Containment

by Hank Parker

  She and Kennedy proceeded to the necropsy area.

  A sealed, four-foot, stainless-steel box—an animal coffin—rested on the floor, next to a stainless-steel bench that looked like a surgery table.

  Mariah opened the coffin. A dog’s body lay inside, enclosed in transparent polyethylene. She could make out dark straw-colored fur. A label taped to the plastic read Calvert. Four-year-old Golden Retriever, male. She made out the vet’s name on the label.

  With Kennedy’s help, she lifted the carcass out of the coffin, noting that it had almost completely thawed since its removal from the freezer the night before. She cut the plastic away, using dull scissors to minimize chances of cutting her suit or herself, and saw two labeled test tubes lying next to the corpse. The labels identified the contents as Calvert’s blood.

  The whooshing sound of umbilical air flowing into the helmet pounded in Mariah’s head. Even with the cooling ventilation, she began to perspire. The dog itself didn’t make her nervous, but the vials of blood reminded her of what she could be dealing with. She took a deep breath, steadied herself, and looked at the carcass on the table. This had been a beautiful dog. Even in death his fur still shone, and she could see that he had been well groomed.

  “Good-looking animal,” said Kennedy, beside her. His voice sounded as if it was coming through a wind tunnel. Mariah had forgotten for a moment that she wasn’t alone.

  She stepped on a scale near the table and weighed herself. Then she picked up the dog, stepped back on the scale, read the result, and calculated that the dog’s weight was fifty-two pounds. She guessed that Calvert had probably lost at least 20 percent of his body weight after dying.

  For the necropsy she’d have to use incision instruments—known as sharps in the trade—and this would increase the risk of accidental cuts or contamination. She opened a white medical cabinet and pulled out a collection of supplies and tools, including a six-inch, molybdenum-hardened, stainless-steel necropsy knife with a yellow “no-slip grip” handle and a razor-sharp blade. This was her personal knife, stored in its own case, with her name on it. It was her most important tool and she didn’t share it. She kept an identical knife back in her lab; this one was reserved for work in the MCL.

  Mariah also retrieved battery-operated hair clippers from the cabinet. She began to shave the retriever, and as she watched the fur fall to the floor, she felt sadness and regret, as if she were removing the last of the dog’s dignity. When the dog was completely hairless, he looked much smaller, almost like a large newborn puppy.

  She next conducted a complete external examination. She made notes on a pad: postmortem rigidity; limited external decomposition; skin showing extensive petechiae and purpura, latter up to two inches diameter; extensive subconjunctival hemorrhaging in eyes; minor bleeding from gums. What on earth did this dog get into? she wondered.

  Time to start the dissection. Kennedy held the dog while Mariah cut, using the necropsy knife. She worked carefully, knowing an errant move or slip of the blade could breach her suit and slice through all protective layers, all the way to the bone. She laid back the skin from the dog’s thorax, abdomen, and cervix, clamped it in place, and examined the exposed tissue. There were no obvious major problems. The diaphragm was intact and there had been no evident bleeding into the chest cavity. Organs also seemed intact, and surrounding tissue and muscle mass seemed normal and healthy, though there were signs of swelling in the lymph nodes. She removed the abdominal viscera, sectioned it lengthwise, and removed a mass of partially digested material. The digestive matter was tinged with red. She placed it into a polyethylene bag and sealed and labeled the bag.

  She cut away the tissue surrounding the hip joints. With a sterile swab, she collected synovial fluid from around the joints and swabbed it onto clean microscope slides.

  Soon her shoulders were getting sore and her neck started to ache, but she knew it was more from tension than exertion. She glanced over at Kennedy. Was he impatient or restless, having nothing to do except observe? She saw him raise his gloved right hand and give it a little pump. Thumbs-up?

  After a short rest, Mariah collected bone marrow samples. She painted the soft, spongy material onto microscope slides with a fine, camel’s-hair brush, added fixative, placed the slides in a holder for later viewing, and sealed the assemblage in a ziplock bag. She removed the major organs and placed each into a separate, labeled plastic bag.

  Time to remove the brain. She first severed the head from the dog’s body, then made three careful cuts through the skull with a bone saw. With a bone chisel she delicately removed the skull sections from around the brain. To free the brain she’d next have to cut through the cranial nerves and pituitary stalk with a scalpel, but the work with the bone chisel had been tiring, and now her visor was starting to fog up. She paused and slowed her breathing. After resting again, she picked up the scalpel and began to cut, working slowly and methodically.

  She soon freed the brain and gently placed it into a 10 percent formalin solution in a large plastic specimen jar. She then removed the spinal cord and radial and sciatic nerves and deposited these into separate jars of formalin.

  With that, she’d finally finished the necropsy. When she looked at what was left of the dog, she felt sadness. A once beautiful, healthy creature had been reduced to an empty sack. Mariah felt as if she’d violated the dog. She imagined having to perform this gruesome dissection on her own dog—Dancer, a little West ­Highland terrier she’d had for five years and loved like a child—and had to pinch her eyes shut to block out the picture. She sensed Kennedy’s gaze on her and willed herself to keep moving.

  If they were dealing with a virus, Mariah would need living cells to get a good look at it. One source of the cells would be laboratory research animals, mice and monkeys, maintained by the USDA research facility. Tomorrow she’d inject Calvert’s blood directly into the animals and wait for replication and symptoms to occur. Depending on the virus, the results could come quickly. The other source would be the Barn’s mammalian cell cultures. Amplification of the virus in the cell culture would take longer than in living animals, perhaps several days, but the culture would be purer than in the animal blood and easier to isolate for further study in the future.

  When Curt and Mariah left the MCL they reversed the entry process, removing the suits and hanging them up where they’d found them. Mariah preceded Kennedy into the change room, where she discarded her disposable clothing and gloves in another biohazards receptacle and showered out. Even though she assumed that no particles had breached her suit, she took care to scrub under her fingernails and to blow her nose before leaving the shower area. After getting dressed again, she waited for Kennedy outside the door of the outer change room.

  “Thanks for your help,” she said, when he emerged through the doorway.

  “Nice work. Impressive,” he said.

  Mariah briefly considered using the compliment as an opportunity to make friendly conversation with Kennedy. She’d wanted to impress him, she realized now, and it was generous of him to say what he’d said. His gruff behavior in Hoffman’s office notwithstanding, he’d been nothing but professional, and even nice, today. But Mariah was exhausted. She’d done dozens of necropsies over the years, but today’s had been tough. The truth was that she loved dogs, and working on Calvert, who she assumed—irrationally, she knew—was a good dog, had shaken her more than she wanted to admit. Any thought of making small talk with Kennedy was overridden by an overwhelming urge to return to her office, shut her door, and simply close her eyes for five minutes.

  “Thanks,” she said to Kennedy, angling her body away from him, feeling rude but telling herself it didn’t matter. “I’ll keep you posted on the results.”

  Kennedy raised a hand in thanks and good-bye, seemingly unperturbed, and they parted ways.

  * * *

  “Keep your fingers together, dear. You don’t want her to
nibble you.” A young mother watched as her four-year-old daughter pressed against the fence of the Chester County Fair’s livestock petting zoo and extended an offering of grain to a young heifer.

  The little girl giggled. “She’s tickling me, Mommy.” The child pulled her hands away from the cow’s muzzle.

  “They have rough tongues, don’t they?” said the mother, smiling. “But they won’t hurt you. Let’s wash your hands.” She looked around for a handwashing station, but didn’t see one. She pulled a tissue from her pocketbook and wiped the girl’s palms and fingers. She took the child’s hand and threaded through the crowd of squealing kids who’d gathered around the enclosure.

  “Are you hungry, sweetheart?” she asked. “Let’s get something to eat.”

  CHAPTER SEVEN

  AUGUST 18, EVENING

  THE BARN

  When Mariah had gotten back to her office after the necropsy, she hadn’t immediately begun working on the results. She’d wanted to get her mind off the dog, so she rested for a few minutes, then worked on her foot-and-mouth disease model and tried to put the necropsy out of her mind for the afternoon.

  Now it was late, late enough that her stomach had begun to groan. She’d skipped lunch, the images of the dissected flesh too vivid in her mind for her to work up an appetite, and couldn’t really even remember eating breakfast, though she was sure she had. Oatmeal. Cereal. Something light.

  Yielding to her hunger, she decided to pop down to the cafeteria for a microwaved cup of soup and a Coke. Minutes later, as she was heading back to her office, head down, deep in thought about the microscope work ahead of her, she rounded a corner and nearly ran into Curt Kennedy, who was standing near her office door. “My God, I’m sorry. Didn’t see you,” she said, wondering what Kennedy was doing at her office.

  Kennedy held up his hands and smiled. “My fault,” he said. “I obviously startled you. Just stopped by to see how it’s going.”

  “Oh,” Mariah said, a little breathlessly. “I’m about to go over to the lab.”

  “Mind if I join you?” he asked.

  Mariah hesitated. She narrowed her eyes at Kennedy. Was he shadowing her because he thought she’d put off the work? Or screw it up? Her mind scrambled for some excuse to turn him away. Not only was she annoyed, but she needed to concentrate and she was afraid he’d be a distraction.

  “Just curiosity,” he said. “And I figure I’ll learn something from you.”

  “Okay,” she said finally, deciding she really had no reason to suspect his motives. “You can help ID the bugs.”

  In the lab, as Kennedy looked on, Mariah prepared the samples and mounted the first one inside a vacuum column on the scanning electron microscope. She activated the SEM’s electron gun, focusing a beam of high energy electrons onto the sample. The result was a three-dimensional image of any particles detected by the electron beam, displayed on a computer monitor. By changing the magnification on the scope, Mariah could focus in on individual particles, revealing an astonishing level of detail.

  She first detected several rod-shaped objects averaging about a half micron in diameter, several times bigger than a large virus particle. She focused on one, then swiveled her chair toward Kennedy. “Want to have a look?”

  Kennedy bent toward the monitor, his shoulder brushing lightly against Mariah’s. “Bacteria,” he said. “Looks like the one that causes canine ehrlichiosis.”

  Mariah stood and pulled a copy of The Manual of Clinical Microbiology from a shelf and quickly confirmed Ehrlichia canis. She thought back to the necropsy. That was no ehrlichiosis, she thought, remembering that Calvert had undergone extensive hemorrhaging. She turned back to the microscope and increased the magnification. A number of much smaller particles came into view, clearly virus particles, spherical in shape, about one hundred nanometers in diameter—more than a thousand times thinner than a human hair—with spiky protuberances all around. Mariah didn’t recognize the particles. She stood and invited Kennedy to have another look.

  Kennedy spent the better part of a minute at the scope, adjusting the focus, resolution, and magnification. When he finally looked up at Mariah, his expression was puzzled.

  “Virus,” he said. “Look a little like flu virions. Maybe the dog had canine influenza. But the particles seem a bit big for flu.”

  “So what else could they be?”

  Kennedy shook his head. “They remind me of something I saw a few years ago—in Afghanistan. But it can’t be the same bug. Doesn’t exist in the Western Hemisphere. This has to be some kind of flu virus. Maybe a new strain. I can ask a colleague at Fort Detrick to have a look. Could I borrow a blood sample?”

  “Help yourself, but I hope you can get that ID quick. We need to brief Hoffman tomorrow.” Mariah thought again about Hoffman’s insistence that they do the necropsy in the MCL. “What was this Afghanistan virus?” she asked.

  Kennedy turned back to the monitor and scrutinized the images. “A zoonotic agent, pretty bad. Case fatality rate around 50 percent. Of humans, that is. But no way could it be here.”

  CHAPTER EIGHT

  AUGUST 19

  THE BARN

  The next morning Mariah settled into an empty seat at a rectangular table in a small conference room at the Barn. She nodded to Hoffman, who sat at the head of the table. He really looks military today, she thought. Ramrod straight, spit-and-polish appearance, even in civilian clothes. She studied his face, looking for a clue as to why he’d called this sudden meeting. No expression. She and Kennedy weren’t due to brief him on their findings until this afternoon. She glanced around the table. It was a small group: Hoffman, Kennedy, herself, and three other people she didn’t recognize: a gray-haired woman; a blond woman; and a male army officer.

  Hoffman leaned forward slightly and cleared his throat. “Thanks for coming together on short notice,” he said. “For those who don’t know everyone, let me introduce you.” He went around the table. The gray-haired woman was Dr. Emily Rausch, the chief of infectious diseases at Pennsylvania Hospital. The army officer was Lieutenant Colonel Wade Davidson, head of the emerging diseases unit at USAMRIID in Fort Detrick. The blond woman was Barbara Wright, director of the Pennsylvania Office of Public Health Preparedness.

  Hoffman nodded toward a television monitor in the corner of the room where an image of a balding man in a white lab coat filled the screen. “We have Dr. Richard Blumenthal, the director of the North American Infectious Diseases Division at the Centers for Disease Control, joining us remotely. Rick, can you hear me okay? Good.”

  Just like Hoffman to be so oddly formal, Mariah thought. He could have left out the long title and just said CDC—especially with this group.

  Hoffman turned back to the table. “Dr. Blumenthal’s on secure video link from Atlanta. Let’s get started. I’ve double-checked your clearances—what we talk about today stays among us. Bottom line is we have a public health emergency apparently caused by a zoonotic disease. Five days ago a woman from Middle Valley brought a sick dog to a local vet. The dog went into convulsions and died in the exam room. Before it died, it bit the vet.” He turned toward the gray-haired lady on his left. “Emily, why don’t you take it from here?”

  Dr. Rausch leaned forward in her chair. “EMTs from Chester County brought the vet in yesterday,” she said. “He was in tough shape—semicomatose, hemorrhaging from the mouth and nose, severe headache, high fever. Died an hour after he arrived.”

  Mariah’s mind raced. This was the vet who had handled the same dog she’d dissected yesterday? And now he was dead? She glanced at Kennedy. Was he thinking the same thing?

  Blumenthal cut in from the TV monitor. “So did they take him directly to Penn Hospital?”

  Rausch shook her head. “They first tried to admit him at the regional hospital in Kennett Square, but they wouldn’t take him. Earlier in the day, the same hospital had admitted the dog’s o
wner—also from Chester County—with similar symptoms. They tried to treat her but couldn’t diagnose the illness. The woman kept getting worse. So they evacuated her to Penn Hospital on a Life Flight helicopter.”

  “I was afraid of something like that,” said Blumenthal. “Now we’ll likely have a lot more exposures. How’s she doing?” he asked.

  “Stable,” replied Emily. “We have her in intensive care in a special isolation unit. We’ve induced a coma, slowed her metabolism. We’ve also admitted her husband and two young children. Husband’s showing symptoms, but so far the kids seem okay.”

  “Anyone else sick?” asked Blumenthal. “The EMTs, for example?”

  “I was coming to that,” Rausch said, and Mariah picked up on a hint of annoyance that she sympathized with. Blumenthal was asking obvious questions. She wished he’d let Rausch speak uninterrupted. “So far we’ve also admitted six medical personnel,” Rausch went on. “Three EMTs and a doctor and two nurses from the Kennett Square hospital. Same symptoms. They’re in the hospital’s isolation wing. Our own attending medical staff are in full protective gear. We’re carefully monitoring them.”

  For several seconds there was silence in the room. Finally Blumenthal said, “So what else are you doing to manage this?”

  “The state has responded aggressively,” said Barbara Wright from the Pennsylvania Public Health Office. “We’ve shut down the regional hospital and are in the process of decontaminating the hospital facilities, vet’s office, ambulances used to transport victims, and the dog owner’s house. We’re looking for a common denominator among the illnesses.”