Fatal

by Michael Palmer

  Matt now did what had been taught to him and what subsequently he had taught to many students and paramedics—he took an extra few seconds to position his new patient and compose himself before proceeding. With the woman on her back on the stretcher, he tilted her head slightly downward, straightening her neck. Gary Lydon knelt beside him to hold her head steady in that position. Physically settled on one knee, and as confident as he could be given the circumstances, Matt slid a curved, lighted laryngoscope blade along the woman’s tongue and pulled the blade straight up toward her chin. All he could see was lake water, welling up from her lungs. Trouble—maybe big trouble. In the ER there would have been suction to clear her airway. Not here. A blind thrust with the semi-rigid tube was possible, but treacherous. Doing so had to be a last resort.

  Easy, now, easy.

  The woman’s color remained poor. Brain cells were being compromised every second. Soon, they would begin to die.

  Come on, Rutledge. Stay cool and don’t panic. You can do this. . . . You . . . can . . . do . . . this.

  Matt took a deep, calming breath, grasped the handle of the scope tighter, and pulled the blade upward another eighth of an inch. The move nudged the victim’s tongue out of the way even more and lifted her epiglottis—the flap that protected the lungs from aspirating food or drink. The slight adjustment caused the pool of water to recede just enough to expose the two silvery half-moons of her vocal cords.

  Yes!

  Matt smoothly slid the tube between the cords.

  “We’re in,” he said, trying for some matter-of-factness but missing badly.

  There was audible relief from both EMTs and the police.

  “Nice going,” one of them said.

  Matt used a large syringe to blow up the balloon fixed around the end of the tube, sealing it in place and preventing air from escaping around it. Kirsten Langham quickly attached the black latex bag to the tube and connected it to oxygen. In seconds, the mottled duskiness of the woman’s complexion began to improve. She was almost certainly going to make it. How much of her brain would make it, too, remained to be seen.

  Matt handled the breathing bag as the troupe awkwardly retraced their steps, pushing the stretcher along the path back to the ambulance. While the woman was being lifted into the back, Matt took the two teens aside.

  “You guys did one heck of a job. In all likelihood, you saved this woman’s life.”

  “Lucky we was there,” one of them said.

  “I’ll say. You’re Harris?”

  “I’m Michael. He’s Harris.”

  “Got it. Two things. First, tell me again. You were fishing and she fell into the water right in front of you.”

  “Yes.”

  “And sank?”

  “She might of stayed on the top for a second or two,” Michael said, “but otherwise that’s the way it happened. I got down ta her, but I couldn’t get a grip afore I ran out of breath. Then we did it together an’ brought her up by the hair.”

  Two minutes, minimum, Matt estimated again. Four maximum, depending on when they started breathing for her and how well they did it.

  “And you did mouth-to-mouth?”

  “Harris did. I screamed for help.”

  “Harris, did you hold her nose closed?”

  “I did, sir. And I tipped her head back, too.”

  “Where did you learn how to do mouth-to-mouth?”

  “They taught us in Health, sir. We used a dummy to practice.”

  “Well, we sure are glad you were paying attention in that class,” Matt said. “Now, about those gunshots.”

  “They weren’t shots,” Michael said. “They were too soft. They were branches cracking, probably. Maybe a car backfirin’ out ta the road.”

  “Were, too, gunshots,” Harris insisted. “Michael, I’m telling you, pistols don’t sound the same as backfirin’. There were two shots, maybe three.”

  “Ready,” Gary called out from the rear of the ambulance. “Kirsten’s going to bag her with you. I’ll drive.”

  “You guys did great,” Matt said again. “Lots of people, doctors included, sometimes think they saved someone’s life, when the truth is, they might not have. Take it from me, you two really did it.”

  He jumped into the ambulance and waved to the boys as Gary closed the door. Then he took a seat on the bench opposite from the EMT and, for the first time, took a careful look at the woman who had come so close to dying beneath Niles Ledge.

  She was still unconscious. The swelling above her left eye was pronounced and beginning to discolor. But to Matt’s touch, there was no evidence for a depressed skull fracture beneath the bruise. The linear gouge above her right temple certainly could have been from a gunshot. There were also scratches on her cheeks and chin, similar to those Matt had sustained just half a day ago. It wasn’t a stretch to imagine her terrified, charging through the dense woods with someone shooting at her.

  He separated her eyelids and used his penlight to check her pupils’ response to light again. This time the results were different.

  “Pupils are both reacting,” he announced to the EMT.

  “Great,” Kirsten said. “Her oxygen sat is ninety-seven.”

  “Decent enough. I can’t say why, but she just doesn’t seem that deep to me.”

  “I know what you mean. She’s sort of begun chewing on the tube a little.”

  Matt brushed her sodden hair from her forehead. Her face, distorted some by the breathing tube, still had a peaceful, gentle quality to it—pale, unlined brow . . . high cheekbones . . . wide, almond-shaped eyes. He lifted her limp hand and set it on his. Her fingers were long and slender, nails cut short. If there was polish on them, it was clear. There was a gold claddagh friendship ring—two hands supporting a heart—on her right fourth finger, and a single gold bangle on her left wrist. No other jewelry. Her palms were soft without a hint of callus, but there was a fullness to the muscles. Matt imagined the hands playing piano or writing or throwing clay pots—something manual and artistic.

  Come on, you, he urged silently, wake up!

  The mobile MRI facility that served the region was currently in its two-month rotation at Hastings Hospital, twenty-five miles away. Montgomery County, though, did have a CT scanner, which for blunt head trauma was nearly as definitive. Matt radioed ahead and asked that the room be reserved in one hour. He also asked the nursing supervisor to call the Belinda Police Department and request that an officer come down to the ER to begin investigation of a possible shooting, and also to try and determine the identity of their patient. He wondered as he rang off whether or not the powers at BC&C had filed any complaint with the police against him.

  Patient saved, doctor arrested.

  The sort of news a small town loves.

  The ER crew was waiting for them as they backed into the ambulance bay. For the next fifteen minutes, Matt was a secondary player. The nurses and respiratory technologist became the major caregivers while the phlebotomist from the lab and the tech from radiology spearheaded the gathering of diagnostic information. Their comatose Jane Doe was lifted from the stretcher to an ER bed, stripped down, and covered in a johnny and a sheet. Her IV and monitor lines were quickly transferred to hospital equipment. A catheter was placed in her bladder to keep close track of hydration and urinary output, and she was hooked up to a ventilator. Next, a portable chest X ray and skull film were taken.

  Finally, the crew stepped aside and Matt resumed his position at the bedside. This time, his examination would be more detailed, including the critical visualization by ophthalmoscope of the retinas in the back of Jane Doe’s eyes. He was relieved to see pulsation in the veins there, as well as a sharpness to the margins of the optic nerves. Loss of either would be a grave sign, indicating significant brain swelling from trauma and/or prolonged lack of oxygen.

  “So, Dr. Rutledge, I understand you called?”

  Grimes.

  Matt turned slowly to face the Belinda police chief. The two of them had h
ad some conflicts over the years, usually surrounding some action or other Matt was running against BC&C. Matt also complained more than once of being harassed with tickets—parking and speeding. Grimes was ex-military and kept the town on a pretty short leash. A displaced northerner with some sort of degree in criminal justice, he had adopted something of a mountain accent. He was divorced, with a kid in Florida someplace that Matt heard he never saw. Their contrast in styles alone would have strained their relationship, but Grimes’s connection with Armand Stevenson and the other directors of the mine all but sealed their enmity.

  Over the years, the police chief had appointed himself as a one-man watchdog committee to step in whenever Matt didn’t have an appropriate permit or was posting notices against a town ordinance. Matt suspected Grimes or his lackeys were behind the disappearance of most if not all of the magenta fliers.

  “I just asked for a policeman,” Matt said, “not the policeman.”

  “You’re a very important person to us,” Grimes replied, smiling civilly. “What do you have?”

  Matt gestured to his patient. At the sight of her, Grimes’s lips tightened noticeably.

  “This woman plunged off Niles Ledge and into the lake,” Matt said. “One of the two kids who rescued her said he heard several shots. The other kid doesn’t think so. She’s got a big bruise over her eye. That may be why she’s unconscious, but she also has a scalp wound that could be from a gunshot. I’m legally required to report any possible shooting.”

  “Thanks for telling me that, Doctor. From time to time I forget some of the laws. How long was she underwater?”

  “I estimate two minutes minimum, four maximum. She had no ID, so in addition to reporting the possible bullet wound, I hoped maybe you could find out who she is.”

  Grimes stepped forward, set his hands on the bed rail, and gazed down at the woman.

  “Her name is Nikki Solari,” he said flatly. “She drove down from Boston to attend Kathy Wilson’s memorial service earlier today. I spent some time talking with her there. Wilson was her roommate. You know who she was?”

  “I know about her, and I’ve heard some of her music, but I didn’t know her personally.”

  “Well, she was hit by a truck in Boston. Died instantly.”

  “I heard something about it from Hal Sawyer. Apparently he knew the family and Kathy.”

  “Yeah, he was at the service. Well, this woman played fiddle in Kathy Wilson’s bluegrass band.”

  Matt decided that playing fiddle was close enough to pianist. He was mentally patting himself on the back for astutely concluding that Nikki Solari’s hands were those of an artist, when Grimes added, “She only played music as a hobby. She’s actually a pathologist—a coroner up in Boston. Spends her time working up to her elbows in gore and guts.”

  Matt immediately stopped the patting.

  “What do you think about that wound above her ear?” he asked.

  Grimes studied it.

  “I guess it could be from a bullet,” he said. “But it could just as easily be from something else, like a broken branch.”

  “Well, we’ll find out for sure when she wakes up.”

  Grimes suddenly whirled to face him.

  “You just make sure that she does!” he snapped.

  CHAPTER 15

  Much of what I write here of my infection with the Lassa virus and my miraculous recovery I gleaned from conversations with those who cared for me during my thirty-day hospitalization. I use their accounts because I was delirious for much of the time, and remember almost nothing.

  THE WORDS WERE THOSE OF DR. SUZANNE O’CONNOR, a missionary physician. She was working in the central Nigerian city of Jos in the spring of 1973 when a patient, Lila Gombazu, crazed with fever, clawed through her rubber gloves and broke the skin on the back of her hand.

  Cloistered in one corner of the Library of Medicine at the NIH, Ellen Kroft read O’Connor’s harrowing account with a dry mouth and an unpleasant fullness in her chest.

  The poor woman who scratched through my glove went into convulsions the next day. In spite of the most heroic measures we could muster, she began hemorrhaging from her nose, womb, and rectum, and died horribly, crying out at the end for her children, two of whom, she had no way of knowing, were already showing symptoms of the disease. Twelve days after my encounter with Lila, my good health and the crush of work caring for our patients had driven the incident to the back of my mind. That day, a Monday, I mentioned to one of the nurses that I had a stuffy nose and scratchy throat, and thought I might be coming down with the flu. Tuesday was more of the same, although the discomfort in my throat was steadily worsening. I couldn’t possibly take time off from my work, though. The hospital was filled to capacity and then some. I put myself on a high dose of penicillin and tried to force fluids past the inflammation and the raw, white sores that now dotted my palate and pharynx.

  On Wednesday, I was making rounds on our patients when I was seized with uncontrollable shivering and profound weakness. Perspiration soaked my clothing as if I were standing in a thunderstorm. My temperature at that moment, as taken by one of the nurses, was 105 degrees Fahrenheit. Within an hour, I was a patient in my own hospital, moaning piteously from the pain in my muscles and joints, unable to take fluids because of the gaping, deep ulcers in my throat, and soiling myself and my bed with uncontrollable diarrhea. The next morning, I was delirious. My temperature had risen to 107 despite vigorous efforts to keep it down. For days, I am told, I lay unconscious, unable to take nourishment or fluids, oozing red blood from my rectum, and coughing up blood as well.

  From the beginning, the diagnosis of Lassa fever was strongly suspected. My associate Dr. Janet Pickford made valiant efforts to fly experts from the CDC to Nigeria along with serum from a woman who had recovered from the disease and had circulating antibodies against it. Unfortunately, the government of Nigeria, angry about having the disease named for the village of Lassa, located along the Nigerian border with Cameroon, delayed issuing visas to anyone involved with my case. Finally, those State documents were approved, and on the tenth day of my illness I received an infusion of the woman’s convalescent serum. By then I had required more than a dozen blood transfusions, and had been delirious or in a coma for almost the whole time. I had lost nearly thirty pounds from a frame that was slender to begin with, and was a mass of bruises and sores. My urine and stool were bloody, as was the mucus from my chest.

  Incredibly, within just two days of receiving the serum, my condition began to improve. A miracle, everyone said. Gradually, the hideous ulcers in my mouth began to heal, and I was able to take nourishment. Over the next two weeks I regained much of my strength as well as my will to live. What I did not completely regain was my hearing, which was lost to the virus in both ears, and which has only returned slightly in my right. I would wish the illness of Lassa fever on no one, and pray that, with time, a cure or vaccine for this most terrible hemorrhagic virus might be found.

  Ellen closed the book called Closer Than You Think—Infectious Diseases in a Shrinking World, and sank down in her chair, staring across the library at nothing in particular. Sixty-one. That was how many cases of Lassa fever had been reported in the U.S. over the past couple of years. Sixty-one and counting. Not that it mattered to Ellen whether the cases were here or in Africa, but for the time being at least, Omnivax was going to be administered here. And the Lasaject component of the supervaccine was, she had come to believe, the weak link in the chain. Now, a day after a very sobering, highly charged meeting at the office of Dr. Richard Steinman, she wasn’t so sure.

  Lynette Marquand’s startling pledge that if even one of the vaccine panel’s twenty-three experts expressed misgivings, release of Omnivax would be put on hold until those problems could be satisfactorily addressed had hit her life like a wrecking ball. Following the pronouncement, Ellen had done her best to continue with business as usual, but that state of existence had proven highly elusive. Less than a day after Marquand’
s speech, Steinman had requested that she meet with him at his office at Georgetown. When she arrived, she found the renowned physician and scientist waiting for her, along with George Poulos. On the corner of Steinman’s desk was a copy of the day’s Washington Post. A headline on the front page proclaimed:

  First Lady promises to rethink Omnivax

  if panel vote is not unanimous

  THE ARTICLE, WHICH Ellen had read, did not mention her by name, but did say that debate among members of the select commission on Omnivax would continue until the vote, to be held in just three days. Steinman, who had a certain amount of charm and warmth, was nevertheless extremely formal, and even after nearly three years addressed all of the commission members by their title.

  “Well, Mrs. Kroft,” Steinman began, “I appreciate your coming up here to meet with me. I hope you don’t mind my having taken the liberty of inviting Dr. Poulos to join us.”

  “No problem,” Ellen said, still smarting some from the exchange with Poulos at the final commission meeting.

  “After Mrs. Marquand’s speech, I, um, felt it was essential to review our conversation with Dr. Steinman,” Poulos said. “I felt that in view of the First Lady’s promise to the nation, he should know that the final vote might not be unanimous.”

  “I suppose I would have done the same thing in your position,” she said, somewhat coolly.

  “Mrs. Kroft,” Steinman said, “I confess I was somewhat taken aback to learn that, at least before Mrs. Marquand’s speech, you were planning to vote against the implementation of Omnivax. Over the years we have been meeting together, I felt that you honored your mandate as a consumer on our committee quite admirably, by questioning issues until you understood them and always being prepared for our sessions. I wondered from time to time if you might vote against approval when yours was only one ballot of twenty-three. But now that your vote can effectively stop the entire Omnivax program, I thought, if it is all right with you, that we might review together what is at stake.”