Crystal Ice

by Warren Miner-Williams

  “Rufus… Rufus listen to me, Rufus…?”

  Suddenly the world outside his head swam into focus once more as he heard Matron Fielding’s voice again. When she shook his arm, he tentatively opened his eyes, all the time anticipating that his headache would get worse.

  “Rufus, hang on love. I’ve got something for your headache. Here, can you sip this? It’s only paracetamol, but it’ll help with the pain and your fever. Come on son.”

  Matron Fielding had put the paracetamol in a 20mL syringe to facilitate its administration to her supine patient. Rufus eagerly swallowed the medicine.

  Although the nebuliser was effective, he could now breathe much more easily and the urge to cough had also subsided. But the pain in his head never abated. Pulsing like the beating of a drum, he physically flinched at its every strike. With bile rising slowly to the back of his throat, Rufus vomited much of the paracetamol into his facemask. Opening his eyes in terror he sought reassurance from those nursing him. As Matron exchanged his nebuliser mask, Nurse Carter wiped the vomit from his mouth.

  “Hang on Rufus,” said Matron Fielding as she mopped his brow with a cool, damp flannel, “we’ll soon get you to the hospital.”

  At that moment two things happened simultaneously. Firstly, one of the jocks on the other side of Ding’s bed began to vomit, and then, as Nurse Carter rushed over to him, the paramedics arrived to transport Rufus to the Ripon Medical Centre, 10 minutes South on Newbury Street.

  Thirty minutes later, after the boys had been transported to the medical centre, the police and the county Medical Examiner, Dr Megan Horoweitz, were in attendance. They asked questions, they took photographs, they took statements from Matron Fielding and Nurse Carter. Then they examined the body of William Bell III. Speaking into a Dictaphone the M.E. described in detail what she saw from the foot of the bed and confirmed with the Ripon College nurses what they had done in their efforts to revive their patient. Finally, she approached the body and looked for evidence to corroborate what Fielding and Carter had said.

  Once the body of Ding had been removed, the two nurses quickly cleaned the sickbay from top to bottom, changing all the bed linen and cleaning every surface with disinfectant. Even though they had opened all the windows, the atmosphere in the sickbay was still heavy with the smell of the cleaning chemicals and vomit. But a thorough spray of lavender air freshener quickly brought the malodorous atmosphere under control.

  ***

  Margaret Evans had trained as a mortuary technician at the Bristol Royal Infirmary, in the West Country of England, before she emigrated to America with her husband Rhys and their two children. Consequently, she was well qualified and had no trouble finding a position as a pathologist’s assistant for the Fond du Lac County Medical Examiner’s Office. Margaret was one third of the team that would perform the autopsy on William Bell III. The other team members were Dr Megan Horoweitz, the ME, and Arthur Hamilton the diener. Arthur was a very tall African-American who had been a diener for almost forty years. At only eighty-five kilos Arthur was slim and athletic, yet he was strong enough to manoeuvre any corpse, regardless of size, that required an autopsy.

  William Bell III at a mere sixty-five kilos presented no problem to the sixty-year-old morgue attendant. Arthur had prepared Ding’s body, along with two others that required dissection that day, thirty minutes before Megan Horoweitz arrived. Once Megan Horoweitz had examined the exterior of the body, Margaret Evans opened the torso, using a large scalpel to make the classic Y-shaped incision. Using electric bone shears, she then cut through the ribs and removed the chest-plate to expose the organs of the thorax. The abdominal organs were also exposed. Using a Rokitansky-style dissection Margaret finally removed the organ block from the torso by cutting the remaining attachments to the pelvic girdle.

  With William’s organs fully dissected out, Dr Megan Horoweitz started her examination. Knowing how this young man died, she first examined the trachea and lungs. The macroscopic appearance of the lungs and trachea showed obvious signs of infection and oedema.

  Once all the organs were examined and tissue samples taken, Margaret replaced all the dissected organs, excluding the brain, back into the abdominal cavity of William before carefully stitching together the Y-incision with a Hagedorn needle and heavy twine.

  And so, on a slab in the morgue, Dr Megan Horoweitz confirmed what Matron Ruth Fielding and Nurse Amy Carter had told her only a few hours before – both lungs of William Bell III were full of pus and interstitial fluid. Quod vide, he died of asphyxia. Dr Horoweitz also noted that Ding had two broken ribs that were consistent with the efforts of the Ripon College medical staff to revive the boy.

  Megan took blood samples for toxicity testing and sent samples of the viscous yellow pus to microbiology. Although she was a scientist and thus never allowed herself to second-guess the lab results, she knew they would confirm the lung infection as being caused by Streptococcus pneumoniae, the common bacteria in pneumococcal pneumonia or Hemophilus influenzae, a secondary bacterial infection resulting from the immune system being compromised by influenza. There was nothing particularly alarming about death of William Bell III, from either bacterial infection, other than the victims of either disease were usually only seen in the very young and the very old. However, the term usually refers to the statistical significance of an event. Statistically more elderly people die of pneumonia than fit people, but that doesn’t mean that they don’t die, it just means that less of them do. So, the death of one fit teenage boy was nothing more than a sad and unfortunate statistical anomaly. But before the day was out another body would arrive at the morgue, another fit teenage boy who hadn’t responded to intravenous antibiotics in critical care and was thus another unfortunate statistical anomaly.

  ***

  Juanita Martinez Rivera, a stocky fifty-seven-year-old, third generation American of Puerto Rican descent, hated her job. She had been a hospital cleaner at the Mercy Medical Centre in Oshkosh for two years, after being made redundant as a school cook. Taking the cleaning job was supposed to be just temporary until she found another cooking position. However, without any formal qualifications she had been rejected in every one of the one hundred and twenty catering positions she had applied for since losing her previous job. She had thought of herself as a skilled worker, yet now she was doing one of the most unskilled and demeaning jobs in the hospital. She was tired of cleaning up blood, urine and excrement; she was fed up with being ordered here, there and everywhere by a supervisor half her own age. It seemed that she was on the lowest rung of the ‘respect ladder’. Invisible to doctors, yet ordered around by both nurses and patients, she was expected to be at everyone’s beck and call without complaint. She earned a pittance for long hours away from her family, in a hospital one hour’s bus journey from home. Juanita hated the job even more because she could see no way out of it.

  Someone on Ward 56, the geriatric ward, had reached the toilet too late and had defecated on the floor. It was diarrhoea and stank terribly. Juanita was now expected to clean it up without complaint, just like the vomit she had just cleaned up on Ward 52, the orthopaedic ward. Even though she had been cleaning up similar stuff for two years, she never got used to it. Juanita always carried at least six cans of air freshener on her cleaning cart and used it liberally wherever she went. Sometimes she would even spray her paper facemask with air freshener to alleviate the worst odours.

  This diarrhoea was of the worst kind, and even with a paper mask sprayed with lavender, the evil-smelling liquid made her retch as she mopped it up. Juanita needed another job. Badly.

  23. An Epidemic

  In October 2003, an epidemic of influenza in chickens spread through many countries in South East Asia, in particular Cambodia, Vietnam, Thailand, parts of China, and Japan. The virus was a type A, H5N1. The haemagglutinin H5 molecule is common among bird viruses, but not in human influenza viruses. The human population has no immunity against the H5 variant and in the few human cases where it has
been detected the mortality is extremely high. In the majority of these cases human infection is directly from diseased birds and not from contact with other infected humans.

  At the Institute of Immunology in Zagreb, Frančiška Ribič had isolated a new strain of bird flu with the H5N3 subtype and compared it with a 1995 Beijing variant H1N1. Having re-assorted the genes she had created a H5N1 subtype which had the potential to be deadly to humans. Having already reconstructed the 1918 Spanish flu, which killed millions at the end of World War I, she wondered which virus was the most potent? She considered that if the two variants were mixed together the virus mixture would be like a double-edged sword –unless a vaccine was developed for both strains the potency of the bio-weapon would remain the same and just as deadly. When Frančiška passed the infected eggs on to her brother-in-law, Goran Sumovich, they contained the two flu viruses.

  ***

  Dr Ellen Augustein was a disease co-ordinator at the Centres for Disease Control and Prevention, (CDC), in Atlanta, Georgia. It was her job to collate the statistics for deaths, from any disease, that were reported to the CDC from healthcare providers across the whole United States. Using such data gathered over a period of time it is possible to develop an epidemiological evaluation; most importantly, whether or not a disease outbreak has occurred, and secondly, the rate of spread of an outbreak. Both of these factors can then be compared to the spread of disease in previous years, pinpointing the origin of the outbreak. Such a study can be used to differentiate between a natural outbreak of a disease and an intentional bio-terrorist attack. In most naturally occurring outbreaks, the number of cases increases exponentially as people who have contracted the disease come into contact with others in the population; as one person infects two and two infects four, and so on. If the number of cases doubles twenty times, there will be over one million people infected. In reality the process is more complex, as one contagious person may infect fifty others, whereas another sufferer may not pass the infection on to anyone at all. In a bio-terrorist attack the biological contagion usually starts from a single point and infects a large number of people all at the same time. However, the development of a statistical map is not definitive evidence of a biological weapon and must be corroborated by other atypical phenomena such as; a disease that is unusual for a given geographic location or outside the normal infective season. The reliable interpretation of epidemiological evidence to differentiate between a natural outbreak and a bio-terrorist attack requires great skill and a large pool of data.

  Following any routine autopsy a final report must be completed within thirty days, however, pathologists are notorious for their tardiness and a final report may be delayed by many months. Ellen Augustein was thus reliant on medical examiners all around the country to supply her with appropriate data, so any delays in reporting their findings to the CDC meant that a clear picture of the spread of any disease, and its origin, would not be revealed for precious weeks, or even months, after its emergence. To complicate matters, influenza was a naturally occurring disease and the incidence of fatalities would not be unusual during an influenza season. Ellen had only a few reports so far: the death of a boy undergoing treatment for a brain tumour, an eighty-one-year-old female in an old folks’ home and a seventeen-year-old student with a previous clinical history of asthma. There was nothing unusual in any of those reports. In each case the strain of influenza had not been determined because smaller medical centres did not have access to a modern virology lab that could identify the different strains of the influenza virus. They would either send them onto a large pathology laboratory in another city or not bother at all. That too was not unusual, because although influenza is a disease that had to be reported to the CDC, many patients died of pneumonia that resulted from secondary bacterial infections. Thus, a number of medical examiners would state that the cause of death was pneumonia not mentioning influenza at all.

  When Ellen Augustein looked at the data collected over the weekend, she was not alarmed by the reports, just frustrated by the obvious gaps in the information supplied. Deaths from influenza were nothing to be alarmed about, they happened all the time. In the U.S. despite annual vaccinations, influenza causes nearly 36,000 deaths and more than 200,000 hospitalisations each year. As a result, alarm bells would only ring when Ellen Augustein found large numbers of victims in specific clusters. Ellen highlighted the blank spaces on the report templates that had been sent through and instructed her technician to follow up on the reports the next week. Unbeknown to her, such a delay would mean that many hundreds of people would die as a result of the growing epidemic before any action could be taken.

  ***

  At the Milwaukee Greyhound Bus Terminal on James Lovell Street, Mariah Toombs pushed her cleaning trolley into the gent’s toilet and put the no entry sign across the entrance so she could clean the facilities in peace. She had worked as a cleaner in the bus station for over twenty years and had experienced it all, from men flashing her in the gents to a woman giving birth in a cubicle in the ladies. As a member of the Milwaukee Revival Church Choir, the good Lord had provided her with a job and she was grateful for cash in her pocket and a bright future for her three boys. The only thing she disliked about her job was ignorant folk cursing her for this, that and whatever. But Mariah had the most disarming smile and won over most of her difficult customers. Her toilets were always immaculately clean. Whilst many people avoided public toilets in the city, her facilities were the exception. There were no drug addicts shooting up, nor pickpockets preying on the innocent, because everyone knew that they would have to face Mariah Toombs, and she wouldn’t tolerate any ‘improper behaviour,’ as she called it. The cops in the bus station and those on general patrol in the area always stopped at Mariah’s little storeroom for a coffee and an update on the ‘improper behaviour’ that she had observed. Everyone loved Mariah. Though she declared her age was fifty, she had remained at that age for the last ten years. Standing at 1.6 metres tall, and with the figure of a thirty-year-old, she did look fifty. Her facial features, her eyes, nose and mouth were subtle, as if they had been delicately carved from Egyptian ebony. Her raven-coloured hair, the responsibility of her daughter-in-law, was always carefully plaited and finished with brightly coloured beads. Mariah was an intelligent woman who could easily have finished her High School Diploma if she hadn’t had to leave school to look after her alcoholic mother. When her mother was ‘promoted to glory,’ as Mariah liked to describe dying, she was already pregnant with her first child and so returning to school was not an option. However, Mariah never looked back at her life and said what if, because she was always so thankful for what the Lord had provided for her. She believed that life was what it was for a purpose, she was grateful for her boys and how they had worked hard at school and progressed to college. She was thankful that they had achieved so much when they had been raised with so few privileges. What ifs, were for losers and quitters and Mariah was neither of those. Her only regret was not having a good man of her own at home. She had loved and been loved, but that had died during the war in Vietnam. Earl Stoddart had been a rogue and into all kinds of shady dealing, but he was kind and gentle to Mariah and her first love. Earl died in Binh Duong on July 18th 1968, a ground casualty on his 54th day in Vietnam. When what was left of him came home Mariah had grieved, but only in private. Earl may have been dead but he would never be forgotten. When Mariah and her beloved boys visited the Vietnam Memorial Wall in Washington, DC, they found Earl’s name carved in the black stone and honoured him with their tears. He was just one of 2,933 from the State of Illinois who had died and one of over 58000 who had died in that conflict.

  It was twelve o’clock and Mariah quickly finished cleaning the gent’s toilet because of the midday rush, when the terminus would be full of buses travelling to destinations all across the North-Eastern States of America. She quickly gave the atmosphere a good squirt of lavender to freshen up the air, before she exited the facilities and removed the cleaning si
gn. There was even a queue of gentlemen waiting as she turned towards her storeroom and the cup of tea, she had promised herself.

  ***

  By the time Paul Miller fell ill at Ripon College, over half of the Red Hawks Football team had succumbed to the disease. Since the death of William Bell III, everyone who fell ill was transported directly to Ripon Medical Centre. Paul, the Red Hawk quarterback, was very fit and had withstood the onset of the influenza better than anyone else, but when he fell over in his room the night after Ding died, he was already dying. That brought the total to 47 students who had contracted the disease and five who had already died.

  At Ripon College panic set in as every student rang home and relayed the news that some killer bug was on the rampage. In hurried telephone conversations the number of dead had tripled and students were “dropping like flies.” Before the CDC could intervene, parents took their children out of the college in a vain attempt to keep them safe from the disease. With the mass exodus of students to homes all across the North Eastern States of America, the virus went with them. So, what was initially a point source of the disease, that might have been contained became a CDC nightmare, involving many potential carriers of the disease in nine separate states, from Minnesota in the West to New York in the East.