Outbreak (12 page)

The operator woke Marissa at seven o'clock. As she showered and dressed, she realized that her anger toward Dubchek had dissipated.  After all, he was under a lot of stress. If Ebola raged out of control, it was his neck on the line, not hers.

When she arrived back at the isolation ward, one of the CDC lab techs told her that Dubchek had gone back to the hotel at 5:00 A.M. He didn't know where either Vreeland or Layne was.

At the nurses' station things were a bit chaotic. Five more patients had been admitted during the night with a presumptive diagnosis of Ebola Hemorrhagic Fever. Marissa collected the charts, but as she stacked them in order, she realized that Zabriski's was missing. She asked the day nurse where it was.

"Dr. Zabriski died just after four this morning."

Although she'd expected it, Marissa was still upset. Unconsciously, she had been hoping for a miracle. She sat down and put her face in her hands. After a moment she forced herself to go over the new charts. It was easier to keep busy. Without meaning to, she caught herself touching her neck for swelling. There was an area of tenderness. Could it be a swollen lymph node?

She was pleased to be interrupted by Dr. Layne, the Director of the CDC's Hospital Infectious Disease Program. It was obvious from the dark circles under his eyes, his drawn face and the stubble on his chin that he had pulled an "all-nighter." She smiled, liking his slightly heavyset, rumpled looks. He reminded her of a retired football player. He sat down wearily, massaging his temples.

"Looks like this is going to be just as bad as L.A.," he said. "We have another patient on the way up and another in the ER."

"I've just started looking at the new charts," said Marissa, suddenly feeling guilty for having left the night before.

"Well, I can tell you one thing," said Dr. Layne. "All the new patients seem to have gotten their disease from the hospital. That's what bothers me so much."

"Are they all patients of Dr. Zabriski's?" asked Marissa.

"Those are," said Dr. Layne, pointing at the charts in front of Marissa. "They all saw Zabriski recently. He apparently inoculated them during his examinations. The new cases are both Dr. Cester's patients. He'd been the anesthesiologist when they had surgery during the last ten days.

"What about Dr. Cester?" asked Marissa. "Do you think that he contracted the disease the same way that Dr. Zabriski did?"

Dr. Layne shook his head. "Nope. I talked at length with the man, and I found out that he and Zabriski were tennis partners."

Marissa nodded. "But would such contact count?"

"About three days before Dr. Zabriski became ill, Dr. Cester borrowed his towel between sets. I think that's what did it. Transmission seems to depend on actual contact with body fluids. I think Zabriski is another index case, just like Dr. Richter."

Marissa felt stupid. She had stopped questioning Dr. Cester just one question short of learning a crucial fact. She hoped that she wouldn't make the same mistake again.

"If we only knew how the Ebola got into the hospital in the first place," said Dr. Layne rhetorically.

Dubchek, looking tired but clean-shaven and as carefully dressed as always, arrived at the nurses' station. Marissa was surprised to see him. If he'd left at five, he'd hardly had time to shower and change, much less get any sleep.

Before Dubchek could get involved in a conversation with Layne, Marissa quickly told both doctors that Zabriski had attended the same San Diego medical conference as Richter had and that they had stayed in the same hotel.

"It's too long ago to be significant," Dubchek said dogmatically. "That conference was over six weeks ago."

"But it appears to be the only association between the two doctors," protested Marissa. "I think I should follow up on it."

"Suit yourself," said Dubchek. "Meanwhile, I'd like you to go down to pathology and make sure they take every precaution when they post Zabriski this morning. And tell them that we want quick-frozen samples of liver, heart, brain and spleen for viral isolation."

"What about kidney?" interjected Layne.

"Yeah, kidney, too," said Dubchek.

Marissa went off feeling like an errand girl. She wondered if she would ever regain Dubchek's respect, then remembering why she'd lost it, her depression was wiped out by a surge of anger.

In pathology, a busy place at that time of day, Marissa was directed to the autopsy rooms, where she knew she'd find Dr. Rand. Remembering his pompous, overbearing manner, she was not looking forward to talking with him.

The autopsy rooms were constructed of white tile and gleaming stainless steel. There was a pervading aroma of formalin that made Marissa's eyes water. One of the technicians told her that Zabriski's post was scheduled for room three. "If you intend to go, you have to suit up. It's a dirty case."

With her general fear of catching Ebola, Marissa was more than happy to comply. When she entered the room, she found Dr. Rand just about to begin. He looked up from the table of horrific tools. Dr.

Zabriski's body was still enclosed in a large, clear plastic bag. His body was a pasty white on the top, a livid purple on the bottom.

"Hi!" said Marissa brightly. She decided that she might as well be cheerful. Receiving no answer, she conveyed the CDC's requests to the pathologist, who agreed to supply the samples. Marissa then suggested the use of goggles. "A number of cases both here and in L.A. were apparently infected through the conjunctival membrane," she explained.

Dr. Rand grunted, then disappeared. When he returned he was wearing a pair of plastic goggles. Without saying anything he handed a pair to Marissa.

"One other thing," Marissa added. "The CDC recommends avoiding power saws on this kind of case because they cause significant aerosol formation."

"I was not planning to use any power tools," said Dr. Rand. "Although you may find this surprising, I have handled infectious cases during my career."

"Then I suppose I don't have to warn you about not cutting your fingers," said Marissa. "A pathologist died of viral hemorrhagic fever after doing just that."

"I recall," said Dr. Rand. "Lassa Fever. Are you about to favor us with any further suggestions?"

"No," said Marissa. The pathologist cut into the plastic bag and exposed Zabriski's body to the air. Marissa debated whether she should go or stay. Indecision resulted in inaction; she stayed.

Speaking into an overhead microphone activated by a foot pedal, Dr. Rand began his description of the external markings of the body. His voice had assumed that peculiar monotone Marissa remembered from her medical school days. She was startled back to the present when she heard Rand describe a sutured scalp laceration. That was something new. It hadn't been in the chart, nor had the cut on the right elbow or the circular bruise on the right thigh, a bruise about the size of a quarter.

"Did these abrasions happen before or after death?"

"Before," he answered, making no attempt to conceal his irritation at the interruption.

"How old do you think they are?" said Marissa, ignoring his tone. She bent over to look at them more carefully.

"About a week old, I'd say," Dr. Rand replied. "Give or take a couple of days. We'd be able to tell if we did microscopic sections. However, in view of the patient's condition, I hardly think they are important. Now, if you don't mind, I'd like to get back to work."

Forced to step back, Marissa thought about this evidence of trauma. There was probably some simple explanation; perhaps Dr. Zabriski had fallen playing tennis. What bothered Marissa was that the abrasion and the laceration were not mentioned on the man's chart. Where Marissa had trained, every physical finding went into the record.

As soon as Rand had finished and Marissa had seen that the tissue samples were correctly done, she decided to track down the cause of the injuries.

Using the phone in pathology, Marissa tried Zabriski's secretary, Judith. She let the phone ring twenty times. No answer. Reluctant to bother Mrs. Zabriski, Marissa thought about looking for Dr. Taboso, but instead decided to check Dr. Zabriski's office, realizing it had to be right there in the hospital. She walked over and found Judith back at her desk.

Judith was a frail young woman in her mid-twenties. Mascara smudged her cheeks; Marissa could tell that she'd been crying. But she was more than sad; she was also terrified.

"Mrs. Zabriski is sick," she blurted out as soon as Marissa introduced herself. "I talked with her a little while ago. She's downstairs in the emergency room but she is going to be admitted to the hospital. They think she has the same thing that her husband had. My God, am I going to get it too? What are the symptoms?"

With some difficulty, Marissa calmed the woman enough to explain that in the L.A. outbreak the doctor's secretary had not come down with the illness.

"I'm still getting out of here," said Judith, opening a side drawer of her desk and taking out a sweater. She tossed it into a cardboard box. She'd obviously been packing. "And I'm not the only one who wants to go," she added. "I've talked with a number of the staff and they are leaving, too."

"I understand how you feel," said Marissa. She wondered if the entire hospital would have to be quarantined. At the Richter Clinic, it had been a logistical nightmare.

"I came here to ask you a question," said Marissa.

"So ask," said Judith. She continued to empty her desk drawers.

"Dr. Zabriski had some abrasions and a cut on his head, as if he'd fallen. Do you know anything about that?"

"That was nothing," said Judith, making a gesture of dismissal with her hand. "He was mugged about a week ago, in a local mall while he was shopping for a birthday gift for his wife. He lost his wallet and his gold Rolex. I think they hit him on the head."

So much for the mysterious question of trauma, thought Marissa. For a few minutes she stood watching Judith throw her things into the box, trying to think if she had any further questions. She couldn't think of any just then, so she said good-bye, then left, heading for the isolation ward. In many ways she felt as scared as Judith did.

The isolation ward had lost its previous tranquility. With all the new patients, it was fully staffed with overworked nurses. She found Dr. Layne writing in several of the charts.

"Welcome to Bedlam," he said. "We've got five more admissions, including Mrs. Zabriski."

"So I've heard," said Marissa, sitting down next to Dr. Layne. If only Dubchek would treat her as he did: like a colleague.

"Tad Schockley called earlier. It is Ebola."

A shiver ran down Marissa's spine.

"We're expecting the State Commissioner of Health to arrive any minute to impose quarantine," continued Dr. Layne. "Seems that a number of hospital personnel are abandoning the place: nurses, technicians, even some doctors. Dr. Taboso had a hell of a time staffing this ward. Have you seen the local paper?"

Marissa shook her head, indicating that she had not. She was tempted to say that she didn't want to stay either, if it meant being exposed.

"The headline is 'Plague Returns!' "Dr. Layne made an expression of disgust. "The media can be so goddamned irresponsible. Dubchek doesn't want anyone to talk with the press. He wants all questions directed to him."

The sound of the patient-elevator doors opening caught Marissa's attention. She watched as a gurney emerged, covered by a clear plastic isolation tent. As it went by, Marissa recognized Mrs. Zabriski. She shivered again, wondering if the local paper really had been exaggerating in their headline.

6

April 10

MARISSA TOOK ANOTHER FORKFUL of the kind of dessert that she allowed herself only on rare occasions. It was her second night back in Atlanta, and Ralph had taken her to an intimate French restaurant. After five weeks with little sleep, gulping down meals in a hospital cafeteria, the gourmet meal had been a true delight. She noticed that, not having had a drink since she'd left Atlanta, the wine had gone right to her head. She knew she was being very talkative, but Ralph seemed content to sit back and listen.

Winding down, Marissa apologized for chattering on about her work, pointing to her empty glass as the excuse.

"No need to apologize," Ralph insisted. "I could listen all night. I'm fascinated by what you have accomplished, both in L.A. and in St. Louis."

"But I've filled you in while I was away," protested Marissa, referring to their frequent phone conversations. While she'd been in St. Louis, Marissa had gotten into the habit of calling every few days. Talking with Ralph had provided a sounding board for her theories as well as a way to relieve her frustration at Dubchek's continued insistence on ignoring her. In both cases, Ralph had been understanding and supportive.

"I wish you'd tell me more about the community reaction," he said. "How did the administrators and medical staff of the hospital try

to control the panic, considering that this time there were thirty-seven deaths?"

Taking him at his word, Marissa tried to describe the turmoil at the St. Louis hospital. The staff and patients were furious at the enforced quarantine, and Dr. Taboso had sadly told her he expected the hospital to close when it was lifted.

"You know, I'm still worried about getting sick myself," admitted Marissa with a self-conscious laugh. "Every time I get a headache I think 'this is it.' And though we still have no idea where the virus came from, Dubchek's position is that the virus reservoir is somehow associated with medical personnel, which doesn't make me any more comfortable."

"Do you believe it?" asked Ralph.

Marissa laughed. "I'm supposed to," she said. "And if it is true, then you should consider yourself particularly at risk. Both index cases were ophthalmologists."

"Don't say that," laughed Ralph. "I'm superstitious."

Marissa leaned back as the waiter served a second round of coffee. It tasted wonderful, but she suspected she'd be sorry later on when she tried to sleep.

After the waiter left with the dessert dishes, Marissa continued: "If Dubchek's position is correct, then somehow both eye doctors came into contact with the mysterious reservoir. I've puzzled over this for weeks without coming up with a single explanation. Dr. Richter came in contact with monkeys; in fact he'd been bitten a week before he became ill, and monkeys have been associated with a related virus called Marburg. But Dr. Zabriski had no contact with any animals at all."