Outbreak (2 page)

Musing about the economics of the clinic, Dr. Richter was unaware of two men who had been waiting in the shadows of the garage. He remained unaware even after they fell in step behind him. The men were dressed in dark business suits. The taller of the two had an arm that seemed permanently frozen into a flexed position. In his hand was a fat briefcase that he held high due to the immobility of the elbow joint.

Nearing his car, Dr. Richter sensed the footsteps behind him as they quickened in pace. An uncomfortable sensation gripped his throat. He swallowed hard and cast a nervous glance over his shoulder. He caught sight of the two men, who seemed to be coming directly toward him. As they passed beneath an overhead light, Dr. Richter could appreciate that they were carefully dressed, with fresh shirts and silk ties. That made him feel a little better. Even so, he

p.

moved more quickly, rounding the back end of his car. Fumbling for the keys, he unlocked the driver's-side door, tossed in his briefcase, and slid into the welcome smell of coach leather. He started to close the door, when a hand stopped him. Dr. Richter reluctantly raised his eyes to what turned out to be the calm, blank face of one of the men who had followed him. The suggestion of a smile crossed the man's countenance as Dr. Richter looked at him inquiringly.

Dr. Richter tried again to pull his door shut, but the man held it firmly from the outside.

"Could you tell me the time, doctor?" asked the man politely.

"Certainly," said Richter, glad to have a safe explanation for the man's presence. He glanced at his watch, but before he had a chance to speak, he felt himself rudely pulled from the car. He made a halfhearted effort to struggle, but he was quickly overwhelmed and stunned by an open-handed blow to the side of his face that knocked him to the ground. Hands roughly searched for his wallet, and he heard fabric tear. One of the men said "businessman," in what sounded like a disparaging tone, while the other said, "Get the briefcase." Dr. Richter felt his watch yanked from his wrist.

It was over as quickly as it had begun. Dr. Richter heard footsteps recede and a car door slam, then the screech of tires on the smooth concrete. For a few moments he lay without moving, glad to be alive. He found his glasses and put them on, noting that the left lens was cracked. As a surgeon, his primary concern was for his hands; they were the first thing he checked, even before he picked himself up off the ground. Getting to his feet, he began to examine the rest of himself. His white shirt and his tie were smeared with grease. A button was missing from the front of his blazer, and in its place was a small horseshoe-shaped tear. His pants were torn from the right front pocket all the way down to his knee.

"God, what a day!" he voiced to himself, thinking that being mugged made the morning's fender-bender seem trivial by comparison. After a moment's hesitation, he recovered his keys and returned to the clinic, going back to his office. He called security, then debated whether to call the L.A. police. The idea of bad publicity for the clinic made him hesitate, and really, what would the police have done? While he argued with himself, he called his wife to explain that he'd be a little later than expected. Then he went into the lavatory to examine his face in the mirror. There was an abrasion over the right cheekbone that was sprinkled with bits of parking-garage grit. As he gingerly blotted it with antiseptic, he tried to estimate how much he had contributed to the muggers' welfare. He guessed he'd had about

a hundred dollars in his wallet as well as all his credit cards and identification, including his California medical license. But it was the watch that he most hated to lose; it had been a gift from his wife. Well, he could replace it, he thought, as he heard a knock on his outer door.

The security man was fawningly apologetic, saying that such a problem had never happened before, and that he wished he'd been in the area. He told Dr. Richter that he'd been through the garage only a half-hour before, on his normal rounds. Dr. Richter assured the man that he was not to blame and that his, Richter's, only concern was that steps be taken to make certain that such an incident did not reoccur. The doctor then explained his reasons for not calling the police.

The following day, Dr. Richter did not feel well but he attributed the symptoms to shock and the fact that he'd slept poorly. By five-thirty, though, he felt ill enough to consider canceling a rendezvous he had with his mistress, a secretary in the medical records department. In the end, he went to her apartment but left early to get some rest, only to spend the night tossing restlessly in his bed.

The next day, Dr. Richter was really ill. When he stood up from the slit lamp, he was light-headed and dizzy. He tried not to think about the monkey bite or being coughed on by the AIDS patient. He was well aware that AIDS was not transmitted by such casual contact: it was the undiagnosed superinfection that worried him. By three-thirty he had a chill and the beginnings of a headache of migraine intensity. Thinking he had developed a fever, he canceled the rest of the afternoon's appointments and left the clinic. By then he was quite certain he had the flu. When he arrived home, his wife took one look at his pale face and red-rimmed eyes, and sent him to bed. By eight o'clock, his headache was so bad that he took a Percodan. By nine, he had violent stomach cramps and diarrhea. His wife wanted to call Dr. Navarre, but Dr. Richter told her that she was being an alarmist and that he'd be fine. He took some Dalmane and fell asleep. At four o'clock he woke up and dragged himself into the bathroom, where he vomited blood. His terrified wife left him long enough to call an ambulance to take him to the clinic. He did not complain. He didn't have the strength to complain. He knew that he was sicker than he'd ever been in his life.

1

January 20

SOMETHING DISTURBED MARISSA Blumenthal. Whether the stimulus came from within her own mind, or from some minor external change, she did not know. Nonetheless her concentration was broken. As she raised her eyes from the book in her lap she realized that the light outside the window had changed from its pale wintery white to inky blackness. She glanced at her watch. No wonder. It was nearly seven.

"Holy Toledo," muttered Marissa, using one of her expressions left over from childhood. She stood up quickly and felt momentarily dizzy. She had been sprawled out on two low slung vinyl-covered chairs in a corner of the library of the Centers for Disease Control (CDC) in Atlanta for more hours than she cared to think about. She had made a date for that evening and had planned on being home by six-thirty to get ready.

Hefting Fields' ponderous Virology textbook, she made her way over to the reserve shelf, stretching her cramped leg muscles en route. She'd run that morning, but had only put in two miles, not her usual four.

"Need help getting that monster on the shelf?" teased Mrs. Campbell, the motherly librarian, buttoning her omnipresent gray cardigan. It was none too warm in the library.

As in all good humor, there was some basis in truth for Mrs. Campbell's whispered comment. The virology textbook weighed ten

pounds-one-tenth as much as Marissa's hundred-pound frame. She was only five feet tall, although when people asked, she said she was five-two, though that was only in heels. To return the book, she had to swing it back and then almost toss it into place.

"The kind of help I need with this book," said Marissa, "is to get the contents into my brain."

Mrs. Campbell laughed in her subdued fashion. She was a warm, friendly person, like most everyone at CDC. As far as Marissa was concerned, the organization had more the feeling of an academic institution than a federal agency, which it had officially become in 1973. There was a pervading atmosphere of dedication and commitment. Although the secretaries and maintenance personnel left at four-thirty, the professional staff invariably stayed on, often working into the wee hours of the morning. People believed in what they were doing.

Marissa walked out of the library, which was hopelessly inadequate in terms of space. Half the Center's books and periodicals were stored haphazardly in rooms all over the complex. In that sense the CDC was very much a federally regulated health agency, forced to scrounge for funding in an atmosphere of budget cutting. Marissa noted it also looked like a federal agency. The hall was painted a drab, institutional green, and the floor was covered in a gray vinyl that had been worn thin down the middle. By the elevator was the inevitable photograph of a smiling Ronald Reagan. Just beneath the picture someone had irreverently tacked up an index card that said: "If you don't like this year's appropriation, just wait until next year!"

Marissa took the stairs up one flight. Her office-it was generous to call it that; it was more cubbyhole than office-was on the floor above the library. It was a windowless storage area that might have been a broom closet at one time. The walls were painted cinder block, and there was just enough room for a metal desk, file cabinet, light and swivel chair. But she was lucky to have it. Competition for space at the Center was intense.

Yet despite the handicaps, Marissa was well aware that the CDC worked. It had delivered phenomenal medical service over the years, not only in the U.S., but in foreign countries as well. She remembered vividly how the Center had solved the Legionnaires Disease mystery a number of years back. There had been hundreds of such cases since the organization had been started in 1942 as the Office of Malaria Control to wipe out that disease in the American South. In 1946 it had been renamed the Communicable Disease Center, with separate labs set up for bacteria, fungi, parasites, viruses

and rickettsiae. The following year a lab was added for zoonoses, diseases that are animal ailments but that can be transmitted to man, like plague, rabies and anthrax. In 1970 the organization was renamed again, this time the Centers for Disease Control.

As Marissa arranged some articles in her government-issue briefcase, she thought about the past successes of the CDC, knowing that its history had been one of the prime reasons for her considering coming to the Center. After completing a pediatric residency in Boston, she had applied and had been accepted into the Epidemiology Intelligence Service (EIS) for a two-year hitch as an Epidemiology Intelligence Service Officer. It was like being a medical detective. Only three and a half weeks previously, just before Christmas, she'd completed her introductory course, which supposedly trained her for her new role. The course was in public-health administration, biostatistics and epidemiology-the study and control of health and disease in a given population.

A wry smile appeared on Marissa's face as she pulled on her dark blue overcoat. She'd taken the introductory course, all right, but as had happened so often in her medical training, she felt totally unequipped to handle a real emergency. It was going to be an enormous leap from the classroom to the field if and when she was sent out on an assignment. Knowing how to relate to cases of a specific disease in a coherent narrative that would reveal cause, transmission and host factors was a far cry from deciding how to control a real outbreak involving real people and a real disease. Actually, it wasn't a question of "if," it was only a question of "when."

Picking up her briefcase, Marissa turned off the light and headed back down the hall to the elevators. She'd taken the introductory epidemiology course with forty-eight other men and women, most of whom, like herself, were trained physicians. There were a few micro-biologists, a few nurses, even one dentist. She wondered if they all shared her current crisis of confidence. In medicine, people generally didn't talk about such things; it was contrary to the "image."

At the completion of the training, she'd been assigned to the Department of Virology, Special Pathogens Branch, her first choice among the positions available. She had been granted her request because she'd ranked number one in the class. Although Marissa had little background in virology, which was the reason she'd been spending so much time in the library, she'd asked to be assigned to the department because the current epidemic of AIDS had catapulted virology into the forefront of research. Previously it had

always played second fiddle to bacteriology. Now virology was where the "action" was, and Marissa wanted to be a part of it.

At the elevators, Marissa said hello to the small group of people who were waiting. She'd met some of them, mostly those from the Department of Virology, whose administrative office was just down the hail from her cubicle. Others were strangers, but everyone acknowledged her. She might have been experiencing a crisis of confidence in her professional competence, but at least she felt welcome.

On the main floor Marissa stood in line to sign out, a requirement after 5:00 P.M., then headed to the parking area. Although it was winter, it was nothing like what she'd endured in Boston for the previous four years, and she didn't bother to button her coat. Her sporty red Honda Prelude was as she'd left it that morning: dusty, dirty and neglected. It still had Massachusetts license plates; replacing them was one of the many errands that Marissa had not yet found time to do.

It was a short drive from the CDC to Marissa's rented house. The area around the Center was dominated by Emory University, which had donated the land to the CDC in the early '40s. A number of pleasant residential neighborhoods surrounded the university, running the gamut from lower middle class to conspicuously rich. It was in one of the former neighborhoods, in the Druid Hills section, that Marissa had found a house to rent. It was owned by a couple who'd been transferred to Mali, Africa, to work on an extended birth-control project.

Marissa turned onto Peachtree Place. It seemed to her that everything in Atlanta was named "peachtree." She passed her house on the left. It was a small two-story wood-frame building, reasonably maintained except for the grounds. The architectural style was in-determinant, except for two Ionic columns on the front porch. The windows all had fake shutters, each with a heart-shaped area cut out in the center. Marissa had used the term "cute" to describe it to her parents.