by Betsy Ashton
One of the doctors moved into the nurses’ station. “While our patient-focused equipment is state of the art, our alert system uses last-century techniques. Emails to all doctors, hospitals, clinics. That sort of stuff. The local television and radio stations help, but nothing reaches everyone. If we could set up an automated system to send broadcasts to all cell phones, which most people have, we could help more people that you could imagine.”
“More and better diagnostic equipment for our lab,” Dr. Running Bear added. “As you could see coming in, this part of New Mexico is pretty remote and has a widely scattered and diverse population. If we had better diagnostic equipment, we wouldn’t have to ship blood samples to the CDC and wait days for test results.”
“What’s wrong with these children?” Dr. Anderson moved from the nurses’ station and peered into a couple of the rooms, but didn’t enter.
“We don’t know.” Dr. Running Bear edged toward his distinguished guest and her detail, a clear indication she should move along with the rest of her tour and leave. “Once the CDC responds, we can target the pathogen directly. Right now, we’re using broad spectrum antibiotics in case this is a bacterial infection and treating the symptoms with inhaled cortical-steroids for the congestion.”
“We’re wearing protective clothing, so you think they’re contagious?” Dr. Anderson stopped in front of Alex’s room and glanced at me.
“As I said, we don’t know. Antibiotics aren’t working with some patients, so we may be dealing with a virus. Until I know for sure, we’re following CDC protocols for an infectious outbreak.”
“We created the IHS to serve Native Americans because their level of health care was abysmal,” Dr. Anderson said, her gaze still on me.
“We treat everyone in need, Dr. Anderson,” Dr. Running Bear said. “We don’t discriminate.”
“I’m sorry if I implied that. It wasn’t my intention. Forgive my rudeness, please.” She smiled at me.
“I’m really glad the hospital is here. We were staying at my friend’s ranch before Alex was injured and then got sick,” I said. I gave her a brief sketch on how we got here and why we were still in the hospital.
Johnny exited Alex’s room, standing next to me long enough to say, “Before you ask, I’m Mexican-American from Albuquerque. Might have some Apache or Navajo in me, but who knows. We’re here because that boy in there was injured closer to San Felipe than any other hospital.” He grinned before pulling his mask back over his face. “If you’ll excuse me, I want to get back to him.”
“Me too.” I followed Johnny. My place was with my grandson, not a celebrity.
“Of course,” Dr. Anderson said.
The Secret Service detail collected their charge and ushered her through the door, Dr. Running Bear accompanying. Alex was sleeping, so I went to the cafeteria. Everyone exiting the ICU paused to throw gowns, masks, and gloves into the bio-hazard barrel.
The entourage had barely reached the end of the corridor when angry voices rose from the lobby. Dr. Running Bear rushed toward the staircase, the Secret Service hustling the vice president’s wife along behind him.
Several new white-and-blue vans and trucks barricaded both ends of the semi-circular drive leading to the front door, trapping the black limo and SUVs. With no clear view of what these new vehicles were, I shamelessly eavesdropped from the balcony.
“Stop right there.” One of the Secret Service agents tried to block a group of people from coming inside. “This hospital is closed until further notice.”
A tall, regal black woman with a shaved head stepped forward, speaking with a light accent. “You are right. It is. Until further notice.”
The door behind her whooshed open. People unloaded equipment from a van, piled cases on the sidewalk, and walked around the men in suits.
“Don’t give us orders,” the lead agent said, taking an aggressive stance, arms slightly away from his body. I could see the bulge of a gun tucked into the small of his back. I wondered if we were about to have a shootout. “We have priority. We’re protecting the vice president’s wife.”
“So I see. Keep your men outside.” The woman’s voice was commanding but low. A confrontation was brewing until Dr. Anderson walked up with Dr. Running Bear.
“What’s going on, and who are you?” Dr. Anderson asked before Dr. Running Bear could open his mouth.
The woman flashed her credentials. “Dr. Nathalie Duval, CDC.”
Leena appeared next to me to watch the confrontation below. “I wondered how long it would take to get someone out here. We need help.”
Dr. Duval motioned to a stranger, who slapped signs on the doors. “Under my authority as head of the infectious disease unit at the CDC, this facility is quarantined until further notice.”
“All the more reason to remove the vice president’s wife immediately,” the agent said, shoving his way into Dr. Duval’s space with his chest puffed out and his countenance dark and glowering. He stood close enough to intimidate a mere mortal, but Dr. Duval didn’t flinch. My first impression was that she was no mere mortal.
The doctor didn’t move, standing eye-to-eye with the agent. “Did you not understand what I said? This facility is under quarantine. This means you and everyone else here are quarantined as well. No one leaves. No one enters.”
“This is the vice president’s wife—”
“You have established that fact. I recognize her, but if you contact your superiors in Washington, you will learn I have jurisdiction under certain conditions. This disease outbreak constitutes one of the ‘certain conditions.’” Dr. Duval turned toward Dr. Anderson. “With all due respect, madam, we cannot let you or anyone else leave until we know what is infecting patients in this hospital. You could be at risk yourself, or you could risk spreading a disease of unknown origin.”
“We can’t stay here,” said the agent, still trying to reassert a modicum of control. “We’ll move her into a hotel.”
“Let me ask you this. Does this hotel have an isolation suite?” Dr. Duval asked.
The agent shook his head.
“Do you have a portable isolation unit for Dr. Anderson?”
The agent shook his head again.
“Then she stays here. As do all of your men who are inside. The rest will remain outside.” Dr. Duval turned her back and gave orders to her staff.
“May we have a word alone?” Dr. Anderson asked her, gesturing toward a section of the lobby right under where I was standing. Leena and I stepped back, out of eyesight should anyone look up, but not out of earshot.
“Dr. Duval, how serious is the danger to the community? I’m not an infectious disease specialist, so I don’t know much beyond the courses we took in med school.” Dr. Anderson lowered her voice, but the acoustics in the lobby projected her words.
“Until we know exactly what we’re dealing with, we consider the danger to be high. We have tested samples Dr. Running Bear sent in. Some of our results do not make sense, so we do not know what precisely we are dealing with.” Dr. Duval’s soft island lilt did little to mask her concern. “Right now, we have a cluster of cases at the hospital, a few more in the community beyond the hospital confines, two on a ranch, and one in a remote settlement.”
“You said the test results were inconclusive. Dr. Running Bear just asked for proper equipment for elaborate tests, so I know his lab is inadequate,” Dr. Anderson said.
“We brought our portable lab in that large truck. We’ll either operate out of it or offload what we need into a separate room. We will release you as soon as it is safe for you and the community.”
“I understand.”
Dr. Anderson returned to her detail, and Dr. Duval moved to speak with Dr. Running Bear. I stepped closer to the railing. I couldn’t hear what she said, but the agent’s angry expression told me they were joining Johnny and me as guests of the Indian Health Service.
“May I ask the detail outside to fetch my overnight case and tote?” Dr. Anderson called to Dr.
Duval.
“Of course. Have them leave them outside the front door. We will send someone out to pick them up.” Dr. Duval stood straighter, if that were possible. The situation was under her control.
CHAPTER FIFTEEN
WORD PASSED QUICKLY that the vice president’s wife was trapped with the rest of us. I fetched Johnny to deliver the news.
“Quarantine, huh?” He rubbed a bristly chin and his eyes narrowed before a smile took control. “Guess you’re stuck with me for the duration, like it or not, pretty lady.”
I lightly slapped his arm. “I’m glad we’re in this together, funny man.”
Several nurses gossiped about the near donnybrook between the CDC director and the head of the Secret Service detail. The lead agent contacted headquarters in Washington to demand a contamination chamber be flown to the hospital. When none was immediately available, he demanded a trailer be sent to quarantine Dr. Anderson.
“You should have seen his face. He was yelling at his boss just outside the cafeteria door. What did he think? That he could snap his fingers and get one delivered in half an hour?”
“It’s not like there are decontamination chambers available at the local pharmacy.”
“I heard the vice president’s wife called her husband to tell him what was going on. I think they had a similar conversation, only they weren’t yelling like the Secret Service agent was.”
I ambled over to the nurses’ station. “Dr. Anderson have any better luck?”
“From what I heard, she and the Secret Service are our guests, so I guess not.”
“I’d be a lot happier if the head of her detail had been left outside,” I said. “He reminds me of a Rottweiler.” Laughter rippled around the ICU, and I ran my hands through my hair, thoroughly mussing it. A few minutes later, a page requested that family, visitors, and the staff not treating the sickest patients come to the cafeteria.
Dr. Running Bear opened the meeting by explaining why no one could leave the hospital until it was cleared by the CDC. The quarantine was absolute. The vice president’s wife sat alone at a table for two near the CDC doctors, while the Secret Service detail arranged itself along one side of the room and glowered at the head of the hospital. Dr. Running Bear paid no attention to them. He thanked everyone for their understanding.
“You can make me the bad guy here. I sent blood samples to the CDC for analysis, because we couldn’t figure out what was making people sick. That triggered the arrival of the team from Atlanta to help us keep you and the rest of your families safe. And now, I’d like to introduce Dr. Duval.”
The black doctor rose. Her height made her impressive, but her calm expression brought a moment of comfort. “I am Dr. Nathalie Duval, chief of infectious diseases for the CDC. Before you ask, I am from Haiti and trained in medicine here in the United States. With me are Dr. Meenu Gupta, our top virologist, Dr. Jerome Klein, one of our pathologists, and Dr. Gretchen White, our best epidemiologist. We will be working with the doctors and nurses here to identify the source of the illness.” Dr. Duval outlined her initial plan of attack. “Our top priority is to identify the organism. We could be dealing with a parasite, a virus, or a bacterium. It could even be a fungus. Our initial lab tests were inconclusive, leading us to think the samples may have been contaminated in transit. Dr. Gupta will explain.”
Dr. Gupta rose. “It is my understanding some patients are not responding well to antibiotics.”
“That’s correct,” Dr. Running Bear said.
“Then either we aren’t using the right drugs, or we’re dealing with a virus. I’ll be drawing fresh samples from each of you.”
“All of us?” One of the mothers raised her hand. “Why do you need our blood?”
“We need to be sure none of you is carrying the organism.”
“Like Typhoid Mary?” a man called from across the cafeteria.
Dr. Gupta smiled. “Exactly. One of you could be a carrier and not exhibit any symptoms.”
The man glanced around the room. Several people smiled at him. Since I’d spoken to him many times up in ICU, I gestured that I believed what the doctors were saying and would roll up my sleeve.
“Think of yourselves as what we call control samples. If your blood is clear, terrific. If not, then we’ll treat you as well.”
“But for what?” countered an upset father. “You just said you don’t know what the problem is.”
“That’s true, but you belong here, where we can monitor your health. If any of you fall ill, we can move you into isolation immediately.” Dr. Gupta looked around after concluding. “Back to you, Dr. Duval.”
“Dr. Klein will be doing autopsies if we have any casualties. If not, he’s also a terrific scientist who will assist in the lab. He’ll be looking for the disease reservoir.” Enough people looked confused for Dr. Duval to explain. “A disease reservoir is the source of the organism. It’s where it hides. It could be an animal, something in the natural world, an inanimate object, even the ventilation system. Nearly anything carries viruses and bacteria, including our own skin and our guts—er, intestinal tracts. One part of our analysis is to find where the organism is hiding.”
Dr. Klein took the floor. “Call me Jerry. We’re going to get real close to each other in the next few days, so I see no reason for you to stand on ceremony with me. Think of what I do as going on a scavenger hunt. I’ll poke into everything, take samples, and swab a lot of surfaces. I’ll analyze everything under a microscope, and eventually figure out what is making your family members sick. I work very closely with Dr. White.”
More parents shifted in their uncomfortable chairs, worried but silent. A nurse shot a glance across the cafeteria, but from where Johnny and I sat, we couldn’t see who caught it.
Dr. Gretchen White stood next—all five feet of her. My gut told me she brooked no nonsense from anyone. “You can call me Tick.”
Johnny raised his hand. “Sorry for the interruption, but why Tick?”
“I work with disease vectors. That’s how diseases get from the reservoir or carrier into you. I map where the outbreaks are, how people become infected, and identify the active carrier. Fleas, ticks, and mosquitoes are frequently the culprits. Mosquitoes carry diseases from dengue fever to West Nile virus to different types of poxes.”
“This is the desert. We don’t have mosquitoes,” Nurse Leena said.
“I understand. Fleas and ticks still carry plague, Lyme Disease, and a bunch of other very unpleasant illnesses. My colleagues at the CDC think I’m weird because I have a huge collection of insects that transmit dangerous organisms we call pathogens,” Tick said.
I leaned over to whisper to Johnny, “Did you hear her say plague?”
“I did. Dengue fever, too.” Johnny stared out the cafeteria windows, jumping slightly right before I felt Ducks’ touch. For the first time, I wondered just how closely Ducks could monitor a remote situation. Could he actually be eavesdropping in some strange way? Johnny and I shared a glance.
Dr. Duval reminded us that the CDC had absolute authority—growls from the Secret Service floated over the heads of the worried audience—but would work closely with the staff to minimize disruption. All remaining doctors and nurses would be called back to duty immediately, even if they hadn’t treated the patients in the ICU.
“This is precautionary. We don’t want the hospital to go into crisis mode should it be swamped with new cases. The emergency room will be closed until further notice except for patients who present with symptoms similar to the current patients. All others will be sent to Albuquerque or Santa Fe.”
“Have you notified the adjacent hospitals? Do they know what to expect?” Toby the vampire asked.
“Yes, we have excellent communication protocols in place. Someone from my office has been on the phone or e-mailing every doctor, clinic, and hospital in a fifty-mile radius.”
“Good,” Dr. Running Bear said. “I’ve been too busy with the outbreak itself to do much along those lines.”
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“Why such a large catchment area?” asked Nurse Leena.
“As I said, we don’t know what the organism is. Therefore, we don’t know how it’s transmitted.”
Dr. Klein spoke up. “We don’t know where it’s hiding.”
Toby asked a question many of us hesitated to ask. “But you said you ran tests. What did you find?”
“Right now, we think this may be a localized outbreak of hantavirus, a relatively rare virus that cropped up in the Four Corners region in 1993, but we found bits of something else.”
“A lot of people died from that,” said a woman I recognized from the ICU. Her son was a couple of rooms down from Alex. “People called it Navajo flu.”
“You are correct. The Four Corners outbreak had a high mortality rate, but if we catch it soon enough, we can treat the symptoms. We need to find out what the ‘something else’ is,” Dr. Gupta said.
“What are the symptoms of hantavirus?” One of the Secret Service agents shifted his attention away from threats to the vice president’s wife toward something that could harm him.
“Fever, muscle aches, shortness of breath. It sounds like the common flu, but it isn’t,” Dr. Gupta said. “The common flu makes you sick, but this virus makes you sicker by a factor of at least four.”
“You said something else was in the sample.” Toby again. “What was it?”
“As I said, our results were inconclusive. That’s why one of the first things we will do today is take fresh blood samples from everyone in the hospital, sick and healthy, to try to isolate it. From there, we hope to identify it. Whatever it is, something causes a rash, which is not part of the hantavirus symptoms.” Dr. Gupta stepped back to sit with the rest of her team.
“But rashes are part of dengue fever symptoms,” Johnny breathed in my ear.
“In a way, it is good that the outbreak struck at this time,” Dr. Duval said. “While we never wish for an outbreak, the common flu season is weeks away. We will not have confusion from it in the diagnosis.”