by Rob Horner
Bitsy flashed a crooked smile up at her while the poster child for anorexia sniffed and turned away, and Carolyn thought that was all right. Even as Bitsy gushed about how the plane couldn’t be a whale because whales don’t eat out of the sides of their heads, she thought that was all right too.
Boarding went by in a flash and Carolyn only had to shush Bitsy once during the explanation of the safety rules. Do people really not know how to buckle a seatbelt, Mommy? Look, I can buckle my own belt and I’m only six. Then it was sit back and let her daughter’s soft voice roll through various waves of excitement as the plane’s engines revved up and it began to trundle down the runway, picking up speed.
“Wow, look down there, Mommy!” Bitsy grabbed at her elbow as the plane climbed, gaining altitude and banking at the same time, pointing its nose west to the land of the gold rush and the actors with the golden smiles, where everyone pissed silver and farted rainbows, as Austin liked to say.
Carolyn looked across her daughter and out the right-side window. A plume of blue-black smoke rose from some big, industrial-looking building on the outskirts of Atlanta. It pulsed as it rose, like there was a broad-shouldered blacksmith down there working a bellows to make it hotter, get the smoke higher. But it only rose so high before it started breaking off, little trails of dusky mist the color of moth ash spreading out in every direction, with most of it blowing back over the city. Other passengers noticed it too, and words slid past her like invisible bugs carried on the processed and recycled air inside the cabin.
Where is that?
What happened?
Looks like a hospital.
I’ve seen that place before.
And then the view was gone, replaced by highway and fields. Cars and trucks became ants that became specks of dust, until the view was obscured by lacy white tendrils as the plane rose into the clouds. Once cruising altitude was reached, the Captain turned off the Fasten Seatbelt sign. Bitsy soon ran out of questions about the interior of the plane—What if I have to go to the bathroom? Where does the pee go? My friend, Allison? She said the plane flushes its big toilet while it’s in the air, and little yellow icicles fall out of the sky. Is that true? What is this magazine? I’ve never seen it before. Look at all the stuff in here. Can I have a swyflatter…um…flyswatter that keeps score of my…um…swings and misses?—and relaxed into her seat, lulled by the low roar of the engines and the minute shifting that occurred as the plane responded to the air currents outside. She could always count on Bitsy to nap in the car. Why should a plane be any different?
Forty-five minutes later she was jarred awake by another passenger hurrying down the aisle, half-doubled over and walking with the squeezed-cheek gait specifically reserved for those who are seconds away from a colon cleansing and are only holding it back by sheer willpower and maximus gluteus clenchimus. The unfortunate man issued a series of groans with each step, a wordless utterance that found strange echoes all around the plane. Across the aisle, an older woman dressed in floppy hat finery, no doubt on a trip to find that elusive groove again, suddenly folded herself in half at the waist, banging the seat in front of her with her head while sounds like the punishing pangs of childbirth tore out of her throat. A younger black woman with the window seat beside the old lady in the hat began yelling for the stewardess, despite that the term was no longer a politically correct way to refer to the ladies of the sky. More sounds of pain came from in front of and behind her, male voices as well as female, and as a haggard-looking flight attendant came down the aisle, responding to the call of the black lady, all Carolyn could think of to ask was Did they eat the peanuts?
She never got the chance to voice her question. Before the flight attendant reached them, she was also struck by a sudden wrenching abdominal pain, her uniformed arms crossing over her middle as a gasp rushed out of her, sounding for all the world like someone had sucker-punched her in the gut. She sank to one knee in the aisle, then was bowled over sideways as another man suddenly jumped up out of his seat, making a beeline for the nearest lavatory. He’s gonna crap his pants if he tries for the same bathroom, Carolyn thought.
It would almost be funny if the people didn’t appear to be in such pain. A dozen passengers all struck by a case of the Hoppin’ Trots, as her mom used to call it.
When Bitsy groaned in her sleep, all traces of humor left Carolyn. One look at her little girl said that maybe this wasn’t related to the food after all, since Bitsy had already been asleep when the snack cart came by. I ate the peanuts though, Carolyn thought idly, unbuckling her seatbelt so she could try to comfort her daughter. As she reached for her, Bitsy’s eyes came open, torn out of sleep by a pain in her stomach she didn’t have the words to describe. Howling, she leaned forward as far as she could.
“Can’t you keep that brat quiet?” someone snapped from the seat in front of them. Carolyn looked up and into the face of the same rude bitch with the pinched mouth from the tarmac, makeup and hair still perfect despite having just been awoken.
There was a reply on her lips just waiting to come out. Something cutting that would either put the heartless woman in her place or guarantee a girl-fight once they got off the plane. And wouldn’t she be surprised then, when Carolyn busted out the Krav Maga she’d been practicing for five years? Her hair wouldn’t look perfect after that!
But that’s when Bitsy suddenly unfolded, lurching back in her seat as a blast of vomit erupted out of her mouth, not arcing up and out like a fountain but shooting straight ahead like a firehose, striking the skeleton-thin, kid-hater straight in her Fuck Me made-up face. Carolyn had no time to think of the irony, no capacity to appreciate the perfect aim or wonder at the appropriateness of the saying Out of the mouth of babes.
There was blood in Bitsy’s vomit.
On average there were 2,700 flights arriving and departing from the Atlanta International Airport on a daily basis, providing service to more than a quarter-million people, making it the busiest airport in the world. In the hour during which the smoke rose from an unnamed building on Atlanta’s south side, 108 planes landed or took off, picking up or discharging more than 10,000 passengers with destinations as varied as San Diego, Chicago, Portland, Dubai, London, and Tokyo.
The smoke rose to a height of about 5,000 feet, where the weight and temperature of the particulate matter inside of it precluded it from rising any higher. Instead it caught the winds, swirling and dispersing to the north and west. As the particulate spread out, its virility didn’t diminish. Eventually all the microscopic matter would fall back to earth, unable to maintain an airborne state without a propulsive means. How long it took it to fall was the great variable. Air currents around Atlanta flowed east and north, with the stronger winds carrying matter only slightly heavier than a molecule of air hundreds of miles.
It was a stable creation, able to survive in the air or on any surface it touched for several weeks, almost as hard to eradicate as a prion, which was one of the goals established during its conception. Also like a prion, though unintended by its creators, its primary target was brain tissue. Unlike a prion, it affected every system within an infected host. Also unique to this creation, it worked well with others of its kind, multiplying its virility by a factor of the number of particulates infecting any individual person.
In other words, the more you got, the faster it worked.
And it didn’t die right away. Particles blown north and east into South Carolina, North Carolina, and Virginia might survive for weeks on a tree branch, though typically only a few hours would pass before a new gust rattled limbs and sent the particle on another journey. In summer, people weren’t quite as fastidious about washing their hands after every contact with another person, or with a handrail on the outdoor staircase of a public building. They might not get sick as fast, only being exposed to a single molecule, but the infection would still spread.
The men and women working in the unnamed building died within minutes of the explosion, though only three were in the a
ctual lab where the accident took place. The other forty-six personnel died without a mark on them. No one made it out of the building.
The firefighters and other heroic first-responders lasted an hour. Even as the fire was dying and Austin felt the first pangs of pain rocketing through his innards, all ten firefighters collapsed, blood pouring from the corners of their eyes, nose, mouths, genitals and rectums. Internal bleeding was widespread and led to rapid death. The second group on-scene also arrived in fire trucks and ambulances, but with strange markings on the vehicles. They wore bulky, full-body suits of some material that crinkled with every step. Thin and pliable face shields made from some clear plastic showed features hardened by circumstance and experience. The backs of their suits bulged strangely, full oxygen tanks carried under the suit in order to minimize the risk of any remaining particulate invading the connections between hoses and tank.
With the wind blowing the wisps of smoke north and east, the airport remained in the area of fallout for another three hours, during which time another thirty thousand passengers were exposed to a thinned-out version of what the people in the first hour received just by stepping outside. The airport’s ventilation systems and in-line filters kept the heavy particulate out, cleansing it from the air it pulled through the intakes, but couldn’t prevent what every passenger, counter salesclerk, luggage handler, airplane mechanic, flight crew, Uber, Lyft, and taxi driver, automobile rental counter person and TSA security screener brought in on their clothes or luggage during the three hour period of time.
The initial explosion projected particles in a wide circle, dispersing them to the west into Alabama as well as north into Tennessee, a huge radius even before the wind currents were factored in, making the total area directly affected by this explosion larger than any previously-recorded fallout ranges from decades of nuclear testing. The true nature of the spread wouldn’t be known for days, as even more particles rode the Jetstream toward the east coast.
By 7 pm, the hospitals around Atlanta and those in the initial fallout radius—Grady, Emory, Higgins, Floyd, Piedmont—were overrun with a surge of patients complaining of wrenching abdominal pain, often accompanied by explosive bloody vomit and diarrhea. Blood work was collected, stool samples bagged and sent off for study, and antibiotics prescribed, because the healthcare providers invariably saw this as a strangely virulent form of Clostridium difficile, a nasty bacterium that lives in the gut of most infants and about three percent of adults. It didn’t usually cause problems until something happened that either lowered the immune system or reduced the numbers of good gut bacteria to such an extent that it could overgrow. The CDC called Clostridium difficile a major health threat because it accounted for more than a half-million infections in 2015 alone. Typical symptoms included abdominal pain, nausea, fever, and frequent, often uncontrollable, diarrhea. The patients came in groups, which made sense; Clostridium difficile often infected entire households, though usually a family could point to the person who got sick first.
Many of the patients felt better within hours--whether from antibiotic treatment or because their bodies managed to successfully drive the infection back--and were sent home. Others weren’t so lucky, their body systems shutting down as the infection went systemic, throwing them into a shock state and earning them a stretcher ride up to Intensive Care. Overworked and unprepared for the rush of patients, no one noticed the blessing of the healthy.
Those who came in healthy stayed that way. Family members, caregivers, or friends, it didn’t matter. For an infection that generally had no natural resistance, it just…skipped some people. The hospital workers were also spared. No one developed any symptoms no matter how often they had to change linens or wipe a corpulent backside—though one Nurses’ Aide had to go shower after an eighty-year-old woman sprayed her in the face with enough foul-smelling butt-juice to paint a barn wall. Seriously, who in their right mind trusts a fart when you have diarrhea?
Theories abounded, everything from contaminated drinking water to food poisoning from a potluck. There was a logic behind both, because the victims all shared a commonality, noticeable in every hospital, whether in a big city or a small community. They came in groups, and they had spent time together outside that afternoon.
Higgins Hospital personnel chalked it up to an interfaith softball tournament and picnic. Floyd workers assumed it was the water, because every year, it seemed, they had to subsist off bottled water or boil everything that came out of the tap due to aging waste equipment. The news channels carried nothing about it, so it must be a local problem. Hospitals not owned by the same company don’t often communicate with each other, unless it was a small band-aid station trying to transfer a patient for specialized care, so there was no real comparing of notes.
That would change when more people started dying.
Chapter 4
Set just a few miles away from the Outlet Mall, in the heart of Gaffney, South Carolina, was a small hospital with a big name. The Cherokee Upstate Regional Medical Center boasted a 16-bed emergency department, 48 inpatient beds, and a 12-bed ICU. Their radiology department featured X-Ray, two CT scanners, and an MRI unit, with an attached office for an in-house radiologist so the doctors didn’t have wait for their images to be read. The hospital also had two full operating suites, a women’s birthing center, and two local orthopedic surgeons who would come see patients in the ED if an injury required. At least, those were the specifications on paper.
Between 2005 and 2019, the hospital changed ownership three times. Contracts for staffing were traded amongst provider partnerships like a fruitcake at Christmas, passed from group to group, just something thrown on to “sweeten the deal.” Over-spending by some departments led to cuts in other places, so the radiologist’s office sat dark and unattended, and all films, scans, and MRIs were read by a group operating out of Tennessee. The birthing center was closed and shuttered; women with pregnancy-related problems were shipped to Spartanburg Regional Hospital. The orthopedic surgeons remained in town, but the operating suites were only staffed on an as-needed basis. The Medical-Surgical in-patient floor carried enough staff to keep 24 rooms opened, and the ICU routinely staffed for 6 beds. If more patients required intensive care, nurses would be moved from Med-Surg to cover, leaving fewer rooms available overall. A single Med-Surg nurse could take care of six beds in a pinch, but more than two ICU patients was considered an unsafe practice.
Administration chalked it up to a “nationwide nursing shortage” which didn’t make sense to the employees, because there were almost a dozen schools within fifty miles graduating new nurses every six months. What everyone knew but didn’t want to say—at least not too loudly—was that the hospital was in a decline brought on not only by operational mismanagement, but also by an increasing population of patients who believed they didn’t have to pay anything to get everything they wanted, and a Medicaid system that didn’t pay enough to cover the costs of treating them. Expectation-management and community education were desperately needed, but the administrators weren’t brave enough to address those issues. Instead they cut costs where they could and tried to manage the decline, hoping to protect their own retirements, rather than attempt to bring the hospital back into the black.
Despite these limitations, CURMC cultivated a group of enthusiastic and experienced emergency department providers and nurses. When you’re forced to do more with less, you learn to be creative in the application of medicine, finding solutions outside the accepted norm which often prove more efficient and more cost-effective in the long run.
The emergency department was shaped like the deck of a boat, or like a bullet cut in half, rounded on one end, then straight down the sides and flat at the back. The rounded portion was the entrance and lobby, where registration and the small triage room were located. Along the right side were rooms climbing up in numbers from one to nine. Nine was the “female” room, with a bed fitted with stirrups for pelvic exams and a private bathroom. The backside of the E
D contained a storage room, the staff break room, and a staff restroom (There were patient bathrooms up near the triage area.) Coming back up the left side were rooms ten through fourteen. Ten was the psychiatric room. The walls weren’t padded but the door locked from the outside, and there was a lot less equipment inside, which made it easy to clear out when a potentially suicidal person needed to be protected from him (or her) self. Rooms twelve and thirteen were the large trauma bays, called Trauma One and Two. There was no room numbered “twelve,” and you’d never find a room thirteen in an emergency department, for the same superstitious reason that you won’t find a thirteenth floor in a hotel. Past the trauma rooms was the emergency entrance with a driveway for ambulances and other government vehicles. Then came room fourteen, and you were back at the registration desk.
Bisecting the center of the ward was the nurses’ station, which is also where the providers sat and worked. And across the desk were rooms fifteen and sixteen, treated like any other room for the most part, but placed where they were in case a patient required constant supervision, like an older man with a broken hip and dementia, who doesn’t understand why he can’t get out of bed any time he wants to.
At the time when Buck Davis was slipping his truck into park just outside the sliding glass doors of the emergency department, just such a patient was in residence in room sixteen, but we’ll get to him in a minute.
It was five p.m. on a Saturday, a time of relative peace in the small ED. (Never say the words quiet, slow, or boring in relation to current conditions in an emergency department, unless you want to find out how angry a nurse can become.) The sky outside was clear, bright, and warm. Though the department was fully-staffed—one of the few days on the current schedule—the nurses were enjoying a day of one or two patients at a time, rather than three or four. The psych room was empty, and most of the drug-seekers seemed to be taking the day off. It was a time for picnics and baseball, not EKGs and X-Rays. That would change as afternoon rolled into evening. But that would be night-shift’s problem.