“Does she have any health problems?”
“I don’t know,” Jeff said. “I’m sorry.”
“Don’t be sorry,” he said. “Not your job to know. This is her private office, right?”
“Yes.
“Does she have any medicines she keeps here?”
“I’m not really sure. Maybe her desk.”
He pointed to a large antique-looking desk on the far side of the room. Adam hurried over to the desk and began pawing through the drawers. In the third one down on the left, he found a black pouch containing several vials of liquid glucagon. Behind that, several sealed syringes and hypodermic needles. He studied the label of the glucagon and was relieved to discover it was one of the newer formulas, the ones that didn’t require reconstitution before use. Glucagon was notoriously unstable in solution, but the drug companies had started to figure out how to stabilize it, which allowed for quicker injection.
“She’s diabetic!” he called out.
He measured out a dose quickly, tapping the syringe to clear the air bubble, and then rushed back to the mayor’s side.
“Jeff,” he said. “Help me get these blankets off her.”
Together, they unrolled the blankets and hoisted Mayor Townsend to a seated position. He jabbed her thigh with the needle and depressed the plunger.
“Will this work?”
“Assuming she hasn’t suffered any irreversible damage, it should work quickly.”
Adam held his breath as he waited for the woman’s blood glucose levels to recover.
Please, he thought. Please.
#
Patient A’s name was Kelly Stoddard. She was a thirty-year-old architect expecting her first child, a boy. She’d spent every free second reading every book and pamphlet she could about pregnancy, delivery, and motherhood. She cut out all coffee and soda, even after Adam had assured her that a little caffeine posed no risk to the baby. Hell, even a glass of wine a night probably wouldn’t harm the fetus, but Adam would never dare tell an expectant mother that.
Kelly’s pregnancy had been unremarkable in every way until her thirty-eight week checkup had revealed a slightly elevated blood pressure reading. Adam reminded Kelly to notify him at once if she noticed any unusual symptoms. The next evening, she called and reported she was feeling a bit lightheaded at dinner, and he told her he’d meet her at the hospital.
He was pretty sure he would go ahead and induce labor at that point. The baby was full-term, measuring more than eight pounds, and there was no reason to keep him in there any longer. Adam couldn’t point to any specific reason why he’d made that decision. It wasn’t the result of any quantifiable analysis he’d done. It was just a decision constructed with the raw materials of ten thousand other choices he’d made in his career as an obstetrician.
The labor and delivery ward was quiet when he’d arrived at 11:21 p.m., about five minutes before Kelly and her husband Hank. It was a slow night, devoid of even a sliver of the moon or thunderstorm or anything that might have triggered a mass wave of labor across the area, which made what happened later that night all the more maddening. There was nothing else Adam could point to, no distractions, no complicated deliveries or emergency c-sections that might have explained, if not necessarily excused, whatever had constituted the first link in the chain of events that had ended with Kelly and her baby both dead long before their time. To this day, he still didn’t know the moment that had constituted the point of no return, the subtle change in her condition that sent things over the cliff, irretrievably so.
Her blood pressure was normal, but her pulse was a bit elevated. The baby’s heartbeat was normal. Cervix was dilated to four centimeters, the contractions intermittent and irregular. Adam administered the oxytocin, the synthetic hormone designed to induce labor, at 12:34 a.m. on November 14. Another patient, at thirty-two weeks, came in at 12:57 a.m. with what turned out to be false labor, and she spent the night resting as her contractions faded. At 1:34 a.m., Kelly, who was then dilated to eight centimeters, suddenly began complaining of a severe headache. At 1:47 a.m., her blood pressure skyrocketed to 165 over 120, sending her cart alarm into conniptions.
Adam rushed her into the operating room for a C-section and made the first incision at 1:59 a.m. The surgery proceeded normally, but Kelly’s headache continued to worsen, and her blood pressure began climbing again. A neurologist scrubbed in and began monitoring Kelly’s neurological condition. Her husband, who’d been friendly and chatty through his wife’s pregnancy, grew quieter as he began to notice that something was amiss.
At 2:10 a.m., just as Adam had successfully opened the uterus, Kelly suffered a massive seizure. A nurse escorted Kelly’s husband into the cold off-white corridor outside the operating room, where he watched his own personal apocalypse unfold through the tiny window cutout in the door.
As Adam extracted the baby from the uterus, Kelly went into full cardiac arrest. Despite extensive attempts at resuscitation, Kelly was declared dead at 2:34 a.m. The baby was alive but minimally responsive; instead of pinking up, his skin remained the color of a light bruise, and instead of crying, he gasped for air like a fish out of water. His heart rate was dangerously low. The neonatal intensive care staff rushed the baby into an incubator and placed him on 100 percent oxygen, but inexplicably, the infant passed away at 2:44 a.m., exactly seventy minutes after Adam’s patient had first complained of a headache. Adam grimly carried out both pronouncements of death.
Adam could not remember specific details of the discussions with his surgical team, but when it was over, and the machines had been turned off, he remembered bellowing “WHAT THE FUCK JUST HAPPENED?”
It was a rhetorical question, and he didn’t wait for an answer. Instead, he slowly made his way to the corridor to talk to the husband, whose face had gone as pale and ashen as the cinderblock walls. Adam could barely stand to look at him, having failed him so egregiously, and so he kept his surgical mask draped across his face, hoping that it hid the shame and bewilderment he was feeling. The man crumpled to the floor, his face in his hands.
“I’m very sorry, Mr. Stoddard,” Adam said. “Your wife and baby experienced significant complications during the surgery. Despite all our efforts, they did not survive.”
He left it at that, namely because he didn’t know what else he could say. Oh, they’d experienced complications all right, on par with a perfectly maintained jetliner plummeting into a field on a clear windless day.
“Nooooooooo!” the man bawled, his sobs mixing with his howls of grief.
Adam stood there, towering over the puddle of a man like an unforgiving god whose answer to a penitent’s prayer had been not only no, but fuck no, his mind a mess of regret and shame, reminding himself not to say a word that might be construed as an admission of guilt and then hating himself for remembering to remind himself.
He waited with the husband for one of the hospital’s grief counselors, and when she arrived to counsel the bereaved, Adam slithered away, feeling very much like a cockroach exposed to bright light. In the meantime, a staffer from the morgue came to collect the bodies, where they would await autopsies.
Adam worked the rest of his shift, and when he got home, he went for a long walk, replaying the episode in his head. He’d had one patient die in childbirth before, but she had had severe underlying health conditions that had put her at extreme risk for complications. Never before had a delivery unspooled so quickly and so unexpectedly.
An autopsy classified the manner of Kelly Stoddard’s death as natural and the cause of death as sudden cardiac arrest. The baby had died of hypoxia. At the morbidity & mortality conference two months later, Adam sat ashamed while his colleagues armchaired his decision-making. It did not make him feel better that, but for a few minor details, the other physicians would have followed the same course of action that Adam had followed that fateful night.
A hospital investigation into the matter concluded that Adam had done nothing wrong, but in January, Kell
y Stoddard’s widower filed a complaint with the Virginia Board of Medicine and retained a well-known medical malpractice lawyer. The Board’s investigation and the lawsuit hummed quietly in the background of Adam’s life for the next seven months, up until the day he’d received the letter from the Board summoning him to appear before it.
The day, as it turned out, he’d first seen the Medusa virus in action.
#
Gwen Townsend’s eyelids fluttered and flew open a few minutes later.
“She’s awake!” Charlotte said, rushing in and taking the mayor’s hand in her own. Adam eased behind her, out of the way of the reunion.
Townsend turned her head slowly toward the sound, her lips curling up in a smile when she saw Charlotte at her side.
“Hiya, sweetheart,” she said.
“This doctor saved you,” Charlotte said, leaning in and kissing the mayor on the cheek.
Mayor Townsend’s eyes roamed around the room until she found the stranger’s face.
“Ms. Mayor, how are you feeling?” Adam asked.
“Better,” she said. “Please, call me Gwen.”
“My name is Adam. And you still need to rest,” he said. “And you’re going to have to carefully monitor your diet and insulin levels.”
She blew out a soft sigh.
“I know. We’ve just had a tough couple of weeks. I let it get away from me.”
“That stops now.”
“Yes, sir,” she said, winking at him.
Adam asked Charlotte to gather some diabetic-friendly foods for the mayor. The others approached one at a time and gave the mayor a warm embrace.
“Can I stand up?”
“Let’s wait on that,” he said.
“So what’s your story?” she asked after the room had emptied out and it was just him, Sarah, and Jeff.
He told her. He told her about Rachel’s six-week-old voice-mail message, about their westward trek across America, about Caroline, and about Nadia and the mysterious camp. He told her the whole story, the words rushing out of him like a swollen river after a storm.
He didn’t know why he felt the urge to unload his emotional cargo on this woman he’d never met, but he felt like he’d been carrying it for weeks, and, after all, she was a captive audience. There was no motivation to lie or shade or hold back. Out came the truth as best as he could remember it. Maybe the fact he didn’t know her made it easier to tell it like it was. Maybe it was because he’d gotten a chance to do a little doctoring here, even if it had been nothing more than administering a simple injection.
He thought about his next move and decided that bluntness would be the best approach. There could be no sugarcoating it. Winter was on its way. Rachel was out there. And he was well on his way to becoming convinced that they all faced a dangerous enemy out there in the never-ending darkness.
“Well, I guess it’s my lucky day you showed up here,” Gwen said.
“What is this place?” Adam asked.
“What do you mean?” the mayor replied.
“How is all the power still on?”
“Haven’t you ever heard of Evergreen, Oklahoma? America’s greenest city?”
He shook his head. Sarah did the same.
“The town generates its own power,” Gwen said. “Wind turbines and solar panels. It’s not on the electrical grid.”
“I didn’t think that was possible on such a big scale,” Adam said.
“The town was owned by NorthStar Corporation. Ever heard of them?”
“Sure,” Adam said. NorthStar had been one of the nation’s largest power companies, supplying electricity to much of the plains states.
“The plant is about a mile away from here. I don’t know all the science behind it, but NorthStar figured out a way to make wind and solar power work on a bigger scale.”
“And NorthStar owns the town?”
“They own every bit of the land and every building on it,” she said. “Or they used to, at least.”
“How long will the power stay on?” Sarah asked.
“They said indefinitely, as long as the plant was properly maintained,” Gwen said. “Even if the nation’s power grid went down.”
“Who lived here?”
“Only NorthStar employees and family.”
“And you all are the only ones left?”
“We think about a hundred and fifty survived the plague. About a month ago, a group of folks from down the road tried to take the town. Things got ugly. We lost another dozen or so that day. I couldn’t believe how folks just turned on each other. We fought them off.”
Adam glanced at Sarah, who nodded.
“Would you think about taking me and my friends in here?” Adam asked.
“You don’t beat around the bush, do you?” Gwen replied.
“No, I guess not.”
“You gonna be the town doc?”
“I think that would be a fair trade,” Adam said. “And we can help defend the town again if need be.”
She sighed, and her shoulders sagged. It seemed like what little fight she’d had in her just sluiced away.
“It’s been a rough couple of months,” she said. “I know it looks like we’ve got it made in the shade, but people are on edge with winter coming and no doctor. We got some disabled folks, I’m not sure what to do about them. One of them’s a sex offender. Believe that? Luckily, he’s got Alzheimer’s, so he doesn’t seem to remember he’s a goddamned pervert.”
“What’s he doing here?”
“His son Jim was a big NorthStar executive. He got kicked out of his last residential facility, so his son arranged for him to come live here about a month before the outbreaks. Jim neglected to tell the Housing Commission about Dad’s proclivities. And of course, the dirty old man survives but I watch a thousand children die in the span of a week.”
“It was an equal opportunity virus.”
“When I woke up here a few minutes ago,” she began, “I was sort of hoping I’d dreamed the whole thing and I was back in my own bed. You know that feeling when you wake up from a nightmare and it takes you a second to realize it was just a bad dream?”
He nodded.
“That’s what it was like,” she said. “I kept waiting for that realization, but it never came.”
Her eyes spilled over with tears.
“Goddammit, look at me.” She wiped her cheeks with the heel of her hand. “I’m sixty-seven years old. What good can I do, I can’t keep up with my insulin? Why did this goddamn thing spare me?”
“The virus didn’t spare you,” Adam said. “It did what viruses do.”
She waved him off with a guffaw.
Then she covered her mouth with her hands and wept.
“How many of you are there?” she asked.
“Four adults, one teenager.”
“How long you been out there?”
“Two months. I started in Virginia. Sarah came from New York City.”
“What’s it like out there? I mean, what’s it really like? I haven’t left town since it happened.”
“Quiet,” Adam said. “You can go days without seeing another person. But there’s this constant feeling of dread, death just a blink of an eye away. It just hits you more and more each day that we’re all on our own. No one coming to help.”
“I can relate to that.”
Something else came to mind, and it felt weird. It wasn’t something he’d given a lot of thought to, but there it was, all the same.
“On the other hand…”
“What?”
He scraped a fingernail against his chin.
“With all the noise of the world gone, it can be quite peaceful. When everything else is stripped away, when it’s just you and the land out there…”
Shame flooded through him like the ocean intent on capsizing a boat.
“Jesus, I can’t believe I’m saying this out loud.”
“No, I think I understand.”
“It almost sounds like I’m gla
d it happened.”
“Whether you’re glad or not,” Gwen said, taking his hand in her own, “the fact of the matter is that it happened. How we deal with it, that’s going to determine whether we make it or not. That’ll be true for each of us. I will admit, I probably had it easier than most in this thing. I’ve been divorced thirty years. Never re-married, never had kids. Parents dead a decade. I had me a stepbrother in Minneapolis, but we weren’t close. I tried calling him when things started getting bad, but I never heard back.
“But I’m getting off track here. The point I’m trying to make is that this is the world we’ve been left with. A world with its danger and this quiet beauty you talk about. You’re a young man. Hell, even I’ve got another fifteen years coming to me according to the actuarial tables. Assuming I can remember my damn insulin, that is. And if we can’t find something worth living for, if we can’t find some joy in something simple, if we can’t be the tiniest bit grateful we’re still alive, then we might as well have died with the others.”
The room was silent.
“True.”
“I’ll tell you all something I haven’t told a soul,” she said, pointing a bony, frail finger at him and Sarah.
“When it started to occur to me I wasn’t going to catch it, I was overjoyed. I didn’t want to die. I was so scared I could barely see straight. I can’t even imagine what it must have been like to be that scared and sick to boot. I didn’t think about what kind of world I’d be facing or that I’d be one of a handful of survivors or what have you. All I could think about was surviving. And each day I didn’t come down with it, I was just glad to be alive, even as the world came crashing down around us. Know what I mean?”
He nodded.
“God forgive me, I know it’s a terrible thing to have felt, to have been so happy as the world ended, but I was. I wanted to live.”
Now Adam was the one crying. He’d thought all these things, and he’d felt guilty for thinking them. It had felt so wrong, goddamn near immoral, to have been glad to have survived. He suspected that most survivors were torn between these conflicting feelings - happy to be alive but sad to have survived such a terrible thing; it seemed like a distinction without a difference, but there was a real if not faint line there.
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