by Mara, Wil
As Beck and Porter entered the neutral zone, they noticed the drop in air pressure—instead of pushing against them, it seemed to be pulling away. This sensation increased further when the first door hissed to a close and electronically unlocked the second. Infectious airborne particles needed positive airflow to move from host to host, but in a negative-flow environment, they were essentially sucked away before they had the opportunity. The positive-pressure atmosphere of connected areas further served to keep the infectious agents trapped within the AIIRs by surrounding it with what was essentially an invisible force field.
Then they caught the odor; even through the respirator, it was awful. A musky blend of fluids, pungent and sour and miserable. It reminded Porter of unwashed laundry and school locker rooms and mold-spotted food in the back of her apartment refrigerator.
For Beck, however, it conjured unwanted memories of a very different species. He tried to fight them off, but that wretched scent pulled him back, over seas and across borders and beyond the safety buffer of time. He began to recall his own words, as clearly as he had written them on the pages.…
Sunday, April 12
We all arrived in Yambuku today. Our single-engine plane landed in an open field near the village just as the sun was going down. I was hoping the heat would taper off in the darkness. But it has to be ninety degrees at least, and the humidity hung on us like a wet blanket. No sooner had we unloaded our gear than our pilot, a bone-skinny Kinshasan named Oudry, jumped back into the cockpit with profuse apologies and zoomed off again. Ebola is killing the Congolese by the thousands right now, and this is one of the hottest of the “hot zones.”
We stood there in the middle of the jungle with our gear around our feet, and I wondered if I’d made a mistake by asking for this assignment. No—begging for it. I pleaded until Maurice gave in and wrote me the recommendation. Like any good professor, he never wants to let go of his students. He prefers to keep them under his wing, like a protective parent. That’s because he’s an academic at heart, in love with classrooms and laboratories and libraries, whereas I want to get out there and start doing it instead of eternally studying it. He was disappointed, but I think that came more from fear than anything else. He thinks I’m going to make a mistake and kill myself. But what’s the point of all that training, all that education, all those years of hard work, if I can’t go out and make a difference? I’ve tried to tell him this a thousand times, but I don’t know if it ever sank in. In the end, he gave me the green light, and that’s all that matters now. Here I am, in one of the most neglected parts of the world. Our job is to study the outbreak in this area and see what we can do to get it under control. I’m feeling very confident of our success. I’m eager to show dear Maury what I’m capable of.
We picked up the bags and cases and walked the two hundred yards to the village. It lay at the base of a wooded hill, and the lights from the huts were pretty from a distance.
Monday, April 13
Very few of the adults are over the age of forty. Life expectancy here is around fifty-two, and that’s under normal conditions. The village leader is an elder named Guychel. He greeted us yesterday in a distinctly businesslike manner. The strain has drawn deep lines around his eyes, eyes that have seen too much suffering already. He’s missing two fingers on his left hand, and he walks with a slight limp. His voice, high and unsteady, speaks broken but understandable English. I already knew he had attended the Université de l’Uélé in Isiro but was unable to finish his degree. He returned to this village to care for ailing relatives who then died. Since the rest of the villagers knew of no one else with a formal education, they asked Guychel to stay.
We put on our protective gear in the morning as he led us to the makeshift hospital: nothing more than a mud-brick hut. Many eyes were upon us now, and, to be completely honest, I got a charge at being regarded like some kind of savior. Relatives loitered about, some of them crying, others so battered by grief, they looked dazed.
The sight that awaited us inside was terrible. Bodies lay on straw mats on the floor, arranged in such a fashion so as to create a racetrack-shaped walkway. Kerosene lamps sat on the little tables, sending up thin lines of black smoke. Some of the patients had their hands and feet tied because they writhed about as madness took them. Others lay still and awaited the mercy of death, their chests barely moving under stained blankets.
I crouched alongside one woman, whom I judged to be in her thirties, and got out my penlight. I inspected her eyes and found the whites had turned a cloudy pink. Another woman, a bit older, had signs of bleeding around the nose and gums, plus a rash on the roof of the mouth. The third patient was a very young boy; maybe five or six. He had a small toy truck clutched in one hand: a Matchbox. I couldn’t help but wonder where he got it from. Guychel told me his parents were already dead. His throat was so swollen, he was barely able to breathe. Pus ran from his tonsils in amber streams.
There were seventy-two patients in total. It took the five of us nearly eight hours to draw all the blood samples we needed.
Tuesday, April 14
In another mud-brick hut, slightly smaller than the hospital, we have our laboratory. I think they gave us this building because it’s the only one with a sturdy table. We had to separate the sera from the blood cells with a hand-generated centrifuge—a startling difference from the modern machinery back home—label each sample (also by hand), then pack them in dry ice. That also took hours. Oudry is coming in the morning to take them back for shipment to the States.
Two of the patients died in the evening. One was the little boy with the Matchbox truck. They buried him with it, next to his parents. There were no markers in the graves; the locals just knew where they were. They seem to know where everyone is buried.
Friday, April 17
We have now managed to separate the infected villagers from the healthy ones. That’s always step one in an outbreak—isolate the sick from healthy to keep the illness from spreading any further. Then, with Guychel’s help, I began interviewing people in the latter group to get a sense of where it originated. As far as I could determine, it was brought to this community by a young man named Prince. Prince had been in Badjoki—another Ebola hot spot just northeast of here—visiting a cousin. This is disappointing information, as we already knew about Badjoki. So Yambuku is likely not the location of the virus’s origin, but rather just another satellite zone.
There were six more deaths today, and four new patients.
Monday, April 20
There were seventeen more deaths over the weekend, and eleven new cases in spite of vigorous efforts to keep the healthy villagers from the infected ones. Most were parents. How do you tell a mother or father they cannot see their dying child? How do you summon the objectivity to physically force them from doing so? The five of us are not a security team. We cannot stand guard outside the hospital day and night.
Wednesday, April 22
They began burning the bodies this evening. Not only the recently deceased but also those who were already buried. We determined that they all continued to pose health risks, and Guychel supported us, so they went along with it. We helped out as best we could, although we are completely exhausted. Some of the bodies were only buried two or three feet down. I cannot describe the hideous condition of the corpses. The little boy with the toy truck already looked as though he’d been dead for a month. The toy truck tumbled from his folded hands and bounced on the soft earth. My God … piles of blackened, lifeless bodies, children being tossed into it by their weeping parents. The stench of rotted, boiling flesh as the smoke rose into the night sky. If I live to be a thousand years old, I will never get the scent of that pyre out of my memory. Now I know what death smells like.
Friday, April 24
K and I hiked up to another village about two miles away this morning after Guychel told us the outbreak had reached there. But we were at the site only about a hour before my cell phone rang. It was M, telling me I had to come ba
ck, there was some kind of emergency. He would not, however, give me any details, only that I needed to hurry. K and I are taking a break now, out of breath, but should get back within the next thirty minutes or so. I have never heard M so upset; he isn’t the type. I cannot imagine what’s going on, but something in my gut tells me it isn’t good.
THREE
“Michael?”
Ben’s gentle voice pulled him back.
“Hmm?”
Cara was staring at him, too.
He took note of them standing there and, with a mighty effort, shoved it all out of his mind. Pretending he didn’t see Ben’s ongoing stare of concern, he went to the patient’s bedside, his shoe covers shuffling softly on the polished floor.
McKendrick’s face was twitching, the pain relentless and determined. Beck’s instinct was to reach out, stroke the young man’s hair, tell him he would be all right. But the goal here, if the situation was to be regarded with the necessary objectivity, was to save those who could be saved. That meant the patient had to be viewed as a lab specimen: a source of information. Beck could never fully adopt this into his thinking, in spite of the many who had urged him to do so.
He checked McKendrick’s vitals—temperature 102.7 degrees F, heart rate 120, blood pressure 144 over 103, respiratory 23. All accelerated, even with the sedatives. There was a nuclear war going on inside this body, and the native forces were losing in a blowout.
He reached down and pressed on one of the larger pustules with his forefinger. It expanded outward for a second, the tissues straining visibly, then exploded. The honey-colored pus eased between the other blisters with a sluggish viscosity.
Porter said, “Do you want me to collect a sample?”
Gillette responded through the intercom—“You’re more than welcome to, but I’ve already collected several from that patient, as well as all the others, and sent them out.” He was watching through the observation window.
Beck leaned down to get a closer look at the exposed left arm. Even through the blistering, he could see the gathering darkness beneath the skin—a faint mauve scarlet.
“Do you recognize this?” he asked Porter.
“Subcutaneous bleeding, looks like.”
“Ben?”
“Correct.”
“And the others had it, too?”
“Yes.”
“Organs, everything?”
“Everything. When they did the autopsy on one man in his early sixties, they said his insides looked like a stew that had been cooking too long.”
Porter issued a tiny laugh. It would’ve been easy to dismiss this as insensitivity, but Beck knew she was merely focusing on the dark humor of it to protect herself. One of her many defense mechanisms.
He studied the ring finger more closely. It looked like the finger of a gorilla. Even if this man survives, that part of him is already gone, he thought. It was as if the finger served as a preview for the rest of the body a day from now.
McKendrick’s head lolled to one side, and a narrow string of blood ran from the corner of his mouth to the pillow. Taking a penlight from the bedside table, Beck gently examined the oral cavity. The tongue and gums were decorated with weeping sores of various shapes and sizes.
“Ben, has everyone had these ulcers, too?”
“Yes, to a person.”
In his bent-over position, Beck noticed the extensive bandaging on McKendrick’s right biceps.
“What happened to his other arm?”
“He tried to burn off one of his tattoos.”
“You’re kidding.”
“No, when the EMTs came for him, he was locked in his garage trying to burn off one of his tattoos with kerosene and a cigarette lighter. It’s a grinning spider, and he was screaming, ‘It’s going to eat me!’”
“A bit delusional,” Porter suggested.
“I’d say. Severe mental distress.”
“So the infection crosses the blood–brain barrier,” Beck said.
“It appears so.”
“God…”
He gingerly pulled the sheet down to McKendrick’s abdomen. Porter didn’t laugh this time, but instead let out a small gasp. The torso was covered with the same fluid-filled vesicles as the arms. It was like an uneven sheet of Bubble Wrap.
“That, too, is surprising,” Beck said.
“What’s that, Michael?”
“When Sheila and I were talking in the car, we both commented on how it sounded as though you could argue a case for smallpox. But then there were other symptoms—” He pointed to the chest area. “—like this that were inconsistent. Cara, see what I talking about?”
“Smallpox vesicles are usually concentrated on the arms, legs, and face.”
“Whereas these—“
“—are spread evenly across the patient’s entire body.”
“Right.” He set the blanket back carefully.
“They’re burning all the sheets after changing them, too.”
“Good idea,” Beck said. “Where’s the other patient?”
“In the next room here.” Gillette pointed down the corridor.
“I’d like to see her now.”
“Sure. But prepare yourself.”
He let Porter return to the neutral zone first, where she removed her PPE following standard procedure. Facial shield, bonnet, and shoe covers were placed in a burn bag. Then the gown, grasped at the shoulders and pulled forward so the contaminated outside layer was kept away from the body. The gloves came off at the same time, trapped inside the gown. Bare hands were washed in a small sink with microbial soap. The respirator was removed by pulling the rubber strap forward from the back. Finally, hands were washed again.
They returned to the scrub room and put on a fresh set of PPEs—including Gillette. Then they went to the second AIIR.
Beck immediately sensed something different. If the specter of Death were merely lingering in the last one, it had taken up residence here. In the corridor, the microblinds had been fully shut. Inside the neutral zone, Beck saw that the lights in the room were so low, they were nearly off. Funerary, he thought. It has the feel of a funeral. It was still and silent, save for the soft electronic beeping of the equipment. And, in spite of the microblinds, the patient was kept behind a curtain that someone had pulled all the way to the wall.
Beck glanced back at Porter, who stood behind Gillette with unabashed fear in her eyes.
“Are you okay?”
She only nodded, her gaze fixed on the curtain.
“Okay.”
He was not a man given to melodrama, unlike some he had encountered through the years. They used patients like exhibits in a freak show, through which they could impress and intrigue their audience. Beck despised them with the heat of a supernova, and he countered their toxic effect on the medical profession by performing his duties as nontheatrically as possible.
With that in mind, he brought the curtain back casually. As the patient came into view, however, his heart began pounding. From the corner of his eye he saw Ben lower his head and cross himself. Cara, her defenses stripped completely away now, said unevenly, “Oh my God…”
It was a woman in her late twenties to mid-thirties. Beck drew this conclusion mostly from her dark hair, which lay long and thick on the pillow. It had no visible streaks of gray or silver, nor did it bear the odd shades of artificial coloring. It was likely the only part of her anatomy still in its original form.
The face had been so radically altered that it was impossible to envision what she once looked like. The pustules ranged from marble-sized to a few that were as big as golf balls. One hung from her cheek with a sickening heaviness. Her eyes and mouth were partially open, as if she was awake but no longer possessed the ability to react. Her skin was an uneven dark purple now that the subsurface bleeding had reached an advanced state.
Beck checked her vital signs. “What’s keeping her alive?”
“I have no idea,” Gillette said, “but it won’t be much longer.”
The bedsheet, Beck noted, was different from McKendrick’s in that it covered her body all the way to the chin. It also had dozens of pale-colored moisture spots, the result of constant vesicle bursts. He had no doubt the nursing staff changed the bedding at the required intervals—they simply couldn’t keep up with the rate at which her body was deteriorating.
“Why is it bloody right there?” Beck asked, pointing to a spot alongside the woman’s midsection. It looked about where her hand would be lying. He also noticed similar spotting on the opposite side.
Without waiting for an answer, he leaned down and carefully lifted the bedsheet. Nothing could have prepared him for what he saw next.
First, there were piles of sloughed skin everywhere, blistered and crusted and sticky. They were literally sliding off her body like meat from the bones of a slow-cooked roast, then accumulating in small heaps.
The blood, Beck discovered, was running from a stomach wound that had been stitched shut and was covered by several layers of gauze.
“What happened?”
“A large kitchen knife,” Gillette said.
Beck turned back to him, incredulous. “She was stabbed?”
Gillette swallowed visibly. “She did it to herself, Michael.”
Beck’s eyes widened slightly. Porter was frozen.
“She had—” His voice became wobbly. “—she was seven months pregnant.”
These words hung in the air for eternity. No one breathed or even moved. The electronic beeps ticked off the seconds as time temporarily lost all meaning.
Gillette cleared his throat. “Her husband said he awoke in the middle of the night to the sound of her screaming. She was trying to cut the baby out in order to save it from the infection.”
A tear ran down Porter’s face and stained her respirator.
Gillette took a deep breath. “She killed the child when she stabbed it.”
