by Betsy Ashton
Johnny was hooked to the same rack of monitors that beeped and swooshed as were in Alex’s room. Every blip on a screen screamed at me, reminding me of how little I knew about what was keeping Johnny and Alex alive. Even more, the noises fed my terror because I was completely without the ability to help them. I grabbed the end of the bed and let it hold me upright.
Nurse Leena entered, tall and reassuring. She nodded to the doctors before proceeding to Johnny’s bedside. Sharon and Dr. Duval withdrew. The nurse clipped a blood oxygen monitor to a finger, made sure the blood pressure cuff was securely fastened on his right bicep, and hung a bag on the IV stand.
“Intravenous antibiotics and fluids.” She inserted a needle into the back of Johnny’s hand, the one I’d held only a few hours before, and taped it to the skin. “We can administer his medications and fluids through this, just like we do with Alex.”
“Why is he on antibiotics? Does Dr. Running Bear know what made Johnny sick?” My voice was hoarse, barely above a whisper.
“His orders.”
“Then he has a strong suspicion about the pathogen,” I said, trying to be logical.
Nurse Leena nodded. She pulled the sheet and blanket up to the middle of Johnny’s chest, adjusted the bed so that his head was raised, and set one monitor to take readings every fifteen minutes.
“He does. He didn’t order a sedative because Johnny hasn’t roused since we took charge of him. He’s in good hands.”
“Yours.”
“I meant Dr. Running Bear’s, but yes, mine too.”
We moved a chair so that I could sit in Johnny’s room and still see into Alex’s. My boy was awake and sitting up, his eyes the size of hubcaps. I walked across the ICU and stood inside his doorway. I knew without having to be told not to touch either of them without changing my gloves. I didn’t want to transmit what Johnny had to my grandson.
The onset of Johnny’s illness in no way paralleled Alex’s. To be sure, both had coughs and fevers, but Johnny was ill in a different way. I struggled to remember what Dr. Gupta told me about the different pathogens—which were bacterial, which weren’t. I tried to reassure Alex they’d both be all right. Alex’s voice was marginally stronger, although his words continued to rasp between chapped lips.
“But what happens if both Uncle Johnny and I don’t get well?” From the unfiltered mouth of a boy came the question I couldn’t voice.
“I promise you, Captain Chaos, you’ll be riding with Uncle Johnny soon enough.”
“Can I have a real cowboy hat?”
Ah yes, back to the hat. “I promise.”
“One just like Uncle Johnny’s?” he pressed.
“Only cleaner.”
The chuckle that followed brought on a wrenching coughing spell followed by a groan.
“My chest hurts.” It had become a mantra.
“Well, you did crack a couple of ribs when you did your face plant. Is your chest hurting any less?” If I’d been nearer, I’d have hugged him and ruffled his hair, which would have resulted in one of his looks.
“I guess.” Alex collapsed back against his pillows.
I spent the night sitting just inside Johnny’s room. I popped over hourly to visit Alex, a spider skittering along a web stretched between the two patients.
I prayed and wept, wept and prayed, until exhausted. Then, I slept.
CHAPTER TWENTY-THREE
NURSE LEENA JOSTLED my shoulder a little before dawn the next morning—not that dawn penetrated the ICU. The glow from the overhead lights created a disorienting sense of timelessness. I blinked and checked the readings, first on Johnny’s and then on Alex’s monitors. No perceptible change. She beckoned me to follow her.
“They’ll be all right for a while. We’re needed downstairs.”
We left the ICU, changed, and walked toward Dr. White’s stronghold. Leena knocked on the door.
At first glance, the room seemed unchanged from the day before, but my initial impression soon proved wrong. The white boards and flip charts were still there, but the data was different. Dr. White had erased the earlier chaos and created three discrete sections. Headings in red screamed across the room at me.
Hantavirus. Pox. Plague. Under each heading were patient names, histories, and symptoms. On separate boards and flip charts were timelines, locations, and situations where patients fell ill. Her map had more colored pins pushed into several locations.
Johnny’s name was under Plague.
I stepped back and drew in a sharp breath. Leena gripped my elbow to steady me. Together we moved into the room. The entire CDC team, Dr. Running Bear, Leena, and I stared first at each other and then at the boards.
“As I suspected, Johnny’s pathogen is plague,” Dr. Running Bear said. “I started him on antibiotics because I was sure as soon as I saw him. Plague responds well to most of the common antibiotics. We’re giving him massive doses through his IV. Think of it as Agent Orange, only friendlier.”
“All indicators are for pneumonic, not bubonic, plague,” Dr. Duval said, laying her hand on my arm. Her touch reassured me slightly. I put a hand on top of hers, mine small and palsied, hers larger and stronger.
“We’ll monitor you closely for signs of infection too, since I’m certain you and Johnny have, how shall I say this delicately, been close,” Dr. Running Bear said.
“You mean it’s sexually transmitted?” I didn’t know whether to laugh or cry.
He reddened and looked away. “That’s not what I meant. Pneumonic plague passes through droplets like shared saliva or being coughed or sneezed on.”
“Well, we’ve definitely shared bodily fluids.”
On the plague board, Johnny was next to the child from room five, who died just before Johnny fell ill. The baby was listed with Alex under Hantavirus.
“I don’t understand. How can three completely different pathogens be infecting and killing people here?” None of this made sense. I needed Johnny to translate, but he was lying in bed a floor away struggling to breathe.
“That’s the million-dollar question,” Dr. Klein said. “I’ve run every test I can, sent more samples back to headquarters in Atlanta, and done a voodoo dance to break the enigma.”
Dr. Duval smiled at him. “Perhaps you should dispense with voodoo. It may work in my homeland, but I doubt it will be effective here. Maybe you should encourage that Native American shaman to return.”
“Two will be here tonight,” Leena said.
Dr. Duval nodded. “It could not hurt, and it might help keep the parents calmer.”
Dr. White stood in her thinking pose, hands clasped behind her back. I stuffed my hands into my scrub pockets to keep them from shaking, and rocked back and forth on my sneakers. I didn’t know what pattern the epidemiologist saw. What I saw was a veritable crazy quilt of symptoms. Nothing stitched together. Strips of colored yarn connected symptoms. The more I studied the white boards and charts, the less comfortable I felt. We were in a maelstrom.
“You got that right,” Dr. White unlaced her fingers. I must have muttered out loud—I had no sense that she was sentient in the same way Emilie and Ducks were. My phone chirped.
You spoke out loud. You’re broadcasting really loud, but she can’t understand you, Emilie texted. She has too much science in her brain to trust her gut.
I texted a response and apologized for breaking Dr. White’s concentration.
“No problem.” She stared at a string of numbers on a chart. “This makes no frigging sense. It’s all wrong.”
I moved next to her. Three columns made up the chart. First column, three medical codes. Second column, a series of numbers. Third column, more words and numbers I didn’t comprehend. None of the columns had headers because the doctor didn’t need them. To me, the numbers were nothing but numbers.
“What am I supposed to see?” I asked.
Tick walked me through the chart. First column contained a series of codes for the three probable diseases. Second column was the normal rate from initial expo
sure to the appearance of symptoms. The third column was what was out of whack. The actual timeline from exposure to symptoms was acutely accelerated.
“No way are these natural rates of infection. Someone or something has modified the viruses and bacteria. Something or someone has enhanced the pathogens’ potency.”
“What kind of scientist does research to modify pathogens?” Curiosity overcame terror. I had to know what and who we were dealing with. “Other than someone who is mad, that is.”
“Microbiologists and molecular geneticists are the most likely, although others might be interested in modifying genes,” Dr. Gupta answered.
Dr. Klein waved a sheaf of papers, indicating that he had new or additional data to add to the boards.
“It’s even more fucked up than you think.” With that preamble, he added information from three more autopsies.
The child across from Alex died from pneumonic plague, that oh-so-rare disease that was both endemic and quiescent in Western America. This strain, though, was unusually virulent. The child came in with pneumonia, which responded to antibiotics, indicating that it was bacterial. Two days after she was admitted, she developed plague. Two days after that, she was dead.
“If plague isn’t prevalent in her community, she had to have been infected after she arrived,” Dr. White said.
“What kind of treatment did you use?” I asked.
“Inhalation, antibiotics. The usual stuff.”
“I agree with Mrs. Davies’ concern about the accelerated timelines,” Dr. Duval said. “Pneumonic plague usually appears between one and six days after infection. Two days puts the origin of the infection inside this hospital.”
“But everyone who works here has been in quarantine since you guys swept in.” I wasn’t liking any of this. Not one bit. “And now Johnny has plague. He didn’t have pneumonia before he got sick and hasn’t been outside in eight days.”
Before I could ask another question, we heard a knock at the door. Dr. Klein was closest.
“Who is it?” he asked.
We made a point of never leaving the room unattended. Only the CDC staff, select members of the hospital staff, Sharon, Johnny, and I were admitted. Dr. White and Dr. Duval had keys.
“Sharon.”
Jerry unlocked the door. Sharon slipped in, followed immediately by her Rottweiler, who had special dispensation to go anywhere in the hospital.
Toby glided along the hall just behind them before heading out of sight. What’s he doing here? An incoming text showed a warning face from Emilie. Watch the vampire. Suited me fine. I promised myself I’d speak to the Rottweiler about my suspicions.
Tick picked up a skein of red yarn and strung it between boards to link illness with locations where people fell ill. “I don’t know where to go next. I can’t find the common denominator.”
Sharon walked among the boards, stroking the strands of yarn. She stopped. Turning on her heel, she went to a clean flip chart. She drew three circles which overlapped at a central point. Venn diagrams. She labeled each circle with the pathogens, then filled in names of the patients. When she added locations, a complex set of data points became clear. The nexus of the infection was indeed the hospital itself. She turned to Dr. Running Bear and Dr. Duval.
“Shit. It is us. We’re ground zero.”
“Ground zero?” Keith studied the diagrams. No one spoke. “I see. Most of the illnesses started inside here, but not all of them.”
“You do community outreach, don’t you?” Dr. Duval asked. She walked from board to board, from flip chart to flip chart, with Dr. Running Bear alongside. The two tall doctors, one black with a shaved head, one bronze with long black hair, stood side by side. Their hands moved in a syncopated dance, one pointing to a bit of data, the other touching an answering piece of information.
“Did you stop them when you suspected hantavirus?”
Dr. Running Bear shook his head. “We had no reason to, because hantavirus doesn’t spread from human to human.”
“What do you routinely do?”
“We have a vaccination outreach program. If we go out onto the Rez with free shots, we prevent more routine childhood diseases.”
“That’s one of the reasons the Indian Health Service was established,” Sharon added.
Shortly after her husband was elected vice president, Sharon had become a champion of the Indian Health Service partly because of its outreach efforts, partly because of her heritage. Several of the nurses did home visits, educated people on good nutrition, and identified potential future health problems.
“Lord knows most reservations have high incidences of alcoholism, diabetes, heart disease, obesity, and other societal diseases and conditions that are preventable or at least could be managed by lifestyle changes.” Leena walked over, another tall person staring at the charts. “Dr. Anderson, we’ve made a lot of progress with some of the families,” she assured Sharon.
“Just because we can’t save them all immediately doesn’t mean we stop trying,” Dr. Running Bear smiled. “We’ve paused for the time being, though.”
“I’ve missed several routine visits since we were quarantined. I worry about how three of my families are handling my departure,” Leena said. Each nurse regularly saw the same series of families, the better to identify health changes when they began and not after bad habits became entrenched. Nurse Leena saw two alcoholic fathers who beat their children when they “got liquored up,” which was as soon as they got their disability checks. Another family was headed by an elderly woman crippled by arthritis and diabetes.
Dr. White put her hand next the circle marked Pox. She pointed to three names. “Were any of these children vaccinated recently?”
The nurse checked her laptop. “The two-year-old and the six-year-old were scheduled for Pertussis inoculations this month. I don’t see any notation that they had them.”
“Alex doesn’t fit into that equation at all. He’s current on everything. Heck, he was even current on tetanus. Besides, he wouldn’t have had any vaccinations since he broke his leg,” I reminded them.
“We need to send the FBI to interview the families again, especially the extended relatives of the baby.” Dr. White shot a look at Dr. Klein, who edged toward the door. “Also have them ask if any of the pox and plague victims had home visits and when. I want to know if anyone remotely linked to the hospital has had any contact with anyone in the families since we went into quarantine.”
“Leena, did you find out who changed Alex’s chart?” I blurted.
Dr. Running Bear’s head snapped around, and his hooded eyes bored into mine. “Someone changed a chart?”
The nurse nodded, as did Dr. White. “A forensic IT tech from the FBI is examining our records to see who accessed Alex’s. The tech seemed pleased that an underlying database controls the health records. He’ll find the trail,” Leena answered.
Keith snarled at this latest revelation. Sharon called across the room. “He’s done.”
“Who’s done?” Dr. Running Bear asked.
“The FBI technician.” Sharon held up a piece of paper. “Do you have anyone on staff named Milton Greene?”
“That’s the orderly who died. Why?” Dr. Running Bear’s shoulders tightened.
“Because that FBI tech says he modified the charts,” she reported.
“Not possible. Orderlies don’t have access to the records.” Leena’s normally smooth brow wrinkled.
Sharon held out the piece of paper. “Here are his ID and password.”
“I repeat, that’s not possible. Only someone with administrative rights can set up a new ID. I sure didn’t do it.” Dr. Running Bear looked lost.
“Who else has these rights?” Keith asked.
Leena answered, “The head nurse and the emergency room doctor. No one else. Even I don’t have privileges. Neither would give Milt access. He had no need.”
“Well, someone did,” Keith said. I heard his teeth grinding from ten feet away.
“If someone in the hospital is behind the outbreak and is tampering with our health records, our top priority beyond keeping the patients alive is to identify whoever is infecting the community before we have a full-blown epidemic. Find the person with unauthorized access, and we will find the source,” Dr. Running Bear said.
Dr. Duval let herself out into an empty corridor, cell phone already at her ear.
“I’ve wondered about the staff, Dr. Running Bear,” Sharon said. “I asked Keith to work with the Secret Service and the FBI to run background checks on everyone to rule out as many as possible.”
“They’re underway.” Keith’s posture was as rigid as his jawline. A muscle tic danced in one cheek.
Dr. Running Bear tensed. He was silent for several seconds. “Much as I don’t want to think someone on my staff could be involved, you made the right call. Let me know how I can help.”
“Do you have everyone’s fingerprints on file?” Keith asked. Dr. Running Bear shook his head.
“No reason to. We’re a hospital. Our normal security is managed though our ID badges. We swipe in when we come to work and out when we leave. Other than that, we’ve never needed more stringent security.”
“Until now,” Sharon said.
“Let’s see what the FBI turns up. If it doesn’t find anything, we’ll fingerprint everyone in the hospital and run the prints through IAFIS,” Keith said, explaining that IAFIS was the FBI’s master fingerprint system. “Anyone who served in the Armed Forces should show up.”
“That’s a lot of us,” Leena said.
“Johnny as well, but back to the question at hand,” I said. “Why would anyone want to do this? Sicken children, I mean?” My phone vibrated with an incoming call. I stepped to a corner of the diagnosis room, far from the door. “Hello, Ducks.”
“I’ve been doing a lot of research on how these pathogens are transmitted. Johnny and I thought we should be asking why it’s happening. It’s not why. It’s how. Later, it’s who.”
My brain buzzed on this shift in emphasis. Ducks asked several questions, none of which I could answer.
“Ask Dr. White.” He hung up.