The Hot Zone (9 page)

She opened up the space suit and laid it down on the concrete floor and stepped into it, feet first. She pulled it up to her armpits and slid her arms into the sleeves until her fingers entered the gloves. The suit had brown rubber gloves that were attached by gaskets at the cuffs. These were the space suit’s main gloves, and they were made of heavy rubber. They were the most important barrier between her and Ebola. The hands were the weak point, the most vulnerable part of the suit, because of what they handled. They handled needles, knives, and sharp pieces of bone. You are responsible for maintaining your space suit in the same way that a paratrooper is responsible for packing and maintaining his own parachute. Perhaps Nancy was in a bit of a hurry and did not inspect her space suit as closely as she should have.

Lieutenant Colonel Johnson gave her a short briefing on procedures and then helped her lower the helmet over her head. The helmet was made of soft, flexible plastic. Johnson looked at her face, visible through the clear faceplate, to see how she was doing.

She closed an oiled Ziploc zipper across the suit’s chest. The zipper made a popping sound as it snapped shut,
pop, pop, pop
. The moment the space suit was closed, her faceplate fogged up. She
reached over to a wall and pulled down a coiled yellow air hose and plugged it into her suit. Then came a roar of flowing air, and her suit bloated up, fat and hard, and a whiff of dry air cleared away some tiny beads of sweat that had collected inside her faceplate.

Around the Institute, they say that you can’t predict who will panic inside a biological space suit. It happens now and then, mainly to inexperienced people. The moment the helmet closes over their faces, their eyes begin to glitter with fear, they sweat, turn purple, claw at the suit, try to tear it open to get some fresh air, lose their balance and fall down on the floor, and they can start screaming or moaning inside the suit, which makes them sound as if they are suffocating in a closet. There was one case in which a man in Level 4 suddenly began screaming, “Get me out of here!”—and he tore off his space suit’s helmet, taking great gasps of air from Level 4. (They dragged him into a chemical shower and kept him there for a while.)

After he had helped Nancy Jaax put on her space suit, and had looked into her eyes for signs of panic, Tony Johnson put on his own suit, and when he was closed up and ready, he handed her a pack of dissection tools. He seemed calm and collected. They turned and faced the stainless-steel door together. The door led into an air lock and Level 4. The door was plastered with a biohazard symbol and warnings:

The international symbol for biohazard, which is pasted on doors at
USAMRIID
whenever they open through a major transition of zones, is a red trefoil that reminds me of a red trillium, or toadshade.

The Level 4 air lock is a gray area, a place where two worlds meet, where the hot zone touches the normal world. The gray area is neither hot nor cold: A place that is neither provably sterile nor known to be infective. At
USAMRIID
, toad-shades bloom in the gray zones. Nancy took a breath and gathered her thoughts into stillness, using her martial-arts training to get her breathing under control. People performed all kinds of small rituals before they walked through that steel door. Some people crossed themselves. Others carried amulets or charms inside their space suits, even though it was technically against the rules to bring anything inside the suit except your body and the surgical scrubs. They hoped the amulets might help ward off the hot agent if there was a major break in their suit.

She unplugged her air hose and unlatched the
steel door and entered an air lock, and Tony Johnson followed her. The air lock was made entirely of stainless steel, and it was lined with nozzles for spraying water and chemicals. This was the decon shower.
Decon
means “decontamination.” The door closed behind them. Nancy opened the far door of the air lock, and they crossed over to the hot side.

They were standing in a narrow cinder-block corridor. Various rooms opened on either side. The hot zone was a maze. From the walls dangled yellow air hoses. There was an alarm strobe light on the ceiling that would be triggered if the air system failed. The walls were painted with thick, gobby epoxy paint, and all the electrical outlets were plugged around the edges with a gooey material. This was to seal any cracks and holes, so that a hot agent could not escape by drifting through hollow electrical conduits. Nancy reached for an air hose and plugged it into her suit. She could not hear anything except the roar of air in her helmet. The air rumbled so loudly in their suits that they did not try to speak to each other.

She opened a metal cabinet. Blue light streamed out of it, and she removed a pair of yellow rubber boots. They reminded her of barn boots. She slid the soft feet of her space suit into the boots and glanced at Johnson and caught his eye. Ready for action, boss.

They unplugged their air hoses and proceeded down the hallway and entered the monkey room. It contained two banks of cages, positioned facing each other along opposite walls of the room. Jaax and Johnson replugged their hoses and peered into the cages. One bank of cages contained two isolated monkeys. They were the so-called control monkeys. They had not been injected with Ebola virus, and they were healthy.

As soon as the two Army officers appeared in space suits, the healthy monkeys went nuts. They rattled their cages and leaped around. Humans in space suits make monkeys nervous. They hooted and grunted—
“Ooo! Ooo! Haw, wah, haw!”
And they uttered a high-pitched squeal:
“Eek!”
The monkeys moved to the front of their cages and shook the doors or leaped back and forth,
whump, whump, whump
, watching Jaax and Johnson the whole time, following them with their eyes, alert to everything. The cages had elaborate bolts on the doors to prevent fiddling by primate fingers. These monkeys were creative little boogers, she thought, and they were bored.

The other bank of cages was mostly quiet. This was the bank of Ebola cages. All the monkeys in these cages were infected with Ebola virus, and most of them were silent, passive, and withdrawn, although one or two of them seemed queerly deranged. Their immune systems had failed or gone haywire. Most of the animals did not look very sick yet, but they did not display the alertness, the usual monkey energy, the leaping and the cage
rattling that you see in healthy monkeys, and most of them had not eaten their morning biscuits. They sat almost motionless in their cages, watching the two officers with expressionless faces.

They had been injected with the hottest strain of Ebola known to the world. It was the Mayinga strain of Ebola Zaire. This strain had come from a young woman named Mayinga N., who died of the virus on October 19, 1976. She was a nurse at a hospital in Zaire, and she had taken care of a Roman Catholic nun who died of Ebola. The nun had bled to death all over Nurse Mayinga, and then, a few days later, Nurse Mayinga had broken with Ebola and died. Some of Nurse Mayinga’s blood had ended up in the United States, and the strain of virus that had once lived in Nurse Mayinga’s blood now lived in small glass vials kept in superfreezers at the Institute, which were maintained at minus one hundred and sixty degrees Fahrenheit. The freezers were fitted with padlocks and alarms and were plastered with biohazard flowers and sealed with bands of sticky tape. The first line of defense against a hot agent is sticky tape, because it seals cracks. It could be said that without sticky tape there would be no such thing as biocontainment.

Gene Johnson, the civilian scientist, had thawed a little bit of Nurse Mayinga’s frozen blood and had injected it into the monkeys. Then, as the monkeys became sick, he had treated them with a drug in the hope that it would help them
fight off the virus. The drug did not seem to be working.

Nancy Jaax and Tony Johnson inspected the monkeys, moving from cage to cage, until they found the two monkeys that had crashed and bled out. Those animals were hunched up, each in its own cage. They had bloody noses, and their eyes were half-open, glassy, and brilliant red, with dilated pupils. The monkeys showed no facial expression, not even pain or agony. The connective tissue under the skin had been destroyed by the virus, causing a subtle distortion of the face. Another reason for the strange faces was that the parts of the brain that control facial expression had also been destroyed. The masklike face, the red eyes, and the bloody nose were classic signs of Ebola that appear in all primates infected with the virus, both monkeys and humans. It hinted at a vicious combination of brain damage and soft-tissue destruction under the skin. The classic Ebola face made the monkeys look as if they had seen something beyond comprehension. It was not a vision of heaven.

Nancy Jaax felt a wave of unease. She was distressed by the sight of the dead and suffering monkeys. As a veterinarian, she believed that it was her duty to heal animals and relieve their suffering. As a scientist, she believed that it was her obligation to perform medical research that would help alleviate human suffering. Even though she had grown up on a farm, where her father had raised livestock for food, she had never been able
to bear easily the death of an animal. As a girl, she had cried when her father had taken her 4-H Club prize steer to the butcher. She liked animals better than many people. In taking the veterinarian’s oath, she had pledged herself to a code of honor that bound her to the care of animals but also bound her to the saving of human lives through medicine. At times in her work, those two ideals clashed. She told herself that this research was being done to help find a cure for Ebola, that it was medical research that would help save human lives and might possibly avert a tragedy for the human species. That helped reduce her feelings of unease, but not completely, and she kept her emotions off to one side.

Johnson watched Jaax carefully as she began the removal procedure. Handling an unconscious monkey in Level 4 is a tricky operation, because monkeys can wake up, and they have teeth and a powerful bite, and they are remarkably strong and agile. The monkeys that are used in laboratories are not organ-grinder monkeys. They are large, wild animals from the rain forest. A bite by an Ebola-infected monkey would almost certainly be fatal.

First Nancy inspected the monkey, looking through the bars. It was a large male, and he looked as if he was really dead. She saw that he still had his canine fangs, and that made her nervous. Ordinarily the monkey would have had its fangs filed down for safety. For some reason, this one had enormous natural fangs. She stuck her
gloved fingers through the bars and pinched the monkey’s toe while she watched for any eye movement. The eyes remained fixed and staring.

“GO AHEAD AND UNLOCK THE CAGE,” Lieutenant Colonel Johnson said. He had to shout to be heard above the roar of air in their space suits.

She unlocked the door and slid it up until the cage gaped wide open. She inspected the monkey again. No muscle twitches. The monkey was definitely down.

“ALL RIGHT, GO AHEAD AND MOVE HIM OUT,” Johnson said.

She reached inside and caught the monkey by the upper arms and rotated him so that he was facing away from her, so that he couldn’t bite her if he woke up. She pulled his arms back and held them immobile, and she lifted the monkey out of the cage.

Johnson took the monkey’s feet, and together they carried him over to a hatbox, a biohazard container, and they slid the monkey into it. Then they carried the hatbox to the necropsy room, shuffling slowly in their suits. They were two human primates carrying another primate. One was the master of the earth, or at least believed himself to be, and the other was a nimble dweller in trees, a cousin of the master of the earth. Both species, the human and the monkey, were in the presence of another life form, which was older and more powerful than either of them, and was a dweller in blood.

Jaax and Johnson moved slowly out of the room, carrying the monkey, and turned left and then turned left again, and entered the necropsy room, and laid the monkey down on a stainless-steel table. The monkey’s skin was rashy and covered with red blotches, visible through his sparse hair.

“GLOVE UP,” Johnson said.

They put on latex rubber gloves, pulling them over the space-suit gloves. They now wore three layers of gloves: the inner-lining glove, the space-suit glove, and the outer glove. Johnson said, “WE’LL DO THE CHECK LIST. SCISSORS. HEMOSTATS.” He laid the tools in a row at the head of the table. Each tool was numbered, and he called the numbers out loud.

They went to work. Using blunt-ended scissors, Johnson opened the monkey while Jaax assisted with the procedure. They worked slowly and with exquisite care. They did not use any sharp blades, because a blade is a deadly object in a hot zone. A scalpel can nick your gloves and cut your fingers, and before you even feel a sensation of pain, the agent has already entered your bloodstream.