The Neuropathology Of Zombies (22 page)

CHAPTER 30

The group was packed into a corner of the mess hall. A single liaison stood guard. A few people were playing cards, others read while lying on cots, and some slept. None of them noticed our approach.

“Petty Officer, may we have a word with your group?” Fitch asked the current liaison.
“Yes, sir,” he replied, and turned to face the group, most of whom were still oblivious to our presence. “Ladies and gentlemen, may I interrupt you for one moment, please. General Fitch from the United States Marine Corp would like to have a word with you!”
Fitch put his arm around me and thrust me forward, “Actually, it’s Dr. Hawk who would like to have a word with you.”
I was caught off guard and must have stammered for a moment or two before making sense, “Good afternoon everyone. How are you holding up?” My question was met with a series of groans. “Just as I suspected, you all want to enlist, now, right?” Everyone laughed and began to pay attention.
“As you know, we have a bit of a bug on the loose. A few of the people in your camp have come down with it,” so far everything I said was true, “You are being kept here until we are sure that none of you have it, we’d hate to have it spread throughout the ship. I’m wondering if you might let me examine you, quickly. I am looking for any sort of rash. If any of you have noticed a rash, please let me know. This will only take a minute, I promise, then you can all go back to enjoying your vacation!”
One man raised his hand.
“Yes, sir,” I said, pointing in his direction.
“Doctor, I have a rash and so does my son,” he said, placing his arm around the boy, who looked around ten years old.
“Thank you, do you mind if I take a look at you both?” I asked.
He nodded his head ‘no’ and stood up.
“Ensign, can you please bring them to the other corner?” I asked.
The other corner of the mess hall was empty and supplied just enough privacy to keep things modest.
The man and the boy sat on two of the randomly placed chairs that happened to be close by. The man rolled up his sleeve and showed me a bright red rash, it was swollen and scaly. The boy pulled up his pant leg and exposed an identical lesion. I shot a quick glance at the General and ensign.
“Would you mind, sir, if we took you to the ship’s sick bay and drew some blood, just as a precaution?” I asked.
The man looked nervous, “Is this something I should worry about, Doctor?”
“No, sir, it’s just an intestinal bug. If it spread to the entire ship, then we would have a problem, really more in terms of man power and supplies.” I laughed, trying to sound reassuring. “I’m not even sure if you have it, some of the sick people have a rash, we’re just trying to stop it before it really gets going.”
I extended my arm towards the ensign and instructed them to follow him to the sick bay. As I stood I noticed movement in the group. Everyone was rolling up their sleeves and lifting their pant legs searching for rashes. One by one the hands went up, until everyone in the group had one arm in the air.
I turned to the ensign, “Go find the other groups, look for anyone with a rash.”
“We should triage the folks on the flight deck,” the General said.
“I agree, let’s go. Ensign, come find us when you’re done. Don’t let anyone leave their group,” I said.
I looked at the father and son. They were visibly scared.
I placed my hand on the father’s shoulder, “Don’t worry, we’ll bring the sick bay to you, just go back to the group and keep doing whatever it was you were doing before we crashed the party.” I hoped my jovial tone would put them at ease.
The General and I ran up several sets of stairs to the flight deck. I opened the stairwell doors and a surge of bright sunlight struck me, I was temporarily blinded. It took me a few seconds to see what was happening, but I could hear the loud rumble of angry voices.
As the world became clearer I could see that the crowd was hysterical and the armed guards were having trouble containing them. People were pushing and yelling for help. I heard someone scream for a doctor and my head turned; a body lay on the ground at the feet of one of the soldiers. The soldier was too busy trying not to get trampled to notice. I ran over and knelt beside the stricken man. He was pale and his hair clung to his forehead, stuck down by a soaking sweat.
I reached for his wrist and felt for a pulse, his arm was heavy and offered no resistance as I bent the elbow. The pulse was weak, but he was alive. I lifted his shirt and examined his skin for the presence of the viral rash. There it was, all across his abdomen, red blotches with elevated white centers. He was infected.
A dark shadow came from behind me, I turned, and saw the General standing tall, blocking out the sun.
“He’s infected!” I shouted. I looked around at the startled group gathered around me. Some had rashes on their faces, some on their arms. One person had a rash extending out from under their shorts, running along their thigh. I inspected the crowd, watching as two more bodies dropped to the tarmac.
I ran across to the other side of the flight deck where the soldiers were attempting to contain another group. I pushed my way into the throng, examining everyone I passed. The warm tropical weather made it easy, the short sleeved shirts and shorts allowed for a quick scan. Everywhere I looked I saw the rash.
I turned my head to the right, an older woman was standing next to me. Her face opened in to a soft smile as we made eye contact, as if she were trying to calm me, trying to tell me everything was going to be okay. She must have thought I was one of the unruly members of the crowd. I stopped, and couldn’t help but smile back. She gave a little nod, and as I began to look away I saw a single red circle on her neck.
My smile must have faded into a look of fear, because her expression became one of concern and confusion. I walked towards her, staring at the spot on her neck. She nervously lifted her hand and covered the area where my eyes were focused.
“Ma’am, don’t be afraid, I’m Dr. Hawk. I need to see that rash on your neck,” I said as calmly as I could.
“What rash?” she replied, annoyed, in a London-sounding British accent.
“The rash under your hand,” I answered, gently lifting her hand from her neck, “How long have you had that?”
“I had no idea I had it at all,” she retorted.
“Do you know anyone else with a rash, a new rash?” I asked her.
“My husband, we thought it was the soap in the lavatory.” “Where is your husband now?”
“I’m not quite sure, he is in this horde someplace,” she said, looking around for him.
“Where were you staying on the Island?” I asked.
“The Grand Royal,” she answered. I placed my face within a few inches of her neck.
“Did you like it there?” I asked, trying to appear interested.
“Yes, it was quite lovely.”
As we made small talk, I examined the spot on her neck. The circular lesion was about two inches in diameter. The outer-most aspect was a light pink and extended out another half an inch until it faded into the pale skin. The color became fire truck red closer to the middle and in the center sat a small white dot that was slightly elevated off the surface.
The back of my neck became hot and started to tingle. A loud ringing sound filled my ears and my entire body felt heavy, feeling as though it might sink into the ground; my vision became tunneled and for a second I thought I was going to pass out. The answer arrived, I knew what was happening.
“Stay here for a moment, will you?” I said, and walked back towards the open space of the flight deck. I saw Fitch nervously looking around for me.
I waved my arms and shouted, “General!”
He saw me and started to walk in my direction. I ran at him, and grabbed him by both arms. He glanced down at my hands and appeared startled.
“It’s not a rash! It is not a rash!” I yelled, “They’re bug bites. I should have seen it sooner; we are dealing with an arbovirus. It’s being spread by insects!”
The general’s lower jaw dropped and his eyes widened. “What,” he snapped in disbelief.
“It’s a virus being transmitted by an insect bite!” I repeated, slower and louder.
“What makes you so sure, Doc?” he asked.
“The inflammation in the brainstem, the basal ganglia, the midbrain, and the spinal cord, it’s typical of an arbovirus, something like the West Nile virus. These viruses are carried by arthropods, you know, insects, and are transmitted by their bites. I should have seen it, but I was fooled by the lack of neuronal injury. Usually the inflammation kills all the neurons, that’s not the case here.”
Just as I finished the Ensign came running up to us, breathless. “Some people in the other groups have the rash, too!” he panted.
The three of us stared at each other not sure what to do next.
“Sirs,” he continued, “Virtually every civilian on this ship is infected!”
The young sailors face was filled with fear. I’m sure he believed he was now carrying the virus.
“The Doc says they’re bug bites, not a rash,” the General told him. “What? How’s that possible?” the ensign asked.
“It’s a virus carried by insects, like West Nile,” I repeated. “What we need to do now is find out what insect is spreading the disease, and where they are on this ship!” I yelled. “My money is on mosquitos, they are pretty common vectors for these infections. We’ve got to look for pools of water near the camps.” I said.
“How did the bugs get on the ship?” the Ensign asked.
“Probably in someone’s suitcase, or purse, I don’t know,” I answered.
“Go call the police barracks and tell them what is going on. Ask if anyone there has a rash,” the General commanded the ensign.
“General, we also need to see if any of the men on the ship have it, as well,” I added.
“Ensign, tell the Admiral what is happening, tell him to make an announcement that any seamen with a rash should report immediately to sick bay. Quick, go!” Fitch yelled.
“I’m going back down to the sick bay, I want to look at the files of the original two Driftwood, that may give us a clue as to where they picked up the virus,” I said. The General extended his arm towards the door and we walked together in silence.

CHAPTER 31

I flipped through the pages of the man’s file. It was filled with the usual type of demographic data such as birthdate, age, marital status, address. I scanned the information, looking for something specific. The last page was a brief note regarding their rescue that simply read ‘please see chart number 792’. They must have processed his wife first.

I grabbed the woman’s chart, number 792, and skipped to the last page. There was a description of where they had been found and how they arrived on the ship. The times and locations were precisely listed. I skimmed the story about the rooftop rescue, and the read the last few lines describing how long they had been on the Island, and where they were staying. Two weeks. The Marina Star Hotel.

“The Marina Star Hotel,” I said to the General, pointing to the words typed across the page. “And I bet you if we checked the files of the nine folks in the ICU, it would say the same thing. They must have brought the mosquitos on board the ship in their belongings.”

“I don’t think they had much in the way of luggage, it was pretty much run or die.” the General said.
“I am sure a few of them must have grabbed a backpack, or something before they left, I would have. Not leaving without my passport, that’s for sure,” I said. “Maybe it was in their clothes. Regardless, I need to get inside that hotel.”
“Doc, that’s going to be tough, the place is infested, our special op’s guys are having a hell of a time getting in the place,” the General said.
“Better call them and tell them to put on some bug spray,” I said. His face turned white at the thought of his men being exposed to the virus.
“The way I see it, we have two choices, room 1215, which was the room of the Driftwood in the body cooler, or room 243, which is where these nice zombies came from. I vote 1215, it’s closer to the roof, we won’t have to travel in too far.”
The General looked at me blankly, “You’re serious?”
“Serious. I think we should get back to the barracks and get ready, it’s getting late, and we need to do it now, while there is still light.”
We hurried back up to the flight deck. The situation had escalated and the rescuee’s were nearing an insurrection. I ran to the helicopter, bodies covered the ground and people were collapsed around me. Within seconds the pilot had the engine running.
General Fitch was still standing on the tarmac. “Aren’t you coming?” I asked.
“No. I think I need to stay here and deal with this mess.”
“Be careful.”
“You, too. I’ll radio ahead and have everyone ready for an emergency meeting in the conference room.” The rotors began to spin, he waved and stepped back.
We lifted off the deck and I looked down at the chaos on the below. The people were panicking. I wondered what was going to happen in a few hours when the entire ship was filled with violent flesh eating ghouls; although I had discovered the cause, the chain of events had already been set in motion, and nothing could stop it now.

CHAPTER 32

The conference room was alive, voices yelled over one another competing to be heard. It was cramped, and I struggled to find a place at the table to set my notes. I tried to slip between the people and bumped shoulders against several Marines.

“Ah, the man of the hour, Dr. Hawk!” a voice called. My head swiveled trying to see who had noticed me. It was the man in the black suit. Standing next to him was the Governor, she smiled and winked at me.

I gave a wave and nodded my head. The room became silent and all eyes fixed on me. I was suddenly hot and uncomfortable.
“Now that you’re here, perhaps you’d like to tell us how to make this little problem,” the man in the black suit paused, “go away.”
“Well, I don’t know if I am going to be able to do that, but I can tell you what’s causing it.” I shouted.
“Please,” he said, folding his arms.
“It’s a virus, called an arbovirus, that’s transmitted by an insect bite, probably a mosquito. Arboviruses infect neurons in the brainstem, the basal ganglia, the limbic system, and the motor neurons of the spinal cord; it’s pretty specific about where it invades. Usually the virus gets inside the neurons and triggers an immune response from the body. That immune response leads to the destruction of the cells containing the virus. One of the interesting things about our Island virus is, although the infected neurons are setting off an immune response, aren’t being killed, somehow they remain alive, and they keep firing; they’re still working. All of this is happening as the uninfected parts of the brain die and begin to decompose.
“I have no idea how the virus is able to accomplish this, it’s impossible. Impossible,” I said and paused for a drink of water. “Unbelievable, is probably a better word. It’s unbelievable.
“Doctor, why are these things still alive?” Major Thomas asked.
“Like I said, I am not sure what the virus is doing inside the neurons. It could be that it’s genetic material has inserted itself into the genome of the neuron, and that now the neuron is expressing a viral gene that is somehow keeping the nerve cell alive. Viruses are unique, they’re not like you and me, and they’re not like bacteria. They don’t need water, air, or food. All they need is another cell. This thing may have hijacked the nuclei of the neurons, making the body an extension of itself: a walking virus.
“Another thing that is interesting about our little microscopic guest is that the infected regions of the brain are part of what’s called ‘the reptilian brain’, which is comprised of the oldest and most primitive regions of our nervous system.
“The role of the reptilian brain is hunting and eating, it’s basic survival. The urges it creates are kept in check by the cortex. For example, something happens to make you angry, you fill with rage, that emotion comes from the amygdala. As your anger grows you begin to feel more and more like hitting someone, normally, at this point, the cortex kicks and puts on the breaks. Without the cortex, inhibition is lost and you end up hitting whoever or whatever made you mad,” I paused and gazed around the room, everyone was listening intently. “In our zombies, the cortex is dead and the reptile brain is still operating, controlling all aspects of behavior.
“You can see this in their actions: the hunting, the killing, all reptile brain. Even more interesting, the EEG changes, which are recordings of brains electrical activity, that I saw in the Marine as he reanimated, were brain waves typically seen in animals as they hunt and sniff. Understand? We have the behavior, the brain waves, and the histology, all corroborating this theory. The reptile brain rules the zombie.
Another question came from somewhere in the group, “Why don’t they die when you shoot them?”
“They do,” I replied, “but you have to shoot them in the head! The heart, lungs, all the internal organs have stopped working and are decomposing. They are just bags of nervous tissue walking around. A head shot disrupts the electrical pathways, and thereby, kills the ghouls.”
“Doc, without heart and lungs, how are they able to walk around?” Thomas asked.
“Probably for a few reasons, sir. One reason why the Driftwood are able to move around is because the basal ganglia are infected and still functioning. This region of the brain initiates very crude movements of the trunk, explaining why the Driftwood shuffle about so uncoordinated. The input from the cortex and cerebellum that would normally smooth out movement, and allow one to perform more detailed tasks, is now gone, so they stumble along, full of anger.
“Another reason these things are moving around is because there is an infection in the midbrain, specifically, in an area called the substantia nigra. The substantia nigra helps to stop unwanted movements. If it’s injured, you get Parkinson’s disease, a clinical disease where the patient has an expressionless face and shuffles when they walk; their arms and legs get stiff, like lead pipes. Stimulating the substantia doesn’t result in movement, but repeated stimulation may wear it out and allow unwanted movements to occur. Although the region is infected, there may well be something else going on, because I saw some very unusual inclusions, called tangles, inside the cells. This may be the result of damage to the cell, and even though it’s infected, it may not be working like the other areas of the brain. I just don’t know yet.
“Now, it’s well enough to generate impulses from the basal ganglia or the midbrain, but they have traveled out to the arms and legs in order for you to move. In our zombies, the motor neurons in the spinal cord, which tell the muscle to move, are also infected and because the neurons are still functioning, the impulses coming from the basal ganglia can be transmitted to the limbs allowing movement to occur.
“Out in the extremities, some of the smaller muscle groups are dead, but the larger groups are alive, probably as a result of the electrical stimulation coming down from the brain. The functioning large muscles groups allow for coarse movements and truncal movements. The muscle cells themselves may also be infected. Also, because parts of the spinal cord are still functioning, the spinal reflexes are intact. Spinal reflexes work with your muscles and help tell your arms and legs where they are in space, they play a major role in maintaining posture. These reflexes greatly enhance our ability to stand up and to walk,” I leaned up against the wall, felling slightly more relaxed than a few minutes ago.
“The spinal reflexes also assist us in responding to a stimulus. And for that matter, so does the midbrain. The midbrain, aside from controlling movement through the substantia nigra, is also the seat of consciousness. In the Driftwood, the level of consciousness derived from the midbrain is more like that of a bug, just stimulus-response, without any sort of upper level understanding of what they’re responding to, again, this is because the cortex, which oversees this upper level function, is dead.
“This awareness of a stimulus, and the ability to react to it, is probably enhanced more by their auditory and olfactory senses, than by their ability to see; you know, their ability hear and smell.
“How, Doc?” another soldier asked. I didn’t recognize him.
“Well, another thing I noticed is while vision is still somewhat intact, it does slowly worsen as the cornea clouds with increasing postmortem intervals. They compensate with an increased ability to smell and hear. While I was on the rooftop with the governor, I noticed one of the Driftwood lift his head, and stick his nose into the air, nostrils flaring. We were on a completely different roof top where he couldn’t see us, but he could smell us.
“When I looked at the brains under the microscope, the inferior colliculi were infected, and had become larger than normal and probably hyper functioning. The inferior colliculus is the control center for the hearing reflexes, so their ability to hear is greatly increased.
“Interestingly,” I continued, “did you know that the inferior colliculus of the vampire bat is uniquely designed and adapted to hear the specific breathing oscillations associated with sleep. It can tell when prey is sleeping, from miles away!”
“Doctor Hawk, why are they eating people?” a voice shouted from the other side of the room.
“I don’t know is the most honest answer. I have a few guesses, though. Probably the simplest reason is they increased activity of the amygdala. Remember what I said about people with Kluver-Bucy syndrome? These people gorge on inappropriate things, what’s more inappropriate then other humans?
“Another reason may be that they are looking for blood,” I continued, “Blood is an excellent food source, it’s full of the necessary sugars, proteins and fats needed for a well-balanced diet. Most of these nutrients are already digested, ready to be absorbed and used as fuel, or building blocks, that the body needs. There are a number of species on Earth that have evolved to be hematophagic, meaning, they only feed on blood. Mosquitos, leeches, the vampire bat, all feed on blood.
“The digestive system of the Driftwood is dead, it’s not working. To get around this, they eat something that’s already been digested and packaged for transport: blood. I think the blood products may be simply diffusing across the wall of the intestine, without the aid of active transport. Although most of the organ systems are gone, the brain is still marching on. The virus needs certain building blocks to continue to produce its DNA; it may be getting these from the blood. These necessary ingredients may simply be diffusing into the body eventually ending up in the brain where they are needed.
“Also, by eating living people, they are getting oxygen from the blood. They might also be getting oxygen that is locked up in muscle as myoglobin. Oxygen leaves tissue very quickly, and I think that once inside the Driftwood, it’s diffusing through the tissue membranes and getting to the brain. I think we need to study this in more detail. But those are my guesses at this point.
“Doctor, I have one more question, if that’s okay?” Major Thomas asked again. I was beginning to have flashbacks to the six hours I spent in graduate school defending my dissertation.
“Yes, please, I want you all to understand as much as possible.”
“Why is the skin falling off and forming all those blisters and sores?”
“Excellent question, sir. I think for two reasons. One, the skin is decomposing, so it forms blisters and slips off. Two, I think the virus is causing an autonomic neuropathy. These are genetic or acquired diseases that affect the nerves and cause skin lesions and alterations in sensation. It’s probably a reason why they can’t feel pain, too.
“There is a very interesting genetic disease called Hereditary Sensory Autonomic Neuropathy, or HSAN for short. There are many different types with a wide variety of clinical manifestations. However, several forms of HSAN cause multiple, deep, festering ulcers that eat down to the bone and sometimes cause the limb to fall off. Remember, this is an inherited disease. But, there are some forms of autonomic neuropathy that can be the result of metabolic diseases or infections. One type of autonomic neuropathy is seen with Lyme disease, an illness caused by a tick bite. We may have a severe form of an autonomic neuropathy here, something similar to HSAN, or something in that same family of diseases.
“In regards to pain, we also have to remember that the cortex is gone, particularly the sensory cortex of the parietal lobes. Another thing to keep in mind, is the basal ganglia are inflamed. Bilateral injury to the basal ganglia can cause athymhoric syndrome, also called psychic akinesia. It’s characterized by extreme apathy, blunted affect, and a profound loss of motivation and conscious thought. Interestingly, people with this disorder fail to react to pain. Cases have been described where patients have placed their hand on a stove and failed to move away, simply because they lacked the motivation to do so, despite experiencing extreme pain. So, the Driftwood may be unable to feel and appreciate pain for a variety of reasons.”
“A virus is doing all this, really?” Thomas called out.
“Yes, in fact it reminds me of something that happened after the deadly influenza outbreak in 1918. After developing the typical headaches, body aches, fevers, and nausea, that normally accompany the flu, a small group of people manifested some very peculiar symptoms such as hallucinations, hyper-excitability, obsessional behavior, and psychosis. At first, the individual became lethargic and stuporous, and appeared to unaware of the environment. When stimulated, they ‘woke up’ and became psychotically violent. Others experienced profound personality changes, eventually becoming dangerous and out of control. The affected individuals also had serious motor deficits and altered gaits; they shuffled and stumbled, appearing to have Parkinson’s disease. Doctors called the condition ‘encephalitis lethargica’.
“At first scientists thought the symptoms were the result of a toxin, but when they looked at the epidemiological data, it fit more with the spread of the influenza virus. To date no one has been able to identify the influenza virus, or any other virus, for that matter, in any of the patients with encephalitis lethargica.
I paused and looked around the group. Everyone stared intently. “Even more interesting, the histologic changes reported in the few cases of encephalitis lethargica that were autopsied are nearly identical to the lesions I’m seeing here with our Island virus. The same regions of the brain are being affected, the same type of inflammation, the same neuronal tangles, just about everything is the same. The only difference is, in the encephalitis lethargica cases, the neurons died.
I continued, “Sound familiar? Maybe we’re dealing with an outbreak of encephalitis lethargica that has mutated. The source of the 1918 infection was never determined, maybe it was an arbovirus all along and nobody looked for it.
“If this thing has been around since 1918, how come we don’t hear about it, where’s it been?” the security leader asked.
“Oh, it’s been around, not very common though. There are a few cases reported here and there. Maybe a handful have ever been reported. It’s been around, but maybe it’s changed its game plan a bit.
“Although we don’t know a lot about our virus, we do know that it’s transmitted two ways: from an insect bite and a zombie bite. My major concern is that if it’s spread by a zombie bite, the virus has to be present in the saliva. It’s not a great leap for it to become airborne through droplets of spit shot out by a sneeze or a cough. This thing replicates very fast, when the genome is being copied at this kind of speed, a mutation is almost certain to happen. It’s only a matter of time until that mutation results in this thing taking to the air. If it does, we’re all in a shit load of trouble.
No one spoke. I broke the silence, “Does anyone have a rash or do you know anyone who has a rash?”
Everyone nervously looked down at their arms and pulled up pant legs. No one was affected.