by Angela Hunt
Shaking her head, Alex went to look for a coffee mug. She found a row of them at a varnished bar against the wall, and a moment later she was joined by Deborah Simons and Lauren Hayworth. Kenneth Carlton stood behind Lauren, his cell phone pressed to his ear.
“Hello?” he shouted, as if screaming would somehow boost his reception. “Can you hear me?”
Lowering the phone, he punched in a series of numbers with his thumb, cursed softly, then knocked the phone against the counter.
“He’s been doing that for the last half-hour,” Lauren whispered, resting one elbow on the bar as she reached for a mug. “He’s convinced he can call out of this place.”
“Trouble at the office?” Alex asked.
Lauren shook her head. “Trouble at home, I think. His wife sent a radio message yesterday, but the help didn’t deliver the note until last night when it was too dark to find the phone in our—in his— room.”
Alex met Deborah Simons’s knowing glance, then looked down to smother a smile. She followed Deborah to an empty table and took a seat, then summoned a smile as Milos Olsson dropped into the empty chair next to her.
“Good morning, all.” The Swede flashed them an energetic grin that practically jumped through his wiry beard. “I’ve news from our dirigible pilot—he launched with the platform at sunrise and will drop it atop a lovely mahogany about three kilometers from here. Unfortunately, he and Lazaro couldn’t agree on the shortest foot route to the tree, so we may have to do a bit of hiking before we find it.” He slapped his thigh and grinned at the challenge. “So—eat a hearty breakfast and be sure to pack enough water. We’ll be heading out at eight o’clock, more or less.”
Deborah dropped her head onto her folded arms and grimaced at Alex. “How are your muscles? I’m aching all over.”
“I’m not too bad.” Alex tested her arms just to be certain. “My shoulders are a bit sore, though—all that resisting, I think, on the way down.”
“It’s going to be hot up in the canopy.”
“It’s always hot up in the canopy.”
The women fell silent as one of the serving boys set a heaping plate in the center of the table.
Alex’s jaw dropped. “Do those look like—?”
“Yep,” Deborah answered. “Good old American Aunt Jemima pancakes. And surely they have syrup—with all the insect life around here, they should have honey by the bucketful.”
Alex reached for the platter. “I’m hungry enough to eat them dry.”
She had just taken a heaping bite of buttered pancake when Lazaro entered, his hands in his pockets and a wide grin on his face.
“Whassa matter, Lazaro?” Deborah called. “You never had pancakes before?”
The guide’s smile deepened. “I have them every morning.” He patted the soft paunch beneath his T-shirt. “I like them very much.”
Alarmed by the mischievous glint in the guide’s eye, Alex stopped chewing. “Um, Lazaro—these are made of flour, right?”
“Si.” He nodded. “Manioc flour.”
Alex hesitated, then swallowed. “I don’t care what it is,” she said, cutting off another bite. “It’s good, and I’m hungry.”
2 APRIL 2003
7:14 A.M.
El doctor?”
Michael swam up from the place between sleeping and waking, then opened his eyes into bright fluorescent light. One of the day nurses stood next to him with a clipboard in her hand.
“El doctor, el paciente es muerto.”
For a moment her words didn’t register, then the creak of vinyl reminded him where he was. He had gone to check on his peritonitis patient and fallen asleep in this uncomfortable visitor’s chair.
Blushing, he brushed his hand across his jaw and felt the rasp of his morning stubble. The native had not moved since Michael checked him at three, but the nurse was correct: The patient had expired.
Michael stood and unwrapped his stethoscope from his neck, then did a perfunctory check for vital signs. There were none.
He lifted the sheet from the man’s thin chest, then pulled it over his tattooed face.
“Um—” His Spanish had never been strong, and his tongue always seemed uncooperative upon waking—“este paciente needs, um, requerir una autopsia.”
The nurse lowered her clipboard. “Autopsia?”
“Si.” He gestured toward the hall. “The morgue—el depósito de cadáveres. Entiende?”
She nodded.
“Thank goodness.”
Blowing out his cheeks, he moved past her and lumbered stiffly down the hall. He needed a shower, a cup of coffee, and about five more hours of sleep, but he couldn’t afford those luxuries if he wanted to serve his patients. They would begin to fill his office by nine o’clock; they would test the capacity of his exam room and his nurse’s patience by ten.
Furthermore, the hospital suffered from intermittent electrical as well as water outages, and the backup generators had been designated for life support, not refrigeration. So if this patient’s autopsy were to count for anything, it had best be done quickly.
Bracing himself for another long day, Michael turned into a secluded hallway and went in search of a splash of cold water.
Fortuna was not happy to hear about the autopsy. “You will have many patients today,” she said, her tone sharpening to cut through the wail of a baby outside his locked office door. “The man is dead. Do you not know what killed him?”
“I know what killed him. If his story is true, I want to find out what kept him alive.”
She dropped her purse into a desk drawer, then crossed her arms. “He was a crazy man, loco. You are wasting your time.”
“I will never know, Fortuna, unless I do this. So keep the doors closed and see if that mother has milk for her baby. I’ll do this as quickly as I can.”
While Fortuna reluctantly held the early arrivals at bay, Michael found his deceased patient in the hallway outside the morgue. He checked the chart sitting atop the body, then wheeled the gurney through the double doors. “You’re lucky you made it this far without mishap,” he told the corpse. “I was half afraid I wouldn’t find you within a reasonable length of time.”
By eight o’clock he had transferred the deceased patient to the autopsy table, a waist-high aluminum fixture plumbed for running water (though there wouldn’t be any at that hour). After positioning the thin corpse on the block, Michael telephoned a second time for assistance and learned there was no one available to help him . . . and he had four patients waiting.
“I’ll be up soon,” he promised Fortuna.
He went to work. After making a Y incision from the shoulders to the pubic bone, Michael lifted the flaps of skin and let them fall to the left and right. He then cut and removed the pericardial sac and the sheath of abdominal muscle in the chest, exposing the internal organs.
Breathing heavily through his mask, he studied the arrangements of heart and lungs, spleen, liver, and intestines. He saw nothing unusual for a man who had died of multisystem organ failure resulting from acute peritonitis. The body had tried to wall off the infection in the colon by sealing it with omentum, part of a fatty apron that hung from the transverse colon, but fluid had oozed throughout the abdomen, sending bacteria into the bloodstream and eventually throughout the body.
Michael exhaled slowly. The examination revealed no surprises. The autopsy and the medical records would validate the cause of death.
The man’s brain should not hold any surprises, either.
He moved quickly through standard autopsy procedures, lifting out the organs, weighing them, recording their weight and his observations. Curiously, the stomach was empty, so Ya-ree must not have eaten during his alleged flight through the jungle.
When he had finished with the organs, Michael turned to the head. He probed the eyes for hemorrhages, found none, then made an incision that would allow him to peel away the scalp. Using a high-speed oscillating power saw, he opened the skull, pried off the skullcap, then severed the connection tha
t joined the base of the stem to the spinal cord. After lifting out the gray brain, he placed it in a glass jar filled with a 10 percent solution of formaldehyde.
Sinking onto a stool, he stared at the organ and wondered how— and if—he ought to proceed.
He had patients waiting—living people with pressing problems. He could do nothing more for the jungle man, and no relatives would appear to mourn him or question Michael’s judgment. The hospital, desperate for doctors, would not care if the autopsy proceeded, and the government would cremate the remains with no questions asked.
He could easily walk away and never think about this fellow again. But the unanswered questions would linger, shimmering like reflections from the river every time Michael looked toward the surrounding jungle.
Despite his rational demeanor, Ya-ree had probably been in the stages of a mild dementia when he related his story to Esma . . . or living alone in the jungle might have snapped his grip on reality. Esma’s translation skills might not have been what they once were; she might have misunderstood several key phrases and twisted a logical story into an incredible one.
The man’s story might have been true . . . and merely a reference to dengue fever or some other common jungle disease in his past. Depending upon the ailment, his body might or might not contain evidence of the previous disease, but only a fool would waste time looking for something that didn’t matter to anyone. This man had died from complications stemming from a nasty wound, period.
The rational part of Michael’s brain told him to sew up the body and set the brain on a shelf. If abnormalities existed within its folds, some medical student in Lima could have the honor of discovery and conjecture. He and his classmates could play “name that disease,” but unless an extremely astute medical professor guided them, no one would guess that holes in the brain, if they existed, had been caused by prions.
Michael exhaled slowly. He ought to close the book on this case and move on. Still . . . if Ya-ree had spoken the truth, his body might have been invaded by a silent killer for which modern medicine had no cure. Brain encephalopathies like kuru and Creutzfeldt-Jakob had been claiming victims for years . . .
And Michael had watched many of them die.
Encephalopathy did not result in an easy death. Depending on the strain of disease, victims experienced trouble walking, eating, and swallowing. Some patients experienced the mercy of dementia while others remained bitterly aware of their physical and mental decline. And though Michael had never witnessed a case of fatal familial insomnia, he had read that those patients, for whom sleep became an impossibility, kept their wits about them until they finally lapsed into a coma that offered no rest until, like a raging oil fire, the brain finally consumed all its resources and died.
Lowering his head into his hand, Michael massaged his temple with his thumb and index finger, willing his tension away. Ashley would have laughed, seeing him like this. She always said he saw himself as a crusader out to save the world, but he’d never minded her teasing because it simply wasn’t true.
And as for saving the world . . . he hadn’t even been able to save his own wife. One day Ashley had stumbled into the room and joked about being drunk on Earl Gray, but he’d seen the fear in her eyes. Fearing a stroke, he had rushed her to the casualty at St. George’s. When the diagnosis arrived weeks later, the neurologist said she was suffering from a variant of Creutzfeldt-Jakob disease . . . as were seven other British young people under the age of thirty.
The mad cow scare had begun . . . and Michael, who had specialized in pediatrics, found himself reading everything he could find on brain diseases. All the materials he read reinforced what the doctors told him—no cures for encephalopathy existed.
He had steeled himself to the reality of Ashley’s illness, tried to comfort his wife in her final weeks, and kept their routine as normal as possible. While she lost her sight, her ability to speak, and even her ability to write, he begged heaven for healing. But like so many of the parents of his terminal patients, Michael discovered that while God granted strength and comfort and understanding, he gently insisted upon his will.
After Ashley’s death in ’96, Michael had tried to focus on his pediatric practice, but he couldn’t enter the office without imagining his wife’s presence at the desk in the reception room. After three years of struggling to function without her, he had taken a vacation in the heart of Amazonia . . . and found a second place to call home.
The simplicity of Peruvian life appealed to him. The average fellow got up every morning and spent the day providing food and shelter for his family. People set different priorities here, and they were not so quick to destroy values of the spirit when they had time for idle imaginings. In Iquitos there were no TV producers designing programs to mock religion, no screenwriters creating scripts intended to rob children of their innocence. Piety was expected, not ridiculed, and no one at the Regional Hospital laughed when he told them he’d come because God wanted him to help the people of the Amazon.
The Peruvian government had hoops to jump through, to be sure, but no one seemed to care if he jumped through them tomorrow or next year, so long as he worked at being part of the solution to their problems. So in the summer of the year 2000, Michael joined the hospital staff, became accredited by the Peruvian government, and established an open-door practice for anyone who came to the hospital seeking help. He still saw children, scores of them, but he also treated women who had never seen an automobile, wizened men with piranhascarred calves, and the occasional shaman who wanted to see what sort of medicine the white doctor had to offer.
Days melted into weeks and weeks into months as the changeless seasons slid by. He had come to help, not to stay, but he had not yet found the time to consider leaving.
He had established a good and fulfilling life in Peru. Until today he thought he had left London and its memories behind, but Ya-ree had proved otherwise. The biological agent that had infected and killed his wife might lie in Ya-ree’s brain—or it might not.
He would never know the truth unless he proceeded.
He pressed his hand to the back of his neck and massaged the knotted muscles that had tensed his shoulders. This hospital did not have an electron microscope, but he wasn’t certain he’d need one. If the patient’s brain appeared normal, Ya-ree’s penchant for inventing wild tales probably sprang from psychological causes. If, however, he was suffering from a prion-based disease, amyloid plaques would almost certainly show up in a microscopic examination.
Michael tugged a fresh pair of latex gloves from his pocket. If this were a hospital in the civilized world, he would send the brain off to a lab for analysis and simply wait for the result. But in Peru, one learned to do for oneself.
Sighing heavily, he pulled on his gloves, then thrust his hands into the specimen jar and removed the brain for dissection.
By midmorning a deep silence lay over the pathology lab, broken only by the squeak of the rusty ceiling fan overhead. Michael rubbed his nose—the smell of formaldehyde had always bothered him—then again lowered his eyes to the lens of the microscope. Since the autopsy he had created more than a dozen slides from each major area of his patient’s brain—cerebrum, cerebellum, thalamus, and brain stem. The same strange images appeared in each slide.
He had immediately noticed that the brain tissue was not inflamed, nor did he see any signs of lesions within the brain itself, ruling out an amebic brain abscess. Under the microscope, however, certain sections definitely appeared spongiform, which supported his suspicion that the “shuddering disease” Ya-ree had mentioned might be neurological in origin.
Now, as he amplified the magnification on the microscope, he saw what looked like black, hairy disks floating among the smaller brain cells. The view pebbled the skin on his arms—he had seen these same shapes in London, in tissue samples from a teenage patient who had succumbed to a variant of Creutzfeldt-Jakob disease. VCJD, as it was commonly known, was a transmissible spongiform encephalopathy, or
TSE.
Like fatal familial insomnia.
And kuru.
And mad cow disease.
In each of those diseases, prions killed millions of brain cells. When the cells died, the brain attempted to replace them with glial cells—the glue that literally bound neurons together—but the damage was irreparable.
Michael pulled a handkerchief from his pocket to swipe at his damp forehead. Hot as it was in the lab, he felt as though a sliver of ice had slid down his spine.
He had to be imagining things. He was tired, overheated, and haunted by the past. No TSE had been reported among the indigenous peoples of Peru or among their livestock, so this had to be something else.
This might not be the result of contamination at all. Sporadic cases of CJD had appeared in several countries around the world, and researchers had never been able to pin the cause on a single source. But it would be impossible, really, to trace every food, every product to which a patient had been exposed over a vast number of years.
Still . . . he closed his eyes as he considered another possibility. Argentina, with its profitable cattle industry, might have imported European feed laced with animal by-products. For all he knew, all of South America had been receiving contaminated products from Britain and other European countries, and it would take years for the disease to appear in the population. A pig exposed to contaminated feed would probably be butchered before it became symptomatic, and the people who ate bacon would be exposed to the infective prions without their knowledge . . .
His stomach dropped. He was certain of only one thing—Ya-ree had not been speaking of chills or palsy when he mentioned the shuddering disease, for a patient with this much spongiform tissue in so many quadrants should have been barely ambulatory.
Yet Ya-ree had allegedly walked out of the jungle. Even in great pain and suffering at the end, he had been coherent enough to relate a logical story.
Michael swiped at his forehead again, then returned his attention to the microscope. Across the decimated field of brain cells a network of swollen glia stretched like brown patches crowding an old woman’s crazy quilt.