Prodrome: 1989
Things fall apart; the center cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.
W.B. Yeats, The Second Coming
There is no truth, only stories.
--Anonymous
Prodrome
Friday, September 29, 1989, 3:10 A.M.
Pathology Department, City Hospital Number 1, Sverdlovsk, East of the Ural Mountains, USSR
Dr. Anna Katasova pressed into the shadows, squeezing her back against a rough stone wall. Its slimy cold penetrated the layers of her surgical clothing, raising yet more goose bumps, and she tried not to shiver. But the icy damp of the subterranean passage won out, and she had to clench her teeth to keep them from chattering.
Fitting entrance to a morgue.
She listened for footsteps.
None.
But her breath leaked out the top of her OR mask and, turning luminous in the icy air, it reached shimmering fingers through the dim streaks of light. Anyone who looked down here would at the very least spot her traces.
Yet Yuri had insisted she not approach the autopsy room at the corridor’s end. “Anechka,” he said over the phone, using his pet name for her, the Ural dialect of his Russian elongating the a sound. “Just come half-way down the hallway, keep watch, and stop the crypt keeper from interrupting me.” His words rasped through the receiver in a raw whisper. She could tell that his vocal cords had tensed to the snapping point.
“What in God’s name--”
“Trust me, Anna.”
“Yuri--”
He’d hung up.
No sound came from the direction of the elevators that led back upstairs to lights and people. Overhead the old pipes moaned, and scurrying noises inside the air ducts gave her the creeps. But nothing human seemed near. And least none living. A row of sheeted stretchers stood end to end along the opposite wall. Twelve she could count; the rest extended into the gloom like linked segments of a white worm. Each held a corpse.
The shrouded forms were more sinister and suggestive of death than if she could see them lying naked and exposed. The pathologists had been lining them up like that for the last five days. Despite the cold, a cloying whiff of rot penetrated her mask, descended through the back of her nostrils, and played at the base of her tongue until she nearly gagged.
“Careful now, Doctor,” she muttered to herself, having already learned that even for a physician, medical cool around a cadaver depended on having something to do--pronouncing it dead, checking it for evidence of foul play, examining it for physical signs that might better yield a diagnosis--anything to keep busy. But with no procedures or duties to hide behind, all her training did squat to protect her imagination from getting the yips. The pale material that outlined the cavity of an open mouth began to rise and fall. A bony imprint of a hand appeared to move beneath its cover.
She tried to distract herself by pressing her gloved palms against the stones behind her. The entire city, since its founding as Ekaterinburg by Czar Peter the Great in 1723, had been hewn from rock by hand, giving rise to generations of master stone cutters. Except in July 1918, those hands picked up rifles instead of tools and, to show there’d be no going back on the revolution, massacred Czar Nikolai II along with the rest of his family, with or without Anastasia. And on May 1, 1960, at the local military base, the hand of a descendant from those stone cutters launched the missile that brought down Francis Gary Powers, setting off a show trial to tweak the nose of America. By then strategic defense industries had dominated the region’s work force, and to this day the city remained closed to the outside world, including those who would visit its airspace at an altitude of 50,000 feet. But over the last year rumors hinted that soon the restrictions would be relaxed and the city renamed Ekaterinburg, thanks to the spirit of Peristroika. Unfortunately, one of the most vociferous politicians nipping at Gorbachev’s heels was a local drunk named Boris Yeltsin who’d never amounted to much. He might offend enough apparatchniks in Moscow that, just for spite, they’d keep his hometown in a political deep-freeze forever--
A familiar shrill whine from inside the morgue interrupted her rambling train of thought. The sound dropped in pitch, a characteristic deepening that occurred whenever the steel teeth of a bone saw bit into their target. Then it returned to the higher note, having completed the cut.
Was Yuri doing an autopsy?
“Oh, no,” she groaned, more worried than ever.
If caught, they’d both end up in prison, or worse.
Of course someone had to have the guts to verify what they were dealing with, but why him?
When the first case came in the door, she’d known the man would die. His ashen face had drained to the color of dusk; his chest wall heaved like a bellows; his eyes flicked right and left, as if a pocket of the air he so desperately needed might be hidden somewhere in the room. She did all the right moves--tubed his trachea, bagged oxygen into his lungs, bolused bronchodilators and steroids into his bloodstream, then topped him off with antibiotics. But his hands restlessly plucked at the covers like a man trying to pick up loose change, a sure sign of severe oxygen depletion. On X-ray the center of his chest bulged with lymph nodes, something normally seen only in cancer patients. But two days earlier, according to a very anxious young wife, he’d been a healthy thirty-five-year-old chopping wood and milking the cows on their farm northeast of the city.
Dr. Anna Katasova had then tried to ventilate him by hand. With each squeeze of the bag, blood-tinged foam poured out the release valve. She nevertheless put him on a respirator, but an hour later, his heart stopped, and no amount of pumping, electrical shocks, or drugs could bring him back.
They’d received twelve more just like him that day. The same the day after, and the day after that.
Within the first twenty-four hours, infectious disease specialists had arrived from Moscow. “Flu,” they said after cursorily examining the latest batch of victims who were still breathing.
Oh, sure.
“Better take precautions. Wear masks, gowns, and gloves,” they’d added.
We already are, you idiots, she’d wanted to yell at them, but kept her mouth shut. Suits, white collars, and ties didn’t disguise their military bearing.
Neither had she nor the other medical students ventured an alternative diagnosis, at least not out loud. Even their teachers remained silent. But people muttered together in small groups, particularly the pathologists. Some old-timers suggested that this had happened once before.
And throughout the hospital, especially in the cafeteria after hits of strong, black tea flooded tongues with courage, whenever anyone nodded knowingly, hinting that they knew what these people really had, everybody glanced toward the northeast, the direction in which a large agricultural experimental farm was situated on the outskirts of town. Officially an arm of the People’s Agrarian Co-operative, it had been nicknamed OepMa Tena, or The Body Farm, and been the butt of sly asides since its inception decades ago. “How come the place has more army trucks than tractors?” the good citizens of Sverdlovsk would say to one another, exchanging wicked grins.
The clatter of an elevator door opening and closing snapped her to attention.
Footsteps approached.
The whine of the saw continued at her back.
She watched the lighted arch, expecting to see a figure enter the passageway at any moment.
Within seconds an orderly appeared, hunched over a stretcher bearing yet another shrouded corpse.
The crypt keepe
r, they called him, because of his creepy manner.
With a final push he glided his load into the lineup, then peered through the darkness toward the autopsy room.
Would he mind his own business, or investigate who’d be cutting up bodies at this hour?
He started down the corridor toward the door.
Time to act.
Anna stepped out from the shadows. “One moment, please!”
The man let out a yelp and jumped backward.
“What is your name?” Anna pressed to keep him on the defensive.
“Pe . . . Pe . . . Pe . . . Petrov--”
“Do you have reason to interrupt the pathologists?” she demanded, striding up to stand toe-to-toe with him. His face was in shadow, and, as did everyone these days, he wore a surgical mask, but enough of his features were visible for her to see the angular scar he bore that extended down his forehead and through his right eyebrow. The mark curved into an arch as he looked up at her.
Like most Russian men, he didn’t match her height. At 1.75 meters, or five foot ten as Yuri’s American friends in Moscow measured her, she liked the advantage. Yet the tall stature had ended her first dream, a promising career in ballet. She towered over most of the male dancers. “Their loss, medicine’s gain,” she’d said a million times when people asked if the forced switch had left her with any regrets. If they pushed her for a more complete reply, she’d wave them off with a breezy denial. But to herself she admitted, Yes, I miss the limelight, the fantasy, the wonder of creating something perfect. The selfishness of it is intoxicating. But when I save a life in ER, it’s the same rush of exhilaration as opening night. The only difference is, in a white coat it’s not proper to admit feeling the diva.
She glowered down at her subject. “Well? Do you have reason to be here or not?”
“Why no--wait a minute. You’re only one of the medical students.” His thick rural accent suggested an older Russian dialect spoken far to the north. It made the pronunciation of “only” sound like clearing phlegm from the back of his throat. “Katasova, isn’t it? What are you doing here?”
She instinctively resorted to a move learned in preparation for the role of Sleeping Beauty that had since helped her win many a confrontation. Ever so slightly arching her back, she raised her shoulders, drew in a breath, and went up on her toes. It made her statuesque, presenting a formidable adversary to man or woman. But in the case of males, and some females, the delicate thrusting forward of her breasts that accompanied the maneuver could be distracting enough for her to completely seize the upper hand. “Yes, I am Dr. Katasova, and you better get out of here. Those men in suits who you’ve seen around the hospital are putting in extra hours to diagnose what killed all these.” She waved her hand at the string of grizzly cargo the way an American game-show hostess she’d seen parodied on Russian TV showed off the prizes. “And don’t you breathe a word of the work they’re doing. They insist that no one know about the extra effort, lest everybody on staff thinks there’s something serious going on and panics.”
He stood nose to her chin, transfixed by her chest, then shifted his gaze to strip the rest of her with his eyes. Looking over her shoulder toward the autopsy suite, he nodded knowingly as the noise of the saw made a series of quick dips, similar to someone revving up what their Western friends in Moscow called a weed-whacker. “Ribs,” he said.
“What?”
“Ribs. That’s the sound it makes when the blade’s going through ribs.” He cocked his head and waited for her response, obviously testing if he could find a squeamish chink in her tough-girl act.
Big mistake. He probably pulled that trick on sweet young things in bars. Well, two could play and she intended to get rid of him fast. “Hearing a corpse get chopped is one thing; seeing it, now that separates the girls from the women.” She reached over and whipped the cover off the nearest body. Its silver-gray flesh glistened in the half-light, and gaunt eyes glittered back at them from the depths of a face so tight with rictus it appeared ready to split open on the skull beneath. “I think this one’s next. Why don’t I tell them in there that you’re willing to clean up the parts once they’ve finished. It’ll speed things along--”
His scar shot upward. “No, no, Doctor, I’ve got my own work to do.” He started to back away, arms extended, hands held palms toward her, the way people do when somebody’s about to shoot them.
“Are you sure? I could check with a supervisor and get you relieved for special duty--”
“Shut up! I’m too busy, and they’re shorthanded upstairs as it is.” He turned and quickly headed toward the elevators, practically at a run.
“Then not a word of this to anyone, Petrov,” she yelled after him. “Otherwise our visitors will still insist you work with them.” She watched him disappear from sight, listening to his retreating footsteps. The rattle of the elevator doors closing and the hum of the cage starting upward confirmed his departure.
“Damn you, Yuri Raskin,” she muttered, pivoting on her heel and heading toward the autopsy door. “You and your harebrained scheme. Let others play the hero.” Only on nearing the entrance did she realize that all had fallen quiet inside.
She grabbed the handle and yanked it open. “Yuri, we nearly got caught. Now let’s get out of here--”
She stopped.
On the table immediately in front of her lay a cadaver with its chest cut open, the blunt ends of the severed ribs pointing upward like amputated claws. The cavity they enclosed was completely empty. On a nearby counter, the freshly removed heart, its arteries and veins drooping out from the different chambers like cut hoses, glistened under the fluorescent ceiling lights. But what held her aghast was the sight of her husband, Dr. Yuri Raskin, holding the dead man’s lungs, both lobes still attached to one another, each dripping with the same pink-stained foam she’d seen bubble out the tube of the first patient she treated. The tissue bridging the middle of the specimen was knobby with whitish nodes that resembled a clump of mushrooms.
“Oh my God, what is it?” she gasped.
Tall, slender, slight even to the point of boyish, Yuri looked up. Above his tightly applied mask, the corners of his eyes crinkled and his jet black brows reared back from one another like caterpillars about to fight. “Unless I miss my guess, anthrax,” he said, sliding his prize into a large plastic bag and sealing the ziplock top. At his feet lay a Styrofoam picnic hamper filled with frozen packs, the kind used to transport organs.
An icy pressure squeezed her chest. “You're taking the lungs?” she said, horrified.
He gently placed the packet in the container and attached the lid. “Don’t worry. It’s all arranged. I made a bunch of calls--”
“Yuri, don’t! This will get us shot.”
He glanced back up at her with those dark brown eyes that never lost their seductive sparkle. “No, Anna. This will get us to America.”
2009
You have been much by the dark river--so near to us all--and have seen so many embark, that dread of the old boatman has almost disappeared.
--Sir William Osler, Aequanimitas
The best sentinels to discover a new disease are doctors who have a beer together after work and talk shop.
--Source Unknown
Chapter 1
Wednesday, January 21, 2009, 6:05 P.M. IPT
USS Ronald Reagan, Nimitz Class Carrier CVN 76
Ten corpses lay in the meat locker below deck.
Two men behind him carried an eleventh.
Unlocking the makeshift morgue, he walked in on what looked like an orgy, the dead who were already there having slid into each other’s embrace from the roll of the giant vessel. No one had thought to tie them down. Their poses were all the more suggestive under the partial cover of disheveled shrouds.
“Back-to-back, belly-to-belly, it’s the zombie jamboree,” an ensign who lugged the head end muttered.
“Shut up,” his partner whispered, and they deposited the newest resident on the floor. “Y
ou want us to straighten this tangle up, Sir?”
What Dr. Paul Wilson wanted was to get out of there. He shook his head, and waved the two men back into the corridor.
Seconds later he was rushing to where he could find fresh air.
On-board gamblers had given three-to-one odds that the body count would reach twelve before dawn. No takers bet against them, and everyone watched each other while going about their duties, probably wondering who would kill who this time. Some grim-faced wags joked that the next murderer might even turn out to be themselves. Nobody laughed.
He stumbled up the last stairwell and stepped outside. Ninety thousand tons of hull shuddered, then rose beneath his feet, forcing him to grip the rail of the smoker’s promenade, a long balcony tucked under the port side of the flight deck. The lurch itself couldn’t throw him overboard. He’d have to help it along with a jump to achieve that. What nearly toppled him had been the nauseating swirl in his head, not suicidal intent. At least not yet.
A shadow scurried deeper into the darkness behind him, one of the phantoms that had recently taken up residence along the edges of his vision. A vanishing leg, the flash of an arm, a darting rat--they skirted his days only to become bolder at night.
Lack of sleep, he told himself. To be expected at the end of a six-month stretch in the world’s last remaining but most enduring war zone. Nothing that wouldn’t clear up once he got off this floating nuthouse.
He focused on the gray walls of water three stories high that surged out from the fog. They split themselves in two at the bow, then sizzled along the hull, their briny spittle licking at the steel in long curling tongues. He understood how primitive mariners on ancient vessels could peer over the side, down into the twisting, hissing foam, and create phantoms of their own, usually in the form of sea serpents.
A wind squall plucked at his uniform, and he shivered, finding the early evening gloom unusually chilly for the tropics. Beyond the colorless sphere where visibility ended, sea bled into murky dusk, and the rest of the ship loomed into shadow. The emptiness out there sucked at him, as if threatening to pull him into its void, portending obliteration. He tightened his hold on the rail, and, for the first time in his life understood the terrors of those who suffered from agoraphobia, the fear of open spaces. Yet he stayed put. Better the bracing wetness of spray, rain, and mist in his face than to go inside. There the walls of this steel warren would close in and squeeze him until he couldn’t breathe. But why? Navy veteran, ship’s surgeon, chief medical officer to five thousand crew since the vessel’s maiden shakedown cruise in 2003--he’d never been bothered by open sea or cramped quarters before.
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