The Pattern Maker

by Nicholas Lim

  ***

  The WHO officer knelt at the first body. The head was twisted round at an impossible angle. The lips were blue. A trickle of blood had congealed to black on the chin. The hands had a yellow tinge to the skin, nailbeds were blue.

  Competing theories raced with the officer’s heartbeat. The majors: yellow fever, dengue, typhoid, malaria. Possible minors: chikungunya, West Nile, Trypanosomiasis, Leishmaniasis.

  He walked over to the second body. An adult male, the same pathology: blueing of nails, lips, around the mouth and nose a rusty smear, yellowing skin, the rigor of sudden seizure. The third body, of a young girl, was the same.

  He straightened and looked out along the shoreline. Five more bodies were scattered along the beach, one in the porch of a seafront hut, the corpse folded over a rail like a blanket left out to dry. Where was everyone?

  ***

  Samir’s door was half-open. Kumar’s knock was answered immediately.

  “Amitabh!!! That officer you contacted in Yogyakarta. Where is he now?”

  Kumar blinked. “I don’t know exactly. You remember, I checked with you before I–”

  “Well I suggest you find out.” Sharma tossed a printout over his desk. “Read that.”

  It was an email. A few sentences in, Kumar began speaking aloud to fill the silence. “…after a fishing trawler picked up an islander from Kepalua who reported many unusual deaths. The account part-confirms the support call from the MSF nurse. Due to the potential health risk, we have instigated a forty-mile perimeter quarantine around the islands.” Kumar glanced up at Sharma then back down at the page. He felt his palms begin to sweat. He swallowed. “Investigations should only proceed jointly with CDSC personnel and local backup. Please acknowledge immediately.”

  “Amitabh. Just tell me you waited for formal clearance before sending our officer out there.”

  Kumar swallowed again. He cleared his throat.

  “Amitabh? Tell me what I want to hear?”

  Kumar re-read the last lines of the e-mail. “I, er, I, umm, I think a ball got dropped.”

  “A what?”

  "That day was the big rush for the Gujerat quake. I–"

  “Get on the phone. Call everyone we know in Jakarta and on that coast. Try and trace the boat he used. Get a name. Get a radio frequency. We must make contact before he reaches those islands. Before. Do you understand?”

  Kumar nodded.

  "Why are you still standing there? Get on with it man!"

  ***

  The WHO officer worked fast, taking blood and tissue samples. The drone of the cicadas from the surrounding forest filled his ears. The meaty stink of a corpse filled his nostrils.

  At the back of the officer’s mind a warning bell was ringing. With narrowed isolated immunity, island communities were accidents waiting to happen. But where were the survivors? Natural diseases, even new, virulent strains, did not exterminate. He had to get the biopsy samples back to a lab.

  He ran back through the village square. Half-a-dozen thatched huts were still-smoking ruins. As he cleared the tree line he saw the ferry. It was in open water, coming about, the captain at the wheel staring away from the island.

  “WAIT!”

  He sprinted down the sand. The ferry continued its rotation, the ship’s prow turning out to sea. The captain was not looking back.

  “WAIT!! WAIT FOR ME!!!”

  Chapter 4

  The headquarters of CDSC, the UK Communicable Disease Surveillance Centre, in Colindale north London, is a modern ziggurat of glass and steel, a fifteen-storey tower block that rises in narrowing terraces out of the surrounding maze of red-brick Victorian semis.

  Simon Kirkpatrick, senior project manager in Surveillance and Reaction, stood in silence beside his desk, head down, hands clasped together in front of his stomach. His hips moved back and forth, back and forth, in small swaying motions. With a sudden jerk his clasped hands swept across his body and his tongue clicked once. A golf ball rolled in his mind across the floor past his desk with a swerve under the window into a hole where the waste paper bin stood. Have it!

  Pop!

  The computer on his desk emitted a sound like a rude schoolboy flicking a finger out of his cheek. Kirkpatrick returned to his chair. He scanned a new email. Subject: Brighton malaria case. It was from Dr Christine Garrett. Already? This woman was a real nuisance. He glanced at the wall clock. Quarter to five. Golf practice tonight. He needed it with the bank holiday match coming up! He logged on to Sentinel and started to create a new case file.

  He worked fast, importing Christine Garrett’s documents. He clicked Initial analysis. A progress bar began to fill up.

  Through a plate glass window he could see three cubes along to where Clarrie sat hunched over her keyboard. He still couldn’t understand how Ms Liu had already made grade 4. She’d only been with CDCS four years. It had taken him seven! Seven years hard graft. And she didn’t even put in the hours. She was often late and left early. She was rarely on-call at weekends. She was always going away! Work-life balance she called it. Work hard, play hard, recharging the batteries, blah, blah, blah! Listening to her was like reading one of those women’s magazines. Nothing but clichés.

  Sentinel initial case analysis complete: new CLC required. Kirkpatrick frowned.

  Sentinel was the CDSC’s new outbreak management system. The key to its incident tracking and alerting was the CLC: the Cluster Lead Case. Each case was ranked and automatically linked to related cases in a cluster; every cluster had a Cluster Lead Case. As the software manual put it: “This single point of control defines responsibility, ownership and overview.”

  When the notification threshold for a cluster was reached, Sentinel automatically alerted the responsible case worker.

  The system had replaced a dozen older applications and had been live since March. They still had CDSC Ahmadabad as manual back-up – offshore case workers who monitored the system round the clock – but they were increasingly seen as unnecessary.

  A new cluster? Yes, that made sense: this incident was an anomaly, with no related cases. Kirkpatrick clicked OK.

  He glanced at the clock. Five already. He should be leaving. Let’s expedite shall we?

  Most of Kirkpatrick’s favourite words began with the letter e: enable, effective, efficient, energy … and if they didn’t, someone often put an e in front of them for him: e-medicine, e-healthcare, e-processing, e-solutions…

  He opened the incident summary, skimmed the first few lines then the odd word here and there. He was prompted to review the attachments – meeting minutes, lab reports – and decided he couldn’t be bothered. The incident sounded like a whale-sized red herring.

  He confirmed the allocated lab: Porton Down, for two members of staff, thirty-five hours total, contact George Skinner.

  Alert thresholds: default. He set the responsible case worker to Clarice Liu and clicked “Publish”.

  Done. He stood and practiced a few more putts then returned to his desk. He clicked the Receive button. Twice. Where the hell was Clarice’s acknowledgement? His phone beeped at his waist. He looked down, cancelled the golf reminder and glanced at the clock: 5:15. He would be late for his lesson if he didn’t leave now. He stood and walked over to the water dispenser in the corner of his small office. Clarrie waved at him through the glass. Kirkpatrick gave her a serious nod. She nodded back, mock serious. At last. Home time!

  A few minutes after he left his office a new email arrived, an out-of-office notification from Clarice Liu. “I will be out of the office until 2 September. (Catching the sun in Crete!) If you have an urgent query, please contact the CDSC Colindale office where another member of the team will be happy to help. Kind regards.”

  Clarice Liu had a philosophy: once she’d set her out-of-office she was officially not at work. No more emails. No more computers. If someone couldn’t be bothered to check her calendar or her email replies it wasn’t her fault.

  ***

  A line of J
ubilee-blue benches faced the cliff-top railings above the Promenade. Garrett sat on one of the benches writing names in a notepad. She had begun to draw connecting lines, a sparse, broken web strung between facts. The first autopsy – Spyder and the second – Grant – both dying on Palace Pier beach. Da Costa’s case – Lizzie: found on the same beach. Spyder, Grant and Lizzie. Three deaths, within a week of each other. All dying in Brighton. All visiting this beach. This place was a common link. It was why she had come here, to find connections.

  After a while she put down her notepad and walked over to the railings. Behind the Big Wheel she could see a parade of stalls, a one-storey, barrel-roofed terrace that extended between the rides out into the pebbles at the top of the beach. Colourful and isolated, the line of low shops appeared like a stranded train of circus wagons, a caravan come to a halt and rested for so long the vehicles had lost wheels and taken root. At the end of the rundown parade Garrett could make out a juice bar, coconut shy and cafeteria. A bald-headed man sat in the shade bent over the outstretched arm of a kneeling young woman. The arm was twisted round, palm up. The pose reminded Garrett of a doctor taking a pulse, or nurse giving an injection.

  She leaned on the railings and waited – for what she couldn’t say exactly, but she knew it was what she should do. For her, medical instinct was a sort of listening, and over the years it was a knack she had come to accept like an article of faith. It was what she had built a reputation on at the Sussex CDSC, called in by experienced doctors, by local hospitals, to trace the invisible infection source, find the missing vector, where others had failed. And years of knocking on doors, interviewing relatives, peering into microscopes, dissecting entrails – had taught her that the tougher medical puzzles were tough because in such cases previous experience was as much a hindrance as guide; you had to let facts speak for themselves, to listen afresh.

  She sat back down on the bench with her notebook open in her lap. She was conscious of a clock ticking somewhere in her mind, and a need to find something more concrete than conjectured lines drawn in pencil on a page. She tried to curb her impatience with this case: impatience was the enemy of listening. Remember, connections present indirectly, like symptoms in a body.

  She remembered the quiet of the hospital Chapel. She found the card the chaplain had given her and placed it face up on the notebook, beside the name Spyder. Dr. Prenderville. Psychiatrist and Research Fellow. Stonehill College, Oxford. She thought of Jason. Where was he? Was he ill? Was he safe?

  She took out her phone and found his address book entry. Trusting blue eyes stared out of the screen at her from under a brown foppish fringe. That image was from a photo taken four years ago. Why hadn’t she updated it? Her finger moved towards the call button as if to touch someone. Panic drew the breath from her. She mustn't. She put the phone away.

  Although it was early evening, the fairground was still in full swing. She could hear a miniature train clanking past. Faint screams floated up from the rocking chairs of the Big Wheel as it spun, and stopped, and spun again.

  Jason had been such a noisy toddler, no hint in those early years of the quiet pious boy to come. Her thoughts shied at the memory, as though retreating from a hole with unstable edges, and she frowned down at the web of lines she had drawn, trying to concentrate on the problem to hand. In that brisk turning away she recognized the survivor’s instinct, a hardness inherited from her mother. She was grateful, accepted the selfishness, knew it had kept her alive and not yet made her mean; but she could wish for some other use to put that tough streak in her.

  A seagull made a slow arc around her head, resting on the cliff-top air currents with bent wings. It landed on the end of the bench and turned its head to stare at her with a yellow eye. Garrett blinked first. She began to doodle a design at random on Prenderville's card.

  The noises of the fairground rose and fell. Tired, sunburned holidaymakers trickled constantly up the cliff stairs. After some minutes, Garrett stopped doodling and looked at what she had drawn. It was an eye, surrounded by rays like a child's sun. Garrett watched the beach from her bench. She saw a liquid immiscible with the facing sea, a tide of people draining back from compartments of sand and stone between breakwaters, a multicoloured stain seeping back across the flat heights, the rising dunes, back to the tracks of the miniature railway. Garrett stood still as a fly fisherman on a river bank, or a hitch hiker beside a quiet road. Her phone began to ring. She ignored it. She tried to stay aware of the broken lines in her notebook. She felt close to something not yet seen. Patterns rose in her mind, slow, shy as wary trout, suggesting effects and causes.

  All her life she had seen patterns and the explanations behind them. Scientific just-so stories, mathematical and mundane. A fading stain on wallpaper around a light switch – to her mother, irritating dirt – had been for her the visible spoor of countless hands, normally distributed. The route her rambler took up the front wall was a living manifestation of averages: of phototropic behaviour summed across days. The hollow in the stone step from her kitchen into the garden counted generations of footsteps in aggregated functions of friction. Clover patterns in a meadow betrayed nutrient deposition; a line between stiles the pollination of boots; clouds the condensation gradients of thermodynamics. All day, every hour, she saw such repeating meanings.

  An intern had once pointed out after a lecture she had given on outbreak causes that she appeared to believe in and talk about patterns much as the religious believed in God: patterns explained; patterns were beyond good and evil; they pointed to a truth beyond themselves; they shaped everyday thoughts, like a morality. Garrett had replied that in that case the Devil was coincidence.

  She took out her phone and thumbed keys. The missed call was from an unknown number.

  A memory sudden as summer rain came to her. Of afternoons sitting at the back of a school library, shading her page from the sun. She had been a shy girl, the quiet one, never the volunteer. And then one hot summer – like the one they were having now – she had discovered a relief, scratching marks in pencil, finding in the personless words of mathematics a silence free of bruising playground chatter and skipping conversations. Garrett could still remember the deepening silence over the hours as a tangle of symbols simplified down the page; conversations – that is how she had seen them, regardless of with what – all ending in certainty, like the prayers her mother had plaited through their lives, and that she in turn had plaited through Jason’s.

  At school she had discovered computers – for her, a sort of mathematics in motion, subroutines simply equations in action. Drawn to the most challenging computational problems, for her master’s she had specialised in the new science of bio-informatics. Then soon after starting her first job her career took a more practical turn when a pathologist suggested a medical degree to complement her theory with practice. By natural steps she found her way into epidemiology, its combined disciplines of medicine and maths the perfect vocation. Looking back, she felt she had been lucky to find a profession in which her x’s and y’s touched lives so directly. It had carried her out of the library back into the world.

  Her phone began to ring again, her bag chirruping as though hiding a trapped bird. It was the unknown caller.

  “Dr Garrett?”

  “Speaking.”

  “It’s George Skinner from Porton Down. I was given your contact details by Colindale. I gather you have some malaria material you want us to take a look at?”

  “Yes. Thanks for calling. We’ve done peripheral smears and quantitative tests. I’d like an OptiMal Assay and maybe ICT. And frankly, I’d appreciate a second opinion–”

  “Well we are very busy at the moment. As soon as we receive the samples–”

  “You’re just outside Salisbury aren’t you? Why don’t I bring them over to you tomorrow?”

  Chapter 5

  The Central line mid-morning on a weekday was always packed as it passed through the City of London. When the businessman got on the first carr
iage of the eastbound train to Ealing Broadway he was pleasantly surprised to find a seat. He made a table of his briefcase on his knees and opened his laptop. A bead of sweat dropped onto the keyboard. Annoyed, he wiped it away with a thumb.

  Two young businesswomen hung from straps in front of him.

  “Anyway when he said she said that, I said you're having a laugh mate.”

  The businessman hunched over his laptop. He tried to block out the chatter of the other passengers. As he typed a password he sneezed. Three million droplets of water and mucus left his mouth at two hundred miles an hour. Fifty micrometres in diameter, they shrank as they dried to nuclei a tenth the size each containing a micro-ecology of organisms that moments previously had been internal to his body.

  At Chancery Lane the women were replaced by young men in shirtsleeves carrying jackets over their shoulders.

  “E-readers are killing that business model. Newspapers are closing faster than pubs. And real journalism started dying a decade ago. Face it, the written word is dead.”

  “I haven't been feeling so well myself lately.”

  “Ha ha.”

  The businessman pulled out a handkerchief and wiped his forehead. He stared at the damp cloth. A dull rhythmic pain beat in his temples. He could see sweat beading the back of a hand. He wasn’t right.

  Truth was, he hadn’t been himself for some days. Not since his trip to Brighton to see Fiona. It had started with a sore throat, then the chills. Now this fever and coughing. He tried to dry his hands on the wet handkerchief and wondered about cancelling his three o’clock. All those investors! He couldn't. He frowned as he tried to remember where they were supposed to be meeting.

  The young men had got out at Oxford Circus. In their place was a couple wearing matching t-shirts and trainers, arguing loudly