The house was decorated in a style that belonged to decades past; she had always guessed the sixties but had no evidence for that other than a black velvet painting of Elvis. She walked through the house and shouted, “Hello?” There was no reply.
Making her way to the north side of the house, she entered the master bedroom. An elderly woman lay in bed, staring at a television that had the sound turned down all the way. Sam pulled up a stool and sat down next to her.
“How are you, Ma?”
“Your uncle Johnny needs to get into the house. Don’t forget to leave your key above the door frame.”
Sam reached over and began to straighten her sheets. “Uncle Johnny’s been dead for over twenty years, Ma. Remember, we talked about this yesterday.”
“He needs the key so that he can get his albums. Oh, him and those albums. I swear he loves those things more than he loves me.”
Sam looked at her a moment; the innocence in her eyes penetrated her. “No, he loves you more than anything.” Sam cleared her throat, choking back the emotion that bubbled inside her. “Where’s your nurse, Ma?”
“Oh that one, that’s another one. The Mexican.”
“Rosa’s very nice. She really likes working here.”
Her mother shrugged. It was confusing for Sam at first: the moments of lucidness coupled with the immediate comment or question that revealed her mother did not know where she was or what time she was in. But Sam was used to it now, as much as someone could be, and she tried to ignore it as much as possible.
“Do you know where Rosa is?”
“She went out for some milk of magnesia. We’re all out. She’s a nice girl to get my milk of magnesia.”
Samantha saw a bowl of cereal on the side table. “Let’s finish the cereal,” she said, taking the bowl and spooning some cereal gently into her mother’s mouth.
She stayed with her mother, rubbing her head until she fell asleep. Rosa got home shortly after. Sam spoke a few minutes with her about the medication situation and told her she would be back tonight to take her mother on a walk in her wheelchair.
Sam stepped outside and had to lean against the door for a moment. She remembered when her mother stood at the oven, stirring delicious stews or baking cakes with generic ingredients bought in bulk because they could only afford to get groceries every other week. Though Sam could afford expensive restaurants now, somehow the cheap cupcakes and beef stroganoff her mother made were the best things she had ever eaten.
After her father’s death late in life, her mother seemed invincible raising four children on her own. To see her shrink away to nearly nothing and not even know who Sam was most of the time tore her guts out, but she couldn’t stop coming. Her mother had been there when she needed her and she was going to return the favor no matter what.
Sam called her sister again but again there was no answer. As she pulled the phone away from her ear, she saw that the voicemail icon had a one next to it. She clicked on it and listened to the message:
This is Gale with CDC dispatch. Please call Dr. Ralph Wilson immediately.
The time display on the message said she had received it at 3:17 a.m.
Sam called the CDC mainline as she leisurely strolled down the sidewalk. It was going to be hot today but for now the temperature was perfect in a cloudless sky. She could see the park no more than two blocks away and throngs of children were already there. Occasionally, she would sit on the benches and watch them for long periods of time.
“CDC dispatch, this is Monique.”
“Hi, Monique, this is Samantha.”
“Oh, hi, Dr. Bower. How are you?”
“Good. I got a message from Gale that Ralph needed to speak to me.”
“Yup. I’ll put you through.”
After a click, Dr. Ralph Wilson, one of the most influential men in public health, sneezed, swore under his breath, and said, “My wife doesn’t return my calls either,” by way of greeting.
“Sorry, I was up until one in the morning working on something for Nancy.”
“Yeah, she’ll do that to you. What was it for?”
“The report you wanted on the influenza outbreak in Khovd.”
“Shelve that. I got something I want you to look in to.”
“What is it?”
“Could be nothing, but could be something. I know it’s Saturday but you’re the agent on call right now I think.”
“I am. We alternate weeks.”
“It’s an emergency room physician in Honolulu. Gerald Amoy. Goes by Jerry. Do you have a pen?”
“No.”
“I’ll text you his information. Give him a call. He’s put in a request for help so I took the liberty of booking your flight for two this afternoon. You okay with that?”
“Sure, I didn’t have any plans for today,” she said calmly, hiding her excitement for a free trip to Hawaii.
“I figured you wouldn’t mind. I’ll send his information over now.”
Sam got to the park and sat on a bench in front of the swing set. A young girl was being pushed by her mother and Sam watched the young girl’s smile and the way she would squeal when she got pushed just a bit too high. Sam didn’t notice that her phone had vibrated with an incoming text and when she glanced down at it she saw that ten minutes had passed.
She clicked on the number displayed in the text.
“Queen’s Medical Center Emergency.”
“Hi, this is Dr. Samantha Bower with the Centers for Disease Control. I need to speak with a Dr. Gerald Amoy. I’m returning his call.”
“Let me page him.”
She was put on hold and heard a ukulele with a soft voice singing over it. The lyrics were in Hawaiian and it excited her even more. She hadn’t been on a real vacation…well, ever. She had worked her way through medical school at the University of Arizona and had no time off during her surgical residency.
Just thinking of the hours she put into her residency in a busy hospital in the suburbs of Chicago sent a chill up her back. As a matter of course she would be in the hospital over a hundred hours a week, leaving no more than six hours a day to eat, sleep, drive, shower, spend time exercising, reading, talking with her family, and anything else she might have had to do. Within the first two weeks, she knew she no longer wanted to be a surgeon.
Luckily, she had met the chief of infectious disease research at the University of Chicago’s Department of Biology at a CME course for physicians. He’d shown up half-drunk and hit on her and then, seemingly to impress her, indicated he was looking to replace one of the physicians on his staff that was leaving the program due to substance abuse issues. She jumped at the opportunity. She applied and got the position after just one interview. The fact that it paid half what the average medical school graduate could expect to earn didn’t hurt, as there were only seven other applicants.
The nine-to-five research schedule made her feel as if she had been freed from prison. She completed three years and was going to take a position with a prestigious clinic in her hometown of San Francisco when she discovered the world of epidemiology on the job, and, almost without any effort, received an offer from the CDC through her connections at the University of Chicago.
“This is Amoy.”
“This is Samantha Bower from the Centers for Disease Control. I’m just responding to a request we received.”
“Oh, I’m glad you called. Just a second.” There was some shuffling and she could hear him give instructions to somebody. “Sorry about that.”
“No problem. So what can we do for you, Dr. Amoy?”
“I have two patients here that are displaying symptoms of an unknown viral infection. One of them is in critical care—I don’t think he’s going to last much longer. The other has just started displaying symptoms. We have them both in isolation here in the hospital.”
“What are their symptoms?”
“The first victim had a rash that’s now displaying on the second. The first victim is hemorrhaging sub-dermal
ly. In the last ten hours or so the skin has begun falling off in sheets. There’s been dark hemorrhaging from the eyes, ears, penis, and anus. We’ve had him on almost constant blood transfusion but it’s not affecting him anymore. Infection is spreading through his body on the portions where the skin has come off. I called because I didn’t think he’d survive more than another day or two and thought you might want to look at him.”
“I won’t be there until tonight. Can I call you when I land?”
“Sure, I’m heading out right now but I’m on a twenty-four-hour shift starting at eleven. Just leave a message if I don’t answer right away.”
“Okay, thanks, Doctor.”
“No, thank you.”
Sam hung up and took a deep breath as she put her phone away. The symptomology of the victims indicated a severe viral infection. There were any number of known viruses that could cause those symptoms, and many more that science hadn’t discovered yet. Of course, she’d seen similar symptoms before and it had been a false alarm. The patient displayed Marburg virus type symptoms and it turned out that they had smoked a bad batch of methamphetamine, cut with dozens of poisonous substances, over the course of a week. An actual unknown viral infection that could cause those symptoms was extremely rare and the likelihood was that this was something else.
Still, her belly tingled with excitement and anticipation, and also fear. This was why she had gone into epidemiology in the first place. She looked at the young girl and smiled at her before rising and heading back to her house to pack.
CHAPTER 5
The layover at LAX took two hours and Sam perused the magazines and books in the gift shop. She had her iPad with her and refused to read any book in paper form that could be found electronically, but there was something relaxing about the actual feel of a book in her hands, the smell of the pages as she flipped through them.
She got a salad with extra cheese and an apple juice from a café at the airport and spent her time reading the New England Journal of Medicine near a window, glancing over occasionally as a plane landed or took off. They called her flight and then delayed it another twenty minutes before she was finally let on the plane.
It wasn’t until past midnight that she stepped onto the tarmac of Honolulu International. Traveling over the ocean at night had been an experience she hadn’t expected. The moon lit the water a dim white and it looked like a flashlight shining in a pool of black oil. A ship was on the sea underneath the plane and she watched it until it disappeared into the murk of the Pacific at night.
She grabbed her two bags and went to the curb to hail a cab. Rather than finding a hotel, she went straight to the hospital.
Honolulu struck her as a resort town created specifically to cater to tourists. The restaurants, bars, shopping malls, and even convenience stores looked uniquely islander. The air had the salty taste of the ocean and it was humid, but pleasant. She kept her window rolled down on the cab ride over and tipped the driver well before getting out.
She stood, staring up at Queen’s Medical Center. It too appeared like a resort rather than a hospital. The valet area was lit with the soft glow of tiki torches and the building itself resembled an upscale hotel. She had read about it on the plane and knew that, with over five hundred rooms, it was the largest hospital in the state.
As she walked through the ER’s sliding glass doors, she was struck by the familiar smell of hospital antiseptic. Rather than a nostalgic, warm feeling as many physicians had upon entering a hospital when they had not been practicing in the profession, it brought up images of being so exhausted she couldn’t keep her eyes open and would fall asleep at a cafeteria table. Or of being yelled at by the attending or the chief for minor errors brought about by the exhaustion, or of turning down dates because there simply wasn’t enough time to sit down for dinner at a restaurant without being called in.
She went to the reception and asked for Dr. Amoy. While waiting, she set her bags down on one of the waiting room chairs and stretched her arms over her head and rolled her neck. She had missed her run today and it was a ritual that, if ignored, would throw off her entire rhythm and cause insomnia at night.
“Dr. Bower?”
She turned to see a man in blue scrubs and a white coat approach her. He was tall and lean. Clearly of Hawaiian decent but with light skin and sandy hair. They shook hands and she picked up her bags.
“I’m Jerry. Nice to meet you.”
“Nice to meet you,” she said.
“I take it you haven’t checked into a hotel yet?”
“No, not yet.”
“You can leave your bags behind the reception desk. The first patient isn’t doing well. We’d better head up there as soon as we can.”
She dropped her bags off but took out a legal pad and pen. It was what she always used for notes on field assignments because she could copy them into her iPad before leaving the scene and then throw away the notebook in case it had been exposed to any pathogens. Such a risk was minimal but it helped her feel better and was certainly worth the two-dollar price tag for a pack of legal pads every few months.
Dr. Amoy took her up the plush elevators to the third floor where there were women’s locker rooms. She changed into scrubs and was given a facemask, gloves, and booties. After changing, she looked at herself in the mirror. Sometimes it struck her how odd a job she really had. She was like a fireman that ran into a burning building when everyone else was running out. It was counter-intuitive and certainly anti-evolutionary. Biologically, humans were not set up to expose themselves willingly to disease. If she didn’t control her thoughts and her breathing, panic could strike her as easily as it would anyone.
When she came out of the locker room she saw Dr. Amoy speaking on his cell phone. “I have to go…love you too.” He looked to her. “Ready?”
“I’d like to see their charts first if I could.”
“Certainly.”
They went back to the elevators and up to the top floor. They walked down a long corridor where there was only one reception desk, which was left unattended. She noticed more offices than hospital rooms and also a kitchen and lounge area.
“They’re converting this floor but this used to be our psychiatric unit,” Amoy said.
“I gotta tell you, this is one of the nicest hospitals I’ve ever been in.”
“You’re preaching to the choir. My residency was done in St. Catherine’s in Detroit. You ever been?”
“No.”
“It’s like a cheap office building with an OR. We’d get a dozen gunshot victims a weekend and it would take the staff days just to clean up the blood. We were underfunded and they contracted the janitors out—it’s just up here to the right.”
They turned down another empty corridor and walked past some construction that was taking place. No workers were there at this hour but Sam saw half-empty Gatorade bottles and burrito wrappers lying out.
Once they were in a small conference room with a fridge, Amoy went in and pulled two charts off a wall hanger. He sat down at the table and Sam did the same.
“Clifford Lane, resident of Honolulu, twenty-nine and in perfect health before this. Second victim is an Erin Simon from Los Angeles. She was here on vacation.”
He passed the charts to her and she began reading. She took notes on her pad of the patients’ statistics: height, weight, occupation, marital status, sexual orientation, etc.
“I’ll need their medical records,” she said.
“We can get that afterward when you’ve signed the HIPPA release. I really think we should see them now and do the paperwork later.”
They rose and Sam checked her gloves and mask for any tears or holes. Amoy did the same and they walked out to the corridor and down to the room at the end of the hall. Two adjoining rooms were connected by a thick door and Sam saw a woman of thirty-six lying on her back, her eyes closed, a morphine drip attached to her arm.
“Hello, Erin,” Amoy said, approaching the bed. “How we feeling today
?”
Sam stood by the foot of the bed, bending as close as she dared to get a good look at her exposed arms and neck. Her skin appeared smooth, no pustules, but splotches of black and dark purple appeared underneath. It didn’t cover her entirely but it occurred frequently enough that she could tell instantly it wasn’t bruising. It was blood that was flooding out of her body just underneath the skin.
Sam looked to the woman’s mouth. Crusted, dried blood lined her nostrils and her lips. Her teeth were stained with it and her mouth was completely dry and hanging open as if she were struggling to suck in air.
She heard something out of the patient that sounded like a groan but caused Dr. Amoy to respond and Sam realized the woman was speaking.
“I want to go for a walk,” she gasped. “I’ve been in this bed for five days. I want to go for a walk.”
“Soon,” Amoy said, checking the morphine. “We just gotta make sure we’re dotting our I’s and crossing our T’s before we take you for a spin. We want to get you home to your family as soon as we can, darling. Would you like anything else right now?”
There was no response and Sam saw that the woman had dazed off into sleep or unconsciousness. Amoy lightly touched the bed, running his fingers over the sheets. Sam could tell he wished to touch the patient; human contact was important to the best doctors, the ones that went into medicine to actually heal patients rather than for money or prestige. Instead, he had to settle for the sheets behind a rubber glove.
“I’d like to see the first patient,” she said, not taking her eyes off Erin.
Amoy walked to the door and opened it to reveal another room identical to the first but set up diametrically opposite. The bed was against the wall, facing them, and Sam stopped at the doorway when she saw the patient.
He looked as if he’d been burned in a fire. His skin was black and large portions of it were covered with antiseptic gel used for burn patients when the skin had peeled off. Bandages covered his legs. He opened his eyes briefly, flashing a feverish anger from confusion, and she could see a bright red conjunctivitis, the whites of his eyes soaked in blood. His eyes closed and he let out a long, raspy whisper.
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