The first physician to see her was a young resident most of the way through his first year of post-graduate study in internal medicine, doing his ER rotation and liking it.
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“What’s the problem?” he asked, as the nursing staff went to work, checking pulse, blood pressure, and respiration.
“Here,” the woman from admissions said, handing over the paper forms. The physician scanned them.
“Flu symptoms, looks like, but what’s this?”
“Heart rate is one twenty, BP is–wait a minute.” The nurse ran it again. “Blood pressure is ninety over fifty?” She looked much too normal for that.
The doctor was unbuttoning the woman’s blouse. And there it was. The clarity of the moment made passages from his textbooks leap into his mind. The young resident held up his hands.
“Everybody, stop what you’re doing. We may have a major problem here. I want everybody regloved, everybody masked, right now.”
“Temp is one-oh-four-point-four,” another nurse said, stepping back from the patient.
“This isn’t flu. We have a major internal bleed, and those are petechiae.” The resident got a mask and changed gloves as he spoke. “Get Dr. Quinn over here.”
A nurse trotted out, while the resident looked again at the admission papers. Might be vomiting blood, darkened stool. Depressed blood pressure, high fever, and subcutaneous bleeding. But this was Chicago, his mind protested. He got a needle.
“Everybody stay clear, okay, nobody get close to my hands and arms,” he said, slipping the needle into the vein, then drawing four 5cc tubes.
“What gives?” Dr. Joe Quinn asked. The resident recited the symptoms, and posed his own question as he moved the blood tubes onto a table.
“What do you think, Joe?”
“If we were somewhere else . ..”
“Yeah. Hemorrhagic fever, if that’s possible.”
“Anybody ask her where she’s been?” Quinn asked.
“No, Doctor,” the admissions clerk replied.
“Cold packs,” the head nurse said, handing over an armload of them. These went under the armpits, under the neck, and elsewhere to bleed off the body’s potentially lethal heat.
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“Dilantin?” Quinn wondered.
“She’s not convulsing yet. Hell.” The chief resident took out his surgical scissors and cut off the patient’s bra. There were more petechiae forming on her torso. “We have a very sick lady here. Nurse, call Dr. Klein in infectious disease. He’ll be at home now. Tell him we need him here at once. We have to get her temp down, wake her up, and find out where the hell she’s been.”
47
INDEX CASE
MARK KLEIN WAS A FULL professor at the medical school, and therefore a man accustomed to regular working hours. Getting called in at almost nine in the evening wasn’t the usual thing for him, but he was a physician, and when called, he went. It was a twenty-minute drive on this Monday night to his reserved parking space. He walked through the security staff with a nod, changed into scrubs, came into the emergency room from the back, and asked the charge nurse where Quinn was.
“Isolation Two, Doctor.”
He was there in twenty seconds, and stopped cold when he saw the warning signs posted on the door. Okay, he thought, donning a mask and gloves, then walking in.
“Hi, Joe.”
“I don’t want to make this call without you, Professor,” Quinn said quietly, handing the chart over.
Klein scanned it, then his brain stopped cold, and he started from the beginning, looking up to compare the patient with the data. Female Caucasian, yes, age forty-one, about right, divorced, that was her business, apartment about two miles away, fine, temperature on admission 104.4, pretty damn high, BP, that was awfully low. Petechiae?
“Let me take a look here,” Klein said. The patient was coming around. The head was moving a little, and she was making some noise. “What’s her temp now?”
“One-oh-two-two, coming down nicely,” the admitting resident replied, as Klein pulled the green sheet back. The patient was nude now, and the marks could hardly have been more plain on her otherwise very fair skin. Klein looked at the other doctors.
“Where’s she been?”
“We don’t know,” Quinn admitted. “We looked
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through her purse. It seems she’s an executive with Sears, office over in the tower.”
“Have you examined her?”
“Yes, Doctor,” Quinn and the younger resident said together.
“Animal bites?” Klein asked.
“None. No evidence of needles, nothing unusual at all. She’s clean.”
“I’m calling it possible hemorrhagic fever, method of transmission unknown for now. I want her upstairs, total isolation, full precautions. I want this room scrubbed– everything she touched.”
“I thought these viruses only passed–”
“Nobody knows, Doctor, and things I can’t explain scare me. I’ve been to Africa. I’ve seen Lassa and Q fever. Haven’t seen Ebola. But what she has looks a hell of a lot like one of those,” Klein said, speaking those awful names for the first time.
“But how–”
“When you don’t know, it means you don’t know,” Professor Klein said to the resident. “For infectious diseases, if you do not know the means of transmission, you assume the worst. The worst case is aerosol, and that’s how this patient will be handled. Let’s get her moved up to my unit. Everybody who’s been in contact with her, I want you to scrub down. Like AIDS or hepatitis. Full precautions,” he emphasized again. “Where’s the blood you drew?”
“Right there.” The admitting physician pointed to a red plastic container.
“What’s next?” Quinn asked.
“We get a sample off to Atlanta, but I think I’m going to take a look myself.” Klein had a superb laboratory in which he worked every day, mainly on AIDS, which was his passion.
“Can I come with you?” Quinn asked. “I go off duty in a few minutes anyway.” Monday was usually a quiet day for emergency rooms. Their hectic time was generally weekends.
“Sure.”
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“I KNEW HOLTZMAN would come through for me,” Arnie said. He was having a drink to celebrate, as the 747 began its descent into Sacramento.
“What?” the President asked.
“Bob’s a tough son of a bitch, but he’s an honest son of a bitch. That also means that he will honestly burn you at the stake if he thinks you have it coming. Always remember that,” the chief of staff advised.
“Donner and Plumber lied,” Jack said aloud. “Damn.”
“Everybody lies, Jack. Even you. It’s a question of context. Some lies are designed to protect the truth. Some lies are designed to conceal it. Some are designed to deny it. And some lies happen because nobody gives a damn.”
“And what happened here?”
“A combination, Mr. President. Ed Kealty wanted ’em to ambush you for him, and he suckered them. But I got that treacherous bastard for you. I’ll bet that tomorrow there will be a front-page article in the Post exposing Kealty as the guy who suborned two very senior reporters, and the press will turn on him like a pack of wolves.” The reporters riding in the back of the plane were already buzzing about it. Arnie had seen to it that the NBC news tape had run on the cabin video system.
“Because he’s the one who made them look bad . . .”
“You got it, boss,” van Damm confirmed, tossing off the remainder of his drink. He couldn’t add that it might not have happened without the attack on Katie Ryan. Even reporters felt sympathy on occasion, which might have been decisive in Plumber’s change of heart on the matter. But he was the one who’d made the carefully measured leaks to Bob Holtzman. He decided that he’d have a Secret Service agent find him a good cigar once they got on the ground. He felt like having one right now.
ADLER’S BODY CLOCK was totally confused now. He found that catching cat-naps helped, and it also helped at the message he was delivering was a simple and fa-able one. The car stopped. A minor official opened the
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door for him and bowed curtly. Adler stifled a yawn as he walked into the ministry building.
“So good to see you again,” the PRC Foreign Minister said, through his interpreter. Zhang Han San was there again, too, and made his own greeting.
“Your gracious agreement to allow direct flights certainly makes the process easier for me. Thank you for that,” SecState replied, taking his seat.
“Just so you understand that these are exceptional circumstances,” the Foreign Minister observed.
“Of course.”
“What news do you bring us from our wayward cousins?”
“They are entirely willing to match your reductions in activity, with an eye toward reducing tension.”
“And their insulting accusations?”
“Minister, that issue never arose. I believe that they are as interested as you in returning to peaceful circumstances.”
“How good of them,” Zhang commented. “They initiate hostilities, shoot down two of our aircraft, damage one of their own airliners, kill over a hundred people, whether by deliberate act or by incompetence, and then they say that they will match us in reducing provocative acts. I hope your government appreciates the forbearance we are showing here.”