Resistant

by Michael Palmer

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  Dedicated with love

  to my sons, Matthew, Daniel, and Luke

  One of the duties of the State is that of caring for those of its citizens who find themselves the victims of such adverse circumstances as makes them unable to obtain even the necessities for mere existence without the aid of others. That responsibility is recognized by every civilized nation.… To these unfortunate citizens, aid must be extended by government—not as a matter of charity, but a matter of social duty.

  —FRANKLIN D. ROOSEVELT, FIRESIDE CHAT, 1933

  Throughout the course of human history people have endured uncertainties brought on by illness, poverty, disability, and aging. Economists and sociologists take delight in labeling these inevitabilities as threats to one’s economic security, when in truth they are the price each individual must pay to fund their existence.

  —LANCASTER R. HILL, 100 Neighbors, SAWYER RIVER BOOKS, 1939

  CONTENTS

  Title Page

  Copyright Notice

  Dedication

  Epigraphs

  Prologue

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Chapter 22

  Chapter 23

  Chapter 24

  Chapter 25

  Chapter 26

  Chapter 27

  Chapter 28

  Chapter 29

  Chapter 30

  Chapter 31

  Chapter 32

  Chapter 33

  Chapter 34

  Chapter 35

  Chapter 36

  Chapter 37

  Chapter 38

  Chapter 39

  Chapter 40

  Chapter 41

  Chapter 42

  Chapter 43

  Chapter 44

  Chapter 45

  Chapter 46

  Chapter 47

  Chapter 48

  Chapter 49

  Chapter 50

  Chapter 51

  Chapter 52

  Chapter 53

  Chapter 54

  Chapter 55

  Chapter 56

  The Boston Globe

  Also by Michael Palmer

  About the Author

  Copyright

  PROLOGUE

  A heavy pall had settled over Boston’s White Memorial Hospital.

  Becca Seabury’s condition was deteriorating.

  The hospital grapevine was operating at warp speed, sending the latest rumors through the wards and offices of the iconic institution, chosen two years in a row as the number-one general hospital in the country. This morning, in all likelihood, the decision would be made—a decision that almost everyone associated with White Memorial, from housekeeping to the laboratories to the administration, was taking personally.

  Before long, the team of specialists—orthopedic, medical, and infectious disease, would either choose to continue battling the bacteria that the press and others had begun calling the Doomsday Germ, or they would opt to capitulate and amputate the teen’s right arm just below the shoulder.

  In room 837 of the Landrew Building, a group of carefully selected physicians and nurses had been assembled. At the doorway to the room, as well as at every elevator and stairway, security was keeping the media at bay, along with any but essential personnel.

  From the day, more than two weeks ago, when Becca was operated on to clean out infection from the site of her elbow repair, she had been front-page news.

  FLESH-EATING BACTERIA COMPLICATING CHEERLEADER’S HEALING

  The seventeen-year-old, captain of her school’s championship team, had shattered her elbow in a spectacular fall during the state finals. The violent injury was chronicled on YouTube and immediately went viral, making Becca something of a household name around the globe. A successful reconstruction by Dr. Chandler Beebe, the chief of orthopedics, followed by several days of IV antibiotics, and the conservative decision was made to wait one more day and discharge.

  That was when Becca Seabury’s fevers began.

  The Landrew Building, less than two years old, was the latest jewel in the expanding crown of White Memorial. The eighth floor featured four negative pressure isolation rooms—airtight spaces except for a gap beneath the door, with a ventilation system that brought more air into the room than it allowed out. By the time a nurse escorted Becca’s family to the waiting area, there were seven in gloves, gowns, and hoods in the spacious room.

  Chandler Beebe, six-foot-six, towered over the rest.

  Nearly lost among them, motionless on her back, was a pale, fair-skinned young woman, with hair the color of spun gold. Her lips were dry and cracked and the flush in her cheeks looked anything but healthy. An IV with a piggybacked plastic bag of meds was draining into her good arm. The temperature reading on her chart was 102.5 degrees. It had been as high as 104. Her blood pressure was 85/50.

  Chandler Beebe, once a guard for the Harvard University basketball team, was generally unflappable. Now, beneath his mask and hood, he was nearly as pale as his patient. It was the smell, he knew, that was getting to him. Despite his years operating in war zones and medical missions to third-world countries, he had never been fully able to accustom himself to the odor of pus and of rotting flesh. Glancing at the monitor, with a nurse holding up Becca’s arm, he began unwrapping the gauze he had placed around it eight hours before. Beebe had two teenagers himself, a boy and a girl, both athletes and excellent students, and as brave and well-adjusted as this girl. But he couldn’t get his mind around the image of either of them being at the crossroads of decisions like this one.

  The progressive layers of bandage as they were removed were first damp with bloody drainage, then soaked. The ooze, from eight inches of filleted incision, reeked of untreated bacterial growth. The color of the flesh darkened. Twelve days before, Beebe and a surgical colleague had reopened the incision he had made when he did the initial, meticulous reconstruction. The infection had come on with the speed and ferocity of a Panzer attack. Fever, shaking chills, new swelling, intense pain, dehydration, blood pressure drop. Signs of infection in an enclosed space. There was no choice that day. The incision had to be opened, debrided, irrigated, and drained.

  Now, it was time for another decision.

  Becca Seabury’s antecubital space—the inside of her elbow—looked like ground beef that had been left in the sun. Muscle fibers, tendons, ligaments, all basted in thick, greenish purulence, glinted beneath the portable saucer light overhead. Beebe heard his brilliant chief resident inhale sharply, and vowed to reprimand her for the audible reaction as soon as it was appropriate. In the next moment, he decided not to mention it.

  “Becca, it’s Dr. Beebe. Can you hear me?”

  There was little response except a fitful moan. Beebe, his jaw set, looked across the bed at the chief of infectious disease.

  “Sid?” he asked

  Sidney Fleishman shrugged and shook his head. “As you can see, she’s still toxic. No change in the bug
, and no effect from every antibiotic in our arsenal. Her white count has dipped a bit, but there are no other signs that we’re winning. We’ve gotten permission to try one of the most promising experimental drugs that is being tested on strep and MRSA, but this Doomsday G—this bacteria—is like nothing we’ve seen. Strep, but not really strep, resistant to methicillin and vancomycin, and carbapenem.”

  “Conclusion?”

  “I think we have some time. Not much, but some—especially with the infection still limited to her elbow.”

  Beebe inhaled deeply and exhaled slowly. Fleishman, as bright as anyone at White Memorial, was advocating a continued conservative approach with the addition of a new, experimental drug, which was showing effectiveness against methicillin-resistent staph aureus.

  How much time do you think? Beebe was about to ask when Jennifer Lowe, Becca’s nurse, standing at the foot of the bed, cleared her throat by way of interruption. She had been massaging lotion onto Becca’s left foot and now had turned her attention to the right one.

  “Dr. Beebe, I think you’d better have a look at this,” she said. “I didn’t see anything here an hour ago.”

  She gently folded back the sheet and gestured to the foot. All five toes were reddened, and swelling extended two inches toward the ankle.

  Beebe stepped to his right and inspected this new development—first with his eyes, then with his gloved hands.

  “Sid?”

  Fleishman studied the foot, then checked for swollen lymph nodes in their patient’s right groin—often a sign of expanding infection.

  “Nothing yet,” he said, “but this is clearly new infection, probably seeded from her arm.”

  Chandler Beebe ran his tongue across his lips and took one more breath.

  “Jennifer, is the OR ready?” he asked.

  “It is.”

  “Call to tell them we’re bringing Rebecca Seabury down for removal of a septic right arm. I’ll speak to her family. Thank you for your efforts, everyone. My team, go ahead. I’ll meet you in the OR. Oh, and Jennifer, call pathology, please, and tell them we’ll be sending down a specimen.”

  The room emptied quickly and silently. These were medical professionals—the best of the best. But every one of them was badly shaken.

  Jennifer Lowe, thirty, and a veteran of half a dozen missions to villages in the Congo, bent over her patient. Lowe’s marriage to a physical therapist was just six months away. She was a sparkplug of a woman, the daughter and granddaughter of nurses.

  “Be strong, baby,” she whispered. “We’re going to get through this. Just be strong.”

  It was at that moment she felt an irritation—an itch—between the middle and ring fingers of her left hand. While she was at work, her modest engagement ring hung on a sturdy chain around her neck. She had eczema, but never bad and never in that particular spot.

  Not all that concerned, she moved over to the sink and stripped off her latex gloves. The skin between the fingers was reddened and cracked.

  CHAPTER 1

  Liberty is worth more than every pearl in the ocean, every ounce of gold ever mined. It is as precious to man as air, as necessary to survival as a beating heart.

  —LANCASTER R. HILL, A Secret Worth Keeping, SAWYER RIVER BOOKS, 1937, P. 12

  “Two-oh-six … two-oh-seven … two-oh-eight…”

  “Come on, Big Lou. It hurts so good. Say it!”

  “Okay, okay,” Lou Welcome groaned. “Two-oh-nine … It hurts so good … Two-ten … It hurts so good … Oh, it just frigging hurts! My … stomach’s … gonna … tear … open … Two-twelve…”

  Lou was doing sit-ups on the carpet between the beds in room 177 of what had to be one of the bargain rooms at the venerable Chattahoochee Lodge. Cap Duncan, shirtless and already in his running shorts, was kneeling by Lou’s feet, holding down his ankles. Cap’s shaved pate was glistening. His grin, as usual, was like a star going nova. He had done three hundred crunches before Lou was even out of the sack, and looked like he could easily have ripped off three hundred more.

  Every inch a man’s man.

  Lou’s best friend, and for ten years his AA sponsor, was a fifty-two-year-old Bahamian, with a physique that looked like it had been chiseled by one of Michelangelo’s descendants. He had earned his nickname, Cap’n Crunch, from his days as a professional boxer, specifically from the sound noses made when he hit them.

  It was April 14—a Thursday. Lou’s trip to Georgia had been ordered by Walter Filstrup, the bombastic head of the Washington, D.C., Physician Wellness Office (PWO), a position that made the psychiatrist Lou’s boss.

  Filstrup’s sweet wife, Marjory, a polar opposite of her husband, was in the ICU of a Maryland hospital with an irregular heartbeat that had not responded to electrical cardioversion. But as one of two candidates for the presidency of the National Federation of Physician Health Programs, Filstrup was scheduled to address the annual meeting, being held this year at the lodge in the mountains north of Atlanta.

  Wife in ICU versus speech in Georgia. Let … me … think.

  Not surprisingly to Lou, Filstrup had actually wrestled mightily with the choice. It wasn’t until Marjory had an allergic reaction to one of the cardiac meds that the man turned his speech over to Lou along with his conference registration, and an expense account that would cover all Lou’s meals, providing he only ate one a day.

  Whoopee.

  “You’re slowing down, Welcome,” Cap said. “You’re not going to get to three hundred that way.”

  “I’m not going to get … to three hundred any way.”

  Cap, his competitive fire seldom dimmed, delighted in saying that most people’s workout was his warm-up. Lou, nine years younger, and at six feet, an inch or so taller, never had any problem believing that. Their connection began the day Lou was checked into Harbor House, a sober halfway house in one of the grittier sections of D.C. Cap, given name Hank, was working as a group leader there while he cajoled one bank after another trying to scrape together enough bread for his own training center. Twelve months after that, Lou was living on his own, the Stick and Move Gym had become a reality, and the two friends, one black as a moonless night, and the other a blue-eyed rock-jaw with the determination of a Rottweiler and roots that may have gone back to the Pilgrims, were sparring three times a week.

  A year or so after that, following a zillion recovery meetings and the development of a new, infinitely mellower philosophy of living, the suspension of Lou’s medical license was lifted, and he was back in the game.

  “Okay, then,” Cap said, “do what you can. It’s no crime to lower your expectations. Only not too far.”

  “Does everything … we do together … have to be … some sort of competition? Two-twenty … two-twenty-one…”

  “I assume we’re going to have breakfast after our run and I don’t believe in competitive eating, if that helps any.”

  “Of course. It would be the one area I could kick your butt.”

  The Chattahoochee Lodge had been built in the twenties for hunters and had been enlarged and renovated in 1957, the same year Elvis purchased Graceland. A sprawling, rustic complex, the main building was perched in the mountainous forest, high above the banks of the fast-flowing Chattahoochee River. As ecotourism boomed in the early 1990s, the place became a major destination for leisure travelers, birders, hikers, and convention goers, with rooms often booked a year in advance.

  Lou, board-certified in both internal and emergency medicine, had never particularly enjoyed medical conferences of any kind, so it was a godsend when he whined about the impending trip to Cap and learned that his friend’s only living relative was an aging aunt, living just outside of Atlanta. Working full-time in the ER at Eisenhower Memorial Hospital, and part-time with the PWO, Lou had more than enough in his small war chest for another ticket south. The quite reasonable rent for his second-floor, two-bedroom apartment down the street from the gym and just above Dimitri’s Pizza helped make a loan to his sponsor even mo
re painless.

  Proof that the idea was a solid one was that Cap haggled surprisingly little over the bartering agreement Lou proposed—two months of weekly sessions in the ring for him, plus an additional four lessons for his precocious fourteen-year-old daughter, Emily. Cap would get the window seat.

  Having to put up with Filstrup notwithstanding, Lou loved his job at the PWO. The pay was lousy, but for him the irony of going from being a client to being an associate director was huge. The organization provided support and monitoring services for doctors with mental illness, physical illness, substance abuse, sexual boundary violations, and behavioral problems. Most new PWO contracts required the troubled physician to enter some sort of treatment program or inpatient rehab, followed by regular meetings with their assigned PWO associate director, along with frequent random urine screens for alcohol and other drugs of abuse.

  Lou was hardly averse to counseling and psychotherapy for certain docs, but he strongly believed that, physician or not, addiction was a medical illness and not a moral issue. Walter Filstrup disagreed.

  When Filstrup finally handed over his carefully typed speech and the conference program, the trip got even better. Not only would Lou and Cap have time for some training runs together in the mountains, but while Cap was visiting his aunt, Lou would be able to take a conference-sponsored guided tour of the Centers for Disease Control—the CDC.

  More irony.

  Lou had spent nearly ten months of his life in Atlanta and had never even been close to the world-renowned institute. The last time he was in the city, nine years before, was for the one-year reunion of his treatment group at the Templeton Drug Rehab Center.

  It was time to complete some circles.

  CHAPTER 2

  One man can dream, a handful can plan, thousands can strike, but just a hundred, properly placed and effectively utilized, can reshape the world.

  —LANCASTER HILL, 100 Neighbors, SAWYER RIVER BOOKS, 1939, P. III

  His name was Douglas Charles Bacon, but to the seven others participating in the videoconference, he was N-38. N for Neighbor.