“I doubt that any of them will work, because I don’t think he’s got bacterial pneumonia.”
Maggio studied the x-ray again, looking for any telltale clues. “You believe it’s viral, eh?”
“Most likely.”
Maggio nodded slowly. “That would explain the boy’s terrible headache and myalgias and, in particular, the pain behind his eyes, which his mother told me about.”
David nodded back, now thinking he may have underestimated the old physician’s diagnostic abilities. “You sound like you’ve come up against viral pneumonia before.”
“A long, long time ago,” Maggio said wistfully. “I was a young Air Force doctor stationed in Japan when we had a sudden outbreak of influenza. It spread like wildfire among the enlisted men who lived in crowded barracks. Some of them ended up with influenza pneumonia, and all of those died terrible deaths.” He paused and sighed deeply to himself. “And we couldn’t do a damn thing for them.”
“We still can’t,” David told him. “We have no effective treatment, so most of the people with this disease die from it.”
“Do we have anything at all to offer the boy?”
David shrugged. “We can try him on antibiotics, just in case he has a bacterial super infection.”
“Of course, there’s still a slight chance the boy’s pneumonia is in fact bacterial,” Maggio mused.
“That’s not going to happen,” David said bluntly.
“Well, I like to leave room for a glimmer of hope.”
Carolyn came to the entrance of the area and stuck her head in. “Will’s CBC is fine. His white blood cell is 6,200, with a normal differential.”
“Your glimmer of hope just walked out the door,” David said to Maggio, and shook his head at the bad news. If Will had bacterial pneumonia, which could be cured with antibiotics, the white cell count would have seen greater than 10,000, with a very high percentage of polymorphonuclear leukocytes. But that wasn’t to be. The boy’s fate was sealed. “How is his cyanosis doing?”
“Worse,” Carolyn reported. “His face is turning deep purple, despite the oxygen.”
David turned to Maggio and asked, “Do you have a positive pressure ventilator down here?”
“We don’t have a ventilator of any type.”
David came back to Carolyn. “Hook up another tank of oxygen and see if you can somehow get it to flow into the mask.”
“That can’t be done,” Carolyn said promptly. “But maybe I can increase the delivery of oxygen using nasal prongs.”
“Give it a try.”
Maggio watched Carolyn dash away, then repeated her description of Will’s complexion. “That deep purple face,” he said quietly, his mind going back forty years. “I knew I had seen it before, yet I couldn’t place it. But now I can. That was the face I saw on the boys in Japan who died of influenza pneumonia.” He sighed sadly at the memory. “That awful purple color, so gruesome you thought it was painted on.”
“Severe cyanosis does that to the skin,” David said. “Virtually no oxygen is getting to the boy’s tissues.”
“But why so severe?” Maggio queried. “You never see this degree of oxygen deprivation in bacterial pneumonia.”
“Did you notice that Will was coughing up blood?”
“Yes, and plenty of it.”
“Well, that’s just the tip of the iceberg,” David went on. “The virus is causing Will to hemorrhage into his lungs. And that blood is filling up every bronchi, bronchiole, and alveoli, to the point no oxygen can get through.”
“It’s as if he’s drowning in his own blood,” Maggio said, after reflecting briefly.
“Exactly.”
“What can we do for him?”
“Nothing aboard the Grand Atlantic,” David said candidly. “We have to transport him to a critical care unit ASAP.”
“How can we accomplish that?”
“With Captain Rutherford’s assistance, I hope.”
David raced back into the examining room. Marilyn was holding Will’s hand and crying, as she tried to understand his high-pitched babbling. The boy’s face remained deep purple, despite the increased oxygen he was now receiving through nasal prongs. Will coughed, and up came bright red sputum that oozed around the edge of his oxygen mask. It began to bubble, trapping even more oxygen. David watched the soundless bubbling increase within the mask. It was a graphic depiction of what was happening inside the boy’s lungs, he thought darkly. Soon no oxygen at all would be getting through.
David took a deep breath and walked over to deliver the bad news. “Marilyn, it looks like Will has severe viral pneumonia.”
“Can he be treated?” Marilyn asked in a rush.
“It can,” David said, deciding to withhold the grim prognosis for now. “But it requires that Will be looked after in a critical care unit.”
Marilyn quickly glimpsed around the sick bay before asking, “But we don’t have one here, do we?”
“No,” David replied. “He’ll have to be transported back to the mainland. I’ll have Captain Rutherford make the necessary arrangements.”
“I’ll want to go with him,” Marilyn said at once. “I will insist on that.”
“Of course,” David agreed. “And Sol too, if you wish.”
Marilyn nodded her answer. “He’ll need care as well. Sol has the same symptoms as Will.”
“Is his face turning purple?” David asked immediately.
“No. but he has fever and is coughing up a little bit of blood.”
“Is he short of breath?”
“No.”
“Good,” David said with an optimistic tone, but he knew that dyspnea would start soon. And so would the change in face color. “I have to go see Rutherford now and make the arrangements for Will to be transported.”
“Thank you, David,” Marilyn said gratefully.
David dashed out and down the passageway, digesting and assimilating all the medical facts he’d just encountered. The diagnosis was certain. All the signs and symptoms fit. But there were several things out of place that bothered him. First, he had never seen more than a few cases of influenza pneumonia, but they always occurred during a major influenza outbreak. And that wasn’t happening now. The only other case was Sol Wyman, who had gotten it from close contact with his stepson. So there was no outbreak, yet there were already two cases of influenza pneumonia. The second bothersome point was that neither Will nor Sol were elderly, had compromised immune systems, or had preexisting pulmonary or rheumatic heart disease. Those were the conditions that predisposed individuals to influenza pneumonia. Yet none of those factors were present in Will and Sol. Peculiar business, David thought to himself, very peculiar.
He went to the staircase and darted up the stairs, still thinking about the out-of-place facts. David had learned from past experience never to discard facts that didn’t fit the diagnosis. They were invariably trying to tell him something. Something important.
six
William Rutherford’s face paled as he listened to the nightmare about to unfold on the Grand Atlantic. David was speaking to the ship’s captain in a very low voice so the other officers on the bridge couldn’t overhear him.
“How far is it to the nearest U.S. port?” David asked.
“Eight hundred miles,” Rutherford replied.
“How long would it take for us to reach the mainland?”
“At full speed, just over a day.”
David grumbled under his breath. “The boy will be dead by then.”
Rutherford gazed down at the expansive deck of the luxury liner. Passengers were strolling along the railing or dozing in lounge chairs, all taking in the bright sun and unaware of the disaster about to occur. “Perhaps the boy and his father will be isolated cases.”
“Don’t bet on it,” David said forthrightly. “Chanc
es are this virus will spread, particularly among the elderly, and we’ll end up with a lot of very sick people on our hands. And those with pneumonia, like Will, will die.”
“Is there any possibility the boy will survive?”
“Only if we can transport him to a critical care unit. And even then, his outlook is poor.”
Rutherford sighed heavily, unsure of what to do next. “Dr. Ballineau, as an ER physician, you must have dealt with similar situations. I’m referring to patients with terrible diseases caught in remote places. How did you handle those predicaments?”
“Usually with a helicopter,” David said. “But most of them have a range of only 400 miles, so you’ll have to contact the Navy and see if they have any ships with helicopters nearby. And if so, maybe they can pick up Will, then hop and skip their way back to the mainland.”
“There’s a problem with that solution,” Rutherford said unhappily.
“What?”
“Our heliport was badly damaged during the storm,” Rutherford confided. “That large panel that fell from the bridge onto the deck split the heliport wide open. It’s so unstable that no one is allowed to walk on it, much less land a helicopter.”
“Shit,” David growled.
“Indeed,” Rutherford agreed. “Do you have any other ideas?”
“None at the moment.”
David hurried from the bridge and took the stairs down as he tried to come up with an answer to the dilemma. Without a heliport, there was no way a helicopter could land safely on the Grand Atlantic. And even if a naval ship with a helicopter came to their aid, how could they transport Will to it? In a lifeboat or a dinghy? Christ! He’d never survive that. The trip alone would kill him.
David continued down the steps, concentrating his mind on other solutions to the problem. The Navy SEALs, as good as they were, would be of no help here. Nor would the speedier Coast Guard cutters, which would still require transferring Will over rough seas. And it was impossible for a seaplane to land and take off in the choppy swells of the ocean. So for now, David concluded, there was no way out. They were all prisoners aboard the Grand Atlantic. And to make matters even worse, without a heliport, they couldn’t bring in life-saving equipment, like ventilators and additional supplies of oxygen.
At the G level, David left the staircase and dashed down the passageway. He went by a spa that was crowded with people waiting for a body massage or facial or some other beauty treatment. All were sitting close to one another, all breathing the same air in and out. It was a perfect setup to spread the virus quickly. David could only hope that his diagnosis was wrong. Maybe, just maybe, Will would turn out to have some strange type of bacterial pneumonia that would respond to antibiotics. But David knew he was hoping against hope. There was a nasty influenza virus on this ship, and it would search for any available host to live and replicate in.
He entered the sick bay and walked through an empty reception area. It was a good sign, David told himself. At least ill patients were not piling in to be seen. At least not yet. In the examining room he saw Marilyn sobbing, with her head resting on Will’s chest. The boy was still cyanotic, his extremities still wrapped in ice cold towels.
Carolyn glanced over and silently mouthed out Will’s temperature: 103°.
David nodded at the improvement. That was some better, but not much. The goal was to keep the temperature below 104º, because above that point it could begin to fry the boy’s brain.
Marilyn looked up, her eyes puffy and red from constant crying. “Did you make arrangements with Captain Rutherford to have Will transported to land?”
“We’re trying to get things set up,” David lied.
Marilyn studied David’s face, as if aware of his half-truth. “Will isn’t going to make it, is he?”
“If we can get him to a critical care unit, he stands a chance,” David said and gently squeezed the woman’s shoulder. “Don’t give up hope yet.”
Marilyn put her head back on Will’s chest and began sobbing again.
David resisted the urge to comfort the woman further. At this point it wouldn’t help. She knew instinctively that her son was barely clinging to life, and all the kind words in the world weren’t going to change that. Mothers had inborn antennas for those sorts of things.
David gazed down a makeshift chart of Will’s vital signs that Carolyn had constructed. The boy’s blood pressure had dropped to 95/60, and his pulse was now racing at 120/minute. But most disturbing was a respiratory rate of 40/minute, which was three times normal. Will was trying to suck air into lungs that were rapidly filling up with blood. It was a hopeless endeavor.
David was about to reach for a stethoscope, but decided not to. He already knew what he would hear. There would be widespread wheezes and crackles and decreased breath sounds bilaterally. The only thing missing would be a death rattle. That would come soon enough.
In his peripheral vision he saw Maggio waving him over to the radiology room. David softly squeezed Marilyn’s shoulder once more, then walked away and joined the old physician in a far corner of the sick bay. The expression Maggio’s face told him that something had gone wrong. Terribly wrong.
“What?” David asked.
“I’ve gotten emergency calls from two other passengers. They’re complaining of high fever and cough. Both have awful headaches.” Maggio hesitated and lowered his voice to a whisper. “And one of them is coughing up blood.”
“Oh Christ!” David groaned.
“It’s spreading,” Maggio said and tried to swallow back his fear. “And it’s spreading fast.”
seven
David put on two surgical masks, one on top of the other, and hoped the double layer would afford him added protection against the virus. Then he placed a stethoscope around his neck to give him the appearance of a physician, and knocked on the cabin door. He heard movement inside, followed by silence, and sensed he was being looked at through the peephole.
“I’m Dr. Ballineau,” David called out. “Dr. Maggio asked me to pay you a visit.”
The door opened immediately. A colorfully dressed, middle-aged man, wearing a brown smoking jacket and yellow ascot, ushered David into the overheated sitting room.
The man introduced himself as Thomas Berns and said, “I should begin by telling you I’m HIV positive, and so is my partner.” He gestured to a younger man lying on the sofa and bundled up in a white terrycloth robe. “Ralphie has become quite ill, as you can see.”
David glanced over and studied the dark, handsome man on the sofa. He had his eyes closed and he was breathing normally except that he coughed with every third breath. From a distance his skin color appeared healthy. But there was a Kleenex in his hand that was heavily stained with blotches of blood.
“We’re both on a triple drug cocktail for HIV,” Berns informed. “I assume we should continue taking it.”
“You should,” David said. “Now tell me, when did your symptoms begin?”
“Late last night,” Berns replied. “We both felt feverish, and chilly. Ralphie’s temperature was higher than mine. A hundred and one, I think.”
David quickly estimated the incubation period for the virus. Will had been ill for two days at the most. So assuming he was the source of the contagion, the incubation period was in the range of forty-eight hours, which was very short. The usual incubation period for the influenza virus was four days. A virulent virus with a brief incubation period, David thought grimly. It was a perfect combination for a major outbreak. At length David asked, “Do either of you have shortness of breath?”
“Not really,” Berns said and tried to suppress a wet cough.
“Are you coughing up any blood?” David inquired.
“A little,” Berns said. “But not nearly as much as Ralphie.”
David walked over to the sofa and placed a stethoscope on the chest of Ralph Oliveri, which
was the name embroidered on his white robe. The man opened his eyes to peer at David, then closed them without saying a word. Ralph Oliveri’s lungs were filled with crackles and wheezes, and his breath sounds were distant. Bad, David told himself, knowing the worst was yet to come. He studied the man’s face again and now saw a blue tinge to his lips. Another ominous sign.
The phone in the cabin rang. Berns quickly answered it, then held the receiver out to David. “It’s Dr. Maggio, for you.”
David put away his stethoscope and reached for the phone. “Yes?”
“More bad news,” Maggio reported. “Two of the deckhands now have symptoms of the flu. Both are coughing their heads off.”
“Do they have hemoptysis?” David queried.
“Not yet,” Maggio said. “But my biggest concern at the moment is the crowded quarters they’re occupying. The beds for the crew are pushed together, almost side by side. They’re going to infect everybody down there, if they haven’t already.”
“Somehow you’ve got to isolate them,” David urged.
“That can’t be done. All the cabins are taken.”
David knitted his brow and concentrated on the problem. Somehow the infected crew had to be separated from the others. But how? There was no good way to do it, so they’d have to settle for a not-so-good way. “Put surgical masks on the sick deckhands, then push their beds into the corner, as far away from the others as possible. Finally, see if you can arrange to have some curtains put up around their beds.”
“I don’t think that’ll be of much help.”
“It’ll have to do for now,” David said. “I’ll meet with you in the sick bay shortly so we can make further plans.”
David hung up the phone and came back to Berns. “The virus you have is beginning to show up in other parts of the ship. It’s obviously very contagious, so here is what I’d like you to do. First, don’t leave the cabin unless you absolutely have to. And don’t allow any visitors in. If you do leave, wear surgical masks that I will have sent down to you. Second, avoid all places where crowds assemble, such as the dining room and movie theater.”
Plague Ship (A Ballineau/Ross Medical Thriller) Page 6
