Weapon of Choice (23 page)

He then led her across the small room, a cubicle, really.

“Mrs. Miller is a longtime employee. She cleaned the E.R. back in the day. Age sixty, former smoker; now presenting with a high fever and escalating respiratory distress. She's restless, on the verge of combative. We drew blood cultures, got the usual labs. Blood gases ordered. Portable lung x-ray shows dense bilateral infiltrates.”

“Was she working in the ICU Thursday?” Laura asked. Everything had seemed fine on Wednesday; somehow the unit must have got contaminated on Thanksgiving Day.

“Yes. She put in a full day. Had the rest of the long weekend off. Started to get sick during the night. She lives alone—a neighbor stopped by—”

As for Michelle, she'd worked in that ICU all day long yesterday, doing postsurgical checks. And Natalie, Laura realized, had been inside that ICU, at least for a short period of time.

Laura looked from one patient to the other. The older woman's breathing was ragged, but then age and a smoking history would make her lungs more susceptible. Yet Michelle looked more anxious, her mental status worse that Mrs. Miller's.

“Get me out of here,” the woman grunted, her eyes unfocused, her free arm flailing. “I know you. You're Dr. Nelson. I gotta tell you somethin'. Get me out of here. I'm burnin' up.”

“Now, Bunnie, calm down,” Dan urged.

Laura recognized the name “Bunnie.” She'd heard it bantered around the ICU, but she'd never bothered to make the acquaintance of this particular member of the housekeeping staff. For shame.

“Bunnie,” she said, careful not to come in physical contact with the woman until she was wearing protective gear, “what is it you wanted to tell me?” Was Bunny suffering from delirium or was she mentally competent?

Bunnie's attention seemed to drift. Laura didn't have much time, but the woman seemed to want to communicate something.

“Bunnie? What is it?” Laura leaned as close as she could while preventing contact.

“Saw a man.” Bunnie's words were garbled, but that's what it sounded like. “Doin' sumthin' to the patients.” The later part came out more clearly.

“Yes,” Laura prompted. “Doing what, Bunnie?”

“Don't know. Just leanin' over. Like he was feedin' them or sumthin'.”

“Who was this man?” Laura asked.
What was this all about?

“Don' know. A doctor, maybe.”

“Lots of doctors in the ICU, do you know him?”

“Musta been new.”

From across the room, Laura and Dan heard a loud moan. They rushed to Michelle's side. She had managed to slip out of a restraint and yank out her IV, upending the pole. Her plastic bag of IV fluid had hit the tile floor and blood was dripping onto it.

“We're setting up an alternative ICU,” Laura said. “Let's transport these two up there now. Admit to Dr. Kellerman's service. I'll call him, get the orders. Then would you help Roxanne Ruiz to get this E.R. locked down to all but patients like these.” She looked from Bunnie to Michelle. How many more would there be?

As Dan called for help to restrain Michelle, Laura left for the
pediatric floor, making one stop at the ICU for a quick update. She needed to see Natalie. To make sure her daughter's condition had not worsened. What could she do to help her daughter, to help her resident? She was powerless against this lethal microbe. With all her surgical skills, she had no weapon to bring to bear on a microscopic organism that was proving resistant to all the sophisticated chemicals specifically designed to destroy it.

Then it hit her: where was her colleague, Ed Plant?

F
RIDAY
, N
OVEMBER
29

Stacy had not been directly involved, but she'd read the reports about the outbreak of necrotizing fasciitis in a Lubbock, Texas, dialysis center a year ago. Caused by group A streptococcus, the disease ravaged chronic kidney patients. Invasive pneumonia struck rapidly and spread just as fast; victims suffered gangrenous flesh and muscle destruction, septic shock, and organ failure. Yet until nine patients had died a horrible death, the center failed to contact the CDC. The lesson: when in doubt, do not equivocate; call in the cavalry. And that's what Stacy had just done. She'd called her boss, who'd called his boss, who'd notified the director. Until fifteen minutes ago, Stacy had never spoken to the director of the CDC. Now she'd disrupted the woman's holiday weekend. Had she overreacted?

The Tampa City Hospital cases reminded Stacy in some ways of the catastrophe last year. High fever, myositis causing extreme pain in the extremities, and a necrotizing pneumonia. But Tampa ICU patients were spared the flesh-eating necrotizing fasciitis that had struck in the Lubbock center. The Texas epidemic was caused by a strep organism and Tampa's by a staph. Both were lethal—but neither as lethal as the staph that were incubating in the restricted section of her lab at the CDC. If her staph ever got out in a hospital like this, infected patients would already be dead, along with staff and anybody who'd come in contact with the patients, including visitors.

Visitors. Natalie. She needed to check on Laura's daughter the minute she'd finalized arrangements for the CDC's rapid-response Emergency Operation Implementation Program—EOIP. Stacy had been on the ICU clerk's phone with the CDC for almost an hour. Ever since Laura was called to the E.R.

Once the CDC program was in place, Tampa would receive all manner of federal support. Stacy would be gratified, but after the EOIP team arrived, she knew her role would be zip. She'd simply be a researcher who happened to stumble into this bio disaster.

Research. The cultures in her Atlanta lab. Stacy needed to get back there tomorrow. She should leave tonight, but if she could get in touch with Charles, maybe she could convince him to go to the lab and do the culture transfers. Certainly he wasn't too ill to cover her in an emergency scenario like this? Stacy wanted to stay to support Laura—and honestly, to observe the EOIP team in action.

On Stacy's advice, a communication center had been set up on the seventh floor at the opposite end of the building from the ICU. All patients other than those in the ICU had been moved from the seventh floor to a quarantined area in another wing of the hospital. As soon as Laura returned to the ICU, Stacy would suggest they check on Natalie.

She'd just hung up with the logistics director of the EOIP team when she spotted Laura rushing toward her.

“Stacy, I have bad news.” Laura tried to catch her breath. “Maybe you know? We have two staff members presumably infected. One is my chief resident. What if—”

No, Stacy had not heard. This faulty communication would come to an end when the EOIP team arrived.

Laura's beeper went off and she dialed from the clerk's phone.

Stacy watched her friend's face go pale.

“Thank you.” She hung up. “Another patient, Norman Kantor, died in the ICU. Fulminating infection. Total organ shutdown. He was in here because of a pulmonary embolus following hip surgery.”

“Norman Kantor? Was he a microbiologist?” Stacy repeated. Laura confirmed he had been. “How weird is that. I know him. I
thought about calling him as a consultant. He was an NIH microbiologist who left and went to Keystone Pharma. Ironic, he's a world-class expert in staph, the developer of ticokellin.”

“The wheels are in motion to get some down here. Not easy, cutting through the bureaucracy with a side effect like aplastic anemia. I think it'll happen, but probably not tonight. Tomorrow's more likely.”

“Stacy, we need that drug. I know there have been cases of aplastic anemia, but what the patients need here, right now, is an antibiotic that will kill that staph. It's ironic and sad that Norman Kantor couldn't get the drug he invented.”

“Laura, before you get all gowned up to go inside the ICU and before the CDC descends, let's go spend time with Natalie.”

“I promised to check on her boyfriend,” Laura said in a low voice. “But I got called to the E.R. Never even got to his chart.”

“Natalie's boyfriend is one of the sicker ones,” Stacy said. “I still can't imagine your little girl with a boyfriend.”

“If he doesn't make it,” Laura said, “Natalie will never get over it.”

If she survives
. Stacy hoped Laura couldn't read her mind.

F
RIDAY
, N
OVEMBER
29

The house was empty when Charles returned home from the Palace Hotel. Why wasn't Banks waiting with further instructions? He wondered whether there was something else he should be doing now. He and the chef had carefully plotted how they'd coordinate tomorrow's mission. The Palace Hotel restaurant would be closed to the public tomorrow to accommodate the
Atlantic Daily Reporter
's celebratory banquet. For dessert, the banquet service would provide only the hotel's signature profiteroles.

Charles had first tasted profiteroles when he'd visited London with his parents. Since then, he'd always been on the lookout for them on dessert menus, but none had equaled the ones he'd devoured at tea in that London hotel. Never could he have imagined the wonderful puffs of chocolate and cream as the delivery vehicle for a bioweapon.

He'd only half listened when Collins explained how the shell was pâte-à-choux. Whatever the heck that was.

“Means the pastry for forming little cabbage shapes.” Chef Lonnie continued, “First, I add the flour to boiled butter and water and beat till it forms a smooth ball of dough. Then I cool it to lukewarm, add eggs, beat, pipe the dough onto sheets, and bake.”

“You can't overheat the bacteria,” Charles warned. “The strain will resist stomach acid, but it can't withstand heat from cooking or baking.” Could this be his ‘sorry, it won't work' exit ploy?

Lonnie wasn't buying in. “Even I know that much,” he said. “It's the cream phase where you'll do your thing.”

“Oh, yeah. Told you, I'm no chef,” he'd mumbled.

“After the pastry shells cool, I split them in half and fill them with my special cream. That's the trick, how I prepare my cream. I fill each round of choux pastry with enough cream so that when you place the top half of the pastry on it, the cream peeks out of the sides. The finishing touch is a drizzle of warm chocolate ganache.”

Charles was about to ask what ganache was, but focused instead on the cream. The staph would go into the cream quite nicely. The smooth texture and the fatty nature of the cream would make the perfect carrier.

“We do the final assembly just before serving,” Lonnie had continued, “so when dessert arrives, the chocolate sauce is still warm.”

Lonnie had laid out all these steps methodically. Might as well have been coaching a sous chef, not plotting to kill hundreds of unsuspecting people.

Charles had tried to be equally matter of fact. Kept his thoughts on the task at hand, not straying from the logistical into the moral or ethical realm.

They came up with a good plan. Lonnie would thicken his cream, so that it would not overflow the shell and perhaps infect the kitchen or waitstaff. The profiteroles would be plated, and fifteen plates arranged on each large serving tray. Twenty-five trays. Just before Lonnie did his drizzle of chocolate sauce, Charles would introduce the bacteria into the creamy center of each of the plated profiteroles. Using a syringe, he would infect the creamy core of each dessert. The chef would control the flow of the trays. No one else would be allowed close enough to Charles to observe that he was injecting each dessert with an inoculum of staph no bigger than a speck. He would use gloves and sterile technique, as he did every day in his level P3 lab.

“Let's hope no waiter grabs one when I turn my back for two seconds,” Lonnie had said with a shrug. “Happens all the time.”

Charles had assured him that no trace of live bacteria would remain in the kitchen. Neither man could predict whether, nor how, their deadly recipe could be discovered. The victims would not fall ill until after they'd left the hotel, so for about twenty minutes or so
Lonnie would carefully monitor the dining room, collect any leftover whole profiteroles, or partly eaten, and put them immediately into the garbage disposal.

At loose ends, Charles retired to his bedroom. Too keyed up to read, he'd watch some mindless TV show. Would the plan work? Charles speculated as he stretched out on his leather sofa. When would Banks reappear to let him know where they'd arranged for him to start the next phase of his life. He was an excellent scientist and under normal circumstances would have no problem getting a job. But with a new identity? The Order would no doubt have figured out all of that. As for his parents, what would they be told?

“All in due time,” Banks had answered when he'd raised the question.
What had he meant by that?

Charles was trying without much success to relax when he heard a car pull up in the driveway. He waited for Banks to walk in the back door, but instead, he heard the front doorbell ring. Mystified, Charles hurried down the front stairway.

Too early for the motion detectors to turn on the porch light. Through the glass pane framed in the polished oak door, a familiar face. Stanley Proctor, his boss—until Stacy Jones's sudden promotion—stood on his doorstep.

Does he know about the cultures?

Charles slumped against the doorframe, trying to look composed, taking a deep breath to control his panic. Should he let Proctor in? What if he came to search for the cultures? But if that's what he wanted, why come alone? The bacteria were an extremely high security risk. The CDC should be sending the army, not a puny middle-aged scientist. Charles inched open the door, hesitating just long enough to glance up and down the street. No federal agents, no soldiers. He opened it wider to let his visitor enter.

“Stan?” Not only had his boss never before set foot in Charles's house, but he was disoriented by Proctor's sweatshirt and khakis. He'd never seen the man in anything other than a business suit or a starched lab coat. “Come in.”