A nurse waited in the hall, and she briskly walked me past the surgery room, then walls of autoclaves that reminded me of steel diving bells, the air foul with the stench of scalded laboratory animals. I was to stay in the 200 Ward, where a red line just inside my room warned patients in isolation not to cross. I looked around at the small hospital bed with its moist heating blanket, and ventilator, refrigerator and small television suspended from a corner. I noticed the coiled yellow air lines attached to pipes on the walls, the steel pass box in the door, through which meal trays were delivered, and irradiated with UV light when removed.
I sat on the bed, alone and depressed, and unwilling to contemplate how much trouble I might be in. Minutes passed. An outer door loudly shut, and mine swung open wide.
“Welcome to the Slammer,” Colonel Fujitsubo announced as he walked in.
He wore a Racal hood and heavy blue vinyl suit, which he plugged into one of the coiled air lines.
“John,” I said. “I’m not ready for this.”
“Kay, be sensible.”
His strong face seemed severe, even frightening behind plastic, and I felt vulnerable and alone.
“I need to let people know where I am,” I said.
He walked over to the bed, tearing open a paper packet, a small vial and medicine dropper in a gloved hand.
“Let’s see your shoulder. It’s time to revaccinate. And we’re going to treat you to a little vaccinia immune globulin, too, for good measure.”
“My lucky day,” I said.
He rubbed my right shoulder with an alcohol pad. I stood very still as he incised my flesh twice with a scarifier and dripped in serum.
“Hopefully, this isn’t necessary,” he added.
“No one hopes it more than me.”
“The good news is, you should have a lovely anamnestic response, with a higher level of the antibody than ever before. Vaccination within twenty-four to forty-eight hours of exposure will usually do the trick.”
I did not reply. He knew as well as I did that it might already be too late.
“We’ll autopsy her at oh-nine-hundred hours and keep you for a few days beyond that, just to be sure,” he said, dropping wrappers in the trash. “Are you having any symptoms at all?”
“My head hurts and I’m cranky,” I said.
He smiled, his eyes on mine. Fujitsubo was a brilliant physician who had sailed through the ranks of the Army’s Armed Forces Institute of Pathology, or AFIP, before taking over the command of USAMRIID. He was divorced and a few years older than me. He got a folded blanket from the foot of the bed, shook it open and draped it around my shoulders. He pulled up a chair and straddled it, his arms on top of the backrest.
“John, I was exposed almost two weeks ago,” I said.
“By the homicide case.”
“I should have it by now.”
“Whatever it is. The last case of smallpox was in October 1977, in Somalia, Kay. Since then it has been eradicated from the face of the earth.”
“I know what I saw on the electron microscope. It could have been transmitted through unnatural exposure.”
“Deliberately, you’re saying.”
“I don’t know.” I was having a hard time keeping my eyes open. “But don’t you find it odd that the first person possibly infected was also murdered?”
“I find all of this odd.” He got up. “But beyond offering biologically safe containment for the body and you, there isn’t much we can do.”
“Of course there is. There isn’t anything you can’t do.” I did not want to hear of his jurisdictional conflicts.
“At the moment, this is a public health concern, not a military concern. You know we can’t just yank this right out from under CDC. At the worst, what we’ve got is an outbreak of some sort. And that’s what they do best.”
“Tangier Island should be quarantined.”
“We’ll talk about that after the autopsy.”
“Which I plan to do,” I added.
“See how you feel,” he said as a nurse appeared at the door.
He conferred briefly with her on his way out, then she was walking in, dressed in another blue suit. Young and annoyingly cheerful, she was explaining that she worked out of Walter Reed Hospital but helped here when they had patients in special containment, which, fortunately, wasn’t often.
“Last time was when those two lab workers got exposed to partially thawed field mouse blood contaminated with Hantavirus,” she said. “Those hemorrhagic diseases are nasty. I guess they stayed here about fifteen days. Dr. Fujitsubo says you want a phone.” She laid a flimsy robe on the bed. “I’ll have to get that for you later. Here’s some Advil and water.” She set them on the bedside table. “Are you hungry?”
“Cheese and crackers, something like that, would be nice.” My stomach was so raw I was almost sick.
“How are you feeling besides the headache?”
“Fine, thanks.”
“Well, let’s hope that doesn’t change. Why don’t you go on in the bathroom, empty your bladder, clean up and get under the covers. There’s the TV.” She pointed, speaking simply as if I were in second grade.
“What about all my things?”
“They’ll sterilize them, don’t you worry.” She smiled at me.
I could not get warm, and took another shower. Nothing would wash away this wretched day, and I continued to see a sunken mouth gaping at me, eyes half open and blind, an arm hanging stiffly off a foul deathbed. When I emerged from the bathroom, a plate of cheese and crackers had been left for me, and the TV was on. But there was no phone.
“Oh hell,” I muttered as I got under the covers again.
The next morning, my breakfast arrived by pass box, and I set the tray on my lap as I watched the Today show, which I ordinarily never got to do. Martha Stewart was whipping up something with meringue while I picked at a soft-boiled egg that wasn’t quite warm. I could not eat, and did not know if my back ached because I was tired or from some other reason I would not contemplate.
“How are we doing?” The nurse appeared, breathing HEPA-filtered air.
“Don’t you get hot in that thing?” I pointed my fork.
“I guess I would if I stayed in it for long periods of time.” She was carrying a digital thermometer. “All right. This will just take a minute.”
She inserted it into my mouth while I stared up at the TV. Now a doctor was being interviewed about this year’s flu shot, and I shut my eyes until a beep said my time was up.
“Ninety-seven point nine. Your temperature’s actually a little low. Ninety-eight point six is normal.”
She wrapped a BP cuff around my upper arm.
“And your blood pressure.” She vigorously squeezed the bulb, pumping air. “One hundred and eight over seventy. I believe you’re almost dead.”
“Thanks,” I mumbled. “I need a phone. No one knows where I am.”
“What you need is to get lots of rest.” Now she had out the stethoscope, which she pushed down the front of my scrubs. “Deep breaths.” It was cold everywhere she moved it, her face serious as she listened. “Again.” Then she moved it to my back as we continued the routine.
“Could you please have Colonel Fujitsubo stop by.”
“I’ll certainly leave him a message. Now you cover up.” She pulled the blanket up to my chin. “Let me get you some more water. How’s your headache?”
“Fine,” I lied. “You really must ask him to stop by.”
“I’m sure he will when he can. I know he’s very busy.”
Her patronizing manner was beginning to really get to me. “Excuse me,” I said in a demanding tone. “I have repeatedly requested a phone, and I’m beginning to feel like I’m in prison.”
“You know what they call this place,” she sang. “And usually, patients don’t get . . .”
“I don’t care what they usually get.” I stared hard at her as her demeanor changed.
“You just calm right down.” Eyes glin
ted behind clear plastic, her voice raised.
“Isn’t she an awful patient? Doctors always are,” Colonel Fujitsubo said as he strode into the room.
The nurse looked at him, stunned. Then her resentful eyes fixed on me as if she did not believe it could possibly be true.
“One phone coming up,” he went on as he carried in a fresh orange suit, which he laid on the foot of the bed. “Beth, I guess you’ve been introduced to Dr. Scarpetta, chief medical examiner of Virginia and consulting forensic pathologist for the FBI?” To me, he added, “Put this on. I’ll be back for you in two minutes.”
The nurse frowned as she picked up my tray. She cleared her throat, embarrassed.
“You didn’t do a very good job on your eggs,” she said.
She set the tray in the pass box. I was pulling on the suit.
“Typically, once you’re in here, they don’t let you out.” She shut the drawer.
“This isn’t typical.” I tied down the hood and turned on my air. “The case this morning is mine.”
I could tell she was one of those nurses who resented women doctors, because she preferred to be told what to do by men. Or maybe she had wanted to be a doctor and was told that girls grow up to be nurses and marry doctors. I could only guess. But I remembered when I was in medical school at Johns Hopkins, and one day the head nurse grabbed my arm in the hospital. I’d never forget her hate when she snarled that her son hadn’t gotten in because I had taken his slot.
Fujitsubo was walking back into the room, smiling at me as he handed me a telephone and plugged it into a jack.
“You got time for one.” He held up his index finger. “Then we got to roll.”
I called Marino.
Bio Level 4 containment was in back of a normal lab, but the difference between the two areas was serious. BL-4 meant scientists doing open war with Ebola, Hantavirus and unknown diseases for which there was no cure. Air was single-pass and negative pressure to prevent highly infectious microorganisms from flowing into any other part of the building. It was checked by HEPA filters before it entered our bodies or the atmosphere, and everything was scalded by steam in autoclaves.
Though autopsies were infrequent, when they were performed it was in an air-locked space nicknamed “the Sub,” behind two massive stainless steel doors with submarine seals. To enter, we had to go in another way, through a maze of change rooms and showers, with only colored lights to indicate which gender was in what. Men were green so I put my light on red and took everything off. I put on fresh sneakers and scrubs.
Steel doors automatically opened and closed as I passed through another air-lock, into the inner change, or hot side room where the heavy gauge blue vinyl suits with built-in feet and pointed hoods hung from hooks on a wall. Sitting on a bench, I pulled one on, zipping it up and securing flaps with what looked like a diagonal Tupperware seal. I worked my feet into rubber boots, then layers of heavy gloves, with outer ones taped to cuffs. I was already beginning to feel hot, doors shutting behind me as other ones of even thicker steel sucked open to let me into the most claustrophobic autopsy room I had ever seen.
I grabbed a yellow line and plugged it into the quick-release coupling at my hip, and rushing air reminded me of a deflating wading pool. Fujitsubo and another doctor were labeling tubes and hosing off the body. In her nakedness, her disease was even more appalling. For the most part, we worked in silence for we had not bothered with communication equipment, and the only way to speak was to crimp our air lines long enough to hear what someone else was saying.
We did this as we cut and weighed, and I recorded the pertinent information on a protocol. She suffered the typical degenerative changes of fatty streaks and fatty plaques of the aorta. Her heart was dilated, her congested lungs consistent with early pneumonia. She had ulcers in her mouth and lesions in her gastrointestinal tract. But it was her brain that told the most tragic story of her death. She had cortical atrophy, widening of the cerebral sulci and loss of the parenchyma, the telltale hints of Alzheimer’s.
I could only imagine her confusion when she had gotten sick. She may not have remembered where she was or even who she was, and in her dementia may have believed some nightmarish creature was coming through her mirrors. Lymph nodes were swollen, spleen and liver cloudy and swollen with focal necrosis, all consistent with smallpox.
She looked like a natural death, the cause of which we could not prove yet, and two hours later, we were done. I left the same way I had come in, starting with the hot side room, where I took a five-minute chemical shower in my suit, standing on a rubber mat and scrubbing every inch with a stiff brush as steel nozzles pounded me. Dripping, I reentered the outer room, where I hung the suit to dry, showered again and washed my hair. I put on a sterile orange suit and returned to the Slammer.
The nurse was in my room when I walked in.
“Janet is here writing you a note,” she said.
“Janet?” I was stunned. “Is Lucy with her?”
“She’ll slide it through the pass box. All I know is there’s a young woman named Janet. She’s alone.”
“Where is she? I must see her.”
“You know that isn’t possible just now.” She was taking my blood pressure again.
“Even prisons have a place for visitors,” I almost snapped. “Isn’t there some area where I can talk to her through glass? Or can’t she put on a suit and come in here like you do?”
Of course, all this required permission, yet again, from the colonel, who decided that the easiest solution was for me to wear a HEPA filter mask and go into the visitors’ booth. This was inside the Clinical Research Ward, where studies were conducted on new vaccines. She led me through a BL-3 recreation room, where volunteers were playing Ping-Pong and pool, or reading magazines and watching TV.
The nurse opened the wooden door to Booth B, where Janet was seated on the other side of glass in an uncontaminated part of the building. We picked up our phones at the same time.
“I can’t believe this,” was the first thing she said. “Are you all right?”
The nurse was still standing behind me in my telephone-booth-sized space, and I turned around and asked her to leave. She didn’t budge.
“Excuse me,” I said, and I’d about had it with her. “This is a private conversation.”
Anger flashed in her eyes as she left and shut the door.
“I don’t know how I am,” I said into the phone. “But I don’t feel too bad.”
“How long does it take?” Fear shone in her eyes.
“On average, ten days, at the most fourteen.”
“Well, that’s good, then, isn’t it?”
“I don’t know.” I felt depressed. “It depends on what we’re dealing with. But if I’m still okay in a few days, I expect they will let me leave.”
Janet looked very grown-up and pretty in a dark blue suit, her pistol inconspicuous beneath her jacket. I knew she would not have come alone unless something was very wrong.
“Where’s Lucy?” I asked.
“Well, actually, both of us are up here in Maryland, outside Baltimore, with Squad Nineteen.”
“Is she all right?”
“Yes,” Janet said. “We’re working on your files, trying to trace them through AOL and UNIX.”
“And?”
She hesitated. “I think the quickest way to catch him is going to be online.”
I frowned, perplexed by this. “I’m not sure I understand . . .”
“Is that thing uncomfortable?” She stared at my mask.
“Yes.”
I was sorrier for the way it looked. It covered half of my face like a hideous muzzle and kept knocking the phone as I talked.
“How can you catch him online unless he’s still sending messages to me?”
She opened a file folder on her Formica ledge. “Do you want to hear them?”
I nodded as my stomach tightened.
“Microscopic worms, multiplying ferments and miasma,” she read.<
br />
“Excuse me?” I said.
“That’s it. E-mail sent this morning. The next one came this afternoon. They are alive, but no one else will be. And then about an hour after that, Humans who seize from others and exploit are macro parasites. They kill their hosts. All in lower-case with no punctuation except spaces.” She looked through the glass at me.
“Classical medical philosophy,” I said. “Going back to Hippocrates and other Western practitioners, their theories of what causes disease. The atmosphere. Reproducing poisonous particles generated by the decomposition of organic matter. Microscopic worms, et cetera. And then the historian McNeill wrote about the interaction of micro and macro parasites as a way of understanding the evolution of society.”
“Then deadoc has had medical training,” Janet said. “And it sounds like he’s alluding to whatever this disease is.”
“He couldn’t know about it,” I said as I began to entertain a terrible new fear. “I don’t see how he possibly could.”
“There was something in the news,” she said.
I felt a rush of anger. “Who opened his mouth this time? Don’t tell me Ring knows about this, too.”
“The paper simply said your office was investigating an unusual death on Tangier Island, a strange disease that resulted in the body being airlifted out by the military.”
“Damn.”
“Point is, if deadoc has access to Virginia news, he could have known about it before he sent the e-mail messages.”
“I hope that’s what happened,” I said.
“Why wouldn’t it be?”
“I don’t know, I don’t know.” I was worn out and my stomach was upset.
“Dr. Scarpetta.” She leaned closer to the glass. “He wants to talk to you. That’s why he keeps sending you mail.”
I was feeling chills again.
“Here’s the idea.” Janet tucked the printouts back inside the file. “I could get you in a private chat room with him. If we can keep you online long enough, we can trace him from telephone trunk to telephone trunk, until we get a town, then a location.”