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

by Scheuring, R. A.

  Ten

  “How soon?” Mack asked, his mind working quickly.

  “We need forty-eight hours to get the troops in place. As you can imagine, enforcing a full lockdown in three major US cities is a pretty big endeavor.”

  “And in the meantime, you’re just going to let the disease spread?”

  Kincade was unruffled. “Our major objective is disease containment. That will be impossible to do if there’s mass hysteria and people start fleeing the affected cities.”

  “But we could lose hundreds, maybe thousands of people, Harry.”

  “That’s probably true, but remember, the Black Death claimed twenty-five million lives. I don’t need to tell you what that number could be in today’s era of global travel.”

  Mack was stunned. He remembered the SARS epidemic in the early 2000s, how quickly it had spread around the world. “We don’t have the staff to fight this. You can’t be suggesting the CDC means to leave us to fight it alone.”

  “Of course not. We’re sending twenty EIS officers out tomorrow to help with contact tracing, government coordination, quarantine set-up. Nesbitt’s got his orders for public announcements. He’ll tell people to avoid going out in the countryside where they might encounter rodents, dust their pets for fleas, you know, all the standard stuff.”

  Mack felt like banging his head against the wall. “But it’s pneumonic plague, Harry! All the flea powder in the world won’t amount to a hill of beans if one pneumonic plague patient breathes on another.”

  “Exactly. Which means you have your work cut out for you. Once the quarantine is in place, get the public to stay indoors. Trace the contacts of all your cases. Limit the local spread. You always wanted to be Chief Banana. Here’s your chance.”

  Mack wanted to throw up. “You’re still an asshole, Harry.”

  “The feeling’s mutual, George,” Kincade said. He hung up.

  The sun was disappearing behind LA County Hospital when Susan Barry crossed Zonal Avenue. She checked her watch. Six o’clock. Still enough time to get to the Doctors’ Dining Room before they shut for the evening.

  Her stomach growled. She had been so engrossed in mapping the plague bacterium that she had forgotten to eat. Besides, it was a pain in the ass to get out of the safety gear that Hodis insisted she wear while she handled specimens. As a consequence, she hadn’t eaten anything all day.

  She made a beeline for the hospital’s side entrance, where a bored-looking security guard checked IDs. She flashed hers and went straight for the DDR. No sign of Brian.

  She frowned. Earlier he’d said he wanted to eat dinner with her, but when she’d paged him, he hadn’t responded. Hoping to catch him before the DDR closed, she headed for the elevators.

  He wasn’t in the Cardiovascular Intensive Care Unit or the OR. She was about to give up when she decided to check the surgeons’ call rooms.

  “Hey, Brian, are you in there?” She said, knocking lightly on the door and pushing it open.

  Susan stared. In the dim light, Brian’s body looked huge under the covers, sticking up like an enormously obese man. He was moving, his hips undulating rhythmically, the bed squeaking beneath him. He abruptly froze.

  “Susan!” Brian snapped. His upper body was propped up in the bed, like he was doing push-ups. Briefly, absurdly, Susan appreciated the sculpted nature of his upper arms. But this thought was quickly replaced by another: Brian wasn’t alone. A mass of long, dark red hair spilled out on the pillow below him. Susan recognized the auburn curls. One of the ICU nurses.

  “Brian.” Susan hated that her voice sounded so shocked and weak.

  But what she hated more was Brian’s response. “For god’s sake, Susan. Can’t you knock?”

  Susan’s phone rang as soon as she got home. She dropped her bag on the floor, listened to the muffled ring within, and went to the bedroom.

  Later, she heard the phone go off twice while she was in the shower, but she didn’t move, just stood under the shower head while the water poured over her body, thinking that she’d let her life wreck itself.

  And for what? To end her medical training with a whimper, without a job and cheated on by a man she’d thought she loved?

  She was sitting on the couch, in her robe, her hair tied up in a towel, when the phone rang again. He left a message this time. “Susan, pick up the phone. It’s Brian. I’m sorry … Susan, please pick up the phone. I need to talk to you.”

  Susan closed her eyes.

  Despite taking two Xanax, Ajay Singh couldn’t help the squeezing panic in his chest. He felt like he was suffocating.

  “How many?” he asked, his hand gripping the phone.

  “Two so far.”

  His staff were calling in sick now, much more and much earlier than he expected. It had been less than twenty-four hours since the three plague cases had come in.

  He had put previous night’s evening shift into quarantine, just as Mack had ordered, which meant the emergency department had lost two physicians, four nurses, and two intake clerks for at least a week. They were already down a physician and nurse after Vangsness’s and Joliet’s deaths. Singh did the math quickly. At this rate, the department would be paralyzed.

  He had to avert a panic. “I’ll be right down.”

  Singh walked quickly down to the back stairway that led to the ER. Technically, the emergency department wasn’t his jurisdiction, but the coordination for plague management had fallen onto his shoulders, which meant that Singh was now intimately involved in the ER’s management. The emergency department was critical as a first line defense in plague management. Future plague victims would come through the ER and would need to be recognized and isolated immediately if they had any hope of containing the epidemic.

  He wished he had a Pepcid. His stomach was burning. He thought fleetingly of his wife and children at home, then pushed their images from his mind.

  He needed to stay focused.

  The emergency department was a madhouse. Singh searched the crowd for Jim Langston, the physician on duty.

  Langston looked harried. He held a clipboard and was barking at one of the nurses. Singh crossed the ER toward him. “Hi, Jim. I hear you’re getting sick calls.”

  The other physician handed the clipboard to one of the department clerks. “Send him home. Can you print up a copy of his discharge summary?” He turned to Singh. “Hi, Ajay. Yeah, we’re down two nurses.”

  “Do you think they’re actually sick?”

  “Just scared shitless, I’m betting. Neither of them had contact with any of our known plague cases that I can tell. People are pretty frightened, this being drug-resistant and all.”

  “I know, but with proper protective gear the staff should be at minimal risk. Remember, there didn’t use to be a treatment for HIV, either. It didn’t mean that all health care workers were doomed.” Singh’s voice was persuasive, reassuring, but inside, his gut churned.

  Langston looked dubious. “But HIV isn’t spread by aerosol.”

  “No, it’s not. But at least we know the transmission route for this. It’s not a new bug. Plague’s been around for millennia. We know how it works.”

  Langston snorted. “Tell that to the triage station. They’re the ones who are really calling in sick.”

  Singh glanced across the ER toward the front door, where the triage station was located. Two figures in bunny suits, N95 masks, and face shields quietly interviewed waiting patients.

  Singh knew he had to do it, but that didn’t stop every nerve in his body from threatening complete rebellion. He had to send a message to the troops. He had to let them know he wasn’t afraid. Again, unbidden, the image of his wife and children flashed through his mind, and again, he ruthlessly pushed it away.

  In his most reassuring voice, he said, “Well, I’ll go help them. They need to know that with the right precautions, there is absolutely no risk to health care providers.” And with that, Singh walked across the room.

  Which was just as well, be
cause at that moment, the walk-in doors swung open to yield a man dragging a collapsed woman behind him. She was coughing, bloody spittle flying from her mouth.

  Eleven

  The sun had only just set, and the heat of the day was slowly giving way to a cool mountain night as Mack filled the tank of his county car. A cigarette hung from his lip, burning slowly, but he didn’t pay attention. Neither did the station attendant, who had his nose buried in his iPhone.

  Mack’s eyes were focused on the freeway below, at the stream of tour buses heading back to California, taking home gamblers that had lost their money at the casinos. He counted five buses passing by in the time it took to fill the car’s gas tank. If each of them carried fifty people, then he had just witnessed 250 people breaking a quarantine they knew nothing about.

  Mack screwed on the gas cap, grabbed the receipt from the pump, and stuffed his frame behind the wheel. He drove down the on-ramp and back onto I-80.

  He needed to see Singh. He wanted to ask about personal protective equipment and ventilators. Mack didn’t think Reno had enough ventilators to treat the oncoming epidemic, but he wondered if it was worth worrying about. With a case fatality rate of 100%, you didn’t need a lot of ventilators.

  The freeway was remarkably normal. People went about their business, some driving the speed limit, some not. Mack wondered what all these drivers would think in two days when their city was shut down and they were forced into virtual house arrest.

  And then, Mack had the oddest thought. He had inside information. No one else knew what was coming. He was still healthy. He could pack up and leave, let Nesbitt and the others clean up the mess.

  He smoked quietly in the car, listening to the road noise, thinking about fishing. Yeah, it would be nice to take a fishing vacation right now. Catch some trout. Get back to nature, away from Reno.

  He wasn’t worried about catching bubonic plague out in the wilderness. That didn’t scare him at all. What scared him was this pneumonic shit. That was the real bugger.

  Mack rolled down the window and tossed out the still-burning butt of his cigarette. All the noises of the night surrounded him, the whooshing of the wind, the blast of air as a semi-truck passed, everything clear and cold and somehow beautiful. He absorbed it all.

  And then he rolled up the window, gave a little shrug, and pulled off at the Winston Boulevard exit, turning his car toward Washoe County Medical Center.

  The pager sprang to life, emitting a shrill beep-beep-beep that ripped Susan out of the dark nothingness of sleep and into a brief moment of disoriented confusion. She sat bolt upright in bed.

  Who the hell was paging her? She picked up her phone from the nightstand and groaned. It was 9:30 pm. She had fallen asleep in her robe, and now she was drenched in sweat, her hair still damp from the shower.

  Brian. Memory rushed back to her. For a brief moment, she was tempted to ignore the page, but guilt got the better of her. She hit the pager’s backlight button and read the display.

  It was Ezra. Susan suppressed a flicker of surprise. She couldn’t imagine anything less likely than Ezra Pilpak’s presence at the hospital at 9:30 pm. Susan turned on the light, cursing herself, and dialed.

  “What’s up, Ezra?” she said.

  “You better get down here. They’re coming.” Ezra sounded excited.

  “Who’s coming?”

  “Plague patients. They’re coming out of the woodwork.”

  “What?”

  “Jesus, Susan, wake up!” Ezra sounded exasperated. “We’ve got three cases down here. Maybe four. I’m not kidding. Get down here. I need your help.”

  Susan hesitated a second. “Does Hodis know?”

  “Who do you think I called first? You?”

  “I’ll be there as soon as I can.” She hung up, went to the bathroom, took a look in the mirror, and grimaced. Her eyes were swollen, her long, beautiful hair matted like a stray dog’s coat.

  She brushed her hair until it was neat enough to twist up behind her head, but the eyes—well, there was nothing to be done about that. She looked like she had cried her eyes out, which she had.

  Ah, to hell with it, she thought. She pulled on a pair of scrubs and headed out for her car.

  Twenty minutes later, Susan walked through the ambulance bay doors into the LA County + USC Medical Center ER, and what struck her immediately was that the place was deserted. No nurses, no sheriff’s deputies, no paramedics. None of the people who usually populated the hallway. Susan was astounded. It was the busiest ER in Los Angeles, perhaps in the country, and from what she could tell, there wasn’t a soul in the place.

  “What are you doing?” The shouted question made Susan jump, and she turned to see a nurse in gown and mask running down the hallway toward her. “The ER’s closed. Didn’t you read the sign?”

  “What sign?”

  “The one on the door, for god’s sake. You’ve got to get out of here!” The nurse was now pushing her back toward the ambulance bay. “We’ve got plague here. It’s not safe!”

  Susan pushed back. “I’m the infectious disease resident. I’m supposed to be here.”

  “Not without a mask and gown! It’s airborne!” The nurse was panicking.

  For one strange moment, Susan thought she and the nurse would wind up grappling on the hallway floor, the nurse trying to keep her out, she trying desperately to get in. Susan spoke again. “Doctor Pilpak called me. I’m supposed to be here. Can you get me a gown and mask?” Susan asked.

  The nurse’s eyes were wide and frightened. The paper material of her face mask puffed in and out with her breathing. “I—of course, I’ll get you a mask. I’m sorry. I didn’t know who you were, and they said to keep everyone out, and—there’s three plague patients here and only two isolation rooms, so we had to shut the ER down until we could figure out how to handle the situation.”

  “Where’s Doctor Pilpak?”

  “He’s in C-booth with the other doctors.”

  Susan tried to peek around the corner to the central ER room, where C-booth was, but she couldn’t see. “Can you get me that mask?”

  “Sure, I’ll get it right now. But stay here, OK? They’re saying it’s airborne, and I hear it’s drug-resistant. It’s really bad,” she said, and then she was gone, back down the hallway, to the supply closet.

  Susan waited in the hallway, thinking. Three cases. Maybe a fourth, Ezra had said. There were certainly enough isolation rooms in the hospital to house them all. Why shut down the ER?

  The nurse reappeared with a respirator mask and gown. Susan pulled on both and immediately felt like she was suffocating. N95s were the tightest-fitting masks available, which meant that they were the safest, but they were also the hardest to breathe through.

  Together the two women went to the Critical Booth, or C-booth, a cordoned-off section in the center of the ER, which held three beds and vast quantities of resuscitation equipment. Susan had seen the place on Saturday nights, times when you were likely to find two gunshot victims and a car accident victim being worked on simultaneously. But now, C-booth was empty, except for several doctors huddled together, along with a couple of nurses.

  Ezra Pilpak stood in the center. “Susan!” he said, when he saw her. Like all the people in the room, he wore a mask and gown.

  Susan scanned the room. “Where are the patients?”

  “Two are upstairs in the ICU, in strict respiratory isolation. We’ve got the other two down here in the isolation rooms.”

  “Are they really plague?”

  “Safety pins on Giemsa stain for three. We’re waiting for the fourth.” Ezra replied, referring to the quick dye job the lab performed to look for the safety pin-shaped Yersinia pestis bacterium in the patient’s sputum.

  “Wow,” Susan said. “How sick?”

  “Dying sick. The two upstairs won’t make it through the night. The two down here? I dunno. Depends if it’s drug-resistant.”

  “Why’d they shut down the ER?”

 
“Because the whole staff was exposed.”

  Susan suddenly became aware of the other doctors and nurses in the room. They were watching intently. “How could the whole staff be exposed?”

  “Because they brought the first patient to C-booth. And he coughed all over the goddamn ER.”

  For a moment, Susan didn’t speak. She knew what they undoubtedly knew: Yersinia pestis respiratory droplets could remain infectious in the air for up to an hour.

  The staff was watching her, eyes round and anxious. “We don’t know that this is drug-resistant,” she said. “We’ll have to start antibiotic prophylaxis. And quarantine.”

  “Yes, yes,” said Ezra impatiently. “There’s more.”

  “What?”

  “I just got off the phone with White Memorial Hospital.” The ID fellow’s expression was grave. “They’ve got three cases there, too.”

  One block away at Norris Cancer Center, Alan Wheeler stood outside his son’s hospital room in the immunocompromised host unit, watching him sleep. It was long past visiting hours, but when you were a huge benefactor of the hospital like Alan Wheeler, rules like visiting hours simply didn’t exist.

  Immunocompromised host, Alan thought. What the hell was that? He stood in front of the window, which separated the outside world from the decontaminated room where his son now resided. Jason was immunocompromised, all right. The doctors had blasted out his bone marrow, and now the boy was desperately trying to build a new immune system with cells that Alan had donated. The key, the doctors had said, was to do this before infection overwhelmed Jason’s weakened body. Hence the isolation room. Hence the designation immunocompromised host.

  Jason had spiked a fever. It wasn’t unexpected after a bone marrow transplant, the doctors had said. But worry ate away at Alan’s stomach lining. He knew that a fever meant some sort of infection, which Jason had no immune system to fight.