“Just use common sense, Marion. Wash your hands frequently and thoroughly. Be careful what and where you eat. Avoid sick people; wear a mask if you do come into contact with anyone ill. How can we prescribe prophylactic antibiotics when we don’t know what the bug is?
“For the time being, let’s approach this problem logically. Panic can only lead to disaster. If there are no other questions, I think we’re about through.”
The men rose, put on their jackets, nodded farewell to one another and started to leave.
“Gentlemen.” It was Max Schwartz who spoke. “A moment more of your time.” He paused. “I am a Jew by birth. I have not practiced much religion since. One can always find excuses. There comes a time, however, when science and skill and knowledge are not enough. A time when we must believe that there is a God, some Being who watches over us. This is such a time. Will you join me in prayer?”
The doctor’s voice was soft, but his eyes reflected his fear. At the acme of a success attained by few, Max Schwartz was humble.
The room fell silent as all returned to the table and stood, heads bowed.
“God, before you stand seven men,” the professor intoned. “Good, wise, dedicated men. But imperfect. Never before in the history of mankind has so great a burden of responsibility rested so heavily on so few shoulders. We stand on the brink of disaster. Help us, Lord, to be wiser, to think clearly. Help us to overcome this enemy whose sword is disease, whose weapon is suffering. We beg You, Lord. Amen.”
As one they turned and left the room.
five
No one could have predicted what it would be like. A virulent epidemic of a fatal disease was entirely foreign to the United States in the 1970’s. In the first half of this century, advances in American medicine had essentially conquered commonplace illnesses, and through antibiotics, most bacterial infections were now controlled. Excellence in preventive medicine had paradoxically made the United States especially susceptible to this new plague. Freedom from epidemic disease had produced a community totally unprepared, and it now began to bend beneath the overwhelming burden of the sick and the dying.
It was a matter of priorities—when thousands were dying, what was the value of a single life? Soon that terrible choice would have to be made between who might survive and who could not. Until then, the need to fight for every life began to saturate the medical facilities available.
It was a matter of medical economics—the number of physicians, nurses, paramedical personnel, hospital beds, and medication versus the number who needed these vital commodities. The first terrible lesson to be learned was that the demand far exceeded the supply. Soon there would be beds in the corridors, in the lobbies, and wherever space allowed, until there would be no empty beds at all; soon the sick would lie on benches, on mats, on the cold concrete floors or wherever there was a space to die. Doctors and nurses became a luxury for the few who came first—the rest died while waiting. It all became a matter of waiting—once illness struck, life waited for death to consume it.
All the normal statistics suddenly became meaningless; the only statistic that mattered was the number of deaths. There was no treatment, no cure, no prophylaxis, to combat this unknown illness that telescoped life into a few short hours of agony before death.
Martin Beck had been sitting for hours in a corner of the lobby of the Baltimore City Hospital. He watched the rain on the large windows blur the headlights of the approaching ambulance. The suspicion and the hatred were returning to rekindle the spark that would soon grow into uncontrolled vengeance.
The night, the rain, the sounds and smells of the hospital were all the same, but that had been years ago…
He had finished his chores at the experimental animal farm at Fort Detrick and was walking back to the guardhouse to turn in his security badge before leaving for the night.
Dark clouds hid the hilltops, and the entire fort and the surrounding countryside were enveloped in a heavy mist. The rain was refreshing, and he could feel it blowing in his face and trickling down his neck. The road wound in a black ribbon from the duck pond, beside the fields used for growing experimental corn, and then down to the laboratories near the main gate. Head down, hands thrust deep into the pockets of his raincoat, he walked slowly, breaking his stride only to kick the pebbles by the roadside. He needed time to think through the inner conflicts that grew each day he worked at Detrick.
His older brother, Jerry, a maintenance man at the Fort, had gotten the job for him. At first it had only been little things that disturbed him. He’d forgotten to turn in his security badge one evening and had been given a severe reprimand. Then he had left the door to one of the “hot” labs open and had been given a long lecture by some second lieutenant fresh out of college. Now all the regulations, the secrets and everything else were gnawing at him. The protestors recently outside the gate with their handout pamphlets had given focus to his dissatisfaction. It wasn’t the place that was wrong—it was the program. That was a threat to mankind. Biological warfare was the immoral utilization of science as a weapon for destruction. But he was not certain he could find another job, and he would have to resolve this conflict between his need for employment and his recently acquired scruples.
He looked up and blinked as the rain struck his eyes. As he brushed away the drops, he watched the distant headlights grow larger and brighter as they approached.
“That son of a bitch must think the speed limit is for everyone but him,” he thought as he moved off the road onto the gravel shoulder to avoid being splashed as the vehicle sped by.
He glanced backward as he heard the squeal of the brakes. The driver stood up and looked back at him. He hadn’t bothered to put the canvas top on the jeep, and the rain ran in rivulets from the rim of his helmet and down the front of his raincoat.
“Martin Beck?”
“Almost the late Martin Beck if you’d skidded on that wet asphalt.” He started to walk back toward the jeep, but the driver was backing up toward him almost as fast as he had passed.
“Something’s wrong with your brother. They want you at the base hospital. Get in; I’ll drive you there.”
As he climbed in, Martin Beck felt a sudden surge of panic. Jerry worked in one of the “hot” areas. It was a dangerous job, but Jerry needed the additional hundred dollars a month hazardous pay—his oldest son had muscular dystrophy, and doctor and hospital bills were high. Jerry had known the risks of working in these buildings, but he also knew that an intricate system of safeguards protected him against all but the most overwhelming exposure to some virulent agent. Martin Beck was certain that was what must have happened, and his rage at Detrick grew as fear for his brother gripped him.
As the driver made a wide turn to head back toward the base hospital, the jeep skidded, swayed, and then sped down the wet, black road. Martin Beck pulled his collar up around his face to protect it from the enveloping spray as they raced through the cold mist of the falling night.
Martin Beck didn’t hear the doctor’s words as he stared at his brother who lay in the isolation room beyond the glass partition. A nurse in a white protective gown, cap and mask was adjusting the intravenous tubing. Jerry Beck was dying, and his brother knew it.
“He was working in the crawl space above one of the ‘hot’ labs and fell through the ceiling, rupturing one of the supply lines. He must have gotten an overwhelming dose of the bug. We’ve done everything possible.” The doctor’s words seemed miles away. “He won’t make it, Mr. Beck. I’m sorry.”
“Sorry?” Martin Beck said the word silently to himself. He pressed his face closer against the glass—as he and Jerry used to do as children when they’d stand at the large living room window and watch the snow paint the Cumberland hills white.
“Jerry.” He formed the word with his lips but no sound came
He stayed until the end.
The siren of another ambulance interrupted his reverie and brought him back to the present. It was the seventh ambulance
in the last ten minutes. Something was very wrong.
He looked up as two doctors, both unshaven, both appearing tired, sat down on the couch across from him. They talked in soft staccato sentences between sips of coffee from paper cups.
“Something’s wrong, Jack. Ten deaths from pneumonia in the past hour, and three more dying in the ER. What’s going on here?”
“Keep your voice down.” The man looked up and seemed to see Martin Beck for the first time. He leaned closer to his colleague.
Beck suddenly became alert. Without moving or changing his expression, he listened harder.
“Paul Kendall called me from Pittsburgh ten minutes ago. Wanted to know if we could spare some penicillin.”
“Pittsburgh? How the hell could Pittsburgh run out of penicillin?”
The voice became lower, but Martin Beck heard every word. “They’ve had eighty-six deaths from pneumonia at his hospital alone. It’s the same at University, Montefiore, and Children’s. They’re all running out of penicillin”—he paused and looked around again—“and everything else. They’re declaring a state of medical emergency.”
“Why didn’t you tell him to call Frank Andrews at D.C. General? He’s an infectious disease man. He should have loads of penicillin available.”
“He’s already done that. Same thing in D.C. Philadelphia, too.”
“New York?”
“Uh-huh.”
Beck had heard enough. He got up quietly and left.
He drove slowly, trying hard to watch the double yellow line in the middle of the road outlined only by the dull headlights. The rain made the road slick and caused the light pickup truck to sway and skid around the curves. The silence, broken only by the rain beating on the roof, gave him ample time to think.
Since leaving Fort Detrick almost ten years before, he had been working part time at the Baltimore City Hospital. This gave him enough to live on and ample time to act as leader of a group of political dissidents.
In all the years he had worked at the hospital, he had never seen so many ambulances—not even during his shifts in the ER—and the conversation he had overheard increased his feeling that something was terribly wrong.
The rain was beating against his windshield making it difficult to see, and he tried to concentrate on a sharp curve ahead. Out of the corner of his eye he was watching the water leak through the metal frame of the window in front of him when it suddenly hit him—a leak—Detrick!
From the first day they said Fort Detrick was to be converted to a cancer research center, Martin Beck had refused to believe it. Perhaps it was his cynical nature; perhaps it was rage over his brother’s death. But he had an unalterable belief that it was a lie. Martin Beck could only see things in terms of black and white—gray was to him an inconceivable abstraction. He had learned much from his association with the Army—the main thing was to doubt the statements for public consumption, the plans for phasing out and for de-escalation. Detrick was a billion-dollar installation endowed with immeasurable war-making potential. He could not conceive that the generals would just call a halt to it all; he could not imagine that they had suddenly acquired such altruistic goals as the health and welfare of mankind.
About two years before, he had persuaded a friend, a deliveryman for the post cleaners, to take him through the main gate in his truck. In disbelief he had walked around the huge complex unnoticed. There was little security, and to the unbiased eye Fort Detrick was, indeed, no longer functioning in its previous capacity. But as fate always predetermines all things, Martin Beck could not help but see the large vans and tank trucks parked at one corner of what appeared to be a closed laboratory. Then it was simply an innocent question here and there and equally innocent answers. All the talk about the destruction of biological warfare agents was, he was sure just that—talk. He was right. No one in his right mind would just throw away this valuable stockpile of death. He had the single half-truth that he needed to perpetuate his cause.
And now, two years later, driving through the wind and rain, he began to put the pieces together. In his fanaticism he had no difficulty devising an equation that he solved with equal facility.
He drove faster. The time had come to act.
six
Alex Kahn was worried. His fear increased as the hours passed. Time was rushing forward—as if the end of its journey were in sight. Max Schwartz’s prayer had disturbed him. He had prayed not as a showman but because this time he was not certain he could handle the “buck.”
For three hours now, Alex had watched the famous Dr. Schwartz work in the laboratory. Wearing the rubber apron that was his trademark, he examined the cultures. With flawless technique, he prepared subcultures to propagate and preserve the organism. He inoculated special media that would reveal specific characteristics of the microorganism that might lead to its identity. Utilizing carefully standardized pipettes, he prepared dilutions for bacterial counts and serologic tests. The next progress meeting was scheduled for 6:00 p.m., and he wanted these preliminary studies underway before then.
As Dr. Schwartz became busier, he motioned Alex to join him at the bench. For a time they worked in silence except for an occasional word to call the other’s attention to some seemingly important observation.
They took special care in preparing the anaerobic cultures. Max Schwartz had preached for years that when cultures did not agree with the clinical disease, one must always suspect an anaerobe, a microorganism that grows optimally in the absence of oxygen. Anaerobes were difficult to work with. Most grew slowly—some required three to four weeks to produce detectable growth. In addition, it was difficult to remove all oxygen from an incubator jar.
As they finished replacing the air in the anaerobic jars with nitrogen, the professor became more talkative.
“I’m betting on an anaerobe, Alex. Probably a mixed infection with the staph we’re seeing plus an anaerobe. A synergistic infection could explain the whole thing.” Max Schwartz’s paper in the Journal of Infectious Diseases in 1946 was one of the first clinical reviews of synergistic infections, where two microorganisms resulted in an infection that neither could produce alone. He had pointed out what had come to be called “Schwartz’s Paradox”—one saw two microorganisms under the microscope but recovered only one by the usual cultural techniques. He explained that the positive culture usually reflected the presence of the aerobic member of the pair; the anaerobic organism, requiring more time for growth, might not appear in cultures until two to three weeks—sometimes longer—after the first.
“I don’t know, Dr. Schwartz. We’ve seen only one organism.”
“We see what looks like one, Alex, but there could be two that look alike. This whole thing is so damned strange, nothing would surprise me.” He looked at his watch.
“Everything cleaned up? All the cultures in the incubator? The next batch of epidemiology reports ought to be in from CDC by now. I want to look at those before the meeting starts. Let’s go.”
“There have been 10,318 cases! We’re in trouble, Alex.” Max Schwartz made a few mental calculations and frowned. “This thing is spreading faster than we anticipated. If we don’t come up with some answers soon, there may be nobody left to treat—if we can find what to treat and how. If we could only get our hands on the bug and identify it! At the rate this thing is spreading, we’ve got only a limited amount of time to find the answer. I don’t like to rush; you make mistakes. And we can’t afford mistakes this time.”
“Maybe something’s turned up. It’s been six hours.”
“Wishful thinking, I’m afraid, but let’s see at the meeting.”
They walked into the conference room. Two new faces had been added. Alex recognized both of them as Max Schwartz greeted the newcomers.
He had met Sam Ross several times at the annual meetings of the American Society for Microbiology. Ross was a classical bacteriologist who had just retired as Chief of Clinical Bacteriology at Walter Reed; he was highly respected for his diagnostic
work in isolating and identifying bacteria from clinical material.
James Calvin was a man of his own age, and he was the person who had made epidemiology a computer science. He could take data other people gave him about outbreaks of disease, convert them into symbols on magnetic tape, and pull the answer out of the other end of a computer. Alex was anxious to see what he could do with their data.
As Alex took his seat, Max Schwartz was starting to speak:
“Before going any further, I want to take a few minutes to tell you what we’re up against. We haven’t had much time, of course, but I’d like to give you what we do have. Perhaps someone will have some suggestions. Especially you, Sam. I’m sure you and Jim have been filled in on the details.” He smiled at the bacteriologist.
“You’re all familiar now with the problem. Basically, the disease is an overwhelming pneumonia. The bug is probably contracted by inhalation. That narrows it down some. This would mean that the bug has to be transmitted either in the air or by dust, droplet or some other inanimate object on which it can live.
“I’m not sure whether it’s transmitted from man to man. I think the clue may be in that resident and the Infectious Disease Fellow at Alex’s place who both died within hours after their first exposure to a patient. I don’t know of any disease that could be passed form one person to another and be fatal so quickly. The inoculum, or number of bacteria that would have to be passed, would be phenomenal. Why, the recipient would almost have had to breathe in pure pus. These patients don’t even bring up sputum. No, I don’t think it’s passed from person to person. The people who seem to ‘catch’ it from one another must coincidentally have been exposed to the same source. It just appears that one has given it to the other. Damned clever. We could waste a lot of time on precautions and isolation rather than looking for the source. What do you think, Alex?”
The 11th Plague Page 7
