Troy Rising 1 - Live Free or Die (33 page)

She walked into the room slowly.

“Hello,” Dixie said, just as carefully. “I'm Doctor Pfau. You didn't sustain any injury
that might account for this infection?”

***

Dixie walked out into the waiting room and looked around. As usual it was packed.

“Hello!” she said loudly to cut through the chatter, arguments and screaming children. “My
name is Doctor Pfau and I would like your attention! Thank you. How many people are here
because they have a small sore on the inside of their left wrist and could you raise your
hand so I can see it?”

Seven people, some of them clearly surprised, raised their left hands.

“Thank you. We'll be seeing all of you very sh...”

“Doctor,” one of the nurses said, walking up and speaking quietly. “We need you in Six.”

Dixie nodded at the crowd and walked back into the hallway quickly.

“Fever of one-oh-five,” the nurse said. “Labored breathing. Slight incoherency.
Complaining of bodily aches.”

Dixie pulled down the chart and looked at it as she walked into the room. Low blood
pressure for a guy his age and physical condition. He looked like he was 'residence
disadvantaged' and they were normally high BP. Heart rate was right off the chart.

“I need an IV run,” Dixie said the moment she looked at the patient. What the nurse had
left out was yellowed eyes and skin. The guy was probably in the terminal stages of
hepatitis. “Get a cart in here. We're admitting him. Sir, do you have any history of
hepatitis?” She gloved and pulled out a syringe to get a blood sample.

“No,” the homeless man said. “I been strong as a horse my whole life, Doctor. This is the
first time I ever been sick. You saying I need to go to the hospital?”

“You're in the hospital,” Dixie said. “What I'm saying is you need to stay so we can get
you fixed up. You're clearly extremely sick.” She wrapped his arm and pulled the cap off
the syringe.

“You gonna take my blood?” the man said, thickly.

“I need to get a blood sample so we can figure out exactly what is wrong with you,” Dixie
said.

“I don...” the man said and his arm came up. It seemed less like a block of the syringe
than an involuntary twitch but it had the effect of sending the syringe across the room.
“I... AAAAAAHHH!” As it barely missed her face she automatically noted... a small lesion
on the inside of the left wrist.

“Sir,” Dixie said, grabbing his arm and trying to restrain it. “You need to calm down,
sir...”

“IT HURTS!” the man screamed. He started scrabbling at his jacket, scratching as if he was
trying to scratch inside his body. “OH GOD!”

Dixie yanked the door open. “I need some
help
in here! Where's that IV?”

Nurses came flooding in the room as the man started to convulse, still screaming. He
seemed to scream so hard it should have ripped his throat right out. Before they could
even get the IV inserted or a shot of Dilaudim in him, the thrashing stopped and the man
dropped limp.

“Code Blue!” Dixie shouted, feeling for a pulse at the carotid. “I need a crash cart!”

***

“ER pronounced him DOA.” Dr. Benjamin Koch was the free clinic attending hospitalist. He
had the job of not only ministering to patients but also keeping an eye on the various
interns and residents that did most of the grunt work. “What happened?”

“I've been thinking about that,” Dixie said. She knew her nickname was 'The Grinder.' New
interns, visitors who were informed of it, new employees, all thought it referred to some
super-sexual ability. They quickly found out it meant that she ground through anything or
anyone in her way like an industrial machine. Her other nickname was 'The Robot.' She
didn't feel particularly machine-like at the moment. “None of the symptoms make sense.
Convulsions, tetany. But you don't get yellowing of the eyes and skin. That indicates
liver.”

“Could have been a combination,” Dr. Koch said, shrugging. “From what I've gleaned he
was... residence disadvantaged?”

“He was a bum, yeah,” Dixie said. “But he said he'd never been sick in his life. And for
all he was sick, you can tell the sickly ones. He looked otherwise fairly healthy for a
bum. But we've got another problem that's more important.”

“Which is?” Dr. Koch asked.

“We've got a large number of patients with identical symptoms,” Dixie said. “At least
seven. A lesion on the inside of the left wrist. No pain response. For that matter... our
DOA had one.”

“
All
on the left wrist?” the attending said. “That's... odd.”

“Identical,” Dixie said, holding out her wrist to show him. She paused. “Oh... hell.”

There was what looked like a pimple on her left wrist.

“I think... we'd better call CDC,” Dixie said.

“I'll page the epidemiologist.”

***

“I need you to hold your arm very very
still
for me, okay?”

Dr. Doug 'Jojo' Johannsen was the chief epidemiologist of the Mayo Clinic. He'd spent
years working around the world for the WHO and CDC tracking down emerging diseases and
potential pestilences. And he'd seen his fair share of odd maladies. But this was one of
the few he'd ever seen that were location specific. Even then, most such things were
location specific for a particular reason. They were affecting lymph nodes for example.
They weren't specific to a more or less random spot on the body. And he assuredly hadn't
expected for them to turn up in the US.

For that matter, as soon as he'd seen the number of cases being reported in not only the
clinic but ER and even among workers at the hospital, he'd called CDC to report a
potential outbreak. Only to find the main line, which had fourteen people manning it
normally, busy. So he'd called three colleagues he knew, personally. All of their office
phones were busy. So then he'd called their cell phones. Busy.

So he'd spent three more minutes making overseas phone calls to colleagues associated with
the WHO. All of
their
phones were busy.

At that point, he'd sent out a standard e-mail, put down the phone and gotten to work.

“No problem,” Dixie said. The pimple had already popped. “There's no pain.”

“Which is why I'm thinking parasite,” Dr. Johannsen said, bringing the camera for the
microscope down. “There's definitely a suite of bacteria there, but I don't think that's
the central problem.”

“What I'd like to figure out is how I got a parasite,” Dixie said. “I guess it
could
have been from that first patient.”

“Hmmm...” Dr. Johannsen said. “Fascinating.”

“Going to leave me in limbo?” Dixie asked.

Dr. Johannsen swung the monitor around so she could look. At the very bottom of the small
sore was what appeared to be something like a centipede.

“And that is... ?” Dixie asked. She had seen and done some very gross things as an intern
but this was something gross happening to
her
body.

“
That
is a nematode,” Dr. Johannsen said, swinging the monitor back around. “Which appears to be
feasting on the bacteria colony in the lesion. I don't recognize the particular species
but there are experts who might. Presumably it carries some of the bacteria with it. It
does gross damage to the affected tissue, the bacteria then have a residence and it then
feasts upon the bacteria. I've seen this before but rarely in the US. Similar infestations
in tropical regions. Primarily in New Guinea. Now hold very,
very
still.”

He took a pair of fine tweezers and pulled the worm out of the wound.

“There,” he said in a satisfied tone, placing the nematode in a jar and sealing it. “I'll
send that to some friends and they can identify the species.”

“So it
is
a zebra,” Dixie said. Quite often, new interns would look at a set of symptoms and
identify them as some rare disease found only in remote areas when they were looking at a
simple combination of fairly normal problems. Identification of a rare disease instead of
common was referred to as 'spotting a zebra.' It was generally a mistake. “What's it doing
in the US? What's it doing in
me
? I was meticulous in my hygiene procedures with Patient Zero.”

“That is the question,” Dr. Johannsen said. “Which is up to the CDC and WHO to determine.
But the treatment is simple. Disinfect the area and maintain integrity. There may be a
reoccurrence. The nematode may leave cysts which will make it necessary to continue
treatment for up to two weeks. Any strong disinfectant should kill it, though, and usually
kills the cysts. And any antibiotic will kill the bacteria. Keep enough Neosporin on the
wound, for that matter, and the nematode should die of malnutrition.”

“So disinfect and bandage was the right choice,” Dixie said, relieved.

“But it will have to be maintained,” Jojo said. “That will be the problem I suspect. It
certainly is in places where this is more common. And it's not normally...” He paused as
his pager went off. “I'm sorry, I'm getting a page from the morgue. I take it you can
clean it yourself.”

“I can,” Dixie said. “But can I come al...” Her pager went off and she looked at it. “I'm
getting paged there, too.”

***

“How's the wrist?” Dr. Koch asked, stopping them both outside the morgue.

“I cleaned it on the way down,” Dixie said, showing him the bandage. “What's up?”

“It's your DOA,” Dr. Koch said, his face grim. “The morgue called a contamination. You
eaten lately?”

“No,” Dixie said.

“Good. You won't puke in your respirator. We need to rig up.”

***

Dixie wasn't even sure she was looking at the same patient. Same height, same hair color
from what she could remember. A sort of dirty, dishwater, gray-brown.

His clothing had been removed at some point and she had had her usual tour of the morgue
so seeing a body on the slab wasn't the problem. The problem was the condition of the body.

“We didn't even have time to put him on ice,” the pathologist said, examining the pustules
covering the man's body with a simple magnifying glass. He was wearing a full body cover,
mask and respirator like the rest of them. “He just started popping up these lesions all
over his body. When we saw that we called a bio alert.”

“Can I see that?” Dr. Johannsen said.

“Hmmm...” the pathologist said, handing over the glass.

Dr. Johannsen leaned into the body so that his mask was almost in contact then leaned back.

“Oh... damn.”

“Nematodes?” Dixie asked, her stomach sinking.

“Yes,” Dr. Johannsen said. “Nematodes.”

***

“Congratulations, Jojo. You were the first person to identify. At least, you were the
first to get an e-mail through. Chuck at Johns Hopkins was fifteen minutes later. And WHO
hasn't reported anyone, yet. Since this may be a new pathology you probably get to name
it.”

“I'll take that,” Jojo said. “Anyone have any idea what we're dealing with?”

“No.” Dr. Leona Cline was Director of the National Center for Preparedness, Detection and
Control of Infectious Diseases at the CDC. She'd gotten into epidemiology when it was
still considered a 'man's' field. Being black and female were benefits in any government
position but it wasn't why she'd gotten to her current job. That had been sheer will and
brains of steel. “We're still working on disease progress but you're not the first
facility to report a death. The nematode apparently stays in the wound, more or less
quiescent, for a period we're still trying to pin down. At a certain point it submerges
into the bloodstream and starts to spread. Again, acting essentially benign. The spread
causes a sharp fever spike but not much else. Then it goes to a third stage where they
begin attacking the body widely and the patient terminates rather quickly. If you don't
stop it when it's in the initial presentation, it's pretty much the whole shooting match.”

“I'm trying and failing to come up with a disease that acts in that manner,” Dr. Johannsen
said, thoughtfully. “Chagras is the closest that immediately comes to mind.”

“You're not the only one,” Leona said, smiling thinly. “Pretty much everybody is
scratching their heads. The general conclusion is a tailored system.”

“I can see that,” Jojo said. “Theoretically. I don't know of any laboratory that could
produce such a species.”

“Again, general conclusion,” the CDC agent said. “Also that it's not a natural spread. We
got slammed by reports starting this morning. Everyone has their own patient zero with no
commonalities.”

“That is... very ungood,” Jojo said.

“We've called a wildfire,” Leona replied, referring to a mass infection event. “USAMRIID
has to call a bio attack. But that's our gut. There's a flip side, though. Which is really
what's putting the hold on calling it as an attack.”

“Which is?”

“Nothing about it makes sense,” Dr. Cline said. “Patients with the lesion that have been
treated show little or no signs of continued infection. It looks like, and I'm going a bit
out on the limb here, if you just treat it, it goes away. And the treatment is...”

“Most people with it probably aren't even reporting it,” Dr. Johannsen said. “Most people
are just going to pour some peroxide on it and put on a band-aid.”

“And even
that
will kill the nematode,” Dr. Cline said, nodding.

“So it's absolutely deadly if untreated but treatment is simple?” Dr. Johannsen said.

***

“That's insane,” the President said. “What kind of a biological attack is
that
?”

“That's the problem, Mr. President,” the head of USAMRIID said. “It's why we're having a
hard time calling this an attack. And it's so dispersed... we can't even figure out the
infection method. It's showing up... well,
everywhere
. All over the world and certainly across the US. At more or less the same time. Our
models are kicking that out as invalid information.”

“You guys need to quit looking in microscopes so much,” the Marine Commandant said.

“Your point, General?” the President said, trying not to snarl.