The Hot Zone (4 page)

He appears to be holding himself rigid, as if any movement would rupture something inside him. His blood is clotting up—his bloodstream is throwing clots, and the clots are lodging everywhere. His liver, kidneys, lungs, hands, feet, and head are becoming jammed with blood clots. In effect, he is having a stroke through the whole body. Clots are accumulating in his intestinal muscles, cutting off the blood supply to his intestines. The intestinal muscles are beginning to die, and the intestines are starting to go slack. He doesn’t seem to be fully aware of pain any longer because the blood clots lodged in his brain are cutting off blood flow. His personality is being wiped away by brain damage. This is called depersonalization, in which the liveliness and details of character seem to vanish. He is becoming an automaton. Tiny spots in his brain are liquefying. The higher functions of consciousness are winking out first, leaving the deeper parts of the brain stem (the primitive rat brain, the lizard brain) still alive and functioning. It could be said that the
who
of Charles Monet has already died while the
what
of Charles Monet continues to live.

The vomiting attack appears to have broken some blood vessels in his nose—he gets a nosebleed. The blood comes from both nostrils, a shining,
clotless, arterial liquid that drips over his teeth and chin. This blood keeps running, because the clotting factors have been used up. A flight attendant gives him some paper towels, which he uses to stop up his nose, but the blood still won’t coagulate, and the towels soak through.

When a man is getting sick in an airline seat next to you, you may not want to embarrass him by calling attention to the problem. You say to yourself that this man will be all right. Maybe he doesn’t travel well in airplanes. He is airsick, the poor man, and people do get nosebleeds in airplanes, the air is so dry and thin … and you ask him, weakly, if there is anything you can do to help. He does not answer, or he mumbles words you can’t understand, so you try to ignore it, but the flight seems to go on forever. Perhaps the flight attendants offer to help him. But victims of this type of hot virus have changes in behavior that can render them incapable of responding to an offer of help. They become hostile, and don’t want to be touched. They don’t want to speak. They answer questions with grunts or monosyllables. They can’t seem to find words. They can tell you their name, but they can’t tell you the day of the week or explain what has happened to them.

The Friendship drones through the clouds, following the length of the Rift Valley, and Monet slumps back in the seat, and now he seems to be dozing.… Perhaps some of the passengers wonder if he is dead. No, no, he is not dead. He is
moving. His red eyes are open and moving around a little bit.

It is late afternoon, and the sun is falling down into the hills to the west of the Rift Valley, throwing blades of light in all directions, as if the sun is cracking up on the equator. The Friendship makes a gentle turn and crosses the eastern scarp of the Rift. The land rises higher and changes in color from brown to green. The Ngong Hills appear under the right wing, and the plane, now descending, passes over parkland dotted with zebra and giraffes. A minute later, it lands at Jomo Kenyatta International Airport. Monet stirs himself. He is still able to walk. He stands up, dripping. He stumbles down the gangway onto the tarmac. His shirt is a red mess. He carries no luggage. His only luggage is internal, and it is a load of amplified virus. Monet has been transformed into a human virus bomb. He walks slowly into the airport terminal and through the building and out to a curving road where taxis are always parked. The taxi drivers surround him—“Taxi?” “Taxi?”

“Nairobi … Hospital,” he mumbles.

One of them helps him into a car. Nairobi taxi drivers like to chat with their fares, and this one probably asks if he is sick. The answer should be obvious. Monet’s stomach feels a little better now. It is heavy, dull, and bloated, as if he has eaten a meal, rather than empty and torn and on fire.

The taxi pulls out onto the Uhuru Highway and heads into Nairobi. It goes through grassland studded with honey-acacia trees, and it goes past
factories, and then it comes to a rotary and enters the bustling street life of Nairobi. Crowds are milling on the shoulders of the road, women walking on beaten dirt pathways, men loitering, children riding bicycles, a man repairing shoes by the side of the road, a tractor pulling a wagonload of charcoal. The taxi turns left onto the Ngong Road and goes past a city park and up a hill, past lines of tall blue-gum trees, and it turns up a narrow road and goes past a guard gate and enters the grounds of Nairobi Hospital. It parks at a taxi stand beside a flower kiosk. A sign by a glass door says
CASUALTY DEPT
. Monet hands the driver some money and gets out of the taxi and opens the glass door and goes over to the reception window and indicates that he is very ill. He has difficulty speaking.

The man is bleeding, and they will admit him in just a moment. He must wait until a doctor can be called, but the doctor will see him immediately, not to worry. He sits down in the waiting room.

It is a small room lined with padded benches. The clear, strong, ancient light of East Africa pours through a row of windows and falls across a table heaped with soiled magazines, and makes rectangles on a pebbled gray floor that has a drain in the center. The room smells vaguely of woodsmoke and sweat, and it is jammed with bleary-eyed people, Africans and Europeans sitting shoulder to shoulder. There is always someone in Casualty who has a cut and is waiting for stitches. People wait patiently, holding a washcloth against the scalp, holding a bandage pressed around a finger,
and you may see a spot of blood on the cloth. So Charles Monet is sitting on a bench in Casualty, and he does not look very much different from anyone else in the room, except for his bruised, expressionless face and his red eyes. A sign on the wall warns patients to watch out for purse thieves, and another sign says:

Monet maintains silence, waiting to receive attention. Suddenly he goes into the last phase—the human virus bomb explodes. Military biohazard specialists have ways of describing this occurrence. They say that the victim has “crashed and bled out.” Or more politely they say that the victim has “gone down.”

He becomes dizzy and utterly weak, and his spine goes limp and nerveless and he loses all sense of balance. The room is turning around and around. He is going into shock. He leans over, head on his knees, and brings up an incredible quantity of blood from his stomach and spills it
onto the floor with a gasping groan. He loses consciousness and pitches forward onto the floor. The only sound is a choking in his throat as he continues to vomit blood and black matter while unconscious. Then comes a sound like a bedsheet being torn in half, which is the sound of his bowels opening and venting blood from the anus. The blood is mixed with intestinal lining. He has sloughed his gut. The linings of his intestines have come off and are being expelled along with huge amounts of blood. Monet has crashed and is bleeding out.

The other patients in the waiting room stand up and move away from the man on the floor, calling for a doctor. Pools of blood spread out around him, enlarging rapidly. Having destroyed its host, the hot agent is now coming out of every orifice, and is “trying” to find a new host.

Nurses and aides came running, pushing a gurney along with them, and they lifted Charles Monet onto the gurney and wheeled him into the intensive care unit at Nairobi Hospital. A call for a doctor went out over the loudspeakers: a patient was bleeding in the
ICU
. A young doctor named Shem Musoke ran to the scene. Dr. Musoke was widely considered to be one of the best young physicians at the hospital, an energetic man with a warm sense of humor, who worked long hours and had a good feel for emergencies. He found Monet lying on the gurney. He had no idea what was wrong with the man, except that he was obviously having some kind of massive hemorrhage. There was no time to try to figure out what had caused it. He was having difficulty breathing—and then his breathing stopped. He had inhaled blood and had had a breathing arrest.

Dr. Musoke felt for a pulse. It was weak and sluggish. A nurse ran and fetched a laryngoscope, a tube that can be used to open a person’s airway.
Dr. Musoke ripped open Monet’s shirt so that he could observe any rise and fall of the chest, and he stood at the head of the gurney and bent over Monet’s face until he was looking directly into his eyes, upside down.

Monet stared redly at Dr. Musoke, but there was no movement in the eyeballs, and the pupils were dilated. Brain damage: nobody home. His nose was bloody and his mouth was bloody. Dr. Musoke tilted the patient’s head back to open the airway so that he could insert the laryngoscope. He was not wearing rubber gloves. He ran his finger around the patient’s tongue to clear the mouth of debris, sweeping out mucus and blood. His hands became greasy with black curd. The patient smelled of vomit and blood, but this was nothing new to Dr. Musoke, and he concentrated on his work. He leaned down until his face was a few inches away from Monet’s face, and he looked into Monet’s mouth in order to judge the position of the scope. Then he slid the scope over Monet’s tongue and pushed the tongue out of the way so that he could see down the airway past the epiglottis, a dark hole leading inward to the lungs. He pushed the scope into the hole, peering into the instrument. Monet suddenly jerked and thrashed.

Monet vomited.

The black vomit blew up around the scope and out of Monet’s mouth. Black-and-red fluid spewed into the air, showering down over Dr. Musoke. It struck him in the eyes. It splattered over his white coat and down his chest, marking him with strings
of red slime dappled with dark flecks. It landed in his mouth.

He repositioned his patient’s head and swept the blood out of the patient’s mouth with his fingers. The blood had covered Dr. Musoke’s hands, wrists, and forearms. It had gone everywhere—all over the gurney, all over Dr. Musoke, all over the floor. The nurses in the intensive care unit couldn’t believe their eyes. Dr. Musoke peered down into the airway and pushed the scope deeper into the lungs. He saw that the airways were bloody.

Air rasped into the man’s lungs. The patient had begun to breathe again.

The patient was apparently in shock from loss of blood. He had lost so much blood that he was becoming dehydrated. The blood had come out of practically every opening in his body. There wasn’t enough blood left to maintain circulation, so his heartbeat was very sluggish, and his blood pressure was dropping toward zero. He needed a blood transfusion.

A nurse brought a bag of whole blood. Dr. Musoke hooked the bag on a stand and inserted the needle into the patient’s arm. There was something wrong with the patient’s veins; his blood poured out around the needle. Dr. Musoke tried again, putting the needle into another place in the patient’s arm and probing for the vein. Failure. More blood poured out. At every place in the patient’s arm where he stuck the needle, the vein broke apart like cooked macaroni and spilled
blood, and the blood ran from the punctures down the patient’s arm and wouldn’t coagulate. Clearly his blood was not normal. Dr. Musoke abandoned his efforts to give his patient a blood transfusion for fear that the patient would bleed to death out of the small hole in his arm. The patient continued to bleed from the bowels, and these hemorrhages were now as black as pitch.

Monet’s coma deepened, and he never regained consciousness. He died in the intensive care unit in the early hours of the morning. Dr. Musoke stayed by his bedside the whole time.

They had no idea what had killed him. It was an unexplained death. They opened him up for an autopsy and found that his kidneys were destroyed and that his liver was destroyed. It was yellow, and parts of it had liquefied—it looked like the liver of a cadaver. It was as if Monet had become a corpse before his death. Sloughing of the gut, in which the intestinal lining comes off, is another effect that is ordinarily seen in a corpse that is several days old. What, exactly, was the cause of death? It was impossible to say because there were too many possible causes. Everything had gone wrong inside this man, absolutely everything, any one of which could have been fatal: the clotting, the massive hemorrhages, the liver turned into pudding, the intestines full of blood. Lacking words, categories, or language to describe what had happened, they called it, finally, a case of “fulminating liver failure.” His remains were placed in a waterproof bag and, according to one account, were buried
locally. When I visited Nairobi, years later, no one remembered where the grave was.

Nine days after the patient vomited into Dr. Shem Musoke’s eyes and mouth, Musoke developed an aching sensation in his back. He was not prone to backaches—really, he had never had a serious backache—but he was approaching thirty, and it occurred to him that he was getting into the time of life when some men begin to get bad backs. He had been driving himself hard these past few weeks. He had been up all night with a patient who had had heart problems, and then, the following night, he had been up most of the night with that Frenchman with hemorrhages who had come from somewhere upcountry. So he had been going nonstop for days without sleep. He hadn’t thought much about the vomiting incident, and when the ache began to spread through his body, he still didn’t think about it. Then, when he looked in a mirror, he noticed that his eyes were turning red.

Red eyes—he began to wonder if he had malaria. He had a fever now, so certainly he had some kind of infection. The backache had spread until all the muscles in his body ached badly. He started taking malaria pills, but they didn’t do any good, so he asked one of the nurses to give him an injection of an antimalarial drug.