Nancy Jaax felt a wave of unease. She was distressed by the sight of the dead and suffering monkeys. As a veterinarian, she believed that it was her duty to heal animals and relieve their suffering. As a scientist, she believed that it was her obligation to perform medical research that would help alleviate human suffering. Even though she had grown up on a farm, where her father had raised livestock for food, she had never been able to bear easily the death of an animal. As a girl, she had cried when her father had taken her 4-H Club prize steer to the butcher. She liked animals better than many people. In taking the veterinarian’s oath, she had pledged herself to a code of honor that bound her to the care of animals but also bound her to the saving of human lives through medicine. At times in her work, those two ideals clashed. She told herself that this research was being done to help find a cure for Ebola, that it was medical research that would help save human lives and might possibly avert a tragedy for the human species. That helped reduce her feelings of unease, but not completely, and she kept her emotions off to one side.
Johnson watched Jaax carefully as she began the removal procedure. Handling an unconscious monkey in Level 4 is a tricky operation, because monkeys can wake up, and they have teeth and a powerful bite, and they are remarkably strong and agile. The monkeys that are used in laboratories are not organ-grinder monkeys. They are large, wild animals from the rain forest. A bite by an Ebola-infected monkey would almost certainly be fatal.
First Nancy inspected the monkey, looking through the bars. It was a large male, and he looked as if he was really dead. She saw that he still had his canine fangs, and that made her nervous. Ordinarily the monkey would have had its fangs filed down for safety. For some reason, this one had enormous natural fangs. She stuck her gloved fingers through the bars and pinched the monkey’s toe while she watched for any eye movement. The eyes remained fixed and staring.
“GO AHEAD AND UNLOCK THE CAGE,” Lieutenant Colonel Johnson said. He had to shout to be heard above the roar of air in their space suits.
She unlocked the door and slid it up until the cage gaped wide open. She inspected the monkey again. No muscle twitches. The monkey was definitely down.
“ALL RIGHT, GO AHEAD AND MOVE HIM OUT,” Johnson said.
She reached inside and caught the monkey by the upper arms and rotated him so that he was facing away from her, so that he couldn’t bite her if he woke up. She pulled his arms back and held them immobile, and she lifted the monkey out of the cage.
Johnson took the monkey’s feet, and together they carried him over to a hatbox, a biohazard container, and they slid the monkey into it. Then they carried the hatbox to the necropsy room, shuffling slowly in their suits. They were two human primates carrying another primate. One was the master of the earth, or at least believed himself to be, and the other was a nimble dweller in trees, a cousin of the master of the earth. Both species, the human and the monkey, were in the presence of another life form, which was older and more powerful than either of them, and was a dweller in blood.
Jaax and Johnson moved slowly out of the room, carrying the monkey, and turned left and then turned left again, and entered the necropsy room, and laid the monkey down on a stainless-steel table. The monkey’s skin was rashy and covered with red blotches, visible through his sparse hair.
“GLOVE UP,” Johnson said.
They put on latex rubber gloves, pulling them over the space-suit gloves. They now wore three layers of gloves: the inner-lining glove, the space-suit glove, and the outer glove. Johnson said, “WE’LL DO THE CHECK LIST. SCISSORS. HEMOSTATS.” He laid the tools in a row at the head of the table. Each tool was numbered, and he called the numbers out loud.
They went to work. Using blunt-ended scissors, Johnson opened the monkey while Jaax assisted with the procedure. They worked slowly and with exquisite care. They did not use any sharp blades, because a blade is a deadly object in a hot zone. A scalpel can nick your gloves and cut your fingers, and before you even feel a sensation of pain, the agent has already entered your bloodstream.
Nancy handed tools to him, and she reached her fingers inside the monkey to tie off blood vessels and mop up excess blood with small sponges. The animal’s body cavity was a lake of blood. It was Ebola blood, and it had run everywhere inside the animal: there had been a lot of internal hemorrhaging. The liver was swollen, and she noticed some blood in the intestines.
She had to tell herself to slow her hands down. Perhaps her hands were moving too quickly. She talked herself through the procedure, keeping herself alert and centered. Keep it clean, keep it clean, she thought. Okay, pick up the hemostat. Clamp that artery ’cause it’s leaking blood. Break off and rinse gloves. She could feel the Ebola blood through her gloves: it felt wet and slippery, even though her hands were clean and dry and dusted with baby powder.
She withdrew her hands from the carcass and rinsed them in a pan of disinfectant called EnviroChem, which sat in a sink. The liquid was pale green, the color of Japanese green tea. It destroys viruses. As she rinsed her gloves in it, the liquid turned brown with monkey blood. All she could hear was the noise of the air blowing inside her suit. It filled her suit with a roar like a subway train coming through a tunnel.
A virus is a small capsule made of membranes and proteins. The capsule contains one or more strands of DNA or RNA, which are long molecules that contain the software program for making a copy of the virus. Some biologists classify viruses as “life forms,” because they are not strictly known to be alive. Viruses are ambiguously alive, neither alive nor dead. They carry on their existence in the borderlands between life and nonlife. Viruses that are outside cells merely sit there; nothing happens. They are dead. They can even form crystals. Virus particles that lie around in blood or mucus may seem dead, but the particles are waiting for something to come along. They have a sticky surface. If a cell comes along and touches the virus and the stickiness of the virus matches the stickiness of the cell, then the virus clings to the cell. The cell feels the virus sticking to it and enfolds the virus and drags it inside. Once the virus enters the cell, it becomes a Trojan horse. It switches on and begins to replicate.
A virus is a parasite. It can’t live on its own. It can only make copies of itself inside a cell using the cell’s materials and machinery to get the job done. All living things carry viruses in their cells. Even fungi and bacteria are inhabited by viruses and are occasionally destroyed by them. That is, diseases have their own diseases. A virus makes copies of itself inside a cell until eventually the cell gets pigged with virus and pops, and the viruses spill out of the broken cell. Or viruses can bud through a cell wall, like drips coming out of a faucet—drip, drip, drip, drip, copy, copy, copy, copy—that’s the way the AIDS virus works. The faucet runs and runs until the cell is exhausted, consumed, and destroyed. If enough cells are destroyed, the host dies. A virus does not “want” to kill its host. That is not in the best interest of the virus, because then the virus may also die, unless it can jump fast enough out of the dying host into a new host.
The genetic code inside Ebola is a single strand of RNA. This type of molecule is thought to be the oldest and most “primitive” coding mechanism for life. The earth’s primordial ocean, which came into existence not long after the earth was formed, about four and a half billion years ago, may well have contained microscopic life forms based on RNA. This suggests that Ebola is an ancient kind of life, perhaps nearly as old as the earth itself. Another hint that Ebola is extremely ancient is the way in which it can seem neither quite alive nor quite unalive.
Viruses may seem alive when they multiply, but in another sense they are obviously dead, are only machines, subtle ones to be sure, but strictly mechanical, no more alive than a jackhammer. Viruses are molecular sharks, a motive without a mind. Compact, hard, logical, totally selfish, the virus is dedicated to making copies of itself—which it can do on occasion with radiant speed. The prime directive is to replicate.
Viruses are too small to be seen. H
ere is a way to imagine the size of a virus. Consider the island of Manhattan shrunk to this size:
This Manhattan could easily hold nine million viruses. If you could magnify this Manhattan and if it were full of viruses, you would see little figures clustered like the lunch crowd on Fifth Avenue. A hundred million crystallized polio viruses could cover the period at the end of this sentence. There could be two hundred and fifty Woodstock Festivals of viruses sitting on that period—the combined populations of Great Britain and France—and you would never know it.
Keep it clean, Nancy thought. No blood. No blood. I don’t like blood. Every time I see a drop of blood, I see a billion viruses. Break off and rinse. Break off and rinse. Slow yourself. Look at Tony’s suit. Check him.
You watched your partner’s suit for any sign of a hole or a break. It was kind of like being a mother and watching your kid—a constant background check to see if everything is okay.
Meanwhile, Johnson was checking her. He observed her for any kind of mistake, any jerkiness with the tools. He wondered if he would see her drop something.
“RONGEUR,” he said.
“WHAT?” she asked.
He pointed at her air hose to suggest that she crimp it so that she could hear him better. She grabbed the hose and folded it. The air stopped flowing, her suit deflated around her, and the noise died away. He put his helmet close to hers and spoke the word rongeur again, and she released her hose. She handed him a pair of pliers called the rongeur. The word is French and means “gnawer.” It is used for opening skulls.
Getting into a skull is always a bitch in Level 4. A primate skull is hard and tough, and the bone plates are knitted together. Ordinarily you would whip through a skull with an electric bone saw, but you can’t use a bone saw in Level 4. It would throw a mist of bone particles and blood droplets into the air, and you do not want to create any kind of infective mist in a hot area, even if you are wearing a space suit; it is just too dangerous.
They popped the skull with the pliers. It made a loud cracking sound. They removed the brain, eyes, and spinal cord and dropped them into a jar of preservative.
Johnson was handing her a tube containing a sample when he stopped and looked at her gloved hands. He pointed to her right glove.
She glanced down. Her glove. It was drenched in blood, but now she saw the hole. It was a rip across the palm of the outer glove on her right hand.
Nancy tore off the glove. Now her main suit glove was covered with blood. It spidered down the outer sleeve of her space suit. Great, just great—Ebola blood all over my suit. She rinsed her glove and arm in the disinfectant, and they came up clean and shiny wet. Then she noticed that her hand, inside the two remaining gloves, felt cold and clammy. There was something wet inside her space-suit glove. She wondered if that glove was a leaker, too. She wondered if she had sustained a breach in her right main glove. She inspected that glove carefully. Then she saw it. It was a crack in the wrist. She had a breach in her space suit. Her hand felt wet. She wondered if there might be Ebola blood inside her space suit, somewhere close to that cut on the palm of her hand. She pointed to her glove and said, “HOLE.” Johnson bent over and inspected her glove. He saw the crack in the wrist. She saw his face erupt in surprise, and then he looked into her eyes. She saw that he was afraid.
That terrified her. She jerked her thumb toward the exit. “I’M OUTTA HERE, MAN. CAN YOU FINISH?”
He replied, “I WANT YOU TO LEAVE IMMEDIATELY. I’LL SECURE THE AREA AND FOLLOW YOU OUT.”
Using only her left hand, her good hand, she unplugged her suit from the air hose. She practically ran down the corridor to the air lock, her right arm hanging rigidly at her side. She did not want to move that hand because every time she moved it she felt something squishing around in there, inside the glove. Fear threatened to overwhelm her. How was she going to remove her boots without using her bad hand? She kicked them off. They went flying down the corridor. She threw open the air-lock door and stepped inside and slammed the door behind her.
She pulled a chain that hung from the ceiling of the air lock. That started the decon shower. The decon shower takes seven minutes, and you are not permitted to leave during that period, because the shower needs time to work on viruses. First came a blast of water jets, which washed traces of blood from her space suit. The water jets stopped. Then came a spray of EnviroChem, coming out of nozzles all up and down the sides of the air lock, which deconned her space suit. Of course, if something lived inside her glove, the chemical shower would not reach it.
There were no lights in the air lock; it was dim, almost dark. The place was literally a gray zone. She wished it had a clock. Then you would know how long you would have to wait. Five minutes to go? four minutes? Chemical mist drizzled down her faceplate. It was like driving a car in the rain when the windshield wipers are broken; you can’t see a thing. Shit, shit, shit, she thought.
At the Institute, there is a Level 4 biocontainment hospital called the Slammer, where a patient can be treated by doctors and nurses wearing space suits. If you are exposed to a hot agent and you go into the Slammer and fail to come out alive, then your body is taken to a nearby Level 4 biocontainment morgue, known as the Submarine. The soldiers around the Institute call the morgue the Submarine because its main door is made of heavy steel and looks like a pressure door in a submarine.
Son of a bitch! she thought. They’ll put me into the Slammer. And Tony will be filling out accident reports while I’m breaking with Ebola. And a week later, I’ll be in the Submarine. Shit! Jerry’s in Texas. And I didn’t go to the bank today. There’s no money in the house. The kids are home with Mrs. Trapane, and she needs to be paid. I didn’t go to the market today. There’s no food in the house. How are the kids going to eat if I’m in the Slammer? Who’s going to stay with them tonight? Shit, shit, shit!
The shower stopped. She opened the door and flung herself into the staging area. She came out of the space suit fast. She shucked it. She leaped out of it. The space suit slapped to the concrete floor, wet, dripping with water.
As her right arm came out of the suit, she saw that the sleeve of her scrub suit was dark wet and her inner glove was red.
That space-suit glove had been a leaker. Ebola blood had run over her innermost glove. It had smeared down on the latex, right against her skin, right against the Band-Aid. Her last glove was thin and translucent, and she could see the Band-Aid through it, directly under the Ebola blood. Her heart pounded, and she almost threw up—her stomach contracted and turned over, and she felt a gag reflex in her throat. The puke factor. It is a sudden urge to throw up when you find yourself unprotected in the presence of a Biosafety Level 4 organism. Her mind raced: What now? I’ve got an undeconned glove—Ebola blood in here. Oh, Jesus. What’s the procedure here? What do I have to do now?
Tony Johnson’s blue figure moved in the air lock, and she heard the nozzles begin to hiss. He had begun the decon cycle. It would be seven minutes before he could answer any questions.
The main question was whether any blood had penetrated the last glove to the cut. Five or ten Ebola-virus particles suspended in a droplet of blood could easily slip through a pinhole in a surgical glove, and that might be enough to start an explosive infection. This stuff could amplify itself. A pinhole in a glove might not be visible to the eye. She went over to the sink and put her hand under the faucet to rinse off the blood and held it there for a while. The water carried the blood down the drain, where the waste water would be cooked in heated tanks.
Then she pulled off the last glove, holding it delicately by the cuff. Her right hand came out caked with baby powder, her fingernails short, no nail polish, no rings, knuckles scarred by a bite from a goat that had nipped her when she was a child, and a Band-Aid on the palm.
She saw blood mixed with the baby powder.
Please, please, make it my blood.
Yes—it was her own blood. She had bled around the edges of the Band-Aid. She did not see any monkey bl
ood on her hand.
She put the last glove under the faucet. The water was running, and it filled up the glove. The glove swelled up like a water balloon. She dreaded the sudden appearance of a thread of water squirting from the glove, the telltale of a leak, a sign that her life was over. The glove fattened and held. No leaks.
Suddenly her legs collapsed. She fell against the cinder-block wall and slid down it, feeling as if she had been punched in the stomach. She came to rest on the hatbox, the biohazard box that someone had been using as a chair. Her legs kicked out, and she went limp and leaned back against the wall. That was how Tony Johnson found her when he emerged from the air lock.
The accident report concluded that Major N. Jaax had not been exposed to Ebola virus. Her last glove had remained intact, and since everyone believed that the agent was transmitted through direct contact with blood and bodily fluids, there did not seem to be any way for it to have entered her bloodstream, even though it had breached her space suit. She drove home that night having escaped the Slammer by the skin of her last glove. She had almost caught Ebola from a dead monkey, who had caught it from a young woman named Mayinga, who had caught it from a nun who had crashed and bled out in the jungles of Zaire in years gone by.
She called Jerry that night in Texas. “Guess what? I had this little problem today. I had a near-Ebola experience.” She told him what had happened.
He was appalled. “God-damn it, Nancy! I told you not to get involved with that Ebola virus! That fucking Ebola!” And he went into a ten-minute diatribe about the dangers of doing hot work in a space suit, especially with Ebola.
She remained calm and did not argue with him. She realized he wasn’t angry with her, just scared. She let Jerry run on, and when he had gotten it all out of his system and was starting to taper off, she told him that she felt confident that everything was going to be all right.
The Hot Zone Page 7