by Bobby Akart
After eleven weeks, the human race had dwindled to a fraction of itself, awaiting its release in the form of death. Day after day, mankind lurched toward the end—the quietus, seeking a final, merciful blow.
PART ONE
WEEK TWELVE
Chapter 1
Day Seventy-Eight
The Quarantine House
Quandary Peak
Overnight, Tommy’s condition had worsened. Barb remained by his side throughout the night, taking catnaps in the chair when Tommy passed out from fatigue. Mac stopped in during the evening to sit with them while Janie and Hunter purposefully allowed the family as much time alone together as possible. It was agreed that the danger of contracting the disease was too great for constantly suiting-up in the protective equipment and then becoming exposed to the plague that was attacking Tommy’s body.
He was in his second full day of being symptomatic. The plague bacteria had invaded Tommy’s body like a thief in the night, wearing dark clothing and camouflaging itself to hide from the body’s immune system.
The disease quickly adapted to its surroundings and began to seek nourishment. Y. pestis required iron, and Tommy’s body had plenty of it within its hemoglobin and other proteins, including transferrin. The pneumonic plague, the thief in the night, committed a burglary. Y. pestis released a molecule that loves iron, so much so that it was able to physically rip it away from the transferrin protein and bring it back to the mother ship—Y. pestis.
With this nourishment, while Tommy was still attending to Marcus and feeling no pain, Y. pestis took up residency inside Tommy’s lymph nodes. With each passing day, the lymph nodes began to scream to the body’s sensory receptors—Houston, we’ve got a problem. The lymph nodes became swollen and the body began to react. For Tommy, the chest pains, fever, headache, and swelling were the first telltale signs.
His body was fighting the good fight. In this ninth day of the war, the plague bacteria were preparing to migrate through his bloodstream to the lungs. This was step one in a three-stage process, indicating the onset of sepsis and ultimately progressing to septic shock.
When Tommy awoke that morning, he complained that his heart was racing. Had he not been exposed to pneumonic plague, a physician might diagnose anxiety associated with an unknown malaise. However, the early signs of sepsis included a body temperature above one hundred one degrees, a heart rate greater than ninety beats per minute, and rapid, shallow breathing of more than twenty breaths per minute.
Tommy exhibited all of these symptoms and Barb determined he was in the first stages of sepsis. At Doc Cooley’s instruction, Barb switched Tommy’s IV fluids from normal saline to a thicker colloid mixture, which included albumin and dextran.
Barbara would now monitor for several signs of severe sepsis, which indicated Tommy’s organs might be failing. As the Y. pestis bacteria began to increase in Tommy’s bloodstream, the immune system would overreact, causing his blood vessels to begin leaking. Abnormal clotting would naturally result and the decreased volume then led to organ failure.
“Hey there, Tommy-gun,” whispered Barb as her husband opened his eyes. She’d been giving him a cold-water sponge bath to help relieve the fever. “How’re you feelin’?”
“Like a million bucks, baby,” said Tommy with a chuckle followed by a gravelly cough. “You wanna get lucky with the gun?”
Tommy was licking his lips, attempting to produce saliva. When a person is in the final stages of dying, they are rarely conscious and usually breathe through their mouth. Tommy’s mouth had dried out quickly, which made it uncomfortable to speak.
Barb kept a cold wet washcloth to wipe out his mouth, providing instant relief, which then allowed him to sip water through a straw. She also kept a tube of Blistex nearby to apply a couple of times an hour to prevent his lips from chapping.
She touched two fingers to her mask and then planted them on her husband’s lips to pass along the kiss. He grinned and then closed his eyes again.
“Thank you for being with me,” he whispered as he tried to open his eyes again. His body was weaker than the day before and he was no longer able to lift his arms. He was also physically unable to urinate into the bedpan provided by Doc, not that it mattered. His urine output had decreased to nothing, a sign that severe sepsis was imminent.
“Hey, are you up for some fresh air and a little sunshine?” she asked, trying to maintain an upbeat tone of voice. The temperatures had dropped into the upper thirties the night before, and Tommy’s fever combined with the cold air to produce uncontrollable chills.
“Yeah,” he strained to respond.
Barb limited the number of visitors to maintain a quiet, peaceful environment. The ever-present Flatus was fighting his own battles with the disease and lay on a bed Barb had created next to Tommy. She’d pulled a small loveseat out of a guest bedroom and scooted it next to Tommy’s bed. Then she’d stacked sofa cushions to create a long series of platform steps to make it easier for Flatus to find a spot near his best friend.
It broke Barb’s heart to see her men staring at each other, seeming to communicate, yet not speaking a word. Are they encouraging each other to continue the fight? Or is it their way of comforting one another in preparation for the end?
“Here we go,” said Barb as she pushed open the windows in the room. A burst of cool, crisp air entered the enclosed space, unexpectedly invigorating both Tommy and Flatus. Flatus lifted his head and panted with a smile. Tommy reopened his eyes and took in his surroundings.
Some cultures call for a window to be open by the deathbed of a loved one to allow the souls of family members who have already died to come retrieve the person who is dying. It is their belief that closed windows trap the soul inside the room, preventing it from moving on.
“Very nice,” said a reinvigorated Tommy. He turned his attention to Flatus. “Whadya think, buddy?”
Flatus winked at his bestie.
“Dear, do you wanna try something to eat? I can whip up some Cream of Wheat with sugar. Maybe some oatmeal?”
“No, thanks. Why don’t you take a break? I know Mac and the others will be coming around soon.”
Barb was puzzled by the request. She didn’t understand why he would dismiss her. Did I coddle or hover over him too much?
“Tommy, I don’t mind. I wanna be with you.”
“I know. We’ve got a long day ahead of us. Take a walk, have breakfast, change clothes. Flatus and I’ll be okay, right, buddy?” He reached his hand toward Flatus, who managed to wag his tail a few times. “See? Now scoot.”
Barb studied her husband for a second. He wanted some alone time, but she didn’t understand his reasoning. It was hard to grant his request, but she decided Tommy might need some time alone to prepare himself mentally. The process of dying required some preparation on his part as well. She decided to grant his wish.
“Okay,” she acquiesced. “I’ll go freshen up and come back in a new yellow suit I bought. You’ll love it.”
Tommy smiled and wiggled his fingers. “I love you, Barb.”
“I love you more,” she replied.
Chapter 2
Day Seventy-Eight
Quandary Peak
“What can I do to help?” Hunter asked Mac, a common question people ask when someone they care about is going through a traumatic, emotional time. Mac, on the surface, appeared to be holding it together. She recognized it was difficult for Hunter or Janie to know what to say to provide her strength and comfort. Mac had a plan to make it through the next few days. Immerse herself in the lab and continue to look for solutions.
“Knowing that you love me is all I need,” she replied. “Try to stay with Mom. See if you can anticipate her needs without asking. Mom’s tough exterior hides her true grief.”
Hunter touched her face before she pulled on her protective headgear. He looked into her eyes. “Am I looking at the Hagan tough exterior?”
“Maybe.” Mac blushed as she responded. She fought back the
tears that had flowed when she woke up that morning. “I’ve got to put myself in another person’s body for this, Hunter. Janie can’t do it, nor can Mom. When I walk into that laboratory, such that it is, I’m Dr. Mackenzie Hagan, not Mac, the daughter of a wonderful father who is depending on me to save his life.”
Hunter kissed her and touched her cheeks. “You’re incredible. I promise to watch over both your parents today. Your work in that room is everyone’s top priority.”
“Thank you. I have to separate my emotions from the task at hand. Hand-wringing won’t help my daddy. There are no arrangements to be made. And I can’t just sit by his bedside, watching the clock, waiting for symptoms of pneumonia and septic shock to reveal themselves.”
Hunter smiled and offered a fist to bump. “That’s my girl, um, Dr. Mackenzie Hagan. Wow, you know something?”
“What?”
“I never call you Mackenzie. You’ve always been Mac to me.”
“And I will be forever. Now listen, Nate, go take care of my mother. That’s no easy task, soldier. Generals have a way about them.”
“Okay. Okay. Nate, jeez. I get it,” said Hunter as he gave her a final peck on the cheek. “Go find a miracle drug. I love you.”
“I’ll come down this afternoon when I’m finished,” said Mac. “I love you back.”
Hunter took the stairs two at a time in search of Barb. Mac rolled her neck to relieve the tension she held inside her and affixed her earbuds, which she attached to her iPod. Today, it would be her grand masters classical mix, starting with Mozart, followed by Bach, Beethoven and Tchaikovsky, who would be sure to keep her eyes open if she was exhausted after a long day.
Her mother assured her that Tommy’s spirits were high when he was awake. His continued playful banter and interaction with Flatus was an encouraging sign. As part of his job, Hunter might have instigated the most deaths of anyone she’d ever met, but Mac had been around dying people more than the others.
It was common for depression and doubt to set in when someone was facing the end of life, particularly if they’d been the leader of the household. Her mother’s military career might have taken priority over Tommy’s teaching jobs, but within the Hagan family, it was understood he carried the weight of raising Mac and keeping their household running on all cylinders.
Although her father hadn’t expressed any guilt for leaving the family under these circumstances, Mac and Barb agreed he was probably holding his feelings in. Barb promised to express her love and admiration for his accomplishments in raising their daughter. She would also remind Tommy that his dedication to their marriage enabled Barb to pursue her career to achieve the highest levels attainable.
All of this was important to maintain a cool head and clear heart as Mac studied her laboratory test subjects. She never assigned each mouse a name, as it was considered bad form to personalize a creature that would be dying soon. They were labeled by the date of the month and their numeric order by which they were infected. She then compartmentalized them accordingly.
Mac recreated the vancomycin d-ala d-lac formula that she had begun injecting into her father the day before. In the chaos of Tommy showing symptoms prematurely, Mac had failed to inject any of the mice who were symptomatic yesterday. They were now in the middle of a two-day freight train ride to their death.
It was her intention to spend the entire day in the lab, trying several variables to see what transpired. Mac had no illusions. Her father would likely be dead within forty-eight hours.
She carefully reached in and retrieved a weak, breathy subject. “Come on down, 09-03-01, you’re the first contestant on the Drug Is Right.”
She injected 09-03-01 and moved on to the next two lab mice from that day. All displayed the telltale signs of sepsis and pneumonia. She checked on her other mice who’d been injected with this same formula from the day before. They exhibited shallow breathing and their body temperatures were the same as the last check.
Last night, before they fell asleep, she and Hunter discussed life after her father passed away. It was a frank, emotion-filled conversation at first, but then Mac considered her future in the makeshift lab.
She promised to continue her work, hoping the drug could be useful someday on some level. Like the stock market crash of 1929, nobody could predict for certain when the precipitous drop in the world’s population would bottom out.
Mac said it was likely this strain of the pneumonic plague would live on through a variety of hosts for eternity, or at least as long as she and Hunter lived. For that reason, she vowed to soldier on in her quest to find a cure, even if it was only for the benefit of their group.
So Mac made copious notes. She undertook a routine that was no different than the one she’d followed in college and continued during her career at the CDC. Somebody would find a way to use them.
Chapter 3
Day Seventy-Nine
The Quarantine House
Quandary Peak
Barb awoke to Tommy coughing violently in the early morning hours before dawn. He was complaining of chest pain and she checked his vitals. His blood pressure had dropped overnight. However, Tommy’s heart rate was elevated. He felt clammy and his brow remained covered with droplets of sweat.
She was concerned Tommy was going into shock. Barb quickly elevated his feet about twelve inches above his head, using the seat cushion from her chair. She retrieved extra blankets and comforters from the closet and made sure he was warm and comfortable.
“I’m so thirsty, Barb. I need water,” Tommy groaned.
“Honey, I’ll get your mouth moist, but I have to be careful.” Barb knew water might enter his lungs and hasten pneumonia.
She wet a washcloth and placed it around his mouth. “Can you bite down on it and allow the water to trickle down your throat?”
Tommy nodded and winced as he soaked his mouth with the fluid. He gave her a slight smile, indicating he had enough.
“Barb, this sucks.”
He said it so matter-of-factly that she burst out laughing and added a few tears as her emotions slipped through the façade.
“Yes, sir, it sure does.”
He tried to lift his arms to point, but the heavy blankets weighed him down. “Flatus. Thirsty, too.”
Barb soaked the rag for him as well and wiped the drool off his mush. She allowed him to take in some water. Unlike Tommy, Flatus was able to lift his head and reposition in the chair. This encouraged Barb to provide him a small bowl to drink from.
“How’s that, big boy?” asked Barb, showing genuine affection for the playful pup who was giving his life to be by Tommy’s side.
His tired brown eyes blinked at her. She gently rubbed his head and down his back. Barb’s gentle touch caused Flatus to relax and curl up nose to tail.
“Thank you, dear. Sit close to me, okay?”
Barb grabbed a chair from the dining room and carried it to his bedside. She sat and held his hand as Tommy continued.
“I’m leaving you in a mess. I’m sorry.”
“Don’t you apologize or feel bad for anything. You and I have shared a wonderful life together. Thank you for puttin’ up with me all of these years.”
He tried to laugh and then winced. Barb tried to get him to relax.
“Let’s treat every last hour like it’s a whole year. Whadya think?”
Tommy struggled to find the words, not because he was weak, but out of love for his family.
“I need to go, Barb. It’s gonna get worse. So painful for you to watch.”
Barb wiped his forehead again. She was concerned the fever and the pain he was suffering might be causing him to become delirious.
“I’m a big girl, Tommy. Don’t worry about me. You make yourself comfortable.”
Tommy closed his eyes and was noticeably trying to control his breathing. Barb continued to watch him as his breathing became shallower, like he was on the verge of falling asleep.
His eyes suddenly opened wide, startling her.
His body jolted, making her think that he was having a seizure.
“Tommy, honey? Are you all right?” Barb was frantic. “Oh, God. Not now. It’s too early. Not now.”
Then Tommy asked something odd and out of context. “Hamlet. Do you remember Hamlet?”
Barb began to shed a few tears. Tommy was slipping away. She had discussed the loss of mental acuity with Janie and Mac.
“Honey, I don’t understand. Hamlet? Of course I know Hamlet.”
Tommy nodded and forced out the word, “Hamlet.”
“Tommy, please rest. We don’t need to waste your strength on Shakespeare, dear. That’s way too heavy of a topic.”
Barb doted over him by wiping his face and arms with a wet rag. She then grabbed another clean washcloth and doused it with cool water to provide him some hydration. He bit down and soaked in the moisture.
“Do you remember the story?” he asked.
Barb shook her head and grimaced. She wasn’t sure if she should continue to insist upon his resting or humor him in his final hours. Studies had shown that talking to a person who is dying, even if they’re in a coma, allows them to feel comfort while hearing your voice. She decided to recount the Hamlet soliloquy the best she could, if that was what her dying husband wanted. It was a play they’d enjoyed several times in their life together. She hoped her voice would calm him down and provide her some inner peace as well.
She began by saying the most famous line first, to be, or not to be, which opened the third act spoken by Prince Hamlet. Barb continued the story and Tommy was apparently drifting off to sleep when he interrupted her.
Like before, his eyes opened wide and his body shook slightly. It was as if Tommy’s brain was overcompensating for his body’s weakened state. He licked his lips and spoke.