DRYP Trilogy | Book 1 | DRYP [The Final Pandemic]

by Scheuring, R. A.

  Behind her, the door opened, and the crash cart banged in as Sanders pushed it through the doorway.

  “Sanders, where’s Anesthesia? This guy needs to be intubated!”

  “They’re out in the hallway. They’re still pissing around about the protective gear.”

  “Can you do it?”

  A flicker of doubt crossed Sanders’s face. The anesthesia residents usually placed the breathing tube down a patient’s throat. It was a procedure not without risk. You could knock out teeth or put the tube down into the esophagus by mistake and send the oxygen into the stomach. The medicine residents weren’t trained in intubations, but some of them knew how to do it. Susan didn’t, but she hoped Sanders did.

  “Yeah, I can do it,” Sanders said, but he didn’t sound certain.

  Susan looked at Sanders. “If we don’t do it, this guy’s going to die.” She turned the crash cart and pulled out an intubation tray. Sanders moved to the head of the bed. Flores was motionless now, his lips blue and his eyes glassy. The intern stood, wide-eyed.

  “Get the pads on.” Susan handed the dumbstruck intern the cardiac shock pads. Without oxygen, it was only a matter of time before Flores’s heart started beating erratically and then finally stopped altogether. The intern’s hands were shaking as he slapped the pads onto Flores’s chest.

  “I see them!” Sanders said from the head of the bed. He had the intubation blade down Flores’s throat and was looking at the vocal cords. He slid the breathing tube between them, pulled the wire guide out, and hooked the tube up to an oxygen bag, which he squeezed to deliver 100% oxygen into the man’s lungs.

  “Am I in?” Sanders asked.

  Susan put her stethoscope to the man’s chest. She heard the whoosh of air into both lungs. She moved the diaphragm of her stethoscope over his stomach. No air sounds there. Good.

  “You’re in,” Susan said.

  She turned quickly to the monitor. Amazingly, Flores’s heart beat in a regular, though incredibly rapid rhythm. That was one thing about the younger patients. Their hearts were stronger. If Flores was any older, he’d be dead by now.

  The door burst open, and two white-suited figures entered. One was the anesthesia resident. Susan could tell by the anesthesia supply box he carried.

  “Nice of you to show up,” said Sanders.

  The anesthesia resident was speechless for a moment and then joked, “Well, we like to let you guys share in the excitement.”

  Susan ignored them. “Can we get some vitals, please? And can someone get me some meds to sedate him when he comes around?”

  The other white-suited figure moved to Flores’s side and slipped a blood pressure cuff around his arm. “There’s protective gear out there now, Dr. Barry. Central Supply delivered some stat. I’d go out there, if I were you.” She turned her white spaceman-like head to Sanders. “You, too, Dr. Sanders.”

  The intern was staring at Flores’s inert figure on the bed. Susan knew he was probably blaming himself for what had happened, wondering what he had done wrong and if he could have done something to prevent the patient’s respiratory arrest.

  “I need you to watch him while I go get my spacesuit on,” Susan told the young resident. “I’m putting you in charge, okay?”

  The intern looked at her, his eyes grave behind his face shield. “Sure.”

  Susan moved into the hallway and was surprised to find she was sweaty. The crowd had dispersed some. She looked for the respiratory technician who had run into the room to turn off the ridaravine, but the technician was nowhere to be found. Susan wanted to thank her. Although it had been Susan’s decision to go into the room without proper protective gear, she still didn’t like exposing herself to chemicals like ridaravine. It was one of those things you did as a doctor, risk your future and sometimes your present, by accidentally inhaling drugs like aerosolized ridaravine, or by treating patients with tuberculosis or any other contagious illness. Despite her cavalier joking with Sanders, Susan still hoped for children, but in the hallway of Ward 10-200 at four fifteen in the morning, it was better to squash those dreams.

  Sanders emerged from the room, pulling off his face mask. His cheekbones were indented with small lines where the straps had cut into his skin.

  “Everything all right in there?” Susan asked.

  “Yeah, the anesthesia resident is supervising your intern, who is supervising the rest of us.”

  A little laugh burbled up in Susan. “Sanders, interns have to get experience somewhere.” She was hooking the blower around her waist, like a belt. “Besides, Flores seemed to have stabilized, otherwise I would have never left the room.” She pulled the white hood of the protective gear over her head and slid the clear plastic plate in front of her face. She instantaneously felt claustrophobic. “Hook me up, would you?” She held up the plastic tubing, through which the blower would pump filtered air into her head gear. Sanders took the tubing from her and plugged it in. He peered through the plastic plate at Susan’s face.

  “It’s a good look for you,” he said.

  “Shut up.” Her voice resonated in the protective head gear. She handed Sanders his own head gear, which he slid on, the plastic tubing dangling like a tail from the back of his head.

  “Take me to your leader,” Sanders said, wobbling idiotically back and forth in front of her.

  Susan looked at him stone-faced, turned back to the room, and burst into loopy laughter. She flicked on the blower, listened to its whirring hum, and breathed deeply, trying to compose herself. She pulled one of the disposable hospital gowns on over her scrubs.

  “You ready?” she said, grabbing Sanders’s plastic tubing and hooking it to the blower on his belt.

  “Yep,” said Sanders, still grinning. “Let’s go transfer that guy to the ICU.”

  Later, when they were eating breakfast, Sanders wanted to ask her out, but he didn’t know how. They sat across from each other in one of the booths that lined the walls of the Doctors’ Dining Room at Los Angeles County + USC Medical Center. It was an ugly room, decorated in fading orange and yellow, a decaying testament to the bad taste of thirty years ago, when the room was last remodeled.

  Susan leaned back in her seat, her breakfast of scrambled eggs and sausage half eaten. It was the best meal of the day in the DDR, but it was still hospital food, and it tasted horrible, even to the half-starving residents. She kept one hand curled around her coffee cup, which held the remnants of her second cup of the morning.

  “You think that guy’s going to make it?” she asked.

  “I don’t know,” said Sanders. “He’s a young guy. The only thing not working in him is his lungs.”

  “Obviously.” Susan pushed a strand of dark hair out of her face.

  Sanders was disappointed. She’d pulled her hair into a pony-tail this morning, so that it fell down her back in a waving cascade. He loved her hair. It was long, shiny, and dark, and it fell well below her shoulders when she wore it down, which was close to never. He’d seen it down only a few times at department parties and once when he had run into her on Melrose Avenue. She had been wearing a sleeveless blue dress that day, and the memory of it was permanently imprinted on his mind.

  “They were treating him for a virus. Sounds like he’s had a complicated post-op course,” she continued.

  She was, of course, the smartest resident in the program, which had always intimidated Sanders. He had heard that she’d graduated first in her class and had been recruited by Harvard and Johns Hopkins for residency. She’d chosen to stay at the University of Southern California to finish her training. No one really knew why.

  Sanders shrugged. He was handsome enough, in a tall, thin way. No great athlete in his college years, he kept in shape by running, which helped offset the effects of poor nutrition and chronic lack of sleep. He was a solid, if not particularly imaginative man, the kind of man that women want their daughters to marry, which Sanders, somewhere in the depths of his conceit and insecurity, already knew.


  He very much wanted to date Susan.

  She was looking away, across the DDR. “There has to be a better treatment than aerosolized ridaravine,” she said thoughtfully.

  He cleared his throat. “Susan, I was wondering…” He searched for the words. “If you would want to go to dinner with me sometime.”

  That brought her around. She turned back to him with a look of surprise, but she didn’t answer immediately, and Sanders knew that was bad.

  “You know, something casual, maybe after work sometime?”

  Her expression morphed into one of kindness, and Sanders felt his stomach sink to somewhere near his knees.

  “That’s really nice, Sanders. Thank you. But you know I’m seeing someone, don’t you?”

  “No, I didn’t. Haven’t been up much on the gossip lately.” He tried to sound gallant. “Do I know the lucky guy?”

  “Brian Cain. He’s one of the cardiothoracic fellows,” she answered, and Sanders inwardly groaned.

  Of course, he thought. She would be dating one of the biggest pricks at the hospital.

  “You know him?”

  “Not really. Met him once last year. We had a case together. Staph endocarditis, patient needed a replacement valve.” He tried to make this sound casual, as though it were a fairly standard, uneventful encounter between two colleagues, but what he most acutely remembered was Cain’s voice: “You fuck, how long have you been sitting on this case? How much more blown does his valve need to be before you realize this ain’t gonna clear with a little IV antibiotics?”

  Sanders had transferred the patient to the Cardiothoracic Surgery service, probably a little later than he should have, so the patient could get the valve replacement.

  “Ah, sounds like a case for Brian,” she said, changing the subject. “Two more months, Sanders. Can you believe it? Then we’re free.” She said this with real enthusiasm. “No more residency. No more in-house call!”

  Sanders couldn’t help smiling. “You’ve still got two more rotations. Game’s not over yet. What are you doing?”

  She was undaunted. “Infectious Disease, and one month of research.”

  Sanders snorted. “ID and research? You’re home free, Susan. It’s just smooth sailing from here on out.”

  Susan grinned.

  It was seven fifteen pm, which meant the workday was over for Chuck Vangsness. That was one of the attractions of emergency medicine. You did shift work. Start your day at seven am (if you had seniority, if not, it was night shifts for you), end your day at seven pm. No call. No pager to wear once you left the hospital. Vangsness liked it a lot.

  So when his cell phone rang as he pulled his Chevy Suburban out of the parking garage, he figured it was his wife, Andrea, wondering where the hell he was and if he’d be home for dinner. For half a moment, he contemplated not answering, but then he picked up the phone, his conscience winning over his momentary impulse.

  It wasn’t Andrea. It was Ajay Singh, the attending physician in Washoe County Medical Center’s ICU. “Chuck, I wanted to call you about Yoshiki Yahagi.”

  Vangsness drew a momentary blank.

  “The Japanese kid with the fever,” Singh said.

  Vangsness shook his head, bemused. He’d forgotten the kid’s name already. To Vangsness, Yoshiki was simply “the Japanese Kid.” “Yeah, how’s he doing?”

  “He’s stable right now. We switched around his antibiotics and are giving him fluids. But hey, we figured out what he has.”

  “What’s that?” Vangsness wasn’t really interested, but if Singh was calling him after hours, it probably meant that it was something a little more exotic than pneumonia.

  “Bubonic plague.”

  “No shit?”

  “Yep. Two out of two blood cultures came back positive today. We switched him to gentamicin and put him in isolation.”

  Vangsness’s mind raced, but his words were calm. “Ajay, I forget. Do I need to take antibiotic prophylaxis after an exposure like this?”

  “No. I just got off the horn with the Department of Health. No antibiotic prophylaxis unless it’s pneumonic plague. His chest X-ray was clear when you saw him, right?”

  “Yeah, no signs of lung involvement on chest X-ray.” Vangsness slowly let out a breath. Wouldn’t that piss Andrea off, he thought, bringing a little bubonic plague home with me.

  “Well, we just keep him in isolation for the first forty-eight hours he’s on antibiotics. He gets a couple extra days in the hospital to recuperate, and then back to Berkeley with a good story to tell the other exchange students.” Singh laughed. “How I caught the plague in America and lived to tell the tale.”

  Vangsness chuckled. “Yeah. Thanks for keeping me up to date, Ajay.”

  “No problem, Chuck. I’ll keep you posted.”

  Vangsness disconnected, but he kept the cell phone in his hand. Something was bothering him. The chest X-ray had been clear. He had checked it twice. But in his mind, Vangsness kept hearing that horrible, hacking wet cough Yoshiki Yahagi had let out in Zone 2.

  Vangsness looked at the phone, then shook his head. This job was enough to make you paranoid. He had checked the chest X-ray twice.

  Two

  Los Angeles County + USC Medical Center, when looked at just right, was a magnificent building. Built on a hill in the center of Los Angeles, the massive concrete structure towered over the surrounding neighborhood like an aging king. The art deco edifice had withstood more than eighty years of turbulent history that included the rise of the modern metropolis of Los Angeles and the depression that had nearly brought the country to its knees; it had withstood wars; it had withstood the terrible shaking of the 1994 Northridge earthquake; it had even withstood the near bankruptcy of Los Angeles County in the 1990s. Throughout it all, County, as the people of Los Angeles called the hospital, stood unyielding.

  Susan Barry hated the place.

  She remembered the Chairman of the Department of Medicine telling her that if a nuclear bomb hit Los Angeles, all that would be left would be a few cockroaches and County. And Susan believed him. Built with an impossible 1800 hospital beds, the hospital now held only 800. It was so old by hospital standards that the county wanted to abandon it for a newer, smaller hospital, but to have it demolished would be too expensive. The plan was to convert the lower floors to office space and leave the rest empty. Susan thought the building would stand a thousand years.

  She walked down the hospital’s first-floor central hallway. The long concrete corridor reminded her of the New York subway. Hundreds of patients, health care workers, and visitors all jostled for position as they made their way to the elevators or exits. Sweat dampened Susan’s scrubs as she pushed through the humid mass.

  Guilt welled up in her. She didn’t hate the place. She was just tired. She was tired of thirty-six hour shifts. She was tired of waking in the middle of the night to admit a drunk from the emergency room. She was tired of being so broke that she couldn’t afford to fix her car or buy a new dress or take a vacation. But what she was most tired of was the endless postponement of everything that her non-doctor friends so readily took for granted.

  Like having a husband. Or starting a family. Or even something so simple as owning a home.

  She pushed through the exit and walked past the security desk, where two guards passed metal detectors over people lined up to enter the hospital.

  She was practically running by the time she reached the residents’ parking lot. Brian wanted her at his apartment by seven o’clock, which would be a stretch given rush hour traffic between the hospital and Santa Monica. But meeting her at the Cardiothoracic Surgery Department party to save a few minutes driving was a compromise that Brian absolutely refused to make.

  “Are you trying to make me look bad?” he’d cried. “Appearances count, Susan. If you want to be my girlfriend, act like my girlfriend. We arrive together.”

  Which meant that she would leave her battered old Toyota Corolla hidden in the alleyway behind his condo a
nd he would drive her in his Porsche. She pushed the implications of this imbalance of power out of her mind and thought instead about the dress that she had bought for tonight, a dress that she had charged on the one remaining credit card she hadn’t maxed to the limit. It was shimmery, black, and clingy. It was the sexiest outfit she had ever owned.

  Susan reached the parking structure and climbed the stairs to the second floor, where the Corolla stood forlornly in the spot closest to the elevators. She wondered why she’d even bought the dress. It certainly wasn’t something that a farmer’s daughter like Susan Barry wore.

  And then she reminded herself: I’m in Los Angeles. Women in Los Angeles wear sexy dresses. I can wear a sexy dress.

  She stood for a long moment, looking at her warped reflection in the Corolla’s driver-side window, feeling strangely unhappy.

  Five hundred miles north, Ajay Singh sat at his desk not far from the ICU where he worked, dreading the phone call he was about to make. His most significant patient, despite forty-eight hours of antibiotics, was not getting better at the rate he’d expected.

  A woman’s voice answered, sounding vaguely irritated. “Hello?”

  “Helena? It’s Ajay Singh.”

  There was a moment of stone cold silence on the other end, and Singh was instantly catapulted into the past. He saw her as she had once been, a pretty young medical resident at UC San Francisco, brilliant and way out of his league.

  “Helena?” he said again.

  “I’m here, Ajay. I haven’t heard your voice in quite a while.” Her voice was cool.

  He cringed. “Too long,” he said, trying to keep it positive, to keep his voice light.

  “Yeah, ten years goes by fast. How’s your wife?” Her voice deepened with the question, a trace of bitterness settling over her words.

  “Great. How’s the job? They tell me you’re Chief now. Congratulations.”