“They got here overnight. I thought that was pretty quick.”
Mike shrugged. “They should have been out yesterday instead of me.”
Donna shrugged back. “I’m kind of glad it was you, because now I get to play a part too.”
“I’d like to go to your clinic when we leave here. Can you show me what tests you’ve run? Help me understand them?”
“Sure. But I can give you the Tweet version now: ran them all and everything came back either negative or inconclusive. A couple of specialized tests that require growing tissue haven’t come back yet, but other than that—deadend.” She pushed her empty plates aside, took a sip of water and reached into her back pocket for her billfold.
Before she could pull out her credit card, though, he’d pulled out his. “Allow me.” He winked. “Expense account.”
She didn’t miss a beat, signaling to the waitress. “In that case, let’s find out what’s on the dessert menu.”
They had finished their apple pie and were sipping the last of their coffee when Mrs. Rourke called. Donna frowned at the vibrating phone. Mrs. Rourke mainly texted; it was rare she wanted to speak, and then it was usually an emergency. “This is Donna.” She heard sobbing on the other end. No-nonsense Mrs. Rourke didn’t sob.
“Dr. Bailey. You’re not driving are you?”
“No, I’m still at the diner. We’re just finishing.”
“I—I have some terrible news. It’s Chad.”
“Chad?”
“His wife just called. She took him to the emergency room.”
“Yes, he told me this morning he was going to the ER.”
“They think he had whatever that disease is…”
“Had?”
“He died at the hospital.” Mrs. Rourke’s voice broke.
“Chad’s dead?” Donna stared into her empty coffee cup, trying to process the enormity of what she’d just heard.
Mike, who had taken his own phone out to check messages, glanced up at Donna’s stricken tone.
She tried to think of something profound to say, but all that came out was, “I didn’t think he was that sick.”
“No, none of us did. He was only 23, Lord bless him. What’s Katy going to do?”
“I don’t know.” Donna still couldn’t think clearly. “I’m on my way back, OK? I’ll be there in about a half hour.”
“Well, you drive careful coming back. There’s nothing you can do to help Chad now, so you just be careful.”
“Yes. I—I will. Thank you for letting me know.” She hung up, the gesture automatic. Dazed, lost, she fumbled with the dishes in front of her before looking up into Mike’s face, searching for a temporary anchor.
“Who’s Chad?” he asked quietly.
She clutched at the question, grateful for the grounding. “My technician. My right hand, really. They think he had the disease. He had some of the symptoms, maybe, yes—but they didn’t seem that advanced. Not so that he’d be dead today.” She shook her head, bewildered. “I just don’t understand.”
Mike pocketed his phone. “The CDIC team doesn’t have any answers yet. Did you say you were still going back to the clinic?” Donna nodded. “Let me give you a lift. We can get someone to come back for the truck later.”
“No. I’ll have to drive home later. I’m OK, really.” She sniffed and straightened her shoulders. “It was just a shock there for a moment. I’m good. I just want to go now.”
The road under her tires seemed to go on long after she thought she should be back at the clinic. Why was time so fickle? Whenever she was desperate for it to slow so she could catch a breath, it raced by on extra horsepower. But now, it was leading her with excruciating slowness, making sure she couldn’t outrace her grief, ensuring it dug into every pore, every molecule, layering into her more closely than skin itself.
She would be strong through it, she resolved, but if she lapsed, she knew her clients, her friends, her family would understand. And lapse she would, because under the umbrella of grieving for Chad, she could grieve in advance for Alfie, too.
Chapter Twenty-Eight
MRS. ROURKE WAS WAITING AT the clinic when Donna arrived. The two of them hugged and traded words of consolation before Donna sent the receptionist home.
“I’ll stop by to see Katy on the way,” Mrs. Rourke promised. “That poor girl’s going to need some help with things. I know you’d go if you had time, but this gentleman,” she pointed to Mike, “seems to be taking up all of yours right now.”
It was a slap in the face, meaning Mrs. Rourke didn’t think anything should interfere with paying respects to the dead and their family. Normally, Donna would agree, so didn’t hold the rebuke against Mrs. Rourke. It was Chad, after all—more than just an employee, he’d been a work companion and friend for over a year. Someone who deserved her time and respect. And her tears.
And someone who would get all that, she promised herself. Just not now. Now she had to keep her emotions in check. No matter how bad things got, she couldn’t cave. Too many clients were depending on her to look out for their interests.
So she disappointed the receptionist by refusing to react to the implied indictment of her behavior, sending her off instead with, “Thank you, Mrs. Rourke. That’s very generous of you. I know how much Katy will appreciate it.”
Donna’s phone beeped just as Mrs. Rourke disappeared through the front door. She glanced at the message from the NDSU laboratory: URGENT. Lab Results. Confirmation of Receipt Requested ASAP. Forgetting Mrs. Rourke and Chad, Donna collected Mike with a curt, “Come on,” and headed for her office. “Something new from the lab,” she said as she pulled up her email on her Pad-L. She looked at Mike as she waited for the attachments to open. “It’s not anything routine. They’ve never asked me to confirm receipt before. And it came to my private number, not through the clinic.”
The download beeped to get her attention. “What the—” She read the message on her screen. “The file’s encrypted.”
By the surprise in her voice, Mike figured that wasn’t normal either. She entered her license number to gain access and the report appeared. He looked over her shoulder, but she was scrolling through the unfamiliar form so quickly he couldn’t keep up.
Until she stopped.
“My God.” The tone of her voice was low, dead. Like an open grave waiting to be filled.
He leaned in closer to read the summary she was staring at:
North Dakota State University Veterinary Laboratories Preliminary Findings
On reexamination of the Spalding samples, ID # MC7529DB through ID # MC7537DB, it is the conclusion of this lab that cause of death of the 4-year-old cow sampled is a previously unidentified variant form of prion disease. It is not the reportable Bovine Spongiform Encephalopathy, which typically causes widespread degeneration specific to the nervous system, and which is why the diagnosis was missed in the original sample tests. This form seems to concentrate not only in certain areas of the brain, but in muscle tissue as well. In addition, there are high concentrations of the variant prion in the milk samples provided.
It is the considered opinion of this lab that this new prion will prove just as infectious to the bovine population as BSE. It is our recommendation that any bovine in close contact with an animal suspected of carrying this disease be marked “U.S. Condemned” and be slaughtered immediately in compliance with the USDA’s recommendations for slaughter and disposal of BSE-infected cattle.
Given the history and number of samples previously submitted for animals displaying similar symptoms in this region, the lab is retesting all samples. We reserve opinion regarding the infectious nature of this new prion in species other than bovines until these samples have been retested.
All results from animal testing in this region over the past 90 days are being shared with the CDC and USDA. At their request, samples may also be shared for further independent testing.
“A new disease.” The strain in Donna’s voice made it sound brittle, o
n the verge of breaking. “That’s why I kept coming up empty. When the lab said it wasn’t BSE, I thought maybe we’d have a chance to control it if we could just identify it. But if it’s prionic like BSE or scrapie, we won’t be able to treat it. Not with any degree of certainty. Not in animals—and not in people.”
“So theoretically I know what diseases like BSE and CJD are and what they can do,” Mike said. “At least from a layman’s view. But how do they work? Prions aren’t like bacteria and viruses, right?”
“Prions aren’t alive like bacteria and viruses, no. They’re just bits of protein—a few amino acids strung together and folded in a way that somehow helps neurons transmit signals, mainly in the brain. And since they aren’t alive, you can’t kill them per se. You have to destroy or denature them. We all have normal prions in our bodies and apparently we need and use them as long as they behave themselves. But when they mutate, the result is kind of like how cancer spreads. Only instead of new cells being formed that are cancerous, which is how cancer grows, the existing prions can become misshapen because of a chromosomal, or genetic, trigger. Or you can eat something that has a lot of these mutant prions and a few could make their way into your body through the bloodstream and infect the normal prions you already have, turning them into diseased bits. The diseased prions then attack the nervous system and you wind up with a brain that’s so eaten away it looks like a sponge. Basically, Bovine Spongiform Encephalopathy is just a snooty way of saying ‘spongy cow brain’.
“Or mad cow disease.”
“Which pretty well sums up what lots of microscopic holes in the brain will do to a cow—or a person. But that’s too visceral a term for science. So they dress it up in Latin and take the passion out of medicine.
“Usually, though, it takes a long time—years in cattle, sometimes decades in people—before a prionic disease progresses to the point where it swiss-cheeses your brain and kills you. Or builds up enough plaque in your brain you can’t remember your own name. We generally don’t even test cattle younger than two-and-a-half years old for BSE because the disease is so slow. Prion disease in children is practically unheard of. But if it’s a new strain…”
”Didn’t you test for prion diseases?”
“Of course I tested for scrapie and BSE. There’s a quick-test for each of them that’s been on the market for about five years. Mix a little spinal fluid with the testing reagent and if those types of prions are present, they glob onto the reagent and precipitate out, leaving a residue at the bottom of your test tube. We can get a preliminary verification in the field in about 30 minutes. We still send all positives to the lab to confirm, though, and those tests take weeks as they actually grow out the samples in mice.
“But our field results were negative. Or at best inconclusive. There was a trace of residue in some samples but that could have been caused by contamination of some kind. You also have to understand that the tests are protein-specific. The test for BSE won’t pick up scrapie and vice versa. Given the symptoms, I couldn’t chance ruling out a diagnosis on the quick-tests alone, which is why I sent samples to the lab anyway.”
“OK, then if we look at the known prion diseases, what do they have in common? People can get mad cow disease from infected beef. Can most mutated prions jump species?”
Donna frowned. All those years of classroom study seemed to slip away the farther removed she was from the rigor of university life. Out here, she had pretty much fallen into a routine of seasons and diseases. Hers was a life of vaccinating, castrating, worming and dosing with preventives to keep diseases from surfacing. Occasionally a horse wound itself up in barbed wire or a dog got itself snake bit or a goat got attacked by a coyote and she had to pull out the usual antibiotics or steroids to cope. And there was the usual run of breached babies and mastitis in the spring, and West Nile and tick-borne Erlichiosis to handle in the summer. That was about as exotic as medicine got in an area where a good many of her patients never made it into old age.
But there was something about BSE and Mike’s question that seemed relevant. Random googling would probably jar her memory; it was just frustrating that she couldn’t put the pieces together without resorting to the internet. A memory of a conversation dredged itself up from the recesses of her cortex. It seemed random yet important somehow. “Bear with me here. I’m thinking out loud. One of the ranchers found tracks around a dead calf six, maybe seven weeks ago, not long after we began seeing symptoms. I’d almost forgotten that call. He wanted us to notify the ranchers that there was a cat on the loose. A cougar, we thought.”
And then it struck her, what she’d been trying to see all along. “Damn. FSE.”
“What?”
“FSE—feline spongiform encepalopathy. Domestic cats can get a variant of mad cow. And if domestic cats can get it, maybe their larger cousins can, too…” It was the piece she’d been looking for ever since their visit to Triple E.
“The tiger.” Mike blanched.
“Coincidence that animals started getting sick around the same time their tiger escaped?”
“But don’t you have to eat part of an infected animal first to get sick?”
“That’s the classic transmission route. For BSE. But even then, mutated prions can be found throughout the animal. In its muscle, in its milk—” she looked pointedly at Mike, “— in its urine. The prions just aren’t as concentrated in other parts of the body as they are in the nervous system. But maybe these new prions do concentrate elsewhere. If an animal grazed over an area where the cat peed…”
Mike worked out the logic trail. “Then if that animal got the disease and began spreading it through its urine in an area where other cattle were grazing, you could get a whole herd infected. And then mother cows would pass it through their milk to their calves—or into the milk shipped to the stores.”
“And if it’s in the urine, it could well be in the saliva, too. After the cat killed a calf and ate its fill, coyotes would likely clean up after it. If they became infected, they would start spreading the disease as well. Hell, for that matter, rats and mice and buzzards could pick it up from carrion and become carriers, too. Who knows how many species are involved? Is it even limited to mammals?”
“My God. We could slaughter every head of cattle in the state and still not stop it, if that’s the case.”
“Something like that would be impossible to prevent if it gets into the migratory bird population. Every place a flock roosted would become a hot zone.”
“We need proof of its transmission route.” The implications of how farspread this disease could become was chilling. This wasn’t a simple case of containing an outbreak of Pneumococcus or psittacosis. This was turning into a potential pandemic that could eradicate a large portion of the human and animal populations in the western hemisphere. Maybe—maybe—it could be contained to North and South America if travel and shipping quarantines were established quickly enough. Aside from the Bering Strait, were there any other points that land animals or birds could easily cross the Atlantic or Pacific? Was Hawaii safe? Or the Bahamas? Cuba was likely in the migration path of some variety of bird. Getting confirmation as to whether the disease was avian borne would have to be the first priority for the CDC labs. Mike’s first priority, meanwhile, given his lack of any helpful medical knowledge beyond some rudimentary principles was identifying Patient Zero, if possible. And for that, he had a pretty good clue. “Didn’t you say you still have the tiger’s head?”
“In a bag in the freezer. Yes. I’ll do quick-tests for BSE and scrapie both, but I’m not sure how reliable the tests will be after the amount of decomposition it had outside in the sun and the time since that it’s been frozen. Same goes for a necropsy. In classic BSE, the entire brain would be so deteriorated at the time of death there wouldn’t be much question about the diagnosis. But this new disease seems to localize the degeneration, which is why it’s been missed. I’ll just take the back of the head and part of the brain stem to look at here and send th
e rest to the lab. I’ve been using the vet lab at NDSU, but I could split the head and send half to the university and the other half to the CDC if you want your teams involved.”
While Mike queried the ZVED teams on how to proceed, Donna placed a perforated stainless steel board over the tub in the kennel area, removed the head from the freezer and laid it on the board. Mike reached out to touch the frozen fur. “It’s bigger than I thought it would be.”
“It was male and a young adult by the condition of its teeth. Fully grown, I presume. Probably weighed around 400 pounds.”
“I thought you said it was a white tiger. I didn’t expect the stripes to be so prominent.”
“In tiger lingo, the color refers to the base coat, not to the stripes. Most tigers have an orange base coat with black stripes. This one has a white base coat with dark brown stripes. A black tiger—which is really, really rare—has a black base coat with orange stripes.” She fetched a sonic bone saw from the surgery cabinet and sliced off a two-inch thick piece of skull from the base of the head where coyotes had made a neat separation between the first and second vertebra, working quickly so the head wouldn’t start thawing in the warm room.
“ZVED says send it all to the university since they know what to look for now. In fact, they’re sending a team to Fargo to take another look at the milk and tissue samples from the herds that you sent earlier.”
“Will that really matter?” Donna repackaged the tiger’s head and placed it back in the freezer.
Mike sighed. “Probably not.” Donna looked at him. “OK, no. It won’t matter. You and your colleagues will be getting phone calls soon. I’m just waiting to see when the alarm will be tripped. It could be as early as tonight, certainly by tomorrow morning.”
The vet slumped into a chair. “My God. It’s really come to this, hasn’t it?”
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