DRYP Trilogy | Book 1 | DRYP [The Final Pandemic]

by Scheuring, R. A.

  He could sense the familiar shrug over the phone line. “Well, you know how it goes. You hang around long enough, they have to promote you or fire you. I guess they decided to promote.”

  Which was utter bullshit, Ajay knew, because Helena Wang was the youngest Chief of Infectious Disease ever hired at UC San Francisco. She was widely expected to be the next head of the CDC, and all self-deprecation aside, she damn well knew it.

  “But please don’t tell me you’re calling to congratulate me on a position I took over a year ago,” she went on, in her signature husky voice. “What’s up?”

  “Actually, I’m calling about a case,” he said. “Bubonic plague. A nineteen-year-old Japanese exchange student.” He gave her a brief rundown on Yoshiki, including the young man’s marginal response to antibiotics.

  She listened politely. “Well, you know, Ajay, even with treatment, fourteen percent of plague patients still die these days. Is he that sick?”

  He hesitated, and then decided to tell the truth, even if it made him look indecisive, even if she might laugh. “He’s in the intensive care unit, but I don’t think he really needs to be there. In truth, I’ve been too damned scared to move him out. I’ve got him on gentamicin and doxycycline as a precaution.”

  “Two antibiotics?” She did laugh then, a short burst that she tamped down. She said dryly, “Well, that ought to kill it dead. Have the antibiotic sensitivities come back yet?”

  “No. We had to send the specimens to the state lab. We don’t see a lot of plague around here.”

  Her keyboard clicked in the background. “All right, then. We’ll arrange transport today.”

  “You want to transfer him?” He repeated, disconcerted.

  “Why else would you call me, Ajay? I’m assuming you’re calling me because you need a little extra help on the case, right?”

  “Yes, but he’s in isolation.” Singh realized he was stalling. He hadn’t intended to transfer the patient. He had only meant to ask for Helena’s expert opinion.

  “How long have you had him on antibiotics?”

  “Forty-eight hours.”

  “Then he doesn’t need isolation anymore. Throw a mask on him for transport, if it makes you feel better, and we’ll take a look at him here.”

  “Well, I suppose,” Singh said slowly.

  “Great,” said Helena, the matter settled. “You’ll have to come down here some time and see the old place. It’s changed a lot since residency.”

  “Yeah, yeah, that’d be great.”

  “Well, gotta go. I’m still working on the keynote address for the World Scientific Conference on Infectious Disease.”

  “Oh, right,” said Singh, who had forgotten the upcoming infectious disease conference. Keynote address, he thought. Well, she was certainly showing him whose career had taken the better trajectory. He glanced around his small office at Washoe County Medical Center, feeling oddly deflated. “Better get back to work.”

  “Nice talking with you, Ajay.”

  “You, too, Helena.”

  There was short pause. “Ajay?”

  “Yes?”

  “Say hi to your wife.” She hung up.

  Helena Wang stared out her office window into the deep San Francisco fog, her ear still warm from the contact with the phone. Despite her braggadocio earlier, there was no way in hell she’d get any further work done on the keynote address this morning. Ajay Singh had just called her, she thought in a kind of wonder. After ten years of cowardly, baby ass silence.

  She picked up the phone and called Jim Carson, one of two infectious disease fellows on her service for the month.

  “Jim, it’s Helena. We’ve got a case coming in today from Reno. Just wanted to give you a heads up. Bubonic plague. Documented by culture. It’ll go as a Medicine admit, but we’ll need to spearhead the treatment. You want first crack at it?”

  “Of course,” said the fellow in a deep southern drawl, which sounded ridiculously incongruous with the fog-bound city by the bay. Helena liked Carson, although many of the others didn’t. She understood his intensity and the complete dedication he brought to his job. It reminded her of herself.

  “Good. I’ll call you when he gets here. It probably won’t be until early this evening.”

  “Treated?” asked Carson.

  “Yes, on antibiotics for forty-eight hours, which means the danger is over, but not thriving like the Reno doc wanted, so he wanted him transferred here for a little UCSF tender loving care.”

  Reno doc, Helena thought disbelievingly. That’s what Ajay had settled for.

  Carson laughed. “Well, I’m always pleased to have a plague case. Always a pretty rare event where I come from.”

  Despite herself, Helena laughed, too. She knew Carson was Duke educated and had spent his youth and early training in the South, where mosquitos and humans carried the most worrisome infectious diseases. “I hate to break it to you, Jim, but plague’s not that common here either. The last case in SF was more than fifty years ago.”

  “Well, I’ll have to live it up, I guess.”

  “Knock yourself out,” Helena said.

  Singh watched the paramedics load Yoshiki onto a gurney for transport. The Japanese boy weakly reached out a hand to the ICU doc, mumbled something unintelligible beneath his mask, and then slumped back dejectedly when Singh didn’t understand.

  Poor kid thought Singh. Yoshiki had been in isolation for more than 48 hours. He had to be absolutely sick of it.

  Yet Singh felt strangely resistant to removing the mask. He knew this reluctance would earn him the unending scorn of the UCSF doctors. Double antibiotic coverage and permanent isolation, they would say, the recipe for treatment at the “outside hospital.” And then they would knowingly look at one another, as if to say, what morons!

  Singh couldn’t help it. His hackles raised. He knew the institutional arrogance at UCSF firsthand. After all, he’d done both residency and fellowship there and, at one point, he’d fully expected to work at the esteemed institution as an attending physician. But he’d made a different choice, one that perhaps carried less prestige, but which did not lessen his value as a doctor.

  The boy spoke again, and again Singh shook his head, not understanding. The boy finally let his head drop back on the pillow, misery and defeat settling across his face.

  Singh couldn’t bear it. He couldn’t stand the suffering on Yoshiki’s face. He couldn’t stand the thought of his former colleagues’ scorn.

  “You don’t need this.” He reached down and pulled the mask from the boy’s face.

  Tears shimmered in the corners of Yoshiki’s eyes. “Thank you,” he said, so softly that Singh almost didn’t hear it.

  Singh watched as the paramedics wheeled the boy away. He held the mask in his hand for a moment and then threw it in the trash.

  The sun was setting in downtown Los Angeles, the glass skyscrapers glowing a spectacular, fiery red as Brian and Susan inched along the Santa Monica Freeway. It was seven thirty pm, and still, the traffic was miserably dense, an endless five-lane queue.

  The slow progress didn’t appear to bother Brian. His spirits were soaring, and as Susan sat beside him in the car, listening to the excitement in his voice, she wondered why, despite being at the end of her residency, she wasn’t feeling the same sort of exultation.

  “I think the offer will come tonight. Matson took me aside and said he had a special message he wanted to give me at the party. I think it’s going to be a job offer.” Brian gazed straight ahead as he said this, his eyes not leaving the car in front of them, but the lines on his handsome face had eased. Susan thought this was perhaps the happiest and most relaxed she had ever seen him.

  “That’s great, Brian. What about Ken?” Ken was the other fellow graduating from Brian’s department.

  “Ken’s going into private practice in Phoenix. He signed a contract this morning. It’s a good job for Ken. He’s always been a private practice kind of guy.”

  Susan recogn
ized the faint put-down. “He doesn’t want an academic career?” Susan had always liked Ken. He was a short man, somewhat older than his peers, but he was kinder than the rest and seemed to carry less of the machismo rampant in the department.

  “Doesn’t have the hands, babe. You should see him sew the proximals. It’s pathetic.”

  “The proximals?” Susan had no idea what Brian was talking about.

  “Ah, forget it. You look nice.” He placed a hand against her neck, and the caress felt good. “New dress?”

  “Yes. You like it?”

  “I do. A little on the slutty side.”

  “Brian!”

  He was laughing. “In a very ladylike way, of course.” He moved his hand to her thigh, and she felt the back of his finger move softly upwards, sending warm tingles through her entire body.

  She leaned back in her seat, soaking up the sensation, but her mind stubbornly refused to completely relax. She kept wondering, in all the months that they had been going out, why he hadn’t once asked her where she was going when she finished the year.

  The house was huge, a sprawling California Tudor spread across three contiguous Pasadena lots. It was the second time that Susan had been to Chairman Matson’s house, but like the first time, she didn’t know whether to feel awe or revulsion.

  Brian brought the Porsche to a halt in the large circular driveway, where two valets waited to drive it off-site. He shot Susan a “See?” glance once the Porsche was commandeered, and then, because he was apparently feeling magnanimous, held his hand out to her. Through the front windows, Susan could see guests in small groups milling about the living room, cocktails in hand. A black-clad waiter wove between them, passing out hors d’oeuvres.

  “Ready?” Brian held Susan’s hand, surprising her. He was in a good mood. He had touched her more this evening than he had in months.

  Elise Matson answered the door with a whispery gush. “Brian! I’m so glad you’re here.” The chairman’s wife, ever the perfect hostess, leaned a lineless cheek toward Brian, which he kissed lightly. “And darling, you brought Susan. Welcome, dear.” She bent to kiss Susan’s cheek, her lips only brushing the air between them. Susan was impressed. She had only met Elise once, and yet, the seasoned hostess had remembered her name. Elise Matson was a pro.

  Elise linked a bejeweled wrist through each of their arms and guided the two toward the living room. “Robbin will be so happy you’re here. I know he had something special he wanted to talk with Brian about.”

  Brian winked at Susan, and she suppressed a grin. In many ways, Elise’s breathless voice made her want to laugh. It was at once charming and utterly ridiculous.

  “You two need a drink. What are you drinking? We’ve got a full bar tonight.”

  They told her, and she glided off, her ankle-length silk dress swishing as she crossed the floor.

  When she was out of earshot, Brian turned to Susan and smiled. “She’s a piece of work, huh?”

  “She’s charming,” Susan said.

  “Well, Matson likes her. She’s wife number three, you know. Used to be an OR nurse, but I think she likes the hostess life a little bit better.”

  Just then, Robbin Matson appeared. “Brian!” His voice boomed, and he slapped the younger man on the back.

  “Hello, sir,” Brian said with a grin. The affection between the two was obvious, and standing next to Brian, Susan felt an odd little pride. Maybe all the sacrifice was worth it, she thought. Maybe it was worth it to work so hard, to give up so much, to lead such a completely focused life, all to have this moment of belonging, to be a heart surgeon, the pinnacle of the medical establishment.

  “Ma’am,” murmured a black-clad waiter at her elbow. He extended a tray holding the two drinks she and Brian had ordered.

  She thanked him and took her drink and then Brian’s, which she held while Brian and Matson talked about things she didn’t understand, something about mechanical hearts and setting up a program with the new bio-graft product.

  She gazed at the people in the room. Some she recognized: the clinical nurses, the administrators, some of the cardiologists. But there were also faces she didn’t recognize. Her eyes fell on a man outside on the patio overlooking the pool, his face lit up by the underwater lights. He stood alone, a drink in his hand, which he didn’t seem to be drinking. His expression held the strongest sense of melancholy, a dark sorrow etched in the shadows of his face.

  “Susan,” Brian said, startling her out of her reverie.

  “I’m sorry,” she said, handing him his drink.

  “Chairman Matson was asking about your plans once you finish residency.” Was that irritation she saw flickering in Brian’s eyes?

  “I’m not sure, Dr. Matson. I was thinking of taking a job up north, closer to where my parents live. But I haven’t started looking.”

  Matson had his hand on Brian’s shoulder. “Well, you know, there are a lot of opportunities for good internists here in Los Angeles. I know Tom Dixon is always looking for good people.” He gave her a meaningful look. Tom Dixon was the chairman of the Department of Medicine at the Los Angeles County+USC Medical Center.

  “Yes. I’ve actually already talked with him.” She wondered what Brian had told Matson. Dixon had approached her soon after she was elected Chief Resident, a position which she had turned down. Dixon had appeared puzzled by this, by why she would refuse a career-advancing appointment, but she found herself utterly unable to explain why she, who had once been on a most promising career trajectory, was now in a position of such deep and pathologic burn-out that the thought of any more days in this hospital was enough to send her into a wordless funk. Dixon knew none of this, but, because of her lukewarm response, cooled in his pursuit of her.

  The truth was that there were no other offers. Susan had made no job overtures, had not sent her resume anywhere. Even Brian was unaware. His infrequent inquiries as to her future had been met with vague replies, and he had never pressed the issue.

  And now, Matson was hinting that she should take a position at USC, which could only mean that Brian would take a position there, and that Matson wanted his junior faculty married. She wondered just how much Brian had been involved in this. Had he hinted to Matson of a future that he had never discussed with Susan? She wondered ruefully if he would marry her, not because he loved her, but rather because it was the right career move. Despite herself, a small, sad smile played on her lips.

  Matson misread it. He boomed, “That’s fantastic! I knew that Dixon recognized a good thing when he saw it. He’s trying to build the department, you know.”

  Susan said nothing. Matson and Brian went on to other topics, deeply engrossed in talk. Susan drained her cosmo and gloomily looked at the bottom of the glass. Another drink? Why not, she thought. She excused herself from the men and wandered to the bar.

  She took the drink and slipped out the patio door. It was lovely outside, a warm Pasadena night. The remnants of an ocean breeze whispered across the backyard, brushing against the surface of the pool and rustling the shadowed palms. She turned her face into it, absorbing the night into her bones, the muffled conversation from the house behind her retreating.

  She didn’t see the man until he stepped out of the shadows. For a moment, Susan thought her heart stopped.

  “I’m sorry. I didn’t mean to frighten you.” It was the man she had observed earlier staring morosely into the pool. Up close, he looked older than she had first thought, perhaps in his early-fifties, but he was lean and well put together, which offset the crow’s feet and faint lines etched in his forehead and cheeks.

  “I didn’t realize anyone was out here,” she said.

  A wry smile twisted one corner of his mouth. “I thought about staying in the shadows, but I didn’t want you to discover me and think I was some kind of stalker. But perhaps I should have.” He eyed her horrified face, a hint of humor in his own. “You look like you’ve seen a ghost.”

  For some reason, this comment caused a
flush to rise along her neck. “I didn’t realize anyone was out here,” she said again, and then, because she thought she sounded unoriginal and awkward, she smiled and stuck out her hand. “I’m Susan,” she said.

  “Alan.” He shook her hand. His hand was warm and dry.

  They stood silently for a moment, and then in a hurried voice, she said, “Well, I’d better get back in. My boyfriend is probably wondering if I fell in the pool.”

  As she moved toward the patio door, she thought she saw the melancholy she’d seen earlier reappear in his face, but all he said was, “Nice to meet you.” He made no move to follow.

  Once inside, she fought the absurd urge to laugh. The whole episode struck her as oddly funny, in that two grown people, who had obviously had some experience in the world, could be as awkward and stilted as teenagers. She glanced back at him. He had resumed his contemplation of the pool. She noticed that the drink he held in his hand remained untouched.

  For a moment she paused, wondering who he was, and then she crossed the dining room and went to look for Brian.

  It wasn’t until well after eight that Yoshiki Yahagi finally arrived at UCSF. The transport ambulance had encountered unexpected traffic through the East Bay and had arrived nearly two hours late, which put Jim Carson in a foul mood.

  He sent a quick text to Niklas Vollmayr announcing that Yoshiki had arrived and then headed for the ER. Vollmayr, a first-year infectious disease fellow from Germany, had asked Carson to call when Yahagi arrived. Although Carson’s field of interest was antibiotic-resistance, Vollmayr was interested in diseases transmitted from animals to humans. He had paged Carson frantically when he had heard the news that a plague case was on the way to UCSF.

  “I’ll take him, Jim,” the German fellow had offered, but Carson had demurred. They both knew that plague was rare, and that, in all likelihood, they would both spend the rest of their careers without seeing another case, but Helena had given the case to Carson, and he’d recognized it as a gift of sorts. He thought he could at least publish a case report about it.