Crystal Ice

by Warren Miner-Williams

  Matron Ruth Fielding became the forty-eighth person to contract the virus and collapsed at home. When Nurse Amy Carter found her that evening, she was already cyanotic and struggling to breathe. By the time the ambulance arrived she had started to cough up blood-stained sputum and was starting to convulse as anoxia set in. Now, when the paramedics came to the college, they were already wearing paper facemasks and double layers of latex gloves. Once they got Matron Fielding onto oxygen, her symptoms began to recede. Amy accompanied her friend to the Medical Centre, holding her hand and giving her reassurance that everything would be fine. But that was far from the truth and Ruth Fielding’s heart gave out in the early hours of the following day. Three days after the death of William Bell III, another 10 people had contracted the disease and Amy Carter and her husband Vince were victim numbers 54 and 55.

  In charge of the Ripon Medical Centres emergency plan was Dr Alice Meyer who co-ordinated every disparate activity in the hospital as if it were a military exercise. But she was running low on space, beds, staff, oxygen and everything else required in a quarantined critical care unit.

  In a short time, the Ripon Medical centre was struggling to cope with the number of influenza victims and calling in help from all over the state. A specially selected triage team, who separated flu victims from everyone else, examined all admissions. Those suffering any flu-like symptoms were quickly whisked away to one of four isolation wards or the newly converted gymnasium. Before long the medical centre could not cope with the number of victims and eventually had to transport patients to the Berlin Memorial Hospital about 13 miles away and then the Mercy Medical Centre about 26 miles away in Oshkosh.

  Using a Becton-Dickinson Directigen Flu test kit the Ripon Medical Centre pathology lab had confirmed that the respiratory disease was a type A influenza. However, there was no quick test to determine the virus sub-type as this required more specialist analysis. Even though nasopharyngeal swab samples were urgently flown to the virology lab at the CDC in Atlanta Georgia, sub-typing the influenza virus required 5 to 7 days. Time which the doctors and nurses of the Ripon Medical Centre had very little of.

  ***

  Angela Levenson had been called back to work after receiving an urgent telephone call from the nursing administrator at the La Rabida Children's Hospital, Chicago. She had not been given any detailed information as to why she had to give up her day off, though she was reassured that she wasn’t in any kind of trouble. When Angela reported to the nursing station on the paediatric ward, she was met by Charge Nurse Hilda Burchard. Hilda spoke brusquely.

  “We have had five children and three nurses with flu, so we’re short staffed. There are reports from other hospitals across the State that they are also seeing alarming numbers of patients with an extremely virulent strain of influenza. Consequently, we’ve been asked to quarantine all our infected patients and monitor all the staff that have been in contact with them. I’m sorry to call you in on your day off, but this is really serious. Have you experienced any symptoms – aching joints, headaches, sore throat?”

  “No.”

  “Good, then come with me. We’ve isolated the children with flu symptoms and we’ve been doling out Tamiflu as if they were lollies. Take a dose for yourself too. You take charge of Annette Lewinson and Brian Hardacre, they’re pretty bad. You’ll need to barrier nurse them, so get kitted up before you go onto the ward. Everything has to be disinfected; the influenza virus can be contracted from non-porous surfaces, such as door handles and light switches, etc, etc. If you have any questions use your mobile to call the work station. And try to keep your movements off the isolation ward to a minimum, OK?”

  “OK, but I’ve not done barrier nursing since college, I hope I can remember what to do.”

  “It’ll all come back to you, I’m sure. Now there’s some Vikon, anti-viral cleaner, already on the ward in the ‘sluice’ so get to it. And be careful.”

  When Angela walked onto the ward, she looked like something from a science fiction film. She was dressed in blue ‘scrubs’, white gumboots, a disposable apron and hat, a paper facemask and plastic visor. On her hands were two pairs of latex gloves. With all this gear on, she thought, she would die of exhaustion before the shift is out.

  She needn’t have worried about what Annette Lewinson and Brian Hardacre might think of her outfit as they were both semi-conscious. Both children were on oxygen and both were still cyanotic. They looked very ill. For the next hour Angela cleaned everything with the Vikon, from the patient’s locker and bed rails to the locks on the toilet doors. When she had finished the place smelled terrible. Luckily, she had a can of Meadowsweet lavender air freshener, but when she tried to spray it, she found that the nozzle was blocked with some kind of gunk. What she needed was a pin or a needle to unblock it. However just as she was about to return to the storeroom, Annette Lewinson began to cough. She had heard that cough before; it was a desperate cough, one that signalled that Annette was fighting to get enough oxygen to survive. Angela forgot the air freshener and went to her patient’s aid. Annette began to improve with a nebuliser. It was the start of a heart-rending shift, one that ended with the death of both patients. She cried as she left the ward to tell each set of parents that their children had died.

  ***

  Gloria Steinberg, at the Alexander Nursing Home in Salisbury, Wisconsin, also had a terrible shift. As much as she didn’t like the guy, she didn’t wish to see Mr Ramon Hernandez ill, so ill that for once her bottom was safe from his wandering hands. Mr Hernandez was cold and clammy and had a strange mottled appearance. He was breathing with a pronounced rale, a rasping, crackling sound, and a fever of over 40oC. Gloria had put him on oxygen at the start of her shift, and that had eased his symptoms a little. She also had put him on a dextrose/saline drip to keep him hydrated and give him some energy to fight the disease. Mr Hernandez hadn’t any the strength to speak to her. However, a little after mid-day she thought she detected the mischievous sparkle that often preceded him touching her up. He was still gaunt and grey looking though, so perhaps she was just imagining it.

  “Come on now Mr Hernandez, you can beat this little head cold. I know that you were a Marine in the war, so fighting is in your blood. You can beat this Mr Hernandez.”

  Ramon Hernandez opened an eye and stared at his favourite nurse. Why was she in fancy dress he wondered? As he opened his mouth to speak, he started a new coughing fit that made him curl up in a foetal position. Gloria hauled him into a sitting position and rubbed his back as if she was winding a baby.

  “Slow, shallow breaths Mr Hernandez.”

  At the end of each bout of coughing Ramon Hernandez retched up the vile yellow sputum that was filling his lungs. Gloria wiped his mouth and chin free of the blood-tinged evil-smelling stuff. Gradually he fought off the fit and settled back on his bed, propped up by half a dozen pillows. Gloria squeezed a small natural sponge full of water onto his sore cracked lips. Then using a flannel, she wiped his face and brow once more. She was determined to make him as comfortable as possible.

  “There you go Mr Hernandez, just try and relax now. Perhaps have a little sleep, because you need to keep up your strength.”

  Ramon Hernandez opened his eyes and attempted a smile, that roguish smile that Gloria knew so well. Then, just as he closed his eyes once again, she felt his hand slowly creeping up her thigh.

  “How do you like that, sweetie?” he croaked.

  ***

  Emergency response alarm bells started to ring all across the North Eastern States of America as victims of the disease flooded into medical centres in Green Ridge Wisconsin, and Oshkosh Milwaukee, then Salisbury in Maryland, and Chicago, Illinois. Although the sub-type of the influenza virus had not been identified, medical authorities all across America who had anticipated that a flu epidemic was imminent put their emergency response plans into action. For many years the question on the lips of virologists across the globe was not if an influenza pandemic would occur but when it would
occur. Now the questions were how bad would it be? And how many would die?

  Suddenly across the North Eastern states of the US everyone was clamouring for the few anti-viral drugs that were on the market? There was also a rush to obtain antibiotics, because although they are completely ineffective against viruses, they are needed to combat secondary infections such as bacterial pneumonia, the main cause of serious illness and death. America was on the edge of a human and economic catastrophe.

  24. A Pandemic

  Juanita Martinez Rivera had returned home from her job at the Mercy Medical Centre in Oshkosh on Thursday evening with a blinding headache and had put herself to bed immediately. After her condition became worse during the night, she died the following day. Her daughter, Alicia, found her body late on Friday afternoon. Although Alicia knew very little about the circumstances of her mother’s death, it had taken the best part of Friday night to get through the red tape associated with a sudden death, before she could telephone her brother at Fort Myer and tell him about the tragedy. The medical examiner had told Alicia that her mother’s death appeared to be from asphyxia, caused by a particularly virulent form of pneumonia. When Alicia told the M.E. that her mother had not been poorly when she went to work on the Thursday morning, he was sceptical, and told her she must have been ill for some time. Not once did he associate the woman’s death with the outbreak of influenza. There was no evidence to suggest it, no history of fever or aches and pains and no sputum on the bedclothes. He told Alicia that he would have to perform an autopsy on her mother before he could be sure of the cause of death, and that the body would not be available until that was complete.

  Alone in the apartment, waiting for her brother to arrive, Alicia couldn’t believe that her mother was dead. She hadn’t had a day off sick for years. Although Alicia knew that her mother hated her cleaning job, she also knew that she was conscientious and would never call in sick unless she was very ill. It had only been three mornings ago that Alicia and her mother had been discussing the future, her ambitions after she finished college that year. Alicia had told her mother that she wanted to be a lawyer in some big Chicago law firm, charging $600 an hour for her time on corporate business and nothing for pro bono work. Juanita Martinez Rivera had laughed about Alicia being a modern-day Robin Hood. Alicia had loved her mother dearly and remembered every last detail of that last breakfast she had shared with her. She remembered her laugh, her smiling face full of pride and love. Juanita Martinez Rivera had always worked hard to provide the best she could for her children and they recognised the sacrifices made for them and repaid their mother by working hard at school and achieving commendable academic success. Now Alicia wept aloud for her mother. She had not only lost a parent; she had lost her best friend. Unsure of her future Alicia believed she would have to give up her ambitions to go to college and become a lawyer.

  “Come on now Sis’ we’ll get through this together, you and me both.” It was her brother José standing beside her, she had not heard him arrive. A little shocked by his sudden appearance, it took her a brief moment to recover before she stood and fell into his arms. Lieutenant José Rivera Gomez had been granted compassionate leave from the US Army, to help his sister Alicia organise the funeral arrangements and had arrived in Oshkosh that afternoon.

  “José, she died so suddenly. She wasn’t even ill. Why José, why?”

  “We’ll know soon enough. They’ll find out at the autopsy. Sit down Sis,’ and I’ll get some coffee going.”

  They talked, reminisced and cried together well into the evening. It was the first time they had seen each other for over six weeks. They discussed Alicia’s college graduation and taking up her scholarship to Yale University. They talked about money, the lack of it and how José would now support her. Alicia’s future was far from secure and as Saturday turned into Sunday José suggested that his sister go to bed.

  But José couldn’t sleep and so spent the small hours of Sunday morning trying to sort out his mother’s business affairs. The first surprise was that the apartment was, upon his mother’s death, paid for. The second surprise was that she had an additional life insurance policy that would take care of all their monetary worries until Alicia graduated and got her job as a lawyer. There were a few outstanding bills and with the money from her life insurance they could be paid off immediately. Not really surprised at his mother’s fiscal prudence, he was never-the-less relieved that the future of both he and his sister were secure. When José opened the top drawer of his mother’s vanity unit, he could smell her perfume and he cried when he thought about having to sort his mother’s clothes, deciding which should be sent to the Salvation Army and which they should keep. At 4.00am it all became too much and he too went to bed.

  José awoke after 9.00am to the smell of fresh coffee and the cooking of bacon, eggs and hash browns. Having not had anything to eat since lunch the previous day, he was famished. During breakfast José told Alicia about what he had learned about their mother’s financial affairs and its implication for their future. It was a time of both sadness and elation. Alicia too was not surprised by what her mother had achieved, she should have had her own business. Both Alicia and José were full of admiration for their mother, who had endured so much hardship in her life and yet had made every cent she had ever earned work for her and the future of her two children.

  With the washing up done, José gave the kitchen a quick squirt of air freshener to rid the apartment of the smell of frying bacon.

  ***

  Mariah Toombs couldn’t believe that a full can of air freshener had to be thrown away. It was the second one whose nozzle had blocked up, and no matter how she tried she couldn’t release the blockage and access the remaining contents. Having changed the plastic nozzle from another can, it too had blocked after just a few seconds. It was then that she realised that the blockage was in the valve mechanism in the top of the can itself. Just as she was about to drop the can in the bin, annoyed at such a waste, she remembered that there was a guarantee on the product. So that afternoon, when things were a little quieter, she wrote an accompanying note, sealed the offending can of spray in a jiffy bag and popped it into the post office box outside the bus station. She had lots of other cans of the same stuff, so she thought nothing more about it, carrying on her cleaning, polishing and spraying without another thought.

  ***

  The autopsy on Juanita Martinez Rivera could not determine why she had died. Toxicity tests did not reveal any common drug or poison, the only thing that was unusual were the purple patches that Juanita had across her face and the upper part of her torso. The only thing that Dr Evan Michaels, the duty ME at Mercy Medical Centre in Oshkosh, had ever seen like this before were chloasmata, dark brown patches of skin discoloration that can occur on a woman’s face as a result of hormonal changes in pregnant women. Juanita Martinez Rivera was fifty-seven and certainly not pregnant. She had no cancerous lumps that he could detect that commonly produce hormones. Although Dr Michaels had never seen anything like this before he remembered his colleague Dr Megan Horoweitz reporting strange marks on the faces of the Ripon influenza patients. He photographed the “chloasmata” so that he could confer with Dr Horoweitz later. Then, as an afterthought, he took a nasal and throat swab from the body and sent them off to virology. A thorough and conscientious medical examiner, he signed the box on the autopsy file, designating that the body should be retained for further examination.

  Dr Michaels telephoned Megan Horoweitz as soon as he got back to his office.

  “Megan Horoweitz,” came the sombre reply.

  “Hi Megan it’s Evan. I’ve just had an interesting case, a fifty-year old woman of Puerto Rican extraction who was a cleaner here at Mercy. She was brought in on Friday night. I’ve just completed the autopsy and I can’t find anything wrong with her except some facial discoloration that I can only describe as chloasmata,” He paused. “Didn’t you have some similar facial discoloration on the influenza victims from Ripon Colle
ge?”

  “Yes, that’s right. Can you e-mail the pictures? I’ll see if they are the same. Look, although I haven’t had the virology results back yet, it looks like we’ve got a new flu virus at Ripon College. It could be a bad one. There was another death today and I’m really worried that we could be in for an epidemic of some kind of killer influenza. I’ve just been writing up my findings for the cases that I’ve seen; I’ll get you a copy as soon as it’s complete.”

  “Good. You should have the photos by now.”

  “Yes, I’ve got them on the screen now.” There was a brief silence. “That’s no chloasmata, it’s the same as the first flu victim from Ripon. I’ll send you a copy of his file immediately. The boy didn’t have spots on his torso like this woman, but the facial discoloration is exactly the same. Have you sent a sample off to virology?”