If Vollmayr had been disappointed, he hadn’t shown it. Instead, he’d offered to help Carson with the admission. That was important in his field. You wanted to see as many rare cases as possible. It was only through this exposure that he might recognize the diseases that he would be expected to in his future career as international zoonotic expert back in Germany.
The ER was packed when Carson arrived. Patients lined the hallways, reaching out hands to the harried emergency department personnel that passed. Carson quickly bypassed them and headed to Room 5, where the isolation patients were traditionally held. He saw something unexpected. A disheveled, fortyish woman was screaming at one of the interns, who was backing up cautiously from her.
He turned to the main desk and grabbed Milosz, one of the third-year medical residents rotating through the ER. Carson liked Milosz, whom he considered one of the brightest residents coming through the medicine program.
“You seen the plague case?” Carson asked.
“Hey, Jim. Welcome to the zoo. He’s in Room Three.” Milosz smiled. Among his many talents, Milosz was unflappable. The chaos around him only seemed to bring out a greater peace in the guy. Carson was amazed, but what he was just told amazed him even more.
“Room Three? But that’s a communal room. There are four beds in there. Are you crazy?”
“Not crazy, Jim. He’s not in isolation. They cleared him in Reno. I was told he’s been on antibiotics for more than forty-eight hours.”
What Milosz said was true, Carson knew, but the patient had been transferred to UCSF because he had not been clinically improving at the rate the Reno attending had hoped. Carson had wanted to make the call to discontinue isolation. This was his hospital, after all. But he said none of this. It would only alienate Milosz.
“Where is he?”
“Bed two, but he’s in X-ray right now getting a chest film. He’s got a clear one from Reno, but we figured we should have one of our own.”
“Has the medicine team seen him?”
“Yeah, the intern has. They’re waiting on the chest film and labs before writing the admitting orders.”
Just then, Vollmayr arrived, his white coat flapping behind him.
Milosz raised his eyebrows. “Wow. Slow week in ID? Two fellows to check out a convalescent plague case?”
“How many cases of plague have you seen, Milosz?” Carson asked.
“About the same as you two, if you’re both down here,” Milosz returned evenly.
“Well, you’re a lucky man then, Milosz. These are for the record books. Last plague in San Francisco was in 1993. And he was like this guy, just traveling through. I don’t know if we’ve had any primary diagnoses in the last fifty years. You got to grab your cases where you can.”
Milosz smiled. “Well, grab away then. I’ve got a case of scabies in room four just itching to be seen.”
“Ha,” said Carson, at the joke. He cringed at the thought of the skin mite responsible for the rash known as scabies. It was one of his least favorite infectious diseases: relatively benign, but highly contagious and itchy.
Beside him, Vollmayr piped up, “Is that him?” He gestured at a sallow, young Japanese man being wheeled in a gurney toward Room 3. “He doesn’t look too good.”
The boy lay on his back, his eyes closed. Short, shallow breaths lifted his hospital gown. He looked exhausted.
“What were his vital signs?”
“Stable. No fever,” said Carson. Vollmayr’s face remained impassive, but Carson was certain he also felt uneasy. Yoshiki was off oxygen and blood pressure support medications. His high-grade fever was gone. He had been treated now with antibiotics for almost three days. And yet to the eyeball test, Yoshiki looked awful.
After a moment, Carson said, “Shall we go meet him?”
They walked to his bedside and stood flanking the bed, neither talking. Yoshiki seemed oblivious to their presence. And then, the boy coughed, a weak, wet sounding noise. Carson’s eyes shot to Vollmayr’s. “What did the X-ray show?”
“Don’t know,” said Vollmayr.
“Shit,” said Carson softly. He grabbed a surgical mask from a box attached to the wall and slipped it over the boy’s face. Yoshiki’s eyes fluttered open, but Carson didn’t see this. He was already crossing the room to the door, heading for the monitor where the ED physicians checked X-ray films. Vollmayr was in hot pursuit.
Brian was laughing when Susan found him. He stood beside a black grand piano in the main living room, talking with Ken and his wife. Susan’s heels sank into the thick Persian carpet as she crossed the room to join him. The room reeked of luxury, from the shiny classical wooden furniture to the antique grandfather clock, to the Steinway that stood at the far end, which Susan doubted had ever been played.
“Hi, Susan,” Ken said. His face was flushed with laughter, and he looked, at the moment, the healthiest she had ever seen him. She was used to seeing him after a day in the OR, when his hair was plastered to his scalp with sweat and his skin gray from fatigue. Now there was color in his face, and his hair looked freshly shampooed and combed. Next to him stood a large-breasted, conservatively dressed blonde woman, whom Susan recognized as his wife.
“Hi Ken. Hi Cheryl,” Susan said lightly. She suddenly felt self-conscious in her clingy black dress, but Brian seemed oblivious to this and threw his arm around her.
“We were just talking about roasting Meyer. I think it might get a little nasty,” Brian said, winking at Ken, who Susan knew held no great love for David Meyer, one of the higher ranking professors in the department. It was a department tradition that the departing fellows selected a faculty member to roast at a good-bye dinner held later in June.
“Wasn’t Meyer roasted last year?” Susan asked.
“Meyer gets roasted every year,” Brian said, laughing.
“Briannnnn,” Ken mocked, in perfect imitation of Meyer’s whining nasal voice. “Let the med student sew the proximals. She’s ready.” Brian and Ken broke into renewed laughter at the frank reference to Meyer’s legendary fondness for young female medical students. Susan looked at Cheryl and shrugged with a lop-sided grin. She had heard many of the stories about Meyer, but had never really met the man, so much of the humor was lost on her.
Across the room, she saw Matson engaged in conversation with the man from the patio. Matson’s wife placed her hand on the man’s arm and leaned toward him, whispering god-knew-what hostess-y thing she thought was appropriate. The man smiled at her briefly and resumed his conversation with the chairman, who leaned toward him intently. A friend of Matson’s? she wondered.
“Checking out Alan Wheeler, Susan?” Ken asked.
“Who’s Alan Wheeler?”
“That guy with Matson. Don’t recognize him, do you?”
“Who’s Alan Wheeler?” Susan asked again.
That same flicker of annoyance crossed Brian’s face. “Wheeler Foundation,” he said, as though it were obvious. “The Wheeler Chair of Cardiothoracic Surgery. He’s single-handedly financed the turn-around of the USC Department of Cardiothoracic Surgery. He’s given a lot of money to Matson.”
“And to other departments, too,” said Ken. “His father died at the old Norris Hospital, and so the foundation has been especially generous to the research facilities there.” Norris Hospital was USC’s comprehensive cancer center, a big shiny new facility at the heart of the medical center campus. “It’s a good thing, too, because rumor has it Wheeler’s son is getting treatment there right now.”
“Really?” said Susan. That would explain his melancholy expression.
“Yeah, leukemia.”
Cheryl, who was not in the medical field, let out a little gasp of horror. Ken put his arm around her. “It’s one of the treatable cancers, honey.”
“But still,” said Cheryl, who had three small children of her own. “I can’t imagine.” Tears filled her eyes.
“I bet he’s getting the best treatment available in the world,” Brian said. “Money will do t
hat for you.”
“And god knows, Wheeler’s got enough of it. His grandfather was one of the original Los Angeles oil men.” Ken followed Susan’s gaze to Wheeler, who was shaking Matson’s hand now. He kissed Matson’s wife on the cheek. “Looks like Matson got another million.” He turned to Brian. “Good. That will help pay your salary, Cain.” The two broke into laughter again.
So, he had officially gotten the job offer. Susan found herself strangely unmoved. Her eyes followed Wheeler’s departing figure as he disappeared through the front door.
Carson peered at the X-ray, and what he saw was not reassuring. Was that a hint of pneumonia, or was it just a bad image?
“What do you think?” he asked.
“I think I would put him back in isolation,” said Vollmayr. “It’s probably just a bad film, but I wouldn’t take any chances with that cough. Have the antibiotic sensitivities come back yet?”
“No, the culture was done at the Nevada state lab. They’re slower than our lab. As a precaution, the attending out there got a little nervous and put him on both gentamicin and doxycycline.”
Vollmayr grunted. “Double coverage? Must have been pretty nervous.”
“The attending out there didn’t feel like he was improving like he should have been.”
Vollmayr looked perplexed. “But he’s got no fever, and he’s back on room air.”
“Right,” said Carson. “I know it doesn’t make sense. He has improved. He just looks like shit, that’s all.”
Carson’s pager went off, and they both jumped. “It’s the ER,” said Carson, reading the pager’s display. He picked up the phone next to the X-ray monitor and dialed. “This is Doctor Carson, returning a page,” Carson barked into the receiver.
The phone call didn’t take long. “I’ll be there in two minutes. And for god’s sake, get him in isolation.” Carson said and slammed down the receiver.
“What is it?”
“Yoshiki’s blood pressure is dropping.”
“Damn,” said Vollmayr, and the two fellows ran for the ER.
Singh took the call in the hallway of the ICU, but after he learned the purpose of the call, he wished he had taken it in the privacy of his office.
It was George Mack, the Director of Public Health for Washoe County. “Ajay, I just wanted to alert you that the preliminary sensitivities have come back on the Yersinia pestis case.” His voice sounded grave, and this made Singh’s stomach drop. “Resistant to tetracycline and gentamicin.”
For a second, Singh was speechless. The doxycycline that he had treated Yoshiki with was a close relative of tetracycline and was thus worthless in fighting his disease. Likewise, gentamicin was also ineffective. “What about other drugs?” Singh asked.
“We’ve started another panel of sensitivities to second-line agents. You know, chloramphenicol, ciprofloxacin, the rest.”
Singh felt the muscles in his face go lax with horror. “I’ve got to call UCSF and warn them. I transferred Yoshiki there today. Out of isolation.”
Mack said carefully, “Ajay, he had no evidence of lung involvement, did he?”
“No.”
“Then you know as well as I do that he’s not contagious unless there’s a blood contact.”
“Right,” Singh said slowly, but his mind was racing. Jesus, he had transferred a drug-resistant Yersinia pestis case out of isolation!
“And,” said Mack, “he’s an isolated case, Ajay. This is not something to start a panic about. We’re already testing on the summit, looking for a source. I’ve got several of our guys catching rodents, looking for plague. We don’t even know if this is local. It could have come from Berkeley, for all we know.”
But his words were lost on Singh, who was staring sightlessly across the ICU, trying to figure out what to do.
“Ajay, are you listening to me? This is only one case. No need to panic.”
Singh forced himself to focus on Mack’s words. “I understand. No panic.”
“It’s an isolated case,” repeated Mack.
“Yes,” said Singh.
But what neither of them knew was that a thirty-four-year-old Evergreen Club employee with the worst flu he’d ever had was being seen in an emergency department thirty miles away in Truckee, California.
Three
Of all the places he had been to, John Harr liked Harney County best. Some called the sparsely populated eastern Oregon plateau a wasteland of sage brush and broken dreams. But Harr loved the solitude of the high desert. He could drive his old pick-up here, and if he crashed it, it was just him against nature. There was no roadside service, and even if someone came to help from Burns, it would still take too long to make much difference.
Not that Harr had any intention of crashing his truck. Harr was a purposeful man. He had plans for the future. He wanted to make sure he followed through on those plans.
Harr turned onto the long gravel road that led to the small ranch house he called home. The sun was setting on the western horizon, turning the desert landscape a warm orange that he knew would change quickly to a cooler pink and then eventually the gray of dusk.
He glanced at the dash clock. Fifteen minutes to tip-off. He stepped on the gas, sending gravel shooting like little bullets up into the air. Normally, Harr watched the Trailblazers in Burns at one of the taverns, but the forty-five mile drive from his home to the little town didn’t appeal. Or maybe he was just afraid of seeing Lola.
She’d accused him of getting old. He peered at his reflection in the rearview mirror. There were crow’s feet around his eyes, true, but he’d had those since he was twenty. They came with the territory. A rancher’s weather-hardened features seemed as natural as the sage brush and the rugged Steens Mountain to the east. There was nothing lush in Harr’s face, but there was an austere sort of beauty to it, or at least Lola had said so.
Harr turned his eyes to the road and frowned. Lola had been angry the last time he saw her, and since she tended bar at the tavern where he did most of his game watching, he found himself suddenly with fewer viewing options. Lola had a lot of friends, and he didn’t feel like answering questions.
The truck’s engine whined as he downshifted over the hill. Harr gazed at the little farmstead on the plateau across Silver Creek, now pink and backlit. It wasn’t much. A cabin and an old wooden barn with a corral out back, where Harr kept his horses. The cattle were farther out, scattered across the grazing land. One new building, an aluminum-sided airplane hangar, stood next to a makeshift gravel runway. A windsock hung limply in the still evening air.
“Make an honest woman of me,” Lola had said.
They were standing in the little park in Burns, she leaning against her old Pontiac, and he next to his battered Ford, four feet away.
“I hadn’t realized I made you a dishonest woman,” Harr had responded.
Which had pissed her off, he could tell, but she was too savvy to show it. Instead, she switched tactics. “You can’t wait forever to settle down,” she said reasonably. “You’re thirty-three. You don’t want to be an old man when you have your babies, John.”
He had to admit she had a point. On a purely intellectual level, he knew he’d do well by her. After all, there was no doubt she was loyal. She had loved him since they first dated in high school and had waited patiently while he’d served in Afghanistan and then afterwards when he’d worked in Idaho trying to save money to buy his ranch.
But Harr didn’t want to marry her. And he didn’t know how to tell her that.
He said as softly as he could, “It’s not going to work, Lola.”
Perhaps it was something in the tone of his voice that told her this time was different. There’d be no fighting and making up and then circling each other warily again. But that didn’t stop her from trying. She said, her words so thin he could hear the heartbreak beneath them, “Of course it’ll work, John. We’re good together. We’ve been together longer than most married people.”
Silence had hung between th
em, volatile, and for him, agonizing. She searched his face and had apparently found something she couldn’t bear. She cried hoarsely, “I’ve been waiting around for you since I was fifteen years old, John! Now you up and tell me it ain’t gonna work?” She gestured at her tear-stained face. “Who’s going to marry me now? They’ll think I’m just your leftovers, just the stupid girl who waited eighteen years for John Harr to finally settle down, only to have John Harr say, ‘No thanks, honey.’”
“Lola, it’s not—" He never finished the sentence, because she drew back her arm and slapped him as hard as she could across the face.
“Shut up!” she cried. “Just shut up! I don’t want to hear another word out of you.” And then, she ran blindly for the Pontiac’s driver’s side door.
He watched with an awful feeling in his stomach as she pulled away. The Pontiac’s tires spun ineffectually in the gravel for a second before gaining traction and sending a shower of pebbles backwards onto the grass. Above the roar of the engine, he heard a sob.
The next day, he went out and bought a new flat screen TV for the ranch. He figured it was better to lay low for a while. Lola would get over him. After all, she was good-looking and had never been married. In Harney County, even at thirty-three, she’d be a sought-after woman.
Besides, he thought irritably, it wasn’t like they had really been together eighteen years. He’d been back in Harney County only three years now. True, they’d stayed in touch while he was in the service and then later, but he’d never known she carried a torch for him the way she made out.
He fingered his cheek gingerly, half expecting it to still sting three days after she slapped him. The welt had persisted for a full day, and he had at first avoided going into town, not wanting to explain what had happened, but finally his desire to see the Trailblazers in high-def had outweighed his reluctance, and he had snuck into town to buy the new flat screen. If the welt was visible, the woman at the counter had made no mention of it. If Lola was dragging his name through the dirt around town, which he half-expected, there were no knowing smirks on the saleslady’s face. Nonetheless, Harr, a quiet man by nature, was all the more withdrawn as he placed his order.
DRYP Trilogy | Book 1 | DRYP [The Final Pandemic] Page 4