Maybe so, Dan thought to himself– but the obit said the cause of death was complications from flu. Dan’s own experience of the local hospital was that one had a better chance of remaining alive if one never went near it. He remembered how his wife Elizabeth went into the Rockinam hospital hoping to cure a mild ailment, but contracted, and died from, a differing incurable disease that was then making the rounds of the hospital.
“I saw Grace Stout occasionally, at St. James,” Dan said to Jimmy, “but I can’t say I know her – knew her, I guess I should say, now that she’s no longer with us. She had a cough from the flu a month or so ago, when she was in the same pew with me in St. James. I tried to keep a respectful distance away from her, because her cough sounded awful. I never knew Kurt Starkherz by name, but I saw him once carrying on his shoulders his son, a nice-looking young kid, who must be the two-year old survivor mentioned in the obit. The kid’s father seemed cheerful enough, and healthy. Starkherz means Strongheart, if my few surviving bits of German serve me. So maybe Kurt’s problem wasn’t a heart attack. I don’t mean to suggest that having a healthy-sounding name will do someone any good in warding off sickness. Jimmy, you suggested that a person who worked in a hospital ought to pick up a lot of information about medicine. I confess that I get nervous about doctors who spend a lot of time in hospitals, especially the one in town here. There’s a lot of disease in hospitals. Didn’t the Rockinam hospital get some notice last year that its staff and doctors risked losing their accreditation if they didn’t do a better job keeping the place clean and washing their hands? Who knows what illnesses you can get in the hospital? The whole thing scares me. And most people around here have been vaccinated against flu. But maybe the pharmaceutical companies who make the vaccines chose the wrong kind of vaccine for this year’s kind of flu. Each year seems to involve a different blend of flu viruses. And why, out of all the people in Rockinam who were vaccinated against flu, or who had some kind of flu, why would viruses pick out these two people, Grace Stout and Kurt Starkherz, to kill them? They were more than 40 years apart in age. I bet they never met each other. Did you know Kurt Starkherz, Jimmy?
“Only enough to sell him newspapers. He seemed like a cheery guy. He was a bit of a show-off, but plenty friendly enough.”
“I’ve heard that sometimes some kinds of flu can get spread from bird to bird, and then from bird to people. You think either Grace Stout or Kurt Starkherz raised poultry in the back yard, or kept parrots in their houses? You think they got bird flu?”
“I sure don’t think so. Grace Stout and Kurt Starkherz both lived right here in town. I never heard of them raising chickens. In fact, I think that’s against the Rockinam zoning laws. God knows about the parrots, and God hasn’t shared that information with me. I have heard that one or two of the many widows in this town have pet parrots, but I don’t know that for a fact. Maybe parrots repeat back what their owners have said, which might make a widow feel less lonely. That wouldn’t do much for Kurt Starkherz, who had a wife and a kid to talk to.”
“I’m a widower, Jimmy. Maybe I should try owning a parrot. But I have enough crap in my house without having to deal with bird droppings. I’ve read that some bird droppings can be full of, and can spread, virus. And for company, I talk to myself a lot. I like doing that. Much of the time I agree with what I’ve said, and I like the way I’ve said it.”
By this time, other people were beginning to come into the news store. That caused the Dan-Jimmy conversation to break off. Dan biked home, bearing the newspaper that contained the Stout and Starkherz obituaries. As he biked he wondered what had caused the flu in Rockinam to become lethal – and how he could avoid, or at least postpone, its lethality. Kurt Starkherz hadn’t coughed or spat on Dan. That much was good. Grace Stout had both coughed and spat on Dan, but that had been over a month earlier, and Dan had applied copious amounts of anti-bacterial sanitizer on his hands tight after the event. By this time Dan was thinking almost entirely about flu risk to him, not about his biking. When Dan pedaled his bike across a main street so he could go into the side street that led to his house, a huge and heavy Cadillac Escalade, turned away sharply from Dan’s bike. The big car tilted to one side but did not fall over. The red-faced driver pushed his car horn, raised an arm and a middle finger, and screamed out obscenities at Dan before proceeding down the main street. Dan, as he pedaled up his side street, waved his arm in a friendly fashion at the Cadillac driver. Then Dan frowned. He had remembered that the sanitizer in the bathroom of St. James Church was an anti-bacterial – not something that worked against viruses. Viruses, not bacteria, were what had caused flu pandemics. Dan’s handwashing after Grace Stout’s coughing in church would not have killed whatever had infected her, though it might have washed away what she had coughed on him.
I am the resurrection and the life, saith the Lord; he that believeth in me, though he were dead, yet shall he live … (John 11:25; The Book of Common Prayer, The Burial of the Dead, Rite One, p. 469).
6
The Passing of the Rector
One week after seeing in the local paper the deaths of Grace Stout and Kurt Starkherz, Dan, when he biked to pick up his morning newspaper, saw posted on the door of Jimmy Madeiros’s news store an excerpt from another page from the Rockinam Sentinel: an excerpt that reported another death, that of Rev. William Templeton, the Rector of St. James Church. The obituary summarized Templeton’s career, and, in words bearing some resemblance to words in the obits for Kurt Starkherz and Grace Stout, said the Rector died “after a struggle with influenza.” The Templeton article also mentioned that the Rector, by bringing communion and prayer to sick members of his large congregation, had helped congregants in his church who had been stricken with the flu. “He probably helped spread the sickness,” Dan said, talking to himself. “That’s a hell of a way to do the Lord’s work.”
Dan went into Jimmy’s store. “What are you doing?” Dan asked Madeiros. “Now the Rector is dead, too? Is any of this your handiwork, Jimmy? Are you trying to kill everyone in Rockinam? Aren’t they paying for their newspapers in a timely fashion?”
“Don’t try to bust my chops, Mr. Floyd,” Madeiros said. “And don’t blame me for stuff that I didn’t do and that I don’t find funny. I hardly knew Father Templeton. I’m a Catholic, not some kind of Protestant – though I do protest a lot sometimes. And Father Templeton had his newspapers delivered to his door. He hardly ever came here to my news store.”
“He was a good rector,” Dan said. “He made house calls on sick parishioners.”
“You can kill yourself and your congregants, doing that, when a dangerous disease like the flu is making the rounds,” Madeiros said. “In that kind of situation, being sick or shaking hands with sick people, glad-handing is bad-handing.”
Madeiros kept talking, but Dan wasn’t listening. He was remembering, as best he could, what Thucydides had written about the plague in Athens: “[N]either were the physicians able to cure it through ignorance of what it was, but died fastest themselves, as being the men that most approached the sick… . All supplications to the gods and enquiries of oracles and whatsoever other means they used of that kind proved all unprofitable… .” Dan realized, from what Thucydides had written, that the people who “most approached the sick” during a plague, as doctors and priests did (getting close to, and trying to help, patients or congregants) were likely, as a result, to die of plague faster than other people, who kept their distance from those who were sick from the plague – especially if the sickness was from a lethal form of flu.
Dan first read about Rev. Templeton’s death on a Thursday. Three days later, on Sunday morning, Dan went to St. James Church for Eucharist. The church was unusually ill-attended, even though Christmas was only a few weeks away. Congregants kept well away from each other. After the declaration of the Peace, few hands were shaken within the church. Instead, congregants exchanged forced smiles, f
rom a considerable distance with each other. At communion, Dan, like many of the communicants, took confirmation just by swallowing pieces of communion wafers proffered by the ministers. Few of the communicants dipped ends of wafers into the chalice, or sipped the wine. Those who did so were stared at with disapproval by the dippers, as if the sippers had done something deeply improper like breaking wind while kneeling at the communion rail. While he was kneeling at the communion rail, Dan noticed the disapproving looks at the kneeling sippers. He thought of the hymn in the Episcopal hymnal that began with the words, “Let us break bread together on our knees.” Decades before, Dan as a teenager had suggested to his high school classmates changing that hymn’s opening line should be changed to “Let us break wind together on our knees.” Dan at age 74, though far from young, could not help giggling at his own teen-aged attempt at witticism, as if he were still only 14 years old – which he had been, sixty years earlier. The curate of St. James Church, an earnest young woman who was conducting the service in the absence of the deceased Rector, scowled down at Dan as he knelt and giggled. She also coughed repeatedly after communion, loud clotted coughs, before she announced that a memorial service for Rev. Templeton would be held in the church at 11 A.M. the following Saturday, followed by a reception in the chapel.
Dan kept his copy of the service sheet from that Sunday’s Eucharist. On Monday morning, he showed to Jimmy Madeiros the service sheet’s list of first names of people who were being prayed for in particular. Madeiros identified four of the names as those of people who, to the best of his knowledge, were badly sick from flu, or who had just died, apparently from flu.
Dan biked home from the newspaper store. The day was still fairly dark at 7:00 o’clock that December morning. His bike path took Dan near St. James Church, and near where he had talked to Kurt Starkherz some weeks earlier. After getting home, Dan turned on his computer and browsed in Google and Wikipedia to learn about Kurt’s father Dr. Konrad Starkherz. There was plenty of information about the man. Born in Germany, Konrad Starkherz and his parents had moved to the United States when he was fifteen. His father Klaus Starkherz had been a doctor in Germany, a virologist, who worked as a doctor in New York for twenty years before retiring. Konrad Starkherz majored in medicine at Johns Hopkins, went to medical school, received a Ph.D. in epidemiology, and worked at the Centers for Disease Control and Prevention for 12 years before he moved to a leading New York hospital as an epidemiologist. Dan googled for references to journal articles written by Dr. Konrad Starkherz. By later afternoon, by the time Dan had produced a fine bottle of Côtes du Rhône wine to serve as his dinner, Dan had found two such articles. Neither struck him as of major importance – though Dan recognized that he himself was not a learned doctor, only someone who had read about pandemics and epidemiology. One of Konrad Starkherz’s articles was short, but so laden with medical terms as to be largely incomprehensible to a layman. The other article, dated close to the time when Dr. Starkherz left CDC, discussed the influenza epidemic in 1918 and 1919, in terms similar to those Nat had used in talking to Dan, on how the H1N1 flu antigens (the cell markings that caused peoples’ immune systems to attack those markings) from those years were made up of new forms of hemagglutinin and neuraminidase – forms that mutated so rapidly that the immune system could not keep up with the mutations, with the result that the virus (not being vulnerable to immune attack) could make itself at home in the patient’s body, often killing the patient. The article noted that soon after 1918, the lethal power of the H1N1 antigens vanished, probably as people’s immune systems became familiar with the antigens and learned how to immunize them. That much Dan had already heard from Nat, and had read in the books on influenza epidemics. Dr. Konrad Starkherz ended the article with a different thought, a reference to possible future pandemics:
“We should not think that the threat of a new H1N1 epidemic is behind us. Imagine, if you will, a case in which H1N1 of the 1918-1919 sort is released and spread – perhaps assisted in dissemination by birds. Will people be able to fight that kind of H1N1 with immune responses that do not destroy the lungs of people who have been exposed to the virus, but rather that destroy hemagglutinin 1 and neuraminidase 1? May we not work to develop effective immune responses to H1 and N1, and, if we succeed in this, save many millions of lives?”
Well, such a salutary result might be possible, Dan thought. He was reasonably sure of what his wise-acre son Michael would say: “A definite maybe on that one, Dad.” Wouldn’t it be simpler and safer not to try to locate H1N1 of the 1918-1919 sort, especially if you’re not sure of being able to develop an effective immune response? If no effective immune response evolved, wouldn’t the people of the world be exposed to plagues that were likely to kill most or nearly all of them –a slaughter far more widespread than any prior pandemic? These issues, however, were ones that needed to be talked over with his knowledgeable son Nat, who knew a lot about virology – not just addressed by Dan and his quickly diminishing second bottle of Côtes du Rhône.
In the bleak midwinter,
Frosty wind made moan,
Earth stood hard as iron,
Water like a stone;
Snow had fallen, snow on snow,
Snow on snow,
In the bleak midwinter,
Long ago. (Christina Rossetti, c. 1872).
7
Bleak Midwinter
The following morning, Dan found himself, not in bed, but lying on the sofa in his study – the sofa he had sat in while looking in Google in his PC for information about Dr. Konrad Starkherz. Not one, but two, empty bottles of wine lay at Dan’s feet on the sofa, their uncorked necks staring like empty eyes in Dan’s direction. Seeing the bottles triggered in Dan a pulsating headache. He pushed the bottles aside with one of his still-shod feet. The two bottles fell to the floor. The floor was paved with stone tiles, which broke the neck off one of the bottles and shattered the other one. That increased Dan’s headache. He was pleased, however, that he, despite his throbbing head, was able to put both the neckless bottle and the many glass shards in the trash barrel in the kitchen, without cutting himself or breaking more glass.
What to do next? It was December 19. Nat, a couple of weeks earlier, had invited Dan to come out to Nat’s house in Santa Barbara for Christmas with the family. Dan had waffled in a variety of ways (among them: “thanks, but that would be an imposition on you and your wife and kids, Nat”; “nice invitation, but a long haul”; “I’ll be back to you”; “you’re very kind, but I don’t think I’m up to that kind of travel any more”). But Nat’s invitation had become irresistible to Dan, now that there were at least three recently dead (Grace Stout, Kurt Starkherz, and Rector Templeton) in Rockinam, probably all three of them killed by the same kind of flu. Would Dan be the next to go? He had been exposed to Grace and a bit to Reverend Templeton, and even more briefly to Kurt Starkherz (no mucus had been sneezed on Nat from either of those men, but Nat had exchanged a few words with Kurt Starkherz). If there really was a pandemic brewing in Rockinam, shouldn’t Dan get out of the town while he could? If there were more flu deaths in Rockinam, wasn’t it likely that the town would be quarantined, which would just increase and intensify the risk of sickness and death? Dan remembered, from his reading about the 1918-19 flu, how the flu had then spread like an explosion in an army camp, Camp Devens, with most of the patients quickly turning blue and black and dying, and men during the epidemic being neither admitted to the camp nor permitted to leave it, and with the camp’s dense population increasing the likelihood of infection and death from the disease.1 But if Dan went to Santa Barbara, would he, by carrying flu virus with him, literally kill Christmas, both at Nat’s home, and among the crew and passengers in the plane that took Dan to California?
Dan pulled out a pad and took notes of points to cover with Nat. Decades of lawyering had inculcated in Dan the merits of copious note-taking – a view that grew as he b
ecame more and more aware, as his age increased, that he was likely to forget things he wanted to talk about, unless he had made notes of those things in advance. After completing notes for his call, Dan brewed strong coffee to combat the lingering effects of his wine, burnt his throat in drinking the coffee, and telephoned Nat. Forgetting the three hour time difference between the east and west coasts, Dan managed to wake Nat at 5:30 A.M. Pacific Time. Nat sounded groggy. Dan apologized for the hour of the call.
“I’ll return the favor sometime,” Nat said. “Probably around 11 P.M. Pacific Time some night. That’ll be 2 A.M. at your place. What’s up, Dad?”
Dan recited his thoughts, without expressly mentioning his fear of contracting a lethal flu. He spoke of the approach of Christmas, his desire to be with his children and grandchildren, the three recent deaths in Rockinam, and his concern that he might end up being stuck in Rockinam if an epidemic were to develop there and if the CDC or similar organizations were to impose a quarantine on the little town to prevent a broad spread of what might turn out to be a nasty flu . “You’re the doctor, Nat,” Dan said. “It’s your call.” He didn’t add “and I certainly don’t want to bring sickness to you and Michael and your wives and kids” – but Nat, as an experienced doctor, focused on that unstated issue as if he were giving his father a detailed exam.
“How long ago was it that the woman called Grace coughed on you?” Nat asked, after a minute or two of silence.
Sometime- the Plague World Page 5