Now Alex knew he’d have to make all those decisions Max Schwartz used to talk about. Cullen was waiting for him to “pull this one out.”
He stood up, put his bulging briefcase on the floor, and scribbled a note to his secretary. New York would wait for him.
He put on his white coat, and, dressed in this armor, walked toward the elevator.
* * *
Alex was tired. His office was dark. He looked at his watch. Almost midnight. He didn’t know it, but he had lived through the first twenty-four hours of doomsday.
He lay down on the couch. At first the cold vinyl felt uncomfortable through his shirt; then it was soothing. He lit a cigarette and lay back to watch the smoke curling up into the darkness. His jaws ached; they always did when he wore a surgical mask for any length of time. His mouth was dry. He felt dirty. He couldn’t remember when he had felt so frustrated. The day had brought his self-esteem crashing down around him. Many questions had been asked, but he had not been able to answer them. He didn’t know if there were any answers. At this moment, he wasn’t sure what he knew. It was a rude awakening.
The situation around him was deteriorating rapidly. In little more than fifteen hours he had seen seventy-nine cases of whatever it was they were seeing. A total of one hundred forty-three patients with fever, coma, cyanosis, hemorrhagic rash, hemolysis and pneumonia on chest x-ray had passed through the swinging doors of the Emergency Room at University Hospital. One hundred thirty-four had died. Nine were still fighting the losing battle. None had survived for longer than three hours from the time their names were entered in the ER log. As if this were not bad enough, calls to other hospitals in the city revealed more of the same. Memorial Hospital had had seventy-one cases; all had died. Methodist, sixteen cases and the same number of deaths. Mt. Sinai, thirty cases; two were still alive—but hardly. He had not bothered to call the other three hospitals located within the city limits.
When he had reached the Emergency Room, Cullen had met him at the door and handed him a mask and gown. As they walked to the small laboratory located behind the nurses’ station, the resident went over the cases. Then for thirty-five minutes Alex Kahn sat silently at the microscope. Only his hands moved—to focus, to move the mechanical stage, to change slides as he systematically and rapidly examined specimen after specimen. He looked at the smears of sputum—actually they were smears of the bloody froth that trickled from the mouth rather than true secretions from the lower respiratory tract. He looked at the smears made from material randomly chosen from the multitude of test tubes, flasks and agar plates that served as media for the growth, isolation and identification of bacteria. He looked at slides until his eyes tired of staring at the round, brightly lit, highly magnified field. Then he carefully examined the few cultures that manifested some growth; these came from the first few patients who had died. Despite the rapid rate that seemed to characterize the growth of the microbe in the human body, it appeared as if it was following a slow and leisurely growth curve in the test tube. At eight hours, there was little to see; but Alex Kahn’s experienced eye extracted whatever visual information was to be had. He smelled each growing culture; he had learned long ago that some organisms could be identified by their odor or that of their metabolic by-products. When he had finished, he knew little except that this overwhelming disease seemed to be caused by bacteria which looked like staphylococci under the microscope and appeared as odorless, creamy yellow colonies on artificial culture media.
He stood up and looked around to be certain all the slides and cultures had been safely put away.
“Now let’s look at the x-rays.”
They walked to the rows of view boxes. Alex Kahn stood in front of the first, legs apart, hands on his hips, staring at the celluloid negative of the first patient’s chest. His eyes scanned the film carefully and systematically. The bony structures—collarbones, breastbone and ribs—looked normal. There were no soft tissue abnormalities; the size and shape of the heart were not remarkable, although he wondered about a certain fullness that could represent early heart failure. Then the lungs. Normally these appeared black or gray in x-rays because the air in them allowed the x-rays easy penetration to blacken the film; usually, the black was arborized by the white markings of larger arteries and veins near the heart. But the lungs of this first patient appeared almost entirely white. Alex shook his head and walked to the next film. He repeated the procedure until each of the films had been examined.
“Christ!” There wasn’t much else that could be said about the x-ray evidence for this overwhelming pneumonia that appeared on film after film. “Let’s see the patients.”
Cullen followed him to the first bed. The patient was dead. They moved on.
He observed. He palpated. He percussed. He listened. Over and over again. As patient after patient came in and died, he forgot his role as the Professor. He drew blood, he passed endotracheal tubes, he suctioned, he started intravenous therapy—things he had not done since training.
As the day wore on, he realized that no matter what they did, the patient died. He started therapy, he changed therapy—and death made therapy superfluous.
His vigor changed to frustration; his frustration to uncertainty, to fatigue, to fear. Finally, when he could see, hear and feel no more that would do any patient any good, he stopped. He felt he needed to get away and try to put everything into perspective. Maybe the answer would come. He removed his scrub suit, showered carefully with disinfectant soap, dressed, and left the Emergency Room. As he walked toward the elevator that would take him to his office, the bustling silence was interrupted by the screams of more ambulance sirens.
He felt better. Not much better, but better. He suddenly realized he was hungry and thirsty. The cafeteria would be closed, but there was probably some instant coffee in his lab across the hall. He sat up and rubbed the back of his neck. He stood up, stretched, and walked to the window to look out. Opening the blinds, he saw through the blackness that it was starting to rain. He wondered what the rain would do to this damned epidemic. His thoughts were interrupted by the ringing of the phone. He walked to his desk quickly and reached for the receiver.
“Dr. Kahn speaking.”
“Alex?”
Alex Kahn knew that voice well. How many times had he listened to it in the middle of the night?”
“Alex—are you there?”
“Yes, Dr. Schwartz. Sorry. Your voice startled me. Gosh, it’s good to hear from you!” He paused, momentarily embarrassed at the boyish eagerness of his own voice.
“Alex, how are things there? How much pneumonia have you seen in the past twenty-four hours?”
The question didn’t surprise him. Maybe it was because Alex always expected Max Schwartz to know everything.
“About one hundred fifty cases here, probably another hundred or more in the rest of the city.”
“How many have died?” asked Dr. Schwartz.
“All but a couple,” he answered, unconsciously dropping his eyes as if the phone before him were the face of the man to whom he was speaking.
“Well, you’re doing better than we are; but the you had a good teacher.”
Alex Kahn suddenly stiffened. “What do you mean?”
“We’ve seen three hundred six cases between here, the Boston City Hospital, and Mass. General. We haven’t been able to save one. Sudden onset, fever, coma, hemorrhagic rash…”
Alex listened as the clear, concise voice described in detail what they both had seen during the previous terrible day.
“That’s just how I put it together.” Alex’s voice had regained some of its usual confidence. “But I just can’t conceive of acute, overwhelming staphylococcal pneumonia occurring so quickly in so many persons.”
“That’s just the point, Alex; it can’t be staphylococcal pneumonia as we’re used to seeing it. And it’s occurring in at least forty cities in the same plague-like fashion, the rapidity of which is unlike any infectious disease I know. I’ve spoken to
everyone I could reach, and it’s the same everywhere—New York, Los Angeles, Chicago. No one knows exactly what it is, and no one has had a case that’s survived for more than a few hours. Have you had anybody who’s survived for more than two or three hours?”
“No.”
“Have you got a smear or culture that looks like anything but common, everyday staphylococci?”
“No.” The worry in Max Schwartz’s voice reawakened his own fear. The Max Schwartz he knew wasn’t afraid of any microorganism.
“Alex, I’ve made some rough calculations. There have been about forty-five hundred cases and almost the same number of deaths already. There’s no reason to believe that his won’t continue in geometric progression. We could lose a million people!” Max Schwartz’s voice was the same, but the tone suddenly became softer—almost a whisper. “If we can’t stop this, we could be wiped out!”
Alex Kahn listened, but he could not believe what he heard. Max Schwartz would not talk about epidemics that could wipe out a country unless he really believed what he was saying.
The voice on the other end of the line continued. “I’ve got to leave in a minute, Alex, so listen to me carefully. Something is very wrong. Natural disease just does not act like this. There could have been an accident somewhere; some major lab working with a very virulent organism might have had a spill. Any reputable lab would have reported it if an accident had occurred. There have been no such reports. So if it was an accident, it’s been missed—unless some goddamned fool is trying to cover it up. Or,” he paused, “someone has decided to start an epidemic. My intuition tells me that we have been attacked.”
Alex sank into his chair. He knew this must be some sort of nightmare. But Max was still talking.
“Alex, I want you to get out of there. Get samples of all the cultures you’ve got cooking on those patients and meet me. Got a pencil? I’ll give you directions.”
“What the hell are you talking about, Dr. Schwartz?” He was surprised at his own words. No one spoke to the “boss” that way. “I can’t just up and leave in the middle of all this.”
He was interrupted before he could protest further—before he could but into words the terrible burden of responsibility he felt.
“Alex, listen.” The voice was not harsh as he had expected it to be. “You can’t do anything there. You and I and many other people have done all we know how to do and have gotten nowhere. We’ve got to concentrate our efforts and find out what’s causing this disease. If we do, then maybe we can come up with something to beat it. We’ve got to do this as quickly as possible. I don’t know how much time we have, but we can’t see forty-five hundred cases a day and survive long—besides, it may pyramid like any other communicable disease. Doesn’t take much arithmetic to figure out what the end result will be. I need your help, Alex.”
In all the time Alex had known Max Schwartz, he’d never known him to need anyone’s help. Alex couldn’t refuse. Besides, Max Schwartz was probably right. What good was Alex doing where he was?
“Go ahead, Dr. Schwartz. Tell me what you want me to do.” Alex snapped on the light over his desk and found a pad and pencil.
“OK, Alex. My secretary has arranged a seat for you on TWA flight 243 leaving at 6:05 a.m. for Washington, D.C. Just pick up the ticket at the airport a half hour before boarding. The reservation is in your name.”
Alex thought as he wrote, “Damn it, there was never any doubt in his mind that I’d come. He hasn’t changed a bit.”
“I’ve already called Donald McBride, the head of your Bacteriology Lab. He’s an old friend. And he doesn’t ask questions. He’s packing the cultures you want right now—himself. Each flask and plate is sealed with parafilm. He’s cushioning them with popcorn and latex particles. This will all be packed in a heavy glass container that fits into a larger one. The space between the two will be filled with nitric acid. It shouldn’t hurt the glass; but if it’s dropped and broken, the acid should kill anything that spills. He’s putting the whole thing in one of those small flight suitcases that will fit under your seat on the plane. When you get to the airport, see a Mr. Tanner; he’ll be the head security guard on duty at that time. I’ve arranged with him to allow you to take the bag onto the plane without having it searched at the gate.”
Alex felt a little better. Max hadn’t changed. The son of a bitch thought of everything. For the first time in hours, Alex began to have faith that the world was not really coming to an end.
“When you get to Dulles in Washington, a Major Small will take you from there. Got it?”
“I’ve got it, Dr. Schwartz. Where can I be reached? I’d like to leave a number. I’d like to know how things are going here.”
“You can’t leave a number, Alex. You’re just going to have to disappear for a while. We’ve got to keep this thing hushed up until we know what’s going on. You’ll understand why soon.” Max Schwartz paused. “Where are Lori and the children?”
Max Schwartz’s sudden interest in his family startled Alex. In all the years he had known the great physician, Max Schwartz had never once expressed even the slightest interest in anyone not connected with his profession.
“They’re staying with her parents in New Hampshire until I can get things settled in New York. The apartment we bought won’t be ready for about three weeks.”
“Let them stay there. Couldn’t be much safer. Can I count on you, Alex?”
“You know you can. I just feel damned uncomfortable not knowing what’s going on or where I’m going.”
“I know. I’ll answer all your questions in a few hours when I see you. Good-bye.”
Alex put down the receiver. The mention of Lori and the children made him feel even more alone. He sat back in his chair and for a few minutes allowed himself the luxury of retreating into the past.
He was an intern with Saturday afternoon off. Harvard had just beaten Yale. It was starting to snow, and suddenly it was a wonderful world.
The cold wind blew in icy gusts through the concrete tunnels of Harvard Stadium as the triumphant crowd surged home. Enjoying every minute away from the overwhelming pressures of a university hospital internship in Boston, Alex allowed himself to be carried along, not paying too much attention to the direction.
“Hi, Alex.” Her face was bright and alive. The cold had painted her cheeks and the tip of her nose a lively pink, highlighting her warm brown eyes. A lock of dark hair fell over her forehead from beneath a white knit stocking cap, and she stopped to brush it away with her mittened hand.
He paused to admire the face and then gave her a puzzled look, somewhat embarrassed because he had a feeling he should know who she was.
“I’m Lori Stack. We went to high school together.” She smiled understandingly. “I’m sure you don’t remember me.”
He didn’t; but suddenly the crowd pushed at both of them, and he took her hand to keep from getting separated from her.
He invited her to dinner that night, and they talked about everything and anything until the restaurant was empty and a disgruntled waiter told them it was time to go.
From then on he saw her at least once a week and found he looked forward more and more to the time they spent together. When he was with her, he could escape from the world of medicine; he could relax in her warmth and understanding. He found himself falling hopelessly in love with her but could not in any way justify this frightening relationship to himself. He was an intern earning $2,460 a year, he had at least two years of residency ahead of him, and he had already decided to apply for a fellowship with the famous Dr. Max Schwartz. There would be no place for a wife in his immediate future. A remark his father used to make further strengthened his decision: “If you want to travel fast and far, Alex, travel light.”
He began to see her less and less but could not bring himself not to see her at all. When February came, it seemed his problem would be solved—he became the intern on the Infectious Diseases Service for two months. This was Max Schwartz’s servi
ce, and it meant being available in the hospital twenty-four hours a day every day—there was no time for anything else. Occasionally, at one or two in the morning, as he sat bleary-eyed going over patients’ charts, he would stop for a moment and think of her with longing. Once or twice he reached for the phone to call her, but he never did. The long hours of total involvement in medicine convinced him that he had made the correct decision.
Then suddenly at 9 p.m., on March 12, everything changed. He was just finishing a progress note on a patient with a urinary tract infection whom he had admitted earlier that afternoon when the phone rang at the nurses’ station. An aide answered it and then covered the mouthpiece with her hand. “Dr. Kahn, it’s for you. Dr. Schwartz.”
Max Schwartz called at night for many reasons: to check on a sick patient, to advise the staff that he was sending in a new one, to give someone hell for something that had gone wrong during the day, or just because he had one of his frequent premonitions that he ought to call to be certain “everything was going smoothly.” Alex Kahn could never tell in advance which reason it was going to be, and he always answered Dr. Schwartz’s phone calls with the fear that this was one of those times he would catch hell.
“Dr. Kahn? Schwartz.” It was always just “Schwartz”—not “Dr. Schwartz” or “Max Schwartz,” just “Schwartz.”
“Yes, Dr. Schwartz,” he tried to keep his voice firm and confident.
“I’m sending in the daughter of an old college classmate. She’s got a fever of 106 degrees, a stiff neck, and she’s comatose. Probably meningitis. She’ll be in by ambulance in about ten minutes. You take care of her. I’m on my way to an American Board of Internal Medicine Meeting in Philadelphia. When you’ve got her worked up, call Dr. Hardy, my associate, and discuss the therapy with him; he’ll come in to see her tonight if you need him, or else he’ll see her first thing in the morning.”
The 11th Plague Page 4