Epiphany shrugged. ‘My grandma always used to say that thinking was invented by the Devil.’
‘Oh yes?’ said Anna. She couldn’t help smiling. ‘And why did she think that?’
‘Thinking makes you ask yourself questions about what the Good Lord has in store for you, and as soon as you start doing that, you’re halfway down the road to Hell already.’
‘Your grandmother sounds just like mine,’ said Anna. ‘Mine used to read a chapter of the Bible every single day. She could quote Revelations from beginning to end.’ She paused and lifted one hand like a preacher, trying to remember the exact words. ‘“And in those days men will seek death and will not find it. They will long to die and death flees from them.”’
‘Wow,’ said Epiphany.
‘Oh, don’t be too impressed. That’s the only bit that I can remember.’
‘All the same. Wow. I can’t even remember the Lord’s Prayer.’
They went out through the revolving door into the warm evening air and walked together toward the parking lot. As they did so, an ambulance came speeding in through the hospital entrance with its lights flashing and stopped outside the emergency room. Anna took no notice; emergency patients were being brought into the hospital twenty or thirty times a day, every day. She said goodnight to Epiphany and walked toward her car, but as she opened the door her cellphone warbled.
‘Anna? Are you still on site? It’s Henry Rutgers.’
‘I was just about to leave. What is it, Henry?’
‘They brought in another one. A female sales executive from Dayton, Ohio, thirty-four years old. She’s convulsing and bringing up blood.’
‘Oh God.’
‘There’s something else, Anna. She has two very obvious patterns of bedbug bites.’
‘You’re sure?’
‘No doubt about it, to my mind. Cimex lectularius.’
Anna slammed her car door shut and pressed the key-fob to lock it. ‘I’m coming back up. Where are you?’
Doctor Rutgers was waiting for her in the scrub room outside the emergency operating theater, his white hair leaning to the left as if he had been out in a hurricane.
‘She’s critical,’ he said. ‘Quite honestly, I don’t think she’s going to make it.’
Anna peered through the oval tinted windows in the scrub room doors. She could see two surgeons and three nurses clustered around the operating table, but all she could see of the patient was a blood-drenched sheet that was violently jolting up and down, as if two dogs were fighting underneath it.
She quickly washed her hands and took a pale-blue theater gown out of the closet and pulled it on. Doctor Rutgers tied it up for her at the back.
‘She’s bleeding even more catastrophically than your David and that other unfortunate guy – what was his name? Bridges. It’s like every gastrointestinal blood vessel has ruptured. And her convulsions are way, way more violent, too. At one point she was almost bouncing herself clear off the table.’
‘Where are the bedbug bites?’ asked Anna. She put on a flower-patterned cap and a surgical mask and tugged on a pair of latex gloves.
‘The worst ones are up here,’ said Doctor Rutgers, patting his left shoulder. ‘There are seven on her upper arm, but a further five just above the elbow. She may have more, but the way she’s jumping around I didn’t get the chance to give her a full histological. I’ll be running tests, of course, whether she survives or not, but I’m ninety-nine percent certain that’s what they are.’
‘Where was she picked up from?’
‘The Gateway Inn at Union Station. All I know about her is that she was here for a convention. A work colleague came in with her, and she’s waiting downstairs.’
‘We need to notify the city health people. This is starting to look like an outbreak.’
‘I did that already. They’re sending over Phil Magruder and some bug specialist from ESSENCE.’
ESSENCE was the city’s program of early notification of community-based epidemics. In the past two days, Anna had already had three visits from ESSENCE in relation to the Meramac Elementary School virus. It was the city’s ESSENCE team who had ordered the closure of the school until further notice and the isolation of any children with symptoms of fever.
‘God knows what’s going to happen if this is caused by bedbugs,’ she said, straightening her cap in the mirror. ‘They’ll have to shut down half of the hotels in St Louis and have them fumigated.’
‘You know something?’ said Doctor Rutgers. ‘This whole thing is beginning to make me feel incredibly itchy.’
They pushed their way through the swing doors into the operating theater. The woman on the table was smothered in blood. Her hair was stuck to her head like a glossy red bathing-cap and her face was streaked with scarlet. The nurses were trying to strap her down so that the surgeons could insert a gastroscope down her throat to see how extensively she was bleeding, but it was almost impossible. She was throwing herself wildly from side to side, her arms flailing, and at the same time she was violently arching her spine. With each convulsion a fresh torrent of blood spurted out of her mouth.
After the woman had brought up yet another gush of blood, she gasped for breath, as if she were desperately trying to say something. She gasped again, and again. Anna circled around the nurses to the side of the operating table and looked down into her war-painted face. Her eyes were wide with panic, and she kept opening and closing her mouth.
At last she managed to find breath enough to speak. ‘Inside me!’ she bubbled. ‘She’s inside me! Please, get her out of me! Oh God! Oh God! She’s inside me!’
One of the nurses managed to grip the sides of the woman’s head, holding it steady while a second nurse wedged a contoured foam cushion underneath it and then fastened a rubber fixation strap across her temples. As soon as she had tightened up the strap, though, the woman gave a single rippling shudder, from her head to her feet, as if somebody had walked over her grave, and then she stopped convulsing altogether. A high, continuous drone from the vital signs monitor indicated that her heart had stopped.
‘She’s arrested!’
A nurse hurriedly wheeled over the defibrillator cart, and one of the surgeons picked up the electrode paddles and pressed them to the woman’s chest. He shocked her again and again, calling out, ‘Clear!’ each time, but after five attempts she still showed no signs of life. One blood-streaked arm flopped down by the side of the operating table.
‘She’s lost far too much blood,’ said Doctor Rutgers, shaking his head. ‘I don’t know what more we could have done.’
‘Time of death nineteen-oh-three,’ said the surgeon, handing the paddles to the nurse standing beside him. He came across the theater, his gown spattered in blood, peeling aside his mask. Anna knew him well. Doctor Farage was Syrian. He had a little clipped moustache, and his soulful brown eyes suited tragic occasions like this.
‘I have never come across any case like this before,’ he said. ‘Never, not in twenty-seven years of emergency surgery. I’ve had bleeding from terrible internal injuries that I couldn’t stop, of course. Men impaled on scaffolding poles, women nearly torn in half in auto accidents, things like that. But nothing like this; not from a virus. Not even from the worst of hemorrhagic fevers.’
‘Did she speak to you at all, before I arrived?’ Anna asked him.
‘Two or three times, Anna, but then she started to hemorrhage so badly that she could hardly breathe, let alone speak. I asked her what she thought was wrong with her – maybe it was something she had eaten or drunk. But no, she kept on saying that another woman was trying to force her way into her body, whatever she meant by that.’
‘Both of our other patients said something similar,’ Anna told him. ‘I’m not sure what it means, either, but they kept on insisting that there was somebody else inside of them, trying to force them out of their own body. They both felt as if they were being attacked from the inside out.’ She didn’t explain that both David and John Patrick Bridges had told
her this after they were clinically dead.
Doctor Farage started to snap off his bloody latex gloves, finger by finger. ‘Of course, these are just delusions. But with this woman – she was bleeding so profusely, I could almost have believed her.’
‘Maybe it’s some mutation of Lassa fever, or Marburg virus,’ said Doctor Rutgers. ‘We know that bedbugs don’t normally transmit these viruses to humans. But maybe they’re carrying a new variation which can infect us.’
Anna said, ‘Henry – we still can’t say for sure if this sickness was passed on by bedbugs. It may be a coincidence that all three of the deceased were bitten. After all, there can’t be many hotels or motels across America that don’t have some degree of infestation.’
‘Now I really do feel itchy,’ said Doctor Rutgers. ‘I stayed at the Templeton Inn last night, because I finished up too late to go home.’
Anna said, ‘As soon as you can provide me with a range of samples, Henry, I’ll get to work on it. Meantime, I’d better go talk to this poor woman’s friend and give her the sad news. Where did you say she was?’
‘I didn’t, but she was in the family waiting room the last time I saw her.’
Anna went over and took another long look at the dead woman lying on the operating table. She didn’t have the terrified expression that she had seen on David or John Patrick Bridges, but under the smears of blood on her forehead and her cheeks she appeared to be frowning, as if she was still being troubled by something, in spite of being dead.
Doctor Rutgers came over with her notes on a clipboard. ‘Mary Belling Stephens,’ he told her. ‘Thirty-four years old, a sales exec for Infinity Software Systems, of Dayton, Ohio.’
Anna noticed the gold wedding-band on the woman’s left hand and felt a pang of sadness. Mary Belling Stephens’s side of the bed would be empty tonight, and she would never again wear the clothes hanging in her closet.
She took off her theater gown and went down in the elevator to the first floor. Seeing her reflection in the mirror at the back of the elevator car, she thought she looked pale and tired. She had always felt that when patients died, they drained something out of the soul of the doctors and nurses who had been trying so hard to save them. It wasn’t surprising that hospital staff always told such cynical jokes: it was one way of protecting themselves from spiritual anemia.
The family waiting room was silent except for the soft bubbling of a tropical fish tank. Its only occupants were an anxious-looking African-American man in a blue Autotire T-shirt and a young woman with curly red hair. The young woman was wearing a pale-green business suit, but the front of her skirt was patterned like an atlas with rusty-colored bloodstains.
‘You must be Mary Stephens’s friend,’ said Anna. ‘Hi. I’m Professor Grey.’
The young woman immediately stood up. ‘How is she? She’s going to be all right, isn’t she?’
‘I think you’d better sit down,’ Anna told her.
‘What?’ said the young woman. She remained standing and slowly lifted her hand to cover her mouth.
‘I can’t tell you how sorry I am,’ said Anna. ‘The doctors did everything they possibly could to save her.’
The young woman’s eyes brimmed with tears. ‘Oh, no,’ she wailed. ‘Oh, no. I can’t believe it. Not Mary! She’s always so lively! She’s always laughing! Everybody loves her! Oh, what’s Alex going to do? Oh God, and her children, too!’
Now she sat down, and Anna sat beside her and held her hand. ‘We’re not sure yet what she was suffering from. She had some kind of convulsive fever that made her hemorrhage. She passed away from heart failure and loss of blood.’
‘But it happened so suddenly!’ the young woman sobbed. ‘One minute she was fine, and she was holding a seminar. She was talking about gate-keeping when she stopped and coughed up blood, all down the front of her blouse. The next thing we knew she was lying on the floor kicking and shaking and bringing up even more blood.’
‘We’ll be running tests to find out what affected her,’ said Anna. ‘Meanwhile, can you please tell your colleagues that if any of them feel even slightly unwell, they should come to the ER without any delay. The city health services will be in touch with you all and tell you what to do now and what precautions you need to take. It’s possible that some of you may have to go into quarantine. Can I ask you one thing? Have you been bitten at all?’
The young woman frowned at her. ‘Bitten? I don’t understand.’
‘Do you have any insect bites anywhere on your body? Pink, inflamed and really irritating? The kind that you can’t stop yourself from scratching.’
The young woman shook her head. ‘No. Nothing like that. Why? Do you think Mary could have been bitten by a mosquito or something?’
‘It’s possible. It’s too early to say. Look – if you have Mary’s address and contact details, we can get in touch with her family and tell them what’s happened. SLU has a wonderful support team for bereaved relatives.’
The young woman nodded. She was clearly stunned. She reached into her pocket and took out her cell. ‘I have her details on here,’ she said and started to prod at it. Before she had finished, though, she looked across at Anna and said, ‘There was one thing. Before she went into the seminar, she did tell me that she was feeling strange.’
‘Strange? Did she give you any idea what she meant by that?’
‘Yes, but I couldn’t really understand her. She said she felt like praying for forgiveness. That surprised me, because she wasn’t at all religious. I asked her what she needed to be forgiven for, and she just laughed it off and said, “Being bad, I guess.”’
Anna was about to ask the young woman if Mary Stephens had done anything that could be construed as ‘bad’, such as having a clandestine affair or undermining one of her colleagues at work, but then she decided that this wasn’t the moment. Besides, even if she had done something for which she felt that she needed to pray to be forgiven, it could hardly have caused her to hemorrhage. Anna had seen patients whose guilt about some transgression had made them clinically depressed and very ill, but she had never seen it kill them.
‘I’ll have somebody from the relatives’ support team come in to talk to you,’ she said. ‘They’ll lend you some fresh clothes to change into, too. You must have had enough of blood for one day.’
ELEVEN
Anna knew she ought to go home now, take a shower and see if she could manage to eat something, and then get some sleep. But what the young woman had said about Mary Stephens had intrigued her. Why should she have felt guilty – so guilty that she needed to pray?
Anna also wanted to see for herself the bedbug lesions that Doctor Rutgers had described. Mary Stephens’ body would have been taken to the morgue now and washed, so it would be possible. She might even find that she had more lesions, someplace on her body apart from her left arm.
It had also entered her mind that maybe these convulsions hadn’t been caused by a virus at all. Bedbugs were rife throughout the United States, in private homes as well as hotels, so why hadn’t hundreds more people contracted the same symptoms – even thousands? She remembered reading a German medical report last year about murder victims being injected with pyromellitic acid dianhydride, a chemical used in making playing cards and cigarette filters. They hadn’t convulsed, but all of them had died from massive lung hemorrhage. It could be that something similar had been used on David and John Patrick Bridges and Mary Stephens. Maybe, for some reason, they had been targeted deliberately. She couldn’t imagine why, or what the three of them might have conceivably had in common, but she couldn’t rule it out.
She went along the corridor to the morgue. When she opened the doors she found that there was nobody there and the room was in darkness. She reached across and switched on the fluorescent lights, which flickered and loudly clicked before they came on full.
She crossed over to the nine-body refrigerator on the opposite side of the room. A handwritten card on the left-hand center drawer tol
d her that Mary Stephens was inside. She rolled it out as far as it would go, and then she lifted the pale-green sheet that was covering Mary Stephens’s body.
Mary Stephens was lying there with her eyes wide open, staring at nothing. She had been washed, so her face was no longer criss-crossed with bloody marks, but she was still frowning. The blood had been rinsed out of her hair, too, and it was still damp and straggly.
Anna folded down the sheet until her body was completely exposed. She was slim-waisted, with smallish breasts, although her hips were a little heavy.
Anna leaned over her, examining her inch by inch, sliding her fingertip along her soft, frigid skin. She located the seven bedbug lesions on her upper left arm, and the five on her forearm. She found three more behind her right knee and a further four at the side of her right ankle.
She carefully turned her on her side, and although there were no bedbug lesions on her back, there was a pattern of marks like a star-map and a tattoo between her shoulders of a crimson heart, with green leaves around it, and the letters M and A. Not ‘Ma’ presumably, but maybe ‘Mary’ and ‘Alex’.
Anna lowered her on to her back again. As she did so, Mary Stephens let out a long, soft exhalation of breath. She sounded as if she were sighing impatiently, but Anna knew that it was only air that had been trapped in her lungs.
She could find no sign of any other lesions – no indications that she might have been injected with a hypodermic needle, for instance – but then Doctor Rutgers would be examining her tomorrow millimeter by millimeter, under powerful lights and high magnification, and if there were any other punctate lesions, whatever had caused them, they wouldn’t escape him.
She lifted up the sheet, ready to fold it back over the body, when a voice whispered, ‘Fuck you, you sniveling bitch!’
She froze, both hands still holding up the sheet. She looked down at Mary Stephens, but Mary Stephens’s expression hadn’t changed at all. Her eyes were still open and staring fixedly at the ceiling. The fluorescent strip directly above her was reflected in her eyes, so that they looked more like a lizard’s slitted eyes than a human’s.
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