by Justin Evans
At last Rhys strode across the drive, all purpose and energy, a head of house ready to take action in his full Sunday regalia of tailcoat and waistcoat and striped trousers. Jute didn’t offer a greeting. Merely turned and waved them up the High Street. He walked deliberately. In his casual clothes (grey slacks, green jumper) he had the air of someone whose Sunday with the newspaper had been interrupted by bad news. Andrew skulked along like a prisoner. He could only assume that Roddy was critically ill, or that he was being expelled for going AWOL, and that Rhys was in trouble, too, for covering for him.
In Jute’s office a woman waited for them. Tiny-framed, fiftyish, she was Indian with an enormous mantle of black hair, and dressed in a stylish cotton dress.
“Boys, this is Miss Palek.”
They introduced themselves.
“I am from the Health Protection Agency,” she said. She had a soothing alto and massive soft brown eyes.
“Is this about Roddy?” Andrew asked in disbelief.
She pursed her lips. “There has been an incident of infectious disease, and we think you were exposed.”
Andrew’s stomach dropped.
I’m a nurse, she explained. She worked for one of the Health Protection Units for the London area, Northwest, which covered Harrow and Harrow-on-the-Hill. One of their responsibilities, which they took very seriously, was response to epidemiological emergencies such as possible outbreaks.
Andrew’s heart jolted again.
A few weeks ago, one of their classmates, a young man, died of a pulmonary infection here at the school.
Rhys and Andrew nodded. “Theo Ryder.”
“But he died of sarcoidosis,” added Andrew.
Miss Palek nodded sagely. Yes, because the death was sudden and the cause of death unknown, the medical authorities at Clementine Churchill Hospital—which they were very lucky is top-notch—performed an inquest, and in doing so revealed a pattern of tissue damage. This was at first diagnosed as sarcoid, but for completeness, a culture for mycobacterium tuberculosis was also performed. Those tests returned positive. Yesterday.
Rhys, whose studies allowed him to follow this jargon faster than Andrew, broke in, indignant. “Wait . . . you’re saying Theo died of tuberculosis? Here?”
“It would have been probable that the student, since he was from Africa, brought the infection with him,” Miss Palek said.
“Very few cases from England,” sniffed Jute.
“Most of our patients are AIDS patients or from sub-Saharan Africa,” confirmed Miss Palek, but her eyes flashed; the snobbery in the headmaster’s remark was not lost on her. She continued.
The hospital notified the HPA when the results returned positive, and the first action they took was to put a watch on the databases for the medical facilities surrounding the school. So when their classmate, just a few hours ago, was also brought to Clementine Churchill, with symptoms consistent with TB, he was immediately moved to another, even better-equipped hospital in London; and Miss Palek’s team was notified. It was their duty to review the circumstances around the incident—or index event—to determine the extent of the outbreak.
“So . . . ,” stammered Andrew, catching up. “Theo had TB.”
“That’s correct.”
“And Roddy has TB.”
Miss Palek hesitated. Obviously she was not supposed to confirm the name of any kid who had gotten sick. “Anyone with symptoms consistent with active tuberculosis will be isolated in a special ward. We need to take precautions with those who have been living in close proximity to the victims, to find out whether they have been infected.”
“You mean us,” said Rhys.
“Isolated?” barked Andrew. “You mean quarantined?”
“Please do not be alarmed. As I said, only those with active TB—fevers, coughing, lung tissue damage—need to be isolated. It is all for your protection. The gentleman accompanying the victim to Clementine Churchill—”
“Fawkes,” interjected Jute with distaste.
“A very quick thinker. He immediately understood the risks, and he provided your names.”
“Never mind the risk of a panic at the school,” mumbled Jute resentfully.
“Panic is not good for anyone,” she intoned, sympathetically. “Right now I would advise only telling the parents of those affected. What we call the inner circle.”
“That means you boys will keep absolute mum, or we’ll have a real crisis,” Jute said.
“Mum about what?” Andrew asked, his voice rising with his confusion.
Miss Palek smiled tightly. “We recommend you submit to a test.”
And there it was.
“A test,” Andrew repeated.
“When,” said Rhys. “Now? Here?”
In answer to his question, she produced two clipboards from a bag at her side and told them, no, it was suggested they accompany her to London, not far, the Royal Tredway Hospital . . . one of the best in Europe for this sort of thing, interjected Jute, certainly the best in London . . . They would need to review and sign these forms . . . this was for their own benefit. . . . The remainder of her words vanished into a haze. They were actors in a play that had been carefully staged by Miss Palek and (grudgingly) Jute. Andrew and Rhys signed the papers. They found themselves being ushered to the street, where a car waited for them. The driver, seeing them, placed a white surgical mask over his face. He started the engine. Miss Palek sat in front. She too placed a mask over her face. She handed the boys their own surgical masks. They were made of spongy, fibrous cotton, folded over in a rippling pattern. Miss Palek looked at them expectantly. Rhys and Andrew pulled the masks over their faces, stretching the pink bands behind their heads. The masks smelled of rubber. Andrew’s made him painfully conscious of his breathing. He involuntarily started counting his breaths as they descended the Hill, passing the Old Schools . . . one, two . . . passing the drive to Headland House . . . six, seven . . . then down to the roundabout, where, for the first time in weeks, sun shone on the yellow warning street sign.
Andrew pulled out his cell phone. He had Fawkes’s mobile number programmed in it. He lifted his mask to speak and turned to the window so he would not be overheard. They’re taking us to some hospital because they think we all have TB. TB as in tuberculosis. Can you come find us? Rhys glared at Andrew, nodding his head at Miss Palek in the front in warning. You’re the only person who understands what’s really going on. Rhys said he felt something when it happened. Harness! he hissed. If you don’t come get us, I’m not sure what’s going to happen. If we don’t make it out alive, he added, write me a good epitaph.
He now counted like a child praying, as if, when he stopped counting, his breathing might somehow stop . . . eleven, twelve . . . The car swept down the Hill and into the flow of traffic. Andrew realized that, from the moment the headmaster had appeared at the Lot to fetch them, no one had physically touched either him or Rhys. They were pariahs.
THE HOSPITAL WAS located in an upmarket corner of London, near sweeping blocks of multistoried and prosperous-looking town houses. Constructed of ruddy prewar brick, it sat high over a busy thoroughfare with only a modest sign and a shallow loading ramp to distinguish it. They parked, and Rhys and Andrew were forced to walk a block, masks over their faces, feeling a sense of shame that only deepened when they passed a family of Scandinavian tourists, who spotted them and pulled their children closer to them protectively as the pair walked by.
Miss Palek removed her mask and led them through the main lobby, down a long, straight corridor to a bank of elevators. The narrow halls bustled with doctors in white coats, orderlies, and administrators with name tags.
They took a battered elevator four flights. Where they emerged was quieter.
“This is our Chest Centre,” Miss Palek announced with a hint of pride.
Rhys and Andrew were checked in by a nurse in scrubs. They were told they could remove the masks. They provided their information. They were led to a treatment room with two beds and
curtains that drew around them. They were asked to change into gowns. They did. Andrew resented the seminakedness, the flimsy gown. It transformed you from citizen with full rights, to inmate—suspect—in a few moments. The nurse reentered, asked them to place their clothes in plastic bags, and after storing these under a cabinet, immediately wrung her hands under the hand-sanitizing foam dispenser.
Another nurse, older, grey-haired, with a wattle and an air of authority, entered with a clipboard and gestured for Andrew to follow her. He coughed. She looked alarmed.
“That’s quite a cough.”
“Ah, I was smoking too much last night.”
“Have you had that cough long?”
“As long as I’ve been smoking.”
“So, for a month?”
“Sure.”
Her face drew up like the mouth of a cinched duffel bag.
“Please replace your mask,” she commanded.
“Oh come on . . . ,” he protested. “It’s a smoker’s cough!”
Her face went flat and implacable. He complied.
“Follow me,” she told Andrew.
“Have fun,” advised Rhys, who slumped on his bed, his hairy legs protruding from his gown.
She led him to a small, bare room whose only feature was a flat examination table and a bulky camera encased in metal that swung from a flexible mechanical arm bolted to the wall. They were going to take an X ray, she told him, of his chest.
“My chest,” he repeated.
“That’s right.”
She laid him on the table. She stepped out of the room. She reentered and adjusted him several times, taking different X rays from different angles. The vinyl of the examining table was cold on his back where the gown didn’t cover him. She came back a final time and lifted the camera up and away. Then she led him to an examination room.
He waited there in his drafty robe. A long time later, a doctor arrived. He was in his mid-forties with a solid build, a shaved head, and extraordinarily thick eyelashes. He introduced himself as Dr. Minos. Another nurse appeared—petite, with a choppy haircut and double earrings. She wore a face mask and busied herself with equipment in the corner. She ripped the plastic off some packaged implements. Andrew watched her warily. Then the doctor came to him, pulling on a mask of his own. All Andrew could see was his scalp and those lush, almost mascara’d-looking eyes.
“I’m going to perform some tests,” the doctor said. “We’re going to be more aggressive than normal. You have symptoms.”
“What?” said Andrew. “Wait, you mean my cough? I told the nurse, it’s a smoker’s cough.”
Thinking about it so much, he got a tickle, and coughed right there.
“You have phlegm,” confirmed the doctor.
“Come on,” said Andrew, angrily. “What are the odds that I have TB?”
“You mean exposed to TB? Nearly one hundred percent.”
Andrew’s eyes widened.
The doctor chuckled grimly. “I know what you’re thinking. In England? At Harrow School? Oh yes, my young friend. Millions of people carry TB. It’s all around us. In the air. In enclosed spaces. The tube. Restaurants. It’s communicated through coughing—sputum. Carried through the air, by coughs like yours, breathed into the lungs. In most cases the immune system fights it off. But not always.” He tried a softer tone, seeing Andrew’s discomfort. “You spent a lot of time with the index patient. Tell me about your relationship with him.”
“So it is Roddy?”
Dr. Minos blinked. “Let’s assume.”
“Will he be okay?”
“Possibly. He’s very advanced. Did you know that?”
“Advanced?”
“Fever. Weakening. Coughing. He’s frightened. As he should be.”
“Jesus.” Andrew shook his head. “He wasn’t even sick before.” The doctor’s face showed surprise at these words but Andrew missed it. “Where is he?”
“I thought I was asking the questions,” said the doctor.
“Is he here?”
“I’ll tell you, because I want you to answer my questions honestly. If you don’t tell me the truth—the more you hide from me—the greater chance you could end up like him.” He paused, his eyes flashing a warning. “Your friend is in an isolation ward. A room with an antechamber, a special ventilation system, and ultraviolet lights on the ceiling to kill the mycobacteria. And he’ll be ingesting a nice bag of snacks every day: INH. Rifampicin. PZA and ethambutol. That’s unless the strain turns out to be drug-resistant. Given that I hear we have Africa in the picture. Yes? The original fatality?” Andrew thought of Theo and his family burned pink by the African sun. He nodded. The doctor continued. “Then your friend Roddy will get injections. Some unpleasant side effects. Renal damage. Even hearing loss. So I want you to be forthright. Do I make myself clear?”
Andrew nodded again. He felt alone, cold in his gown, and towered over by the doctor.
“What’s your relationship to Roddy?”
“We’re next-door neighbors.”
“In a dormitory?”
“A house, yeah.”
“Roddy and the other bloke, the South African—were they close?”
“No, not especially.”
“Close at all?”
“I guess. I mean, they were in the same house for years.”
“I’ll lay it out for you, Andrew,” said the doctor. “Schools like Harrow have a certain reputation.”
“Okay . . .”
“You know the word buggery in America?”
Andrew snorted. “You’re kidding, right?” Dr. Minos’s dark-rimmed eyes assured him he was not. “Ah, yes, I know that word,” Andrew said sarcastically.
“See any of that at Harrow?”
“No.”
But Andrew’s face burned. No, except for the buggery that happens in a small, cold, stone room, that either was or wasn’t real; no, except for the boys with giant uncircumcised penises performing rape in the showers; no, except for the slippery white-haired boy with the twisted grunting face holding a kerchief to his neck. . . .
“Ever hear of any? Say, between Roddy and the African bloke?”
“No. Why are you asking me this?”
“Did Roddy have HIV?”
“Are you kidding?”
Suddenly Dr. Minos came very close to him, mask to mask, finally losing his composure. “Do I look like I’m fucking kidding, mate?”
The nurse glanced up from her work.
“He’s seventeen years old,” Andrew objected. “He’s straight. Healthy. No. I mean, not that I know of.”
“Drug user? Did he shoot up?”
Andrew held his breath for a second. “Definitely not.”
“The other one?”
“Theo? No.”
“What about you? Do you engage in anal sex or intravenous drug use?”
“No,” he said, going scarlet. John Harness could not count, he told himself: he was not a living person. And the heroin—well, that had been months ago, and he had always snorted it. “Why are you asking me this?”
Dr. Minos stood back. “You said it yourself. Not sick one day. Sick the next. That’s very aggressive. Know how long it takes a normal TB patient to show the kinds of symptoms your mate is showing?”
“No.”
“Two months. According to you—according to everyone—he made these advances in twenty-four hours. Same with the index event.”
“Theo.”
“The only explanation is that your friend Roddy, and Theo, have HIV.”
Andrew shook his head. “I really don’t think so.”
The doctor gave him a sad, sidelong smile. “How well do you know your friends?”
Andrew did not answer, but Dr. Minos did not seem to notice.
“You should have seen this place around, say, oh, 1986,” said the doctor. “Out of nowhere—over the course of a summer—we had ten, twenty, then scores of patients in here with tuberculosis. Not your typical African or Asian immigrants arr
iving here looking for work, too sick to walk. Nice English stock. Lots of men. Place full of them. We had to clear out beds, bring additional equipment, doctors. The place was flooded. Everyone working eighteen-, twenty-hour shifts. We thought it was an epidemic. I went home at night and couldn’t sleep, lying awake wondering how I was going to help save London from a new plague. We didn’t realize susceptibility to TB was part of the HIV pattern. The immune system that protects you and me from those floating mycobacteria wasn’t working for those patients then.” He paused. “And that’s the only explanation now.”
“But what if they don’t have HIV? Does that mean it’s a . . . virulent strain?”
“No. No TB strain on its own is that potent. If they don’t have HIV . . .” The doctor turned to Andrew and shrugged. “Then I don’t know.”
“But what about Theo. At first they told us he had”—Andrew groped for the word—“sarcoidosis.”
“Sarcoid? Did they?” The doctor nodded. “That makes sense. One has necrotizing granulomas, the other nonnecrotizing granulomas.”
“Huh?”
“They look the same on the autopsy table. Honest mistake. Both cause caseosis in the lungs. That’s when your lungs turn to cheese. The culture from the autopsy no doubt corrected the error.”
Andrew imagined a grey chunk of Theo’s lung growing mold in a Petri dish. Nausea rose in his gorge.
Then, unbidden, came the image of John Harness. The sunken cheeks and putty-colored skin. The wild, desperate eyes.
“So this would be a mystery,” Andrew prompted, suddenly eager. “Something you couldn’t explain.”
“That’s correct.”
“Can—what are they called, mycobacteria—can they survive in a building? Like, the dorm?”
“For how long?”
“Two hundred years?”
The doctor gave a curious half smile and shook his head. “No chance.”
“What do you look like with TB? When, say, you don’t get treatment, or you get, like, antiquated treatment?”
“Antiquated treatment. I’ve seen plenty of that in Africa. Bone-skinny. You’re starved because the lesions on your throat prevent you from eating. If you get far enough along you’ll be coughing blood. But at that point . . .”