by Bobby Akart
Only the slightest accidental prick of her finger by the bloody tip of the used scalpel brought her back to being fully alert. Sister Juanita didn’t notice it at first, but then a droplet of blood oozed through the tip of her glove and she immediately ran to the wash basin to rinse the wound.
The pathologist attempted to comfort Sister Juanita by assuring her that the quick reaction to irrigate and clean the wound protected her from any disease. But then, whether Sister Juanita’s cut was potentially fatal wouldn’t matter to him, as he would be traveling for months and not see her again until the fall.
Chapter 5
Day One
El Naranjo, Guatemala
Mac and Janie rode down the mountain to El Naranjo to learn the results of the autopsies. The two got a kick out of the Guatemalan soldiers arguing over the honor of escorting them in one of the available Jeeps. Ultimately, rank overtook practicality and the acting officer on duty drove the pair himself. After they had an opportunity to meet with the pathologist, Mac planned on catching a flight back to Atlanta while Janie would travel to Guatemala City to begin the meticulous process of shoe-leather epidemiology. Janie would provide Mac a full report every morning.
“Good afternoon,” a receptionist greeted the women with a heavy accent. Janie conversed with the receptionist in Spanish while Mac observed their surroundings. There were very few locals in the lobby. Two uniformed police officers stood near the entrance. Whereas in America, the presence of armed personnel meant protecting a medical facility from possible terrorism, in a Central American hospital, the concern of law enforcement was a raid upon the hospital in search of drugs. Narcotics could be transported to America for a huge profit. Antibiotics could be sold on the black market within Southern Mexico for even more.
Janie approached Mac, shaking her head in disgust. “Well, there won’t be much to learn here, I’m afraid.”
“Why’s that?” asked Mac.
“Apparently, the nurse assisting the pathologist cut herself during the procedure and was too distraught to continue. As a result, the prima donna pathologist, who, I’m told, has only been on the job for three months, refused to continue without an assistant.”
Mac rolled her eyes and shook her head. “Where does that leave us?”
“He did one autopsy today, on a seven-year-old boy.”
“That’s something,” said Mac. “Where’s his office? We’ll learn what we can from today’s work.”
“That’s just the thing,” Janie added. “He’s a traveling pathologist. He left for another town. There won’t be a new pathologist on duty for many weeks.”
“C’mon,” said a frustrated Mac. She wasn’t qualified to conduct an autopsy, even if the locals would allow her in their morgue. If she could get the chart, even if the findings were handwritten notes, they could narrow down the disease. But could she trust them?
Janie stopped them before they headed down the stairs. “You know what? I’ll go find the chart. Wait here and try to keep the receptionist busy. I’ll be back in a jiffy.”
Mac smiled as Janie slipped off down a hallway toward the stairwell. Mac chatted up the receptionist and tried some of her conversational Spanish she’d learned years ago when she was growing up. The receptionist seemed to enjoy the opportunity to talk with an American, so she tried out her broken English as well.
On the end of the building opposite the stairwell that Janie took to the basement, Mac caught a glimpse of a man walking back and forth across the light pouring into the west wing of the hospital from the setting sun. The glare of the tile floor blinded her somewhat, but she could make out the clothing of Nathan Hunter from the DTRA.
What’s he doing here? Mac noticed a restroom sign near the entrance to the hallway and asked the receptionist if it was okay to use it. With a wave of the arm as approval, Mac slipped away to get a closer look at Hunter, who appeared to be talking on the phone.
Mac slid behind the wall at the entrance to the hallway and eavesdropped on Hunter. He continued to walk back and forth, talking only sporadically. Janie emerged from the stairwell behind Mac and began to speak.
“Of course, the pathologist is gone, and there’s no sign of his findings. I was alone down there, having my way with their filing system, but I found nothing.”
Mac encouraged Janie to keep her voice down and pulled the smaller petite woman against the wall with her. “I think I know where the autopsy report went.”
“You do?”
“Yeah, look down the hallway,” replied Mac. Janie slipped past Mac and studied the pacing figure. “There’s our new friend Hunter. Doesn’t it look like he’s got a clipboard tucked under his arm?”
“It sure does!” exclaimed Janie under her breath. “What’s he up to?”
“I don’t know, but the DTRA suspects something. I’m not buying his explanation that he just happened to be in the area.”
“But what?” asked Janie.
Mac took Janie by the arm and led her back into the main lobby. “Okay, listen. We have to get these bodies back to the States, where a proper autopsy can be performed.”
“What can I do?” asked Janie.
“Clear the removal of the remains to our custody through the Guatemalan government,” replied Mac. “I’ll call the higher-ups in Atlanta and get approval to use the CDC private jet to pick up the bodies. I wouldn’t trust the autopsy of a part-time pathologist anyway. We need to re-examine these remains in a way this rookie pathologist never contemplated.”
Janie nodded toward Hunter. “What about him?”
“I intend to find out what he’s up to as well.”
Chapter 6
Day Two
Flight from Flores, Guatemala, to Atlanta, Georgia
Mac was about to board the single-wing Cessna aircraft that was to transport her to Belize City and her Delta Airlines flight home when she received a phone call from Janie. The Guatemalan government refused to release the bodies for transportation to America. They stubbornly insisted that native Guatemalans should be buried on Guatemalan soil.
Mac quickly arranged for a pathology team to fly the CDC jet into Flores, Guatemala, a much larger city than El Naranjo. This required her to spend the night, which gave her an opportunity to clear her head and provide written instructions to the team.
She was particularly interested in the condition of the lower respiratory tract, which includes the trachea, the lungs and bronchioles. The symptoms described by the boy who found the sick villagers sounded like a form of pneumonia or bronchitis. Evidence of a bloody mucus mix around their mouths indicated a number of options, including streptococcus, tuberculosis, and Y. pestis—the plague.
She typed out her instructions and prepared an email to Dr. Kathy Farrow, the head of the pathology team. Dr. Farrow was a seasoned veteran of the Ebola battles in Africa and Mac trusted her completely. Nonetheless, she wanted to make her requirements clear.
LOWER RESPIRATORY TRACT—sterile, screw-capped containers, store and transport at 2°C–8°C
BLOOD—transfer at ambient temperature, no refrigeration!
TISSUE/BIOPSY SPECIMENS—sterile container, add two drops of sterile normal saline to keep moist, keep chilled at 2°C–8°C
SWABS OF TISSUE—Don’t bother, transport time too long
“I’m not going to follow in my mother’s footsteps,” muttered Mac as the jet containing the team touched down at the Mundo Maya International Airport. She made her way to the gate area servicing executive aircraft and waited for her associates to disembark. It was unseasonably cool after the low-pressure system crossed the Yucatan Peninsula the day before. Sixty-three-degree temperatures felt like fall in Atlanta.
As Dr. Farrow led the way across the tarmac and into the waiting area, Mac’s mind began to wander back to those days when she was first exposed to fieldwork in the battle against infectious diseases. The West African Ebola virus disease was the most widespread outbreak of EVD in history. She and Dr. Farrow were at ground zero of the
epidemic, while her mother was at ground zero of the political firestorm.
“Hi, Mac!” Dr. Farrow greeted Mac heartily with a wave and then a genuine hug. Dr. Farrow was a willing and competent mentor during those days, as well as someone Mac could vent to.
“Hey, Kathy, here we go again, right?” asked Mac with a chuckle.
“Are we? I mean going again?” replied Dr. Farrow with a question of her own.
“I don’t know, Kathy. The situation is odd. The village was isolated from the world—no transportation, little interaction. They were only susceptible to one of the usual carriers of disease—the spider and howler monkeys.”
“Maybe it’s zoonotic,” speculated Dr. Farrow. “I got your email, by the way. One thing bothers me about this. There are some loose ends to tie up such as the boy who discovered the sick villagers. Has he been located? Also, do we have any of the primates to study?”
“No, yes, maybe. How’s that?”
“You learned that from me.” Dr. Farrow laughed in response. “The unit in Guatemala City should be able to study the monkeys. Are they looking for the boy too?”
“We’ve assigned that task to the military, which has been marginally helpful,” Mac responded. “They don’t want any part of the disease. The soldiers assigned to the site kept their distance, which resulted in the invasion of the curious spider monkeys. Our specimens could have been compromised because of their lack of control.”
Dr. Farrow paused as she waited for an announcement to be made over the airport’s public address system. “You need to get back to Atlanta. We can discuss this more later. It’s gonna take us the rest of today to travel. We’ll hit it hard tomorrow and the next day. I’ll have the lab notify you when they’ve received the samples from our autopsies.”
“Thank you, Kathy. We’ll see what the pathology tells us.”
The two women shared an embrace and Mac approached the gate. Two of the ground personnel assisted her with carry-ons and led her up the stairwell into the Learjet. She would have the plane to herself for the flight back to the Peachtree–Dekalb Airport in Chamblee, just northeast of Atlanta.
As the aircraft taxied down the runway, Mac’s mind wandered back to West Africa. Before she was deployed to Liberia, her mother had called her and encouraged Mac with these words, “Never read too much into things. Stay focused, disciplined, and inquisitive. Above all, never give up.”
Chapter 7
Day Three
CDC
Atlanta, Georgia
Ordinarily, Mac avoided leading the Disease Detective tour at the CDC Museum like the plague, but today she felt like a day of transition from what she observed in Guatemala was a good idea. Besides, Dr. Farrow’s team wouldn’t be back with their findings for at least another day or so and Janie was constantly sending her text message updates.
Today’s group was made up of high-school-age kids and their parents. The teens were participating in the Disease Detective Camp at the museum as part of the CDC’s mission of educating the public about their work. Each week, for a period of five days, the campers were exposed to the inner workings of the CDC in order to give them a broad understanding of the agency’s role in public health.
Every year topics varied, but ironically, this summer, the focus was on infectious diseases. Mac was a perfect candidate for leading the tour. She took the group through a series of exhibits that pointed out the specifics of a particular disease and how the CDC helped solve the mystery surrounding it. After the midway point, she opened up the floor for questions.
A parent, naturally, was the first to speak up. Mac often wondered if the Disease Detective Camp should have an adult version. “What’s the difference between an outbreak, an endemic, and a pandemic?”
“That’s a great first question,” replied Mac truthfully. “Understanding epidemiological technical terminology can be confusing—especially with the fact they are misused so often in the media. Oftentimes, reporters throw around these terms without realizing they have very different meanings.”
The group tightened their circle around Mac as she continued. “An outbreak refers to a number of cases that exceed the norm for a given region or disease. Based upon our data, if a disease is common to a particular geographic location, a slight increase in the number of afflicted patients would be deemed an outbreak.
“Now, if you take that same disease in the same geographic area and it continues to exist without eradication, then it rises to the level of an endemic. In other words, the disease is perpetual.”
One of the young detectives raised her hand. “Do you have an example?”
“Dengue fever,” Mac quickly replied. “Dengue fever is a very painful, debilitating, mosquito-borne virus that is typically found in tropical locations like the Philippines and Thailand. In those regions, there are mosquitoes carrying the disease and transmitting it from person to person. Dengue fever has remained in those regions since the middle of last century; thus it’s classified as an endemic.
“Recently, we saw an outbreak on the Big Island of Hawaii. Somebody entered the country who was infected with dengue fever, got bitten by mosquitoes, which then created local chains of transmission throughout the Big Island. In this case, it was declared an outbreak due to the fact the disease was imported with subsequent transfer.”
Three other hands rose. She picked a young man in the rear of the group. “Why didn’t they just stop the person with dengue fever from entering Hawaii?”
Wow, Mac thought to herself. Be careful with this question.
“Well, for one thing, he or she may not have been exhibiting symptoms at the time. If the person was showing signs of illness, oftentimes they mirror those of the common cold or flu. In the United States, we haven’t shown a willingness to quarantine people for cold or flu symptoms.”
More hands flew into the air. “What if the disease was more serious? You know, like Ebola?”
“Okay, let’s finish with our definitions first,” replied Mac, avoiding the question. “We’ve discussed outbreaks and endemics. A pandemic is when there is an outbreak that affects most of the world.”
“You mean like the plague?” queried the young man with a follow-up question.
Mac led them down the hallway toward a display titled Plague—The Three Great Pandemics.
“Yes, that’s one example. In recorded history, there have been three world pandemics of plague recorded.” She pointed to a timeline of events that also depicted estimated death tolls.
Mac continued. “In medieval times, like the year 541 and later in 1347, the plague ravaged the world, causing devastating mortality rates in both people and animals. The disease was so widespread that it travelled rapidly across nations and onto other continents. Both of these events were spread largely by human contact. The third great plague pandemic, which began in 1894, originated in China, then spread to India and around the world. The most prevalent disease host of the plague organism was the rat. Throughout Europe, for example, there were open sewers and ample breeding grounds for rats.”
Mac took another question. “How long do the plagues last?”
“The plague pandemics increased and decreased over time. The third plague pandemic was officially declared over in 1959, although outbreaks of the plague occur from time to time, most recently in Madagascar, an island nation east of Africa.”
“Has the plague come to America?” asked one of the parents.
“Plague was introduced into America in the early 1900s when steamships carried infected rats into our ports. Today, we receive reports of a dozen or so cases per year, primarily in the rural areas of Western states like New Mexico, Arizona, and Colorado.”
Mac laughed to herself. Every time she conducted one of these tours, the questioning always turned to the plague. Every child had heard about the plague, the Black Death, from cartoons or television shows. Of all the diseases that posed immediate dangers to their everyday lives, they wanna talk about something exotic and rare like Y. pes
tis.
Chapter 8
Day Three
BSL-4 Laboratory
Franceville, Gabon
Dr. Alexis left the BSL-4 laboratory after dark that night. He was a free man, yet he wasn’t. For six months, he had done the bidding of the ISIS terrorists, who no longer attempted to hide their identity from him. He had accepted the consequences of the actions imposed upon him for so long as his family was safe.
He now wondered what was going to happen next. His work would be considered groundbreaking if only he were allowed to share it. Dr. Alexis had made copious notes on the methods he used to replicate the Y. pestis bacterium. A small notebook tucked into his shirt pocket remained with him at all times. But the replication process was not his la plus grande réussite—his greatest achievement.
The genetic modification of the Y. pestis bacterium to make it multidrug resistant was worthy of a Nobel Prize in physics, chemistry, and medicine. Dr. Alexis knew a Nobel Prize would never be awarded to a criminal, so any delusions of being rewarded for his work never crossed his mind.
Dr. Alexis suspected what the terrorists intended to use his work for, but he had no idea of the intended target. He assumed the United States, the very existence of which provoked the ire of every radical Islamic terrorist.
He crossed the street to head toward his modest apartment when a shadow caught his eye in the alleyway to his left. He picked up the pace and began to trot towards the gated entry when he heard footsteps racing toward him.
Without hesitation, he rushed to the steel gate that guarded the entrance to the apartment building and fumbled with his keys to open the locks. Hurry! His mind raced, taking him back to his few days of captivity six months ago.
Once he got through the gate, he stumbled up the stairs, slipping and bruising his shins in the process. He turned to see a hand insert itself between the gate and the latch at the last minute. Dr. Alexis quickly scrambled up the stairs and crashed into his door.