by Daniel Kalla
Her Bluetooth phone rings through the car’s speaker, and expecting more news from the office, she answers before checking the name on the screen. She regrets picking up the moment she hears her husband’s voice.
“Hi, Lees.”
“Oh, Dom. Hi. Can I call you back? Just dealing with an emergency.”
“A public-health emergency?” Dominic asks.
Maybe she only imagines condescension in his tone. Perhaps, these days, she just expects judgment even where there is none. Regardless, she can’t suppress the flicker of hurt. But she keeps it from her voice. “For real. I’m almost at the hospital. Can I call you back?”
“I just wondered if you wanted to carpool to our session today,” Dominic says.
Shit! She had forgotten about their appointment. Originally, she was the one who had cajoled Dominic into couples’ counseling. But six months into the weekly sessions—with so little, if any, progress made—Lisa has lost faith in the counseling, their counselor, and, if she’s being totally honest, their twelve-year marriage itself.
“My day’s going to be crazy,” she says. “I’ll have to meet you there.”
“See you there. Looking forward to pulling more Band-Aids off with the skin still attached,” he says in what she realizes is an attempt at lightheartedness. “Love you, Lees.”
“See you soon,” Lisa says as she hangs up, struck by her husband’s uncharacteristic words of affirmation and her struggle to reciprocate them.
She thinks again of her sister’s reaction when Lisa finally confessed—after a second Moscow mule—to her growing sense of detachment and progressive loss of interest in their sex life, and how it had only made Dominic more affectionate and attentive.
“And that surprises you?” Amber asked. “People are emotional lemmings. The more you pull away, the more they throw themselves into it.”
“It being off a cliff?” Lisa said.
“Yeah. In your case, a really rocky one, too.”
Lisa brushes off those thoughts as she pulls into the on-call parking lot at Harborview Health Care Center. She spent countless hours at the hospital during her residency, but she never got accustomed to the vastness of the campus. Or to the sounds, smells, and frantic busyness of the place. As the biggest regional medical center in the Pacific Northwest, Harborview spans five city blocks and runs four separate intensive care units for trauma, cardiac, burn, and medical patients. Lisa heads straight for the East Building, which houses the medical ICU.
She weaves through the bustling corridors and rides the elevator to the sixth-floor ICU, where she identifies herself to the indifferent clerk at the front desk. She has to wait a few minutes before a chatty nurse named Mick, with colorful tattoos that encircle both biceps and resemble cuffs to his scrub tops, arrives and then leads her past individual glassed rooms—each housing a patient besieged by medical gadgetry—to the negative-pressure isolation rooms at the far end of the unit.
As a student, Lisa used to love the rush that came during rotations in critical care, but she never adjusted to the deaths and the heartbroken families that were so often the outcome of all the medical drama.
They reach the first of the isolation rooms, and Mick hands her the personal protective equipment, or PPE, kit. A folded gown supports a pair of gloves and an N95 mask, which filters out all microbial-sized particles. He departs with a quick wave.
Lisa slides the gown on top of her clothes and secures her mask snugly over her mouth and nose. The simple steps conjure grim memories of donning PPE during the dark days when COVID-19 terrorized Seattle. As she is pulling on the second glove, an African American man with contemplative brown eyes appears beside her. “You’re from Public Health?” he asks as he slips into his own gown.
“Yes. Lisa Dyer.”
“Edwin Davis. I’m on for ICU.” He closes his eyes briefly and shakes his head. “And what a disaster of a day it’s been.”
“I can only imagine.” In Lisa’s experience, intensivists—the doctors who treat ICU patients—rarely if ever appear so fazed. Or dejected. “When did the meningitis cases show up?”
“We got the first call from the ER yesterday, late afternoon. A fifteen-year-old with suspected septic shock. By the time I got there—twenty minutes later—he was already dead. Six more kids rolled in over the course of the night and into the morning. Two others never made it out of the ER. One died up here. The other three are all on life support.” Edwin sighs. “I can’t say with confidence that any of them are going to survive. At least with COVID-19, most of the ones who died were much older.”
His despondence is contagious. “And the lab confirmed it’s meningococcus?” Lisa asks.
“The medical microbiologist ran stat gram stains on the cerebrospinal fluid as well as PCRs,” he says, using the acronym for polymerase chain reaction, a rapid sequence test that allows for almost instant DNA recognition—the genetic equivalent of a reliable witness at a police lineup. “He says he still has to confirm it with further testing, but he’s convinced it’s meningococcus type B.”
The mention of the pathogen’s specific type sends a chill down Lisa’s spine. Neisseria meningitidis, more commonly known as meningococcus, is among the deadliest of bacteria. And type B is the most feared of the four major subtypes, because of the lethal outbreaks it causes, and its notorious resistance to most vaccines.
None of that would be news to Edwin. So, instead, Lisa asks, “Do we know how many kids attended this Bible camp?”
“A ton of them. Not to mention camp counselors and other staff.” He arches an eyebrow. “A lot of contacts for your team to track down.”
“It’s what we do.” Lisa hides her doubt behind a matter-of-fact shrug. “And what about your staff? Have they been put on prophylactic antibiotics?”
He nods. “Anyone who’s had direct contact with the cases has already been put on Rifampin and cipro.”
“Including you?”
“I got the first dose,” Edwin says as he secures his own mask. “No ‘women and children first’ policy around these parts.”
Lisa turns her attention to the nearest room, where, behind the glass, a freckled girl with long dark hair lies motionless on the stretcher. A tube leads from her mouth to the ventilator, while other lines extend from her neck and arms and connect her to the transparent bags of fluid that dangle above her. A nurse dressed in full PPE on the near side of the bed adjusts one of those bags, while across from her, a stooped man in the same garb hovers awkwardly over the patient without touching her.
“Kayla Malloy,” Edwin says. “Sixteen years old, same ballpark as the others. She’s the most recent victim to reach us. Got to the ER just over two hours ago. Her kidneys have shut down, and we’re struggling to keep her blood pressure up.”
“What are you treating her with?”
“The kitchen sink. Three of the most potent antibiotics available for the infection. Multiple cardiac meds to support her blood pressure.”
Lisa glimpses the displays above the patient’s bed that list her vital signs. The dire readings validate the wariness in Edwin’s tone. She nods to the man at the bedside. “The father?”
“Grandfather. Kayla’s parents are dead, apparently.”
Lisa motions to the window. “Can we?”
Edwin opens the door of the outer room with his shoulder and backs through the second, which seals the inner room, allowing the powerful fans and filter above to suck out any airborne germs. Lisa follows him inside. All eyes, except for those of the comatose patient, turn to the new arrivals, but no one says a word over the hum of the fan and the whir of the ventilator.
Even before Lisa reaches the bedside, her gaze is drawn to the scattered blood blisters that range in size from pinpoints to nickels and cover Kayla’s exposed upper chest and arms. Lisa recognizes the skin condition as petechial purpura. The rash is a classic sign of meningococcal infection, and it also tells her that the patient is in septic shock and her blood-clotting system is in disarr
ay.
Edwin introduces Lisa to the nurse and then Kayla’s grandfather.
“Public Health?” The grandfather grimaces. “How… how can that help Kayla?”
“We can’t. Not directly,” Lisa admits. “Public Health is responsible for outbreak control, Mr. Malloy. Can you tell me when Kayla first became sick?”
“This morning, I suppose. She seemed all right yesterday when she came back from camp.”
“Bible camp?” Lisa asks.
“Yeah, that’s the one. Out in Delridge,” he says of the suburb just south of Seattle. “Never been a churchgoer, myself. But Kay somehow stumbled onto Jesus last year or so. Fat lot of good it’s done her.”
“Kayla wasn’t complaining of feeling unwell last night?”
“Nope. Ate a good dinner. Big plate of chops. Seconds, even. Guess they were feeding her more God than food up at that camp.”
“This morning…” Lisa prompts.
“Kay didn’t come down for breakfast. She’s an early riser. So I went to check.” He swallows. “She was in bed. Unconscious, or what have you. Eyes closed and groaning something awful. And the stench! Her sheets were covered in vomit. I called 911 as soon as I saw the blood in it.”
Lisa feels for the older man. She can’t imagine how traumatic it must have been to find his granddaughter semiconscious in a pool of her own bloody vomit. “She hasn’t woken up since?”
He waves a hand over her. “She’s not even moaning anymore.”
“We are keeping her in a medically induced coma with powerful sedatives, Mr. Malloy,” Edwin explains.
Malloy grunts, either unconvinced by or uninterested in the distinction. “This meningitis…” he says. “The nurse told me, but I still don’t understand. What’s it do exactly?”
“Meningitis is an inflammation of the membranes that surround the brain and the spinal cord. Along with the typical headache, nausea, and neck stiffness, it causes a general flu-like illness.” Edwin explains patiently, waiting for the other man to digest his words before proceeding. “There are many different microscopic bugs that can cause meningitis. With viruses, the infection is usually no worse than the flu and resolves on its own. The bacterial infections are much more serious. Unfortunately, Kayla is suffering from the most aggressive form of bacterial meningitis.”
Malloy reaches out and tentatively strokes the back of his granddaughter’s hand, as if handling an antique vase. “Will she make it?” he asks in a small voice.
Edwin inhales before answering. “Kayla has developed what we call septic shock. Her bloodstream has been overwhelmed, and her organs have begun to shut down.”
Malloy’s hand freezes on top of his granddaughter’s. “No, then?” he croaks.
“It’s too early to know, Mr. Malloy,” Edwin says. “But Kayla is in the best place she can be. And we will do everything possible to help her fight off the infection.”
Malloy’s shoulders slump lower. “And in the meantime?”
“All you can do is be here for her. To offer your love and your prayers.” The corner of Edwin’s eye twitches, and Lisa sees that he regrets the last remark.
“Prayers, huh?” Malloy snorts. “Lost my wife to an aneurysm ten years back. Then we lost Kayla’s mom, dad, and her little brother to a drunk driver, not a year after. Kay’s all I got left. And now I just might lose her to this meningitis. From a Bible camp? What kind of God would allow that?”
CHAPTER 4
Lisa is walking toward her car in the Harborview parking lot when her phone buzzes again. Since she doesn’t recognize the number, she considers ignoring it, but intuition tells her to pick up.
“Lisa, it’s Edwin Davis,” the intensivist says. “Sorry to call so soon. But I just heard back from the microbiologist with more news.”
“What is it, Edwin?”
“He ran further PCR tests on the samples. He now believes our cases are the same strain of meningococcus that hit Iceland.”
Iceland. The word stops Lisa dead in her tracks. “The outbreak from last winter?”
“The very same. Thought you should know.”
“Yes, absolutely, thanks,” she mumbles as she disconnects.
Like most epidemiologists, Lisa closely followed developments the previous winter in Reykjavík, where an outbreak of meningitis killed a number of people—mostly teenagers and children—in the span of weeks. Health authorities across the globe braced for a spread of the same virulent strain of the bacteria that hit Iceland, but it did not materialize.
Until now.
How the hell does a microbe travel from Reykjavík to Seattle without stopping anywhere in between?
Lisa is still mulling over the implications as she parks her car and climbs the stairs to the offices of Seattle Public Health. Inside, she weaves between cubicles, distractedly acknowledging greetings from staff members, on her way to her office in the back corner. She steps inside it to discover that her desk is already occupied.
“About time,” Angela Chow says, glancing up from where she sits, typing at Lisa’s computer.
“Angela!” Lisa approaches the other woman with arms extended.
Her boss—technically, former boss, since Angela left on an indefinite medical leave three months ago—waves off the approach with a flick of her bony wrist. “No hugs. I got brittle bones. Besides, this place is supposed to be all about infection control, right?”
Lisa’s grin masks how alarmed she is at Angela’s appearance. Along with most of her hair, Angela has lost significant weight. Weight she didn’t have to lose. And the scarf tied around her scalp only accentuates the deep hollows of her sallow cheeks.
“What are you doing here?” Lisa asks.
“Taking a break from my daily poisoning session,” Angela says of her chemotherapy. “Truth is, Lisa, I’m bored as fuck.”
“Sounds about right,” Lisa says as she sits down on the other side of the desk.
“Also, I needed to get away from Howard. He’s driving me nuts with all the coddling. And I’d feel bad about putting a bullet between the eyes of a living saint.”
“Poor Howard is a saint to put up with you.” Lisa chuckles. “Seriously, Angela, how’s the treatment going?”
“Treatment? Yeah. Up and down. The nausea is better for sure. Anyway, forget all that. I’m here to talk business.”
“You heard?”
“Course I heard. First the new school HPV vaccine program and now this meningitis scare.” She rolls her eyes. “You steal my job and in no time at all you score the public-health equivalent of the moon landing and 9/11 in the same week.”
Lisa laughs. Clearly, Angela’s metastatic ovarian cancer hasn’t dulled her penchant for hyperbole. “All you ever dealt with was COVID.”
“Yeah, that was a time to forget.” Angela had led the city’s public-health response to the novel coronavirus outbreak. Even after she fell ill with it herself, she worked twenty-hour days from home, videoconferencing and answering emails, brilliantly managing the response while calming the city. She never got the credit she deserved, mainly because she didn’t want the recognition.
“It’s been quite the morning.” Lisa sighs.
“Tell me.”
Lisa doesn’t even bother describing the backlash she faced at the HPV vaccine forum, aware that her ailing friend has no patience for the anti-vax movement. Angela’s remark to one anti-vaxxer at a public health forum—“Let’s see how you feel about vaccines after you get bitten by a rabid bat”—is still legendary in the office.
Instead, Lisa updates Angela on what she knows about the meningitis outbreak, its origins in Iceland, and her initial thoughts on containment strategies.
Angela leans back, absorbing the news. “All the victims come from the same camp?” she asks.
“So far. We’re heading out there this afternoon. We have to launch our contact tracing immediately if expanded antibiotic prophylaxis is going to be effective.”
“And you’ve got no idea how our outbreak tr
aces back to Iceland?”
Our, Lisa thinks with a smile. She’d long suspected that, regardless of her deteriorating health, Angela wouldn’t be able to keep away from the job for long. “No. I only just heard. But Iceland is one of the world’s most popular tourist destinations, especially in the summer. I’m assuming one of the campers’ families must’ve visited recently.”
“But Reykjavík hasn’t reported any new cases of meningitis since the winter, have they?”
“Not that I am aware of. But you know how it is with meningococcus. Especially type B. You can’t declare an outbreak over until you go a year without a single new case. After all, healthy people can be colonized with the bacteria growing in their noses or throats without causing any infection.”
“Or them having any idea they’re even carrying the murderous little bastards. Have you spoken to anyone over there?”
“I just found out.” Lisa checks her watch. “Besides, it’s got to be pretty late in Iceland right now.”
Angela pushes the desk phone toward Lisa. “Trust me when I tell you, there’s no time like the present.”
“If you were on call, would you pick up an overseas call at almost midnight?” Lisa asks.
“Hell no! But Europeans are weird.”
Lisa digs her mobile out of her purse. She Googles the number for Reykjavík’s public-health officer, spots the twenty-four-hour emergency contact number, dials it on her speakerphone, and is surprised to hear a male voice answer on the second ring in a staccato of Icelandic.
Assuming that, like most Scandinavians, he must also speak English, Lisa says, “Hello, this is Dr. Lisa Dyer and Dr. Angela Chow from Seattle Public Health.”