Deadly Passage

by Lawrence Gold

  ‘‘What about Syria’s role in this?’’

  ‘‘It’s old news, Mr. President. With the civil war raging, I don’t think we’ll get anywhere bringing it up at this time. They’re on our radar, and we’ll take every opportunity to express our dissatisfaction and extract our pound of flesh, once we get the chance. I assure you, sir, they’ll regret their part in this despicable act.’’

  ‘‘I must speak to the nation. It’s going to take our best speechwriters to present the truth, and avoid public panic. Have the CDC get ready to begin widespread vaccination. At least that way, we won’t have to live under the threat of smallpox.’’

  ‘‘I know it’s necessary, sir, but vaccinating our population means that three hundred Americans will die from the vaccination, alone, and many millions more will suffer a variety of complications.’’

  The President sighed. ‘‘They’ll try again. We don’t have a choice.’’

  ‘‘I know, sir.’’

  The President stood, and walked to the window. ‘‘I don’t know when the world will come to understand the true nature of terrorism, and label it for the abomination that it is.’’

  ‘‘It’s virtually impossible to eliminate an effective technique, sir, and, unfortunately, terrorism works.’’

  Later that afternoon, when Andy and Jesse returned to Rachel’s room, they had difficulty awakening her.

  Andy turned to the nurse. ‘‘When did she get so sleepy?’’

  ‘‘I didn’t notice until now.’’

  When Andy shook Rachel more vigorously, she opened her eyes. ‘‘Hi, Daddy,’’ she whispered. ‘‘My head really hurts.’’

  As she spoke, Andy noticed, for the first time, smallpox lesions on her lips and in her mouth. He turned to the nurse. ‘‘Hand me your penlight, please.’’

  Andy grabbed a tongue depressor, and looked into Rachel’s mouth. As he lifted her cheek to see the lining of her mouth, he suddenly felt sick. The rounded, shiny bumps, the pox, were bleeding at their bases.

  ‘‘God, Jesse, look at this!’’

  Andy held the light, while Jesse looked into Rachel’s mouth. ‘‘I see the bleeding sores. What is it?’’

  ‘‘It’s the characteristic appearance of hemorrhagic smallpox, the most serious variety.’’

  ‘‘What should we do?’’

  ‘‘We need to get our hands on cidofovir, and start it at once. I don’t care if they’ve proven its effectiveness or not. We’ve got to play all the odds for Rachel.’’

  Chapter Fifty-Nine

  The director of the CDC came into the virology laboratory to check on the specimen from Nicole’s draining smallpox sores. ‘‘What have you got?’’

  The chief tech checked his notes. ‘‘Nothing, yet.’’

  ‘‘Nothing?’’

  ‘‘We sent our material on smallpox, and the specimen, to a reference laboratory capable of creating a DNA profile on the virus.’’

  ‘‘That’ll take weeks,’’ the director said.

  ‘‘No, boss. This lab is doing a rapid DNA analysis technique, which gives accurate results in minutes, not days.’’

  ‘‘Call and have them fax the results to us.’’

  The director and the chief tech stood by the fax machine. When the 4-page document came through, the director said, ‘‘Well?’’

  The tech scratched his head as he read down the parallel columns. ‘‘Something must be wrong, sir. We’d better ask them to run it again.’’

  ‘‘What’s wrong?’’

  ‘‘Our specimen doesn’t match anything in the database.’’

  An hour later, they looked at the new results.

  ‘‘This is smallpox for sure, sir, but it’s unlike anything we’ve seen before. Somebody’s been monkeying with this bug’s DNA. Moreover, it shares the DNA profile of the specimens we received from Kamal’s lab in Pakistan.’’

  The director got on the phone with the DHS.

  After the DHS heard the results, he said, ‘‘I’m sending a biological and security team to the reference lab to secure the specimen. The team will impress upon the techs that ran the test the meaning of National Security, and the consequences of the violation of its regulations.’’

  ‘‘If smallpox isn’t bad enough,’’ Preston Harding said, ‘‘those bastards had to make it worse.’’

  ‘‘What did they do?’’

  ‘‘They modified its genes, and you can bet it wasn’t to make it less infectious, or less deadly.’’

  The President looked flushed. ‘‘What in God’s name does that mean for us?’’

  ‘‘We need to approach this infection as if it were a totally new biological agent. Fortunately for us, we have two specimens.’’

  ‘‘Specimens?’’

  ‘‘The traitor, Nicole, and the girl, Rachel Reiss.’’

  The President reddened. ‘‘Preston, if I ever hear you talk about an innocent American girl as a specimen, then that will be the last time you step into this office. Is that clear?’’

  ‘‘I’m sorry, sir. Sometimes I think I’ve been at this too long. I only deal with the problem, and not the people. Please accept my apology.’’

  ‘‘I understand that we do have something to learn from these poor patients, but the first thing should be how to get them through this alive and well.’’

  ‘‘I’ll make every asset of the government available to that task, sir. You have my word.’’

  In Flamingo, Andy and Jesse rushed into Rachel’s room. It was crowded with masked and gloved figures.

  ‘‘What’s going on here?’’ Andy demanded.

  A tall man approached with an outstretched hand. ‘‘I’m the assistant director of the CDC, and I’ve brought my best clinicians and researchers here to help your daughter, sir. The President of the United States has issued the order that we do everything possible.’’

  Andy remained silent.

  What do they know that they’re not telling me?

  ‘‘You’ve been with her every minute. Tell us how she looks to you today.’’

  As Andy approached the bed, the figures backed away.

  The nurse said, ‘‘I couldn’t get her to react to me this morning, Doctor.’’

  Jesse moved in close on the other side of the bed. When she reached out to caress Rachel’s face, her hand wavered as the putrid pox came into view. When Jesse felt a fleeting moment of revulsion, she remembered the little girl beneath, and cried.

  The pox had progressed to pus-filled sores all over her face, arms, and legs. Few sores appeared on her trunk.

  ‘‘They’re much worse,’’ Andy said. ‘‘Did you bring the cidofovir?’’

  ‘‘Yes,’’ said the director. ‘‘The nurse has it ready to infuse, if it’s okay with you.’’

  ‘‘Do it. I think we should cover her for secondary bacterial infection with a broad-spectrum antibiotic, as well.’’

  ‘‘Let’s do it,’’ the director said.

  Jesse and Andy sat at the bedside continuously. They watched as numerous physicians and consultants conferred at Rachel’s bedside.

  When the director reappeared, Andy said, ‘‘We appreciate all the attention, sir, but what aren’t you telling us?’’

  ‘‘Nothing,’’ he said, touching his face.

  ‘‘You’re not a poker player, are you?’’

  ‘‘No, I’m not.’’

  ‘‘We have a right to know everything,’’ Jesse said.

  The director took Andy and Jesse aside. ‘‘You never heard it from me, but the DNA profile on Nicole’s virus is unique. We can’t find it in any known smallpox database. We must assume that they genetically modified the organism. Its profile matched the organism we removed from the lab in Pakistan.’’

  ‘‘Those bastards.’’ Andy cried.

  ‘‘What does that mean for Rachel?’’ Jesse asked.

  ‘‘Our people are studying the research data from Kamal Yamin’s bioweapons laboratory. Maybe we’ll get somethi
ng we can use. In the meanwhile, your guess about the nature of Rachel’s illness, its natural history, and its dangers, is as good as ours.’’

  Chapter Sixty

  Sunshine and clear skies followed the storm, and lent an air of renewal. Rachel had completed two days on cidofovir, and Andy and Jesse had awoken that morning with hope. When they reached Rachel’s bedside, however, they took one look at their daughter, and hope’s false promise evaporated at once. Everything was spinning out of control.

  Jesse held Rachel’s hand. ‘‘I can’t stand to see her this way.’’

  While they had the full support of the CDC, and an impressive array of specialists and researchers, Rachel’s condition, by anyone’s assessment, was worsening.

  ‘‘We’re doing everything possible, Andy,’’ Seth Pinker said. ‘‘The President has made Rachel’s survival our top priority. We’re getting incredible pressure from above.’’

  ‘‘What’s with that guy?’’ Andy said, ‘‘He was willing to leave us to the mercy of a hurricane, and now he wants to help. Politicians drive me nuts.’’

  ‘‘Tell me about it. I can only share with you where we stand, and believe me, it’s with Rachel.’’

  Andy stared at Seth. ‘‘The government’s interested in effective treatment for smallpox should an attack occur, aren’t they?’’

  ‘‘Of course. At last count, the Department of Defense has screened over 11,000 compounds for activity against smallpox. That’s a serious effort.’’

  Rachel’s mental status varied between semi-consciousness and coma. While awake, she tried to speak through her pox-encrusted lips, but they couldn’t understand her.

  ‘‘It’s a blessing,’’ Jesse said, ‘‘that she’s sleeping through this. I can’t imagine what it must be like to be awake, and be so sick.’’

  ‘‘Nature’s one kindness in the face of severe illness,’’ Andy said, ‘‘is that Rachel doesn’t know what’s happening, and won’t remember it afterward.’’

  ‘‘How’s Nicole?’’ Jesse asked.

  ‘‘She’s just as bad,’’ Seth said. ‘‘She’s on cidofovir, too.’’

  Jesse wrapped her arm around herself. ‘‘God, there must be something else we can do.’’

  Andy reached for his cell phone. ‘‘I’m going to call Aaron Klein, my former chief, and the Director of Infectious Diseases at U.C. San Francisco.’’

  Seth shook his head. ‘‘Okay, Andy, but you can’t use the word ‘smallpox’.’’

  Andy looked at him as if he were a lunatic. ‘‘Are you nuts?’’

  ‘‘Until the President speaks to the country, nobody is to use that word.’’

  ‘‘Fuck you, Seth, and if the President stands between me and any possible help for Rachel, then screw him, too.’’

  The phone rang in at 5 a.m. in Tiburon in San Francisco’s Marin County. The half-asleep Aaron Klein answered. ‘‘This better be pretty damn important.’’

  ‘‘Aaron, it’s Andy Reiss.’’

  ‘‘Andy, how the hell are you? I thought you were somewhere out on the high seas?’’

  ‘‘We were,’’ Andy said. ‘‘I need your help.’’

  ‘‘Anything.’’

  Andy told him about Rachel, but omitted the details. Aaron would know at once that smallpox meant bioterrorism.

  ‘‘Rachel’s on her third day of cidofovir, but she’s getting worse. Is there anything else we should consider?’’

  ‘‘Until last week, I would have said no, but, now, I’m not so sure.’’

  ‘‘What is it?’’

  ‘‘This is more than bizarre, Andy. My broker called me last week to ask me what I knew about a company called SIPA Technologies. Their stock had recently run up about 130 percent; on the news, they said that they had an effective drug that prevents and treats smallpox.’’

  ‘‘What is it, and how does it work?’’

  ‘‘They call it SIPA-246, and it’s a protease inhibitor, like drugs we use for the treatment of HIV. It blocks the reproduction of the smallpox virus. In primates, Andy, it was 100 percent effective in blocking the development of the disease.’’

  ‘‘Incredible. How do you give it? Can we get it?’’

  ‘‘It exists only in an oral preparation, and, as far as I know, it’s only available from the manufacturer. The FDA approved it under the provisions of the Orphan Drug Statutes, and fast-tracked it, as well. That’s an offhanded compliment to bioterrorism.’’

  ‘‘Thanks, Aaron.’’

  ‘‘Give Jesse my best, and kiss Rachel for me. My prayers are with her.’’

  Andy repeated the conversation to Seth Pinker.

  ‘‘What do you want me to do?’’

  ‘‘You said we have the President’s full support?’’

  ‘‘Yes. I’m sure of it.’’

  ‘‘Ask him to place a phone call to the President of SIPA, and have him send us the SIPA-246 ASAP.’’

  ‘‘Will do, Andy.’’

  Six hours later, an Army Med-Evac. Helicopter landed next to the Flamingo Lodge, carrying the SIPA-246.

  Andy scanned the research protocol and the instructions for administration of the drug. ‘‘Do you have a gastroenterologist, here, Seth?’’

  ‘‘Of course; we have every specialty represented. What do you want?’’

  ‘‘Rachel can’t swallow reliably, so we need a tube inserted into Rachel’s stomach so we can give her the SIPA-246.’’

  Half an hour later, the gastroenterologist, using a fiberoptic gastroscope, inserted a small feeding tube. Andy reconstituted the drug, pulled it up in a large syringe, attached it to the end of the tube, and then stared at Jesse. She nodded, and then half-smiled as Andy injected the drug.

  Andy wiped the sweat from his forehead. ‘‘Based on the best available data, we’ll give the drug once a day, until…’’

  ‘‘Until she gets better,’’ Jesse said. ‘‘Until she wakes up and says ‘enough’.’’

  Rachel remained semi-responsive for the next two days.

  ‘‘This is killing me,’’ Jesse said as tears streamed down her face. ‘‘I can’t stand sitting here day after day, doing nothing.’’

  Andy brought his wife close to his chest. ‘‘We’re doing everything possible.’’

  ‘‘I know.’’

  ‘‘She’s a strong girl, like her mother. She’s going to make it… I can tell.’’

  Jesse squeezed Andy’s hand.

  When Andy and Jesse came to Rachel’s bedside at 8: a.m. on the third day, they found her asleep.

  When Jesse reached for her, Andy shook his head. ‘‘Let her rest. She needs all her energy.’’

  Jesse turned, and moved into Andy’s arms. ‘‘I can’t stand seeing her this way.’’

  ‘‘What way?’’ Came a small voice.

  They turned to Rachel. She was sitting up in bed. ‘‘You guys don’t look so good. What’s up?’’

  Jesse embraced her daughter, and cried.

  The next two days brought further improvement as the smallpox lesions scabbed over, and melted away.

  Rachel sat up in bed, eating a breakfast of pancakes and bacon. She turned to Andy. ‘‘Does this mean we don’t have to go back to sea, Daddy?’’

  Nicole awoke the same day as Rachel. She remained depressed and withdrawn. The Army interrogator said, ‘‘She’s humiliated and shamed by what happened. She continues to blame her brother. She’s convincing, but nobody’s buying it.’’

  ‘‘She’ll have a long time to mull over the consequences of her actions,’’ the DHS said.

  When Preston Harding heard the fantastic results, he called the President, and explained the success of the new medication. ‘‘I think it’s time, sir, for you to speak with the nation.’’

  Chapter Sixty-One

  The three major networks, plus CNN and Fox, made time at 8 p.m. eastern for an address from the President of the United States.

  The CBS anchor sat before the camera. ‘‘We have no sp
ecific information about the President’s statement, although there’s been a great deal of chatter about Cuba.’’

  The camera moved to the Oval Office and the President’s desk. The off-stage voice resounded. ‘‘Ladies and Gentlemen, the President of the United States.’’

  The President sat with his arms placed reassuringly on his desk.

  ‘‘My fellow Americans. It’s not necessary to tell the citizens of the United States of America the costs of fighting the war on terrorism. We’ve paid the price in terms of lives lost on 9-11, the war in Afghanistan, and the war in Iraq. Those are but a small part of our global efforts to rid the world of Islamic terrorists, who murder the innocent in pursuit of their political and religious objectives.’’

  The President reviewed the recent successes against terrorists, especially Al-Qaeda, around the world.

  ‘‘In spite of recent problems, the world admires America as the best example of freedom and democracy. While that gives us our strength, it leaves us vulnerable to those terrorists, those murderers, who hate the very freedoms we enjoy, and who seek to re-impose the religious oppression of the past. They have proven repeatedly that they hold no respect for human life.

  ‘‘We must remain on guard, because, with terrorists, we must be right 100 percent of the time. They need succeed but once.’’

  The President shifted in his chair, getting ready for the meat of his speech. ‘‘I’ll speak about an unfortunate incident at sea between an American-flagged vessel in international waters, and the agents of the Cuban government, and then I’ll speak of a terrorist attack we were able to thwart.’’

  The President told of the attack on the sailboat Prophecy. He described the high-level meetings between his administration and the President of Cuba.

  ‘‘These unfortunate events in no way change the nature of the relationship between the United States and Cuba.