by Glenn Cooper
“You’re right,” Jamie said, “and I hope like hell it’s not the time. We don’t need a new virus on our hands, do we? Mandy—sorry, Dr. Alexander—did you ever test for the recombination potential of your virus and the Japanese encephalitis virus?”
“That one specifically? No. We couldn’t test for every virus known to man. We had to prioritize. JE is a member of the Flaviviridae, a family that includes West Nile and St. Louis’s encephalitis. I tested both of those, but JE is not identical. I certainly will test it now.”
Steadman was not going to fade into the wallpaper just yet. “While all of you are wringing your hands over extremely remote hypothetical concerns, I’ll be working on identifying the next patient so we can keep this critically important research moving forward. Millions of patients with Alzheimer’s and their families are waiting for us.”
Jamie nodded curtly. “Those of us around this table are every bit as committed to Alzheimer’s research as you are, but I for one am relieved that this committee required you to insert a suicide gene into the vector. In the worst-case scenario, and I’ll freely admit it’s remote, we’ll be able to destroy any new recombinant virus.”
Jamie sat back and waited for him to respond, but Steadman remained largely quiet and sullen for the rest of the meeting.
5
She was resembling her mother more and more and Jamie worried it was affecting the way he reacted to her. She wore her red hair long, with fat spiraling curls the way Carolyn had worn hers, her lips seemed to be in a semi-permanent pout like her mother’s, and as the baby fat melted, her figure was starting to resemble Carolyn’s too. Sometimes, when he was especially tired, he had to catch himself from using the wrong name. Carolyn had been a master at pushing his buttons, and Emma was becoming an all-star herself. It had to be more nature than nurture; she was only two when Carolyn died.
Tonight, Emma marched in two hours later than promised, reeking of cigarettes, wearing too much makeup for his liking, her skirt ridiculously short. The positives: he was pretty sure she wasn’t stoned, and she didn’t have alcohol on her breath.
“Where’ve you been?”
“The mall.” She paused to rub the belly of their dog, Romulus, before making for the stairs.
“You didn’t say you were going to the mall.”
“You didn’t ask.”
He raised his voice. “Do I have to? You said you were coming home.”
“Oh, please.”
“Did you at least eat?”
“What does one do at the mall? I wonder? Oh, I know, eat.”
“Would you cut the crap, Emma? I had a messed-up day.”
“Well, boohoo. Join the club.” And with that, she was gone. Heavy steps and, seconds later, a door slamming.
He kicked off his shoes and reached for the remote. Romulus, a black, wire-haired mutt, just turned eleven, jumped on board and rested his head on Jamie’s legs.
The Bethesda meeting had dragged on, and after a group dinner, knots of scientists talked in the bar until late. Steadman hadn’t stuck around. He begged off to return to Baltimore to check on the autopsy results. Jamie watched Mandy peel off and head to the elevators. He didn’t try to stop her.
In the morning he caught the first shuttle to Boston without seeing her again. When he landed, he went directly to the hospital to do clinical rounds with his neurology fellows. The afternoon was consumed by his outpatient clinic. Now he wanted nothing more than to watch something unchallenging for an hour before packing it in for the night, but his ringing mobile got in the way. He grunted at the number. It was the ER at Mass General.
“Jamie, sorry to bother you but I’ve got a case that’s not making sense.”
Carrie Bowman was his strongest neuro fellow. She was rarely stumped and rarely called for help.
He put the TV on mute. “Okay, shoot.”
She summarized the case. “This is a twenty-six-year-old white male, a personal trainer, who presented a few hours ago with global amnesia after a day of low-grade fever and cough. There’s no history of head trauma or headache. The amnesia isn’t a type I’ve seen before. He’s fully conscious and alert, but over a period of several hours he seems to have progressively lost his memory, this according to his brother who brought him in. Now he’s largely non-communicative, but he responds to auditory stimuli with startle reactions. He can’t write or point to letters. He’s also got an intermittent, dry cough.”
Jamie switched off the TV. He already knew he’d be heading into town. “What’s his affect?” he asked.
“He looks like a scared animal. He’s making guttural and whimpering sounds mostly, with a few simple words scattered in—kind of a word salad.”
“You said he had a fever.”
“It was 38.1 a few minutes ago.”
“Chest x-ray? Scans? LP?”
“Give me a chance.”
“Sorry.”
“Other than his altered mental status and his temperature, his physical and neuro exams were normal. On chest x-ray he’s got a diffuse, ground-glass infiltrate the radiologist says is compatible with a viral pneumonia. His brain MRI was unremarkable. For labs, his white count was mildly elevated with a moderate lymphocytosis. His CSF was under normal pressure with slightly elevated protein and gamma globulin, a normal glucose, and eight mononuclear cells.”
“All compatible with a viral syndrome,” Jamie said. “Any exotic travel?”
“None. The house staff did send off cultures and serologies.”
“All right,” he said, getting up. “I’m coming in.”
He got his jacket and car keys and bounded up the stairs. He had to knock loudly to be heard over the music.
“Emma, I’ve got to go into the ER. Emma?”
Through the door he heard, “Knock yourself out.”
“Homework and bed. And walk Rommy. I’ll call you.”
*
The patient’s name was Andy Soulandros. Jamie reviewed his chart and parted the curtain around his bed. He was a tall, well-muscled fellow who immediately alerted to the sight and sound of the moving curtain. Carrie’s scared-animal analogy was apt. He looked like a rabbit at night stunned by a flashlight. His eyes were fixed on Jamie’s every motion and he was shaking.
“Hello, Andy, I’m Dr. Abbott. Do you remember Dr. Bowman? She examined you earlier. Nod your head if you remember her.”
There was no sign of comprehension.
Jamie approached the bed.
The young man said, “I-I-I—” and then made a high-pitched sort of a moan and pulled at his wrist and ankle tethers.
“They had to restrain him to keep him from bolting,” Carrie said.
“Look at the hairs on his forearms,” Jamie said. They were bristling. “He’s got a vigorous piloerection reflex, a primitive reaction to fright or cold and it’s not cold in here.”
“I didn’t notice that,” Carrie said.
“It’s okay, Andy,” Jamie said. “I know you’re frightened. We’re going to try to help you. Are you having any pain?”
There was more pulling at his restraints.
“Do you know where you are? Do you know your name?”
When he didn’t respond, Jamie said, “I’m going to examine you, if that’s okay.”
Jamie took out a penlight and shone it into his eyes.
“Oh-oh-oh-oh!”
“Does the light hurt?”
“I-I-I-I—”
During the exam, the patient was rigid, grunting and spouting a few nonsense monosyllables and out-of-context words. When Jamie was done, they regrouped at the nurses’ station.
“I agree with your exam, Carrie. There’s not much that’s remarkable about it, certainly nothing helpful except for his pulmonary signs. I wonder if he might have taken hallucinogens.”
“The intern sent off a toxic screen,” she said. “I asked his brother if he could have taken any drugs. He says Andy’s a health nut, completely drug free. He won’t even take an aspirin.”
“Is his brother still here?”
“He’s in the waiting room.”
Dave Soulandros rose when his name was called, and Jamie took him to an interview room.
“What’s wrong with him, Doc?” he pleaded.
“We don’t know yet,” Jamie said gently. “We’re still doing tests. I know you’ve spoken to several doctors tonight, but could you take me through what led up to this?”
“We were supposed to have dinner tonight, but he was a no-show and all my calls went to voice mail. So, I went over to his place in Charlestown. He didn’t answer. I let myself in with my spare key. I found him on the floor in the bedroom. I asked him what was going on. He said he couldn’t remember. He was confused.”
“But he knew who you were.”
“At first. But after, I don’t know, ten minutes, he asked me who I was. That’s when I called an ambulance. By the time they got there he wasn’t saying much of anything at all. He looked scared shitless.”
“Before this, he was in good health? Nothing remotely like this ever happened?”
“Perfect health and no, nothing like this.”
“I understand he doesn’t take drugs.”
“He’s a ‘my body is a temple’ kind of a guy. Definitely no drugs.”
“He’s got some signs of pneumonia. Had he complained of being feverish?”
“I haven’t seen him for a week. He was away. He texted me yesterday that we should get together when he was back in Boston ’cause he had news.”
“He was out of town?”
“Yeah, he was with his girlfriend, hanging out for a day or two. I had a feeling he was going to tell me they were engaged.”
“Where was he?”
“She’s down in Baltimore.”
Jamie blinked. “Baltimore.”
“Yeah.”
“What does his girlfriend do for a living?”
“She’s a—what’s the name of the head scan?”
“CT? EEG? MRI?”
“She’s an MRI tech.”
Jamie felt his own forearm hairs bristle. His mouth got dry. “Where does she work?”
“In a hospital down there. Name some.”
“Baltimore Medical?”
“Yeah, that one.”
“Stay here! Don’t leave this room!” Jamie said, dashing from the cubicle.
Carrie was talking to the senior medical resident at the coffee machine.
Jamie tried to control his tone, but the urgency spilled out. “Carrie, Stephanie, come over here,” he said, pulling them into an empty trauma room.
“What is it?” Carrie asked.
“I don’t have time to explain,” he said, “but we need to do a number of things quickly without causing a panic.”
The two doctors got very serious very quickly and began taking notes.
“I want a Level One Biocontainment Emergency declared. This ER and the entire hospital need to be locked down. No one in. No one out. Andy Soulandros needs to be given 200 milligrams of doxycycline STAT. Carrie, handle it personally.”
Carrie interrupted him. “Why are we giving an antibiotic for a viral infection?”
“There’s no time to get into it now but it’s not to treat an infection. It’s to activate a doxycycline-sensitive suicide gene, a fail-safe switch, built into a gene therapy that may be the cause of this.”
“Got it,” she said, although by the querulous look on her face, it was obvious she had a lot of questions.
He kept going. “Then I want him put into an Ebola suit by nurses in Ebola suits and transferred to the Biocontainment Unit. I want Dr. Collins contacted at home. Tell him his hospital is closed by my order. All ambulances need to be diverted to other facilities. I want to speak to the directors of public health for the city and state. They’ll have the right contacts at CDC. And when you’ve done all that I want the names of everyone in the hospital who had any contact with Andy Soulandros or his body fluids. They’ll be joining the three of us in quarantine.”
The senior resident abruptly stopped writing. “What the hell is going on, Jamie? You’re acting like this guy’s got Ebola. He doesn’t.”
“I hope to God I’m wrong,” Jamie said, “but this could be a lot worse than Ebola.”
6
It was 4 a.m. and Jamie was running on adrenaline and bad ER coffee. Over thirty people, medical personnel mainly, but also some patients and visitors, were quarantined inside the emergency ward. Andy Soulandros was upstairs in the Biocontainment Unit, his status unchanged. All entrances and exits to the ER had been sealed with plastic sheeting and duct tape. Outside the hospital, hundreds of police and emergency services vehicles and media vans clogged the hospital forecourt, spilling onto Cambridge Street.
Jamie was under siege. There wasn’t a single physician, public health official or politician who agreed with his decision to call a Level One emergency, but there was also no one who had the guts to reverse the order. A SWAT team of CDC personnel from Atlanta was en route via government jet. Everyone was counting on them to restore sanity.
Jamie had been trying to reach Roger Steadman at all his numbers, but he had gotten no further than voice mails. The Baltimore Medical operator assured him that she was attempting to page both him and Dr. Pettigrew. Jamie was on a landline with the Mass General chief of infectious diseases when he saw a Baltimore area code appear on his mobile.
“Roger, finally.”
A sonorous English voice said, “No, I’m sorry, this is Colin Pettigrew.”
“I’ve been trying to reach you and Steadman all night,” Jamie yelled.
“I’ve been trying to reach Roger as well. Sorry for not getting back to you sooner. I’ve been in the thick of it, I’m afraid.”
“What’s going on?”
“A rather bizarre case, actually.”
“I hope you’re not going to say you’ve got someone with fever, cough, and global amnesia.”
There was a pause on the line. “How could you possibly know that?”
Jamie could feel his free hand trembling. “Is your patient’s name Amelia Gennaro, an MRI technician at Baltimore Medical?”
“I don’t understand. Has someone from our shop called you about her?”
“Listen, Colin. I’ve got her boyfriend here at MGH. He was with her in Baltimore this week. He’s got the same syndrome. Check your records. I’m a hundred percent sure she’s going to be your Patient One’s MRI tech.”
“Yes, I can confirm she was. At first, we thought she might have Japanese encephalitis, but it’s not behaving at all like JE.”
“My patient’s syndrome is completely different from JE too,” Jamie said. “Mrs. Noguchi is the likely index case, but I don’t think it’s JE she transmitted to your MRI tech. I think we’ve got a new virus on our hands. I’m the least popular guy in Boston, but I’ve declared a biocontainment emergency here. You need to do the same and put all of Gennaro’s contacts into quarantine. CDC’s on the way to Boston. I’ll report your case and give you as their primary contact at Baltimore. I dosed my patient with doxycycline to activate the vector’s suicide gene, but we haven’t seen an effect yet. I’ve been trying to reach Roger to confirm the gene’s sensitivity levels. I’ve left him detailed messages.”
Pettigrew said, “I also left him detailed messages about Miss Gennaro, although I admit I didn’t put things together as you have. Let me sort out our disaster plan and I’ll have someone literally bang on Steadman’s condo door. I’ll also get Steadman’s chief lab tech on the line and find out the details on the suicide gene. You’ll hear back from me shortly.”
Jamie hung up and tried to collect his thoughts. In the heat of battle, he’d neglected to call Emma. It probably hadn’t bothered her in the least, but he beat himself up anyway. He couldn’t ever recall skipping a nighttime call or text when he was away. In under three hours, she’d be up to catch the school bus. He’d call her then.
Then the panic hit. He was in quarantine.
Whe
n would he be able to see her again? Of all his single-parent anxieties over the years, this one took the cake.
His mobile rang again, an Atlanta number. It was one of the officers from the Viral Special Pathogens Branch he’d spoken to earlier. In response to an urgent email blast, CDC was beginning to receive preliminary information about sporadic cases of a febrile amnesia syndrome from Texas, Virginia, and Florida.
When he hung up, he had an overwhelming desire to speak to Mandy and he didn’t care what time it was. She needed to know what was happening and he needed to hear her voice. He hoped Derek wouldn’t pick up, but he got a sleepy male.
“Derek, I’m sorry to call so late. This is Jamie Abbott.”
“Four o’clock?”
“It’s an emergency. I need to speak to Mandy.”
“She’s not here. Did you try her mobile?”
“Where is she?”
“In the lab. What kind of emergency?”
“She’ll explain, Derek. I’ve got to go.”
When she answered, he experienced the first moment of calm in hours.
“You’re up late,” she said.
“You too.”
“I’m in the lab.”
“I know.”
“Shit. You called Derek.”
“You said you power your devices down, remember?”
“Tonight was an exception.”
He went first. She didn’t pause during his account of the night, but he knew she was still there. He could hear her breathing.
When he was done, she said, “I’d better tell you what I’ve been up to. I got Mrs. Noguchi’s brain tissue by courier this morning. I’ve been working on it non-stop. Unfortunately, it’s fitting with what you’re seeing on the ground. I read the western blots earlier and I just got some sequences.”
He couldn’t believe the volume of data she’d generated in one day and when she finally said, “It’s a completely new virus, Jamie, just like you were afraid of,” he backed against the nearest wall and slid to his haunches.
The virus in Mrs. Noguchi’s tissues had elements of both Mandy’s original adenovirus and the Japanese Encephalitis virus.