Alan E. Nourse - The Fourth Horseman (6 page)

BRUSH FIRES

It was 2:00
a.m
. when Dr. Ed O'Hara jolted awake and groped for the ringing telephone. He recognized the young, anxious voice instantly. "Ed? I've got a guy down here in the emergency room with something funny going on with his chest. I'd sure like you to come take a look at him."

"What kind of 'something funny'?" Ed growled.

"Well, it looks like pneumonia."

"That's funny?"

"No, but I think he's got heart failure too."

Ed sighed. "A lot of old geezers get heart failure with their pneumonia," he said.

"Yeah, but this guy's only seventeen. Can you come take a look?"

The older doctor got dressed and started driving down toward the Rampart Valley Community Hospital.
Damnation,
he thought-as he stopped at the town's only stoplight, invariably red. /
knew I should never have left that kid alone in the ER until I'd seen him in action a little bit more.
Some of these Family Practice residents were dynamite in a crisis, he reflected, and some of them just fell apart. Pete Whitehead was showing signs of being the falling-apart kind.

Ed pulled into the ambulance entrance of the hospital, a handsome modern structure, fifty patient beds, including an eight-bed maternity ward and birthing rooms in an adjacent building, a fully equipped emergency room, intensive-care facilities and a good basic lab with twenty-four-hour coverage. The building was about the only handsome thing there was in

Rampart Valley, Colorado, he reflected, what with the lead mines, the zjnc mines, the uranium mines, and every hill in sight scarred and ravaged by years of mining operations. It had taken Ed O'Hara years of prodding to get the other doctors and the people of the town galvanized into building this hospital, and it was a pearl of its kind, saving the local people hundreds of eighty-mile round trips down to Colorado Springs for medical care each year. To Ed O'Hara it was the most beautiful structure in the world.

Pete Whitehead met him at the emergency-room door, looking veiy young and very nervous. Quite the picture of the proper young doctor, Ed thought, with his crisp white knee-length clinical coat and the stethoscope tucked into a side pocket on that hot summer night, but the illusion faded as he kept tugging uncertainly at his wispy mustache and looking back over his shoulder. As Ed walked in, wearing his "Here today, Gone to Maui" T-shirt and a pair of shorts and sandals, he heard somebody coughing up a storm in one of the draped cubicles to the rear of the ER. "Okay," he said to the young doctor. "Now what the hell's going on that you've got to call me out at two in the morning?"

"Well, this kid came in just before dinnertime this evening, and I didn't know whether to believe his story or not." Dr. Whitehead tugged at his mustache. "He was just a drop-in, said he was driving down from the airport in Denver to Canon City and couldn't go any farther because he was coughing so much and his head ached so bad. Said he could hardly see to drive. Seems like he'd been up north somewhere with a big crowd on a camping trip this past week, and then all of a sudden everybody started getting sick. Three of them died—"

"Died!" Suddenly Ed O'Hara blinked awake.

"That's what he said."

"Died of what?"

"I'm not just sure. Pneumonia, it sounded like. They'd begun packing down the mountain when they started getting sick, and they tried to get the three worst ones to some hospital in Seattle, but all three were dead on arrival. At least I
think
that's what he said, the story was getting pretty garbled. I gather that he was getting sick too, and somehow lost contact with the rest of the party and just took a cab to the airport and flew back to

Denver on the ticket he had in his pocket. Stopped here because he couldn't go any farther."

"So what did you do?"

The young doctor took a deep breath. "Well, I examined him and took a chest X ray—he had consolidation in both lungs, looked like double lobar pneumonia, but he wasn't cyanotic yet, just coughing like mad, so I took a culture and smear of his sputum and ran a fast gram's stain on the smear, but the bug sure wasn't pneumococcus or anything else gram-positive. All I could see was gram-negative rods. Of course, I plated out the culture and put it in the incubator, but he was getting worse in a hurry, coughing more than ever, getting up some blood, and I didn't think we had time to wait around for a culture, so I started him on gentamycin and clindocin."

Ed nodded. "On the premise that it was some kind of atypical
E. coli,
I suppose."

"Right. I hoped the antibiotic might hit it, but it hasn't done anything yet that I can see. And then about an hour ago he started bringing up lots of blood and getting very short of breath and cyanotic, so I had Miss Towne and a couple of the LPNs help me get him on the respirator back there—his temp had gone up from 101 to 105 in three hours—and that was when I found out he had a pulse of 240 and damned little blood pressure at all, and 1 decided I'd better call you."

"Good thinking," Ed said sourly. "Well, let's take a look at him."

They took a look. The youth was coughing weakly in the respirator; otherwise he was barely responding at all. When Ed stopped the machine and bent to listen to his chest, the patient burst into an explosive paroxysm of coughing, spraying Ed's face and T-shirt with blood and splattering Peter Whitehead's white lab coat with red-streaked sputum. Ed wrinkled his nose. "God, what a stench. You don't suppose he's got a lung abscess, do you? Ho—wait a minute."

The doctor had been stripping down the youth's gown when he saw the purple hemorrhagic welts on the arms and chest. He felt under the armpits. "Did you feel these lumps?"

"Uh, lumps?"

"Yeah, under his arms. Groin, too. Did he have these welts when you first saw him?" "Uh, not like that."

Ed O'Hara's face was gray when he came out of the cubicle. "Let me see those slides you made."

The young doctor tagged along behind as Ed headed for the little emergency-room lab. "I'm afraid they aren't the greatest slides, Ed. They just didn't seem to take the stain worth a darn ..."

"Don't worry, just show me the slides." Ed adjusted the microscope and stared down through the, oil-immersion lens, a muddy-looking field filled with pus cells and red cells and debris, rod-shaped bacteria all over the place, but barely pink and barely visible, certainly not the sharp red-staining appearance of
E. coli
organisms.

"I hope I didn't do something wrong," Whitehead said nervously, tugging his mustache.

Ed looked up. "Son, you did everything you knew how to do and did it just exactly right. Now I need to know if you did one other thing. Did you save the original sputum specimen?"

"Yes. It's in the incubator."

"Great. Have we got any Wilson's stain around here?"

"Wilson's stain? There's Wright's and Giemsa . . ."

"Giemsa might do, but Wilson's would be better." Ed rooted around on a shelf. "Yeah, Wilson's. You heat-fixed that first slide?"

"Yes."

"Then make another just like it and I'll stain it."

Moments later he was staring down at a newly stained slide, filled with bacteria, far more distinct and sharply defined. "Take a good look."

Peter looked and looked. "They're rods, all right, but they've got a little spot of chromatin in each end. They sort of look like closed safety pins ..."

"Right," Ed said. "They're the murderer."

"What do you mean?"

"I mean we've got a dead man back there on that cot. He was probably beyond help before he even walked in here. He's got a couple of hours left, no more. And we're liable to be dead men, too, if we don't move fast.'' Ed looked at the bloody smear on his T-shirt and the brown splattering on Pete's white coat and swallowed hard. "First of all, get those nurses down here, the ones who helped you with the respirator. Get them
off the hospital floor
and get a list of every patient they've been near since they were down here—or anyone else they've contacted. Tell Miss Towne to open up the pharmacy and bring down ail the streptomycin and chloramphenicol we've got, and I hope to Christ we've got quite a lot. Meanwhile, lock the doors to this place and don't let
anybody
in until we can get some help-God! You, me, the whole emergency room, the respirator, those nurses, the patients, all contaminated. We're going to have to close this place down. A whole fine modern hospital turned into a pesthole in eight hours flat by that little bug that looks like a safety pin . . ."

"What is it?"

" Yersinia pestis.
The kid's got plague pneumonia, and he's blowing it around with every breath he takes.
Now get going,
fast, and then come back. I'll have some other things for you to do when you get that all taken care of."

"But what are
you
going to do?"

"First I'm going to make a couple of calls, to the State Department of Public Health and then to the Centers for Disease Control in Atlanta to find out what you do when you've got a live case of plague pneumonia that's contaminated a whole community hospital." Ed took a deep breath. "Then I'm going to start feeding streptomycin to everybody in sight—if we have enough on hand—and then I think I'm going to pray for a while. We're liable to need all the help we can get, before long."

10

Carmen Dillman had martinis already made when Jack came down from his studio around five, paint still on his fingertips. "Did you get that dust jacket finished?" she said.

"Finally."

"Do you like it?"

Jack made a face. "Alonzo will like it, and that's all I care about. It's part of a series layout, so it's nice exposure." Jack took half a martini down at a gulp. "I'll take it with me down to the city tomorrow and see what else he has stacked up for me."

"And lunch with Jocelyn, I suppose," Carmen said.

"Sure, why not? She hands me a lot of artwork to do. And I have to see that aerospace client of hers, too. That sounds like a nice fee—all kinds of fancy color work for their annual report."

Carmen nodded glumly, staring at her cocktail in silence. Jack watched her closely for a moment. "So what's the problem?" he said finally. "You know I go down there on Tuesdays. Why so gloomy about it?"

"Jack, 1 saw a rat in the backyard this morning."

"Oh yeah? You're crazy. We haven't had a rat here in Brookdale since the town council passed those sanitation ordinances ten years ago—and started enforcing them. You must have seen a squirrel."

"It was a rat," Carmen insisted. "I saw it come out of the woodshed and cross the backyard toward the house. It was a foot long, and black, with a pointy nose and a long naked tail. I grabbed a broom and ran outside. By then it was running along the foundation of the house, and then it just disappeared. I think it went in the basement."

"And where was Dummy all this time?"

"The cat? Asleep on the sofa. Where else?"

Jack poured himself more martini and stared soberly at his wife. She could have been right, of course. The rats used to come up from the river, years ago, when the restaurants in town were still leaving big cans of garbage open in the back alleys. He could remember seeing them dart across the road in his headlights now and then. But then people began to complain, and the County Health Department climbed all over the town council, and there was a big extermination program and the lids went onto the garbage cans and the disposal trucks started coming daily instead of once a week, and pretty soon the rats all disappeared . . .

No,
he thought,
it was a squirrel she saw, or maybe a wood-chuck, they're all over the place these days. But just the same
. . . "Tell you what," he said. "Why don't you get Dummy off her ass and put her down in the basement for the night? If we've got a rat down there, she'll get it. And listen, for God's sake: don't go chasing rats with a broom anymore, okay? They can be vicious when you comer them."

11

"Who was that on the phone?" Amy Slencik said as she came into the cabin on Grizzly Creek with an armful of beets from the garden.

"That was my job foreman," Harry said sourly. "He says Ted Smith has pulled his crew off the underground wiring job."

"He's
what?"

"Pulled out. Disappeared in the night. His boys came in.and hauled off their backhoes and trucks about midnight. No sign of them in town today. Said they were losin' money, so I could just go suck rocks."

"But Harry, Ted
bid
that trenching job! He signed a contract with you."

"So what's a contract? He's
gone.
Am I supposed to chase him to California? I can't even hold up his last week's payroll he's got it already."

"Well, you can sue the bastard," Amy said.

"I could if I was rich—but I haven't got time or money to sue him. What I've got to do is get those trenches dug, somehow. You can't lay underground without trenches. Goddamned has tard." Harry walked over to the cabin window. "Well, at Icasi I got your irrigation pump going again."