Outbreak (20 page)

It was five-thirty when Marissa crossed the pleasant lobby of her hotel. As she passed the tiny newsstand, she saw the Washington Post's headline: EBOLA STRIKES AGAIN!

Like iron responding to a magnet, Marissa was pulled across the room. She snatched up a paper and read the subhead: NEWEST SCOURGE TERRIFIES THE CITY OF BROTHERLY LOVE.

Digging up change from the bottom of her purse to buy the paper, she continued reading as she walked toward the elevators. There were three presumed cases of Ebola at the Berson Clinic Hospital in Abington, Pennsylvania, just outside of Philadelphia. The article described widespread panic in the suburban town.

As she pressed the button for her floor, Marissa saw that Dubchek was quoted as saying that he believed the outbreak would be contained quickly and that there was no need for concern: The CDC had learned a lot about controlling the virus from the three previous outbreaks.

Peter Carbo, one of Philadelphia's Gay Rights leaders, was quoted as saying that he hoped Jerry Falwell had noticed that not a single known homosexual had contracted this new and far more dangerous disease that had come from the same area of Africa as AIDS had.

Back in her room, Marissa turned to an inside photo section. The picture of the police barricade at the entrance to the Berson Hospital reminded her of Phoenix. She finished the article and put the paper down on the bureau, looking at herself in the mirror. Although she was on vacation and was officially off the Ebola team, she knew she had to get the details firsthand. Her commitment to the Ebola problem left her with little choice. She rationalized her decision to go by telling herself that Philadelphia was practically next door to Washington; she could even go by train. Turning into the room, Marissa began collecting her belongings.

Leaving the station in Philadelphia, Marissa took a cab to Abington, which turned out to be a far more expensive ride than she'd anticipated. Luckily she had some traveler's checks tucked in her wallet, and the driver was willing to accept them. Outside the Berson Hospital, she was confronted by the police barricade pictured in the newspaper. Before she attempted to cross, she asked a reporter if the place was quarantined. "No," said the man, who had been trying to interview a doctor who had just sauntered past. The police were there in case a quarantine was ordered. Marissa flashed her CDC identity card at one of the guards. He admitted her without question.

The hospital was a handsome, new facility much like the sites of the

Ebola outbreaks in L.A. and Phoenix. As Marissa headed toward the information booth, she wondered why the virus seemed to strike these elegant new structures rather than the grubby inner-city hospitals in New York or Boston.

There were a lot of people milling about the lobby, but nothing like the chaos that she'd seen in Phoenix. People seemed anxious but not terrified. The man at the information booth told Marissa that the cases were in the hospital's isolation unit on the sixth floor. Marissa had started toward the elevators when the man called out, "I'm sorry, but there are no visitors allowed." Marissa flashed her CDC card again. "I'm sorry, doctor. Take the last elevator. It's the only one that goes to six."

When Marissa got off the elevator, a nurse asked her to don protective clothing immediately. She didn't question Marissa as to why she was there. Marissa was particularly glad to put on the mask; it gave her anonymity as well as protection.

"Excuse me, are any of the CDC doctors available?" she asked, startling the two women gossiping behind the nurses' station.

"I'm sorry. We didn't hear you coming," said the older of the two. "The CDC people left about an hour ago," said the other. "I think they said they were going down to the administrator's office. You could try there."

"No matter," said Marissa. "How are the three patients?"

"There are seven now," said the first woman. Then she asked Marissa to identify herself.

"I'm from the CDC," she said, purposely not giving her name. "And you?"

"Unfortunately, we're the RN's who normally run this unit. We're used to isolating patients with lowered resistance to disease, not cases of fatal contagious disease. We're glad you people are here."

"It is a little frightening at first," commiserated Marissa, as she boldly entered the nurses' station. "But if it's any comfort, I've been involved with all three previous outbreaks and haven't had any problems." Marissa did not admit to her own fear. "Are the charts here or in the rooms?"

"Here," said the older nurse, pointing to a corner shelf.

"How are the patients doing?"

"Terribly. I know that doesn't sound very professional, but I've never seen sicker people. We've used round-the-clock special-duty nursing, but no matter what we try, they keep getting worse."

Marissa well understood the nurse's frustration. Terminal patients generally depressed the staff.

"Do either of you know which patient was admitted first?" The older nurse came over to where Marissa was sitting and pushed the charts around noisily before pulling out one and handing it to Marissa. "Dr. Alexi was the first. I'm surprised he's lasted the day."

Marissa opened the chart. There were all the familiar symptoms but no mention of foreign travel, animal experiments or contact with any of the three previous outbreaks. But she did learn that Alexi was the head of ophthalmology! Marissa was amazed; was Dubchek right after all?

Unsure of how long she dared stay in the unit, Marissa opted to see the patient right away. Donning an extra layer of protective clothing, including disposable goggles, she entered the room.

"Is Dr. Alexi conscious?" she asked the special-duty nurse, whose name was Marie. The man was lying silently on his back, mouth open, staring at the ceiling. His skin was already the pasty yellow shade that Marissa had learned to associate with near-death.

"He goes in and out," said the nurse. "One minute he's talking, the next he's unresponsive. His blood pressure has been falling again. I've been told that he's a 'no code.'"

Marissa swallowed nervously. She'd always been uncomfortable with the order not to resuscitate.

"Dr. Alexi," called Marissa, gingerly touching the man's arm. Slowly he turned his head to face her. She noticed a large bruise beneath his right eye.

"Can you hear me, Dr. Alexi?"

The man nodded.

"Have you been to Africa recently?"

Dr. Alexi shook his head "no."

"Did you attend an eyelid surgery conference in San Diego a few months back?"

The man mouthed the word "yes."

Perhaps Dubchek really was right. It was too much of a coincidence: each outbreak's primary victim was an ophthalmologist who'd attended that San Diego meeting.

"Dr. Alexi," began Marissa, choosing her words carefully. "Do you have friends in L.A., St. Louis or Phoenix? Have you seen them recently?"

But before Marissa had finished, he'd slipped back into unconsciousness.

"That's what he's been doing," said the nurse, moving to the opposite side of the bed to take another blood-pressure reading.

Marissa hesitated. Perhaps she'd wait a few minutes and try to question him again. Her attention returned to the bruise beneath the man's eye, and she asked the nurse if she knew how he'd gotten it.

"His wife told me he'd been robbed," said the nurse. Then she added, "His blood pressure is even lower." She shook her head in dismay as she put down the stethoscope.

"He was robbed just before he got sick?" asked Marissa. She wanted to be sure she'd heard correctly.

"Yes. I think the mugger hit him in the face even though he didn't resist."

An intercom sputtered to life. "Marie, is there a doctor from the CDC in your room?"

The nurse looked from the speaker to Marissa, then back to the speaker again. "Yes, there is."

Over the continued crackle of static, indicating that the line was still open, Marissa could hear a woman saying, "She's in Dr. Alexi's room." Another voice said, "Don't say anything! I'll go down and talk with her."

Marissa's pulse raced. It was Dubchek! Frantically, she looked around the room as if to hide. She thought of asking the nurse if there were another way out, but she knew it would sound ridiculous, and it was too late. She could already hear footsteps in the hall.

Cyrill walked in, adjusting his protective goggles.

"Marie?" he asked.

"Yes," said the nurse.

Marissa started for the door. Dubchek grabbed her by the arm. Marissa froze. It was ridiculous to have a confrontation of this sort in the presence of a dying man. She was scared of Dubchek's reaction, knowing how many rules she had probably broken. At the same time, she was angry at having been forced to break them.

"What the hell do you think you're doing?" he growled. He would not let go of her arm.

"Have some respect for the patient, if not for anyone else," said Marissa, finally freeing herself and leaving the room. Dubchek was right behind her. She pulled off the goggles, the outer hood and gown, then the gloves, and deposited them all in the proper receptacle. Dubchek did the same.

"Are you making a career out of flouting authority?" he demanded, barely controlling his fury. "Is this all some kind of game to you?"

"I'd rather not talk about it," said Marissa. She could tell that Dubchek, for the moment, was beyond any reasonable discussion. She started toward the elevators.

"What do you mean, you'd 'rather not talk about it'?" yelled Dubchek. "Who do you think you are?"

He grabbed Marissa's arm again and yanked her around to face

"I think we should wait until you are a little less upset," Marissa managed to say as calmly as she could.

"Upset?" exploded Dubchek. "Listen, young lady, I'm calling Dr. Morrison first thing in the morning to demand that he make you take a forced leave of absence rather than a vacation. If he refuses, I'll demand a formal hearing."

"That's fine by me," said Marissa maintaining a fragile control. "There is something extraordinary about these Ebola outbreaks, and I think you don't want to face it. Maybe a formal hearing is what we need."

"Get out of here before I have you thrown out," snapped Dubchek.

"Gladly," said Marissa.

As she left the hospital, Marissa realized she was shaking. She hated confrontations, and once again she was torn between righteous anger and guilty humiliation. She was certain she was close to the real cause of the outbreaks, but she still could not clearly formulate her suspicions-not even to her own satisfaction, much less someone else's.

Marissa tried to think it through on her way to the airport, but all she could think of was her ugly scene with Dubchek. She couldn't get it out of her head. She knew she had taken a risk by going into the Berson Hospital when she was specifically unauthorized to do so. Cyril! had every right to be enraged. She only wished she had been able to talk to him about the strange fact that each of the index cases had been mugged just before becoming ill.

Waiting for her plane back to Atlanta, Marissa went to a pay phone to call Ralph. He answered promptly, saying he'd been so worried about her that he'd gone to her house when she had failed to answer the phone. He asked her where she'd been, pretending to be indignant that she'd left town without telling him.

"Washington and now Philadelphia," explained Marissa, "but I'm on my way home."

"Did you go to Philly because of the new Ebola outbreak?"

"Yes," said Marissa. "A lot has happened since we talked last. It's a long story, but the bottom line is that I wasn't supposed to go, and when Dubchek caught me, he went crazy. I may be out of a job. Do you know anybody who could use a pediatrician who's hardly been used?"

"No problem," said Ralph with a chuckle. "I could get you a job right here at the University Hospital. What's your flight number? I'll drive out to the airport and pick you up. I'd like to hear about what was so important that you had to fly off without telling me you were going."

"Thanks, but it's not necessary," said Marissa. "My Honda is waiting for me."

"Then stop over on your way home."

"It might be late," said Marissa, thinking that it might be more pleasant at Ralph's than in her own empty house. "I'm planning on stopping by the CDC. There is something I'd like to do while Dubchek is out of town."

"That doesn't sound like a good idea," said Ralph. "What are you up to?"

"Believe me, not much," said Marissa. "I just want one more quick visit to the maximum containment lab."

"I thought you didn't have authorization."

"I can manage it, I think," she told him.

"My advice is to stay away from the CDC," said Ralph. "Going into that lab is what caused most of your problems in the first place."

"I know," admitted Marissa, "but I'm going to do it anyway. This Ebola affair is driving me crazy."

"Suit yourself, but stop over afterwards. I'll be up late."

"Ralph?" Marissa said, screwing up her courage to ask the question. "Do you know Congressman Markham?"

There was a pause. "I know of him."

"Have you ever contributed to his campaign fund?"

"What an odd question, particularly for a long-distance call."

"Have you?" persisted Marissa.

"Yes," said Ralph. "Several times. I like the man's position on a lot of medical issues."

After promising again to see him that night, Marissa hung up feeling relieved. She was pleased she'd broached the subject of Markham and was even happier that Ralph had been so forthright about his contributions.

Once the plane took off, though, her sense of unease returned. The theory still undeveloped in the back of her mind was so terrifying, she was afraid to try to flesh it out.

More horrifying yet, she was beginning to wonder if her house being broken into and her dog killed was something more than the random attack she'd taken it for.

11

May 20-Evening

MARISSA LEFT THE AIRPORT and headed directly for Tad's house. She'd not called, thinking it would be better just to drop in, even though it was almost nine.

She pulled up in front of his house, pleased to see lights blazing in the living room on the second floor.