DRYP
The Final Pandemic
R.A. Scheuring
Copyright © 2020 by R.A. Scheuring
All rights reserved.
No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without written permission from the author, except for the use of brief quotations in a book review.
For Mom and especially Dad
Contents
Los Angeles
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Chapter 57
Chapter 58
Chapter 59
Chapter 60
Chapter 61
Chapter 62
Chapter 63
A Note from the Author
Acknowledgments
About the Author
During these times there was a pestilence, by which the whole human race came near to being annihilated.
-Procopius
Los Angeles
Preces meae non sunt dignae
Sed tu bonus fac benigne
Ne perenni cremer igne
The words drifted down the wide boulevard, so soft at first that they could almost have been mistaken for the whisper of the Santa Ana winds blowing through the palm trees. But as Dr. Susan Barry drew closer to the crowd of robed figures, the sound separated itself. Words became chanting. Chanting became shouts.
Confutatis maledictis
The man on the platform was listening. He held something in his hands which he showed to the white gowned people below him. They cried back at him:
Flammis acribus addictis
The chanting grew louder. The man on the platform brought the whip down across his back. He lashed himself over and over again. Crack, crack! The gowned figures shook, their chanting now deafening.
Finally, the man reached up to the sky one last time. He held this position for a few endless seconds before he collapsed forward, landing on the platform in a heap of bloody cloth.
The crowd erupted. White and red figures surged toward the platform, screaming and shouting and crying. Spectators dropped to their knees, their hands clasped before them. No one wore a mask.
How had it come to this?
One
Three Weeks Earlier
Reno, Nevada
The Japanese kid was the index case.
But Chuck Vangsness didn’t know that when the exchange student rolled through the door of the emergency room of Washoe County Medical Center. Vangsness, an ER doc with twenty years’ experience, looked the boy over, noted his pale, feverish appearance, and made a fateful decision.
“Take him to Zone Two,” he ordered.
The paramedics rolled the boy into the step-down side of the ER, where the less sick patients were brought. The large room held six beds, which were filled with a general selection of mid-day emergency room visitors—kids with cuts, kidney failure patients who had missed dialysis, old men with congestive heart failure. Vangsness directed the paramedics to an empty bed in the corner.
“What’s the story?” he asked.
The taller paramedic grunted as he slipped the boy off the ambulance stretcher and onto the hospital bed. “Nineteen-year old exchange student from Japan, up at the Evergreen Club Lodge. Developed a fever two days ago, refused to go to the doctor. Finally can’t get out of bed this morning, so his friends called nine-one-one. His temperature is one-oh-three. Blood pressure one-seventeen over eighty. Heart rate ninety-eight.”
Vangsness’s eyebrows rose faintly. He turned to the boy who was watching this interchange dully, his eyes half closed. “How you feeling?” asked Vangsness.
The Japanese kid seemed to reach deep inside for a reply, but what came out was a weak little croak that still somehow carried a heavy accent. “Very sick.”
“How did it start?”
The kid looked blankly at Vangsness.
“His English ain’t too good, doc.” The taller paramedic pushed the empty stretcher back toward his partner. “Probably picked up a bug at the Lodge. You know how those tree huggers are. Hygiene’s not too good.” His partner rolled his eyes, and the taller paramedic grinned.
If Vangsness thought the paramedic’s comments were insensitive, he didn’t show it. He knew emergency responders didn’t care much for standard medical calls. They lived for the gore of gunshot wounds and car wrecks, the latter more common than the former in Reno, Nevada, where too many tourists were brought after crashing their brand new SUVs on the mountain roads of Lake Tahoe. It was not surprising, then, that a Japanese exchange student with a fever failed to ignite the paramedics’ interest. In the long tradition of medical practitioners, their departing smiles spoke volumes. Not my problem anymore, pal. All yours.
Vangsness called for the nurse.
They managed to glean a little more information while the nurse got the boy situated. His name was Yoshiki Yahagi, and he had arrived only weeks before to spend a year at the University of California at Berkeley, where he hoped to improve his English and work part-time in a lab. Yoshiki repeated this last part several times, leading Vangsness to conclude that he’d practiced these sentences, probably in preparation for arriving in America. Hello, I am Yoshiki Yahagi. I am here to improve my English and to work in lab part-time.
Unfortunately, Yoshiki had not practiced how to answer medical questions. Vangsness figured he’d probably need to call for a translator.
“Where are your friends?” Vangsness tried again.
“They come in van,” said Yoshiki. He had assumed the fetal position under the blankets. Despite the inevitable hardening of Vangsness’s soul by many years of dealing with the sick and desperate, he couldn’t help but feel sorry for the kid. Yoshiki looked small, pale, and now much younger than his nineteen years. He was shaking.
The nurse, Joliet, said, “His vital signs are about the same, Dr. Vangsness.”
“Hm.” Vangsness had seen many fevers in his career, but something about this one made him uneasy. He wasn’t sure why. He turned back to the boy. “How many days at the Evergreen Club Lodge? he asked, carefully enunciating each word. “How many days?”
Yoshiki’s eyes were closed. For a moment, V
angsness wondered if the boy had fallen asleep, but then the exchange student answered in a voice not much more than a whisper, “Four days.”
“Cough?”
Yoshiki’s eyes fluttered open and closed. He shook his head mutely, his expression miserable.
Vangsness turned to Joliet, who had quietly watched the entire exchange. “We need to talk to the friends,” he said. Vangsness liked Joliet. She was pretty and young, probably only a few years out of nursing school.
“I can ask the clerk to call over to the Evergreen Club Lodge to find out where his friends are,” she offered.
“That’d be great.” They walked to the desk across the room. Vangsness leaned against it and rested his elbows on the countertop. “Are they ready for him in Radiology?”
“They said to send him over when we’re done with him.”
“Good. I want to see that chest X-ray.” Maybe it would shed some light on why a nineteen-year-old boy was sitting in his ER, looking sicker with each passing moment. As an afterthought, Vangsness added, “And Joliet, when he gets back, let’s put him in a monitored bed. There’s something I don’t like about this case.”
The chest X-ray was clear. No signs of pneumonia. Yoshiki’s urine was clean, too. No signs of infection there. The blood tests were still pending. They wouldn’t get bacteriology results for another day, so Chuck Vangsness found himself in the odd situation of having a patient with a high fever that didn’t have a clear source.
He sat at the ER’s main desk, pondering the wisdom of just giving the exchange student antibiotics. Vangsness knew that administering antibiotics without a good reason was a medical no-no, but sometimes ER doctors did it anyway. Hell, all doctors did it. The infectious agent wasn’t always immediately clear, and you didn’t want to wait around for your patient to get worse before you treated them. In the long-run, there might be hell to pay, because all that wanton antibiotic usage was creating some scary drug-resistant microorganisms. Vangsness hoped he was dead long before the super-bug, as the public health doctors like to warn, reared its ugly, drug-resistant head.
Joliet appeared. “Did you see his groin? He’s got a huge inguinal lymph node.”
“Really?”
The nurse led the way back to Yoshiki, who now lay in a bed with a vital signs monitor overhead.
Vangsness glanced at the monitor and was not reassured. “Turn up his IV fluids, would you? He looks like he could use a little juice.”
Yoshiki remained curled up on his side, the blankets pulled up around his neck, his eyes closed, a small furrow between his brows.
“Yoshiki, hon, I need you to straighten out.” Joliet gently pulled at the young man, who groaned at the disturbance but allowed himself to be placed on his back. She rearranged the blankets and lifted his hospital gown, revealing the area where his left leg met his hip. In the crease, an ugly, red-rimmed bump protruded from his skin. Vangsness reached out to touch it. Yoshiki moaned.
“Sorry, Yoshiki. Tender, huh?” The student probably had no idea what he was saying. He marched his hands down Yoshiki’s legs, feeling and looking for a bug bite or break in the skin.
Nothing. Vangsness was stumped.
Yoshiki let out a wet, gurgling cough.
Joliet’s eyes met Vangsness’s. “You said the chest X-ray was clear?”
“Yeah.” He glanced at the monitor.
“We’ve run two liters into the guy, and look at his blood pressure.” Joliet fingered the empty IV bag.
“I see that,” Vangsness said. Yoshiki’s blood pressure had dropped to 96/52. His face was sallow and waxy, his eyes closed, his pale lips parted as he drew breath. It was the face of systemic infection. Vangsness knew the face.
“Put a mask on him and hang Zosyn and vanco,” he ordered, knowing he’d gone from zero to one hundred in the antibiotic arsenal in nothing flat. Zosyn and vancomycin were big guns, antibiotics reserved for the sickest cases. Vangsness didn’t know what this boy had, but he knew he didn’t like it.
Five hundred miles south, the high chirp of a pager pierced the darkness. Susan Barry shot straight up in bed as though electrocuted, every nerve in her body jangling. She didn’t know where she was. She couldn’t see anything except the dull LED display of the alarm clock.
Three forty-two in the morning. She was in a hospital call room.
Shit.
She fumbled for the pager on the desk next to the bed and hit the button to light it up. The tenth floor was paging her, and she could tell by the code that it was the intern night float, calling Susan in for back-up. Something must be going down.
As she reached for the light switch, the pager went off again, this time with a far more ominous text message.
Code blue. Room 10-225.
“Shit!” Someone was having a cardiac arrest. Susan shot out of bed, stumbled into her running shoes, grabbed the pager and mobile phone off the desk, and ran down the hallway toward room 10-225.
Ahead of her, the ICU resident burst out of the stairwell, his orange code blue pack bouncing as he sprinted through the darkened hospital hallways. He’d beat her there, but not by much.
Who was sick enough to code, she wondered? And why hadn’t the intern night float called her earlier? She was the senior resident on call. She was supposed to know which patients were threatening to die.
The overhead public address system kicked in. An eerily calm female voice repeated over and over again: “Code blue. Room ten, two-twenty-five. Code blue. Room ten, two-twenty-five. Code blue. Room ten, two-twenty-five…”
Susan rounded the corner and saw the pandemonium. The hallway was filled with people, too many people for a code blue in the middle of the night. Why weren’t they in the room helping the patient?
Susan forced her voice down into a lower octave, but she was out of breath, and the words came out like a gasp. “What’s going on?”
“Flores, the lung transplant patient. He can’t breathe.” The nurse was panicking. “He’s on aerosolized ridaravine. You can’t go in there without protective gear. Ridaravine’s poisonous. It gives you birth defects!”
“Where is the protective gear?”
“We’re out.”
“What do you mean you’re ‘out’?” Through the small window in the door, Susan could see two figures in the last of the white protective gear, looking like the crews that clean up toxic waste dumps. The two workers, one whom Susan presumed was the intern night float, were struggling to get an oxygen mask on the patient, who was flailing wildly on the bed, the treatment tent in which he was supposed to lie thrown haphazardly aside. The fine mist of the ridaravine floated in the air.
“Get the crash cart,” Susan ordered. “We might need to intubate him.”
One of the nurses said, “I’m not going in there without protective gear.”
“Then get out of the way!” shouted the ICU resident. It was Sanders, one of Susan’s fellow third-year residents.
He turned to Susan. “There’s not enough time to go down to central supply for more protective gear. I’m going in.”
Susan looked through the window at the flailing patient and the mist swirling in the room. She heard herself answer, “I’m coming, too.” She grabbed two face masks from the hallway cart and handed one to Sanders.
“No kids for us for a while.” He pulled the mask over his face as they moved in.
“I never knew you even cared,” Susan cracked, and then they were inside.
Flores was in a full-blown panic. The intern night float was trying to speak to him in Spanish, trying to calm him down, but the words were muffled by the protective gear. Flores was trying to climb out of bed, his hospital gown flapping open, revealing well-healed surgical scars on his chest. He was young, probably not much older than thirty-five. Susan fleetingly wondered why he’d had a lung transplant but knew it didn’t matter now.
“I’m getting the crash cart.” Sanders ran out of the room.
“What’s his sat?” Susan asked, knowing already the p
atient’s oxygen saturation levels were low, otherwise, why would he be thrashing about like that? Her own heart pounded in her ears, and she vaguely remembered the advice the chief resident gave to her when she was an intern: The first pulse you take when you go to a code blue is your own. She tried to calm herself.
The intern’s eyes darted from Flores to Susan. “I don’t know! He won’t hold still.”
The door flew open, and a mask-less woman darted into the room. “What are you doing?” Susan cried, but the woman ignored her. She wore the blue scrubs of a respiratory technician, and she fumbled with the tank by the bed. She was turning off the ridaravine. She had come into the room, unprotected, to turn off the ridaravine.
Susan looked dumbly at her for a moment, realized that the tech was holding her breath, and turned back to Flores. “Get him on the bed,” she ordered. The intern and the other white-suited health care provider grappled with Flores, whose struggling grew weaker as his body shut down from lack of oxygen. His lips looked blue. His panicked eyes were dulling.
DRYP Trilogy | Book 1 | DRYP [The Final Pandemic] Page 1