Alan E. Nourse - The Fourth Horseman

by Alan Edward Nourse

  A buzz of conversation, then, when Monique had finished. A flurry of questions, mostly for background and detail. A pro forma request for dissenting opinions from the others on her team, with none forthcoming. Finally Carlos stood up. "Well, my friends, now it's our turn. I'm going to start by briefing you on how it is out in the real world in Canon City, Colorado, and about a dozen other brush-fire sites in four states. Then we're going to sit down and brainstorm exactly what we're going to do to break this thing in half wherever it's turned up."

  With Carlos at the head of the table, they turned to the disease at hand.

  27

  After the Fort Collins council, one thing was frightfully clear: they were no longer fighting brush fires. They were facing a major conflagration that required a massive and vigorous field operation to break it, and once the real nature of the fight was defined, the battle moved fast. The goals and motivations were all just right: faced with a mutant plague, they had to stop it fast and they had to stop it cold, because every one of them knew without any reminder from Carlos that the only way they would stop it at all would be while it was small and localized. Excise a small nest of cancer cells early in the tumor's life and you can kill the cancer; let it spread beyond its immediate confines and you have lost the fight most bitterly.

  The battle plan, in its essence, was simple and straightforward: localize, isolate, inoculate, medicate, tabulate. In its execution, it was a staggering task. In many places in the world, it might have been easy: the government would declare martial law, order out the army, tanks, sten guns and armored cars to block all roads and highways: airports would be shut down; rough men would pull citizens' IDs; curfews would be declared, orders of command given out and the region blockaded within twenty-four hours. So it could be in some places, but not in south-central Colorado: in a real sense the price of freedom is—freedom. Carlos and his people did the best they could within the limits of established law. All Wilderness Areas and National Forests in the region were closed by Forest Service edict (the timber companies screamed, but the wives of the loggers did not). All secondary roads were blockaded by the State Patrol on grounds of local emergency and traffic on major highways was stopped and screened to discourage the ingress of tourists and sightseers and the egress of possibly infected people. It was not a matter of law or force but of reasonable persuasion, and it mostly worked; word got out about three-hour delays at the roadblocks and dissuaded many; and at each roadblock a team of CDC Shoeleather Boys were on hand with vaccine for immunization and antibiotics for prophylaxis, however unsatisfactory these agents may have been.

  In times of crisis a single voice of sweet reason can counteract panic, and help of a vital nature came from one unexpected direction—the local Canon City newspaper, with a public-information campaign that was just at that time beginning to make itself felt through the person of thirty-three-year-old Terry Linder. For the past five years Linder had been the editor of the Canon City Record, circulation 14,300 copies, a weekly tabloid that served many of the small communities that had been stricken. Linder dealt only with local news, generally, since the Denver papers reached everybody anyway, but this did not minimize his stature as a responsible reporter. He was a large man in a small job, quietly and competently bringing his readers news and editorial opinion of interest to them, and his quiet writings were known, liked and believed throughout the region. Infuriated beyond words by the destructive TV spectacular that had broken earlier, Terry had spent a long evening with Carlos Quintana over a bottle of middling good whiskey, and then had gone to his typewriter and quietly and calmly written a long discussion of the truth of the situation for his circulation to read. When Carlos saw it, he had leaped into the air and clicked his heels: it was exactly what was needed—a sober, true account of the real risks, the real dangers, the useful precautions people could take, the folly of trying to flee, the work the CDC was really doing. Carlos urged Terry to print off twenty thousand extra copies of the page with the story on it and gave handfuls to his Shoeleather Boys to distribute far and wide. Immediately Terry wrote an update, and then the CDC subsidized a special issue with a more detailed report and again helped distribute an extra printing. People all over southern Colorado stood outside their post-office windows to read it; banks in the region had it prominently posted, as well as all the supermarkets, hardware stores and grade schools.

  Terry Linder wrote only one more update, a week later, off press just after the Fort Collins meeting and just as the campaign began in full strength. It was a voice crying in the wilderness, a voice of reason that people read and listened to. By then the wire services were picking out sections of this material, far superior to the sorry stuff their own reporters were providing, and publishing it in far-flung national newspapers; and then one wire service, at least, headlined a small supplementary item, datelined Canon City, Colorado, when Terry Linder died painfully in his bed of the bubonic form of plague in the middle of the third week of the affliction.

  Other steps of the campaign moved into full swing. Stockpiles of plague vaccine from throughout the West, never in too great supply, came in by special plane. Sources in the East were also tapped, and the manufacturers, with considerable reluctance and at special-order price guarantees, agreed to step up production, using the plague bacteria strains they had on hand. There was never enough to go around, so Carlos arid Roger Salmon each day determined a priority list—who should get what from the amount available that day, who should wait until the batch turned up from San Diego tomorrow (well, they promised tomorrow, but then the day before they promised today)—while Ted Bettendorf in Atlanta spent hours and days on the tele-' phone trying to spring more from health agencies that suddenly and inexplicably wanted to keep what little supply they had at home. . . . The antibiotic supply, by that time, was a little better in hand; Parke-Davis was pulling in chloramphenicol from all over Mexico, where it was far more heavily used than in the States; streptomycin continued to arrive from all corners; and there were so many cartons, crates and hampers full of useless tetracycline that everybody kept tripping over them.

  As for the new antibiotic, identified only as Sealey 3147, Carlos had a jubilant call from Monique toward the end of the week. "Carlos, baby, we've got a weapon! This Sealey stuff is dynamite. It stops this bug cold on the plates and it stops it in the animals. Effective blood levels in twelve hours on oral doses, and it seems to be deadly to the bug. If it's started within two or three hours of onset of fever, recovery rate is over fifty percent, and I think it'll be even better if we start it earlier."

  "And how deadly is it to the animals?" Carlos said.

  "You mean toxicity? Nothing that we've been able to see; it looks as harmless as aspirin. Sealey's production man, Man-cini, has been hanging over my shoulder, and he and Ted have gotten a special experimental-use order cleared with the FDA. Ted says we should go with it if you agree—use will be up to you—so Mancini is on his way down there to set things up with you."

  Mr. Mancini arrived in Canon City that night, a short, heavy, black-haired man with yellow eyes and lips twisted into a perpetual snarl around a set of badly protuberant teeth. He was accompanied by an even shorter, rounder man with a gray face and a gray suit, gray hat and gray tie to match. Mancini introduced himself, obviously ill at ease, obviously not wishing to be where he was at that moment nor anywhere near it. "Vice-President, Production, Sealey Labs," he said. "You're Quintana, I take it." Carlos acknowledged the fact. Mancini waved a thumb at his globular gray shadow. "This is Lunch, legal staff. Untested drag, liability problems, you know how it is. Okay, your woman in Fort Collins says you want supplies of 3147, experimental protocol. How much do you want?"

  Carlos told him how much, for openers. "Then it'll depend on what happens. We're in up to the neck here, and the old drugs don't work. If this one does, we're going to need it."

  Mancini scowled. "We're not in production, you know. We pulled this off the shelf because Bettendorf asked us to shake our slee
ves. Totally untested beyond routine screenings. If we gear up, it'll cost money."

  "Then it'll cost money," Carlos said.

  "Okay, as long as you understand." Mancini started to turn away.

  "Records," said Mr. Lunch.

  "Yes, there's that," Mancini said. "We'll need copies of all your clinical records, patient names, histories, doses, responses, side effects. Can't waste a good clinical test, with the FDA to fsght later."

  "All right, we'll get you the records," Carlos said. "Just get the drug out here. Air freight to Denver and our chopper will pick it up—"

  "Shipping cost," said Mr. Lunch.

  "Yes, you bear the air-freight cost FOB Indianapolis."

  Carlos's fingers began twitching. "Shipping costs. Anything else?"

  "Limitations," said Mr. Lunch.

  "I nearly forgot," said Mr. Mancini, presenting a sheaf of papers. "A few FDA restrictions under the experimental-use protocol. Maybe you can iron them out."

  The restrictions, as it turned out, ran to four legal-sized pages, spelling out a series of special extenuating circumstances under which the new drug could and could not be used—circumstances Carlos found so extremely limiting as to be ridiculous to try to cope with in a swift, hard-fought field campaign against a deadly killer, and he spent most of that night and half the next day on the telephone off and on to Bettendorf in Atlanta and the FDA people in Washington and half a dozen others concerned before finally gaining permission for him personally (but no one else) to dispense the drug according to his own best judgment over and above the restrictions and limitations of the experimental protocol when he determined that it was necessary. Mancini had a small stock of the drug on hand in Canon City within twenty-four hours, with more to follow as soon as possible, while he and Mr. Lunch remained on hand and underfoot to monitor its use, and Carlos, soberly mindful of the limb the CDC had been forced out upon, reserved the supply solely for those persons actively and unmistakably ill with the plague. It seemed, on the basis of first experience, that Sealey 3147 might not prove to be quite the clinical triumph it had appeared to be in Monique's laboratoiy; most people who took it became violently nauseated after the second or third dose, and it made people's hair come out by the handful, and it seemed, in some cases, to interfere, to some degree, with visual acuity—but it also seemed, on the basis of initial field data, to turn advanced cases of plague around where nothing else would, at least in some cases. At any rate, Carlos reflected, it was—well—a weapon. . . .

  Field stations were established. Carlos commandeered time on the local radio station, and soon lines of people were forming at the field stations for vaccine or prophylactic antibiotics or both. It was twenty-hour-a-day work for everybody, and there were questions, because the campaign became a focus of national television and news coverage, and inevitably questions were raised, irrelevant questions mostly, but questions just the same. Nor did the campaign escape international attention. The British press was restrained and sympathetic, but British customs began quietly but firmly checking all American passport holders to determine what prospective enterers had been in Colorado, checking those for vaccine and prophylactic medication and determining closely where they were going and for how long. Reuters reported a terse preliminary report from Tass that a plague outbreak had been confirmed in Denver (incorrect, but close enough for Tass); a later Tass report, in much greater detail, charged that the outbreak was confirmed "by informed sources" to have resulted from leakage of the organism from a huge stockpile of bacteriological warfare agents illegally maintained by the United States government in underground vaults in the central Rocky Mountains. Carlos read the reports and sighed and answered questions and moved like a scourge from field station to field station, looking for holes, finding holes, plugging holes, like a dike with too, too many leaks in it, and snatching each morning's tabulations of new cases discovered, contacts covered, old cases dead, old cases still surviving, cases medicated with what, contacts vaccinated and when, contacts not vaccinated and why not, plotting the graphs, watching for the sign he was watching for, watching for everything, anything that would tell him what he wanted to know, talking to Atlanta, talking to Denver, talking to New York. . . .

  Through it all Frank Barrington worked as Carlos's ex officio first lieutenant, learning skills strange and unnatural to a forester: how to autoclave old-fashioned glass syringes from time to time when the current supply of plastic throwaways gave out; how to give subcutaneous injections without arousing the ire of the injectee; how to do brief physical examinations for evidence of lymphadenopathy or subcutaneous hemorrhage; how to run statistical analyses of raw data and apply the appropriate statistical rules and calculate standard deviations; how to drive cases of pharmaceuticals in the back of a pickup over rocky, rutted mountain roads without smashing every package in the load; how to face a wire-service reporter and talk as if he were a doctor and make the reporter believe it—a dozen diverse activities including ringing hundreds of doorbells and transporting thousands of people to the field centers when necessary. On three occasions when materials had to go to Fort Collins to Monique's attention, Frank elected himself chief courier, rather peremptorily, leaving Carlos staring thoughtfully at him as he went out the door, but Carlos—perhaps curiously—did not argue this self-appointment.

  A week passed and the upward curve of the statistics continued to climb. Nothing seemed to be happening, and bit by bit the tension and long hours and the incessant drive, drive, drive, began to wear through Carlos's implacable calm and good cheer; more and more he became snappish, irritable, impatient with the holes that had to be plugged. There were times of brooding, as though his built-in fatalism was slowly closing in on him like a shroud, until he shook it off and got moving again. He told himself it was still too early, that all they were doing couldn't show effect overnight, but something mocking in his mind kept saying, You started too late, you didn 7 move fast enough, and he found no way to argue. Two days into the next week after the Fort Collins meetings, there was still no pattern—nor in three days, nor in four days. Mr. Mancini and Mr. Lunch did not add to his general peace of mind; they hung about the wings like a pair of ever-patient vultures. Mr. Mancini spoke only to Carlos, and then very seldom indeed; Mr. Lunch spoke to no one, not even Mr. Mancini, but maintained a gray globular presence—until one day both of them vanished, without preamble, and Carlos heaved an enormous sigh, as if a staggering weight had been lifted from his back, and moved on. . . .

  Then, just after 3:00 a.m. on the fifth day of the second week, the young intern who was handling the raw tabulations broke Carlos out of a dead sleep and thrust papers into his hand. "I couldn't wait," he said. "I just finished them."

  The new case figures were the same as for the day before. For the first day since the beginning they weren't higher than the day before. In addition, old case survivals were up a whisker—more known victims had survived longer after onset of symptoms than any previous day.

  Carlos whooped and hugged the young man. "Go home to bed. Let me go over these. It could be a fluke, there's always a bobble in the curve now and then. But let me just study them. You go to bed."

  He was up the rest of the night, too excited to sleep. He went over the figures, paced the floor. It could mean—Yes, yes, it could, but it's more likely a fluke. You can't make a federal case out of one day's raw figures. But if it were—

  The next day he haunted the headquarters field station, where the raw data filtered in, unable to tear himself away to check—or indeed think—about anything else. This time he worked with the intern and half a dozen others in an atmosphere of growing excitement, although he had said nothing and warned the intern not to. They wrapped up the raw figures by midnight, waiting for final data from Pineville and McCardle, and Las Madres down in New Mexico. And this time there was a drop in new case reports, small but real, and a larger rise in case survival.

  At 1:30 in the morning Carlos and the intern drove to Colorado Springs to an
all-night steak house and each had a huge steak. "Don't say a word," Carlos told the youngster, almost unable to contain himself. "Just keep your mouth shut one more day. It's like it was with the old vacuum-tube computers—you could never trust them. What they told you once from some data was very likely wrong. What they told you twice could still be wrong. But what they told you three times was true. One more day."

  They ate in silence. Then the intern said, "Something I've never understood. Why didn't it take off up in Seattle or We-natchee the way it took off here?"

  Carlos threw up his hands. "Who can say? Not enough cases and contacts, probably. Nearly everybody the girl, the index case, infected, came down here. The few that were nailed from her were identified, and good isolation techniques were used. But basically, it had to be a matter of numbers. Even with a virulent mutant bug like this one you need a certain threshold number of cases for it to perpetuate itself and move. Somehow, they didn't cross the threshold—the flash point—up there. I don't know why. Sheer blind luck, maybe. ..."

  Next day, again, the vigil. Word was out that something was up, something was about to break, and a large number of people began drifting to the headquarters station, more and more as midnight approached. Carlos checked and double-checked the tabulated figures, and the figures told him three times. He went out to the waiting team members, his hands trembling with excitement. "Okay, my friends, this is official: we've crested. The figures confirm it. We've broken the back of this bastard, and you can all take the credit."

  There was no cheering, just one huge collective sigh. The fight had been too hard and bitter, the enemy too murderous, to cheer. The people turned to each other, talking quietly. "However, " Carlos said, and they stopped talking. "This does not mean we can quit. It means we work harder than ever. The mop-up is the toughest part, and here it has to be very thorough. Okay? Get some rest and tomorrow we'll arrange things to see the mop-up gets done exactly right."