The 11th Plague

by Albert S. Klainer MD

  “Mark, these guys are no fools. They certainly can’t expect us to be unarmed two nights in a row.”

  “You’re wrong, Marion. Beck knows the army with its rule and regulations. He figures that if he can hit us within twenty-four hours he’s OK. He’s betting it’ll take us longer than that to cut through the red tape. Well, he’s wrong. We’ll be waiting for him and his crummy friends.

  “We’ve moved in three fully armed companies of paratroopers and a company of riot police. When Mr. Beck and Company take their first step onto government property, we’re going to give them one chance to surrender. If they do, they’ll be arrested and get a fair trial.”

  “And if they don’t surrender?”

  “We’ll cut them to pieces, Alex. We’re giving them more warning than they gave the people at Edgewood. It’s more than they deserve.”

  “What irony, Mark!”

  “What do you mean, Alex?”

  “Because the Martin Becks succeeded in closing Fort Detrick down a few years ago, we are now under attack with a biological weapon. And now Detrick may be the only thing that can save us, and Beck and his band of cutthroats are bent on destroying it. And to stop him, you’re probably going to have to slaughter a few hundred people. What a paradox—we must kill in order to live. Maybe Dr. Schwartz was right—‘Perhaps it is better that we do not survive.’”

  fifteen

  As they walked back to the laboratory in the shadows of armed guards assigned by Mark McKitridge, Alex Kahn and Sam Ross barely spoke.

  Somehow everything seemed different. What had happened at Edgewood Arsenal the night before and what might take place at Fort Detrick in about twelve hours was the antithesis of reason.

  But once in the laboratory, Alex’s depression was short-lived. This was his world, where one made a hypothesis, devised and performed an experiment to prove it or disprove it, and examined the results. Although bedside medicine was a unique mixture of science and art, laboratory medicine was an exact discipline.

  In microbiology, time was a variable that was almost unalterable. The species of microbe, the characteristics of the growth medium, the temperature of incubation, the amount of oxygen in the environment—all of these and many other factors could be manipulated and controlled; but despite the technical advances and vast accumulated knowledge, very little was known about ways to accelerate the growth of microorganisms. Growth consumed time—time the group at Fort Detrick did not have. But now, finally, the results of the sensitivity tests were ready to be examined. The survival of mankind—whatever its worth—depended on their outcome.

  “That about does it.” Alex wrote a “plus” in the last box on the data sheet. “Let’s see what we have.”

  He and Sam Ross bent over to study the multitude of pages on which were written the sensitivities of the microorganism to a wide variety of single antibiotics and combinations.

  “It’s just as I thought, Sam! Insensitive to everything but a combination of murocillin and ampholysin!”

  “What even made you think of those two drugs? About a year ago they were both found to be ineffective against strains of staph that produced penicillinase. We know that this microorganism produces penicillinase. I wouldn’t even have included them in the sensitivity tests.”

  “I tested every damned drug I could think of. To be a successful weapon, the bug had to be resistant to all the antibiotics commonly used; but for the bastards to be able to handle it—or stop it, if necessary—it had to be sensitive to some drug or combination of drugs. To be certain not to miss any possibility, I included murocillin and ampholysin and a few others that had been tried but had never become clinically important. After I read Machdi’s article, I realized that I had lucked out by including the two drugs he hadn’t used during the induction of his mutant. It’s saved us valuable time.”

  “I wonder why they work together.” Sam glanced over the data sheet. “The organism isn’t sensitive to either one separately.”

  “I think I know. As you said, they’re not clinically useful because singly they’re both inactivated by penicillinase. But when they’re used in combination, the murocillin, which has a much greater affinity for penicillinase than ampholysin, binds the penicillinase irreversibly. Once it’s bound, none is around to inactivate the ampholysin. If you’ll remember, ampholysin is a pretty good antistaphylococcal drug when penicillinase isn’t around. Actually, the ampholysin is what kills the bug; the murocillin just takes care of the penicillinase.”

  “Why did all the other sensitivity tests show something different? If I remember correctly, didn’t the ones run by your hospital and others fail to show the pattern of resistance we got?”

  “Because I ran these new tests anaerobically. The mistake we made before was a reasonable one. We recovered a staph aerobically, and because most staph are aerobic, we studied it as such. In all the years I knew Dr. Schwartz, very few of his hunches were wrong. I decided to play his hunch that an anaerobe was involved. He was right—but there’s only one bug, Sam; and believe it or not, it’s probably an anaerobic staph. This guy Machdi was a sneaky bastard. His mutant probably acts like an anaerobe in the body; but it converts to an aerobe in the test tube. I’ve got an experiment in mind where the trick will be to maintain strict anaerobiosis; if we can do that, we should be able to recover the organism in its pathogenic state. Then we’ll be able to study it in the form that causes disease in man.”

  “Makes sense, Alex. Let’s say we are right. Is there much of these drugs available? I would assume the drug companies stopped manufacturing them when they didn’t look like winners.”

  “I’ve already checked, and there’s a fair amount still in stock Anyway, the method for commercial production is simple, and if we are right, the companies will be able to supply us with all we need. In fact, I can probably get them to donate the drugs—the publicity will be worth millions.”

  “Well, the drugs seem to work in the test tube. When do we try the combination out in a few sick patients?”

  “Not until we’re sure it works in a human, Sam.”

  “And just how do you propose to do that? Don’t tell me Detrick has a few experimental humans around mixed in with the monkeys.”

  “Could be, Sam. I’ll need a little time to think it through.”

  “Don’t take too much time, Alex.” He looked at his watch. “Think fast, hotshot.”

  He found Mark McKitridge sitting in his jeep near the main gate.

  “Mark, I’m sorry to bother you, but if we don’t keep on plugging, we’re going to run out of time.”

  “It’s O.K., Alex. Everything’s just about set, anyway. What can I do for you?”

  “I want you to call Jim Rahway and ask him to send me a pump-oxygenator and a surgeon.”

  “What for?” McKitridge looked at Alex with puzzlement and suspicion.

  “For an experiment.” Alex sat down next to him. “You see, there’s a big difference between what we find in the test tube or in an animal and what happens in the human body. We only have time for a single experiment. The only one that’ll make any difference will be the human one. It may give us our ultimate answer—the treatment.”

  “If you’ll tell me what the hell you’re talking about, maybe I can help you. You’ve lost me Alex.”

  “I think this bug we’re working with is a multiphasic staph. It’s probably identical to one described in an article I found. It’s a typical aerobic staph in the usual artificial culture media and, so far as we can tell, even in experimental animals. But in the human body, it changes its characteristics: it becomes an anaerobe. It probably causes disease by producing a toxin, but only under very specific conditions that could take us years to reproduce exactly right in the laboratory.”

  Alex handed him a copy of the article. “Read it if you get a chance. In one section, this guy Machdi tells how he uses minute but increasing amounts of a variety of antibiotics in the culture media. By doing so, he induced resistance to each of these dru
gs. But among the sensitivity tests I ran was a combination of drugs this bug hadn’t been exposed to before. Sam and I finished reading the test results a short time ago; this combination kills the bug—at least in the test tube.”

  “Great! Why not just try the drugs on a bunch of patients instead of doing an experiment on a human first?”

  “First, we’d never know whether we gave the drugs early enough, since most of the sick don’t come into the hospital until they’re almost dead. Second, if my theory is wrong, we’ll have gained nothing. My way, we have a chance to study the organism while we’re testing the drugs, and we can tell if it does change its characteristics in the human body. Even if these drugs don’t work, we’ll be in a much better position to evaluate other therapy.”

  “I’m sorry, Alex. I still don’t follow you.”

  “What I intend to do is a perfusion experiment.”

  “A what?”

  “A perfusion experiment. I want to study what the bug does in living human tissue, but infecting the whole body would be much too dangerous. I think we can get the same information by using an arm. We can isolate its blood supply from that of the rest of the body and supply it with oxygen with the pump-oxygenator. We can then inject the bug into the arm with much less risk. If we’re careful and we’re wrong, the most we can lose is an arm.

  “By taking blood samples from the arm at intervals, we’ll have a chance to study the organism as, I suspect, it changes in human tissue. Also we can inject antibiotics into the arm and watch their effect under essentially the same conditions we’d have if we treated a patient. In a nutshell, we’ll have a human arm as our laboratory.”

  “I’m with you. But where does this pump-oxygenator thing fit in?”

  “It’s a machine that essentially does the job of the heart and lungs.” He took out paper and pencil and sketched a diagram. “The blood will go from the arm to the machine where it mixes with oxygen just as it would in the lungs. Then the machine pumps the oxygenated blood back to the arm. In other words, we’re going to bypass the entire body except for one arm to keep the blood with the bug in it from mixing with the blood that circulates in the rest of the body.”

  “I think I understand, Alex. I’ll call Rahway right away and ask him to send you a good surgeon and the pump. Now as for a volunteer…” He paused and frowned.

  “I’ve already got one, Mark.”

  “You have? Who?” He looked surprised and relieved.

  “It’s a military secret.” Alex laughed. “Leave it to me.”

  “Alex, I…” Mark McKitridge started to ask the question and then thought better of it. “Never mind.”

  Alex wondered if this was McKitridge’s way of trying to make him feel that his word was good enough—or if it was a gesture of silent admiration.

  When Max Schwartz died, Alex knew time would run out. Even before his discovery of Ahmed Machdi’s recent work, he had begun to plan. As experiment after experiment in the laboratory had led them nowhere, he knew that the time limit would necessitate at least one experiment in which the identity of the organism and the efficacy of antibiotic therapy were tested in a living human host. Only this would give them the ultimate answer.

  He also knew that there was only one person he could ask to take the risk—himself. Prisoners, conscientious objectors, and similar persons volunteered for studies testing vaccines, most of them wanting to make a personal contribution to medical science. But Alex felt that no man had the right to ask another to die for him.

  He was no hero nor was he a fool. He openly admitted that he would take any way out if he found one. But he knew there would be no other way. It boiled down to honor, conscience, responsibility, and that same old buck—this was his, and he knew it.

  He thought long and hard about the odds. They were stacked against him if the organism should spread beyond the perfused arm. There would be only one chance. If the therapy failed, he would lose the arm—and he could lose his life.

  He thought about Lori and the children. One of the most important things he wanted for his family was the privilege of living in a world free from oppression,­­ want and disease—especially this kind of disease. He wondered why he had never thought of that as a “privilege” before. It was as Max Schwartz had said about life: its value comes when you’re faced with losing it.

  The generals could handle the oppression. His life insurance would take care of his family’s wants. But if he himself wouldn’t fight against disease, who would? Lori and the children had never seemed so precious; they gave meaning to the risk. This right to die for them belonged to him.

  sixteen

  Alex was sitting in the cafeteria with Sam Ross and Warren Tracey. Although the monotony of the institutional food was hardly appetizing, mealtime was a welcome break in their demanding schedule.

  “You know, Alex, when we get through with this project, we ought to do something really worthwhile—maybe we can get the government to serve better food in these places. If I see chipped beef on toast on the menu once more, I may become psychotic. Why, I’d even vote for you for President if you could only get them to make better coffee.” Sam sat back and lit a long black cigar.

  “I didn’t know you smoked, Sam.”

  “Ordinarily I don’t, Alex. It takes away the taste of the food.”

  Sam twirled the cigar between his fingers and studied the ashes accumulating at its tip. “I don’t mean to look a gift horse in the mouth, but something has been puzzling me. How come none of us have died of the disease?”

  Alex thought for a moment. “Probably several reasons. In any epidemic, some people get sick; some don’t. Individual resistance must play a role; it’s probably a combination of immunity and chance. As far as this epidemic is concerned, we know nothing about the immunity. And maybe it’s just coincidental that we all have survived. Whatever the reason, let’s count our blessings.”

  “Agreed!” responded the other two simultaneously and emphatically.

  “By the way, did McKitridge get you what you needed?” Warren threw out.

  Alex looked around the cafeteria. The three men were alone except for a busboy cleaning up in the corner. He leaned forward to make his voice audible. “He’s taken care of it. I wanted to talk to you both about something. I guess this is as good a time and place as any.”

  “You mean about your ‘experiment’?” Warren’s expression hardly changed.

  “McKitridge talk to you? And to you, too, Sam?” Alex really wasn’t surprised. The general was the type who would seek advice about things he didn’t understand fully.

  “He talked to both of us, Alex,” Sam acknowledged. “We both thought it was an excellent idea—with certain reservations.”

  Warren continued: “I’ve given it considerable thought. I’m concerned that the arm may not tell us what’s going on in the lung. But I agree that the danger of infecting a lung, even in an isolated perfusion system, is far too great. And there’s one other thing.” He looked at Sam to indicate that he should carry on.

  “We’re very much against you being the guinea pig.”

  “I didn’t tell McKitridge who the ‘guinea pig,’ as you call it, would be.”

  “Come on, Alex.” Warren sounded a little annoyed at Alex’s coyness. “Mark may be a general, but he’s no fool; and he’s a damned good judge of men. He knew it was you. That was why he spoke to us. He’s dead set against you being involved as an experimental subject, and he asked us to talk you out of the idea. He doesn’t want to lose another chief.”

  “What else did he say?”

  Sam Ross interrupted. “Look Alex, I agree that your plan is sound, it’s necessary, and it could give us the answers we need—and quickly. But you’ve got to think of your responsibilities. To the project, to your family, to your new job.” He paused. “Max told me some time ago that you were his choice as his successor. Look what you might be giving up. This is no time to be a hero.”

  “I’m the logical choice, Sam. It�
�s my responsibility.”

  “No, Alex. I’m the logical choice.” The older man’s clear brown eyes reflected the sincerity of his voice. “I’m sixty-five, Alex. I’ve had a good life. What’s left? Five, ten years? My children are grown up and married. My wife is well taken care of. I have the least to lose of any of you. You’re just starting out, with a young wife, small children—this is the time when they need you most. Besides, if something goes wrong, you’re going to be no help to anybody as a physician tied down to a table with tubes stuck in your arm. This is something I can contribute. I want to do it.”

  “And you, Warren? Are you going to give me a tough time, too? Are you also volunteering, or did you two decide that one volunteer was enough?”

  “No, Alex. I’m a realist. My job is to oversee the army’s research program, not to volunteer for experiments. I think you are not taking your responsibility fully if you insist on risking your life. You’re the chief of a damned important project—probably the most important ever for medical research. As chief, it is your responsibility to choose, not to be, an experimental subject. A good chief considers the facts objectively and delegates the responsibility wisely. I know that it would be easier for you to do it yourself, but you have to live with your decision—and your conscience.”

  “And what did General McKitridge have to say about all this? You’ve obviously discussed this at length with him.”

  Warren laughed, then suddenly turned serious. “He said you were like Max Schwartz—we’d never talk you out of it. You know, Alex, Max didn’t want you to do it, either.”

  “I didn’t even get the idea until after he died. Don’t tell me the army’s got a ‘hot line’ to heaven.”

  “No, Alex. The night before he died, Max called Warren, Mark and me to his room. He had a feeling you were leading up to a human experiment, with yourself as the subject. He told us about this chest pains and made us promise that if anything happened to him we would not allow you to sacrifice your life this way.”