Alex Kahn was elated. The fact that Max Schwartz trusted him sufficiently to take care of one of his patients was an unexpected compliment, one that came to few interns.
“I’ve already called and arranged for her admission. They’ll send her directly up to the fifth floor. She’s pretty sick, so don’t waste any time. Do a lumbar puncture the minute she arrives. I want her on therapy within an hour.” He paused. “No screw-ups, Dr. Kahn.” He paused again. “Any questions?”
“Just her name, Dr. Schwartz.”
“Lori Stack. She’s twenty-three. The rest of the information will be on the face sheet of her chart. Call Hardy if you need any help. Good-bye.”
Alex Kahn was numb. He clutched at the silent phone until his knuckles were white; and then he put it down with an uncertain shaking hand. He was still sitting there in thoughtless silence when the nurse’s aide announced Lori’s arrival.
“Your patient is in, Dr. Kahn. She’s in 512. The nurse is taking her temperature and blood pressure now. The lumbar puncture set is by her bedside. Looks pretty sick. I’ll get some blood culture bottles for you.”
He made himself get up and put on the mask and gown used for protection against communicable diseases. Until he knew definitely what she had, he’d have to assume it was contagious. He went down the corridor to her room.
“Temp’s 106 degrees, blood pressure ninety over forty.” The nurse rolled up the cloth blood pressure cuff, put it in the wire basket behind the head of the bed, and began to open the green sterile wraps of the lumbar puncture set on the bedside table.
He walked to the bedside and looked down. For the fist time he learned, as every doctor must, that it is hard to be rational when treating someone loved. This wasn’t the Lori that he knew. The vibrant skin was hot and pale, the soft lips parched and dry, the dark hair without sheen. And in that terrible moment, as he stood watching her, he realized for the first time that something besides medicine could be so very important to him.
“Dr. Kahn?” The nurse’s voice startled him. “I’ll help you do the lumbar puncture. Here are your gloves.”
Somehow, Alex Kahn rose to the occasion. He had little choice. Max Schwartz had left for Philadelphia. It would take Dr. Hardy an hour to get in, and there was no one covering the Infectious Disease Service now but him. Besides, what excuse did he have? That his love was so great that he couldn’t help her? Right now she didn’t need his love—she needed medical skill and knowledge. It was this realization that saved him.
He worked quickly. A short physical examination substantiated what Max Schwartz had told him earlier. He did a lumbar puncture. The spinal fluid was crystal clear, like water—normal. He sent samples to the laboratory to be certain of his finding. Being busy stimulated his mind, and he began to think more clearly. He remembered what Max Schwartz always preached: “When you’ve got a comatose patient with a stiff neck and the spinal fluid is normal, look for that upper lobe pneumonia.” As usual, Dr. Schwartz was right. The chest x-ray showed an occult lobar pneumonia of the upper lobe of the right lung. After informing Dr. Hardy of the situation, he started Lori on intravenous penicillin and sat down by her bedside to write up her chart. He stayed by her all night.
At 7 a.m. her fever was down to 100˚, and she was breathing peacefully; he knew she would be all right. He left to shave and change his clothes. When he returned to see her with Dr. Hardy during teaching rounds at 10:00 a.m., she was beginning to stir; her temperature was normal.
He had given her life. Now he would give her his love.
Lori lay quietly in bed watching the IV fluid run into her vein. Tomorrow the IV would come out; the following day she would be discharged to finish convalescing at home. At first, she had dreaded each day that brought her closer to leaving the hospital. At least here she could see Alex. But as she began to recover fully, she realized that this illness had been simply an artificial hold on him. She loved him, she respected his love for medicine, and she was willing to accept the fact that his profession would be a jealous mistress. But she had made up her mind. She would have him only if he were ready to make her a part of his world—even a small part.
“IV ready to come out?”
“Oh, I don’t know. I may miss it.” She smiled.
“Tell you what. I’ll trade you.”
“It’ll have to be something special.”
“It is.” He withdrew the ring from the pocket of his white jacket.
They were married three months later.
It was a good marriage. Good because she loved him enough to make it work. She created a world for him outside of medicine, one filled with love and understanding to which he could escape when the burden of administering to the sick and the dying became overwhelming. She knew her role in his life and played it well. He wanted her to stay aloof from his career. She was there when he needed her and tried with great success to remain in the background except during the social occasions inevitable in any university setting. She kept silent when he didn’t want to talk and listened avidly when he chose to share even a small problem with her. She loved him unceasingly, and he knew it; and in his own way, he returned her love. Their marriage flourished because she could give and did not expect him to give equally in return.
They had been married two and a half years when their first child, a son, Peter, was born. Alex Kahn was then in the first year of his fellowship with Max Schwartz and for the first time in their marriage, she began to hate the terrible loneliness and to suffer the effect of Max Schwartz’s total influence over her husband.
Before Peter was born, she had been able to compensate for Alex’s absence by busying herself with her job as a teacher, with visits to friends, or even by window shopping with dreams of the day when they would be able to afford some of the things brightly displayed behind the large plate glass windows of the many department stores that lined Washington and Tremont streets in downtown Boston. Once or twice a week she had been able to meet Alex for a hurried supper in the hospital cafeteria or for a late evening snack in the residents’ lounge.
Now she found herself imprisoned in their three-room apartment by this tiny infant who was the product of their love but who now demanded her constant attention. Her loneliness was accentuated by her feeling of guilt that she could not accept motherhood without this ambivalence. It might have been different had Alex been there, if only for moral support and to share in the wonder of their first child; but his long hours at the hospital allowed them little time to be a family. Even on the rare occasions when she could afford a baby sitter, she found that she was too tired to enjoy going out. She minded Alex’s absence most in the evening when she had put Peter to bed and was left alone in the dark emptiness of the apartment with little to do but finish folding the day’s laundry. Predictably she converted her loneliness into resentment of the man she felt was keeping her husband from her.
Like most of the wives of “Max’s boys,” she knew of his greatness but resented what she thought he was doing to her marriage. They all felt the same way. It was more than the canceled dinner parties, the missed concerts, the movies they never saw. It was the feeling that he came first. When Max called, his “boys” jumped. Where he went, they went. Those years meant a family without a father and a husband. Max Schwartz demanded a loyalty and devotion that left no time for anything else. His Fellows were tired, insecure men, who occasionally came home to eat and sleep.
None of the wives had ever met him. Each had her own mental picture of what he must be like—this legendary man whom their husbands feared and loved and hated all at the same time.
But despite her loneliness and her resentment, Lori tried—sometimes more successfully than others—to keep conflict between herself and Alex to a minimum. She kept telling herself that she could tolerate today because she hoped for a better tomorrow—and she knew that tomorrow would come when Alex finished his training with Max Schwartz.
Alex was at University Hospital as an Assistant Professor when their t
wo daughters were born, and it was better. Despite the fact that he was no less devoted to medicine, he could be his own man. He was able to take Saturday and Sunday afternoons off to be with Lori and the children; and she began to feel for the first time that they were, indeed, a family. She became more content and settled comfortably into the life of a doctor’s wife. As long as she knew that they had a very special place in Alex’s heart—there had been times during his training with Max Schwartz when she had questioned it—she was happy. Now that he was successful and becoming more so, she felt that the sacrifices had been worth it; and when she lay in his arms in the quiet darkness of night and felt his warmth and his love, she knew it was so.
Over the years, Alex Kahn had loved her more than he had thought it possible to love anyone. All of his fears had been needless—she had not been a hindrance to his career at all. Her love had sustained him through times when he felt he might not otherwise have been able to withstand the overwhelming pressures thrust upon him. He knew they had had their difficulties, especially when Peter was first born; but somehow it had been convenient for him to interpret her complaints of loneliness as postpartum depression. Selfishly, he had allowed her unhappiness to pass; and it did. He could not have wanted more in a wife, and though he was sure he rarely showed it, he was totally devoted to her.
Now suddenly faced with the monstrous plague, Alex realized how much Lori and the children truly meant to him. He felt alone and helpless. There was nothing he could do to protect them or to insure their safety. The realization that a disease threatened their very existence that at present was beyond the scope of all of his skill and knowledge frustrated him. He was beginning to understand the terrible significance of Max Schwartz’s statement that they could all be “wiped out.” It was possible that he might never see Lori and the children again.
“I love you, Lori.” He said the words aloud to himself and listened to their echo in the empty office.
He glanced at his watch. It was 4:30 a.m. Time to start for the airport.
He looked around the empty office—again. So much had happened since the last time he had done this.
He picked up the suitcase Donald McBride had delivered. It was heavy and uncomfortable to carry. It suddenly occurred to him that in this dark-brown, leatherette flight bag, protected from the world by glass and acid, popcorn and latex, parafilm and cotton plugs, was death—death which could hurl mankind to a premature end unless someone, somewhere, could find a key to turn it off.
four
Alex looked down through the glass nose of the helicopter and watched the hills of western Maryland fly by several hundred feet beneath him. He figured it was Maryland from the direction and distance they had flown since Dulles. Neither Major Small nor the pilot had been willing to tell him their destination, and he couldn’t even guess which army installation it would be because there were so many that surrounded the nation’s capital. He just sat beside the silent pilot, listening to the motor above and watching the peaceful landscape below.
As his eyes caught the sun reflecting off the aluminum-painted surface of a water tower above the hills several miles ahead, he felt the helicopter start to descend. He knew where he was.
“Of course,” he thought. “The logical place—Fort Detrick. It’s ideal. Secluded, yet accessible, with an excellent communication system and the best infectious diseases laboratories in the world for the isolation and identification of a ‘hot’ bug.”
He spread his feet for balance and braced himself as the helicopter accelerated its descent.
Fort Detrick. Once the home of the army’s biological warfare program, it lay peacefully hidden at the edge of Frederick in the rolling hills of western Maryland about fifty miles northwest of Washington.
Detrick had started as a single building at the beginning of World War II. As time went on, it became the country’s largest and most sophisticated facility for research in microbiology. At its peak, it consisted of some 460 buildings situated on 1,230 acres of farmland surrounded by security wire fencing. What took place behind the fence was known only to the army personnel who worked there for a year or two—rarely more—and to the members of a distinguished civilian advisory board who sat as consultants and overseers to the programs.
Actually Detrick had two fences. Behind the outer one were the administrative facilities and tenant units, an army unit from the medical research center at Walter Reed and a navy liaison unit.
The medical unit was the antithesis of the biological warfare program. Staffed by hand-picked physicians from many medical specialties, it concentrated on research into the early detection, diagnosis and treatment of infectious diseases, especially those which might be used as weapons of war against the United States. From the work of this small group evolved many advances for the good of mankind. Their research had led to the development of vaccines against tularemia and plague and against several of the viruses known to cause encephalitis. There were few secrets, and the results of most of its studies were readily available to prestigious scientific journals.
Within the inner fence were a group of brick buildings that, for lack of a better name, were termed the Biological Warfare Laboratories. They were surrounded by this second fence not only for secrecy, but also to prevent persons from trespassing where they had no business and thus inadvertently being exposed to agents that could do them harm. The discoveries made in these buildings were indeed lethal, but the possibility of their actual use had never seriously arisen. As the cold war eased in the late sixties and the beginning of the seventies, political pressure mounted against the whole program. Finally, in 1971, public opinion forced the conversion of Fort Detrick to a center for cancer research.
Alex Kahn had been there once before. As members of a panel established by the President’s Science Advisory Committee and the National Academy of Sciences, he and six others had visited Fort Detrick to decide the disposition of those laboratories that had been designed specifically for work with highly virulent and communicable infectious agents. Their decision had resulted in the setting aside of a small area for this purpose under the supervision of the National Institute of Health at Bethesda, Maryland, and of the Communicable Disease Center in Atlanta, Georgia. Perhaps because of their previous identity, these few laboratories had remained empty and unused. Until now.
Max Schwartz was sitting at the far end of a long and empty conference table. Chair tilted back against the wall, knees up, his stubby fingers folded over his sport coat, he looked up and smiled as Alex opened the door, giving the younger man a silent nod of recognition.
“Same old Max,” Alex thought as he walked the length of the table to shake hands with the respected physician, teacher and scholar. Dr. Schwartz wore a light-blue oxford-cloth shirt with button-down collar, a maroon wool tie, a tweed sport coat that wouldn’t button over his ample mid-section, and flannel slacks that hardly reached the top of his penny loafers. In Boston they all used to kid about it as Max’s uniform of the day.
Beneath the slicked-back gray hair Max’s face appeared somewhat more wrinkled and his eyes more tired since Alex had seen him last at the Atlantic City meetings two years before.
They shook hands warmly. For a moment the traditional barrier between teacher and student was gone.
“Good to see you, Alex. Wish it were under better circumstances. The others will be here in a moment.”
“The others?”
“You don’t think they’d let you and me play war without any soldiers, do you? But they’re all pretty good people. By the way, did Major Small take the cultures off your hands?”
Alex nodded. He started to speak but was interrupted by the opening of the door and a shuffling of feet.
Five men entered. Three wore the traditional green uniform of the army; their insignia identified them as generals. The other two wore bland civilian suits.
Alex watched them carefully as they took their places around the table. He couldn’t tell if their serious faces meant the
y were irritated at being there or concerned because they knew the reason for the meeting. He was surprised not to see any of Max’s other “boys,” until the alarming thought occurred to him that he might be the sole survivor of the “club” rather than the only member chosen for attendance.
His thoughts were interrupted by the heavyset, balding general next to Max Schwartz, who rose as he spoke.
“Gentlemen, I think you all know Dr. Max Schwartz, the distinguished specialist in infectious diseases. Dr. Schwartz has raised some very serious questions related to national security. I am afraid that I must agree with him now that I have had time to look at the statistics. In a moment, I will ask him to brief you on a situation that only he seems to have been astute enough to recognize. Before doing so, however, I see at least one face I don’t recognize”—he looked at Alex apologetically—“so perhaps we can take a moment to introduce ourselves.
“For those of you who don’t know me”—he looked at Alex again—“I am General Mark McKitridge, advisor to the Chief of Staff of the Army in all matters related to unconventional weapons. I was commanding officer of the Chemical Corps until two years ago when—and I’m sure I don’t have to remind you of this—the army’s formal program in this field ended. I am a soldier and an organic chemist by profession, with a doctorate in organic chemistry from M.I.T.” He turned to the office next to him and motioned for him to continue.
The 11th Plague Page 5
