Shiki: Volume 2

by Fuyumi Ono

  Taking Ishida's car back to the hospital, Toshio held up his recently unused umbrella and jogged across the grounds. Trying to find a place for his feet to fall that wasn't a puddle of water proved difficult. When he stepped into the white Corolla, he was already soaked from the knees down.

  Ishida slid into the driver's side and closed the door. With the sounds of the rain now sounding a bit far off, the inside of the car had the air of a locked room.

  "...Ishida-san, I want to discuss something with you."

  Yes, Ishida asked, starting the engine and turning to look at Toshio.

  "This case; could I have you keep it quiet for a while?"

  "Yes, but of course."

  Toshio looked to the front pane of glass fogged by moisture out into the darkness and the rain of the grounds as he spoke.

  "That's not what I mean. For a while, I want you to hold off on reporting to your superiors. Until I say it's okay, I don't want you to send anything out of Sotoba."

  Ishida blinked. Cutting off Ishida before he could day 'but', Toshio urged him to start driving. For the short distance to the Ozaki clinic he said nothing, opening his mouth only once they were at their destination. In the parking lot at night, in the curtain of rain that left nothing to be seen, the inside of the car was a completely isolated world.

  "...Ishida-san. To tell the truth, I think it's a plague. I dare say I'm sure of it. And no common one. I researched and researched, but no epidemic that matches the symptoms was found."

  "You can't mean a new strain?"

  "A new strain or a variant strain, I can't tell. It's possible that it just simply looks that way, but. At any rate, what's certain is that this is a something momentous. Just looking at the victims we can see, they have a terrifyingly high mortality rate. Of course, there might be those with a sub-clinical infection. An outbreak that healed without anybody noticing is a possibility. But when that's not the case, it takes a sudden turn for the worse, and they die right away without any opening for treatment. And looking at just the death certificates, by the time it's at the level where anybody could notice the symptoms, it's already too far gone to do a thing about it."

  Ishida's throat suddenly, audibly tightened.

  "I don't know if it's sure to break out if someone's infected. But, I'm under the impression that once it breaks out, it's out of my hands. Starting in Yamairi, Sotoba's been contaminated. Like that, it'd been spreading."

  "Y... yeah, yes."

  "You report this to the administration. You do that, and what do you think will happen?"

  "What, you say...."

  "If at the end of the day it was a known epidemic, there'd be nothing to fear. I have an obligation to report, too. I can't just stay quiet. But if this is like I said before a new strain, what then? In that case, what can the administration do?"

  Ishida moaned deep in his throat.

  "...They can't do anything. As long as it isn't covered under the Communicative Diseases Prevention Law, or it isn't food poisoning with means determined by the food hygiene laws, there isn't any guideline for how to handle it."

  "That's it exactly. In this case, it's not food poisoning. What's covered by the Communicative Diseases Prevention Law?"

  "Uhm...."

  "Eleven infectious diseases requiring official reporting, two kinds of specified communicable diseases, twelve a physician is required to report within twenty four hours of diagnosis, the Parasite Prevention Law, the Tuberculous Control Law, one counts under the Leprosy Prevention Law, the Venereal Disease Prevention Law covers four, for a sum of thirty-two types covered. Furthermore of those infectious diseases that are regulated to be kept under surveillance, none overlap with those thirty-two. ---If it's one of those, there's no problem. Even if it's a variant strain. But, if that's not the case? Of course the administration has to do something."

  "Yes...."

  Ishida was shivering. That was correct. If there was no legal method of handling it the only thing to do would be to isolate the patients. The doctors and administration couldn't very well ignore the person's wishes and strap them down!

  "When it comes to giving them an honorable little push for assistance, we can't count on the Kanemasa's son. It's just like you said. It'd be good if the predecessor was still alive. Even if this gets out we can't count on the administration's help. And that's not all. If this is a new strain of disease, and if it is one that spreads by direct transmission, what do you think's gonna happen?"

  "...I don't know."

  "Look at what happened with Ebola and you get the idea, don't you? They shut it in. It gets out that there's an unknown epidemic spreading through Sotoba. After that the first thing to do to try to contain it is to isolate it. Sotoba's quarantined, patients are kept from leaking out. If there's no legal basis to do that on, then there's no stopping it from being done in some underhanded fashion. The administration and the Medical Association could collude and move to have Sotoba kept on the down low, handled behind the scenes. That'd be the only way it could go."

  "Yes, that's correct."

  "Certainly, with that you could protect against it spreading. It's especially valid when it comes to containing an epidemic with as high a fatality rate as this one. But, Sotoba can't be saved like that, Ishida-san. It's like waiting for a fire to burn itself out without sending in a fire truck. If there's not a blade of grass left to burn, the fire might naturally die out but what's that mean for Sotoba?"

  Ishida nodded.

  "I by no means want to hush up the situation. If it is an infectious disease we're legally required to report, I have that obligation too, and of course the minute it's identified as one I'll report it. If I can convey that it's not spread by direct contact, so there'd be no meaning in closing off Sotoba, we'll pass it up to the administration. But, if the source of the contamination really is in Yamairi, if this's an epidemic that's unique to Sotoba, if it turns out to be directly transmitted, it's going to need to be handled with a certain delicacy."

  "I understand what you're saying, Junior Doctor. I understand, but...."

  "If it really does spread by direct contact, even I can think of some ways to handle it. There are ways to independently and cooperatively isolate it, ways to announce it indirectly through the Medical Association. I'm promising that it's going to be handled, so can't you keep it down for just a while for me?"

  Ishida hesitated to respond. As if seeing through his hesitation, Toshio looked at Ishida. His voice was somehow penetratingly cold as he lowered his voice to a whisper.

  "It'd be better if it spreads outside, Ishida-san. If it's something the administration can't help with anyway. If they personally aren't feeling the heat, they won't do a thing. Unless it's to protect themselves, not a damn thing."

  "Junior Doctor."

  "Mount Unzen, Okushiri Island, Matsumoto." Tosho murmured as if reciting a chant. "....If you believe the administration will cooperate to help the people at the scene of the tragedy, I'd like to ask your basis for that belief."

  Ishida opened his mouth, then, hesitatingly, closed it. Taking in Ishida's silence, Toshio opened the passenger side door. The mists and deafening sound of the rain suddenly flowed in.

  "Sorry 'bout this, Ishida-san. I'm counting on you."

  "....Yes, sir."

  Having gotten out of the car, Toshio bent his body down to speak to Ishida. "And also, could you keep this a secret from Seishin? He's an idealist you know, he can't handle balancing good and evil."

  I understand was all Ishida replied.

  Chapter Two

  1

  Nao's results that were requested from the Tajima National Health Institute ASAP were delivered to Toshio's hand the following day just before noon. The rain from the night before had lifted. Again, the sunlight poured in, downright annoyingly.

  Bringing in the results and the coffee, Ritsuko looked over the waiting room that had become piled with books in such a short time and sighed. Answering Ritsuko's question as to whether the ro
om could be cleaned with a retort to do as she pleased, Toshio looked over the results. He laid them side by side with the simple examination results performed at the hospital yesterday.

  It was the same as Megumi's case. All types of blood cells were decreased, as were her hemoglobin and hematocrit levels. Clear signs of anemia. More specifically normocytic normochromic anemia. However, serum bilirubin and LDH levels were normal. With all other values normal, there appeared to be no irregular functioning of the liver or kidney. The results of the Coombs tests were negative. While it was negative, there was no abnormal hemolysis. The same as Megumi. It didn't look like there was anything that could be it besides anemia.

  (Is it really simple anemia, or is it...)

  Last night, he put the peripheral blood smears and the bone marrow sample under a microscope. The blood smear showed an increased reticulocyte count, as well as nucleated red blood cells. Hyperplasia was occurring in the bone marrow but while Toshio was no hematology specialist he found nothing amiss in its form. There was nothing that could be thought of as abnormal other than the blood production levels. Rather, it'd be better to think of it as a release of young red blood cells due to an expenditure of a large quantity of red blood cells.

  (If that's the case)

  Was it lost to internal bleeding, or was it quickly destroyed by hemolysis?

  (It isn't internal bleeding...)

  Neither through palpations nor x-rays were there particular signs of internal bleeding. It didn't look like there was really any swelling of any internal organs either.

  (But, I can't think of it as hemolysis either.)

  The Coombs tests came back negative. It wasn't autoimmune hemolysis, and looking at the images of the blood smear, it wasn't hemolysis stemming from irregular cell shapes either. With serum bilirubin and LDH levels normal, it really couldn't be thought of as hemolysis.

  No matter how many times he thought about it, the more he thought on it , the more each possibility was thoroughly denied. What shouldn't have been happening was happening. Something was strange.

  Deep in thought as Toshio was, for a while he didn't realize that Ritsuko who was sorting the mountains of books had asked him something.

  "---Doctor, are you listening?"

  "Nn? Aa?"

  Ritsuko's expression faintly clouded. "Is she that bad, Nao-san?"

  "Nah. That's not what it is. I just get the feeling the results have a kinda mismatch with common sense. ---So what about what, now?"

  Ritsuko forced a smile. "It wasn't important. I just said it seems that the mountains are crumbling in here and there, aren't they?"

  "Heeh?"

  "Before, Sagawa-san from Naka-Sotoba had come, for treatment. At the Sagawa Ojii-chan's place, which is built facing the western mountain cliff, that cliff gave out and mud came pouring into the house, he said. He was lamenting how hard it was to clean up."

  "Damn---it'd have been just as well if the mud swallowed the whole house and was done with it."

  "Ojii-chan was saying the same himself. The main room was a field of mud but it should have just finished the job, he said. After all, if the whole thing collapses in, it might turn into a crisis."

  "You said it."

  "The northern mountains might be giving too. I heard noises last night you know. As if exposes were being used, 'boom', like."

  "....The northern mountain?"

  Yes, Ritsuko nodded. Ritsuko's house was in Kami-Sotoba. Near the base of the northern mountain.

  "I think it was the northern mountain. Going by the noises, I wonder if it wasn't a major landslide? But, as the northern mountain is the temple's territory, there wouldn't be anybody there, would there."

  That's true, Toshio murmured. Would it be good to let Seishin know? As he thought that, Ritsuko piled up the last book on top of the low table. "I've inserted blank memo sheets into the pages they were open to so you can find where you were again, so don't worry."

  Thanks, Toshio said with a forced smile, then calling out to Ritsuko as she made to step out. "Sorry again, Ricchan. Could you call the construction firm and ask about Nao-san's condition for me? It's fine if it's the family rather than her. Anyway, ask how she is, let them know that if she needs a re-examination, even this evening is fine, so be sure to come."

  Ritsuko's brows furrowed. "Is it that serious....?"

  "It's not for sure it's that bad, I told you that right? The results seem to defy reason in a weird way. I thought we should try re-analyzing her one more time."

  Is that so, Ritsuko said, sounding unsatisfied with the explanation. He called out once again to stop Ritsuko who was leaving, holding the tray.

  "That's right, Ricchan. One more thing. After the break, before the front desk opens could you call everyone together?"

  "Yes?"

  "I was thinking we'd add some appointments into the schedule. Not for all the patients, by any means. Just the patients I specify are fine."

  "Uhm.... starting tomorrow, is it?"

  Toshio nodded. He'd give more precise details when everyone was gathered, so he dismissed, but Ritsuko's expression was somewhat unsettled.

  She must be suspicious, Toshio thought. But that's fine, he said to himself. The hospital staff was on the front lines. Sooner or later, they'd notice the unusual circumstances, and furthermore, since they couldn't help but be on the front lines facing the threat, he couldn't leave it hushed up forever.

  "What do you think this is about?" Ritsuko asked Yasuyo. Yasuyo looked to Kiyomi, exchanging glances, then gravely nodding.

  ".....I knew it. I thought something was strange."

  That's right, Kiyomi said with a sigh. "I got the feeling he's being clearly protective over the young wife of the Yasumoris, too."

  What do you mean? Satoko and Yuki both tilted their heads. Yasuyo resolutely folded her arms.

  "What I mean is, aren't there too many dead around? Yuki-chan, you two might not have noticed but, since this August, it's been unusual."

  "Has it?"

  "It wouldn't be impossible to think that. After all, the patients never came in, all that comes in are notices of their death. And on top of that, early in the mornings. Before we've even come in to work."

  Kiyomi nodded. "In Kami-Sotoba, somebody under forty died, didn't they? And then the three in Yamairi."

  Aa, Yuki and Satoko nodded.

  "And after that, in Shimo-Sotoba, a high school student. From there, Giichi-san, and the mother of the first death."

  Eh, Yuki's eyes were wide. "Seven people? Since August began?"

  "That's just it. I was sure it was something suspicious. Death does tend to come in mysterious patterns but, no matter how you think about it, these are too many in a row."

  "Do you think something's happening?"

  Listening to the two of them, Ritsuko nodded as if thoroughly understanding what the older nurses were saying.

  "I wonder if it isn't an epidemic. At least, the Junior Doctor may be suspecting it. Patients may be coming in with that from here on, and those patients he would want to give preferential examinations."

  "Then, Nao-san is also...."

  "The way he's so vigilant on her, he may suspect it."

  Yuki and Satoko exchanged worried looks.

  "Uhm... I wonder if we'll be all right?"

  "Who knows? But, if it's dangerous, the Junior Doctor would tell us wouldn't he? That he isn't saying anything may mean he has no positive proof yet, but for the time being the hospital's all right, isn't it? That person is, even if only in matters like this, a precise and proper doctor."

  Kiyomi breathed another sigh. "Either way, it'd be better to use disinfectant and be sure to wear gloves at all times. We have to at least be aware of that much."

  Yasuyo nodded. "There's a disease we don't know anything about going around after all. ....It'll be good if it's not too unusual of one, but."

  2

  Seishin stopped his car at the shoulder of the road and looked at the note Toshio made. Th
erein were the listed elements that needed to be investigated.

  The deceased's sex, age, occupation. Education history, standard of living. Household circumstances, particularly if they used well water. Family structure, maritual status, their parents ages, birth order, family medical history. The individual's medical history, if they drank, if they smoked, eating habits, customs. Their daily sphere of activity, particularly their actions throughout July. The note was made out like a form, with what was filled out filled out from their death certificates and the family registers but there were many blanks.