Pestilence: A Medical Thriller (2 page)

3

When Samantha’s plane touched down at Thurgood Marshal International Airport outside Baltimore, she had logged fourteen hours of flying time. As she walked into the terminal, her legs hurt, her back hurt, the atrocious food she had eaten sat in her belly like a lump of coal, and she had a migraine that was pounding ceaselessly against her skull.

Her car was back in Atlanta
, so she waited on the curb outside for Duncan to pick her up. She felt bad that he had to come to the airport at five in the morning, but he said he was usually up jogging at that time anyway.

Before long, a gray Lincoln pulled to a stop in front of her
, and she threw her gym bag into the backseat and climbed into the passenger seat. She kissed him and anticipated that, for a fraction of a second, he would hesitate to kiss her back since she’d just gotten back from an Ebola outbreak, but he didn’t. Both of them worked with hot viruses, and he had grown accustomed to the roulette they played every day.

“How was Africa?”

“Hot. And the insects are the size of my head.”

“Did you call your sister like I asked?”

“Yes, but she didn’t answer. What’s going on, Duncan?”

He was quiet as he pull
ed out of the airport and made his way to the interstate. “What did they tell you after the last outbreak of black pox?”

Images flooded Samantha’s mind
—patients turning to jelly and entire hospital staffs unwilling to treat them, a gymnasium full of patients because the hospitals didn’t have enough room, and a man in her house who had nearly killed her.

She
’d spent nearly a week in the hospital after the break-in. Two weeks after her release, she’d returned to her job and had been informed that the outbreak had been contained to Hawaii and South America.

“They told me
it’s over.”

“Have you talked to your sister since she went to California?”

“No, she’s been there a week. Her in-laws are there.”

He paused. “Samantha, it was never contained.”

“What do you mean?”

“It got to the mainland. California. We think some of the infected snuck onto flights out of Hawaii and landed
at LAX. There’re over a hundred reported cases. The problem is that they’re spread throughout the state and are difficult to contain. Someone higher up than me made the call that California can’t be contained.”

“What does that mean?”

“It means they’ve been closing all the bridges and highways in and out. Shipping’s stopped, and flights were grounded this morning. No travel to or from the state. They’re imposing martial law today.”

“You’re exaggerating,” she said.

“I’m not.”

“They’re going to violate the liberty of thirty-eight million people because of a hundred possibly infected?”

Duncan sped up the onramp onto the interstate. “Someone in the military’s determined that this infection, Agent X, is deadly enough that it’s the prime national security threat… at least for now.”

Agent X. She
’d thought she would likely never hear that again in that context. She knew that samples had been taken and stored in the Centers for Disease Control biosafety level four laboratories, which were the most secure laboratories in the world, where everything from Ebola and smallpox to a strand of airborne AIDS virus were contained and studied. The United States Army Medical Research Institute for Infectious Diseases was the only other laboratory stateside that could even compare.

“Why haven’t I heard about it?”

“I only found out because we’ve been issued leave from all other projects to work on a vaccine. This is really top secret stuff. They’re going to shut down the news stations and radio, even the internet. With the flip of a switch, they’re going to shut down all information in an entire state.” He shook his head. “The fact that they can even do that is what’s most frightening for me. But anyway, they worked out some deal with the media outlets. You guys can stay on, but if you report anything about what’s coming, you’re done. They’ve got everything in place now, and they’re going to make it official this morning. No one in or out, under penalty of imprisonment or death.”

“Death?”

“That’s what they said.”

“It’s too big a border to secure. They can’t do it.”

“You haven’t worked in the military, Sam. You don’t know how they think. They know they can’t secure the whole border. They don’t need to. Thomas Edison did an experiment with elephants. He chained them to the ground, and the elephants would try desperately to get away. He did it for a long time, and eventually, the elephants stopped trying to escape. Then Edison replaced the chain with a string. The elephants couldn’t get away. They would feel the string and were paralyzed. They don’t need to prevent everybody from escaping. They just need to make an example out of the first few people that do. Everyone else will be held in place by a string.”

She sat quietly and processed th
at. All the pain and horror she had experienced during the past couple of months came flooding back to her, making her heart race. Short of breath, she had to close her eyes and take deep breaths to calm herself.

Agent X spread through even casual contact
, and its incubation period was far shorter than even a normal strand of smallpox. Most viruses would have to flood the body to cause infection. The HIV virus, when passed through contact with an infected person, floods the new host’s body with millions of viruses. Agent X, from everything they could tell, only needed one virus to enter the body to cause infection. The world, she was convinced, had never seen anything like it.

And the most frightening part was that they weren’t sure where it had come from. They had found the index patient, or patients, in South America. They had been infected through a canister believed to have come from
one of only two places in the world that still held diseases as deadly as smallpox: the United States and Russia. The thought that some rogue nation like Iran or North Korea had developed it as a weapon was much more terrifying.

She took out her cell phone and tried her sister again.
The call went straight to voice mail.

4

After
spending a day with Duncan, Samantha had to get back to Atlanta. She’d filed her reports on the Ebola outbreak in Kinshasa electronically, and she’d gotten a reply that the assistant director wanted to meet with her in person to go over them.

Duncan drove her to the airport in the morning
, where she kissed him and said goodbye. He handed her something before she walked through the metal detectors: a copy of Seneca’s
On the Shortness of Life
.

“Now?” she said.

“Its subtitle is ‘life is long if you know how to use it.’ It’s a book about overcoming tragedy.”

“Thanks. I don’t know if I can concentrate enough to read
, though.”

He hugged her
, and she watched him as she went through the metal detectors.

The flight didn’t take long
, and after landing and using the bathroom, she retrieved her car from long-term parking. She put the hundred-and-twelve-dollar parking fee on a government-issued expense card.

Atlanta was warm but
had a dry heat that didn’t affect her. She rolled down her windows as she drove home and listened to an Enya station on Pandora.

When she arrived at her ho
use, she was struck by how much she had actually missed it. It was really nothing more than a small brown-brick house with three bedrooms—one for her, one for her mother, and a guest bedroom that was never used—but it held a comfort she’d lacked growing up in apartments and condos in Southern California. Samantha went inside and heard someone in the kitchen.

She walked in
to find her mother’s nurse, Dana, cooking lunch.

“Back already?” she
asked.

“I got done quicker than I thought. How is she?”

“Yesterday was bad. She didn’t remember who I was and kept thinking I was a burglar. She tried to call the police.”

“I’m so sorry, Dana.”

“Hey, that’s why you pay me the big bucks. She’s much better today. She’s watching her soaps if you want to go up.”

Samantha dropped her gym
bag by the closet and went upstairs to the bedrooms. She went into her mother’s room and saw her lying on her back, staring blankly at the flat-screen television on the wall.

“How are you
, Mom?”

“I didn’t get my medication today. I need my medication for my flu.”

Samantha sat next to her and gently brushed back her hair from her eyes. “You don’t have the flu, Mom. But I’ll check with Dana and make sure she gets your medication to you.”

“I need my medication. It makes my throat feel better.”

Samantha leaned down and kissed her forehead. She sat back up and held her mother’s hand. Placing her back against the wall, she turned toward the television.

“So
, what’s going on in this episode?”

Within an hour, her mother was asleep. Samantha quietly rose
, turned off the television, and left the room, shutting the door softly behind her. She went downstairs and found a note from Dana saying that lunch was prepared and in the fridge. Tuna fish sandwiches were wrapped in Saran Wrap, with small bags of chips placed next to them. She took hers and went out on the porch. Sitting down on her steps, she unwrapped her sandwich and took a bite, looking out over her neighborhood.

Her
community was quiet, without any commotion in the short winters and few calls to the police in the long summers. The neighbors mostly kept to themselves, but they would invite her to summer barbeques and picnics, which she would always take her mother to. She tried to get her mother out as much as possible, but within the last year, that had been getting more difficult. The Alzheimer’s was slowly sucking away the strong, confident person Samantha remembered as a child. It had set in early, while Samantha was still an undergrad at New York University.

Dates were the first to go
; she’d started out missing birthdays and holidays. Those were followed by events. Her mother would frequently confuse something that happened to her sister with something that happened to her. Or something she saw on television would become an occurrence that had happened to her. At first, Samantha, her brother, and her sister were in denial. They attributed everything to the natural processes of aging. But when she forgot how to open a soda can, they knew something was wrong.

Samantha placed the sandwich down on her lap.
She took out her cell and tried her sister, Jane, again, and then she called her sister’s husband, Robert. Neither of them answered.

5

Samantha leapt out of the double
-engine plane over a clearing outside of Atlanta. The chute was wrapped tightly around her, and the wind screamed in her ears. Her goggles were coming off, and she wished she’d adjusted them beforehand, but her mind had been elsewhere.

The ground in front of her looked like a patch
work of green and yellow squares stitched together with roads. Cars moved on the stitching like parasites, and she had hoped that she wouldn’t see any. She’d wanted the flight to be her, the sky, and the ground.

On some jumps
, she would imagine she didn’t have a jumpsuit and that she was racing toward the ground to her death. She tried to imagine it so vividly that she would think the actual thoughts she might have before her death, rank the priorities in her life. It never happened. Something about the feel of the chute on her back never let her believe that she was actually going to die. But she had gotten that feeling in the biosafety level four laboratories more than once.

On one occasion, she had suited up and inflated the
biohazard suit with negative pressure, letting the air from the hose push everything away from her body, then began running a routine test using samples of Lassa virus. By all accounts, Lassa hemorrhagic fever was one of the most dangerous diseases in the world.

The Lassa virus was known as an
ambisense RNA virus, which meant it was a non-coding strand of RNA that attached to the main RNA code. It could cause RNA interference, blocking an expression of a gene. Experiments were being done on RNA interference, mimicking Lassa, to attempt to block the expression of genes that cause Down syndrome or even genetic heart conditions.

But Lassa
’s RNA interference had a much more sinister purpose: to stop the host’s immune system from attacking the virus. It took over the immune system and used the body to reproduce the virus itself. In Sierra Leone, Samantha had seen what this did to a human body. Some of the symptoms were flu-like, such as headache and sore throat, and others were hemorrhagic, like bleeding from the eyes and genitals.

But she wasn’t thinking of that when she had been handling the Lassa. She was thinking of her sister’s upcoming wedding.
Almost immediately after the experiments were complete, she noticed something on one of her gloves: a small tear.

The glove was thick double-stitched rubber. When she decontaminated, she pulled it off and checked the glove underneath
—and spotted the same tear. Underneath that was the final layer, a thin sheet of latex. It was torn, as well.

Panicked, she quarantined herself
in the laboratory. The CDC staff could do nothing but wait. They brought her meals, fluids, and books, but they had to wait for the incubation period to run its course. Once it had, a blood test showed she had not been infected.

Sitting in quarantine late at night, listening to the hum of the machines and the occasional plane
flying low overhead, she questioned her life and her choices. She had reached decisions, but she couldn’t remember them anymore. The terror of the moment was so strong that it overtook her reason, and her memory of the quarantine epiphanies faded every day that she was away from the laboratory.

Samantha pulled
her ripcord later than she should have. The recoil jerked her up and sideways, and the sensation was jarring. She hit the ground hard and fell on her stomach as the chute collapsed around her like a deflating balloon.

She lay on the ground a long time, staring up at the sky through her rose-tinted goggles. Pulling them off her head, she took in a deep breath and
then exhaled through her nose. She did this until some of the others who had jumped came up and asked if she was okay.

The jumps were relaxing and uplifting, but something was different this time. She couldn’t exactly put her finger on it. But it seemed, almost,
as if she were just going through the motions rather than experiencing the moment. The jump felt futile.

Whatever it was, she felt the same as
she had before she’d jumped out of the plane.

After a change of clothing, she headed back into Atlanta
, to Clifton Road, where the Centers for Disease Control and Prevention were headquartered.

M
ultiple buildings dotted the landscape, and most of them were rectangular and made of blue glass. A blue-and-white sign marked the white CDC emblem of a bird that she guessed was a hawk, but looked like a pigeon, and it sat at the forefront of the building.

After p
arking in her reserved stall, she tried her sister again and left a message, probably her fifth one, stating she was worried and would like a call back. Jane usually called her immediately. Going black for long periods of time was definitely out of character for her.

The metal detectors didn’t buzz when
Samantha passed security. She went up to her office on the fourth floor, which overlooked the grassy knoll across the street, and collapsed in her chair. Her hair was a mess, and she took out a hair elastic and pulled it back. Several papers were scattered over the desk and piled in two boxes in the corner. She pushed the papers aside and then turned on her Mac.

Her inbox said she had ninety-six unread e
-mails. The number was so overwhelming that she turned on Pandora and sat there for a good fifteen minutes, unable to open even one. Then she stood up, stretched her arms above her head, sat back down, and began going through them. She scanned them quickly for anything important, anything about California. But she saw nothing relevant.

Someone knocked on her glass wall
, and she glanced up and saw Frederick Hess, assistant director over Infectious Diseases, who waved to her. She waved back, and Fredrick came to the door. He leaned against it but didn’t come in.

“How was it?”
he said.

“Hot and terrifying. How was everything here?”

“Pretty much the same.”

She grinned and leaned back in her chair. “The outbreak was contained. I think the final nineteen patients will probably pass
, and that’ll be it as long as the doctors from the WHO treat the bodies with care.”

“Why wouldn’t they?”

“Some of them are poorly trained on hot viruses. They’re not common enough for someone from Thailand or Peru to deal with. They don’t recognize how deadly they are.” She paused. “There was a doctor there that became infected because he refused to leave patients untreated. I’d like to write an article about him. Maybe a blurb on the CDC website, if that’s okay.”

“He didn’t run out the door like everyone else?”

“No. He knew he would probably die, and it was worth it for him.”

“I didn’t think doctors like that existed anymore. I’m on the admissions committee over at UMD medical school. You should see some of the reasons people put for wanting to become doctors. They think it’s prestigious or they’re going to make a lot of money. I tell them for the hours they’re going to put
in, they’d make more money managing a restaurant. And nothing’s more prestigious than doing rounds, asking patients how much they pooped the night before.”

“It has its moments. My uncle was a doctor as well
, and he worked for Doctors Without Borders. I don’t know of any other professions that let you travel to any country in the world and do good. I don’t think lawyers and politicians can do that.”

“Yeah, well, maybe actors adopting kids from countries nobody’s ever heard of.”

She hesitated. “Can I ask you something, Freddy?”

“Sure.”

“Do you know anything about California?”

“Their
taxes on small business is killing their economy.”

“I meant have you heard anything a
bout military involvement there?”

He glanced away.
The movement was quick, but she caught it.

“It’s classified, Sam.”

“Classified? Since when is anything at the CDC classified?”

He stepped into her office and sat down across from her. “I know in medical school they trained us to question everything. To find every detail, even what someone’s grandmother did for part-time work back in
Uzbekistan when someone comes in with flu-like symptoms. But sometimes, as employees of the government, we have to stop questioning and just do what we’re told.”

“That sounds like you don’t agree with what’s about to happen.”

“Doesn’t matter what I think. I’m a cog in a wheel.” He rose and started out of her office, turning back to her at the door. “I can tell you one thing, though. There’s a Chinese curse that says, ‘May you live in interesting times.’ And this is definitely an interesting time.”