“Not these guys. But I put state on alert. You should call your people in Atlanta, just to give them the heads-up.”
“Done. I wanted to talk to you first.”
“Thanks for the thought.” He seemed about to hang up, then said, “Nate, let’s nip this thing in the bud. It could get nasty.”
Nobody knew, I think, how right he was.
CHAPTER 9
When I landed in Baltimore to help out St. Raphe’s and a few other hospitals in Maryland, I had just begun the second year of my two-year stint with EIS. So I guess you could say I was seasoned, at least as the Service goes. But I sure as hell wasn’t seasoned enough.
I didn’t know that, of course, as I dialed my way through the list of hospitals in the area, calling the infectious disease docs at each place to see if they’d come across anything like what we were seeing, to make sure they were on the lookout. Fortunately, the victims seemed to be confined to St. Raphe’s. Fortunately, too, the doctors were spooked. Vigilance is one of the few things you have going for you at the beginning of an outbreak.
Nearly two hours later, after finishing the calls, I suited up to reenter the biocontainment area to interview Bethany Reginald.
We needed to talk, Bethany and I, before she got too sick to be of any help. Later, I would compare notes with Verlach, who, despite our worries about the situation, was the only other person on the case besides me. According to Verlach, the woman from state assured us we would have more help later in the day, tomorrow at the latest.
I looked down at Bethany Reginald, slant eyed and slightly fat, lying uncomfortably in the bed. Her genetic bad luck—an extra chromosome twenty-one, Down’s syndrome—was not as severe as it might have been. A rose is not a rose is not a rose with Down’s, and Bethany was relatively lucky. She could speak coherently and didn’t have any of the heart or gastrointestinal abnormalities that one often sees with the syndrome. That day, despite the virus or whatever lighting through her system, she seemed to be in relatively good health. The calm before the storm. Just one IV perforated her arm—the St. Raphe’s sniper had been at work again—taped heavily to prevent her from tearing it out.
But still I worried. Down’s wreaked havoc with the immune system. Bethany, at twenty-five, had already lived a relatively long life for someone with her condition.
I took her small hand in mine and said hello. She responded with a “hi” and a squeeze, the hallmark single crease in her palm wrapping over my gloved fingers. The squeeze lasted a little too long.
“How are you feeling, Bethany?”
“I feel sick.”
“Do you feel worse than you did yesterday?”
She thought about that for a moment. “Yes. I feel sick.”
“Bethany, where do you live?”
“I like you,” she responded.
And that’s how we began.
We covered the same topics I’d tried to cover with Helen Jones. Fortunately, Bethany was in relatively good spirits and willing to talk. Unfortunately, she seemed to have an inability to remember many details of her life.
“Bethany, what did you eat for dinner last night?”
“Hmmmm. I don’t know.”
“Bethany, can you remember anything you ate yesterday?”
“You’re cute.”
She was lying, of course, considering my getup.
We tried food questions for a few more minutes, with negligible results. No matter. I could get the menu at her group home. We moved on to animals, for which she had a much better recollection. She’d seen rats at the home, as well as cats and dogs in the neighborhood. She’d seen dead birds. However, she wasn’t able to tell me when she saw these things. I switched subjects from animals to what would prove to be one of Bethany’s great passions: sex.
“Sex,” she said almost wistfully. “I love it.”
So we talked about it. I asked about partners. Lots, she said. Jerry, Douglas, Thomas, et al.—she couldn’t remember them all, and she couldn’t give me last names. I asked her about sex with women. She’d done that. I inquired about oral and anal sex, about other activities involving the exchange of body fluids. And let me tell you, describing anal sex and water sports to Bethany Reginald was a singular experience; I felt the heat rising in my face and was glad, for once, to have a mask on. Anyway, this girl had done quite a bit in her short life. Certainly more than I had, which isn’t saying much.
“Bethany, do you have sex in your room where you live?”
Her eyes widened. Suddenly she was not tired; she was scared. “No, no, no, no—” The words came as a stream.
“Where do you have sex?”
“—no, no, no, no, no, no.”
“Bethany, this is important. Listen to me, honey.” I took her hand again. “I won’t tell anyone. I promise.”
Muttering her no-no-no, she tried to curl into a fetal ball. In doing so, she rolled away from the IV, which pulled tight, tipping its metal stand. I grabbed the stand before it fell; the motion scared Bethany and she began to scream, rolling toward me and ripping at the IV, yanking it out of her arm. Blood welled from the gash in her vein. When she saw the blood, she started to claw at her gown, spattering blood across her body, across my gown and mask.
I stepped back, watching Bethany roll back and forth and wail. That’s the bitch of these diseases. Heroism—trying to restrain Bethany Reginald, for example, to prevent her from hurting herself—can get you killed. In stark terms, the diseases force you to look out for Number One. It’s not something doctors do easily.
I hit the emergency call button and barked to the nurses to get into the room with some restraints. Because of the precautions, it would be a few minutes until anyone from outside the suite appeared.
Verlach pushed into the room, having heard the call from Helen Jones’s room.
“What happened?” he asked. I didn’t answer; it didn’t matter anyway.
The two of us, two doctors whose lives were dedicated to saving the sick, stood impotently by while blood flowed from the hole in Bethany’s arm. The blood wasn’t clotting; it was flowing too fast. The virus or whatever had taken hold.
Forty minutes later, after Bethany had calmed down, after she had been restrained, and after a central line had been placed in her chest, I was standing outside St. Raphe’s, leaning against my car, smoking a cigarette that I’d bummed from the intake nurse on the first floor. The security guard gave me some guff about smoking on hospital grounds, so I told him to shoot me if he wanted. He didn’t want, and he left me alone.
My hand, I realized as I pulled the cigarette to my mouth, was shaking. One of the downsides of this job is that you spend a lot of time around things that have spent thousands of years evolving inventive ways to kill you. When some of those things actually splash on you, well, it’s a pretty intense experience. It’s kind of like being in a bad car accident and walking away, except you don’t know whether you’ve really walked away: you feel fine for a week, then you’re puking up your GI tract and getting last rites from the chaplain.
Verlach appeared, sweat already beading on his forehead in the ninety-plus-degree heat. He looked at me and the cigarette and frowned, thinking, I suppose, whether he should say something to the only public-health doc in the country who smoked. Good man that he is, he let it lie.
“Any contact with the blood, Nathaniel?”
“No.”
“You sure?”
“I spent ten minutes in the mirror, Herb. I’m sure. No contact.” I took a long drag on the smoke. “She okay?”
“She’s sleeping now. What happened?”
Unfortunately, I was at the end of my cigarette. I stubbed it out on the bottom of my shoe and cupped the butt in my hand. I may pollute my lungs, but I don’t litter. “I asked her about having sex in her room.”
“That’s it?”
“That’s it.”
“Well”—Verlach wiped his head with the back of his hand—“everybody’s touchy about sex.”
&
nbsp; “Not Bethany. She was okay with the sex talk. She freaked when I asked about her doing it in her room.”
Verlach got a confused look on his face. “Why would that be?”
I shrugged and walked to a trash can in front of the hospital and tossed the butt into it. “You ready to hit the streets?”
CHAPTER 10
An hour later, the transfer of patients out of St. Raphe’s was in full swing. It seemed everyone knew who to blame for the shutdown, and Verlach and I suffered the sharp stares and mumbled comments. I was happy to be out of there.
Verlach and I were set to march into the community for our investigation. We were going in light, armed with specimen kits—swabs, labels, phlebotomy kits for taking blood samples—notebooks, and a few small-mammal traps. We were going out to look for reservoirs—animals or insects that served as hosts for the disease—and vectors—animals, insects, or people that served as conduits between the reservoirs and the sick women. We wanted to capture rodents and insects and send them to the labs for analysis. We also wanted to look at people, at their blood, their saliva. For diseases like the one we faced, the normal modes of transmission were rodent to man, insect to man, or man to man. Man-to-man transmission usually happened through body fluids. All very sloppy stuff.
Verlach went to the Baltimore Haven home, where Deborah Fillmore was a resident. I went to Open Arms, home to Bethany Reginald and Helen Jones.
I drove fast through the afternoon swelter. By that time, the city had soaked up most of the heat the sun poured in during the day, and radiated it back up at me. Flags lay limp on their poles, and fumes from cars and buses had little chance to disperse. Few people wandered outside. It wasn’t a heat wave per se, but the ninety-three-degree days had been going on for over a week now, and a few unfortunate denizens of that city would be dead before the spell ended. Poverty means no air-conditioning. That and old age can kill you.
I pulled my car to the curb outside a brick row home that looked pretty much like the other brick row homes on the block. Maybe it had a few more flowers outside. Maybe it was a little better cared for than the others. But I’m splitting hairs here. On the whole, the block was nice, on the outskirts of the chichi Federal Hill neighborhood, the bleeding edge of gentrification.
An intercom box with a button sat to the right of the slate-blue door. I buzzed. A moment later, a voice cracked across the system, asking who I was. I answered, and the door opened.
Mary D’Angelo was a kind-looking woman in her fifties or sixties, dark hair just turning to gray, weight settling heavily on her hips. She embraced me, her arms wrapping lightly around my back. Those two limbs, I supposed, were the inspiration for the home’s name. “Dr. McCormick, I hope we can help.”
I told her I was sure she could. And I thanked her for the public service she was performing by allowing me to come.
“We’re just so worried about Helen. Bethany, too, of course.”
“I know. We’re doing our best to help them and to make sure no one else gets sick. I know you’re as concerned about this as we are.” Always good to enlist support early on. “How many residents live here?”
“There are eight altogether.”
“Are they here now?”
“No. All of our residents are able to function in society, Dr. McCormick. They’re at work. The home is usually closed during the day. I’m here only to help you.”
“What time do they return?”
“Everyone is home by six o’clock.”
I looked at my watch. “Well, either I or someone else will be back then to take blood samples and talk to the other residents. Now I’d like to take swabs from the kitchen, from the bathrooms, also from Bethany’s and Helen’s rooms.”
“They share a room.”
I’d forgotten the two were roommates. A small mistake, but an amateurish one. Made it look like we had less information than we did. I played it lightly. “Well, that will make it easier.”
“Well, that’s good.” I could sense Mary D’Angelo starting to dig in her heels. This happened more often than not, this reluctance to be probed and analyzed. Not to mention the threat of a PR catastrophe that can result from having a pathogen found at your place.
“I’d also like to set rodent and insect traps in the kitchen, the basement—”
“Dr. McCormick, we don’t have rodents or insects.”
“Then the traps will be much lighter when I take them away.”
Mary D’Angelo crossed her arms.
“Would you mind giving me a tour?”
“Not at all, Dr. McCormick,” she said flatly.
We started in the dining room, remarkably homey, with a large round table on which sat a lazy Susan. Framed images of Jesus, scriptural passages, and nature paintings covered the walls. Few of the paintings looked professional. Mary saw me looking at them.
“The Maryland Institute of Art has Saturday classes. Our residents often go.”
“You seem to do a very good job of caring for them.”
“We think so.”
From there, we went to the kitchen. Now, I haven’t investigated many group homes, but I’ve poked through quite a few restaurants. This kitchen was as clean as the best of them. Pots and pans, all washed, hung from hooks above an island counter. The drain in the spotless floor was unclogged and, well, spotless. Dishes were stacked in shelves above the sink. As for the smell, the kitchen at Open Arms didn’t have the funk of an institutional kitchen.
Mary D’Angelo opened those ample arms as she presented the kitchen to me. She didn’t say anything.
Back through the dining room to a living room with a piano, where, according to Mary, the residents sang and prayed before dinner. Then upstairs to the bedrooms.
There were four bedrooms, two bathrooms. Though all the beds were made and all the laundry in wicker hampers, there was a certain sloppiness to the second floor: dresser drawers not closed, food wrappers left on desks. The bathroom sinks had soap scum and toothpaste dried to the bowls; someone forgot to flush a toilet that morning. Mary flushed it.
“We try,” she said.
She led me to a room at the end of the carpeted hallway. “Helen and Bethany are in here.”
The room was like the others, perhaps brighter because of two large windows. The shag carpet was old but clean. One side of the room was decorated with religious-themed paintings and drawings, some from Saturday classes at the Maryland Institute, others clipped from magazines or books. The opposite side had a few religious pieces, but more nature pictures: animals, landscapes, and—perhaps I should have guessed this—a picture of Brad Pitt with his shirt off.
Mary walked to the movie star’s photo, carefully removed the tack, and folded the picture into a pocket in her skirt.
“Will you be staying here this morning, Ms. D’Angelo? I’d like to get my samples and ask you some questions.”
“Of course I will, Dr. McCormick. I wouldn’t think of leaving you here all alone.”
With that send-off, I walked back downstairs, took my specimen kit, and began in the kitchen.
The refrigerator, the sink, the floor, the drain in the floor, the drain in the sink. I daubed each with a swab and sealed it into a labeled plastic container. Food samples went into their own vials, as did squirts of dish soap and hand moisturizer. I checked under the sink, behind the refrigerator, in the cupboards for mouse feces. I didn’t find any.
In the dining room, I took samples from the condiments on the lazy Susan. In the bathrooms, upstairs and downstairs, I took pieces of soggy soap, I took swabs from the moist ends of the faucets.
I rummaged through Helen’s and Bethany’s personal items. Sunscreen, Vaseline, moisturizer, all went into the specimen kit. In the bottom of one of Bethany’s drawers—it had to be Bethany’s—I found an old Cheri magazine. Hard-core pornography. It was under the loosened contact paper, difficult to find if you weren’t sleuthing like I was. You had to hand it to the girl. I covered it back up with socks.
More quickly, I searched through the other residents’ rooms. I pawed through the basement, into the backyard, through the living room, into the attic. I set up nine rodent traps; twenty traps for insects.
With Ms. D’Angelo’s blessing, I rounded up all the mail dated within the past two weeks. We weren’t looking for anthrax, but mail collection was de rigueur for anything that smacked of bioterrorism. Some days it felt as if we were moving as many pieces as the Postal Service.
Two hours later, my bag considerably heavier with sealed and labeled containers and J. Crew catalogs, I was finished. Mary D’Angelo sat in the living room, surrounded by religious tchotchkes, paging through a magazine.
“Finished?” she asked without looking up.
“Almost. I’ll need your menu for the last month.”
“Of course,” she said, closing the magazine, an old copy of Good Housekeeping.
“Who makes the meals?”
“I do.”
“Well, I’m sure they’re very good, then.” Mary looked at me with a frozen, impenetrable smile, totally unmoved by the compliment. I soldiered on. “Who makes the breakfasts and lunches?”
“The residents do. Breakfast here, lunch to go. I’m here until they leave for work.”
“And what time do they leave for work?”
“Different times. Some of the girls work in the kitchens of nursing homes, so they have to be there early. Others work the laundry. They go in about an hour later.”
“Helen said she worked at a nursing home.”
“Yes. All of the girls do. We have an agreement with a company that runs a few homes in the area.”
“Both Helen and Bethany worked in the kitchen?”
“Bethany worked in the kitchen, Helen in the laundry.”
“Did they have any friends at work?”
“Friends?”
“I have some questions, Ms. D’Angelo, about the behavior of the residents here. You may not like them—the questions, I mean—but I need to ask anyway.” Her smile stayed frozen. “I’ll cut to the chase, then. Are you aware if any of the residents here are intimate? Sexually, I mean.”
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