sam when they were alone.
“I remember what that was like. I usually looked as terrified as they did when a boss walked by.”
“Not me. I figured most of the other students were kiss-asses so I took a different approach and had balls. I always told the attending and the chief what I thought if I ever got the chance.”
“Did it work?”
“Not really. That’s why I went back and got my MBA and got into management instead. Too much bureaucratic BS in medicine nowadays. Especially with managed care and the government stepping in.”
They turned down another corridor and into the hospital cafeteria. It was clean and open with enough seating for at least a hundred people. They were serving Indian food and the smell of broiling chicken and spices filled the air. It reminded Sam that she hadn’t eaten today and she made a note to get a plate of Indian food as soon as they were done speaking.
Whitman got two juices out of a cooler and cut in line, paid with a five, and left the change. They sat down at a table by the window. The sun was bright and warmed Sam’s cheeks and neck as she opened the juice bottle and took a sip.
“So any word on a culprit?” Whitman said.
“No. I would expect that our labs are growing a culture from the samples right now and that’s going to take some time.”
“But you have to have some guess as to what it is.”
“I do.”
Neither of them spoke for a long moment.
“You’re not going to make this easy on me, are you?”
“Dr. Whitman, I’ve been in this situation before. I’ve been at this table with other chiefs and directors having this same conversation. I know what you want to ask me so just ask me.”
“And what exactly do you think I want to ask you?”
“You want to ask me not to get the media involved and to keep this as quiet as possible. No hospital wants to be the epicenter of an epidemic and I don’t blame you.”
“So?”
“What?”
“So what’s your answer?”
“I will try to keep this quiet as long as possible, but not because of the hospital’s bottom line. Because a viral epidemic causes panic and people can’t think when they’re panicked. It just makes things more difficult for us. But I will tell you that eventually word will get out and reporters will be all over this hospital. When it gets near that point, it’ll be much better if we control the message and hold a press conference. But that isn’t my department.”
“Whose department is it?”
“My boss’s, Deputy Director Wilson.”
He grimaced and took a long swig of the juice. “Then maybe he’s the one I should be talking to?”
“When we get the lab results, if it is anything to worry about, I promise you he’ll be on the next plane out here.”
Whitman leaned forward on his elbows. “You know why I became a doctor? I genuinely thought I could help people. Most people apply to med school for the prestige, but I thought that if I could really pick a good place to practice, somewhere without too many other physicians where I would really be needed, I thought I could make a difference.” He sighed. “But’s that’s just idealism. And idealism has no place in this.” He rose. “If word gets out prematurely, we will file a suit against you, the CDC, and the United States government. Make sure that it doesn’t.”
CHAPTER 8
Samantha finished her lunch of curry chicken and basmati rice and threw away h
er paper plate and utensils. She went to the second floor near pediatrics to a small couch and table that were placed in a quiet area in the corridor and pulled out her iPad. She opened a document that listed the names of the four patients: Clifford Lane, Erin Simon, Allani Haku, Jacob Ichimora.
One of these might be the index patient: the point of origin. The one that spread it to the others. Unless of course the index patient had not been admitted yet. But they would be so ill that a hospital or clinic would be the only alternative and Amoy had sent out an announcement to all the hospitals and clinics on the island—which were only a handful—to notify them of any patients that were admitted with similar symptoms. There were no hits as yet, so Sam had to go forward on the assumption that one of these four was the index.
Once the index was found, she then had to scour his life and determine where he could have picked up the virus. Its origin would tell them as much about the disease as they would find out in a laboratory.
Logically, the patient with the worst symptoms had the latest stage of a disease, which meant they had carried it the longest. In this instance, that was Clifford Lane.
She opened Clifford’s file, which she had scanned as a PDF, and began reading all the information they had about him. But the hospital file was like a resume. Birthday and genetic history wasn’t the type of information she was looking for. The best place to search for the information she needed was on a patient’s Facebook and Twitter accounts. Clifford Lane could no longer speak or respond to voice commands. She would have to find out the passwords to his accounts another way.
At the back of the file was a list of emergency contacts. The first was his wife, Suzan Lane. There was an address and a phone number. She took out her iPhone and dialed. After three rings she heard Clifford’s voice and realized it was his cell number.
Sam walked out of the hospital into the parking lot and hailed a cab from a line of three that were waiting for passengers. While she was thinking about it, she scheduled a time tomorrow on her calendar to go rent a car.
“Where to?” the cabbie said in a thick, Hawaiian accent.
“1572 Kalakaua Avenue.”
They pulled away from the hospital and onto the streets. It was overcast today and she usually responded poorly to bad weather. She had been troubled by seasonal affective disorder since she was a child. On snowy or rainy days, she would sometimes get so depressed she couldn’t function. Her mother had tried to get her on antidepressants but since it only occurred during bad weather, Sam refused. She figured a better cure was to move somewhere with a temperate climate.
“Where you from?” the cabbie said.
“Montana originally.”
“Lotsa cows.”
“There are definitely lots of cows, yeah.”
“What you doing here?”
“Visiting some patients. I’m a doctor.”
“Oh yeah? You know my wife have diabetes and they said that she losing circulation to her foot. Will they have to cut off her foot?”
“Ten years ago I’d say yes. But in this day and age they shouldn’t have to do that.”
“Yeah, that’s what I think. But doctors say they may have to.” He chuckled. “She loves cream and butter mochi. You had this yet?”
“No, what is it?”
“Very very good dessert. You have to have it. But don’t go to restaurant. On the streets you see, um, merchants, and they sell. Much much better.”
“I’ll have to try it.”
They rode in silence a few minutes and then the cabbie would ask another question about diabetes or about his cousin who’s getting migraines or about the thousand other medical concerns she was asked about every day. It often surprised her how much need there was for medical doctors and how few the medical schools were actually training.
She arrived at the address and asked the cabbie to wait for her. He turned off the meter and said it was for answering his questions and then pulled out a magazine and began to read. Sam stepped out of the cab and saw a two-story house with concrete steps leading up to the front porch. The steps and pavement leading to them were cracked and weeds were growing out of them.
Sam walked to the front porch and, as she knocked on the door, noticed the stains on a rocker that was placed outside. From inside she heard some motion, things being moved, and then she heard a toilet flush. A woman came to the door and opened it, peering over the chain that connected the door to the frame.
“Yes?”
Sam could instantly smell the marijuana smoke coming from the home.
“Mrs. Lane?”
“Yes, and who are you?”
“My name is Samantha Bower. I’m a doctor with the Centers for Disease Control. I’m one of your husband’s physicians.”
“Oh, hang on.”
She closed the door and slid open the chain before opening the door all the way. “Is there news?”
“No, I’m sorry. Clifford is about the same, last time I checked. I was just wondering if we could talk for a few minutes.”
“Sure, come inside.”
The home was messy. Books and dishes and clothes were left out, like they had been too busy to clean up, but the entertainment center with the large screen television and state-of-the-art stereo was spotless. On the walls were posters of rock climbers, snowboarders, explorers, and surfers. A golden retriever sat on the couch, eyeing Sam suspiciously.
Suzan sat on the couch next to the dog and began petting it, running her fingers through his fur as she put her sandaled feet up on the coffee table. Sam sat across from her on the love seat. She saw the burnt remains of a joint in an ashtray. Suzan saw that she had noticed and panic gripped her face for an instance before it faded away.
“You’re not gonna call the cops, right? Doctor patient privilege and all.”
“Technically you’re not my patient, but, no, I don’t care.”
“It’s medicinal. I got a medicinal license from California and the chief of police here don’t care if you smoke if you got a medicinal license from another state.”
“It’s really none of my business, Mrs. Lane. I’m just here to see if there’s anything I can do to help your husband.”
She looked down, biting her lower lip as she gripped the dog’s fur tighter and then let go. “He’s a good man. He ain’t never hurt anybody in his life.”
“I have to ask you some sensitive questions, Mrs. Lane.”
“Suzan.”
“Suzan, I have to ask some questions that are going to make you uncomfortable. Is that all right?”
“More uncomfortable than my soul mate dyin’ in the hospital?” she said, a little annoyed.
“I’m sorry. I didn’t mean it that way.”
She took a deep breath and leaned her head back on the couch. “I know you didn’t, sweetheart. I’m sorry. I’m just beside myself, you know?”
“I can’t imagine what you’re going through right now but I want you to know, Suzan, that I—we—are doing everything possible to make your husband well again.”
“I believe you. So, what’re these questions?”
She pulled up a note-taking program in her iPad. “Has Clifford ever had a blood transfusion?”
“No.”
“Has he ever done any illegal drugs?” They both smiled and Sam blushed. “I’m sorry. I meant has he ever done any intravenous drugs?”
“No. Well maybe when he was a kid, like sixteen or seventeen. He had some crazy years.”
“Did he ever tell you whether he shared needles or anything like that?”
“No.”
“How many sexual partners has he had in his life?”
“In his life? I have no idea. I think he said nine or ten, but you know how men lie about that.”
“How many sexual partners have you had?”
“Twelve.”
“When was the last time you and Clifford had sexual intercourse?”
“Um, some four weeks ago. Somewhere around there.”
“Hav
e either of you ever had an extramarital affair?”
There was pain on her face and she glanced away. “Yes. I had an affair about three years ago. With a younger man; nineteen. You’re still young and don’t think this way, but when you get to be my age, the attention of younger men is very flatterin’. It lasted about a month.”
“How old are you if you don’t mind my asking?”
“Thirty-nine.”
“How many sexual partners do you think the man you had an affair with had?”
“No idea. I don’t even remember his last name.”
“Have you or Clifford ever had any sexually transmitted diseases?”
“Yes.”
She waited a moment but got no response. “What type?” she finally said.
“I had chlamydia twice. He had herpes.”
“Right before he got sick, did Clifford begin spending time with anyone new in his life?”
“Why? You think he was having an affair?”
“No, not that. Just curious about new friends or social clubs. Anywhere he might be exposed to new people he wasn’t exposed to before.”
“No, I don’t think there was anythin’ like that.”
“His chart just said he’s self-employed. What does he do for a living?”
“Tour guide.”
Sam looked up from her iPad. “Where?”
“South America.”
“When was the last time he was there?”
“About a month ago. Peru, I think. An Amazon tour.”
“How many people were with him?”
“I don’t know. We never talked much about his job unless something weird happened.”
“When he came back, did he mention anything? Specifically anything about not feeling well?”
“No. He did say some other guy had gotten sick and he had to leave the tour early.”
“Sick with what?”
“Malaria.”
Sam took a few quick notes. “This is an unusual request, but is there any way I can look at his electronic data? I’m interested in his Facebook, Twitter, and email. If he had a blog or a Tumblr I’d like to see that too.”
“Oh, Clifford hated computers. He didn’t have an email address. He said they were corrupting and taking us away from nature.”
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