by Judith Lucci
Robert gave her a half smile and said sardonically, “Don on vacation is perfect. He’s generally a pain during these kinds of things anyway.”
Alex nodded and added, “Oh, Robert, what are we going to do if we have a bioterrorism threat?”
“The very best we can, Alex, just like we always do. Come on, we’ve got work to do.”
Alex followed him out of the Cajun Café, visibly upset about what might be happening.
Chapter 4
The mood in the ED conference room was highly charged and palpably tense. Dr. Dave Broderick, the head of infectious disease at CCMC, Dr. Tim Smith from the Tulane Medical Center Tropical and Infectious Medicine Division, Elizabeth Tippett, media relations specialist for the hospital, Robert, and Alex sat around Alex’s conference table. Absent were Dr. John Ashley, chief of medicine, who was on sabbatical, and Don Montgomery, the supercilious and obnoxious CEO who was on vacation in the Caribbean. Also absent was the useless chief of nursing, Bette Favre. Rumor was that she was on the trip to the Caribbean with Don.
“Tim, what do you and Dave think we're dealing with here?” Robert asked, his face grave. He was feeling the full weight of his responsibility as interim director of medicine for CCMC in John Ashley’s absence.
Dave shook his balding grey head. “I’m not sure, Robert. It is a viral outbreak of some type but it doesn't appear to be Ebola or Marburg due to the onset of symptoms and hasty death of the one patient. Generally, it takes several days to develop and for the symptoms to become so severe.”
“Could it be rapidly mutating and that’s the reason the guy died so quickly?” Alex questioned.
“Possibly, but I don’t think so. And I certainly hope not," Dr. Smith replied. "If it is, we’re in for a bad time. There are currently six species of Ebola that are named for where they occurred – Bundabugo, Ivory, Cossi, Reston, Sudan, and Zaire. Of course, the very worst species, the one with the 90 percent kill rate, is Zaire. The Reston case is the only U.S. outbreak and that occurred in Reston, Virginia in 2005.”
Robert nodded his head. “Yeah, I remember that well. I was a resident at UVA in Charlottesville. That outbreak was near D.C. and there was a childcare center next door. It was pretty hush- hush.”
"Yeah, it was, but they were able to identify and control it very quickly. That’s what we have to do here,” Tim replied to Robert. “When does the CDC get here?”
Robert checked his watch. “Soon. Should be here in about 20 minutes. They’re coming by helicopter from Atlanta. The folks from the Special Pathogens Branch will arrive first. They will also send their mobile unit down by interstate. The mobile unit can handle quick testing with the most current technology for virus determination and testing. That will take another five hours.” Robert paused to answer his cell phone.
“Sandy, what’s up?” Robert’s faced grimaced as he listened to her words.
“What, Robert, what?” Alex persisted as she stared at Robert’s anxious face.
“There are two more patients who just came into the ED. Same symptoms of nausea, vomiting, and high fever. Fred Patterson needs help so I’ll go over there if you guys will meet and direct the CDC when they get in. Their ETA is soon.” Robert turned to Alex and Elizabeth, "Can you all figure out the best way to handle this with the staff and media? Frankly, I am more worried about our own staff than the press.” Robert headed for the door.
“We will, but we aren’t saying anything until we talk to the CDC,” Alex assured him. "We are doing this right!”
Just then, the hospital overhead page center announced, “CODE BLUE, CODE BLUE, ICU.”
Tim and Dave stared at each other. Tim said, “Well, Dave, that’s probably number two, the first patient that was admitted. Let’s get up there and see what we have." Before he left the room, Tim turned to Alex, Robert, and Liz, "Remember, it could be many things other than Ebola. It could be Marburg, Lassa, Dengue fever, who knows? I feel pretty confident, at this point, that it's a hemorrhagic fever, but it could also be something that we have never heard of."
Alex and Elizabeth shared a stunned look. This couldn’t be good, Alex thought to herself.
"Alex, phone up there and make sure they are using HAZMAT gear including the positive pressure personnel gear with the segregated air supply.” God, I hope they are, Tim prayed to himself. “Also, make sure they have two extra pressure suits for Dave and me. Thanks.”
Chapter 5
The medical center was bustling. CCMC was doing pretty well, under the circumstances, with a viral outbreak and potential bioterrorism threat. The medical and surgical units were quiet, but the emergency department was frenetic with activity. Emotions were intense and staff moved at a feverish pace. ED physicians, nurses, respiratory therapists, and other staff were dressed in full HAZMAT gear, the hospital ED was closed to all outside traffic, and only admitted patients with viral-like illnesses.
Alex was amazed as she looked through the glass at Sandy Pilsner. Sandy appeared relatively calm in the wake of a potential disaster. She had adjusted well to her HAZMAT positive air pressure suit and air hose, and seemed in control as she directed the ED and the Centers for Disease Control personnel. Alex was convinced Sandy could handle anything, and she pretty much had over the past year. Boy, we are lucky to have skilled folks like her, Alex thought to herself.
“Hey girl, what’s up?” Sandy asked through the glass partition.
“You tell me, Sandy. How’s it going in there?”
Sandy shrugged her shoulders. “Pretty good, I guess, considering. The CDC team leader is Dr. Yvette Charmaine who is from, guess where, New Orleans.”
Alex was surprised, “Great, how is she?"
“Yep, she’s one of us. She's an LSU undergrad, Harvard Medical School, and an infectious disease residency at Johns Hopkins. Doesn’t get much better than that, huh?”
Alex, always the Virginia girl, gave Sandy a quick smile. "Well, not too bad, I guess. But a stint at University of Virginia wouldn’t have hurt her,” Alex smiled playfully. "Give me a report, can you?”
“Sure, CDC hasn’t named the virus. They’re meeting with all of you, with administration, shortly with an update. We have three new admissions, one is currently meeting the criteria for the virus we saw earlier today, and he has been isolated in the first trauma room. The other two are being worked up. We have a total of two confirmed, one dead, and a total of five admissions, including the deceased patient. CDC decided to keep the known viral patients together to decrease any chance of contagion and have set up an infirmary in trauma rooms 2 and 3. Trauma 4 and 5 are available if we need them.”
Alex nodded. “I sure hope we don’t need then. How about the staff?”
“Stressed, but okay. They are getting tired. You know that no one can leave the hospital, right? We’re working 50 percent now and have let the others rest. The stress of the staff is the worse part.”
Sandy continued on seeing Alex’ prompt nod, “It would be good to keep the same staff working until we figure out what’s happening, less chance of cross contamination and besides, I am sure all of the lucky ED staff who are not working today will be happy to have a few extra days off, right?”
“Yep, I’m sure. I wish I wasn’t here,” Alex admitted.
“Yeah, me too. How’s Don taking this? I know how he is in emergencies and he’s probably beside himself with the impact of bioterrorism on our image.” Sandy shook her head.
Alex gave Sandy a great big smile and said, “Don's on vacation, in Aruba. So help me, we cannot reach him and that’s just fine. Of course, he wouldn’t come back anyway because he is such a chicken.”
Sandy gave her a big, wide grin. “I think that’s a blessing for you, Alex.”
“Yeah, it is. Robert and I are running the place. Scary, isn’t it! Wish us luck.”
Sandy gave Alex, ‘the look’ that Alex immediately recognized as she added, "Al, you and Robert really need to be running a life together. You know how much he loves you.”
Alex cut her off. “Not now, Sandy. Let’s talk when this is over. I don’t have time for this right now. Anything else I can do for you?” Alex’s voice was curt.
Sandy looked a little hurt by Alex’s reaction, but said, “No, I’ll call you when the CDC wants to report.”
“Thanks, girl. Love you,” Alex said as she hurried off, aware she had been rude to Sandy. I just wish they would all leave me the hell alone about Robert. I am sick of it. But I shouldn’t have been mean to her, on this day especially.
Chapter 6
Ali ducked into an equipment storage closet and dialed his brother's cell phone, a fearful dread thudded his heart.
“Allo,” Nazir answered on the second ring.
“Nazir, there is a bioterrorism outbreak here at CCMC and it’s not us,” Ali said softly into the phone.
“Whatever are you talking about? How could there be?" Nazir was stunned.
Ali was careful with his response. "I don't know who it is. We haven't isolated the virus yet, but it has already killed at least one person that I know of. There are others who are sick. The CDC is here."
"Who could do this?” Nazir demanded, fear in his voice.
"No idea but I’d guess Vadim. Gotta go,” Ali said, and hung up the phone.
Nazir could not sit and paced incessantly around his Marigny apartment. Could Ali be right? Was Vadim not to be trusted? Surely, he wouldn't be a big enough idiot to double-cross Nazir and the cell members. They were his countrymen. They were fighting for the same cause. Besides, a double-cross would be confirmation of an immediate death. Should he call his fellow cell members and ask for a meeting? No, he thought. This was his mission and he didn't want anyone to doubt his ability. Better to just wait and see what Ali finds out.
He stuck his memory card into his cell phone and began to listen to Jihadist hymns to settle himself down, calm his fears, and renew his commitment. The real truth was that he would need to run away if this mission failed because they would murder him and his brother without reservation. He would no longer have any respect or trust. Allah, please guide me, he prayed. Finally, the Jihadist hymns singing of victory and a new world calmed him and he dozed off. It didn't matter that the memory card was merely propaganda for recruitment into Jihad. To Nazir, it was a lullaby giving him comfort and confirmation of his cause.
Chapter 7
Dr. Yvette Charmaine calmly surveyed the group of medical professionals, hospital administrators, community leaders, and politicians seated around the ED conference room table. Their stress was evident and the cheat sheets provided for them by the CDC had only increased their anxiety. This was the part she hated the most about her job with CDC. She would rather care for a dozen patients with Marburg, Ebola, or Simian virus than tolerate the inane and often dim-witted questions of hospital administrators and politicians.
She’d already pegged the Mayor of New Orleans as a total pain in her butt who needlessly sucked up energy she desperately needed. His anxiety was uncontained and infectious, but she guessed a lot of that was because of the political Operation Fix America brouhaha scheduled to begin tomorrow. He had attempted to call her six times on her cell phone while she was assessing ill patients and even having her assistant return the call hadn't satisfied him.
Alex examined Dr. Charmaine with interest. She was strikingly lovely. Not beautiful in a classical sense, but she had magnificent cheekbones, a beautiful mouth, and the most expressive, green eyes Alex had ever seen. Alex likened her eyes to Columbian Emeralds and guessed her eyes appeared even greener due to the green surgical scrubs she wore. She had long, curly red-blonde hair that she had pinned up in a haphazard chignon with curls that were dying to escape and tendrils framed her face. All in all, she was a knockout. At 42 years of age, Robert said she was the youngest section leader in the Special Pathogens Branch of the CDC and destined to do great things.
"Alex, come here. I want to introduce you to Yvette Charmaine," Robert said, as he motioned her forward.
Alex moved toward the front of the room with her hand outstretched and a smile plastered on her face.
Robert continued, "Dr. Yvette Charmaine, I'd like to introduce you to Alexandra Destephano. She’s the legal counsel here at the hospital and a close friend. Alex is also a registered nurse."
Yvette accepted Alex's hand thinking to herself. Hmmm, so this is Robert's ex-wife. Why in the world would he divorce her? She's a knockout. She smiled at Alex and said, "Alexandra, how wonderful to meet you.” She lowered her voice and asked with a tight-lipped smile, "Any idea how this group is gonna be? This is the worst part of my job. Should I expect anyone to freak or fall out?"
Robert looked around the room and deferred to Alex.
She said, "Dr. Charmaine, it's hard to say with these folks. Most of them are okay, but I barely know Stuart Tansill, the Governor's assistant. I do think the Mayor will most likely be a pain. What do you think, Robert?"
“I think Alex is on target. There's nothing we can't handle here so we best get started."
Yvette nodded and eyed the group again. They were an impressive bunch that included Jack's nemesis, the newly elected Mayor, Anthony Devries, a mousy-looking guy with an obvious comb-over. The special assistant to the Governor of Louisiana, Stuart Tansill, Commander Jack Françoise of the Eighth District, and Jack's boss, Theodore (Ted) Scott, the NOPD Police Commissioner, who was in charge of and accountable for the security, safety, and welfare of all citizens and visitors to the city. Also included in the meeting were Elizabeth Tippett of CCMC media relations, Alex, Robert and Drs. Broderick and Smith from infectious disease from CCMC and Tulane. All of them looked expectantly to Yvette for answers. The Mayor, however, only looked impatient and angry.
Yvette checked her watch, cleared her throat, and began slowly. "Good afternoon. My name is Dr. Yvette Charmaine, and I am from the Centers for Disease Control in Atlanta." She looked around the room and continued, "I have the pleasure of knowing several of you, Dr. Bonnet and Commander Françoise, as I am a New Orleans native and graduated from college at LSU. It is good to see some old friends in the group." Yvette smiled warmly at Robert and Jack. Both men responded in like manner.
Elizabeth and Alex glanced at each other and rolled their eyes, and thought again how small the medical world, and indeed the world at large, seemed to be in New Orleans. Just earlier this year they had learned that Jack, Robert, and Dr. Monique Desmonde had grown up together. Now, it was old home week again at CCMC.
Yvette continued in her clear, well-modulated voice. "I received a call this morning from your ED department about a viral outbreak and a came up via helicopter from Atlanta to help you determine what was doing on."
She really doesn't sound like a native, Alex thought. I wonder how she got rid of that telltale accent.
The Mayor held up his hand to stop her, but Dr. Charmaine continued, uninterrupted, "Let me tell you a little bit about myself and the Special Pathogens Branch of the CDC. The SPB works with hemorrhagic fever viruses that are classified as bio safety level four. These viruses are generally Ebola, Marburg, and Lassa. Sometimes, they are difficult to identify because they change and mutate constantly. Currently, we are treating three individuals with some type of a hemorrhagic virus."
"So, which virus do we have here?" Elizabeth interjected, frantically taking notes. As media relations director for the hospital, Liz was responsible for all media statements, press releases, and responses to the press. Already news outlets had gotten wind of a potential catastrophe at the prestigious world-class hospital and TV vans, cameramen, and reporters had gathered outside the ED area.
"I don't know," Yvette said flatly. “I don't have any answers yet, but we are fairly certain we're looking at a viral hemorrhagic fever, or VHF, that has possibly mutated. I have not yet narrowed it down to a specific virus. Does everyone understand what hemorrhagic fever is?"
The Mayor erupted, "I don't give a damn what it is, I just want to know when you and the CDC are going to fix stuff aro
und here and get these people out of New Orleans. Do you realize the President of the United States, along with dozens of senators and congressmen, are arriving here today and over the next few days for the Operation Fix America political summit? We cannot have people dropping like flies from some sick, perverted disease probably caused by a monkey or something."
There was an audible gasp around the table. Alex was shocked, but Jack Françoise was absolutely furious. His face was suffused red with anger. It was a known fact to Jack's close friends that he and the Mayor didn't get along well. Frankly, they hated each other. Alex could literally see Jack's temper flaring up as she watched his eyes narrow and glitter.
Robert, always the mediator, noticed it as well and intervened, "Mr. Mayor, why not let Dr. Charmaine give us a report so we can all understand exactly where things stand now. We need for her to bring us up to speed." He gave the Mayor a deprecating, yet challenging look. Only Robert could get away with such behavior because his family was so politically powerful in Louisiana.
Alex gave Robert a furtive thumbs-up and noted a ghost of a smile on Jack's face.
The Mayor didn't respond verbally to Robert, but cut his eyes toward the CDC special leader and said, "Go ahead, Doctor. Tell us your plan." His voice was tinged with sarcasm.
Alex was amazed. Yvette Charmaine seemed unruffled by the Mayor’s rude behavior. Had Devries been that rude to her, she'd have jumped across the table and ripped out his carotid arteries. What a jerk, she thought to herself. Plus, he was gross with his slick baldhead and comb-over. His half-beard made him look like a rodent. She couldn’t stand to look at him. How in the world had he been elected Mayor of New Orleans?
Dr. Charmaine continued, "Viral hemorrhagic fevers are a group of illnesses that are caused by several distinct families of viruses. In general, the term ‘viral hemorrhagic fever’ is used to describe a severe, multisystem syndrome or simply said, a disease that can affect many parts of the body. It can cause major parts of the body to break down, like the heart, liver, kidneys, and so forth. The vascular, or blood vessel system is damaged, and the body's ability to regulate itself is impaired. These symptoms are often accompanied by hemorrhage or bleeding that can be very frightening but the bleeding itself is rarely life-threatening. What happens is that the walls of the tiny blood vessels become leaky and the patients may bleed from their mouth, eyes, ears or any other body openings," Dr. Charmaine added, noticing the look of confusion on the faces several of the men in the room. Mayor Devries face was dark as thunder and he clearly wasn’t up for a lecture in virology.
