by Jim Shepard
Jeannine and Danice complimented her on her English and asked if most of the doctors and nurses spoke English, and she said no.
She led them through the wards, which were chaotic. Everyone who wasn’t inert looked terrified. She said there were fifty-one suspected cases and sixteen confirmed dead. They asked where the hospital had been keeping the bodies and she said they’d turned the maternity ward into a mortuary. She said that despite antipyretics the patients’ fevers had stayed high, and the antibiotics hadn’t worked, and the doctors hadn’t gotten very far in their work-ups. The X-rays they’d taken had shown infiltrates in both lungs or sometimes even white-outs. The stages seemed to be coughing and lethargy and severe respiratory distress and confusion when speaking, and clearly the affected weren’t getting enough oxygen, but intubations hadn’t worked, and now three of the nurses who had performed the intubations were feverish and had developed their own coughs. Jeannine asked where the sick had been isolated and Marie Louisa pointed down the hall to a set of double doors with a bunch of homemade signs hung on them.
She led them into an office she identified as Dr. Kristensen’s and showed them on a computer what she’d been able to compile, with help, so far, on the clinical features of the outbreak. The document went case by case, listing every patient by name, age, and gender, with their dates of hospitalization and treatments and outcomes.
Jeannine asked her when she’d found the time to do all of that, and Marie Louisa said mostly very late when the ward was quiet, and Jeannine said she was surprised it got quiet, even very late. Marie Louisa admitted that since this had happened, most nights it didn’t, and Danice congratulated her on the quality of her work. Jeannine led Marie Louisa back out into the hallway and had her call for everyone’s attention. When there was finally enough of a diminishment in the noise that a shouted voice could be heard, she had Marie Louisa translate for everyone that the CDC was here, and that she knew everyone was frightened of the epidemic and angry about the quarantine, but she and her colleague were going to help with both. The head of the escort team seemed miffed that she hadn’t asked him to do the translating. One of the medical staffers standing beside her put his face in his hands and said to himself what Jeannine assumed was something in Danish for “We’re doomed.”
The New Key in an Old Lock
On average the world encounters one new communicable disease each year, as pathogens evolve by leaps and bounds in ways that enhance their durability, transmissibility, and virulence: the keys to evolutionary success. What they’re learning, through generations of trial and error, is how to work with their victims in order to work against them.
Ring-a-Levio
The WHO communicable disease guy still hadn’t arrived, and the head of the escort team didn’t seem to know when he would. But all sorts of doctors were coming from Denmark, as well. And Jeannine immediately got on her cell to her supervisor, who agreed that until they knew what was going on, no one should be rushing in from other countries to try to help out, and that he would contact WHO to see if they could at least make sure of that. Jeannine and Danice took over a storeroom, and while Jeannine set up their laptops Danice unpacked the lab equipment the escort team had lugged in, including her TaqMan and GeneXpert systems. “Imagine?” she said as she unpacked them. “All this used to take up two rooms. Now it all fits in a check-in.” “Isn’t science amazing?” Jeannine asked, and Danice answered, “Aw, shut up.”
One of the doctors who hadn’t responded to his pager, a Dr. Olsen, had turned up and spoke some English. He said he was twenty-nine, he looked fifteen, and his specialty was obstetrics, but after they got him masked and gowned and eye-shielded, he was a much-needed extra pair of hands when it came to trying to keep all the patients under investigation corralled. He had very white eyebrows over what seemed like perpetually wary eyes, and something about the way he watched Jeannine made her self-conscious. The next step before examinations could even begin was to shore up the quarantine, and Jeannine had Olsen and Marie Louisa deputize six or seven of the bigger staff workers, even if they had no weapons to brandish. And while Olsen and Marie Louisa were addressing that group, which itself looked panicky enough to bolt, two teenage patients under investigation sprinted past the guard at the door and down the ramp, through the courtyard, and up the street. An older patient also tried to get out and had to be grappled back inside. It was like the Ring-a-Levio game from Jeannine’s grammar school playground, when you tried to keep the kids you had captured rounded up while the other kids tried to break those kids out of jail, the result being a complete free-for-all.
They set up temporary negative pressure rooms for isolated patients, with a HEPA machine that discharged filtered air to the outside, and they set up a triage system in which the most febrile cases would be at the end farthest from the rest of the hospital, down the hall in the new surgery. Jeannine talked with Marie Louisa about what operators should tell people who were calling in, and how to go over the parameters for whoever was working the main entrance triaging new arrivals. In the meantime, some of the awaited supplies had rolled in, and everybody had new gloves and masks and eye guards and hair bonnets and that seemed to help a little. It also helped that the resupply had apparently involved cheese and beer. Everywhere you looked in the hallways, patients were sitting on the empty boxes that had been unpacked.
More antibiotics had arrived, as well, and with Olsen and Marie Louisa they worked their way through the quarantined patients, combining treatment with interviews. The notion that medicine was being handed out seemed to further help with some of the panic. That took most of the evening, and when it was over and most of the quarantined were sleeping wherever they could stretch out, the four of them convened to share information and to track on a big whiteboard who had reported what and when. Once they’d worked backward in time to the very first patient under investigation’s reporting symptoms, it became clear that whatever this was, it had arrived on a boat with a guy who had come from Ilimanaq, a tiny settlement across the bay to the south. That guy had died the day before, and so had the two friends he’d stayed with. Even as late as it was, Jeannine had Marie Louisa try the health service nurse in Ilimanaq, and then the post office, as well, before she made some calls herself to arrange a helicopter from the Danish military for the following morning. When she asked Olsen if he could accompany them, he shrugged and gave her another wary look and said, “My morning’s free.”
A Danish news crew was now camped out in the courtyard, and had spent the evening shooting various exteriors and updates and otherwise killing time and waiting for the Americans to come out and provide some information beyond what everybody already knew. After Marie Louisa was thanked yet again and told to go get some rest, Jeannine headed out with Olsen and the leader of the escort team to meet with the crew to try to spread around some non-panic and at the same time take the opportunity to get some potential prevention messages out there. She took off her hood and mask before she got outside, to help with the non-panic part of things.
It was after three in the morning when she got back into their little office to collect Danice for the ride to where they were staying. Olsen had announced he’d be fine sleeping under the counter at the nurses’ station. Danice had worked up some community surveys in addition to the work she’d done on the case definition. She’d also emailed some updates back to the CDC. They were both exhausted and frightened and didn’t talk much beyond catching each other up. The hospital had quieted enough by that point that they could hear the delicate glass-breaking sound of ice collapsing off the gutters.
Danice needed to pack up, so Jeannine found a restroom and splashed her eyes and washed her face and did some stretches. They’d have time for about four hours of sleep before the helicopter was due to arrive. Jeannine wove her way past the sleepers in the hallway and stopped across from the maternity ward and peeked through the glass. She cupped her hands around her fa
ce to see better. Her eyes were so tired, it took them a long time to adjust.
The bodies were piled head to foot. Outside the window, in the gloaming of the not-quite-white night, a forklift was parked on the rock overlooking the harbor, along with two short rows of cargo containers. One of them was festooned with a bright roll of neon biohazard tape, as if constituting someone’s idea of a mass grave.
The Dead Zone
They met the helicopter at the airport, and the pilots were clearly disconcerted by the Tyvek suits and Olsen’s full-body suit minus their breathing apparatus. One said, by way of introduction, that he liked to be addressed as “Pilot” rather than his given name. When Jeannine looked at him in response, he said he was just kidding. He then asked Olsen something in Danish, and Olsen gave him a noncommittal response. The copilot helped them load their equipment and there was a problem with the preflight checklist so the pilot had to shut the engine down and restart it. While they all waited, the copilot asked the women if their husbands were nervous for them, since they did such dangerous work. Danice said ironically that she was not a one-man girl, and the copilot, confused, said, “So you sleep around?,” and Jeannine clarified that no, that wasn’t what her colleague had meant. The pilot and copilot still looked puzzled, and Olsen looked worried and distracted, and then the pilot made a face and said that sleeping around was pretty much all he did.
The pilot asked Jeannine if it was hard for her in America, and she took him to mean because she was a dark-skinned Algerian, and answered that it was hard for a lot of people in a lot of places.
Then there was a twenty-minute delay because the pilot had been given orders only to set Jeannine and Danice and Olsen down in Ilimanaq and not to wait on the ground for them, and he complained up his chain of command while everyone waited. During a lull in the radio transmissions, Jeannine reminded him that they had to get to Ilimanaq, because they were doctors, and the pilot responded that from what he had heard, no one in Ilimanaq needed a doctor, because everyone in Ilimanaq was dead. Jeannine said that she doubted very much that whatever had happened there had been that dire, but her skepticism didn’t seem to convince either of the pilots, so she finally made a call back to Atlanta. Her supervisor told her to sit tight, that he was all over it, and more calls were made while Olsen went off by himself and sat cross-legged on the ground with his chin on his fists. After another twenty-five minutes, someone got through to the pilots and yelled at them in Danish. They acknowledged the transmission unhappily and gave Jeannine and Danice some baleful looks, after which they rooted around in a plastic case in the cabin, donned masks and rubber gloves, handed their passengers headsets, and, finally, took off.
Once they had left the airport and the town behind them, they flew over a dazzling field of icebergs, some themselves the size of small towns. The pilot explained that this was the great Kangia Icefjord and then looked over his shoulder and seemed disappointed, though apparently unsurprised, at the women’s lack of wonder in response. After ten minutes in the air at high speed, the dots of the settlement’s houses in their primary colors appeared on the edge of the land ahead, scattered in their brightness across the huge rocks, but before they’d even made landfall, they could see bodies here and there on the rocks and the walkways and the grasses.
Over their headsets they could hear Olsen making all sorts of horrified sounds he didn’t seem to be aware of. They did two passes over the settlement and saw lots more bodies but only some spooked dogs moving. Are you kidding me? Jeannine said to herself, and Danice, when they exchanged glances, looked equally stunned. They took off their headsets and pulled on their hoods and respirators. The copilot noticed and pointed it out to the pilot.
They came in low to set down beside the little lake at the settlement’s helipad, a thirty-meter square laid out in the grass with rope anchored with buckets dug into the ground and loaded with rocks. To make it more official, there were orange hazard cones and a windsock.
The rotor wash disturbed the hoods and collars and sleeves of the bodies scattered nearby. On the other side of the lake, two more bodies were in the adjacent picnic area with its two tables, garbage can, and flagpole.
Jeannine and Danice and Olsen climbed out and unloaded their equipment. It took Jeannine a minute to adjust to the blinding quality of the light. The pilots stayed in their seats, saying nothing but looking like offended soccer players protesting a call. Olsen crouched over the nearest body while Jeannine and Danice divvied up what they’d have to carry and the dogs from the closest houses lunged and barked at them like they were defending the town. While all this was happening, the pilots’ expressions were so exaggerated with resentment that Jeannine finally gestured that they could leave, and after some shouting to get them to understand that they should return in two hours the copter lifted off before she had finished speaking.
The women had to hunch over to steady themselves through the hurricane of rotor wash debris. Mostly because they were still stunned, they didn’t move until some time after the helicopter was only a faint noise in the distance.
To their north they could hear the echoey yips and whoops of sled dog puppies. Jeannine resisted an immediate panicked call to Atlanta. They double-checked the seals on their gloves and masks. Danice hung her camera strap around her neck and slung everything else in her load onto her shoulders.
The three of them in single file tried to keep to the duckboards and wooden walkways because of the mud of the snowmelt. They had to step over a boy who was hanging off a walkway intersection beside an ATV frame that had been cannibalized for parts. There were a lot of flies and crows and ravens, and it looked like the dogs had taken an interest in some of the bodies as well. It was already hot in the Tyvek suits.
Jeannine unfolded the map with the health service nurse’s house marked on it, and Danice helped her hold it steady and get her bearings, and then they headed toward it. The noise of the flies came and went with each body they passed. One of the dogs that had gotten loose tracked their progress but only kept up its barking halfheartedly.
They looked into every house along their way. Jeannine checked for anything useful, doing her best to adhere to that old axiom of field epidemiology when it came to the possibly relevant onsite clue: Get it while you can.
But it was impossible to maintain focus. In one house it looked like the whole family had died together. In another, the smell, even through his mask, made Olsen totter, and as they opened the entryway to the light Danice had to put a hand to her face shield.
While they checked subsequent houses, Olsen’s face was streaming with tears he was unable to wipe away. Jeannine felt like she was still in a state of shock. Was there really no one here to treat? Were they looking at some kind of impossible mortality rate?
The nurse’s house was a big red duplex with a plywood ramp up to the back door. They wove their way through a chaos of ATVs and homemade wagons out front and found her on one of the beds alongside some of her patients. Her head was black with flies. Other patients clogged the floor and the hallways and the other rooms. Some had their arms around each other.
There were big sheets of cardboard under all the shoes on the entryway floor. A Greenlandic flag was stuck in a little spray of dried flowers in a vase on the nurse’s desk.
They brought her computer out of sleep mode and saw that some of her files were still open. They scrolled through them, waving away the flies, while Olsen translated. The woman had collected every piece of clinical data she could that might help someone understand what was happening, from medical histories with records of vital signs and the progression of symptoms to a catalog of throat swabs and blood samples and how they were marked in her refrigerator. Everything was there, waiting to be analyzed. There was still a big backlog of sent emails that hadn’t gone out. They looked at each other in awe at what the woman had accomplished in the face of what she’d been confronting. And t
hen Danice shrieked, almost giving Jeannine a heart attack, because there in the door behind them was a black-haired boy wearing a blue sweater with white stars and holding a full plastic bag to his chest, like that would keep him safe.
III
Valerie Landry Who’s Always Late
Val’s sister for her birthday the week before had given her a little homemade sampler, framed, with “Valerie Landry Is Always Late” stitched prettily in the center, so after Val tapped her ID on the reader at the parking lot gate at Rochester General, she texted, Fourteen minutes early, Beeyatch, and her sister texted something back, but then the gate was opening so Val wove her Prius between the buildings of the medical center, poking along with her windows open and imagining she could smell the landscaping. She only read her sister’s answer when she was standing outside the glass-walled lobby that led to the ICU. On her way down the hall she nodded at all the worn-out men and women in green scrubs passing by at the end of their shifts. In her little office she hung her sweater on the hook on the back of the door and shrugged into her white coat and turned on her coffeemaker and woke up her computer. While she was waiting for her coffee she answered some emails. Her keyboard looked like it was nested in all the printouts and Post-it notes and eight thousand pens advertising labs or medications all over her desk.
When she was on her way to the department meeting for the shift handover, her sister texted again, and she silenced her phone. Two nurses at the nurses’ station flirted in low voices behind their computer screens, and two interns around a crash cart were also murmuring, though it was clear they were arguing. The ICU quieted people, maybe because of the way it was set apart from the rest of the hospital, and everyone in it seemed to register that. Everything about it suited her, from the quiet to the importance of what she was doing to the combination of being needed and on your own, even if the latter could be scary. When she’d been an intern she’d even appreciated the way she could get a jolt of energy on some of the worst nights from just how worn down she was.