Authors: Wil Mara
“Thomas McKendrick,” Gillette said, retrieving the folder from the plastic rack outside the door. “Thirty-two years old. Landscaper, married, one son.”
“Does the boy or his mother have it?”
“Not as far as we can tell. We’re watching them, though.”
“I’d like to go in and examine him.”
“Sure.”
“Cara, you should see this, too.”
“Okay.”
Gillette said, “Come and get prepped.”
He took them into a narrow, brightly lit room with three large scrub sinks on either side. The widemouthed basins tilted downward, like ice machines in a hotel hallway. On the wall above each was a large mirror, and bottles of sterilizing cleanser stood on the shelves over the faucets.
There was a tall cabinet at the far end of the room. Gillette opened it and took out two boxes. Each was uncolored cardboard with the words
PERSONAL PROTECTIVE EQUIPMENT (PPE) KIT
on the top. Underneath was,
TO BE WORN PRIOR TO ENTERING NEGATIVE AIR SPACE
.
Beck and Porter opened the boxes and removed the contents, then discarded the masks and gloves the security guard had given them. Then, following a procedure they could’ve performed blindfolded, they methodically donned their costumes. The fluid-resistant gown came first, made of a tough polyethylene-coated polypropylene and colored a medium blue. They slipped their arms into the sleeves, then tied the dangling plastic strips behind each other’s backs. Next came the shoe covers, with rubber band inserts that grabbed the ankles. The N95 respirators looked like ordinary dust masks, and the narrow strip of aluminum that ran over the bridge of the nose had to be pinched and pressed to facilitate a custom fit. They tested this by placing both hands over the mask and exhaling to feel for air leaks. After that, they covered their hair with “shower cap” bonnets, and their faces with transparent shields fitted onto their heads with rubber straps. Finally, the gloves had to be stretched over the sleeves of the gown to protect the wrists. The entire process took about twenty minutes and was performed with excruciating delicacy; haste usually resulted in unseen rips. Then they went out with Gillette trailing behind.
Beck had been satisfied with the isolation rooms at first glance. Each had two doors with a “neutral zone” in between. Recent studies of AIIRs—airborne infection isolations rooms—around the nation showed that single-door chambers often permitted escape of infected air. Particularly bad were those with doors that didn’t close automatically. Beck could see the hydraulic modules at the top and thought someone had done their homework. Also satisfactory was the solid ceiling, which did a much better job of maintaining negative air pressure than a false one. A digital monitor on the wall near the interior door read −3.1 Pa (Pascals), well above the recommended minimum of −2.5 Pa in comparison to the pressure of connected, “ordinary” areas.
“How many air changes per hour, Ben?” His voice was slightly muted by the respirator.
“Ten. This is one of the better hospitals in the state for infectious containment.”
State regulation required that at least six complete air changes occurred in an isolation room per hour, twelve if the area was newly constructed. The infected air would go through a high-efficiency particulate filter before being blown outside. HEPA filters were able to remove at least 99.97 percent of airborne particles with a diameter of 0.3 micrometers. They were originally designed for the infamous Manhattan Project to prevent the spread of radioactive material. Now they had contemporary applications that ranged from domestic vacuum cleaners to nuclear plants.
As Beck and Porter entered the neutral zone, they noticed the drop in air pressure—instead of pushing against them, it seemed to be pulling away. This sensation increased further when the first door hissed to a close and electronically unlocked the second. Infectious airborne particles needed positive airflow to move from host to host, but in a negative-flow environment, they were essentially sucked away before they had the opportunity. The positive-pressure atmosphere of connected areas further served to keep the infectious agents trapped within the AIIRs by surrounding it with what was essentially an invisible force field.
Then they caught the odor; even through the respirator, it was awful. A musky blend of fluids, pungent and sour and miserable. It reminded Porter of unwashed laundry and school locker rooms and mold-spotted food in the back of her apartment refrigerator.
For Beck, however, it conjured unwanted memories of a very different species. He tried to fight them off, but that wretched scent pulled him back, over seas and across borders and beyond the safety buffer of time. He began to recall his own words, as clearly as he had written them on the pages.…
Sunday, April 12
We all arrived in Yambuku today. Our single-engine plane landed in an open field near the village just as the sun was going down. I was hoping the heat would taper off in the darkness. But it has to be ninety degrees at least, and the humidity hung on us like a wet blanket. No sooner had we unloaded our gear than our pilot, a bone-skinny Kinshasan named Oudry, jumped back into the cockpit with profuse apologies and zoomed off again. Ebola is killing the Congolese by the thousands right now, and this is one of the hottest of the “hot zones.”
We stood there in the middle of the jungle with our gear around our feet, and I wondered if I’d made a mistake by asking for this assignment. No—begging for it. I pleaded until Maurice gave in and wrote me the recommendation. Like any good professor, he never wants to let go of his students. He prefers to keep them under his wing, like a protective parent. That’s because he’s an academic at heart, in love with classrooms and laboratories and libraries, whereas I want to get out there and start doing it instead of eternally studying it. He was disappointed, but I think that came more from fear than anything else. He thinks I’m going to make a mistake and kill myself. But what’s the point of all that training, all that education, all those years of hard work, if I can’t go out and make a difference? I’ve tried to tell him this a thousand times, but I don’t know if it ever sank in. In the end, he gave me the green light, and that’s all that matters now. Here I am, in one of the most neglected parts of the world. Our job is to study the outbreak in this area and see what we can do to get it under control. I’m feeling very confident of our success. I’m eager to show dear Maury what I’m capable of.
We picked up the bags and cases and walked the two hundred yards to the village. It lay at the base of a wooded hill, and the lights from the huts were pretty from a distance.
Monday, April 13
Very few of the adults are over the age of forty. Life expectancy here is around fifty-two, and that’s under normal conditions. The village leader is an elder named Guychel. He greeted us yesterday in a distinctly businesslike manner. The strain has drawn deep lines around his eyes, eyes that have seen too much suffering already. He’s missing two fingers on his left hand, and he walks with a slight limp. His voice, high and unsteady, speaks broken but understandable English. I already knew he had attended the Université de l’Uélé in Isiro but was unable to finish his degree. He returned to this village to care for ailing relatives who then died. Since the rest of the villagers knew of no one else with a formal education, they asked Guychel to stay.
We put on our protective gear in the morning as he led us to the makeshift hospital: nothing more than a mud-brick hut. Many eyes were upon us now, and, to be completely honest, I got a charge at being regarded like some kind of savior. Relatives loitered about, some of them crying, others so battered by grief, they looked dazed.
The sight that awaited us inside was terrible. Bodies lay on straw mats on the floor, arranged in such a fashion so as to create a racetrack-shaped walkway. Kerosene lamps sat on the little tables, sending up thin lines of black smoke. Some of the patients had their hands and feet tied because they writhed about as madness took them. Others lay still and awaited the mercy of death, their chests barely moving under stained blankets.
I crouched alongside one woman, whom I judged to be in her thirties, and got out my penlight. I inspected her eyes and found the whites had turned a cloudy pink. Another woman, a bit older, had signs of bleeding around the nose and gums, plus a rash on the roof of the mouth. The third patient was a very young boy; maybe five or six. He had a small toy truck clutched in one hand: a Matchbox. I couldn’t help but wonder where he got it from. Guychel told me his parents were already dead. His throat was so swollen, he was barely able to breathe. Pus ran from his tonsils in amber streams.
There were seventy-two patients in total. It took the five of us nearly eight hours to draw all the blood samples we needed.
Tuesday, April 14
In another mud-brick hut, slightly smaller than the hospital, we have our laboratory. I think they gave us this building because it’s the only one with a sturdy table. We had to separate the sera from the blood cells with a hand-generated centrifuge—a startling difference from the modern machinery back home—label each sample (also by hand), then pack them in dry ice. That also took hours. Oudry is coming in the morning to take them back for shipment to the States.
Two of the patients died in the evening. One was the little boy with the Matchbox truck. They buried him with it, next to his parents. There were no markers in the graves; the locals just knew where they were. They seem to know where everyone is buried.
Friday, April 17
We have now managed to separate the infected villagers from the healthy ones. That’s always step one in an outbreak—isolate the sick from healthy to keep the illness from spreading any further. Then, with Guychel’s help, I began interviewing people in the latter group to get a sense of where it originated. As far as I could determine, it was brought to this community by a young man named Prince. Prince had been in Badjoki—another Ebola hot spot just northeast of here—visiting a cousin. This is disappointing information, as we already knew about Badjoki. So Yambuku is likely not the location of the virus’s origin, but rather just another satellite zone.
There were six more deaths today, and four new patients.
Monday, April 20
There were seventeen more deaths over the weekend, and eleven new cases in spite of vigorous efforts to keep the healthy villagers from the infected ones. Most were parents. How do you tell a mother or father they cannot see their dying child? How do you summon the objectivity to physically force them from doing so? The five of us are not a security team. We cannot stand guard outside the hospital day and night.
Wednesday, April 22
They began burning the bodies this evening. Not only the recently deceased but also those who were already buried. We determined that they all continued to pose health risks, and Guychel supported us, so they went along with it. We helped out as best we could, although we are completely exhausted. Some of the bodies were only buried two or three feet down. I cannot describe the hideous condition of the corpses. The little boy with the toy truck already looked as though he’d been dead for a month. The toy truck tumbled from his folded hands and bounced on the soft earth. My God … piles of blackened, lifeless bodies, children being tossed into it by their weeping parents. The stench of rotted, boiling flesh as the smoke rose into the night sky. If I live to be a thousand years old, I will never get the scent of that pyre out of my memory. Now I know what death smells like.
Friday, April 24
K and I hiked up to another village about two miles away this morning after Guychel told us the outbreak had reached there. But we were at the site only about a hour before my cell phone rang. It was M, telling me I had to come back, there was some kind of emergency. He would not, however, give me any details, only that I needed to hurry. K and I are taking a break now, out of breath, but should get back within the next thirty minutes or so. I have never heard M so upset; he isn’t the type. I cannot imagine what’s going on, but something in my gut tells me it isn’t good.
THREE
“Michael?”
Ben’s gentle voice pulled him back.
“Hmm?”
Cara was staring at him, too.
He took note of them standing there and, with a mighty effort, shoved it all out of his mind. Pretending he didn’t see Ben’s ongoing stare of concern, he went to the patient’s bedside, his shoe covers shuffling softly on the polished floor.
McKendrick’s face was twitching, the pain relentless and determined. Beck’s instinct was to reach out, stroke the young man’s hair, tell him he would be all right. But the goal here, if the situation was to be regarded with the necessary objectivity, was to save those who could be saved. That meant the patient had to be viewed as a lab specimen: a source of information. Beck could never fully adopt this into his thinking, in spite of the many who had urged him to do so.
He checked McKendrick’s vitals—temperature 102.7 degrees F, heart rate 120, blood pressure 144 over 103, respiratory 23. All accelerated, even with the sedatives. There was a nuclear war going on inside this body, and the native forces were losing in a blowout.
He reached down and pressed on one of the larger pustules with his forefinger. It expanded outward for a second, the tissues straining visibly, then exploded. The honey-colored pus eased between the other blisters with a sluggish viscosity.
Porter said, “Do you want me to collect a sample?”
Gillette responded through the intercom—“You’re more than welcome to, but I’ve already collected several from that patient, as well as all the others, and sent them out.” He was watching through the observation window.
Beck leaned down to get a closer look at the exposed left arm. Even through the blistering, he could see the gathering darkness beneath the skin—a faint mauve scarlet.