They had agreed to allow the experiment to proceed for thirty minutes without instituting therapy unless something occurred to force their hands. Now Sam Ross handed the bottle of murocillin to Paul Ryder.
“This is 500 milligrams of murocillin dissolved in 100 cc. of five percent ‘D and W,’ Paul.”
The anesthesiologist hung the bottle on an IV pole and removed the plastic cover from the needle at the end of the tubing. He inserted the needle into the tube leading to the arterial catheter, fastened it in place with adhesive tape, and initiated the flow of the antibiotic solution.
They all watched in silence as drop by drop the bottle slowly emptied its contents into the blood of Alex’s arm. It took about fifteen minutes. They obtained samples of blood at five-minute intervals during the next fifteen minutes and then repeated the procedure with the ampholysin solution.
Over and over again, drops formed at the tip of the small plastic tube, swelled, and then dropped into the small reservoir hanging beneath the inverted glass bottle. Although the flow-rate and volume were the same as those for the murocillin, it seemed to take forever for the small bottle to empty. Each of them stared at the dripping solution, knowing that this was it. This was the end of the line. They had pooled their knowledge and experience to place their bet on these two drugs. Soon they would know if they had won or lost. If they lost this time, who knew if they could win—ever. Then mankind would drown in a flood of disease against which no dike could be built—it was a frightening, unthinkable thought. If they won—but at that moment the idea seemed beyond their reach.
The quiet was interrupted only by the whirring of the pump-oxygenator, the clicking of the spools of paper recording data in the monitoring equipment, and their own movements as they obtained blood samples.
They all knew they should see some effect in fifteen to thirty minutes as the level of ampholysin in Alex Kahn’s blood reached its peak and began to subside. Each silently rationalized that perhaps it would take a while for the organisms to die after the peak drug level had been reached. The minutes passed.
Alex Kahn watched the silent group. His dilemma was unique. If the drugs did not kill the organisms, how long could the arm remain isolated from the rest of him? Unless the drugs worked, John Keith would be forced to amputate the limb. He looked at the arm. At least it was his left one; he was right-handed.
To pass the time, he began to recall what he knew about the recent advances in artificial limbs. He remembered reading about a battery-powered prosthesis controlled by the wearer’s own nerves and muscles. Special transistorized microcircuits in the artificial fingertips provided an actual sense of touch. He tried to think of things he did with his left arm and hand. For some reason all that came to mind was that he wore his old baseball glove on it—how long ago was it that he and Peter had last played? It seemed both like yesterday and yet years ago. He wondered when and if they would play again.
The white face of the clock seemed stark against the shiny beige tiles of the wall. Was the second hand really stopping and starting, or was it a combination of his imagination and anxiety? He tried to stop thinking and looking.
It was fifteen minutes since the ampholysin had been administered. Sam Ross sat bent over the bacterial counter, his eyes glued to the oscilloscope screen. The pattern of light electrically bent into a curve reflected the number of bacteria in the blood that flowed from Alex’s arm into the counting chamber and between the magnetic grids of the equipment.
Twenty minutes.
Twenty-five minutes. The slope of the curve continued to rise slowly as each bacterial cell divided; two became four; four became eight; and so on.
Thirty minutes. By every previous study with the drug, this was when the concentration of ampholysin should reach its peak in the blood. There was no change in the curve.
Sam Ross felt the beads of sweat form on his forehead as hope began to fade into frustration and fear. He knew only too well what failure meant, and he hoped he would not live to see its consequences. He continued to watch the screen.
Thirty-two minutes. With each full circle of the second hand, the chance of success became more and more remote.
Their anxiety filled the air. The silence became deafening.
Thirty-three minutes.
“It’s dropping!” The scream shattered the silence.
Sam Ross jumped up and bent over the screen. He grasped the machine by its sides as if he were shaking success out of some unseen human being with an oscilloscope for a face.
“They’re dying! The dirty, rotten little bastards are dying!” He continued shouting as he watched the curve of light turn downward and begin to head toward the zero mark “They’re all dying! The curve is going to hit bottom! There’s no doubt about it! They’re not even intact any more. The drug is breaking them up! We’ve done it! My God, we’ve done it!” Losing all inhibition, he laughed, he wept, he danced around. He ran up to Warren Tracey and threw his arms around him. “We’ve done it, Warren! We’ve won! Do you understand?”
Warren couldn’t tell if his cheeks were wet with Sam’s tears or his own. He was seeing what he had really felt would never come to pass. In those few days they had managed to solve what was perhaps the greatest single puzzle ever to challenge the talents of American medicine.
John Keith stood and watched them, his gloved hands thrust into the pocket of his surgical gown to maintain their sterility. “Well, Alex, as you can tell from the rather subdued antics of your two associates, the experiment seems to have been a success.” The drawl revealed little emotion, but the expression in his eyes above the mask revealed what his voice did not.
Alex just lay there, tied down to the operating table and chained to the pump. He did not have to shout or dance. No words, no actions, no expression, could show what he felt. He watched the group until his tears blurred their images, and then he just smiled. It had been a long road from that day in his office when the ringing telephone had interrupted life as he had known it.
“Repeat it, John.”
“What, Alex?”
“I said we’ve got to repeat the experiment. You know one successful experiment doesn’t make a cure. As long as I’m all set up, anyway, let’s take advantage of it.”
They all knew he was right. They had to be certain.
“I’m satisfied now, Alex. Are you?”
“Yes, I am now, Sam. We’ve done it four times. At least by the counter, we’ve eliminated the organism each time in twenty-five to thirty-five minutes. I think the drugs will work. Do you agree, Warren?”
“Absolutely, Alex. I’m convinced.”
“Then call Marion Slade, will you, and ask him to inform the President? It’s getting close to midnight. And John, untie me.”
“Wait just a minute, John.” Sam Ross interrupted him. “When you remove those catheters, the blood that’s been in his arm will get into the rest of the circulation. Right?”
“Right, Sam.”
“I want to have some drugs mixed and ready to go, as a precaution in case a few of those little bastards are hiding someplace. We don’t want to lose our hero now.” He turned back to his bench and mixed the antibiotic solutions. He labeled each and set them on a table near the IV stand. “OK. You can disconnect him now.”
Alex turned his head to watch the surgeon disconnect the tubes from the pump after certain adjustments were made to insure that his arm would be adequately supplied with blood. Keith worked quickly to prepare needles and suture material to close the incisions.
“I’m going to remove the catheters now, Alex.”
In a moment, the circulation would be intact.
Alex Kahn felt suddenly warm. For a brief moment everything looked yellow. He started to speak, but no words came. He felt only panic as he recognized the tightness in his chest as air hunger. He couldn’t breathe. He moved his chest, but the motion caused no air to fill his lungs. He fought for breath, but none came. He tried to move but felt no movement. The rest of his body b
egan to feel like his left arm—numb. His vision blurred and then grew dim. He was left in darkness, isolated from the world around him. The last voice he hard was that of John Keith; the last word, “Adrenalin!” His last thought was, “After all this, we lost.” And then the peace and loneliness and silence of coma let him rest alone in endless darkness.
twenty
He could hear voices through the silence and see the light penetrating the darkness. His chest still felt tight, but the air hunger was subsiding. As his mind began to clear, he could remember what had occurred until coma had blotted out his memory. Multicolored bright shadows danced before his eyes and beyond his closed lids. For a brief moment, he squeezed them tight in fear of what he would see when he opened them. But then he recognized the voice of John Keith and realized he could not be dead. First the right eye opened, and then the left. As his eyes adapted to the uncomfortable brightness from the operating lamp, the familiar faces came into focus.
“Welcome back to the world of the living, Doc.” Keith’s face broke into a broad smile. “Enjoy your nap?”
Alex looked around. He was still lying on the operating table, but his arms were free. The tubes were gone, and neat gauze bandages covered the sites of their insertion. The electronic equipment was silent. His left arm was less numb; he could move his fingers. He touched the tip of his index finger to that of his thumb; he could feel the contact—barely, but he could feel again.
Sam Ross bent over the table and patted his cheek with fatherly tenderness and then gave it a playful slap. “You couldn’t be satisfied with an uneventful recovery? You had to go ahead and have an allergic reaction to the dye.”
Alex looked at John Keith.
“That’s right, Alex. You had an anaphylactic reaction to the dye I used as a monitor. It had nothing to do with the bugs. You gave us an uncomfortable second or two, but you’ll be OK.”
“A second or two?” Sam made a feigned, painful expression. “That’s the understatement of the year! You can thank John that you’re still around—he recognized what happened immediately. I was certain you were going to die from the damned infection.”
“And spoil the experiment?” Alex laughed. It felt good. He reached out to grasp Keith’s hand. “Thanks, John. Remind me to say something nice about surgeons someday, will you?”
The experiment was over. It had been a dangerous gamble, but they, and mankind, had won—at least for now.
The atmosphere in the conference room was far different from that first morning six days ago. There was laughter, and there was hope; and it appeared that tomorrow the sun would rise on a world that would survive to enjoy a healthy future.
Marion Slade had taken off his jacket and even loosened his tie. “I sent out your messages to the major hospital centers about 2:30 this morning, Alex. At nine the first report came in from Boston; three patients treated with your drug regimen have survived so far, and it looks like they’ll recover.” He held up a handful of teletype messages. “At least twenty-five hospitals report the same. There are still deaths, but the Communicable Disease Center reports the data is coming in so rapidly, it’ll take them another twelve hours to sort it out.”
“I’m sure we’ll still see many deaths, Marion. Some of the people were far too sick to be saved. But I think we’ll see a leveling off in the number of cases in the next few days and a decrease in four or five days. By my rough calculations, we should have everything under control in ten days to two weeks.”
General McKitridge puffed contentedly on a black cigar and motioned to Roger Bergen to speak first.
He rose. “Alex, the President has asked me to inform you that he did not send the messages. We were able to get word to him in time.” He paused. “It’s not my place to extend his gratitude or that of the country to you; I know he’ll do that himself. But I want to thank you—all of you.” He sat down. They all knew the sincerity with which he spoke.
“I can’t really add much to what Roger has said.” The general now spoke, remaining seated. “It’s funny how a crisis brings together men who might otherwise never have met. It’s been a privilege to have worked with this group, and I hope we’ll meet again under different circumstances. I think we’ve demonstrated that, even in this day and age, at a time of crisis men can still work together unselfishly for the common good. It’s too bad that it took this epidemic to show that patriotism and devotion to humanity are still in vogue.”
Alex rubbed his left arm. “Well said, Mark. You’ll excuse me if I don’t stand up. I think I can sum it all up by saying that without the contribution, large or small, of any one person here, we were doomed to failure. All I would like to add is that if we’re still around to talk about it next year at this time, the treat’s on me. We’ll have a blast and celebrate in Boston.”
They applauded loudly.
“To get back to business for a moment. I’ve been thinking about the immediate problem of getting the drugs to those who need them.
“Ordinarily, I’m very much opposed to mass antibiotic prophylaxis; but I see no other choice in this situation where there’s no way to determine who’s been infected until they get sick.” He pushed a folder toward Marion Slade. “I’ve outlined a program to administer murocillin and ampholysin orally, especially to those in areas where the density of the disease has been greatest. The two companies that make the drugs assure me that 250 milligrams of each drug taken four times a day for three days will provide the necessary antibacterial effect. They’re evidently well absorbed when taken by mouth. Marion, can you have the Public Health Service take care of this?”
Slade took the folder. “Consider it done. Anything else?”
“Yes. I want the signs and symptoms of the disease and the recommended treatment advertised from one end of the country to the other. I want every person who gets the first symptoms to get his ass to a doctor fast, and I want every doctor to recognize the disease the minute it walks in the door and know how to treat it properly. Can do?”
“We’ll start a publicity campaign that’ll make the guys on Madison Avenue look like a bunch of amateurs. Anybody who doesn’t hear about it will have to be out of touch with the rest of humanity. Leave it to me.”
“I guess that’s it, then. I know where to reach you all if I need you. Let’s finish up. I want to go home!”
Alex was starting to get up when an MP entered and handed two messages to Mark McKitridge.
The general opened the first, glanced at it, and then read it aloud without emotion. “‘Martin Beck died at Hagerstown Memorial Hospital at 2 p.m. today from overwhelming pneumonia.’ I guess you could call that poetic justice.”
He opened the second message and paled; his hand trembled as he handed it to Alex Kahn.
Mrs. Lori Kahn and son Peter acutely ill with pneumonia. Condition of both poor after receiving last murocillin and ampholysin available to us. Unable to get more drugs for 6 to 12 hours. Please advise Dr. Alex Kahn that …
Alex dropped the note. Had he come this far only to have it all end this way—to have to sit by and watch his wife and son die from a disease for which he knew the cure—a cure which he could not administer because of time and distance? His sudden grief and his terrible frustration left him numb and void of rational thought.
“Alex!” Sam Ross had read the note and handed it to Marion Slade. “Get off your rump. They’re not dead yet. Maybe the drug they’ve had will hold them for a while. We’ve got enough of the two antibiotics to spare some. Don’t sit there and mourn, man! Get some medicine to them!”
“He’s right, Alex.” Marion Slade stood up and reached for the phone. “We can get you to Andrews by helicopter, and I can arrange to have a jet take you to the air force base outside Manchester.” He glanced at the message again. “They’re at Nashua Memorial Hospital—how far is that from Manchester?”
Alex sat upright. The sudden ray of hope seemed to revitalize his mind. “About fifty miles, but it’s all good highway.”
“This
message was sent only a short while ago. I think we can get you there in about two hours. Do you think whatever drugs they’ve had will keep them alive that long?”
“I don’t know.” Alex Kahn’s voice was barely audible.
Sam Ross did some quick mental calculations before he spoke. “It’s possible, Alex. Peak blood level occurs after about thirty minutes, but some drug may remain in the blood for four to six hours.” He stood up and turned toward Marion Slade. “Get those travel arrangements made, Marion. I’m going to pack up some of the drugs for you, Alex. Take some extra along for the other patients at that hospital with pneumonia. They can probably use all the drugs we can spare.” He started to leave.
“Sam?”
“Yes, Alex?”
“Thanks.”
“Go save your wife and boy. Then you can thank me.” He smiled affectionately.
Alex held the small hand and watched each precious breath cause the slight frame to rise and fall. The hemorrhagic rash was starting to fade, and the sickening blue color of the skin was turning into a healthy pinkish glow. He reached down and pushed the brown hair away from the still shut eyes and ran the back of his hand lovingly across the hot cheek.
At his touch, the eyelids fluttered open.
“Hi, Dad.” The voice was soft and weak.
“Hi, Pete. Feel better?”
“Some.” He took a deep breath. “I can breathe better.”
“Good. Go back to sleep. You need your rest. I’ll see you later.” Alex Kahn turned to hide his tears, picked up his coat and tiptoed to the door.
He walked slowly down the corridor to see Lori again. He was very tired, and his left arm still ached from the surgery. The hospital was dark and quiet. Although one hospital or another had been his home away from home for so many years, this one was now just a lonely, empty place where Lori and Peter must do battle with this disease. He watched his shadow extend down the long, dimly lit corridor—the lonely shadow of a lonely man.
The 11th Plague Page 16
