The Judas Strain (5 page)

Monk pictured Lisa aboard the cruise ship. The Australian Coast Guard cutter patrolled the waters around the tiny port. At least she should be safe.

Unlike them.

Cliffs cut off any retreat. To either side, empty beaches stretched.

Monk dragged Graff behind a tumbled boulder, the only shelter.

The speedboat aimed toward them. Gunfire chattered, pocking the sand in an arrow toward their hiding place.

Monk pulled them lower.

So much for that lazy day at the beach.

11:42
A.M.

D
R
. L
ISA
C
UMMINGS
smeared the anesthetic cream across the back of the crying girl. Her mother held her hand. The woman was Malaysian and spoke in soft whispers, her almond eyes pinched in worry. The combination of lido-caine and prilocaine quickly soothed the burn across the child’s back, dissolving the girl’s pained cries into sobs and tears.

“She should be fine,” Lisa said, knowing the mother was employed as a waitress at one of the local hotels and spoke English. “Make sure she takes the antibiotics three times a day.”

The woman bowed her head. “
Terima kasih
. Thank you.”

Lisa nodded her toward a group of men and women in blue-and-white uniforms, the staff of the
Mistress of the Seas
.

“One of the crew will find a cabin for you and your daughter.”

Another bow of her head, but Lisa was already turning away, stripping off her gloves with a snap. The dining room on the Lido Deck of the
Mistress of the Seas
had become the major triage point for the entire ship. Each evacuee from the island was examined and divided into critical and noncritical cases. Lisa, with the least experience in crisis medicine, had been assigned to first aid. To assist her, she was given a nursing student from Sydney, a skinny young man of Indian descent named Jesspal, a volunteer from the WHO medical staff.

They made an odd couple: one blond and pale, the other dark-haired and coffee-skinned. But they operated like an experienced team.

“Jessie, how are we doing on the cephalexin?”

“Should last, Dr. Lisa.” He shook the large bottle of antibiotics with one hand while filling out paperwork with the other. The young man knew how to multitask.

Snugging the green scrub pants higher on her hips, Lisa glanced around her. No one waited for immediate care. The rest of the dining room remained in a state of subdued chaos, punctuated by cries and occasional shouts, but for the moment, their station was an island of calm.

“I think the bulk of the islanders have been evacuated,” Jessie said. “I heard the last two tenders from the docks arrived only half full. I think we’re seeing the dribs and drabs from the smaller outlying villages.”

“Thank God for that.”

She had treated over a hundred and fifty patients during the course of the interminable morning, cases of burns, blisters, racking coughs, dysentery, nausea, a wrist sprain from a fall at the docks. Yet she had only seen a fraction of all the cases. The cruise ship had arrived at the island last night, and the evacuation had been well under way by the time she arrived at daybreak, flown in by helicopter. It required her to hit the ground running. The tiny, remote island had held over two thousand inhabitants. Though quarters were tight, the ship should accommodate the entire populace, especially as the number of dead had tragically climbed past four hundred…and was still rising.

She stood for a moment, hugging her arms around herself, wishing it were Painter’s strong arms instead, embracing her from behind, his cheek, rough with stubble at her neck. She closed her eyes, tired. Even though he was absent, she borrowed a bit of his steel.

While laboring, case after case, it had been easy to turn clinical, to detach, to simply treat and move on.

But now, in this moment of calm, the enormity of the disaster struck her. Over the past two weeks, the illnesses here had started small, a few burns from immediate exposure. Then in just two days, the seas had churned up a toxic cloud, erupting in a final volcanic expulsion of blistering gas that killed a fifth of the population and injured the rest.

And though the toxic cloud had blown itself out, secondary illnesses and infections had begun afflicting the sick: flus, burning fevers, meningitis, blindness. The rapidity was disturbing. The entire third deck had been designated a quarantine area.

What was she doing here?

When this medical crisis first arose, Lisa had petitioned Painter for this assignment, stating her case. Besides her medical degree, she held a PhD in human physiology, but more importantly, she had extensive field experience, especially in marine sciences. She had labored for half a decade aboard a salvage ship, the
Deep Fathom,
doing physiological research.

So she had a sound argument for her inclusion here.

But it was not the only one.

For the past year Lisa had been land-bound in Washington and found herself slowly being consumed by Painter’s life. And while a part of her enjoyed the intimacy, the two becoming one, she also knew she needed this chance away, both for herself and for her relationship, a bit of distance to evaluate her life, out of Painter’s shadow.

But maybe this was too much distance…

A sharp scream drew her attention toward the double doors into the dining room. Two sailors hauled in a man atop a stretcher. He writhed and cried, skin weeping, red as a lobster shell. It looked as if his entire body had been parboiled. His bearers rushed him toward the critical care station.

Reflexively, she ran the treatment through her head, going clinical again.
Diazepam and a morphine drip
. Still, deeper inside, she knew the truth. They all did. The suffering man’s treatment would be merely palliative, to make him comfortable. The man on the stretcher was already dead.

“Here comes trouble,” Jessie mumbled behind her.

Lisa turned and spotted Dr. Gene Lindholm striding toward her, an ostrich of a man, all legs and neck, with a shock of feathered white hair. The head of the WHO team nodded at her, indicating she was indeed his target.

What now?

She didn’t particularly care for the Harvard-trained clinician. He came with an ego to match. Upon arriving, rather than helping here, he had sequestered himself with the owner of the cruise line, maverick Australian billionaire Ryder Blunt. The billionaire, notorious for his hands-on approach to business, had been aboard the ship for its maiden cruise. And while he could have left when the ship was commandeered, the billionaire had remained on-site, turning the rescue event into a marketing opportunity.

And Lindholm cooperated.

However, such cooperation did not extend to Monk and Lisa. The WHO leader resented the strings that were pulled to include the pair on his team. But he’d had no choice but to acquiesce—still, that didn’t mean he had to be pleasant about it.

“Dr. Cummings, I’m glad to find you here idling with nothing to do.”

Lisa bit back a retort.

Jessie snorted.

Lindholm glanced to the nursing student as if he’d been unaware of the man’s presence—then just as quickly dismissed him and returned his focus to Lisa.

“I was instructed to include you and your partner in any findings related to the epidemiology for this disaster. And as Dr. Kokkalis is out in the field, I thought I should bring this to your attention.”

He thrust out a thick medical folder. She recognized the logo for the small hospital that served Christmas Island. Staffed with only on-call doctors and a pair of full-time nurses, the hospital had been quickly swamped, requiring the more severe cases to be airlifted to Perth. But that became impractical after the full brunt of the biological meltdown struck the island. Once the cruise ship had arrived, the hospital had been the first to be evacuated.

Lisa flipped open the folder and saw the patient’s name listed as John Doe. She quickly scanned the history, the little that there was. The patient, a man in his late sixties, had been found five weeks ago wandering naked through the rain forest, clearly suffering from dementia and exposure. He could not speak and was severely dehydrated. He subsequently slipped into an infantile state, unable to care for himself, eating only if fed by hand. They sought to identify him by fingerprint and by searching through missing person records, but nothing had turned up. He remained a John Doe.

Lisa glanced up. “I don’t understand…what does this have to do with what happened here?”

Sighing, Lindholm stepped next to her and tapped the chart. “Under the list of presenting symptoms and physical findings. At the bottom.”

“‘Moderate to severe signs of exposure,’” she mumbled, reading down the list. The last line stated
deep dermal second-degree sunburn to calves, with resultant edema and severe blistering
.

She glanced up. She had treated similar symptoms all morning. “This wasn’t just a sunburn.”

“The island’s clinicians jumped to that conclusion,” Lindholm said with evident disgust.

Lisa could not blame the island’s doctors or nurses. At that time, no one was aware of the environmental disaster brewing. She again checked the date.

Five weeks ago
.

“I believe we may have found Patient Zero,” Lindholm said pompously. “Or at least one of the earliest cases.”

Lisa closed the folder. “Can I see him?”

He nodded. “That was the second reason I came down here.” There was a grim waver in his voice at the end that disturbed Lisa. She waited for him to explain, but he simply turned on a heel and headed out. “Follow me.”

The WHO leader crossed the dining room to one of the ship’s elevators. He hit the button for the Promenade Deck, third level.

“The isolation ward?” she asked.

He shrugged.

A moment later the doors opened into a makeshift clean room. Lindholm waved for her to don one of the bio-suits, similar to the one Monk had taken to collect samples.

Lisa climbed into a suit, noting the slight body odor as she pulled the hood over her head and sealed her seams. Once both were ready, she was led down a passage to one of the cabins. The door was open and other clinicians were crowded at the entry.

Lindholm bellowed for the others to clear a path. They scattered, well trained by their leader. Lindholm led Lisa into the small room, an inside cabin, no windows. The only bed stood against the back wall.

A figure lay under a thin blanket. He looked more cadaverous than alive. But she noted the shallow rise and fall of the blanket, a panting weak breath. Intravenous lines ran to an exposed arm. The skin on the limb so wan and wasted as to the point of translucency.

She instinctively looked to his face. Someone had shaved him, but hastily. A few nicks still oozed. His hair was gray and wispy, like a chemo patient, but his eyes were open, meeting hers.

For a moment she thought she noted a flash of recognition, the barest startle. Even a hand lifted feebly toward her.

But Lindholm strode between them. Ignoring the patient, he peeled back the lower half of the blanket to expose the man’s legs. She was expecting to see scabbed skin, healing from a second-degree burn, like she had been treating all day, but instead she saw that a strange purplish bruising stretched from the man’s groin to toe, pebbled with black blisters.

“If you had read further into the report,” Lindholm said, “you would have discovered these new symptoms arose four days ago. The hospital staff surmised tropical gangrene, secondary to the deep infection in the burns. But it’s actually—”

“Necrotizing fasciitis,” she finished.

Lindholm sniffed tightly and lowered the blanket. “Exactly. That’s what we thought.”

Necrotizing fasciitis, better known as
flesh-eating disease,
was caused by bacteria, usually beta-hemolytic streptococci.

“What’s the assessment?” she asked. “A secondary infection through his earlier wounds?”

“I had our bacteriologist brought in. A quick gram stain last night revealed a massive proliferation of
Propionibacterium
.”

She frowned. “That makes no sense. That’s just an ordinary epidermal bacterium. Nonpathogenic. Are you sure it wasn’t just a contaminant?”

“Not in the numbers found in the blisters. The stains were repeated on other tissue samples. The same results. It was during these second studies that an odd necrosis was noted in the surrounding tissue. A pattern of decay sometimes seen locally. It can mimic necrotizing fasciitis.”

“Caused by what?”

“The sting of a stonefish. Very toxic. The fish looks like a rock but bears stiff dorsal spines envenomed by poison glands. One of the nastiest venoms in the world. I brought Dr. Barnhardt in to test the tissue.”

“The toxicologist?”

A nod.

Dr. Barnhardt had been flown here from Amsterdam, an expert in environmental poisons and toxins. Under the auspices of Sigma, Painter had personally requested the man’s addition to the WHO team.

“The results came back this past hour. He found active poison in the patient’s tissues.”

“I don’t understand. So the man was poisoned by a stonefish while wandering in delirium?”

A voice spoke behind her, answering her question. “No.”

She turned. A tall figure filled the doorway, a bear of a man squeezed into a contamination suit too small for his girth. His grizzled and bearded face fit his size, but not the delicacy of his mind. Dr. Henrick Barnhardt pushed into the room.

“I don’t believe the man was ever stung by a stonefish. But he is suffering from the venom.”

“How is that possible?”

Barnhardt ignored her question for the moment and addressed the WHO leader. “It’s what I suspected, Dr. Lindholm. I borrowed Dr. Miller’s
Propionibacterium
cultures and had them analyzed. There is no doubt now.”

Lindholm visibly blanched.