by Bobby Akart
“We will take a brief ride to our General Hospital. It’s an old facility, originally built in 1855, but it is fully modernized, I can assure you. We are a teaching hospital for the University of the West Indies. Our pathology department, as you will see, is second to none.”
Dr. Roshan opened the passenger door of the Jaguar for Mac, who got settled in for the ride. She wasn’t going to argue the point, but her dossier on the Trinidad medical facilities differed from Dr. Roshan’s words of praise for his pathology department.
The lone pathologist for their Forensic Science Centre had walked off the job recently, stating that he would not continue working until there was an improvement in the facilities’ operations.
Through May, Dr. Peter Alexandrov had performed three hundred and ten autopsies, half of which were homicides due to the increased criminal activity in the country. That was more than double international standards, which could result in his license being censured. He demanded more staff, new equipment and, of course, a raise.
“Today, you will be meeting with Dr. Evelyn Burris, a new addition to our staff. She comes to us from St. Kitts as our regular pathologist takes a brief leave of absence.”
More like a time-out, thought Mac.
Dr. Roshan parked the car outside General Hospital. “Give me just a moment while I retrieve Dr. Burris. She will ride with us up to Barbados Road and the Forensic Science Centre. In the meantime, let me provide you this updated file on the patient in question.”
Mac thumbed through the reports created by Dr. Alexandrov. The unidentified male was of Arabic descent. He was found on the front porch of a house destroyed by a bomb several days ago. The cause of death was indicated as blunt-force trauma when the porch supports and trusses fell on top of him, crushing his skull. The report seemed to be fairly routine considering the man was adjacent to an exploding house.
Then Mac found something within the clinical information that wasn’t provided to her in the original dossier. Dr. Alexandrov had taken tissue samples from the liver, spleen, and lungs. In his clinical notes, he pointed out that the patient’s lymph nodes appeared to have been enlarged prior to being obliterated by necrosis—the death of the lymph nodes’ cells due to infection.
Mac slammed the folder closed and thumped her head against the seat’s headrest. Had she not been actively involved in the Guatemala cases, she might not have noticed the obvious signs.
When Baggett told her to fly here for the day, she immediately questioned him about the purpose. The investigative team on the ground in Guatemala would be providing hourly updates and she wanted to remain informed. Mac didn’t need the distraction of an isolated case that might or might not have infectious disease implications.
Suddenly, she became apprehensive. She shoved the folder onto the dashboard and exited the Jaguar. She paced back and forth on the sidewalk, unaware that she was attracting the attention of several nurses who’d gathered outside the hospital to have a cigarette.
Dr. Roshan and, presumably, Dr. Burris, approached Mac from behind. “Is everything okay, Dr. Hagan?”
No, everything is not okay. Mac stared briefly at the two before unconsciously taking a step backward. “Dr. Burris, have you examined the patient in question?”
“No, I’m sorry. I have not. Dr. Alexandrov left suddenly and—”
“Where is he?”
Dr. Roshan stepped toward Mac, who once again shied away. “Dr. Hagan, I can assure you that Dr. Burris has the requisite knowledge to answer any questions you might have. She is most competent in forensic—”
“Sir, this is important. Where is Dr. Alexandrov?”
“Well, he was in need of some time off, so he returned to his family home in Ukraine.”
Mac started to rub her face and then pulled her hands away from her face. She turned her attention back to Dr. Burris. “Doctor, we may have a serious problem here. I just reviewed Dr. Alexandrov’s notes. He conducted extensive tissue sampling and specimen taking. Do you know why? Did he not tell anyone about this?”
Dr. Roshan interrupted and answered, “Dr. Alexandrov was under a lot of pressure. Working long hours and handling a lot of cases.”
Mac shook her head. “No, there’s more. He must’ve suspected something. Why else would he conduct the clinical tests that he did?”
“Our medical facilities are all part of the University of the West Indies teaching complex. It was likely that this was routine for him.”
Mac retrieved her briefcase from the car and pulled out her cell phone. Before she called Atlanta, she gave instructions to the dumbfounded doctors.
“Number one, you must immediately quarantine the facility. Nobody is to go in without proper biological safety level 2 precautions.”
“What, why?” stammered Dr. Roshan.
“Number two, Dr. Burris, you and I are going to retrieve the tissue samples, patient specimens, and any subcultures for delivery to the CDC. Nobody else goes anywhere near this patient or the results of the prior autopsy. Are we clear?”
“Yes, but—” began Dr. Burris prior to Mac interrupting her.
“Number three, find Dr. Alexandrov and tell him that he may have been exposed to the plague.”
“What?” shouted an incredulous Dr. Roshan.
“You heard correctly,” replied Mac. “The autopsy report provides strong indicators for a diagnosis of Yersinia pestis, the causative agent of plague. Dr. Alexandrov and every one of the students who assisted him may have contracted the disease. We have to act quickly to start an antibiotic regiment or they will die.”
Dr. Roshan fumbled for his cell phone. He dialed the head of the TTPS, the Trinidad and Tobago Police Service. He quickly explained the situation and the officer on the other end of the line assured him that the contacts would be made.
He turned to Mac. His face was ashen and pale. Dr. Roshan was holding something back, Mac could sense it.
“Dr. Roshan, what are you not telling me?”
“Our crime scene investigators found remnants of something in the debris caused by the explosion. It was out of sorts and did not make sense considering this was an alleged bomb-making facility.”
“What was it?” pressed Mac.
“A microscope.”
Chapter 28
Day Thirteen
CDC
Atlanta
It was late in the day when Mac returned with the results of her autopsy of the Trinidad patient. Dr. Alexandrov was fairly thorough in his procedure, although he didn’t maintain the specimens following standard protocols for Y. pestis.
Plague was a naturally occurring infectious disease that affected rodents and other animals throughout the world. The Y. pestis bacteria was a holdover from centuries of transmission through fleas and human-to-human contact. Mac surmised that Dr. Alexandrov considered his autopsy results an anomaly, or it scared him out of the country.
Of the three types of plague, bubonic plague was most widely known. This form, as was true in medieval times, was transferred by fleas and rats. Once a human was bitten by a flea, the bacteria entered the body and accumulated in the lymph node closest to where the bacteria was inserted. From there, the bacteria multiplied and spread throughout the body. Catching an infected person early has always been the key to a patient’s successful recovery.
Pneumonic plague, which was indicated in the patients from Guatemala, and now Trinidad, was far more deadly and easily transmitted. After inhaling infectious droplets, the disease spreads to the lungs, resulting in pneumonia. Without immediate antibiotic treatment, the patient experiences respiratory failure and shock. Pneumonic plague was the most serious because it is easily spread from person to person.
But of particular concern to those who monitor terrorist activity was the ability to become infected by inhaling respiratory droplets after close contact with diseased animals, individuals, or contact with the virus via an artificial vessel like an aerosol spray.
After repeated testing of the specimens from T
rinidad, the results showed an F1 antigen level—meaning that the bacteria within the body’s immune system was producing antibodies against it. The results were conclusive and now a second case would have to be investigated.
Mac had already set the wheels in motion to dispatch another team to Trinidad. They would need to examine the crime scene where the structure was destroyed by the explosion. There were med students to locate and interview. Finally, there needed to be a determination if something more was happening in that house. Common sense told her that a microscope wasn’t needed to make bombs.
Mac ordered genetic testing of the two strains. With genome sequencing, she could determine if there was a connection. The host patients appeared wholly unrelated. She couldn’t think of a scenario where a man of Syrian descent could be related to a remote village in the jungles of Guatemala.
However, the Syrian patient might have traveled to Madagascar or nearby Mozambique. The Trinidadian authorities hadn’t identified the man, much less determined his recent travel activities. They had called the FBI in to assist with the investigation, but information would be slow in making its way to her.
She really needed to learn more about the Y. pestis strain in Madagascar. Based upon her research while flying back from Trinidad, there were seventeen whole genomes of Y. pestis across the planet. Of the cases studied in the last decade, all six hundred twenty-six cases in Madagascar reflected one strain and all eighty-two cases in the United States contained a different strain.
Overlaid on a map, the seventeen different strains were easily segmented to separate parts of the world. On only a few occasions did the strain jump continents, probably due to human-to-human contact.
The plague bacterium could survive outside its host on a variety of surfaces. Studies had shown that it could survive in humidified soil for up to twenty-four days, if not longer. Typically, the surface life span of Y. pestis was seventy-two hours. By comparison, salmonella could only survive for one to four hours while most flu viruses lived only twenty-four hours.
Mac’s mind raced as she considered all of the possibilities of surface-to-human contact that could occur in a seventy-two-hour period. How many people pulled the door handles to enter Macy’s at Lenox Square in a given day? Then, how many times did they touch their mouth or nose thereafter?
Every time people touched their mouth or nose, they transferred bacteria and viruses between their hand and their face. Self-inoculation, as Mac’s mother called it, was the primary way that germs spread from contaminated surfaces to people’s faces and from sick people to often-touched surfaces.
Research has shown that people touch their faces an average of four times per hour and they handled common objects in public places more than three times an hour. While the body’s immune system offers good protection against diseases like the cold and flu, it was incapable of fighting the more deadly bacteria that reside among us.
Pneumonic plague was rare, isolated and considered a disease that had run its course. Yet it still existed and had reared its ugly head once again. The question for Mac was why did they have two potential outbreaks occurring in Central America within a couple of weeks of each other. The plague was making a return, it seemed, but why now?
Chapter 29
Day Thirteen
Park Place on Peachtree
Buckhead
Mac kicked off her Skechers and reached into the refrigerator to grab a cold Budweiser. She searched for anything edible and opted for an unopened package of Cracker Barrel sliced cheddar cheese. Okay, wine and brie, it’s not, but it is basic sustenance. She opened one of the drawers in the spacious, rarely used kitchen in search of Fellini’s take-out menu. After biting off a hunk of cheese and throwing down a long gulp of the cold Bud, she decided a meat and cheese calzone would be a pretty good option.
Mac made her way into the living room, which offered incredible views of the Atlanta skyline to the south and the bustling retail district of Buckhead below. She turned on the TV, which displayed CNN and her customary closed-caption setting. On a typical day, by the time Mac returned home, she was exhausted from twelve to fifteen hours of interaction with others. She wanted to keep abreast of newsworthy events. She just didn’t want to hear the voices accompanying the reports. Besides, too often these cable news networks offered argumentative interaction rather than straight news reporting. She wasn’t interested in the negativity tonight.
Fellini’s delivered her calzone and a side of their signature marinara sauce, which Mac quickly devoured. She glanced at the packed gear, which was still laid out by the front door. Should I even bother to unpack? Who knows where they might send me tomorrow?
She immediately thought of something she’d learned from her dad. She’d had her heart broken during her senior year in high school by a high school jock who had suddenly showed an extraordinary interest in her prior to their senior prom.
Mac suspected the boy had an ulterior motive, but when he asked her to go with him, she readily accepted. As it turned out, he was using her to make another girl jealous, and Mac had to call her dad to pick her up after the dance, as she’d been left alone, abandoned for another girl.
His words rang in her ears to this day. “Honey, always trust your gut. Your brain can be fooled and your heart is an idiot, but your gut doesn’t know how to lie.” Mac chuckled to herself as she let out a belch. She disposed of the Styrofoam calzone container and washed her hands. Remembering his advice suddenly made her want to call her folks. She opened up another beer and returned to the couch with her cell phone.
Her dad answered on the third ring. “The name’s Bond, Hydrogen Bond,” Thomas Hagan said to his only daughter. He began laughing. “Get it?”
“Of course I get it, Daddy. How are you?”
“Great, honey. And you?”
“Fine. Well, tired.”
“Okay, let me perk you up, then,” said the retired high school chemistry teacher. “A photon checks into a hotel and is asked if he needs any help with his luggage. The photon replies, no, I’m travelling light!” Her dad guffawed at his own cornball joke, one of hundreds he’d picked up over the years and entertained his students with. Mac laughed along but shed a few tears as well. She really missed her parents and wished they didn’t live twenty-seven hundred miles away in Coos Bay, Oregon.
“Daddy,” started Mac, with an attempt to reciprocate.
“Yes, dear.”
“Did you hear the one about two blood cells who met and fell in love?”
“Nope.”
“Alas, it was all in vein.”
Silence.
“Daddy?”
“Honey, I love you. Stick to your day job, okay?” Then her dad busted out laughing. “That’s not bad for an amateur. I’ll try it out on the boys at breakfast tomorrow morning.”
“Are you still going to the Pancake Mill Restaurant over at North Bend?” she asked. It was a regular haunt for her parents. Mac loved the sour cream blintzes topped with blueberries. Her mouth began to water at the thought of some down-home cookin’.
“Heck yeah, once a week with the boys. Then your mom and I go at least twice a week for lunch. She’s not much of an early riser.”
Mac laughed about the wonders of heredity. She wasn’t an early riser either. “I love you, Daddy, and I miss you. Maybe we can get together soon?”
“Anytime, honey. I love you too. Your mom’s reaching for the phone. Love you!”
Mac glanced at the news, which was discussing the Zika virus. Over a week ago, the CDC had issued a bulletin warning that the virus had mutated and spread into the southwestern part of the country. Genetic mutations in the virus had made it more deadly.
Zika had started in Africa as a seemingly harmless strain, but as the virus spread across South and Central America, and subsequently into the Caribbean, it picked up some nasty genetic modifications. Birth defects and paralyzing disorders were becoming more common.
The changes in Zika’s genetic structure explained w
hy the disease spread exponentially in the human population throughout the Americas. The new, improved Zika virus could replicate more efficiently, invade new tissues that customarily provide protective niches for viral propagation, or evade the immune system altogether, leading to a deadly viral persistence.
“Mackenzie? Are you there?”
Her mom’s voice snapped her out of the rabbit hole she was about to descend into. If Zika could mutate to become more deadly and transmittal, why couldn’t Y. pestis?
“Hey, Mom. Sorry,” replied Mac. “How are you?”
“Just fine, dear. Your dad is driving me crazy, of course. He still plays golf. Once in a while, he’ll mosey down to the Oregon Dunes and watch the windsurfers. The other day he threatened to take up the sport, just to see if I was paying attention. Naturally, I told him to go for it!”
“Mom! Don’t encourage him. He might do it just to spite you.”
“Dear, he’s gonna spite me one way or the other. Might as well be hanging on to a kite board while he sails off to Alaska or some such.”
Major General Barbara Stinchcomb Hagan was the complete opposite of Mac’s father. He was a throwback to the sixties with a little bit of hippy in him. It was probably his California upbringing. Mac’s mom was raised an army brat who was used to a regimented life and had little use for frivolity. The Army years cemented her approach to life and it rubbed off on Mac during her childhood. Barbara Hagan had, in her retirement, loosened up somewhat, but would never reach the level of silliness that Mac’s father achieved.
Barbara retired as the commanding general of the U.S. Army Medical Research Institute for Infectious Diseases—USAMRIID, at Fort Detrick in Maryland, a position she held for six years and through two administrations.
She’d earned her master’s degree in clinical and patient centered technologies from the University of Washington as well as a master’s level certification in emergency and disaster management from the American Military University. This launched her into a military career, which began as a clinical staff nurse at Fort Sam Houston, Texas, and ultimately landed her in charge of the prestigious unit charged with the responsibility of conducting important medical biological defense research.