He reached up and turned off the oxygen. Sitting on the edge of the bed holding the cold hand, he looked at the now silent face. And he remembered the man and his work and his devotion to medicine. He remembered all he had learned, and he knew then what Max Schwartz’s legacy was to the world.
Alex wept. He wept for Max Schwartz. He wept for himself. He wept for mankind. All had lost with his death.
Alex lay on his bed and stared at the dark ceiling. For the first time in the past two days, he was on his own. In a few hours, the cultures would be ready for examination. Although he was grateful that Sam Ross would be there to help him, he knew that the final decision as to the identity and treatment of the organism would be his—he was now the physician-in-charge. The buck had passed to him.
His thoughts were interrupted by a knock on the door.
Marion Slade smiled. “I just stopped by for a minute, Alex, to tell you how sorry we are about Dr. Schwartz’s death; we know how close you were to him. I also wanted to say that we know you can do the job. We’re all behind you.
“Dr. Schwartz told me you could do it, too. He must have had a premonition; he asked me to give you this letter in case something happened to him.” He handed Alex an envelope with his name on it in Max Schwartz’s handwriting.
“I also thought you’d like to have this—as sort of a memento.” He handed him several sheets of crumpled paper. “These were in Dr. Schwartz’s hand when the MP’s found him. He must have been reading them when he became ill.”
He shook Alex’s hand warmly and left.
Alex was grateful for the memento; he put down the crumpled article to read later.
Then he sat on the edge of the bed, opened the envelope, and unfolded the several pages, written in Max Schwartz’s own hand.
Dear Alex,
I feel the need to write you because I have been having chest pain for the past few months; it has become more severe and more frequent during the past several days, and I am concerned about an impending infarct.
You know, I suppose, that I have already chosen my successor. You, Alex, are my choice. I know you will bring fame and honor to the department I am leaving in your capable hands.
But first you must establish your own image. You will never be entirely successful if you continue to be just Max Schwartz’s successor—you must be Alex Kahn, Professor and Chief in your own right.
I know that you and everyone else often think I am the world’s biggest bastard. Well, Alex, I’ve tried hard to be just that. Good departments are run with a heavy ruling hand. Let up, weaken, compromise for only one minute, and the whole thing falls apart or someone who can be a bigger bastard than you will take it all away. Don’t let that happen. Perhaps with your personality you can discover how to be a bastard and a gentleman.
Whatever you do, don’t lose your love for human life. Fight for it, Alex, with all the knowledge, experience and talent you have; but in that fight, never lose the ability to be kind, to be understanding, to be compassionate.
Whatever I have helped you to be, continue to give a little of that to the many more young men and women you will send out into the world to care for the sick and the dying.
Good luck, Alex.
Max
Alex’s tears blurred the last words, causing the ink to run and the words to fade. But he would not have to read them again to remember them.
He knew now that he could handle the buck. He turned off the light, confident that he would finally be able to sleep.
It was starting to rain.
The wind blew in cool gusts from the distant green hills, and sheets of misty vapor seemed to rise and fall.
Alex Kahn saw the empty grave on the hillside and felt a terrible loneliness as he looked at the small group of men who had come to attend Max Schwartz’s funeral. He couldn’t believe that this was to be the final tribute to a great man’s stay on earth.
Max Schwartz’s fame had brought him many acquaintances and admirers but no true friends. He had had no time for roots or for the lasting relationship of a family; he had had no real home and did not even own a burial plot. And so these few cubic feet of earth on a hill overlooking the duck pond at Fort Detrick—a gift from the United States Government—were to be Max Schwartz’s final resting place.
The rain fell on Alex’s cheeks and made his salty tears taste cold. As he watched the plain wooden coffin being slowly lowered into the earth, he realized that it was over—all over. Max Schwartz was only a memory.
The faceless forms began to fill the gaping hole with dirt. Alex heard the brassy echo of a sorrowful bugle in the distance as the notes faded into the cold, gray sky.
twelve
There was little time to dwell on grief. Though Max Schwartz’s death would always remain as a sorrowful memory, the fight to preserve life now took precedence over all else. And so Alex returned to the laboratory.
All the growth on solid media was monotonously similar. Whether obtained from living patients, from autopsy material, or directly from the packages recovered in the post office, the ultimate visible evidence of bacterial growth was a small, round, creamy yellow colony with little characteristic odor. Microscopic examination and standard biochemical and serologic tests all revealed a single microorganism that appeared to be a common variety of staphylococcus. After many hours’ work, the team of investigators knew nothing they hadn’t known twenty-four or forty-eight hours before. There seemed to be no explanation why this disease was different from any other staphylococcal infection.
Alex pushed his chair back from the glove box and exercised his fingers to relieve the stiffness resulting from prolonged manipulation in the close confines of the heavy gloves. He stared at the carefully tabulated results on the pages of the laboratory notebook open before him. He tried to think of some explanation for the findings they had obtained over and over again. He tried to think through again what Max Schwartz had taught him to do.
“When you’re stuck, Alex,” the Professor used to preach, “walk into the patient’s room again as if you were doing it for the first time. Start over. Approach the problem as if you had never seen it before.”
Alex turned to Sam Ross. “We’re stuck. Let’s start over again—from the beginning. Maybe we can find something we’ve overlooked.”
“It’s about the only thing we’ve got left to do.”
Slowly and methodically, the two men reviewed all the basic information about staphylococci. Neither of them could find an oversight in their previous thinking. The microorganism was a staphylococcus; the disease that killed was staphylococcal pneumonia.
“Sam, are there any anaerobic staphylococci? Could we be dealing with an unusual anaerobic strain of staph?”
“There are a few, Alex, but they’re very uncommon. And remember, we’re recovering an aerobic staph. Besides, we have to think of the common first and the rare later.”
“I know, but this whole thing is weird. Max was convinced an anaerobe was involved; maybe he was right.
“You know, Sam, we know very little about the actual mechanisms of staphylococcal infections. The bugs probably cause disease by the toxins they produce. Maybe this bug isn’t different, but maybe it produces a toxin that is—one that causes a disease in man that we’re not used to seeing.”
Suddenly Alex remembered the reference to the paper by A. Machdi he had seen the night before. “I came across a reference last night to the use of staphylococcal mutants to study bacterial respiration. I didn’t think much of it until we started to review staphylococcal infections just now.”
“I’m not sure I follow you.”
“Look—we’ve recovered the flasks with staph in them; we can culture staph from the people who get sick. There’s nothing different about it as far as we know. Is there?”
“Not as far as I can tell.”
Alex went on. “Coming back to that article—if someone could induce mutation in a staph to study some pathway in bacterial respiration, why couldn’t someon
e induce a mutant strain which would produce a toxin that would be capable of killing a man in a way we’ve not seen before? Also, couldn’t it be possible that the production of such a toxin would be the only difference between the parent strain and the mutant? If it were, the cultural characteristic would be exactly the same. We could culture the bug a million times and never see the difference!”
The bacteriologist squinted and rubbed his chin. “You know, Alex, that’s a very interesting thought. In fact,” he paused, “it’s probably the best theory you’ve had so far. But prove it to me, Doc.”
Alex stood up suddenly and went over to the wall phone.
“What are you doing, Alex?”
“I’m calling Marion Slade. If I’m right, we need some help. I’m no expert on toxin identification or bacterial mutants. Are you?”
“No, sir, but what you say makes a lot of sense.” He thought for a moment. “Matt Raleigh. Ask him to get Matt Raleigh. Raleigh knows more about bacterial toxins than anyone else I know.” He thought for another, longer moment. “And Carl Stafford. Get him, too. He’s been playing with bacterial mutants for years. Matt is at Cal Tech; Carl is at the University of Indiana Medical School. By the way, do you have that article? Let’s look at it.”
“No, but I’ll ask Marion to have it picked up at the library. In all the confusion…” he seemed embarrassed—“in all the confusion of Dr. Schwartz’s death, I must have left my notes in the library.” He paused. “I hope Raleigh and Stafford are still alive. Funny, isn’t it? A week ago when you called someone, you hoped they’d be at home—now you pray they’re still alive.”
He took a piece of paper from his pocket and dialed the number written on it.
“Marion? Alex Kahn. Listen. We’ve come up with a theory that may be important. Can you do a couple of things for me?”
He told Slade what he wanted from the library and the names of the two men whose help they needed. After he was certain the general understood, he hung up the phone.
“Marion will take care of everything.”
“We don’t have much time left, Alex. No matter how good those two are, it’s going to take time to isolate and identify a toxin or to work out the identity of the mutant.”
“You’re right, Sam. But maybe we’ll be lucky for a change and get a break. We’ve got to get lucky sometime.”
“I hope so, Alex. Some people take five years—or ten—just to get started working on a new toxin, let alone isolate it, identify it, and find a way to counteract it.”
“And we have only a few days!”
It was the first progress meeting of the group without Max Schwartz. Alex left the chair at the head of the table vacant and sat where he had before. He wasn’t sure whether it was out of respect or just that he wasn’t certain he deserved to sit there yet.
He looked around at the small group. Calvin had gone back to CDC to handle the statistics, Rahway was still in Washington attending to his responsibilities at Walter Reed, and Mark McKitridge was at a meeting of the Joint Chiefs of Staff. There were only Sam Ross, Warren Tracey, Marion Slade, Roger Bergen, and himself now. Five men—left behind to look for that needle in the haystack.
The latest reports from the Communicable Disease Center were now available for examination. Alex was pleased that the Teletype reports were handed to him first—as they had been to Max Schwartz at previous meetings.
He opened the folded sheets. There had been a total of 47,840 cases reported! Even more disturbing was the appearance of an increasing number of cases outside of the original forty cities. The “mail” was getting through.
The problems, the theories, the possibilities—all had been discussed before. To go over them all again would merely waste valuable time. The conference was quickly over. With so few participants and so little time, they agreed to dispense with the formality of progress meetings. They would just keep in touch—unless something came up.
When Alex returned to the laboratory, he sat down and tried to plan the work for the next few days. He had finally persuaded Sam Ross to go back to his room to rest.
There were hundreds of flasks of broth containing the staph available for Matt Raleigh to study. If there were a toxin, it would be in the broth, and Raleigh would find it. But how long would that take him?
There was plenty of material for Carl Stafford, too. He would need the bacterial cells themselves. Alex was less sure how Stafford would go about looking for a mutant or investigating its characteristics, if he found one. That was his problem, though.
What was missing? They had gone over the organism, the disease… The treatment! That was it! Hell! Why hadn’t they looked harder for a means of therapy? They’d been so busy trying to put a name on the damned bug they just hadn’t looked hard enough at the response of the organism to antibiotics in the test tube. All they really knew was that every commonly used drug they had tried so far to treat severe infection in man had failed, and no one had lived long enough to allow them to try anything experimental.
Alex began to prepare the tests to investigate the antibiotic sensitivity of the organism. First he would test the effect of increasing concentrations of single antibiotics. Then he would investigate combinations of drugs—the trick was to find the optimum concentration of each drug that was most effective against the organism in question when two or more were used together. There were many possible drug combinations, and evaluating them could be difficult. If they weren’t lucky with the tests under preparation, it might take more hands than were presently available. If necessary, he would ask for more technicians.
He was interrupted by a messenger who handed Alex the notes he had left at the library and a copy of the article he wanted. There was also a message from Marion Slade telling him that both Matthew Raleigh and Carl Stafford were being flown to Detrick and would arrive later that evening.
After several hours, Alex finished inoculating the tubes for the sensitivity tests. He made notations on other things he wanted done, and then sat down to read the article by A. Machdi.
Matthew Raleigh was what Alex called a forty-eight-year-old swinger. His long sideburns and handlebar mustache contrasted sharply with his almost bald head. He wore a double-breasted, light-blue blazer and a wide floral-print tie. Navy-blue bell-bottom slacks and white loafers completed the outfit.
“I hope his mind is as sharp as his clothes,” Alex thought as he shook Raleigh’s hand and offered him the coffee and sandwiches that had been prepared for the latecomers.
Carl Stafford was a slender, outgoing, humorous man. He had the type of personality that made you feel you had known him for years.
Despite their appearance Alex knew their reputations well. Matthew Raleigh was Professor of Microbiology at Cal Tech, where he had done much important work in the field of bacterial toxins. Carl Stafford was Eli Lilly Professor of Bacteriology at the University of Indiana Medical School at Indianapolis. His major field of interest was alterations in the genetic code of bacterial mutants, and he and his graduate students had developed many methods presently available in the field. His talents would be very useful.
Alex briefed the two men on the situation as they ate. Neither seemed surprised to learn of the origin of the epidemic. They listened with interest as Alex explained the team’s attempts to identify the microorganism; they had little to add. Both thought that the most recent theory about a mutant and a toxin was reasonable and worth pursuing.
“To determine whether an unusual staphylococcal toxin is produced by this organism isn’t so hard, Alex; it will just take time.” Raleigh played with the ends of his mustache as he spoke. “Give me a few days to get some of my equipment and one of my technicians, and I’ll be ready to start.”
“I can’t give you more than a couple of hours, Matt. Call anyone you have to to get the equipment; we can have it and your technician flown here by jet as soon as possible.”
“Now wait a minute, Alex.” Raleigh twirled his mustache a little faster. “What’ll I tell them
? They’ll think I’m nuts.”
“Tell them their lives may depend on it. Tell them anything. But get what you need. I’ve already arranged for laboratory space for you. We don’t have much time, Matt.” He wished he could tell him it was four days—or else. But he couldn’t. “There are almost 50,000 cases of this damned disease, Matt, and it’s spreading. In a couple of weeks, who knows who’ll be around? You—everybody in this room—could be dead!”
Raleigh whistled. “Show me the phone; I’ll see what I can do. I guess I should have known that when the army sends a private jet for you it’s not to attend a tea party. Are we really that badly off?”
“Worse, Matt. Whatever you need, we’ll get you; but we’ve got to solve this thing—and quickly.”
“Well, I guess it’s my turn.” Carl Stafford smiled broadly. “I think your theory is excellent. But I’m afraid I’m going to be of little or no help to you. You just can’t figure out if a certain bug is a mutant or not in a matter of hours. If you could tell me who the mother was and what had been done to induce the mutation, I might be able to take a crack at it—even then it would be trial and error. Sorry, fellows, but I’m a bacteriologist, not a magician.”
“Isn’t there anything you can do, Carl?”
“Not really, Alex. I’ll be glad to take a look at the bug. But starting from scratch, even if I had unlimited time and help, it would take at least several months to come up with anything. An organism may have ten thousand or more individual characteristics, and you’re asking me to tell you which one is different. Why, it could be only a single amino acid in a single enzyme that makes it different from its parent. If I knew how the mutation had been induced, I’d have some place to start. This way, if we’re lucky, I might stumble onto it in a day or a week; if we’re unlucky, it could take me ten years. And then only to find we weren’t dealing with a mutant at all. See what I mean?”
The 11th Plague Page 11
