“Ezra.” Susan looked troubled. “You said you think our patient has plague pneumonia. Isn’t that the same as pneumonic plague?”
“Yes.”
“Pneumonic plague is contagious from person to person. No need for fleas.”
“Right.”
“How many people did our patient see before he got to us?”
“I’d say a few, but I’m sure they had him in isolation.”
“From the get-go, though?”
Doubt flickered across Ezra’s face. It was unlikely that the Arrowhead Hospital staff would have suspected their patient had pneumonic plague, since the disease was so rare. The real question was the timing. When had the contractor’s symptoms generalized to include lung involvement? That was when the real danger arose. How many people had been unwittingly exposed?
Jenna Niven was writing a procedure note when Ezra exploded through the doors of the medical ICU. For a moment, the third-year resident was taken aback. She had seen many things in her life, but never the sloth-like Ezra Pilpak moving faster than a stroll. He stood in front of her panting, and for a second, she wondered if he might be having a heart attack. He couldn’t seem to get any words out, and his face had turned a bright red.
“Ezra, are you okay?”
“Your patient has pneumonic plague,” he gasped.
She kept her face expressionless, but inside her mind raced. Had she always worn a mask around the patient? What about the others? “He’s been in isolation the entire time he’s been here, Ezra. Arrowhead transferred him with a mask on.”
“Yeah, but did they know he had pneumonic plague?” He was still breathing hard, but his words were insistent.
She shook her head. “He wasn’t that sick there. They put him in isolation once they saw the bubo, but before that … I don’t know. I don’t think so.”
“They’re in danger there. Have you called them?”
“No. He just got here three hours ago. We’ve been trying to stabilize him.”
“Well, you better fucking call them! There’s a fifty percent death rate with pneumonic plague!” Ezra exploded.
“Holy shit,” said Jenna, as the magnitude of the exposure sank into her work-numbed mind.
“They need to quarantine every person who was in contact with him. Including the girlfriend. And no one, absolutely no one, can violate his isolation here.”
“I’ll call them right away.”
“Good,” said Ezra, peering through isolation room’s closed glass door. The patient was now hooked up to a ventilator, a tube blowing air in and out of his dying lungs, the skin of his hands and feet starting to darken with reddish-purple splotches. “Buddy,” said Ezra, under his breath. “You don’t know what you’ve started.”
The contractor didn’t make it through the night. At four am, his heart stopped. Jenna Niven and the rest of the code team pushed epinephrine into him, shocked him, and then, in desperation, tried to pace his failing heart with external electrical stimulators. For forty minutes they labored, breaking his ribs with chest compressions, trying to keep his blood circulating, but the twenty-nine-year-old contractor’s lungs had given out. His heart had quickly followed.
At seven am, Susan stood at his bedside, gowned, masked, and numb. It was one of the most rapid deaths she had seen in a young person. She couldn’t quite fathom how this man, who had come in with labored breathing, was now lying dead and motionless before her. His skin had turned a mottled purple, the splotches of the day before becoming confluent. The ventilator tube was still in place.
So this is the Black Death, thought Susan. Even with all of our technology, we still can’t beat the plague every time.
She wondered if he would have survived if he’d come in earlier, if the antibiotics had had more time to work. He was a young and healthy man. Of course, he’d probably thought this was just the flu. But unfortunately, by delaying treatment, he’d sealed his fate, and possibly infected scores of others.
She turned away from his body and took off the mask and gown as she moved from the isolation room. Jenna sat at the nursing station, bent over a computer terminal, a hand in her disheveled hair. Susan saw over her shoulder that she was documenting the events that had led up to the patient’s death.
Jenna looked up, a stunned expression on her face. “It happened so fast. I mean, the antibiotics didn’t even touch him. They didn’t even slow it down a bit.”
“It’s a fifty percent death rate, even with treatment.” Susan said, knowing that this was little comfort to the resident who had been up all night trying to save the patient.
Jenna kept shaking her head. “I don’t even know why they transferred him here. So he could die here?”
Susan felt sorry for her friend. “Listen, I don’t know if you called Arrowhead—”
“I did, an hour ago. To let them know he died. And to also let them know they need to put some people in quarantine.”
“Are you going to go in quarantine?”
Jenna looked momentarily surprised. “Me? Why? I didn’t get exposed. I wore a mask around him the whole time.”
“They may recommend you take prophylactic antibiotics.”
“Who is ‘they’?”
“The Department of Public Health. Ezra called them yesterday. Did you know this goes all the way up to the World Health Organization? They have to report this case to the WHO.”
Jenna laughed shortly. “Splendid.”
Susan smiled a half-smile. “Well, you can consider yourself one of the few who has seen plague in this lifetime. And not only just plague, but pneumonic plague.”
Jenna gave her friend a look. “I couldn’t care less about plague, Susan. I want to run a Women’s Health Clinic.”
Susan had to hand it to her. At least she knows what she wants.
Helena Wang, UCSF’s Chief of Infectious Disease, hated to fly. She never admitted it, but she always felt a moment’s terror as the plane took off, certain that the engine would cut and the jet would plunge, and she and everyone on board would die in an agonizing jet fuel inferno.
Ajay Singh, she thought, trying to distract herself as the plane rattled over the tarmac, making its way for an open runway. The son of a bitch who left me for a woman he’d never even met.
Helena closed her eyes. She didn’t know his wife’s name, only that she was Indian, and that his parents had chosen her. And goddamn Ajay, ever the obedient son, had said yes.
It astonished her that ten years after the fact, the memory still had the power to wound. She’d thought herself beyond such pain, the armor of her accomplishments too solid and impermeable to let hurt take root in her chest again.
But she‘d been wrong. A deep ache wound itself through every muscle in her body, so all-encompassing that she wanted to forget the conference and curl into a ball and shiver.
She couldn’t allow it. If this latest interaction with Ajay had led her to this state of fatigue and vulnerability, she damned well wouldn’t let it keep her there. As the jet engines roared and gathered speed, she forced herself to focus on the plague case, disappointing though it was.
Yoshiki Yahagi was failing. Carson had called her just before the flight to let her know they’d put him on the ventilator.
“What about the sensitivities?” she’d asked.
“Resistant to tetracycline, chloramphenicol, Bactrim—pretty much the whole panel,” Carson had said, in a tell-tale, emotionless voice. “We’ve been treating him with chloramphenicol, Bactrim, and moxifloxacin, but I guess that’s sort of useless now. What do you want us to do?”
“Call Pharmacy. See what new drugs they have coming down the pike that might help him. He’s in strict isolation?”
“Yeah, now he is, but he wasn’t down in the ER, or from what I understand, in Reno.”
Helena had frowned. Bad news. “Who saw him before isolation?”
“Me, Niklas, the ER staff, the paramedics, the Reno hospital staff.” Carson’s voice was toneless.
Oh
Ajay! she thought, as the memory of the phone call flickered like a mini-nightmare in her brain. To expose not one, but two hospitals to antibiotic-resistant plague. What a fuck up!
“You better quarantine yourself. Niklas, too.” She’d told Carson. “I know. It’s a pain in the ass, but so is antibiotic-resistant plague.”
Now, as the plane at last left the ground, its engines still loud and strong, Helena reminded herself that plague was rare, only seventeen cases in the entire nation in a bad year. But antibiotic-resistance and possible person to person spread? That was another story altogether.
Thank God, she thought as the plane assumed cruising altitude, we caught it early. With proper isolation and quarantine, they’d keep it under control. Sure, there might be a few deaths, but certainly not more than four or five. After all, it had been more than a century since the last significant plague outbreak in the US, and the medical establishment had managed to contain it back then without antibiotics or modern medical surveillance techniques.
No, she thought as she slipped into an exhausted semi-sleep, we’ve got it controlled. She’d circle back with the Department of Public Health and the CDC as soon as she landed, but there was hardly a reason to panic.
Ezra was jubilant. He hung up the phone and thought, these are the sort of cases that make physicians famous. And baby, I’m on my way to the big time!
The Los Angeles County Department of Public Health had just called to alert him they were sending over a specialist. They wanted Ezra’s help to assess the risk of a plague outbreak. Him! Ezra Pilpak! The brilliant infectious disease fellow who had recognized the first case of pneumonic plague in Los Angeles in a hundred years!
He’d for sure get a paper out of it. Maybe even in the New England Journal of Medicine. He might even be on television!
He spent a moment contemplating life as a TV consultant and then discarded the idea, as delicious as it was. There was still a potential focus of plague at Lake Arrowhead, and several health care workers were in quarantine up at Lake Arrowhead Medical Center. Not that that was any reason to panic, Ezra reasoned, but still, it was probably better to clean up the mess quietly before the public found out. It certainly wouldn’t help containment efforts if people went into a blind fucking panic about plague.
He had to admit, though, it was impressive to watch Public Health roar to life. In the twenty-four hours since the Arrowhead contractor died, the CDC had announced it was sending an Epidemic Intelligence Service officer out to LA to investigate, and the Los Angeles County Department of Health already had several people up at Lake Arrowhead retracing the dead contractor’s last few days and looking for a source for Yersinia pestis. In addition, a major effort was underway to identify all the dead contractor’s contacts, including his girlfriend, who for some strange reason seemed to have disappeared shortly after dropping off her dying boyfriend at Lake Arrowhead Medical Center.
On the whole, Ezra thought, Public Health is doing a damned good job.
He locked up the house staff room and headed down to the morgue. Hopefully there would be some good slides from the post-mortem lymph node biopsy. The blood cultures had already grown confirmed Yersinia pestis, so Ezra didn’t expect to learn anything new in terms of microbial agents, but he had never seen plague in a lymph node specimen, and he wondered what it looked like.
But before he had the key out of the lock, the phone rang and the answering machine went off. Ezra listened momentarily to the muffled voice of a surgical resident asking for a consult on a post-surgical skin infection before pulling the key from the lock.
A surgical wound, thought Ezra with disgust. Let Susan and Andy take care of that one. He, Ezra Pilpak, infectious disease fellow, didn’t have time for a surgical wound. There was plague out there!
Chuck Vangsness was dying. They could go no higher on the ventilator, and his oxygenation was abysmal. He was on two different blood pressure support medications designed to keep his blood pressure high enough to supply his brain, heart and other vital organs, but even that treatment was failing.
Ajay Singh looked gloomily through the glass door of the isolation room. Chuck was a friend. Their kids had played soccer together. Their wives were in the same book club. And now Vangsness lay in the ICU, his ravaged body supported by the best that medicine had to offer, which in this case was not enough.
Singh turned to the room next door, where Andrea Vangsness lay, her body similarly hooked up to a ventilator. Singh glanced at the IV pole. Four bags flowing into her: three antibiotics, as well as a blood pressure medication, all to keep her blood pressure from bottoming out and hopefully stop the plague that was tearing through her body. The IV fluids were taking their toll. Her body was grotesquely swollen, her face distorted beyond recognition. And on her hands, the same ghastly purple splotching he had seen on Chuck’s.
The deterioration had been so fast. Singh knew the Black Death reputedly took lives within a day, but to witness it in modern times was horrifying. He simply couldn’t believe what he was seeing.
“How’s the boy?”
Singh nearly jumped. He hadn’t realized the nurse was there.
“Stable. He’s still out on the floor in an isolation room.” Singh shrugged. “Maybe we caught it in time.”
The nurse looked scared. “That’s five cases of plague this year. And all but one of them at this hospital, Dr. Singh.” She glanced uneasily at Vangsness’s room. “I heard the one at UCSF died. And I’m not so sure there won’t be more deaths soon.”
What she’d said was likely true, but Singh’s scientific training told him that the actual danger to himself and the others was small. He said, trying to sound confident, “Let’s not write off Chuck. He’s been a friend to all of us.”
The nurse gave Singh a strange look, and Singh hurried on, “Look, normally, plague isn’t particularly infectious, and we’ve got strict isolation in place now. Chuck got sick because he didn’t know what he was dealing with, but now we do. We’ve contacted all the people who were in contact with him. No one else in Reno has gotten sick. We’re going to be okay.”
She looked at him doubtfully, which only made what he was hiding all the worse. He turned away from her and hustled down the hallway, so that she wouldn’t see in his face what he’d learned only moments before.
The ER nurse who had taken care of Yoshiki Yahagi with Vangsness was now in a Sacramento hospital, infected with the same disease that had taken down Chuck.
“Can’t make it, Suz. Got a sick one in the unit. Need to stand guard.”
Brian sounded cheerful. Susan wasn’t quite sure how one could be so cheerful about a sick patient in the intensive care unit, but somehow, she wasn’t surprised. She recognized the tone from nearly a year of dating the young heart surgeon. A good case. That was what it really was. Another challenge for the great Brian Cain to rescue from the brink.
Susan tried to make her voice light. “Sure. You want to do dinner tomorrow instead? I’m not on call anymore. I’m free.”
“Well, we’ll see. You know what they say. A heart surgeon is always on call.”
“Right.” It was true. Brian always carried his pager and cell phone, but unlike Susan, he seldom had to stay in the hospital overnight. He just needed to be available to come in for emergencies or answer nursing calls. Funny how that now seemed to be Brian’s overriding concern whenever she broached the subject of doing something together.
I think I’m being blown off. She cradled the phone against her cheek and stared sightlessly across the room.
“Hello?” Brian sounded annoyed. “You still there?”
“Of course.”
There was silence for a moment, and then his tone was softer. “I’ll see what I can do, Susan. Dinner tomorrow sounds good.”
She wished him a quiet evening, but inside she felt the stir of unwanted emotion that Brian always elicited in her. The waters were never certain with him: one either pitched on stormy seas or floated in radiant sunlight. She told hersel
f to cut him some slack. He was enthusiastic because he was passionate about his work. And really, she admired his extraordinary surgical talents.
But there was no use lying about it. She’d seen the new ICU nurse. Susan hoped Brian wasn’t passionate about her as well.
An hour later, Susan accelerated onto the freeway. The sun was sinking over western Los Angeles, the sky a fiery orange-red.
That’s about the only good thing about smog, she thought as she merged from the 110 onto the 5. It makes for spectacular sunsets.
Fifteen minutes later, she pulled the Toyota into the large parking structure next to the medical school. Despite the residual warmth, Susan hugged her arms to her chest as she hustled across campus to the Stauffer Medical Research Building. She wasn’t scared, exactly, but she’d been at USC long enough to know that it was best not to travel alone on the urban campus, especially after hours.
Stauffer Hall was locked, which was no surprise. Most researchers, no matter how dedicated, packed up their bags Friday night for a well-deserved weekend reprieve. But not all. Susan stepped back and gazed up the side of the building, pleased to see the lights blazing in several windows, including Tom Hodis’s lab.
She rapped on the building’s double glass doors, just as the lobby elevator doors opened. Two men came out. They looked surprised to see her, but they held the door for her anyway.
“Forgot your key card?”
“Yes,” she said, even though she had no key card. She just wanted to see Hodis.
It had nearly been five years since she’d worked for the white-haired molecular geneticist, but she still considered him a mentor and a friend. The Assistant Chief of Medical Genetics was the kind of man people loved instantly. He was kind, patient, and knew more about the genetics of infectious diseases than anyone around.
Susan’s intention to discuss her remaining research month with the elderly scientist abruptly evaporated when she saw Ezra Pilpak slouched in a chair before Hodis’s desk. Ezra turned around and said, “Hi.”
DRYP Trilogy | Book 1 | DRYP [The Final Pandemic] Page 8
