by Daniel Kalla
Haldane shook his head. “Duncan, this is not Ebola.”
McLeod nodded. “I know. And it’s a bloody shame.”
“Oh?”
“Nice and clean killer, Ebola.” McLeod nodded in admiration. “But its ruthless lethality is its shortcoming. Kills everything in its path. If this were Ebola, we’d have a few hundred dead farmers and some very cheap farm-land on the market, but the disease would bum itself out for lack of new victims.”
Haldane nodded, picking up on McLeod’s logic. “Whereas ARCS only kills the significant minority of its victims, allowing the virus to propagate and spread beyond the site of the index cases”
“And spread rapidly.”
“That is yet to be determined, Duncan,” Haldane said, but he was unconvinced by his own argument.
The car slowed before turning off the main road and onto the driveway of Jiayuguan’s regional hospital. They passed through two checkpoints, manned by masked soldiers, and drove into the gravel parking lot in front of the hospital. A cold spitting drizzle fell as Haldane and McLeod hopped out of the car, bundled their jackets, and strode for the front entrance.
Once they cleared the internal security measures, McLeod and Haldane were led into the change room. Haldane had slipped into too many biohazard, or HAZMAT, suits to feel the slightest alarm. As he stepped out through the two sets of sealed doors and into the clinical area, he actually felt relief to be among the appropriate high-level, scientific protective measures and away from the irrational fear he had seen on the streets in the eyes behind the surgical masks.
A hospital guide, fully suited in blue HAZMAT gear like the rest of the staff behind the doors, acted as their translator. The chubby man led the two emerging pathogens experts to a hospital room on the second floor. Haldane was surprised to see that the door was locked. They had to wait for a security guard to let them in. “Why the guards?” Haldane asked the translator.
The translator spoke to the security guard and then turned to Haldane. “The men might still be contaminated,” he said in a voice that was muffled by the spacesuitlike hood he wore. He pointed to the guard opening the door. “They take no chances.”
Inside, with the door locked behind them, they stood in a bleak windowless hospital room befitting a second-world country. Two beds were hidden behind drawn curtains. On the other side of the room, two men wearing masks, gloves, and shower caps along with standard hospital pajamas sat across from one another on narrow cots and played mahjong with small white domino-like tiles.
“Why are they still here?” McLeod pointed at the healthy-looking men.
“Still might be contaminated,” the translator replied.
“‘Infectious”’, Haldane corrected distractedly. He waved to the two men, who responded with friendly nods, and then he asked the translator. “When did they become sick?”
The translator spoke for several minutes to the two patients in their native Mandarin.
“Watch,” McLeod said, shifting impatiently from foot to foot. “I’ve seen translators do this a thousand times before. They’ll gab back and forth for half an hour and then the guy will turn to us and say ‘yes’ or ‘no.’”
Haldane had witnessed the same frustrating happening, but in this case, McLeod was wrong.
“Both men live in the same town fifty miles north of Jiayuguan,” the translator said. He pointed to the smaller man on the cot nearest them. “Seven days ago, Xiang got a high fever. In a day, he started to cough. Then he became very, very sick. The oxygen did not help him. He was suffocating on his own mucus.” He put both hands on his own throat and pantomimed a choke. “The town’s doctor arranged to bring Xiang here, but he told his wife it was probably no good. Here at our hospital, the doctors put Xiang on a life-support machine. After three days, he got much better.” The translator snapped his finger to indicate the rapidity of his sudden improvement. “Now, he waits for two days until the doctors say he is no longer infectious.” The translator glanced at Haldane with a proud nod.
Haldane chuckled and nodded back. “And the other man?” he asked.
“Tan,” the translator said, thumbing at the tall, thin man. “He also got sick a week ago. He never became as very sick as Xiang. Only a heavy cough. But...” The translator cleared his throat. “Tan’s sister died from the virus three days ago.”
“Oh,” Haldane said. “Please tell him how sorry we are.”
The translator and Tan spoke for a moment. Tan raised a hand and waved it at Haldane, leaving him confused as to the intent of the gesture.
“We want to ask some questions about their illness,” McLeod said to the translator.
Through the translator, McLeod and Haldane focused their questions on the early symptoms of the infection. Neither patient had the classic sore throat or vague aches that are the harbingers of the common flu. Their symptoms began with a sudden fever and weakness, followed within hours by agonizing muscle pain, cough, and some degree of respiratory collapse.
Haldane had heard enough to know that whatever caused ARCS was one scary pathogen. It hit quickly. And it hit hard.
After thanking the patients for their time, the translator banged on the door. Released by the security guard, they headed into a stairwell and up to the fourth floor. Haldane had to twice catch the railing when he tripped on the stairs walking in his bulky rubber suit.
On the fourth floor the contingent passed through another set of sealed doors. Though Haldane couldn’t read the Chinese lettering, from the bustling activity of the staff at the nursing station he recognized the ward for an Intensive Care Unit. Not as sleek or modern as the North American or European ICUs Haldane had seen, the air was taut with the same sense of urgency. Maybe more so.
After consultation with the nurses, their translator led them to one of the closed rooms that surrounded the nursing station like the spokes of a tire. But this door wasn’t locked. As soon as they opened it, Haldane understood why. The patient wasn’t going anywhere soon, except possibly the morgue.
As they approached the bed, the translator explained, “This is the doctor. Dr. Zhao Fung.”
“Which doctor?”. McLeod asked.
But Haldane answered before the translator. “He’s the town doctor. The one who looked after the two men we just interviewed.”
The translator nodded his head vigorously.
“Shite!” McLeod said. “I thought they told us there hadn’t been any intra-hospital spread.”
The translator waved his gloved hand. “No hospital in that town. Only the ... clinic ... where he worked. He used the best precautions he had, but...”
Haldane nodded absentmindedly. He was thinking of his colleague, Dr. Franco Bertulli, dying of SARS in a similar room in Singapore after following all the recommended precautions. He remembered how Bertulli joked about his mother encouraging him to go into medicine because she thought it was so much safer than his alternate choice, the police force. In the case of both Bertulli and Fung, the viruses managed to circumvent their protective measures. In the end, medicine turned out to be a very unsafe choice for both doctors.
Dr. Fung looked older than fifty. Behind a deathly pallor, his face was swollen and contused. His oozing lips were as thick as the endotracheal tube sticking between them and leading to a ventilator, or artificial life-support system. Bloody sputum fluttered inside the transparent plastic tube, flapping back and forth with each breath the ventilator forced in and out, like a piece of paper trapped at the opening of a vacuum hose. Bruises covered his flaccid arms. A blanket shrouded the rest of his skin from his chest down, but Haldane knew that he would see similar welts and bruises on any exposed surface. Haldane made the diagnosis from the foot of the bed: disseminated intravascular coagulopathy or DIC. The inflammatory reaction instigated by the virus was chewing up the clotting factors in the patient’s blood. As a result, he was bleeding spontaneously under his skin; thus the bruises.
Haldane experienced the same helplessness he had felt in Singapore. The local specialists
had done all they could—all anyone could—for their colleague. Standing at the bedside in his rubber suit, Haldane felt embarrassed, as if he were a nosy bystander gawking at the sight of a fatal car crash. He was of no use to the doomed physician. All he could do was try to prevent others from following down the same road. He silently vowed to do just that.
He’d seen enough. He spun and walked to the door. McLeod and the interpreter followed behind. Even McLeod was silent as they headed back to the change rooms where guards supervised their showers to ensure proper decontamination steps were followed.
Once they were dressed their translator led them into a modest gray office, which smelled of herbal tea, on the main floor. The associate director, Dr. Ping Wu, jumped up from his desk and walked around to meet them. Wearing thick glasses and a crisp white lab coat, the middle-aged doctor stood chest-high to his two Western colleagues.
The translator made the introductions, but the diminutive administrator addressed Haldane and McLeod in a slightly accented English. “My English is most poor, but I think I can manage,” he said with typical Oriental humility. “I studied four years at UCLA.” He waved to the interpreter who turned and left the room.
Haldane and McLeod sat down across the desk from Wu. “My deepest apologies, Doctors,” Wu said. “The director, Dr. Huang, is at the provincial capital Lanzhou reporting to the governor. He very much wanted to meet you.”
“We appreciate you taking the time to meet us, Dr. Wu,” Haldane said.
Wu bowed his head. “It’s an honor.”
“Likewise,” Haldane said. “Dr. Wu, I understand your hospital has had the most experience of any facility with this disease.”
“Very true, Dr. Haldane,” Wu said. “We have treated 146 cases at this hospital. As many as the other hospitals combined.”
McLeod rubbed his beard roughly. “How many dead?”
“Twenty-seven.” Wu cleared his throat. “I fear that number will rise to thirty by day’s end.”
“Including Dr. Fung?” McLeod said.
“Yes.”
“It would be very helpful for us to hear about your firsthand experience with this virus,” Haldane said.
“Certainly.” Wu looked down at his desktop. “It began twenty-three days ago. A farmer from the north was sent to us with a high fever and complete respiratory failure. He died within twenty-four hours of arrival. We were concerned about the possibility of the Bird Flu or even SARS.”
Haldane frowned. “Did SARS ever reach Jiayuguan?”
“No. Not anywhere in the Gansu Province. Still, we exercised precise pulmonary protocol with our patient. We did not know until the blood tests came back negative for the SARS coronavirus. Soon more patients arrived with the same symptoms. Abrupt onset of high fever followed by respiratory symptoms, pneumonia, often associated with hemoptysis.” Wu used the technical term for coughing up blood.
“Followed by respiratory collapse,” McLeod said.
Wu shook his head. “Not in all cases, Dr. McLeod. Over half the patients never became short of breath. Just a cough, fever, and severe weakness. Prompt recovery in less than four days in all cases. We believe there are still others who have a subclinical form of the illness and do not require treatment.”
“And in those who did become critically ill,” Haldane said. “What treatments have been tried?”
Wu sighed. “Everything our infectious disease specialists can think of steroids, ribavirin, acyclovir, amantadine, even the HIV antiviral medications.”
“And?”
Wu held up his little hands in a helpless gesture. “We have seen no benefit from any of them. The only intervention that seems to make a difference is the ventilator. The support of the artificial life-support system has helped some patients stay alive long enough to recover.” He shrugged. “If the patient lives for four days, then it seems he or she will recover. But our resources are limited. All the ventilators are in use. We have to guess who has the best chance of surviving. And the others ...” His shoulders sagged. He looked down at the table, as if personally responsible for the lack of resources.
“Understandable,” McLeod said. “How about the town doctor? How long has he been on the ventilator?”
“This is only Dr. Fung’s second day. We will remove the life support in the next few hours.” He glanced away in embarrassment. “We need it for one of the others who might have a chance.”
Haldane nodded sympathetically. His heart went out to Wu and the rest of the staff, knowing this kind of life-and-death rationing of resources was the worst kind of decision health-care professionals ever had to face. “Dr. Wu, what measures have you instituted to prevent spread within the hospital and beyond?”
Wu stiffened in his chair. “I don’t understand what you mean by the question, Dr. Haldane,” he snapped. “We have not had any spread away from this hospital.”
Haldane was taken aback by the administrator’s abrupt defensiveness. “Dr. Wu, we appreciate the excellent work you and your staff have done. What I meant is, can you describe your infection control program?”
Wu nodded, but he still eyed them guardedly. “We implemented the same precautions the hospitals in Beijing used with SARS. In this hospital, we now only accept patients suspected of having the virus. Other patients are diverted elsewhere. All patient care areas in the hospital have negative pressure airflow and filters. The rooms and wards are sealed behind airtight doors. All staff wear bio-hazards suits in patient care areas. So far we have not had a single incident of transmission to a staff member within the hospital.”
“I thought Dr. Fung followed the precautions, too,” McLeod pointed out.
Wu crossed his arms over his chest. “He was infected at his clinic. He only wore a surgical mask, gown, and gloves. This was proven during the SARS outbreak to be inadequate, especially if the masks were not fitted properly.”
Haldane noticed that Wu’s attitude had subtly shifted from that of deferential collegiality to bureaucratic wariness. While he didn’t understand the reason for it, Haldane realized that they would learn little more from the associate director. He rose from his chair. “Thank you, Dr. Wu. You have been most helpful,” he said.
Before rising, McLeod looked at Wu and asked, “Between us, how much does this bug scare you?”
Wu looked away, as if ignoring the question. Finally, he said, “I never saw a patient with SARS, but I believe this virus is worse. I think this is the worst thing to ever strike Gansu.”
“Will it stay in Gansu?” Haldane asked.
Wu’s eyes narrowed to slits. Then, slowly, he shook his head.
Dr. Ping Wu stood at his window and watched until the car carrying the two WHO physicians pulled out of the driveway. Then he turned down the window shutters, locked his door, and returned to his desk. He left instructions with his administrative assistant that he was not to be disturbed under any circumstances.
He cleared the papers off his desk, cleaned his glasses with his handkerchief, and then folded his hands on the desktop. He sat perfectly still, trying to compose his thoughts before proceeding.
The two WHO doctors had struck Wu as sincere, but he had his doubts. Their questions and innuendoes about the virus spreading from the hospital and beyond Gansu hadn’t come out of thin air. Maybe they already knew?
How did it come to this? He tried to retrace the steps in his mind.
For four years of residency at UCLA in the 1970s, he lived below the poverty line, ever the good communist. Never complaining or wanting for the material wealth that was everywhere around him. Returning to China, he continued to live a life of virtual asceticism, forsaking a family of his own to work harder than all his colleagues and subordinates while he watched lazy party officials grow rich from graft and corruption. He practically built the hospital in which he now sat, but when the time came to appoint a director, an underqualified party hack, barely out of his teens, was placed ahead of him. None of it softened Wu’s rigid ethical conduct, until his eighty
-year-old parents became too frail to live in their own hovel. In order to help them, he needed to supplement his income. So he did what he had to. What he was entitled to do, for all his years of service.
It had begun harmlessly enough. He accepted small gratuities for providing priority access to diagnostic services like lab tests or X-rays for people who might have otherwise waited months. In that first year, the money barely covered the expense of the homecare worker he hired to help his parents. From there, his services expanded. For a larger fee, he would move people to the top of elective surgical waiting lists. Soon surgeons began to pay for more operating time to work on their own “private” patients. For a substantial fee, Wu would even “doctor” disability and other pension applications.
When he first heard Lee’s offer in exchange for allowing two “relatives” to visit a dying infected patient, he balked at the idea. But the black marketer offered more than Wu had ever seen before. In spite of huge misgivings, Wu could not resist. The moment he laid eyes on the foreigners, he knew they were not honest in their intentions. He tried to convince himself that they were just reporters, capitalizing on a sensational story and that they needed privacy to capture the virus’s victims on film but in his heart he never believed that. He knew something more sinister was at work.
When hours after their visit, a nurse discovered that the dying patient had puncture marks over his jugular vein, Wu managed to cover it up. However, he could lie to himself no longer. They had stolen the man’s blood and with it the virus. And he had facilitated the theft.
Wu had long since quelled the stirrings of self-recrimination about his acts of petty corruption. It was understandable, even expected to some degree, within the system he lived. But his life had been dedicated to the practice of medicine. Never before had his profiteering been undertaken at the patients’ expense. His role, inadvertent as it was, in disseminating the virus beyond Gansu was beyond rationalization. Or forgiveness. And in the week since the men had stolen the virus, he barely slept at night.