by Judith Lucci
Sandy grimaced. “Well, Kelsey, you called that one right! Let’s see what we can do,” as two nurses rushed towards the opposite end of the ED, one pulling an extra crash cart in case it was needed.
The Code team was in action and two amps of bicarb had already been administered when Sandy and Kelsey reached Bed 3. The patient's lips were blue from circumoral cyanosis . His nails looked as though someone had painted them with a pearly blue nail polish. His eyes, which were open and staring were blood red from petechiae and broken blood vessels. There was bloody drainage from the right orbit staining his cheek. Sandy noticed the flat, and raised maculopapular rash on his chest. She could swear he hadn’t had that rash 30 minutes ago.
The ED doc in charge, Dr. Fred Patterson, saw Sandy and hollered, “What the hell does this guy have? He’s bleeding from everywhere and I have no idea what is wrong with him! Give me a history and for God’s sake, get us some protective gear in here."
Sandy stood quietly, transfixed. She had never seen Dr. Patterson anxious or even tense. She panicked for a moment but didn't know why.
Dr. Patterson glared at her. "Give me a history. He’s bleeding out, for God's sake, Sandy, and I don’t know why. This is at the very least malaria or typhoid or perhaps something worse. Holy Shit, I don’t like this! Get us some protective gear, NOW.” Sandy’s stress soared exponentially. Fred Patterson was their calmest ED doc and he was freaked.
She grabbed the chart from the medication nurse and said, “Fred, not much to tell. The guy came in several hours ago; he was staying at the Burgundy Hotel in the Quarter. He’s part of the staff for the Democratic Caucus that starts tomorrow. His friend who bought him here said he started feeling sick last night, had some nausea, vomiting and a sore throat. Then this morning his temp got higher and he couldn’t stop vomiting so they brought him in. We started some IV fluids and gave him from nausea medicine. He was OK 30 minutes ago.
“Well, he sure as hell isn’t OK now! I'm sure he is in liver failure at least and probably multisystem failure. Any recent blood work? Does he have any friends or family here? Any idea where he’s been? Do you know if he has been traveling?” Fred was barking the questions at Sandy nonstop.
Sandy shrugged her shoulders as she and Fred watched as the Code team continued and respiratory intubated the patient. There was no cardiac response at all. Flat line. A nurse rolled the defibrillator closer.
“I’ve no idea," replied Sandy. "His friend stayed about thirty minutes and took off. Said he had a bunch of stuff to do. You know the politicians are here for the next few days, right? They are trying to clean up their act in the Washington."
“Yeah, goody, goody and the President is coming over the weekend, right?
Sandy could detect the sarcasm in Fred’s voice. She really couldn’t blame him for his jaded and sarcastic nature. Just this year, his twin brother, Ron, also at ED doc for CCHSC had died working in the ED. No one had recovered from it and most assuredly, Fred had not. Nevertheless, he was a great ED doc and he knew his stuff. Besides, almost everyone in America had lost respect for the politicians in Washington D.C. and Fred wasn't any different.
“Yep, that’s what the papers say. I think a food service worker from the hotel was admitted earlier. I’ll need to check.” Sandy's voice was casual. She didn't want to upset Fred anymore then he already was.
“Find out where he’s been from his friend that brought him in. Call the hotel. I think he has some kind of really bad virus. Get the infectious disease people in here too. I'm bringing in Tim Smith in Tropical Medicine over at Tulane as well."
Sandy could hear the tension in Fred's voice and paused for a second to respond but Fred Patterson glared at her and said, “STAT, Sandy, we need to know what we are dealing with. If it’s bad, we need to contain it. Be sure we have gathered all available blood samples for diagnostic testing. Get a tube for everything.”
Sandy, an old hat ED nurse who thought she had seen everything working in New Orleans, was disturbed by Fred’s behavior and the wild look in his eyes. She could feel herself becoming anxious, something she hardly ever did as an expert practitioner. She replied calmly “Got it Fred, I’ll take care of it,” she said, pushing a reluctant Kelsey forward so they could get to work. Sandy could feel the slow but increasing thud of her heart. Oh my God she thought to herself, suppose we have an outbreak of Ebola or some unknown hemorrhagic virus.“
Sandy looked at Kelsey who was even whiter than she was before. "Kelsey, have central supply bring in full gowns, masks and booties for all staff in the ED. Face shields as well. We need to start isolation on all patients and close the ED to further traffic. We must close down and transfer out the patients we can and divert potential admissions to other local EDs. I'll call and let administration know. This could be bad. We don't know what the guy's got."
Kelsey was onboard and quick to respond. “I’ll take care of it, Sandy. I’ll get the gear and report back to you. I’ll call CCHSC infectious disease docs in here too if you want.
“Thanks, Kel. I'll call the infectious disease people. You’re the best,” Sandy patted her shoulder as she rushed towards her office to call administration and report a potentially serious biological threat to the health sciences center. She almost collided with Dr. Robert Bonnet, the interim chief of medicine at CCHSC.
Robert smiled brightly at Sandy, “Whoa! What’s up, Sandy! Why are you hurrying so fast? I heard the CODE BLUE so I came down. What’s going on?
“Come into my office, Robert. We need to talk for a moment. We have a guy, the Code actually, which I am sure they will call if they haven’t already, who looks like he has some type of really weird virus. Fred said typhoid or malaria at the best and perhaps something else. Maybe even a really bad virus of some kind. The patient works for the Democratic Party. He was bleeding out, has a significant trunk rash and high fever. Also, his kidneys and liver have shut down. Bad rash over his trunk area too."
Robert’s smile disappeared as he analyzed the info Sandy gave him. “This could be bad. Get Dave Brodrick, our head of infectious disease here at CCHSC and get him over here. If it looks like a hemorrhagic fever, we will need to call the CDC as well. Has anyone else been admitted with similar symptoms?”
‘Yeah, but he was transferred to Intensive Care where this guy was headed before he coded. I think the guy in the ICU is South African and I believe he is food service staff at the Hotel Burgundy . He had a temp of 105.2 as well as nausea and vomiting. His platelets were whacked and WBCs were way up. Short of breath too, but we treated him symptomatically. He was just like the guy who coded, but the South African guy stabilized and was transferred to ICU an hour or so ago.” Their symptoms were almost identical at admission.
“Find out how he is and call me. I think we have a serious situation, at the very least a viral outbreak." Sandy noted the etched lines of concern on Robert’s handsome face as he left her office and started down the hall.
Damn, that man is hot....if I were a few years younger.....Sandy thought admiring Robert's retreating figure as she picked up her phone. She had just completed her call to infectious disease when Robert returned, framed her doorway and asked, “Sandy, when does the political convention start? Do you know?”
Sandy shrugged her shoulders and said, “I don’t know, sometime this weekend. Today is Thursday, right? I think it is Saturday morning but I'm not positive.” She gave him a reproachful look and teasingly added, "Really, Dr. Bonnet, you should know. You father is a Senator!"
Robert cracked a half smile. “Find out,” he said as he stared at her steadily, his eyes unwavering and holding hers.
After several seconds, Sandy got the message and asked, "Dr. Bonnet, you don’t think someone is…..?"
Robert interrupted her, “I don’t know, Sandy, but we have to think proactively. There're gonna be a lot of very powerful people in the city this weekend. We've got to consider it.
“Oh my God, Robert. We’ve had enough this year, please not this.” Sandy's voice was shril
l with fear.
“Yes, we have but I have a bad feeling that this could be the worst. Close the ED to further traffic, have everyone wear full protective garb and for God’s sake, no one is allowed to leave until we figure out what we are dealing with. Implement our full biocontainment protocol and only accept patients with flu-like symptoms into the ED. It's better to be safe than sorry.
Sandy stared at him, her eyes wide with amazement as she nodded and said, "I've already closed the ED and we are transferring everyone out we can. I just need to contact administration."
Robert smiled and said, "You have. These days I am administration. I'll talk to Alexandra. We're the administrators in charge. Keep this viral thing under your hat. It may be nothing but a bad bug but just to be safe, I'm calling CDC.”
Sandy watched Robert leave for the second time as a dark, ominous feeling of dread permeated her body. Oh my God, what are we in for, she thought as she wiped the chill bumps from her arms.
Chapter 2
In the back of a deep warehouse off of Chartes Street in the Quarter, Ali, a thin, frail 23 year old Muslim stared at his older brother, 31 year old Nazir and said, “Nazir, are you sure we know what we are doing? I don’t trust Vadim at all. Every since I hacked into his email and saw the exit plans he sent to his comrades in Russia, I have been suspicious. Maybe we should abort this mission. At least postpone it." Ali's young face looked scared and uncertain.
Nazir's face remained unchanged and he rolled his eyes and looked at his little brother condescendingly. “Ali, stop it. I thought you were ready for this. I thought I could trust you to be OK. We are doing the work of Allah.” Ali seemed to shrink in stature at his brother's criticism and impatience. He seemed to retreat into his skin.”
“I am ready, I really am,” Ali replied with bravado in his voice. “I just don’t like working with others, those that are not dedicated to our cause.
Nazir’s impatience continued. “You have been training for over 3 years and I have been planning for a mission such as this for many years. Sometimes in order to do Allah's work, we have to work with others. This is one of those times.”
Ali still looked doubtful, uncertain. His brother's words did not sway him.
Nazir moved over and put his arm around his little brother. Ali certainly wasn’t a warrior, but he was a brilliant scientist and computer genius. He said gently, “Vadim is OK. He’s just different from us. He is Russian and they do things differently. But he is a Muslim and worships as we do. He is one of the leaders in the Red Jihad movement at home in Eastern Europe."
Ali nodded as Nazir continued, "Remember, we needed Vadim and his connections to get us the virus. The Russians have been holding that strain since the Cold War. It would have taken us years to produce a similar strain. You more than anyone know we haven’t been able to produce the more virulent strain in our laboratories.” Nazir eyed him reprovingly.
“I know, I know,” lamented his brother. “But we were very close. If you had just given me six more months I could have had the very same thing or perhaps something even better with a higher kill rate. Maybe even a virus that would be even harder to detect. Nazir, you have to understand that these things take time, believe me. I haven’t been doddering.” Ali’s dark eyes were brooding and angry.
"No, my little brother. I certainly don't think that at all." Nazir continued to talk softly and reassure his brother how much he and the local jihad cell appreciated his talents and contributions. “I know that, I know that, little one. But you know how the Americans are. Very seldom are there so many of them from all parts of their leadership gathered together in such an iconic, filterable city such as New Orleans. Washington is just too difficult to attack. It is a fortress. But New Orleans…. What can I say? This is a perfect place for an attack. Ali, the place is half underwater and a sewer. It cannot be secured. Besides, they’ll have a hard time figuring out if the virus is endemic to New Orleans. Nazir smirked to himself and continued, "They have so much stuff growing over there in Tulane’s lab not even to mention all that stuff they’re growing since Katrina. Besides, we have hundreds of places we can hide. We can hide here for years if we need. The time is right and the time is perfect. Besides, it will cause terror and fear in the hearts of Americans if we are successful so soon after Boston.”
Ali was being stubborn. “I like New Orleans. I like all of our friends and where we live. I have fun here. I am happier than I have been in anywhere since we left home after our parents died. I like going to school at Tulane too and studying with Dr. Smith. I like being his lab rat and he says he can get me financing for my PhD if I decide to get it. He’s taught me a lot, and in some ways he has been helpful to our cause.”
Nazir’s face had darkened and he shook his younger brother violently until Ali’s teeth chattered. He gritted his teeth and barked at the slightly build young man in a hoarse voice, “Ali, for the last time. Don't you remember the Americans killed our parents. It was their droan that killed them. These people are our enemies. We are here to KILL them, not become their friends and help them in their labs. Do you get it or do you need to go back to Yemen?”
Ali was shocked at his brother's words. “I get it, I get it, Nazir. I am sorry. Now let me go. I must get to work. My shift starts in less than an hour,” Ali shuffled out of his brother's arms, terrified but trying hard not to show it. He left the warehouse quickly walking quickly towards Canal Street and Tulane Medical Center.
Ali's heart was heavy on his way to work. He didn't like the business of hurting others, even though his parents had been killed. Hadn't the Taliban killed the parents of many American children during 9/11? Wasn't jihad just as destructive as the Americans had been over the years. He guessed his western education had made him question his supposed "mission". He was startled when his phone alarm sounded signaling a text. The text was from Dr. Smith that said,
ALI, CAN YOU COME ASAP? WE HAVE A VIRAL OUTBREAK IN ONE OF THE HOSPITALS. Tim.
He quickly texted back and said, I AM ON MY WAY. Ali. He didn’t feel good about this at all. There was nothing good about a viral outbreak that could be good for he and Nazir or Vadim even, for that matter. At least not today. He wondered what was up. His heart began to thud with anxiety. Things were just not right and that bothered him. It bothered him a lot.