by Joseph Xand
An hour after the last of the crime scene tape had been stretched out and about the same time as the chief of police was about to update the media on what he knew so far (which wasn't much), the incident repeated itself, across the mouth of Raritan Bay, on Coney Island.
Thousands of carnival attendees, both tourists and native New Yorkers, were enjoying their evening on Coney Island as a cool breeze blew off the Atlantic. Most were too busy eating hot dogs, riding rides, playing games, and shopping the various open markets and bazaars to notice strange-looking individuals stroll out of the water, walk up the steep grade, and either tumble over the small barrier separating the carnival events from the water or slowly navigate up the narrow sets of steps leading to the main promenade.
And even when the screaming started, few people paid it any mind, assuming a carnival ride was playfully torturing its riders.
As bad as the situation at Shoreline Hook had been, it paled in comparison to the confusion and pandemonium at Coney Island.
Imagine.
Seventy-three corpses walked out of the water. Hundreds of people were injured. Forty-five were killed, many trampled underfoot by the civilian stampede. Even though police and other crisis personnel were in closer proximity to what those in Shoreline Hook had been, the disorder and bedlam led to a slower response time.
Dozens of amateur videos hit the internet shortly after the Coney Island attacks began.
And, from his high-rise office at Levinson Pharmaceuticals in Midtown Manhattan, Thad sorted through them all. He was particularly interested in shots that offered good, clear views of the assailants. In each screenshot, he noticed commonalities among the strange people attacking others with no apparent motive; namely bloated faces and hands—traits typical of dead bodies that have been decomposing in temperate waters for several days. What homicide and forensic experts would call "floaters." As putrefaction ensues, the body's tissues accumulate gases, beginning with the face and hands. This accumulation forces them to float, hence the term.
Thad resisted the urge to call Jennifer again, but his lack of involvement was torture.
The next day, members of the general public, via blogs and Facebook and other social media outlets, began speculating the attackers were the vengeful ghosts of the Liberty Coast passengers. The mainstream media and leading medical and military experts called such conjecture ludicrous. Thad wasn't so sure. And once again the President was being tight-lipped.
Two days after the attacks, Thad's cell phone finally rang. He recognized the caller immediately. He quickly shut his office door before picking up.
"Jen? Are you out of aspirin?"
"Thad. I'm sorry about…the other day when you called. I was…"
Back at his desk, Thad gathered his belongings as he talked. "Jen, forget it. Just tell me what I can do. I can be on the next flight to Atlanta and probably arrive at CDC headquarters at, uh…"
"I'm not in Atlanta."
Thad paused. "No?" He closed his briefcase slowly. "Where are you?"
* * * * *
Two hours later Thad pulled into the parking lot of the Shoreline Hook Regional Medical Center, having passed through a military checkpoint after turning into the driveway. There security phoned in his approval to enter, signed him in, and issued him parking and security passes.
Amazing. Thad had never seen anything like it. The Centers for Disease Control and Prevention had commandeered the entire five-story hospital. Jen told him on the phone how every patient had been relocated to surrounding hospitals in less than five hours.
He met Jen in the hospital's lobby, which he was allowed to access only after having his security pass slid through a device, his ID checked, his picture taken, and handprint scanned.
"You always had a flare for the dramatic," he told her. But her stifled grin told him this was anything but overly-cautious protocol.
He leaned in for a hug, but after she glanced at the soldiers on duty, Jen stuck out a hand and he shook it.
"It's good to see you again, Dr. Palmer," she told him.
"So how are you set up here?" He was itching to get started.
"Well, other than the regular CDC personnel, we've also kept on the hospital's professional medical staff, as well as a skeleton crew of OR, ER, and ICU nurses."
"They didn't mind being ordered to duty?"
"You kidding me? We didn't request anyone's assistance. They offered help and we quickly realized we needed it. They were so damn curious as to what's going on, they jumped at the chance."
"I know the feeling. So that's everybody, other than the soldiers?"
"Oh, and the EMTs. They're the only ones initially quarantined against their will. They've been helping out here, too."
"EMTs? Why are you holding them?"
"All in good time. But you wanted to know the layout, I guess? The top two floors are for the autopsies of the dead bodies and their storage, for the most part. That's where most of the research is happening. And that's where most of the professional staff are located. Trauma surgeons; the neurosurgeons; orthopedic, cardiac, ENT, and pediatric surgeons; even a hand surgeon and a plastic surgeon. Right now they are all forensic pathologists, performing autopsies."
"Jesus."
"Floors two and three are where we keep the most dire cases. Unfortunately, it's proven to be one giant waiting room until they are moved to the top floors."
She paused to let him take that in.
"Wait a minute. They've all succumbed to their injuries? No one's recovered?"
"Not yet."
Could the news reporters have been wrong in estimating the extent of the injuries? He thought on that, looking around the quiet lobby that would normally be bustling with patients and concerned family members.
Family members. Something wasn't right.
"Well, I thought you were going to tell me that the first floor was reserved for the family of the injured, but now I'm not so sure…"
"The first floor is for new admissions," she corrected. "Family members are not being allowed anywhere near this facility. The only reason they are not packed outside and protesting is because we've lied to them as to where their loved ones are being kept."
Thad's jaw dropped in disbelief. Just what had he gotten himself into? But he chose to ignore it for now.
"Okay…new admissions. Those injured in the attacks who maybe underestimated the extent of their injuries? They went home and only later realized they required medical attention?"
"Yeah, there's some of that. But not all."
Thad stared at her, puzzled.
"Do you remember New York?" she asked.
He nodded slowly, cautious and unsure.
"Come on. It's time I show you around. We'll start with the first floor."
Before Thad could go any further, he was ushered into one of the lobby bathrooms, which had been thoroughly sterilized and converted into a scrub room. He changed into scrubs (Jen was already wearing them), and then they helped one another into biohazard suits, complete with small oxygen tanks strapped to the back.
The first corridor they entered led to the ER. There Thad saw many patients suffering various stages of what looked to be some advanced pneumonia. As they walked, Jen discussed the patients' symptoms. High fever, sweating, uncontrollable shaking, dehydration, headaches, body and joint pain and swelling. Other, oddly enough, exhibited symptoms reminiscent of botulism—vomiting, abdominal pain, lack of motor functions, dry mouth and pharynx, dyspepsia (both atonic and cholelithic), alternating mydilasic, and a barking cough. Some of the patients were lucid and conversational. Others were completely unconscious, sometimes still trembling involuntarily. Jen led him to one of these patients first. She grabbed the chart and passed it to him. Flipping the pages was not easy in the thick, rubber gloves of the body suit, but he managed.
"What do you see, doctor?" Jen asked him.
Thad studied the blood test results carefully. "Gram-negative bacteria. Mucoid growth. Excessive formation of caps
ular polysaccharide. Klebsiella. Carbapenem-resistant. This patient has contracted a KPC."
Thad suspected as much. Earlier Jen had asked him if he remembered New York. Well, he lived in New York and had any other of his friends or acquaintances asked him such a broad-ranging question, he'd have had to ask them to be more specific. But with Jenny, he knew she wasn't talking about any random moment the two of them had shared. She was talking expressly about Tisch Hospital on the East Side of Manhattan in the middle of 2000.
* * * * *
KPC stands for Klebsiella pneumoniae carbapenemase and it is a particularly nasty bacteria, highly resistant to even the most advanced antibiotics, called carbapenems.
Thad was a microbiologist working at New York Presbyterian Hospital in mid-2000 when four intensive care units at Tisch Hospital saw patients developing Klebsiella infections resistant to every drug the ICU physicians had at their disposal. They were baffled.
At the time, Thad was already making a name for himself in the world of disease and infection. With three books, several journal articles touting a number of controversial studies, and a speaking tour under his belt, he was the closest thing the medical field had to a celebrity. Tisch Hospital's chief surgeon called Thad and asked if he might advise them on what to do.
When Thad was told of a Klebsiella resistant to carbapenems, he was skeptical. But when he arrived at the hospital and saw the test results, he realized he was facing a bacterial strain by which he was woefully outmatched. Within a week of working with Tisch researchers, Thad waved the white flag and called the CDC.
The fact the CDC jumped into action with little evidence to back up Thad's claims told Thad this seemed to be a call they had been reluctantly expecting.
Even with the combined efforts of Tisch researchers, the deep pockets of the CDC, and the expertise of Dr. Thaddeus Palmer, it took a full year to get the infection under control.
In the end, when it was determined that the drug needed to fight the infection had yet to be invented, doctors fought back with good, old-fashioned sanitation. They took protocols for sterilization of both people and equipment to a whole new level, and even then the bacteria rebounded more than once before it finally folded.
But it didn't go without leaving its mark. Twenty-four patients were subjected to the KPC strain, ten of which carried it without symptoms. The other fourteen developed pneumonia resistant to drugs, as well as developing bloodstream and surgical infections. Eight of the fourteen died.
In the world of global pandemics, a plague that kills five percent of the people infected by it is considered catastrophic. This new bacteria, even with the world's greatest infectious disease experts working against it, had a mortality rate of thirty-three percent.
And it wasn't finished.
The bacteria swept through several Brooklyn hospitals in 2003 and 2004, infecting more than sixty patients. Seven infections at Harlem Hospital in 2005. Only two patients survived. Soon the bacteria spread beyond New York City, into New Jersey, Chicago, Florida, and Arizona. By 2010, thirty-seven states had patients testing positive for KPC.
It also spread to other parts of the world—Canada, England, Brazil, Greece, China, and many more countries, starting with a single infected patient in Paris in 2005.
Fortunately, by then, drug companies were finally back in the fight. They developed a new class of antibiotics called glycylcyclines, such as tigecycline, that the bacteria wasn't resistant to. However, this drug was ineffective for urinary tract and bloodstream infections. That forced drug companies to create polymyxins, a class of cyclic polypeptide antibiotics that performed well against bloodstream infections. But even these carried a heavy chance of nephro- and neurotoxicity, causing damage to the kidneys and the brain. By 2009, KPC began to evolve resistance to both drug classes, and only dangerous combinations of both worked to beat back the infection. There were no clear answers.
But one thing was clear. The emergence of KPC was the best thing that could have happened to Thad's career.
The CDC, impressed with his performance at Tisch Hospital, asked him to head a team dedicated exclusively to researching and fighting KPC infections. More books and journal articles were written. He frequented talk shows and news programs. Hospitals all over the country paid ungodly sums of money to have Thad train their medical staff and other personnel in proper sanitation and sterilization techniques in hopes of stopping a KPC outbreak before it began.
Tisch Hospital is also where Thad met Jennifer Laramie, then a junior epidemiologist working for the CDC. Thad found himself enamored by her tenacity for knowledge and admired the impassioned responsibility she felt for civic duty, even if it was overly ambitious.
In him, Jennifer was starstruck at first. But as that faded, she proved to be a formidable challenger to Thad's even more accepted theories. During the time they worked together in eliminating the KPC outbreak, an affectionate friendship blossomed.
Once the outbreak was finally quashed, the CDC hired Thad full time. It was then they shared with him the history of the KPC bacterial strain and why they'd anticipated its emergence.
The first KPC was discovered by accident in 1996. The Centers for Disease Control and Fordham University had collected hundreds of samples of bacteria from hospitals in twenty-six states for testing and study. A hospital in West Virginia sent a sample that tested positive for Klebsiella, which in itself wasn't particularly unusual. Klebsiella is a common nosocomial infection spread in many hospital ICUs.
This particular Klebsiella sample, however, was different. Although Klebsiella is well known for its resistance to most antibiotics, including penicillin, it had always responded to imipenem and merapenem, two carbapenems. The West Virginia sample responded to them as well, but extremely high doses of the medication would be needed to treat an infection caused by this brand of Klebsiella.
Although the discovery of what was dubbed KPC made the epidemiologists at the CDC squeamish, no other samples were found and the CDC filed it away as an isolated incident, but had always kept itself poised to sound the alarm should KPC surface again. That was why the CDC was ready when they received Thad's initial distress call about the New York strain at Tisch Hospital—which was tougher, even, than the West Virginia strain, not responding to imipenem or meropenem in high doses.
The CDC allowed Thad his own office in Manhattan near where most of the KPC bacterial outbreaks were centralized. He also was allowed to choose his own team, and although Jennifer decided to stay in the Atlanta office, the two saw one another regularly. A physical affair inevitably ensued.
As the relationship between Thad and Jennifer became more and more obvious, Thad's marriage disintegrated. But he no longer needed his father-in-law's aid in receiving research grants—the CDC was well-funded and provided him with anything he asked for. Plus there was no denying his feelings for Jennifer were much stronger than he'd ever had for his first wife.
For the first time in his life, Thad was happy in love. He stopped pursuing affairs with random women and one night stands and focused his romantic attentions exclusively on Jennifer. Whereas his daughter Karen settled him into New York so he could be close to her, Jennifer filled him with the unfamiliar desire to settle down completely.
And as often happens, it was their differences that made them the perfect match. He was opportunistic, borderline megalomaniacal, willing to capitalize on the circumstances created by the KPC outbreak to further his reputation, prestige, and wealth. Jennifer, on the other hand, avoided the spotlight, seemed satisfied by her meager salary (by comparison) at the CDC, and took seriously her commitment to the public well-being.
But in the end, the opposing mindsets that brought them together would irrevocably pull them apart. As a microbiologist for the CDC, Thad worked closely with multiple pharmaceutical companies fashioning drugs to fight the vigorous and unyielding KPC bacteria. One of them, Levinson Pharmaceuticals, recognized his natural leadership presence as well as his inclination towards self-aggran
dizement and offered him a job with a lofty salary, complete with stock options and other benefits he couldn't ignore.
Jennifer, who wanted to work on the front lines against disease and contagion, was having none of it. She considered the money-grubbing pharmaceutical companies to be part of the problem. She pointed out that the main reason drug companies were so slow to respond to the KPC epidemic was because there was little profit in researching a product it would be able to sell to what amounted to only a handful of people worldwide. In Jennifer's opinion, Thad was selling out. Their relationship floundered.
Until the Liberty Coast Disaster, they'd barely spoken in years.
* * * * *
Thad lowered the chart. "Well, obviously the contagion isn't responding to cyclines or polymyxins, or we wouldn't have all this." Thad waved an arm in the air and looked around the room, regarding the entire hospital when he did so.
"Check the micro-shots," Jennifer told him. She leaned against a table and folded her arms as best she could in the bulky, inhibiting biohazard suit.
Thad flipped to the back of the charts where microscope photos showed a still shot of the familiar tubular Klebsiella bacteria. Something was different.
One of the things that makes Klebsiella bacteria carrying the KPC gene so hard to eradicate is that Klebsiella cells have a double-layered outer membrane that antibiotics need to penetrate before they can have any effect. KPC enzymes can usually charge and attack the antibiotics before they can infiltrate the double wall. It's not impossible, but it takes a strong drug to withstand the attack.
The micro-shots showed a strain of a KPC-latent Klebsiella cell with a quadruple membrane. No drug would ever come close.
"Now I think I see why I'm here," Thad said, studying the photo.
"And just what's that supposed to mean?" Jennifer asked, suddenly on guard.
Thad looked at her and smiled. "I'm the best damn microbiologist you know. And you are in way over your head."
"Don't flatter yourself, Palmer," Jennifer shot back. "First off, you're not a microbiologist. Not anymore. You're a pharmacologist. Secondly, I need to know what Levinson's working on. What sort of drugs are in the works that I can possibly use. The CDC director is calling around to the other pharmcos to see if they've got anything cooking as well."