by Daniel Kalla
Lisa shrugs. “I’m only requesting a few thousand doses.”
That’s the last thing in the world we need, Nathan thinks as he casually lowers his cup. “What would be the point of that?”
“To vaccinate the people at the highest risk. Direct contacts, health-care workers, and people living nearest to the victims.”
Nathan shares a quick look with Fiona. “That would put Delaware in a no-win situation,” he says.
“How is it different from the trial you’re planning in Reykjavík?”
“With the relatively small sample size you’re suggesting, you can’t really show clinical efficacy,” he explains. “And you’re talking about the highest-risk group of individuals. If one of them were to still to get sick after immunization…”
“What if no one does?” Lisa asks. “Imagine what a powerful endorsement of your product that could be.”
“No vaccine is a hundred percent effective. Besides, if no one gets infected, people would argue that it wasn’t a large enough target population.”
“And,” Fiona stresses, “if someone does have a serious adverse reaction…”
“It would look even worse for Neissovax,” Nathan says.
Lisa frowns. “Adverse reactions are a risk with every drug, old and new.”
“But when it comes to new vaccines, those kinds of stories are magnified and distorted by the anti-vax community.”
Lisa sips her coffee before replying. “What if Seattle were to take the place of Reykjavík? Let’s say we dispense all fifty thousand doses here instead of over there?”
“We’re all set up in Iceland,” Fiona says. “We don’t have any of the infrastructure in place here.”
“That’s true. The potential exposure for us…” Nathan holds up a palm. And then he delivers the message he flew across the country to give in person. “Obviously, we would love to help. But it’s just too soon to release Neissovax here in the Pacific Northwest.”
“You have a business to protect. I get that.” Lisa’s eyes bore into his. “But I was at the bedside of a young girl just hours before she died. If you could’ve seen her grandfather…”
“I can’t even imagine.” Nathan thinks momentarily of his own sons before focusing back on his primary goal: to minimize Delaware’s exposure. “But it’s our job to make sure we don’t put the cart before the horse.”
“And it’s my job to do everything I can to prevent more deaths.”
CHAPTER 12
“Hey, buddy, what’s up? Your video over?” Max Balfour asks, trying to hide how startled he feels. His son has a habit of sneaking up on him, especially at times like now when Max is in his home office, totally consumed by the latest blog entry he’s writing.
Without removing his bulky wireless headphones, Jack stares past his dad with a look that is simultaneously blank and intense. “I’m hungry.”
Reluctantly, Max spins away from his desktop computer and rises to his feet. “Let’s make you a grilled cheese.”
“No crust.”
“As if! What kind of amateur do you take for me?” Max squeezes his son’s shoulder before Jack, as expected, jerks away.
Max can’t believe how much Jack has grown. His son, who just turned thirteen, is almost as tall as him. Max is dreading the teen years—both the new challenges they will bring and the loss of childhood they mark. “Four carrots, right?”
Jack nods. “Four. Sliced in quarters.”
His son is so exact about numbers. They have to be even and, ideally, divisible into one another. Max understands the obsession is a common feature of the autistic spectrum—a coping skill that helps Jack bring order to his chaotic thoughts. While deeply devoted to his son, Max finds his behavior so foreign and, sometimes, extremely frustrating. But he rarely reveals that to Jack. No, he saves his wrath for his activism. For the people responsible for his son’s condition.
As they walk toward the kitchen, Max asks, “Jack, you want to tell me what happened at school today?”
Jack shakes his head. “We did a puzzle. Water Lilies by Claude Monet. He died when he was eighty-six years old. In France.”
“That’s not what I mean, Jack. What happened with you and Francis?”
“I needed that piece,” Jack says. “It fit in my corner. Francis didn’t have any lily pads in his.”
“And so you punched him?”
“I needed that piece.”
“Then you use your words and ask him for it, Jack. Now Francis has a black eye.” And I’m not even sure the Institute will take you back. “You didn’t want to hurt Francis, did you?”
Jack looks away, neither embarrassed nor engaged. “I wanted the piece.”
“There are other ways, Jack. You just can’t hit like that. Francis won’t want to play with you anymore.”
“Ms. Appleby says tomorrow we will do a Rembrandt puzzle. He lived in Holland.” Jack scrunches up his nose. “He died at sixty-three,” he adds with obvious disgust at the odd number.
Max’s brief disappointment in his son dissipates as he’s reminded again that Jack has no insight. He might as well reprimand the clouds for causing a storm. His tone softens. “OK, buddy, just no more hitting.”
Jack nods blankly.
“Let’s go get lunch.”
Max hears the front door alarm chime and turns to see his ex-wife, Sarah, rushing in. “The Institute just called me,” she says. “What’s going on?”
“I spoke to them when I picked him up,” Max says. “I think it’s all sorted out now.”
“You think?”
“Not now, Sarah,” Max says evenly to avoid any escalation.
Their fights used to be epic. They almost all centered around how to best manage Jack’s autism. Max still doesn’t fully understand how their relationship fell apart. He used to love Sarah so much. And seven years after their divorce, he still misses her. His current girlfriend, Yolanda, is kind, devoted, and much more tolerant than Sarah ever was, but she will never capture his heart the way his ex-wife did.
Sarah hugs Jack and kisses the top of his head. He is motionless in her arms but, Max notes with a tinge of jealousy, he doesn’t recoil from her.
“Hey, buddy, go watch another episode of your show while I make you lunch, OK?” Max tells him.
Jack turns for the other room. “No crusts,” he says again as he walks out.
“What if they kick him out, Max?” Sarah asks as soon as their son is gone.
“They won’t,” Max replies, bending the truth. “I spoke to his teacher. They might need another aide for the class. That’s all.”
Her shoulders slump with obvious relief. “The Institute has been a godsend. I don’t know what we would do…”
“It’s going to be OK, Sarah.”
“God, I hope so. Jack doesn’t even need ‘OK.’ He just needs status quo for a while.”
Sarah follows Max over to the counter and watches him prepare Jack’s lunch. “Did you hear about the meningitis thing?” she asks.
Max shakes his head as he melts the butter in the frying pan.
“A bunch of kids at a local summer camp got sick from meningitis,” Sarah says. “Five of them died. It’s all over the news.”
“Seriously? How?”
“They don’t know, but they’re advising anyone with a fever and a headache to get checked out right away.”
“Maybe it’s not such a bad thing that Jack got sent home today.”
“Let’s not overreact.”
“Speaking of health threats, can you believe what’s going on with this HPV vaccine?”
“What are you talking about?”
“The government, Sarah,” he says. “I went to that public-health forum three days ago. They’re making the vaccine mandatory for all school-age kids. So frustrating. I couldn’t help but get into it with the chief public-health doctor.”
She brings her fingers to her temples and begins to massage them. “This again?”
“What do you mean this?
” he snaps. “They only announced the insane measure last week.”
“Vaccines! And your quixotic quest to stop them.”
“Enough with the melodrama, OK? I’m just doing my bit. I’m not alone, either. There are lots of good people who share our view.”
“I don’t know that it’s my view. And even if you’re right about the MMR shot being the cause of Jack’s—”
“You know I am!”
“What good will it do, Max? You could ban every vaccine in the world, and it still won’t help Jack one iota.”
Max only stares at his ex-wife, suddenly remembering why he was happy the day she walked out. After all they had been through with Max, how could she be so selfish? She never did really care about helping other families avoid the kind of pain that they have to live with every day.
But I sure as hell intend to.
CHAPTER 13
It feels more like Groundhog Day than déjà vu to Lisa. Once again, she finds herself garbed from head to toe in infection-control gear while standing inside an isolation room at Harborview’s ICU and staring down at another meningitis victim, who barely clings to life with the aid of a ventilator and an arsenal of antibiotics and other ultrapotent medications—anything and everything to improve his slim chances of survival.
But there’s one key difference between Zeke Dolan and the other nineteen patients from this outbreak. And it’s the primary reason for Lisa’s visit. Unlike the other victims, Zeke has never stepped foot on the grounds of Camp Green.
As predictable as the spread beyond the members of the Bible camp was—community spread, as it’s known in epidemiological circles—the confirmation of it slammed Lisa like a gut punch. She wasn’t alone, either. The noisy Outbreak Control Team briefing for day five of the outbreak fell silent when, an hour earlier, Tyra announced the first such case. Lisa abruptly ended the meeting and headed straight for Harborview in search of answers she knows she’s unlikely to find.
Zeke is twenty-eight years old but, with his smooth face and small frame, he could pass for another teenage victim. Despite all the medical interventions, his vital signs are poor, and his skin is mottled with the pinpoint red spots and larger blood blisters that are telltale signs of the petechial purpura rash. Blood trickles from his nostrils and oozes around the clear ventilator tubing that passes between his chapped lips, indicating that his blood-clotting system is failing as badly as or worse than the rest of his organs.
Dr. Edwin Davis stands close enough for Lisa to pick up on the floral scent of his shampoo. Unlike their previous encounter, the veteran intensivist no longer seems fazed. “Zeke arrived at the ER about six this morning,” he says dispassionately. “He had a headache and a fever, but he was conscious and alert. Within half an hour, his blood pressure plummeted, and he went into full septic shock. He’s barely hung on since.”
Lisa’s gaze drifts to the gobs of blood flickering inside the ventilatory tube with each forced mechanical breath in and out of Zeke’s lungs. “Can he survive this?”
“Used to be, I had a sixth sense for who was likely to make it out of here. But with this meningitis?” Edwin’s shoulders twitch. “We’re averaging almost fifty percent mortality among the first twenty cases.”
“Similar to Iceland’s experience.”
“Deadly similar,” he says with a note of defeat.
“Does the speed of onset and/or progression of symptoms matter?”
“The quicker they go into septic shock, the worse it is. But every one of them gets so sick so fast with this infection, even that’s hard to tell.”
Lisa goes cold with the morbid realization that if Zeke dies, the death toll for this outbreak will reach double digits. “I understand he got antibiotics almost as soon as he got to the ER,” she says. “Maybe the ultra-early administration will make a difference?”
“These patients just can’t seem to survive long enough to give the antibiotics a chance to work.”
“Even more reason to vaccinate.”
“With what? The available ones don’t work.”
Lisa nods, biting back her frustration. She thinks of her meeting with the representatives from Delaware Pharmaceuticals. They might not be ready to distribute Neissovax in Seattle, but as she stares down at Zeke’s ashen face, she realizes the city might be literally dying for access to it.
“You have to choke off the source, Lisa.”
“We hoped we had. We’ve tracked down every attendee of that camp. We’ve started all of them on prophylactic antibiotics. And we’ve covered as many of their household contacts as we’ve been able to reach.”
He motions to the patient. “Then how do you explain this?”
“Zeke is a piano teacher for the Mitchell family.”
“As in Noah Mitchell?”
“Yes, the third victim,” Lisa says of one of the patients who was lucky enough to survive the infection and has already been discharged from the ICU. “Zeke gave Noah a piano lesson the day he got back from camp.”
“A piano lesson? That was enough for this thing to spread into the community?”
“Apparently,” she mumbles, struck again by the relatively casual nature of the contact.
Edwin opens his mouth to reply, but he’s cut off by the shrill wail from the overhead monitor.
Lisa’s eyes dart to the chaotic squiggly line running across the screen, signaling ventricular fibrillation.
Edwin shoots a gloved hand up to Zeke’s neck. “No pulse!”
Lisa reacts instinctively. She lunges forward and clamps her interlocking palms onto Zeke’s breastbone. She rhythmically pumps her arms, aiming for a hundred thrusts per minute, feeling the rubbery spring of his chest with each compression.
Other staff members flood into the room. A woman nudges Lisa out of the way and assumes the role of chest compressions. Lisa steps back and presses herself against the wall to make space for the expanding team.
Edwin directs the others with concise words and gestures as each person occupies a space without being told where to go. Soon Zeke is surrounded. Defibrillator conducting pads are slapped to his chest on either side of the hands of the woman performing CPR, without her breaking her rhythm.
“Shock at two hundred joules!” Edwin orders.
As soon as the woman’s hands are free of the chest, another nurse presses defibrillator paddles to the pads on Zeke’s chest. “All clear!” she cries. With a quick scan to establish no one else will be in contact with the current, she depresses both red buttons on the paddles’ handles.
Zeke’s body jerks from the shock. But after a moment, the tracing line on the monitor reverts to its helter-skelter course. “Resume CPR!” Edwin says.
A husky man wordlessly takes over, compressing Zeke’s chest even deeper than the woman had.
“One milligram of epinephrine push,” Edwin orders. “And three hundred milligrams of amiodarone.”
A nurse injects medications through the syringe into the intravenous line in Zeke’s neck while another holds a second loaded syringe out ready for her.
Someone else calls, “Two minutes!”
The CPR is paused while Zeke is shocked again. But the jerky tracing on the monitor refuses to budge from that of ventricular fibrillation.
More shocks are applied. More meds ordered. The CPR is never stopped for more than seconds at a time.
Lisa silently admires the calm choreographed dance of the attempted resuscitation. But none of the interventions make a difference.
She feels it in her bones. Zeke is already gone.
CHAPTER 14
It’s hard to remember how many times this experiment has been repeated over the past six months. But practice makes perfect, and in this case, perfect is a necessity. Especially, since the next time, it won’t be a dry run.
The powder floats briefly on the surface but then begins to dissolve with a minimal shake of the vial. Soon, the clear liquid inside the vial rolls smoothly back and forth. Nothing precipitates out, no matter ho
w hard it’s shaken. It could pass for water. It looks identical to the other vials.
Perfection in a bottle.
CHAPTER 15
It’s been a good streak by Pacific Northwest standards, Lisa thinks as raindrops spit across her windshield. It hasn’t rained for over two weeks, which isn’t that unusual for August. Unlike the rest of the year, when a week without precipitation in Seattle would be newsworthy, the summer often brings protracted dry spells. Still, Lisa’s mood reflects the charcoal skies above. It’s been a while since anyone died in front of her eyes, which is disturbing enough, but Zeke’s case also represents the escalation of the outbreak that she had dreaded: community spread.
Lisa parks in the garage below her office and heads upstairs, hoping to reach her desk without having to speak to anyone. But Tyra stops her the moment she steps into the main office.
“We found him!” Tyra waves a piece of paper triumphantly at her.
“You found whom?” Lisa asks.
“Alex Stephanopoulos.”
Lisa shrugs, unable to share in her colleague’s obvious enthusiasm.
“Alex happens to be Grace Brown’s boyfriend,” Tyra says.
“The second victim?” Lisa says, perking up.
“I’m thinking we need to renumber the victims now. Grace was the second person to land in the ER and, sadly, the second to die. But I think she might actually be our very first victim.”
“Because?”
“Her boyfriend is Patient Zero.”
Lisa grabs the page from Tyra’s hand. “Are you saying this Alex…”
“Stephanopoulos.”
“Connects back to Iceland?”
Tyra points to the page. Lisa looks down at the image of five people, two adults and three kids, posing in front of a towering narrow waterfall. “That’s Skógafoss—” Tyra exaggerates the sh sounds. “Or, however the hell you pronounce that mouthful.”
“The boyfriend’s family was in Iceland recently?”
“Less than two weeks ago, if you trust Instagram.”
“How did you figure that out?”