Pathological

by Jinkang Wang

  1979—Africa

  When Mei Yin was ten, her adoptive parents finally finished the last of the paperwork in China, and brought their orphan girl to America, a new and glamorous vista for her. Later, Walt Dickerson brought her on a voyage to Africa, opening yet another landscape before her: undeveloped, beautiful, ravaged by bone-deep poverty and awful epidemics, yet imbued with such strong life . . . All of this, in the end, would sublimate itself into her philosophy of life.

  It was the summer of 1979, and her father brought her to the Serengeti National Park to see wild animals—but they found themselves on a very different kind of adventure. The pair took a plane to Wilson Airport in Nairobi. As soon as they reached the gangway, an officer in his forties came over. “Professor Dickerson from the Atlanta CDC? I’m Mr. Smith, the American ambassador to Kenya.”

  Her father smiled. “Yes, I’m Dickerson. I didn’t expect a welcome from the embassy—this is just a private vacation.”

  Mr. Smith smiled grimly. “I’m afraid your vacation will have to be postponed. The CDC’s just sent a telegram, asking me to pass it to you.”

  This message read:

  Deadly epidemic in Yambio, South Sudan. Suspected Ebola. CDC and WHO sending teams ASAP. Prof Dickerson and daughter traveling in Africa. Please inform him necessary to obtain virus specimens from Yambio. Prof knows where to get supplies. Thank you.

  Dickerson did indeed know how to find the necessary supplies. Three years earlier, during the first outbreak of Ebola in Africa, he’d been part of the medical team sent here, and on that occasion they’d left behind equipment, including syringes, glass plates, specimen bottles, hand-operated centrifuges, and so on. They were all stored at a nearby Belgian church, in the church refrigerator (which operated on kerosene, the local electricity supply being none too reliable), along with some blood plasma from recovered victims. The team thought it likely that they’d need these things again before too long, and unfortunately they were right. Dickerson didn’t have a current visa to Sudan, but that wasn’t a problem. Epidemics frequently cross borders, no visa required, and by convention medical response teams were often allowed to use their yellow cards—the WHO’s international certificate of vaccination—to get through immigration. Dickerson paused for a moment after reading the telegram. As an epidemiologist, he was duty-bound to obey, but he had to consider what to do with Cassie.

  Mr. Smith said, “Your daughter is welcome to remain at the embassy, where I will be responsible for her. Is she here to see the wildlife? I can send someone to take her on safari, so her vacation won’t be interrupted.”

  Mei Yin protested. “Dad, I want to go into the epidemic zone with you.”

  Before Dickerson could say anything, Smith exploded in shock. “The epidemic zone? A young girl like you? You don’t know what it’s like there—hell on earth! Even the airlines are refusing to land there, and no drivers are willing to go.”

  Mei Yin said nothing, only looked at her adoptive father. In the few years since she’d arrived in the United States, she’d more or less become an American girl, though the marks of China would never completely fade. She’d never forgotten her biological parents, for instance, and the fact that they’d died of plague had made up her mind to be an epidemiologist like her adoptive father. Dickerson knew this was her ambition, and so said, after another pause, “All right, come with me.” Then, to the stunned Mr. Smith, he said, “My daughter wants to be an epidemiologist, and this is a rare chance for her to get some practical experience. Besides, I could do with an assistant. Don’t worry—the so-called Level-Four viruses are terrifying, but they can be defended against, and we know how.”

  Smith argued with him for a long time before finally giving up and arranging plane tickets. The three of them sat in the airport lounge, waiting for the next flight to Khartoum. Smith asked Dickerson what he thought the outbreak might be—Lassa fever, green monkey disease, yellow fever, Crimean-Congo hemorrhagic fever, or Ebola, only just discovered in 1976.

  “That’s what I’m going there to find out. But I’d guess it’s Ebola.”

  Mei Yin knew that all the illnesses Smith had mentioned were extremely deadly, particularly the last one, which was both airborne and spread through contact. During the 1976 outbreak in Zaire, the death rate was 90 percent. A vaccine had still not been found, and there was no treatment.

  Smith asked, “Mr. Dickerson, you’re an expert, perhaps you can tell me why pestilence is so fond of Africa? This continent has almost all the diseases of Europe and Asia, including leprosy, smallpox, tuberculosis, rabies, and so on. It also has quite a few of its own, such as Lassa fever, green monkey disease, Crimean-Congo hemorrhagic fever, Ebola, the sleeping sickness, all of them particularly virulent viruses. Conditions in the New World were exactly the opposite. When America and Australia were discovered, the natives only gave the colonizers syphilis, a relatively benign illness; the colonizers brought them smallpox and the flu in return.”

  Smith’s question gave Dickerson pause. “I don’t know. I’d guess it might be because this is the ‘Old World.’ Humankind had its start here, and it’s quite possible that so did all pathogens. The long process of evolution would have created many different varieties of illnesses.”

  “That can’t be right! I know in the medical world they say pathogens and human beings, in general, have a cordial relationship. One the one hand, humanity slowly develops immunities; on the other, extremely virulent pathogens die along with their hosts, which doesn’t help them at all. So in the course of evolution, pathogens generally grow milder. If you look at how smallpox and the flu have changed in various continents, Europe and Asia, Australia and the Americas, this theory is borne out. Yet it breaks down in Africa—why? This continent was the cradle of humanity, yet it’s also where viruses are strongest.”

  Dickerson was silent for a very long time, and finally had to admit, “I don’t know. The experts don’t have any answers for that one. Let me think about it, and see if I can come up with a convincing explanation.”

  The plane to Khartoum was boarding, and Mr. Smith tried one last time to dissuade them. “It really is terribly dangerous to head into an epidemic zone. Why don’t you let the girl stay behind at the embassy?” Mei Yin smiled and shook her head, and Dickerson said, “Thank you for your concern, but she’s coming with me.”

  Mr. Smith sighed and patted Mei Yin on the shoulder. “All right, then. Bon voyage, brave girl. I salute your courage.”

  At Khartoum, they needed a connecting flight to Nzala, but just as Smith had said, no one would fly there. Dickerson, who had experience in this area, went straight to the American embassy, and got them onto a police plane that would bring them directly to Nzala. On the flight, he whispered to Mei Yin, “Don’t mention the epidemic in front of the pilots.”

  “They don’t know they’re flying into an infection zone?”

  “From the way they’re talking, it appears not, or at least they don’t know how serious things are. But if they did, they might not . . .” He shrugged.

  Mei Yin felt this way of doing things was a little dishonorable—tricking unwitting pilots into entering an outbreak region. But her father spoke very calmly, and clearly believed that if it meant saving thousands of suffering, near-death victims in the area, God would forgive him a few small lies. They landed at dusk. Nzala Airport was just a bumpy tarmac runway, and the arrivals hall a tin shack next to it.

  The pilots learned about the severity of the epidemic in short order, and were desperate to leave. Unfortunately, the plane couldn’t be serviced and refueled until the next day, which meant they’d have to spend the night there. Dickerson quietly rejoiced: now he could collect blood plasma samples overnight, make some hasty analyses, then have the returning plane bring them straight to the American embassy at Khartoum, where the samples could be delivered to the CDC for closer study. In 1979, no detailed research had been done into Ebola, and they could only use indirect immunofluorescence to identify antibodies. It wou
ld take more time and specialized equipment to separate a particular virus from cultivated tissue or cells. Reaching that point a day earlier might save hundreds of lives.

  The pilots spent the night at the local government rest house. Father and daughter headed to the Belgian church to pick up their supplies, after which they drove through the night to the hospital at Yambio. Although Mei Yin had spent more than ten years of her life in China, she’d never seen such grinding poverty. The hospital was a row of mud huts with thatched roofs, each with small kerosene lamps throwing flickering light over two dozen dying patients lying on straw mats on a dirt floor, their bodies rigid, wheezing deep in their throats. There was only one doctor here, named Adi—the rest of the medical staff had abandoned their posts and fled. Some patients had their families with them, though most awaited death alone. Even Dickerson, accustomed to terrible scenes of infection, was shocked by the desolation. Family ties were important here, and the sick usually received very good care. Flocks of relatives would usually descend on hospitals to tend to them, and after death, they’d be ritually washed, inside and out, and the entire tribe would hold a wake, wailing and smearing ash on their faces. The funeral rituals would last more than ten days. Unfortunately, these customs often led to even more infection, and in the past medical teams had tried hard to dissuade families from visiting, but to no avail. It was unheard of for patients to be left in such isolation like this. Apparently, the virulence of this epidemic had shaken the very foundations of traditional African society.

  Adi was a kind-hearted doctor with curly black hair, a fondness for palm wine, and an optimistic outlook on life that allowed him to focus on the big picture. Dickerson learned from him the source of the outbreak: a few tribespeople had contracted the illness while eating chimpanzee meat, but it was this hospital, with its poor hygiene and untrained staff, that had turned an infection into an epidemic.

  He helped Mei Yin put on a white plastic protective suit and mask. Dickerson himself wore no such thing, finding the gear unbearable in the high summer heat of Africa, and restrictive to his work. Ebola might be terrifying, but experience told him a mask alone would be sufficient to prevent airborne infection. The main thing was to avoid accidents such as getting pricked by a syringe. Still, for the sake of precaution, he insisted his daughter wear full protective gear.

  Dickerson knelt to examine each patient, while Mei Yin held the kerosene lamp for him, her eyes round as she watched her adoptive father at work. Going by the symptoms, this was very likely a second outbreak of the dreaded Ebola. As Dickerson carried out his inspection, he told Mei Yin how to make a diagnosis. Mild internal bleeding was a classic early symptom, but it was difficult to see the telltale red or purple spots on the dark-skinned patients, particularly in such poor light. Instead, he pried open their eyelids, searching for blood in the whites. Or else he opened their mouths, looking for blisters on the palate, checking if their throats were inflamed. Among twenty-one patients, he found seven confirmed cases of Ebola, the rest highly likely. He told Adi to inform the relatives, and to move the seven definite infections to a quarantine room, where blood plasma could be drawn from them. All this had to be done very fast, because the plasma and red blood cells would need to be separated. In the absence of electricity, this could only be done with a manual centrifuge, a process that took a good half hour.

  Adi had been working for five days straight, and was near the point of collapse. After the initial examination was complete, Dickerson insisted he go home to rest. Father and daughter had been on the road for more than twenty hours, and then come straight to the hospital to work. They were so exhausted they could barely keep their eyes open. Dickerson urged his daughter to rest, but she shook her head and pushed away the fatigue. Her voice blurred by her mask, she said, “I’m not tired. I’ll help you finish.”

  Dickerson pitied his daughter, but also needed an assistant, so he nodded. “All right, you can sleep when we’ve taken all these samples.”

  Now it came to the taking of samples, which Dickerson did while Mei Yin held down the patients—many of them weren’t lucid and couldn’t follow instructions. They began to draw blood from the suspected cases. One of them was an old woman with loose skin and prominent bones. She had a high fever, and was incoherent. There were no obvious marks on her body, but she’d definitely come from the Ebola zone, and her high temperature made Dickerson suspect she was infected too. Mei Yin held down her arm while her father stuck a needle into a vein, and began extracting the blood. The old woman suddenly reared up, with surprising strength. Perhaps Mei Yin was too tired to hold the arm in place—the needle slipped out and stabbed through Dickerson’s left glove.

  He immediately ripped the glove off. At the base of his thumbnail was a bright drop of blood.

  In 1976, during the first outbreak, Dickerson had been in a lab in London when his colleague Bradley, who was working on animal experiments, was nicked by a needle. Even though Bradley immediately flushed the wound with disinfectant, he fell gravely ill and almost died. Fortunately, the accident took place in England rather than Africa, and he’d had access to first-rate medical care. During the subsequent inquiry, an official at the British Department of Health asked why he hadn’t taken more decisive action, and sliced off his thumb right away? It wasn’t a joke; losing a thumb would be far preferable to contracting Ebola. If Dickerson didn’t try, it was likely because he didn’t want to frighten his daughter.

  Mei Yin’s face drained of blood. Her clumsiness might have cost her father his life! Tears fell from her eyes, leaving two streaks inside her mask, and her shoulders trembled. Dickerson rushed to comfort her. “Don’t, don’t be frightened. I’ll disinfect it right away. It’ll be fine.”

  He soaked his hand in antiseptic. There was no cure for the Ebola virus, apart from an injection of blood serum from a recovered victim, which contained the necessary antibodies. He did have samples of such blood serum on hand, and while they weren’t fresh, they’d been through a thorough filtering process to remove impurities. An injection would provide at least psychological reassurance. He filled a syringe with the antibody-rich serum and asked Mei Yin to inject him with it.

  Now they could only wait. It was two in the morning by the time they’d finished with the seven confirmed cases. Apart from praying that the old lady didn’t actually have Ebola, they also prayed that the antibodies would be effective. Although Dickerson’s mood was dark and his body exhausted, he still had to finish the task of separating the blood. Mei Yin brushed her tears away and said, “Dad, you rest, I’ll crank the centrifuge.”

  Knowing he couldn’t talk her out of it, yet not trusting her to work on her own, he sat to one side, directing her as she separated out a dozen blood samples, storing them in the dry ice they’d brought from Khartoum. The centrifuge was exhausting to operate, but Mei Yin refused to let her father take a turn. It was almost dawn by the time the job was done, the last stars twinkling in the dark blue sky, the wide grasslands shrouded in fog. Dickerson forced his daughter to rest, though he still needed to carry out a luminescence test for antibodies, the first step in confirming the nature of the epidemic.

  Pulling off her protective gear, Mei Yin lay on the straw mat next to her father, and in a short while was fast asleep. Dickerson put a portion of the infected blood serum into a small jar, having already prepared glass slides fixed with Ebola-affected cells. When he dropped the blood serum onto the slides and shone fluorescent light onto them, a twinkling light would mean it was positive for Ebola antibodies.

  Dickerson left the old woman’s test for last. Six of the earlier tests were definitely Ebola, seven death sentences pronounced by a gleam of light. When Dickerson got to the final slide, he adjusted the microscope particularly slowly. On the slide the cells came into focus, revealing their outlines and nuclei, gray and green and black, with patches of brightness—but no twinkle.

  Dickerson let out a long breath. It didn’t definitely rule out Ebola, as the patient might have b
een in the early stages of infection, before antibodies developed. At the very least, though, his death sentence had been postponed. He longed to tell his daughter the good news, but she was sleeping so soundly he couldn’t bear to wake her. But at this moment Mei Yin lifted her head and asked blearily, “Dad, did you do the fluorescence test? Was it negative?”

  Even in her dreams, she’d been worried. Dickerson wanted to kiss her, but stopped himself with the thought that he wasn’t completely in the clear yet. Instead, he lightly said, “Yes, negative.”

  Mei Yin was wide awake in an instant. She jumped up and hugged her father, cheering, her eyes shining. Dickerson quickly put his hand over her mouth, lest she kiss him in her excitement.

  In the morning, father and daughter rushed to Nzala Airport. The pilots were itching to depart. Dickerson handed over the packed blood serum and cell samples, and asked the pilots to deliver them to the American embassy as quickly as possible. The pilots had no medical knowledge, and no idea that their cargo contained the very Ebola virus they were so desperate to flee. The lead pilot only asked in passing, “What’s so urgent?”

  Deadpan, Dickerson answered, “Just my papers. They’re almost out of date, and I need to rush them to the embassy for a new visa.”

  Cheerful now that departure was imminent, the pilot smiled and said, “Don’t worry, I’ll get it to them pronto.”

  The broken-down police airplane wobbled down the bumpy runway, looking for a moment like it might not take off, before finally rising and disappearing into the northern sky. Mei Yin sneaked a glance at her father’s face. He looked peaceful, not in the least bit guilty at having just told a lie. Of course, the specimens were all sealed up, and the pilots shouldn’t be at any risk of infection—though if they got curious and decided to have a look inside, or if the plane crashed and someone else stumbled upon them, that would be a different story. This was Mei Yin’s second lesson in her father’s way of doing things, and an important one: in the pursuit of a noble goal, it may be necessary to use ignoble tactics.