by Bobby Akart
Janie, who was fluent in Spanish, added, “They’re calling the village Cerro de Muerte—the Hill of Death.”
Mac thought of her escort who’d led her up the path earlier. As soon as they reached the clearing, he’d stopped and left. He didn’t want any part of this detail.
She contemplated for a moment and then gave Lawrence instructions. “Is there any place to land a chopper up here?” The village was in the midst of dense jungle vegetation. Mac hadn’t seen a clearing.
“I’ll find out or send someone to locate an opening,” replied Brown. “Do you want me to take the bodies to Guatemala City? I’ll need to get approval from their government for that.”
“Why wouldn’t they approve?” asked Mac. “They called us in, right?”
“True, but they assumed we would deal with the investigation here. They’re in the midst of a presidential campaign. President Morales would like to see this kept out of the media. In fact, my understanding is that the military will raze the village, together with the bodies, as soon as we’re done here.”
Mac considered her alternatives. Transporting dead bodies carrying an infectious disease was a dangerous proposition, as she and others had learned during the Ebola outbreak in Guinea, Liberia, and Sierra Leone. Containment was a challenge anyway, but tribal burial customs, which included a final kiss of the deceased loved ones, had assisted in the transmission of the Ebola virus throughout the West Africa region.
After the first cases of Ebola were reported in Guinea in 2013, containment practices were instituted by the World Health Organization, which published a road map of steps to prevent further transmission. These steps were not always followed, and within a year, Ebola had exploded. Mac was not interested in a repeat of those failures.
The nearest U.S. military base was in El Salvador, which was too far away to ferry dead bodies by helicopter. There weren’t any good options. She gulped down the last of her coffee and stood, ready to examine some of the bodies for herself.
“Well, we’d better get to work. But, Lawrence—” she paused briefly before continuing “—keep the monkeys out of the village. We don’t need this disease spread all over the country.”
Chapter 3
Day One
Guatemala Jungle near El Naranjo
At five foot ten, Mac was accustomed to donning protective gear designed for men. Her slender, athletic build was part genetics, part training. She found working out and participating in athletic events to be an excellent way to relieve stress. Daily, she faced the possibilities of a global pandemic. Some people feared nuclear war or economic collapse. Mac lost sleep over the myriad of possibilities that would result in a large number of deaths like those lying at her feet, multiplied by millions.
Mac had seen the worst of the worst. She had been to Zimbabwe in Southern Africa to investigate an outbreak of Lassa, a viral hemorrhagic fever first identified in Nigeria decades earlier, but had never been seen outside of West Africa. The natives were exhibiting symptoms common to most diseases—high fevers, severe diarrhea, vomiting, and rashes.
The first investigators on the scene from the World Health Organization made a diagnosis of Marburg disease, commonly known as the green monkey disease. Under the microscope, Marburg was distinctive with its long snakelike loops and twists. Lassa was similar in look, but different in treatments. Mac was able to lead researchers at the WHO to a different diagnosis, ultimately saving a lot of lives.
From that experience and others, Mac never accepted an initial hypothesis. She was known to check and recheck specimens. Her personality suited long hours in the lab, avoiding social interaction with co-workers or potential suitors. Mac had no use for the dating game. She enjoyed a quiet evening at home with a cold beer and a science journal.
Janie took Mac on a brief tour of the village to allow the entire picture to come into focus. As specimen gatherers knelt over bodies, carefully extracting tissue and blood samples, Mac would pause to observe.
She approached one of the technicians. “Have you seen any signs of lesions, pustules, or discolored skin tissue?”
“No, ma’am,” he replied.
Mac nodded and left the man to his work. She continued her walk with Janie, periodically looking into the small adobe homes. The mostly rectangular structures consisted of block walls, thatched roofs, and only a few rooms. Bodies were found in beds or at times near makeshift latrines behind the homes.
She stopped for a moment and looked toward the perimeter, where two soldiers were jousting with a group of spider monkeys who were attempting to get into the village. “Have you found any dead animals in the village? You know, monkeys, rats, bats, etcetera?”
“Only a dairy cow that was still tied to its post near a barn. The horses, which were kept in a small barn up the hill, were unaffected.”
“Have you seen any fleas since you arrived on the scene?”
“No. No mosquitos either. All of the typical carriers of disease appear to be absent except for the monkeys.”
Mac motioned for Brown to join them. “Sir Lawrence,” started Mac jokingly, “will you coordinate with our soldier friends to capture half a dozen monkeys for analysis? Also, we’re gonna need to send our teams out to the surrounding areas to interview anyone who has come in contact with this village.”
“I’m already on it,” he replied. “Well, one more thing. I want to question the boy who reported the illness. He may be able to shed some light on the condition of the villagers before they died. Sadly, he might also be infected.”
Brown hustled off, so Mac and Janie continued. “Why wouldn’t they go for help?” queried Mac aloud.
“They just don’t believe in modern medicine,” replied Janie. “They have their own forms of homeopathic treatments, which obviously didn’t work in this case.”
“I’ve spent a considerable amount of time in Africa,” started Mac. “Those of us who live in the modern world wouldn’t believe that primitive people like this still exist. Despite what happened here, it does prove that mankind can exist without the conveniences of smartphones and fast food.”
The two spent another hour surveying each body and discussing the initial findings with members of the CDC team. Brown secured more troops from the Guatemalan military and they were winning the battle in repelling the curious monkey population.
After completing their decontamination process, Mac and Janie returned to their civilian clothes and entered the administration tent to compare notes. As they entered the tent, a man was standing over the shoulder of a microbiologist while studying the file that Janie had provided Mac earlier.
Mac immediately approached the man and firmly snatched the file from his grasp. “May I help you?”
“Well, actually,” he started as he removed his Ray-Ban Aviators from his head and tucked them into one of the pockets of his khaki cargo pants, “I was doing just fine until you rudely snatched the file out of my hands.”
“Now, hold on, mister,” protested Janie. “This file is not for public viewing. Maybe you should identify yourself.”
“Sure, Nathan Hunter, Defense Threat Reduction Agency.”
“Wait,” interjected Mac. “DOD? Why would the Department of Defense be interested in this?”
He didn’t respond, but instead stuck out his hand to shake. “And you are?”
As always, Mac avoided shaking hands, drawing a puzzled look from Hunter. “My name is Dr. Mackenzie Hagan with the CDC. This is my associate Janie Turnbull. Now, why are you here?”
Hunter acted sincere and apologetic. “I’m sorry, Miss, um, Dr. Hagan, if I’ve overstepped my boundary. I’m a soldier, of sorts, so I follow orders. Someone at Fort Belvoir thought it necessary for me to visit, so I’m visiting.”
“How about some credentials,” said Janie bluntly. Hunter glared down at her for a second before reaching into his shirt pocket and producing an ID issued by the Defense Threat Reduction Agency.
Janie handed it to Mac, who returned the laminated ID
card to Hunter. Because of her mother’s background, Mac was familiar with the DTRA, which was an agency within the DOD. Their main function was countering weapons of mass destruction, which included chemical, biological, and nuclear threats.
Hunter continued to focus on Mac, who was momentarily mesmerized by his steel-blue eyes. The man was an intruder into her realm, but he was handsome and built like he was carved out of granite. She seriously doubted this Mr. Hunter’s sole responsibility with the DTRA was bird-dogging an isolated disease outbreak.
“Seriously, I don’t want to get in your way,” said Hunter. “I happened to be in the region and was asked to stop by to get an update. My superiors are interested in this sort of thing.”
“Well, Mr. Hunter, this sort of thing can have catastrophic consequences just as much as Assad’s chemical weapons program or Putin’s nukes,” said Mac, who handed the file over to a scowling Janie, who still had smoke coming out of her ears. “I’m hoping this incident doesn’t give rise to a thing of concern to the DTRA.”
“I agree.” Hunter motioned for them to sit at an empty table. The three got settled and he got down to business. “Is there anything you can tell me? I realize that you’re just getting started. I mean, you arrived this morning, correct?”
Mac hesitated before responding. How did he know that? She shook off the urge to challenge him and decided to respond. She wanted to get this over with so she could travel into El Naranjo. She wanted to see the results of the autopsies.
“Well, you know, I don’t think that this situation will be one of interest to the DTRA. Normally an arenavirus doesn’t rise to the level of a WMD.”
“An arenavirus?” asked Hunter.
“Yes,” continued Mac. “An arenavirus comes from the Latin word for sand. Under the microscope, the virus particle is round, and with further scrutiny under an electron microscope, the particle appears to contain grains of sand.”
“Okay, good to know,” said Hunter somewhat sarcastically.
Mac set her jaw and studied the man sitting across the table from her. If you didn’t want an explanation, you shouldn’t have asked. She continued. “Several of the diseases that are caused by an arenavirus fall under the broad category of hemorrhagic fever, like a dozen other infections from members of different viral groups such as Ebola, Lassa, and Marburg—three very deadly viruses. Make no mistake, in its most critical form, hemorrhagic fever can be as dramatic and relentless as anything you’ll ever see in medicine.”
“Based upon your observations, what leads you to a preliminary conclusion that an arenavirus is involved here?”
Mac leaned back in her chair and crossed her legs. She adjusted her blouse and took a quick glance down to make sure there were no distractions. It was warm in the tent and she was a little sweaty, but she resisted the urge to undo another button on her shirt. One set of groping eyes was enough for the day.
“The impact of hemorrhagic fever on the body is swift and severe. It comes on abruptly and leads you on a downward slope as you feel worse and worse with scattered symptoms being felt throughout your body’s vital organs. The sense of fatigue is numbing, as though you were crushed under a boulder. Fever saps your will to work or go about your daily activities. Your skin becomes flushed and so sensitive that you don’t even want your bedsheet to touch it.”
“It sounds brutal. Almost like a really bad case of the flu,” said Hunter.
“But much, much worse,” added Janie. “Unfortunately, a patient stricken with hemorrhagic fever doesn’t know the specifics of what is going on inside them. The liver begins to rot away. Internal bleeding will impact the kidneys. Surfaces of the patient’s internal organs will show signs of hemorrhaging as plasma oozes out.”
With each sentence, Hunter grimaced more. Mac sensed that Janie knew this and was therefore piling on the gory visual. She decided to join in the fun.
“Janie’s right. The small bleeding points are one of the key features of hemorrhagic fever. They are the visual evidence of the many sites of damage to the tiny blood vessels located throughout the body, including on the surface, like your eyes and gums. As the soft mucosal surfaces of your gastrointestinal tract begin to break with the slightest provocation, like after eating too many Tabasco-rich burritos, blood will enter your mouth and eventually leave your body as you experience coughing fits.”
Janie jumped in. “And the eyes. Yes, the eyes are a telltale sign. The small blood vessels will burst the first time a patient rubs them out of sleepiness or due to an allergy. The eyes usually bleed first. It can be gruesome.”
Hunter studied the women for a moment, seemingly visualizing bleeding eyes. “Is that what you have here—hemorrhagic fever?”
Mac chuckled. “Well, we don’t know, Mr. Hunter, because we haven’t performed an autopsy yet. You see, hemorrhagic fever is just one of a dozen or so possibilities, all of which will be considered once we get on with our work.”
“There’s nothing you can give me at this point?”
“Nope, I’ve been on the scene for all of six hours,” Mac responded. “There’s a lot to do before I can satisfy the curiosity of the folks at Fort Belvoir.”
Chapter 4
Day One
El Naranjo, Guatemala
Sister Juanita Gomez was an experienced, skilled nurse. Having come to Guatemala as part of the Catholic Church’s outreach program, she found a home in El Naranjo, where she brought her New World skills to a third-world country. Over the years, she’d performed her job dutifully, and she was sure God smiled upon her accomplishments.
As time passed, she learned more about medicine and began to study postmortem examination of cadavers. This earned her the opportunity to work with the traveling pathologist, as he was affectionately called by the circuit of small hospitals dotting the Guatemalan landscape. These hospitals, challenged by minimal budgets, were accustomed to sharing specialists with other facilities. Without a pathology department per se, the hospital at El Naranjo utilized nurses like Sister Juanita to undertake the occasional rare forensic autopsies.
Sister Juanita still enjoyed her job, but after thirty years in the same place, she was growing weary of the routine. Plus, at sixty years old, the fourteen-hour days had taken their toll. In her younger years, prayers gave her the strength and determination to work the long days at the hospital. With age, however, prayers didn’t have the same impact as they did during her more energetic years.
Over time, the physicians had gone their way, but Sister Juanita remained, dutifully performing her tasks even though, like a rock, she’d become worn down. And with wear and tear, any machine, the human body included, becomes fatigued. And with fatigue came mistakes.
Sister Juanita knew what to be wary of. More people died of lower respiratory infections caused by parasitic diseases than any other cause of death. Over the years, thanks to sexual promiscuity interjecting itself into Guatemalan culture, a new killer had taken root—AIDS. Like other infectious diseases, the precautions during autopsies in dealing with dead bodies inflicted with the AIDS virus were set in stone.
As with the plagues of old, all that a medical professional could do with these potentially deadly diseases was to protect themselves. AIDS was always on Sister Juanita’s mind when she assisted the pathologist during a procedure. But this time, the deceased was a seven-year-old boy. He was too young for sex and not as likely to be a carrier of the AIDS virus.
The bodies delivered to them by the military convoy came without advance warning or explanation. In fact, no one had formally requested that the autopsies be performed. It wasn’t until Sister Juanita learned that the American CDC was going to be involved did she take an interest in the six villagers who rested in their morgue.
As it happened, a new, young pathologist was making his rounds and happened to be in El Naranjo before he left for the much larger city of Poptún located to their east. They determined to undertake the autopsy out of concern for the local villagers. If there was some form of con
tagion, including malaria or yellow fever, which had been present in the jungle, it was a matter of time before other citizens became infected. Sister Juanita wanted to help protect God’s children.
Typically, the morgue and the pathology rooms were quiet during all times of the day. Sister Juanita liked its basement location and the cool air it contained. While the pathologist scrubbed and donned his protective gear, Sister Juanita prepared the young boy for the autopsy. She set up the tools of the trade and provided all of the customary necessities for the pathologist to do his work.
The doctor arrived and immediately began the procedure. He was new, inexperienced, but methodical. It took him twice as long as the doctors she was used to working with.
He examined the outside of the boy’s body, noting aloud anything out of the ordinary like droplets of blood, signs of bruising, or open wounds. Next, he would normally obtain simple X-rays, which was not possible at the El Naranjo hospital. Small facilities did not have the luxury of digital radiological equipment, so this part of the autopsy would have to wait for the mobile radiologist to visit in two days.
The pathologist took several blood and tissue specimens and then began examination of the boy’s body cavity. Using his scalpel, he made a large Y-shaped incision from each shoulder across the chest and down to the pubic bone. Sister Juanita didn’t flinch as the body’s internal organs were revealed. She’d practiced the incision herself on unclaimed patients.
As one hour stretched into two, Sister Juanita’s mind wandered to an upcoming church social. The pathologist reported his findings into a small recording device in his monotone voice—a voice that lured Sister Juanita into boredom and then sleepiness.
The pathologist asked for a 10 blade in order to make a small incision in the lungs. Sister Juanita snapped out of the doldrums and fumbled through the instruments neatly aligned on the tray. He handed her the larger used scalpel in exchange.