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

by Scheuring, R. A.

  He didn’t feel withdrawn now as he pulled his Ford into his yard. He felt relieved. There was something eminently soothing about the ranch: a quiet, an order, none of the static of human interaction. Gage, his dog, greeted his arrival by running alongside the pickup, escorting him past the gate and into the yard. He stopped, opened the door, and scratched the dog’s head.

  The sky was turning gray when he at last sat, beer in hand, to test out the new television. He surfed the channels and stopped on a pretty newscaster reporting on something happening in Nevada.

  “Public Health Authorities report that this is the third case of plague in the United States this year and warn that there may be even more cases as we head into summer. They caution campers and other outdoor workers to avoid chipmunks, squirrels, and other rodents that might be carriers of the plague bacteria.”

  A small map of Nevada with the word PLAGUE superimposed on top of it stood in the corner of the screen above the newscaster’s head.

  Harr let out a little grunt of surprise. Like most ranchers, he knew that ground squirrels and prairie dogs carried plague, but there had never been a case in Harney County that he was aware of. Nevertheless, he looked out the sliding glass window at Gage, who lay faithfully on his dog bed, head resting on his paws, and wondered if he ought to be worried.

  Only three cases, he thought. Probably not.

  The newscaster moved on to another story, and Harr flipped the channel to the Trailblazers. The announcers were talking excitedly. Harr took a slug of his beer.

  Jim Carson was livid.

  “Bolus him a liter of IV fluids,” he barked at the nurse who hovered over Yoshiki. “For Christ’s sake, what’s taking the ICU resident so long?”

  Yoshiki, now in the isolation room, had been running a blood pressure in the low eighties for fifteen minutes now. He was a young man, and thus presumably better able to tolerate the low reading, but a blood pressure in the eighties meant Yoshiki was getting less blood to his brain, and less blood meant less oxygen. The net effect was that the Japanese exchange student’s brain cells were dying by the thousands as they waited for the goddamn resident to arrive to assess the patient for transfer to the ICU.

  Carson’s pager went off. Every muscle in his body tensed. He glanced irritably at the pager’s digital readout. The hospital operator. Why in hell was the hospital operator paging him?

  Milosz appeared. “How’s he doing?”

  “Like shit. Did you draw new blood cultures? Sputum cultures?”

  “Yes and yes.”

  “Did you even bother to look at the chest X-ray before you allowed this guy to cough all over your ER?”

  Irritation flashed across Milosz’s face. “Yes, Jim. I looked at the chest X-ray. Pretty non-specific, if you ask me. Radiology agrees. They’re recommending a repeat X-ray with two views.”

  “That’s a nice idea, given that if this guy stood up right now, his blood pressure would drop to the fifties.”

  Milosz was impassive. “Jim, he wasn’t coughing on my exam. The report out of Reno is that he had a clear chest X-ray with no cough. He’s been on antibiotics for three days. There was no indication for isolation.”

  “Well, things have changed now.”

  “Obviously.”

  Carson’s pager went off again. “Goddamnit.” The hospital operator again.

  “Who is it?” Milosz asked.

  “Hospital operator. Last thing I need right now is some clinic patient paging me with a medication refill request.”

  “I’ll get it,” Vollmayr offered.

  Carson turned to him in surprise. He had forgotten the other man was there. He handed the German fellow his pager and turned back to Milosz.

  “What have you given him?”

  “Nothing. He’s not due for another dose of antibiotics for four hours.”

  Carson was quiet for a moment, thinking. “Something stinks here, Milosz. He’s been on antibiotics for three days now. He shouldn’t be deteriorating.”

  “You think he’s resistant to antibiotics?” Milosz asked.

  “Doesn’t make sense. There’s no antibiotic-resistant plague in the US. Never has been.” Carson crossed his arms and stared down hard at Yoshiki, whose eyes were closed. “Besides, he was on two antibiotics. No way could he suddenly be resistant to two different drugs.”

  “Maybe he’s just sick. One out of seven plague patients still die from the disease, Jim. Even with treatment.”

  “I know that, but he was getting better.”

  Vollmayr reappeared. His face showed no emotion, but he was breathing fast, which Carson realized meant that he had run back to them.

  “What’s going on?”

  Vollmayr held up the pager. “That was Dr. Singh up at Reno. The preliminary drug sensitivities are back from the Nevada state lab.”

  Carson snapped, “What’d they show?”

  “Resistant to tetracycline and gentamicin.”

  For a moment, all motion in the room stopped. The three men stared at each other, dread settling over the group like a cloud. Finally, Carson spoke, his voice flat. “And the other drugs?”

  “Still pending. Apparently, they had to run a second sensitivities test. They say they’ve never seen drug resistance in Yersinia pestis in the US, so they typically don’t even do one round of sensitivity tests.”

  “Well, I guess we all know what that means,” said Carson.

  “What’s that?” said Milosz.

  Carson’s voice was cold. “You better hope that chest X-ray is negative. If not, you and I and the rest of us here,” he gestured across the ED, “are fucked.”

  He looked down at the unconscious Yoshiki. “Not to mention you, buddy.”

  “What are you going to do about a job?” Brian asked as he piloted the Porsche onto the Santa Monica Freeway.

  Susan sat back in the passenger seat, her head resting against the black leather, the exhaustion of the past three years soaking through her, drawing her downward into the apathy of sleepiness. “I don’t know,” she said.

  “You know, tomorrow is May first. Getting a job takes time.”

  “I know,” she said.

  Maybe she’d had a few more drinks than she intended. Maybe that’s why she didn’t care, why his tone didn’t upset her.

  “And no offer from Dixon?”

  “No offer from Dixon,” she repeated, her voice sounding remarkably light, the voice of a drunk woman.

  “Any offers from anyone?”

  “Nope,” she said.

  “Where’d you apply?”

  “Nowhere. No applications. No offers.” She was so tired. Tired to her bones, tired of residency, tired of Brian’s questions.

  The hint of irritation in Brian’s voice changed abruptly to a flash. “For god’s sake, Susan. What’s the matter with you? What are you going to do? Work in some dumpy urgent care clinic?”

  She opened her eyes at that. She hadn’t really thought about working in an urgent care clinic. In truth, she hadn’t really thought about working at all. “That’s an idea,” she said, the fuzz in her head making her want to sleep or giggle helplessly. She wasn’t sure which.

  “You turned down Dixon, didn’t you?”

  “No. He never asked.”

  “But you turned down the chief resident job,” continued Brian. “Which is why he didn’t offer you a staff position. What were you thinking?”

  “I was thinking that I didn’t want to be chief resident.”

  Brian was frankly irritated now. “What’s the matter with you? You’re the smartest person in that whole goddamn program.”

  She sighed. “Oh, Brian.” How to explain to him? Why bother?

  They were in Santa Monica now, driving down the wide, dark streets of Wilshire Boulevard, the lights of the movie theaters and restaurants casting moving reflections across the windshield.

  “I’m not like you, Brian,” she said at last. “You’ll be chairman someday. But I won’t.”

  “You
could be.”

  “I’m not finished, Brian,” she said quietly. “I don’t want to be chairman.”

  They drove in silence, the car filled with Brian’s anger and Susan’s apathy, an uneasy mixture of tension in the air. He pulled onto Grattan Way, driving the half-block to his condo. He stopped the car in the driveway, pushed the button on the remote, but made no move to drive into the garage.

  “You’re not the person I thought you were,” he said.

  Susan winced. “Probably not.”

  His hands gripped the steering wheel, and he stared straight ahead. She watched him, trying to read his thoughts, but came back with nothing. Silence hung between them, heavy and painful.

  He didn’t look at her when he finally said, “Your car is over there.”

  The cat was gone.

  “I thought you said there was a cat here,” George Mack said to the innkeeper at the Evergreen Club Lodge. The two men stood in front of the yellow crime scene tape that blocked off the now empty timbered inn. Morning sunlight was just beginning to warm the air.

  “I never saw the cat,” Kevin Tarnack repeated patiently. “I only heard there was a cat here from one of the employees.”

  “Which employee?” Mack demanded.

  “Jason Tippett. He’s one of the part-time cooks and maintenance guys.” All the employees at the lodge multi-tasked, serving in any capacity the inn required.

  “Where’s Tippett?” asked Mack.

  “I don’t know. He only works weekends.”

  “Well, get the guy. I need to talk to him.”

  The innkeeper glared at Mack and walked to the small parking circle in front of the lodge. He pulled out his cell phone and dialed.

  Goddamn tree hugger, Mack thought. A veteran of the Gulf War with years of experience in the Army’s health services, Mack had little patience for the Bay Area hikers that frequented the Evergreen Club Lodge. He preferred the more conservative constituency of Reno, but here he was, across the state line in Placer County, California, doing what the California State Health Department should be doing. Where the hell was the Placer County Health Officer?

  Bob Sparks, one of Mack’s colleagues from the Washoe County Health Department, approached carrying a small cage in his gloved hand.

  “What’ve you got?” Mack asked.

  “California ground squirrel, Spermophilus beecheyi. He’s the fifth specimen we’ve got so far. Any word on any of the serological testing so far?”

  “Still pending. Cultures from the innkeeper’s dog are also still pending. The dog had fleas, looks like Diamanus montanus, but no word yet if they’re carrying plague.” Diamanus montanus was the common ground squirrel flea, the most important carrier of plague in the western United States. Mack peered into the cage, where the squirrel cowered in the corner.

  “Easy does it, boss,” said Sparks. “I don’t know if this one’s a carrier.”

  “Doesn’t look sick,” said Mack. He pulled a pack of Marlboros out of his front pocket and tapped out a cigarette. “I’m still looking for the goddamn cat.”

  “Which cat?” Sparks said as Mack lit up.

  “One of the employees said there was a cat in the lodge last week. We need to track down all domestic animals that have been in the lodge. Cats can carry pneumonic plague.” Mack blew a puff of smoke out of the side of his mouth. “I hate cats.”

  Sparks smiled. Mack’s ill temper was legendary. “What about the lodge?”

  Mack looked over his shoulder at the empty building surrounded by pine trees. “If we find even the slightest hint that plague came from here, I’m shutting this place down and burning it.”

  “Or maybe our colleagues in California will shut the place down.” Sparks said mildly. “Technically this is their jurisdiction.”

  Mack dropped his cigarette onto the gravel driveway and ground it out with his foot. “If they ever get here.” He gazed at the innkeeper as he made his way back. “Well, look who’s coming.”

  Tarnack stuck his cell phone in his back pocket as he approached, an undeniably troubled look on his face. “I just got ahold of Jason Tippett’s roommate. Tippett’s in the hospital.”

  “How long?” said Mack.

  “He went last night with a bad flu.”

  “Which hospital?”

  “Sierra Tahoe down in Truckee,” said Tarnack.

  “Come on,” said Mack, gesturing at Sparks. “Let’s go.” Mack was already moving toward his truck, and Sparks rushed to follow, throwing the small cage into a specially ventilated box in back.

  “What do you want me to do?” Tarnack called after them.

  Mack paused at the door of his truck and gave the innkeeper a withering look. “Find the goddamn cat.”

  Helena Wang stood in the intensive care unit on the ninth floor of UCSF Medical Center Hospital, where Yoshiki Yahagi lay in one of the new isolation rooms. She watched impassively through the sliding glass door as a nurse in a gown, gloves, and a respiratory mask hooked him up to a second IV pole.

  God, Ajay, she thought. You sent me a stinker.

  But in truth, she wasn’t angry. Yoshiki represented one more set of challenges for her, to keep him alive, to bring him through this. If they failed, well, that was a risk. Helena had long ago given up the emotional attachment to life that non-doctors held sacred. Death was to be avoided, if possible, but it was ultimately unavoidable. And for Helena, the only way to remain sane in the madness that was modern medicine was to detach herself: to view a case objectively, not from an emotional vantage, but from a technical one. Keep the lungs working. Keep the heart pumping. Keep the blood circulating at the right blood pressure.

  Carson had spent much of the previous twelve hours working with the medicine residents to keep Yoshiki stable. They had succeeded, to a degree. Yoshiki still required blood pressure support medication, but remarkably, he was breathing on his own. From Carson’s description on the phone, Helena had fully expected Yoshiki to be intubated and placed on a ventilator by morning. But instead, the tenacious young exchange student remained awake and oxygenating well enough that he required only a nasal cannula.

  He’ll pull through this, she thought. They just needed the new antibiotic sensitivities to come in, and then they could tailor his antibiotic regimen to the bug. For now, though, the boy remained on an extraordinary three drug regimen, all targeting plague.

  As an additional precaution, she’d ordered Carson and Vollmayr, as well as all the other emergency department personnel who had come in contact with Yoshiki, to take an antibiotic called Bactrim as plague prophylaxis, but now she doubted the necessity. The second X-ray was still far from convincing for pneumonia. And as mysteriously as he had started, Yahagi had stopped coughing. The night nurse had reported that he hadn’t coughed once during her shift.

  Helena shrugged mentally. In her heart, she knew that Ajay had really done her a favor. The first documented case of drug-resistant plague in the United States, and not just resistant to one drug, but potentially resistant to two. It would make an excellent write-up for the New England Journal of Medicine. She’d let Carson have first authorship, of course, but she would make sure her name was on the paper, too. Hell, she’d even mention the case in her keynote address on antibiotic resistance later this week at the World Scientific Conference on Infectious Disease. It’d be perfect.

  She glanced at her watch and thought, if I ever get that damn address written. She knew the speech needed to be flawless. She was the youngest keynote speaker in the 105-year-history of the conference, and all eyes of the world’s assembled scientific elite would be on her. She had exactly two days to write the best address of her life.

  And Helena fully intended to blow them away.

  At nine am, Susan Barry strolled into the Infectious Disease Department at Los Angeles County + USC Medical Center and realized in a flash that she was the only resident present. The office was empty.

  Susan sank onto the couch beneath the dry erase board and contentedly placed
her feet on the coffee table in front of her. She could get used to this, a day that started at nine am with no in-house call. Why hadn’t she ever considered Infectious Disease as a specialty?

  She gazed around the office. It was messy, like many of the rooms inhabited by the residents. Three desks lined the walls, separated by filing cabinets and a locking bookcase. The couch, a Naugahyde affair that looked like it had been wiped down with antiseptic one too many times, backed against the opposite wall. Altogether, the long narrow room had a crowded feeling, but not an unpleasant one. Susan instinctively liked it.

  The door to the office opened, and a short, overweight man walked in. He had an air of disarray about him that verged on slovenliness. His curly black hair was thinning on top and didn’t look like it had been combed. Beneath his white physician’s coat, one tail of his shirt had come untucked. And in his pudgy fingers, the man held the remnants of a glazed donut, which he was now popping into his mouth.

  “Hi,” he said, a crumb shooting from his mouth into the space between them. “Ezra Pilpak. I’m the fellow on consult service this month. You must be Susan Barry.” He wiped his hand on his coat and stuck it out at Susan, which she shook, the skin of his fingers sticky against hers.

  “Yeah, that’s me,” she said, standing up.

  Ezra waved her down. “Don’t get up. We’ve got to wait for the medical student. What a lazy pud he is.” Ezra moved to the far desk and plopped himself down on a chair. He punched the button on the answering machine. There was a click and a whir as the tape briefly rewound before a mechanical woman’s voice reported, “There are no new messages.”

  “Geez,” said Ezra, disgusted. “It’s been slow as hell. What happening around here? All the surgeons finally learning how to wash their hands before operating?”