by Betsy Ashton
Dr. Gupta talked between bites of dinner. “I can’t tell you as much as you’d like to know, because the actual research in these facilities is highly classified. But there are four levels, each tied to a different level of security.”
The numbers referred to the amount of security needed to work with the pathogens. Not all pathogens were created equal, so the CDC used different protocols for containment based on the relative danger to the community should the pathogens escape the lab environment. In Level-1 labs, the organisms might include E. coli and cell cultures for other bacteria that weren’t particularly dangerous. No special decontamination or containment measures were in force. At Level-2, the organisms held moderate danger to humans, including Lyme disease, measles, and MRSA. Maybe cholera.
“Level-2 labs have restrictions on who can enter, higher standards for decontamination, and more extreme precautions when using sharp instruments. Things get exciting in Level-3 and Level-4.” Dr. Gupta’s face glowed, more from warming to a favorite topic than from her hot tea. “By Level-3 you begin working with what Dr. Klein would call ‘the bad boys.’ We have very strict protocols for protective clothing, filtered air, and double-door access, although the older Level-3 labs don’t necessarily have the double-door access.”
“What kind of bad boys would be there?”
“Things like plague, SARS, West Nile, rabies.” She conducted much of her research in one such lab.
“And Level-4?”
“Serious research only. All pathogens undergoing Level-4 research are lethal. Many have no known treatment or prevention other than avoidance of contamination. We conduct most of our drug research on vaccines for the worst pathogens in Level-3 or -4 labs.”
“But I wouldn’t think plague could be in a Level-3 lab.” I struggled to comprehend the differences. “I’d consider it potentially lethal.”
“Plague is, but it can be cured when caught early. Pathogens in Level-4 include the hemorrhagic viruses like Ebola, because patients who contract such diseases have very little chance of survival. For some of the hemorrhagic viruses, fatality rates are over 90 percent. AIDS was there until we found a treatment protocol that worked. Were we to do research on smallpox, it would be restricted to this level,” Dr. Gupta explained.
“But we aren’t doing research on smallpox, are we?”
“If we were, it would be under highly controlled conditions, and I wouldn’t be able to disclose where. Double-door access, air and water filtration, space suits with their own air supplies, and other decontamination procedures would have to be followed to the letter.”
My coffee cup was empty again, but I didn’t want any more. I’d be awake most of the night as it was. I’d moved the recliner from Alex’s room to Johnny’s, rousing at any change in his breathing, his shifting in bed, or a nurse checking his vital signs or changing an IV bag.
I knew we’d been over this before, but my shopworn brain needed a refresher course. “Assuming money wasn’t a problem, you said I could set up one of the Level-3 or -4 labs, didn’t you?”
“You wouldn’t need all that much money, Max,” Sharon interjected, inviting herself to the table. “And as we talked about earlier, some of what you’d need you could get at Home Depot.”
“Not the space suits, but you could build a small cabinet with secure air filters. You’d put your arms through holes and use heavy lab gloves to protect yourself if you worked inside of one.”
I felt worse the more she talked. I held up a hand. “Okay, let me see if I get this. I can order a lot of the lab equipment, new or used, from supply houses using the Internet. I can buy and build filtration systems with parts I buy at a big box store. Assuming I want to do something like this, it looks like I’d be set to conduct research.”
“You would still need access to the pathogens themselves. As I said, we don’t sell them on eBay,” Sharon smiled. Pathogens were even more strictly controlled than narcotics.
“And remember, you have to be a licensed lab with sufficient protocols in place. You must have trained researchers, usually microbiologists, virologists, and pathologists—all sorts of -ologists before you can get your hands on the bad boys. Most of all, you’d have to have a reason for the research, usually a government grant. Idle curiosity wouldn’t gain you access,” Dr. Gupta said, shaking her head.
“Unauthorized personnel do not handle these pathogens,” Sharon added.
“So, where would I find the Level-3 and -4 labs?” I asked.
“Scattered around the world. The CDC, Fort Detrick in Maryland, some universities, NIH, and other government facilities.” Dr. Gupta stopped counting them on her fingers. Her eyes met mine. “I never thought about how many labs there are just in the States.”
“Just in the States? Does the US government have these labs in other countries?”
“Yes and no. We set up temporary labs when we have viral outbreaks. Think Ebola or AIDS in several African countries,” she said.
“Or plague here,” Sharon added.
“I assume somewhere is a list of which pathogens are in which labs.” I wasn’t too happy with where my brain was leading.
“Of course. We maintain strict control of our inventories.”
“When Dr. Duval talked about smallpox the other day, she said the samples in Russia and in the U.S. were frozen in officially secured labs.”
“That’s right. As I understand it, smallpox is locked away in a freezer somewhere deep inside the CDC.” Sharon stared at a dish of melting soft-serve vanilla before pushing it aside. Sprinkles stained the remainder a cheery pink and green. We felt anything but cheery.
“And you’re positive no one can access the samples without you knowing it?” I’d turned into a Rottweiler myself. I couldn’t let the idea rest.
“Absolutely. Those of us in biomedical research stay sane by believing smallpox is locked away forever,” Dr. Gupta said.
Sharon asked more questions while I tuned out to form others.
“What if a lab was destroyed?” I finally asked. “Would we know?”
“We would, but you, as part of the public, wouldn’t,” said the virologist. “We guard news of such incidents very closely. You might hear about a fire in a warehouse or office building, or of structures blown apart by weather phenomena, but little else. More than likely, these would be local stories and wouldn’t register in the wider world.”
“You mean, the building where my engineering company is located in Manhattan could also house research labs?”
“Technically, yes, but it’s highly unlikely. We don’t usually locate them in large cities, for obvious reasons. We need to verify their security. Should leaks happen, we don’t want them happening in large population centers. They might be in a strip mall outside of Topeka, for example. Or near a major university like Virginia Tech.”
“Have any labs burned down or been destroyed by some other means? Earthquake? Tornado?”
No matter how uncomfortable Dr. Gupta was, she nodded. Sharon slipped out of the cafeteria, cell pressed to her ear. Dr. Gupta and I turned to each other.
“Was it something we said?” I asked.
“I certainly hope so.” She picked up her tray. “I’m going to grab a nap in the diagnosis room. Why don’t you get some rest, too?”
I went upstairs to settle in for the night. Nurses came and went, taking readings from the monitors, changing soiled bed linens. I talked with Alex until he was too sleepy to speak with anything resembling his normal degree of Alex-centric chatter. I sat inside Johnny’s room, held his hand, and lost myself in a book I’d borrowed from one of the nurses: Prey by Michael Crichton.
Johnny seemed to be holding steady right up until the middle of the night, when suddenly he wasn’t.
CHAPTER TWENTY-SIX
ALARMS JERKED ME awake. I leaped from my chair and whirled to see lines that should be stable spiking all over Johnny’s monitors. Someone shoved me out of the way. Light codes and cell phone alerts brought doctors and nurses r
unning.
I felt the door at the end of the ICU whoosh open before my brain registered people entering. Nurses from Med-Surg joined the ICU night staff in Johnny’s room. Last came Dr. Running Bear, living up to his name once again. He tied his mask as he shoved to the front of the room. He cast a look at me over his mask. I knew what it meant: Time for me to get the hell out of Dodge.
I retreated across the hall to Alex’s room, changed my gloves, and tried to control my trembling hands. Lucky for him and lucky for me, Alex was fast asleep even with all the tumult. I stroked his head to assure myself that he was getting better. His forehead was cool and dry. I assumed he had grown used to alarms going off. All the monitors in his room registered reassuring normal lines and blips. I pulled a chair into the doorway.
Seconds turned into minutes. Another doctor arrived across the hall. All the night nurses were in the ICU. Fragments of words drifted out of Johnny’s room, twisted and unintelligible. I heard “coded” several times. A nurse squirted out of the hive, walked with quick strides to the medical cabinet behind the nurses’ station, unlocked the door, and extracted a tray. I strained my neck to see what was on it, but all I could see was a shrink-wrapped kit.
I closed my eyes and turned to the mantra I used when Merry lay near death. I whispered, “Please, don’t let Johnny die.”
No one answered. No feather. No spreading warmth. No call from Whip asking how Alex was. Nothing. I’d lost Merry; I wouldn’t survive losing Johnny, too, no matter who else needed me.
I curled into a ball in the chair, arms locked around my knees, and rocked. And rocked. And rocked. I laid my head on my knees and wept, silent sobs wracking my body.
Please, dear God, not again. Please don’t take someone else I love. Please don’t let Johnny die. I barely registered Dr. White’s arrival, Dr. Klein in her wake. I raised my head when Dr. Klein ran back out of the room. I replaced my head on my knees, salt tracks on my face drying in the air conditioning.
“Charging.”
“Stand back.”
“Push [mumble] of epi.”
Each phrase slammed against my skull. The pattern repeated itself.
“Charging.”
“Stand back.”
“Push [mumble] of epi.”
I closed my eyes.
Sometime later, a hand squeezed my shoulder.
“Johnny?” I peered blurry-eyed into Sharon’s face.
“He’s going to be all right.” She sat on the arm of my chair and held me while I sobbed.
“I can’t lose him,” I whispered against her paper gown.
“You won’t.” Dr. Running Bear helped me stand and led me toward the door of the ICU. I tried to pull away; I wanted to stay. The doctor’s grip, gentle but firm, refused to release me. He steered me to an empty room, the one where I’d napped earlier, sat me on the edge of the bed, and took both hands in his.
“Johnny went into cardiac arrest.”
That set off the alarms. His respiration stopped when his heart did. They’d used the defibrillator several times, because as soon as he seemed to stabilize, he crashed again.
“One of our night nurses, who usually works in the emergency room, guessed he OD’d from a narcotic overdose.”
“How can that be? He wasn’t on pain killers,” I asked.
“That’s right. There was no reason to administer narcotics of any kind. All I’ve given him is the antibiotic, which was working until a few hours ago.”
Dr. Running Bear released one of my hands. Sharon sat on my other side and picked it up.
“He didn’t take the drug, Max. Someone gave it to him,” she explained. She removed my gloves and gown and wadded them up to be thrown in the burn barrel.
“Someone entered his room while you were sleeping and injected him with an overdose of morphine.” Dr. Running Bear’s face tightened. Crazed as I was, I didn’t want to be around when he found the perpetrator.
Leena entered with a pill and a glass of water, which I swallowed without thinking. I jerked upright and spilled the remainder of the water. I just swallowed a pill without asking what it was.
“What did I take?” My eyes flared wide in sudden understanding of how easy it would be to give a patient the wrong medication without the patient knowing what he took.
“It’s a very mild sedative, Max,” Dr. Running Bear explained. He stood and motioned Leena to leave. “You need some rest.”
“But Johnny. I need to be with him.” I tried to stand, only to be pushed gently back by Sharon.
“You stay here. He’s in Leena’s good hands.”
“How did someone give Johnny narcotics? I was sitting with him the entire time. Who would do that?” I was clear-headed enough to get the question out.
Sharon took my hand again. “We don’t know.”
“Rest assured. I will find him.” Dr. Running Bear’s face was smooth again, his expression impassive—all but his eyes, which flashed with rage. “I will not let this hospital be compromised more than it already is.”
“Would you like me to stay with you?” Sharon asked.
I nodded. Whatever I’d swallowed worked, because I floated above the surface of a pond, lighter than air. I closed my eyes.
I was in a landscape devoid of color, alone. No matter which direction I looked, I couldn’t see any landmark, person, or building. Unbroken grayness hid the demarcation between sky and land. I searched for something or someone just beyond the horizon. I called out, but couldn’t hear the sound of my own voice.
A cool hand smoothed the hair from my forehead.
I fell into a deep sleep.
CHAPTER TWENTY-SEVEN
NO SUNLIGHT PENETRATED my blind-darkened room, but my internal clock suggested I’d slept until late morning. I stretched my arms over my head and opened my eyes to see Sharon sitting on the edge of my bed. She held up a hand and smiled.
“I thought you’d want to come say hello to Johnny. Shower first and get yourself prettied up. He’s awake, sort of.” She rose and stepped aside.
Showering faster than I thought possible, I did as she directed. When I was clean, I suited up and entered the ICU. Nurses moved in syncopated rhythms; no one rushed to an emergency. Dr. Running Bear and Dr. White met me outside Johnny’s room. Like Sharon, their eyes were bright.
“Don’t stay too long. He’s pretty weak. Come down to the diagnosis room when you can.” Dr. Running Bear led Dr. White and Sharon toward the swinging doors. I took a deep breath and pushed aside the curtains obscuring Johnny’s room.
“Hey, funny man.”
“Hey, yourself, pretty lady,” Johnny said, his voice weak. “Heard you were playing sleeping beauty.”
I swallowed a lump the size of Nebraska. “Yes. I took a nap after you stopped coding. Dr. Running Bear ordered me to leave once he had you stabilized.” I swallowed hard again and wiped away a tear. Before I could stop myself, I climbed into bed and buried my face in the notch in Johnny’s neck.
Johnny touched my face with a trembling hand. “I’m going to be all right. No need to worry. I’m not leaving you.”
“I was so scared.” I didn’t try to hold back my tears. I let them soak Johnny’s hospital gown.
“If I’d have been conscious, I’d have been scared myself,” he said. He stroked my cheek, wiping away tears with a thumb.
“I wanted to stay, but Sharon is a force unto herself. So was the sedative Dr. Running Bear gave me.” I pulled down my mask and kissed his forehead; I clung to his hand, reluctant to release it. We were silent, overcome with emotion and fatigue. Johnny’s eyelids fluttered as he struggled to keep them open. I squeezed his hand. “Sleep. I’ll be back later.”
He nodded, eyes closed. By the time I was out of the room, his breathing was deep and regular. I shut my eyes against more tears. I wasn’t going to lose Johnny. I stuck my head in Alex’s room. He was lost in his Game Boy. I pulled an ear bud free to interrupt him with the good news about Johnny.
“I know. I knew bef
ore you did,” Alex said, glancing at me before returning to his game, thumbs working overtime to move the arrows around Grand Theft Auto.
Leena stepped up beside me and pulled Alex’s door partially closed. “Are you coming to the diagnosis room?” she asked.
While I was all but passed out, the CDC team had been busy. The nurse gave me a few hints while we walked together but left the detailed discussion for the team.
No sooner had I entered the locked room than I blurted out the question most pressing. “What the hell happened to Johnny? Forget the rest. Forget the growing mystery. Tell me why he crashed.”
At the height of Johnny’s crisis, Nurse Leena had shone a light into his pupils. Pinpoint and non-responsive. Depressed breathing. Dr. White had drawn a vial of blood for Dr. Klein to test. I vaguely remember him bolting for the door. “Someone on staff directly injected Johnny with the morphine,” Dr. Running Bear said.
“We don’t know who,” Sharon said. She glanced at Leena and Dr. Running Bear. “God, I’m getting damned sick of saying we don’t know.”
“Rest assured, I will find him.” Dr. Running Bear walked over and did a quick visual assessment of my physical condition. He must have approved of what he saw, because he smiled and patted my back.
“With Johnny having plague, we would never order morphine. It slowed his heart rate and made his breathing shallow.”
“So, someone walked past me and injected morphine. I don’t remember anyone coming in.
“You could have been asleep, Max.”
Possible, because I often dozed in Alex’s or Johnny’s rooms.
“You’d think I’d notice.” I stared off into nothing.
“Not if it was someone who routinely was in the room,” Sharon said.
“Or if it was the white dragon Alex saw.” I told the group about his nightmare. “Do any nurses routinely wear white scrubs?”
Dr. Running Bear nodded. “Some do.”
“We believe he was injected through the port, so we changed it and sent it to an off-site lab for analysis,” the nurse said.