Alan E. Nourse - The Fourth Horseman

by Alan Edward Nourse

  31

  In Canon City, Colorado, Madge Miller, twenty-nine-year-old housewife, got out of bed on yet another bright September morning and looked out at the brilliant sunshine as though peering through an ever-darkening screen.

  It wasn't that she couldn't see, exactly. The images were quite sharp and clear—that tree, that street, that pickup driving by—but the total light, day by day, was receding to a dim twilight. A week ago colors were largely gone, as though a color print, fully developed, were unaccountably darkening and fading and turning to black and white. The change had been going on for two weeks now, ever since she had begun pulling out of the plague infection that had nearly killed her. The doctor had a name for what was going on, retinitis pigmentosa, he called it, where cells in the retina slowly collect an abnormal pigment and cease to respond to light. There was nothing to be done, he'd told her. Maybe it was just a temporary reaction to the new medicine they'd given herforthe plague—and after all, she had survived when a lot of others hadn't, he'd said. Probably it wouldn't last, he'd said. Maybe it would just go away, pretty soon; but then, again, maybe it wouldn't. He really didn't know.

  And meantime, Madge Miller couldn't drink her morning coffee, either. She slopped it all over the table tiying to get the cup to her mouth. Along with the dimming of her vision, her hands had begun to shake. Not when she rested them in her lap, they were just fine then. It was only when she started to move them, to reach for something—then they started shaking, and shook worse and worse the closer she got to what she was reaching for. An intention tremor, the doctor called it, and he didn't know what caused that, either. It was a little like Parkinson's disease, he said, but he didn't think it was that. She was awfully young to get Parkinson's disease. It would probably go away, he assured her, he didn't see any reason it wouldn't, but if it got any worse, he'd have her try some L-Dopa and see if that helped any. Meanwhile, she could use one of those plastic straws to drink her coffee with and probably do okay—And to pour the coffee, doctor? Can I do that with a straw? Or sign checks? Or wash dishes? Or change the baby? Or stroke Jerry to get him hard these days when he's almost scared to come near me ? Can I do these things with a plastic straw?

  Madge Miller stared out at the dark sunny street for a long time, her hands at rest at her sides. The medicine had saved her from a fast, dirty death, all right—she knew that. But now, for the first time, she was beginning to wonder what, exactly, she had won. . . .

  32

  It was abundantly clear to Carlos Quintana that the major problem in Savannah, when the plague first appeared there, had been that the index of suspicion was appallingly low. There was simply nobody there who had thought of it quickly enough.

  Cholera would have been nailed down in twenty-four hours, typhoid fever in forty-eight. Yellow fever, certainly, who could miss that? Malaria—of course. But plague? Preposterous. Of course, they'd heard reports of the trouble out in Colorado or Wyoming or someplace, but that was the sort of low-grade endemic sylvan plague from wild rodents that kept turning up in those remote parts all the time, wasn't it? A sort of a local flareup, out there, they assumed, and who paid attention to patches from a TV scare story? As for Savannah, they hadn't had a case of plague there since—since—since when? Hell, they hadn't ever had a case of plague there. Period.

  Index of suspicion has always been a vital factor when it comes to making an obscure diagnosis. As Carlos pointed out later to Jack Cheney, "It's really very simple—you have to think of it to diagnose it. A doctor in this country is never going to think of loa-Ioa when his patient complains about something crawling around under his skin. There isn't any loa-loa in North America, that I ever heard of. He's not going to think of yaws when a patient turns up with a festering leg ulcer, either—he's going to think of varicose veins. And before the Vietnam refugees started coming over, most local docs would have missed primary leprosy until their patients' fingers dropped off. You think of things that are familiar and likely, you don't think of things that just don't happen. ..."

  Whatever the reason, Carlos saw clearly, the reality of plague in Savannah had been missed for far too long. He arrived on the scene much too late for any hope of tracing elements and events back to their index sources; it would have been folly to have tried. But if he had made up a scenario out of whole cloth, the things that had actually happened would have fit into his imaginary screenplay with uncanny accuracy.

  The truth was that the dance of death Chet Benoliel had triggered in Savannah some three weeks before had played to an indifferent audience at first. Two men from Sundown Explorations, Inc., wisely dispatched to Savannah to back Chet up at that critical oil-executive meeting at the Hyatt, had found Chet's body at the Hilton Head condominium after he had failed to make any appearance at all at the appointed time. They had found his clothes and the car-rental packet in his hotel room, and figured that Hilton Head was where he had gone.

  They'd expected to find him stoned giddy and shacked up with a whore; when they found him alone and dead instead, it shook them up a little, and they checked with the home office fast. After considerable hasty debate, they followed orders and turned things over to the local constabulaiy. The investigation was perfunctory; he'd been rolled but not knifed, and it didn't really look like homicide. The local coroner wrote it off as bilateral lobar pneumonia with pulmonary hemorrhage—reasonably close, without benefit of autopsy, but still half a light-year away from the answer. The coroner released the body to a Savannah mortuary, where he was cremated and buried in some inexpensive niche somewhere, courtesy of Sundown Explorations, Inc., who sent a bunch of flowers to his mother in Cincinnati and thanked the Almighty that they'd had wit enough to send backup men to nail down that meeting. All told, including the two backup men, two police, a detective, a doctor, a coroner, a mortician and sundry ambulance attendants and hotel clerks, Chet Benoliel had exposed a total of nineteen people to a virulent bacteria before they got him tucked away, all nineteen of them in a state of wide-open susceptibility.

  Shari Adams did much better. After ditching the car and getting a few hours sleep, Shari had turned up for the dinner shift at the restaurant feeling vaguely unwell, a state she chalked up to her unsettling experience the evening before. Since things were slow, she went home early and straight to bed. That night she had trouble with the bedbugs in her mattress again, quite a bit of trouble, to judge from the bites she found on her legs and arms. It was an old story—she'd been fighting these "bedbugs" in her mattress for months, every time she spraiyed the damned things they just went away for a day or two and then they were right back again, which was not really surprising considering that they were actually not bedbugs at all, but the fleas which she shared with the rats which she knew sublimi-nally were always around the place and which, at the moment, were sharing her mattress with her, scuttling out of their warm, cozy nest inside and into the baseboards whenever she got into bed, just waiting for her to leave again for them to return. They were large, black Norway rats, the kind that were thriving in swarms all around the riverfront area despite Savannah's vigorous rodent-control program, and their fleas were largely indifferent to the species they bit, man or Rattus, as long as whatever they bit had blood in it.

  The second morning Shari almost didn't go to work. She felt feverish, and she was coughing—but she was down for the lunch shift that day, and the boss had been getting nasty about her absences, and it was too good a source for paying dates to let the job go, so she dragged herself out of bed, gave the mattress another spray with bug killer and went to work. All day long she was coughing—into the hand that carried the plates, into her sleeve, into a clean napkin that she swiftly replaced on a fresh-set table, into the other waitresses' faces, into the customers' faces, into the food—coughing, coughing, coughing. She waited on a total of thirty-seven people on that shift as well as coming in close contact with the boss, the boss's wife, seven other waitresses and everybody in the kitchen. She was chilling and spitting some blood by the
time she got off and dragged her way home, completely forgetting the after-hours date she had made with the young visiting tennis pro at lunchtime—too bad. He'd thought himself pretty lucky when she'd coyly agreed to the date, and he would never know how fantastically lucky he was that he'd leaned down to pick up his napkin just as she started to cough in his face. . . .

  Shari was not remembering much of anything by the time she got to her room and flopped into bed in her bra and panties, leaving her uniform on the floor where it fell. She was shaking and burning at the same time, so constantly thirsty she brought a pitcher of water to the bedside and emptied it in an hour, coughing and panting and pouring sweat. She slept a little, waking up to horrible nightmares. About two o'clock she dropped off for an hour and a half but woke up shaking violently and nearly suffocating. Delirious by now, she wasn't entirely certain where she was; something in her mind urged her to go tell her boss she couldn't come to work in the morning. Finally, at 3:30 a.m. she pulled herself out of bed and started out the door into the hall and fled down the stairs in a final feverish fugue.

  In the warm outdoor air she made her way down to the riverfront, still wearing the bra and panties, but the restaurant was closed when she got there. A car swinging around a curve on River Drive nearly struck her, then squealed to a stop as the occupants saw her lurching up the street. Terrified, she fled up a narrow file between warehouse buildings, up a steep stone stairway barely wide enough to permit passage, onto a dark middle-level ramp of Factor's Walk. Thinking she heard shouts and footsteps behind her, she rushed on up the ramp, ducked through a stone passageway to a place where another up ramp passed through a tunnel to higher ground. Stumbling over garbage and trash in the way, she reached a point where she thought she could leap up onto the next higher ramp directly, failing to notice the heavy, nisty overhead davit that once had lifted cotton bales from the loaded wagons and lowered them onto handcarts for transfer into the warehouse. She leaped and struck the davit with her forehead and crumpled down into a trash-filled crevice between the ramps, two feet wide and five feet deep. Four rats scuttled out from under her as she fell and struck bottom; they waited until they saw that she did not stir before returning to their hidey-hole. Of course no one had been shouting or following her, but it didn't matter to Shari anymore. A secretary making her way up the ramps toward her job at an architect's office found her at eight in the morning, lying in the crevice in her bra and panties with one arm upraised, her skin blotched and mottled with purple. In her short and terminal illness, Shari Adams had left behind her no fewer than fifty seriously contaminated people, a contaminated room in a tenement lodging house and a random selection of very sick rats.

  Nobody recognized Shari Adams as an index case of plague, any more than they recognized Chet Benoliel or Althea Willis as anything but normal, if sad and untimely, deaths. Downtown cops spotted Shari in the morgue as a familiar part-time hooker who worked out of the Seafood Express down on River Street; they knew her well enough from the string of minor arrests that had always left Shari free on the street but invariably poorer. "Musta run into somebody she couldn't handle," one of the cops remarked after a glance at the bruised and battered body. "But then, they're always on the thin edge, those babes."

  Nor did anybody see anything odd a week later, at the beginning of a late summer heatwave, when a whole scattering of hemorrhagic pneumonia cases began to surface here and there throughout the city, no particular area, except that more seemed to come from the River Street area and the west side of Forsythe

  Park than elsewhere. Bacterial pneumonia isn't generally reported—-nor even noticed much—unless somebody later reviews the death certificates. It was not until some local doctors and nurses and hospital personnel began succumbing that the Public Health Department in Chatham County, Georgia, already short-staffed because everybody had fled the steamy coastal area on vacation, began to realize that they had a very real epidemic of something very nasty on their hands and began wondering for the first time just what it might be. And only then, after the original coals had already spread into a hundred smoldering pockets of fire, did the culture plates and fermentation tubes and the immunofluorescent assays begin to spell plague in large red letters, and the Chatham County Public Health Director, Jack Cheney, begin figuring out what had really happened and came up with the astounding statistics that had greeted Carlos on his arrival: that probably-identified cases of plague had leaped from two or three cases on one day to more than five hundred on the next—and the health workers who had been frantically called back from their vacations began trickling reluctantly back to the city and found themselves facing a nightmare.

  Dr. Jack Cheney had a crash planning session already set up when Carlos and his team from CDC arrived—top people from the Health Department, the President of the Chatham County Medical Society, people from the Mayor's office in charge of public relations, the chief of police, two dozen other people. It was early in the morning; Carlos had had just two hours' sleep, and felt bleary and strangely out of touch with reality. He soon found the others were too, only more so. "Okay, folks," he started off, "let's begin with some basics. As I was coming in here I heard somebody say that our first job would be to keep this thing from getting out of control. Well, it's already far past that point. From the figures Dr. Cheney has shown me, we're already dealing with an epidemic disease that is badly out of control, by definition. It's here, it's moving fast, and nobody is controlling it. And with the head start it's got, it's going to be a lot worse before we get a handle on it, no matter how fast we move or what we do."

  There was muttering in the room, city leaders eyeing each other, sounds of skepticism. Damned doom-singer from Atlanta coming down here—"Do you really think it's going to be all that bad?" somebody asked.

  "If this outbreak is related to the one in Colorado," Carlos said, "it's going to be worse than anything you ever dreamed of. That's one of the first things we've got to find out. Out there we had wide-open spaces, low population density. Here people are packed in cheek by jowl. If it's the same mutant organism here, we're in serious trouble. ..."

  More mutters, and louder—They really don't believe it, Carlos thought as he burrowed into the planning, trying to force people to be convinced that there was real trouble afoot. Protection for the health workers was a first and obvious step, but Jack Cheney hadn't even started planning for that. Only fifty doses of the old protective vaccine in the whole city, the big companies like Merck and Lilly were both working on a vaccine specifically for the mutant strain, but no guessing when it would be ready. No stockpile at all of the new Sealey antibiotic drug to use for treating people who had been hit—Just have to get Ted Bettendorf to work blasting that loose, and use the chloramphenicol and streptomycin we have as a stopgap. . . .

  A long, hard day of planning with people who didn't really believe what was happening. Time spent urging Jack Cheney to get some kind of microbiology lab working—Monique, where are you now when we need you? A long, hard fight with the local hospital administrators to square away plans for one hospital for plague victims alone—Did you say a whole hospital?— and finally settling on the big Civic Center Performing Arts Pavillion to use as an emergency hospital to handle as many victims as' possible, with Jack Cheney directing the setup. A long, hard fight with the city police and State Patrol, trying to plan some way of controlling people and activities without imposing a de facto martial law, which absolutely nobody wanted to try to impose on a hot, frightened city like Savannah. A long, hard fight with the communications people, trying to plan some fail-safe method for getting official notices and vital information out to the most people the fastest. In fact, a long, hard fight with practically everybody there, right down to the rodent-control people, who couldn't or wouldn't seriously believe that Carlos was, indeed, planning to go after the rats with as much dispatch and vigor as possible. . . .

  He plowed through it all, through the whole long, grinding morning and late into the afternoon, a
rguing and cajoling and warning and pleading, and above all, planning the direction of battle. About four-thirty Jack cornered Carlos with some updated figures on probable cases to date, looking sober-eyed and white around the mouth. "I've finally got a teani going that's taking this seriously," he said, "and I'm afraid that figure of five hundred cases I quoted you this morning should be closer to two thousand. Christ alone knows how many unreported pneumonia deaths there were in the same period. But if these figures are even close, it has to be your mutant bug that's doing it."

  "Yes, it's the Colorado bug," Carlos agreed.

  "Well, I'll keep them digging and get them onto suspicious septicemias as well. I assume you do want them to keep on digging. . . ."

  Carlos smiled and clapped the man on the arm, sensing at least one solid ally who was beginning to come alive. "If I had to guess, I'd guess the real figure is almost double the numbers you've got there, early on like this. Later on, the proportion will flip-flop, when people get scared and start blaming eveiy runny nose on plague. But yes, by all means keep your people working, Jack, and you stick around, too. We've got a night's work ahead of us dying to coordinate this mess into some kind of rational program. ..."

  By late afternoon it was blindingly clear to Carlos that he was going to have to tackle the medical-supply problem at once, and head-on. Preventive vaccine and antibiotic drugs were both going to be utterly essential, and the sooner he knew how much of each was on the way the better. First he spent an hour on Jack Cheney's office phone tiying to reach the right people at Lilly and Merck and the other vaccine-manufacturing outlets. Oh, yes, they assured him, production was continuing on batches of the old vaccine, and they could round up pretty good stockpiles within a few days—well, at least within a few weeks. As for the new vaccine being made from the mutant Yersinia strain, Carlos encountered nothing but evasions and vaguenesses from the vaccine makers. That first test batch had been totally consumed in Canon City, and no one could seem to say whether more was being actively processed or not. No one could even seem to tell him if the drug houses had consulted with the FDA on emergency-production protocols—or even intended to. Carlos finally threw down the phone in exasperation, recognizing determined, obdurate stonewalling when it walked up and kicked him. Bettendorfis just going to have to get on this, he thought. I can't spend the next week talking to a bunch of nitwits who are not going to tell me anything whatsoever until the sky falls in. . . .