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  “He’s unresponsive at this point,” Amoy whispered so the patient couldn’t hear. “We’ve spoken with the family and they’re upset that they can’t see him but I figured I’d wait for the OK from you guys first, in case this is something serious and dangerous to the public health.”

  “We shouldn’t be in this room,” Sam said. “We need to set up full-barrier nursing for both of them. You need to make sure no one has access to this room except nurses who know how to handle the barrier and won’t have a problem with it.”

  “Why would they have a problem?”

  “Nurses can get brave around illness over time. They may feel it’s not a big deal.”

  Amoy took a deep breath. “You’re right. I should have done that from the beginning.”

  “I understand why you didn’t. I’ll need tissue and blood samples to send to the labs in Atlanta. Until we find out what this is, nobody can be up here.”

  CHAPTER 6

  On a quiet stretch of land in Fort Detrick, Maryland, Duncan Adams pushed on his brakes as he arrived at the United States Army Medical Research Institute of Infectious Diseases, the most advanced research facility in the world dealing with bioterrorism and home to over eight hundred scientists, both military and civilian.

  At the entrance of the unassuming building, which could have easily passed for a community college or an antiquated office building, Duncan showed his identification to the guard and parked in a stall reserved for civilian employees. He took out his notepad—a small pad bound by looped wires that he carried around in his pocket—and wrote “19%” on the front page underneath today’s date. The percentage was what he thought the probability was that he would catch a fatal disease that day.

  It was morbid, childish, immature, and completely unscientific. The number, after all, was based on nothing more than what he felt as he parked and turned off his car every morning. It wasn’t based on any reports or conversations or historical data. It was just a gut hunch. Despite this, he stuck to it with religious fervor. If the number he wrote down on any given morning was higher than 40%, he would take a vacation day and not go in. It had happened twice in the four years he’d worked at the Institute.

  Duncan went inside, preparing his badge to show the layers of security set up at the site. He went to the fourth floor and rode the elevator with what he guessed was a colonel and they both stepped off and went in separate directions.

  Housed at USAMRIID were some of the deadliest diseases Mother Nature had ever produced. He needed a top-secret clearance just to enter the offices he was entering and log in to the computer he was logging in to.

  Most of the organisms didn’t concern him. Four levels were set up, corresponding to the safety required when handling a biological agent. Biosafety Level 1 were viruses, such as canine hepatitis, thought not to be dangerous to humans. Biosafety Level 2 were viruses and bacterium, such as Lyme disease, thought dangerous though not typically deadly to humans. Level 3 contained potentially deadly viruses, bacterium, and parasites, such as SARS and anthrax. It was reserved for a select few within the military and civilian workforce that had the experience, education, and guts to work with such agents day in and day out.

  Duncan was a researcher in Biosafety Level 4.

  Level 4 was, by his estimation, one of the most dangerous spaces on the planet earth. There were obviously better candidates for deadliest environment—such as the bottom of the Marianas Trench in the Pacific where a screw becoming loose in your helmet could result in your head imploding from the pressure—but to a person not seeking out extreme environments, no place could bring about such a thrill, and at the same time paralyze you with fear like Biosafety Level 4.

  It was where nightmares lay dormant, frozen in liquid nitrogen. Marburg, Ebola, Congo Hemorrhagic Fever…and numerous other viruses referred to as “hot agents.” A section of the laboratory was devoted to what were termed X Agents: viruses that had yet to be identified. This was the area Duncan most liked to spend his time. The Age of Exploration had ended and his generation and every generation after would not have anywhere on earth to explore and declare discovered. Most people believed space was the next great landscape of discovery. But in this building was a storage unit that housed ancient beings as strange as anything science fiction had dreamed up. When he was there, surrounded by unknown agents, he felt like he was on a different planet, like an explorer observing things that no one before had known existed.

  He saw Dr. Janice Dickinson working in another part of the lab and she came over and sat on his desk, sipping coffee out of a mug that said, WORLD’S GREATEST MOM.

  “What’d we get today?” Duncan said, opening his email.

  “Reporter coming to watch a blood extraction.”

  “I thought that was next Friday?”

  “Nope, today.”

  “Who’s he with?”

  “LA Times.”

  “Oh, I kinda like the Times actually. Maybe I’ll decide not to hate him.”

  “Any big plans for the weekend?”

  “Racquetball with my pops and then back here for some good old-fashioned thesis research.”

  “When’s that damn degree gonna be done anyway?”

  “This summer, I hope. My bioinformatics professor is giving me some grief but he’s a raging alcoholic. I think once he has a lucid spell I can get what I want out of him.”

  She finished her coffee and took a deep breath. “You ready?”

  He closed all the windows on his mac and stood up. “Let’s do it.”

  Duncan followed Janice up to the BSL 4 area and to the locker rooms where he changed into scrubs. He thoroughly washed himself and put on latex gloves, rubber gloves over those, and Kevlar gloves over those. Then he did the same for his feet with different booties. In the waiting area leading to the labs, he found his blue suit and began to prepare.

  The suits were essentially space suits. They held positive pressure and inflated with a hose that connected to the back and made the scientists appear like they had tails. There were ports in various rooms where they would hook up and fresh air would circulate in the suits.

  Over their heads they placed thick plastic helmets with clear faceplates. They connected with the suits and prevented any sort of penetration by airborne pathogens. Except of course if the zipper that ran down from your neck to your crotch ever opened up, which it did all the time because the suits were only replaced when absolutely necessary. There was a mirror up near where he was dressing, and Duncan looked at it every day, wondering what the hell he was doing here exactly. He had a master’s in microbiology and epidemiology and soon would have a doctorate. He had also finished his MD a long time ago and only needed to complete a residency he had begun and abandoned. He could work at a lab as a director and have a plush office and a well-endowed secretary. Instead, he was putting on an old space suit and about to handle some of the most dangerous substances on earth.

  He and Janice moved from the dressing area to a negatively pressurized chamber. That meant air was being sucked into the room rather than being allowed to escape. Only one door could be opened at a time and to enter they locked the heavy steel door behind them and unlocked the one in front leading to the first room, which contained a chemical bath.

  They made their way to the exterior door of the laboratory and hooked up their blue suits using their hose attachments. They roared to life. The sound in the helmets was so loud you couldn’t hear without shouting. They opened the final door, and entered the laboratory.

  Standing over a microscope were two men in blue suits. The first was explaining something about protein synthesis to the second who tried to angle his faceplate so he was able to see into the microscope.

  “FIND ANYTHING GOOD?” Duncan shouted.

  Dr. Taylor Nielson looked at him and smiled. “THAT TWENTY BUCKS YOU OWE ME.”

  “I PAID THAT BACK.”

  “NO YOU DIDN’T.”

  “YES I DID. WE WERE AT THE DODO EATING BURGERS AND I PA
ID AND YOU SAID WE WERE EVEN.”

  Taylor thought a moment. “ALL RIGHT FINE, BE THAT WAY.” He turned to the man seated at the microscope. “THIS IS ALEJANDRO NEVAL. CALL HIM ALEX.”

  “ALEX,” Janice shouted, “HOW DO YOU LIKE OUR LITTLE LABORATORY?”

  “IT’S AMAZING. I CAN’T BELIEVE HOW MUCH NORMAL STUFF IS IN HERE.”

  Duncan knew what he meant. When he had first come to the labs, he was amazed that a laptop sat on one of the counters. Some of the scientists had been taking notes on Teflon treated plastic that could be decontaminated in the intensely hot decontamination process that all inanimate objects leaving the BSL 4 labs went through. There were also the standard instruments, cleaning products, and other items you might find in any laboratory.

  “YOU READY TO SEE OUR SPECIMEN?” Duncan asked.

  Alex nodded and rose from the microscope. Another sealed door led to what appeared like an autopsy room one might find in a pathology department at a small hospital. They unhooked their hoses, stepped into the room, shut the door, and hooked their suits back up to the outlets there.

  On a metal gurney at the far side of the small room lay a monkey. It was a howler monkey, its eyes frozen in the last expression it had in life. Duncan walked to it and ran his thickly gloved hand over the fur. The monkey’s blood contained a level 4 hot agent, one of the deadliest in the world: the Ebola virus. Though Ebola habituated some unknown host somewhere in the jungles of Africa—perhaps a bat or a fly—when it performed an inter-species jump to primates, it was absolutely devastating.

  Janice got the surgical instruments out of a container. They gleamed in the harsh lights of the lab as she set them one by one on a tray next to the gurney. Taylor approached; he was the zoologist of the group and would be performing the extraction. A vial of the liver would be taken for analysis at the labs in the Centers for Disease Control in Atlanta: the only other laboratory in the United States capable of handling BSL 4 hot agents.

  As Taylor readied the instruments, Alex stood behind him, attempting to take notes on one of the Teflon tabs provided. Taylor began lecturing Alex about the process of tissue extraction and how the monkey had ended up at USAMRIID. Janice stood next to him in case he needed anything and Duncan stood behind them near the door, wondering exactly why three people were required for any visit from a reporter.

  Taylor began with an incision in the monkey’s belly. He was shouting to Alex the whole time, impressing him with his knowledge of primate physiology, and Alex was leaning in close so he could actually hear over the endless air pumping through his suit. Duncan had always thought it sounded like a vacuum cleaner pushed up against each ear. He was about to tell Alex not to get too close and give Taylor some breathing space when Alex leaned just a little too far forward. The awkward shaped suit created enough forward momentum that he bumped Taylor’s arm.

  There was a moment when nobody moved. Duncan thought that perhaps some delicate procedure was happening. Tissue extractions on a liver that was an inch across were difficult enough. Throw the space suits and thick gloves on top of that and you would have to be a skilled surgeon to get the proper samples.

  But that wasn’t what had occurred.

  Duncan, in a moment that seemed to slow down time, saw that a thick, black liquid was dripping off Alex’s faceplate and onto the floor. The elbow bump had caused Taylor to nick the heart, causing blood to spray over the three people and the ceiling.

  Duncan’s first thought was that he should grab one of the disposable towels on a metal rack in the corner and clean the blood before taking Alex to a chemical shower and beginning the decontamination process. Before he could move, he heard the muffled scream and saw Alex raise his hands to his helmet.

  “No!” Duncan yelled.

  But it was too late. Alex ripped off the helmet in panic and began tearing at the spacesuit. He tried to run to the door and Taylor had to tackle him at the waist and pin him to the floor. Janice stood frozen, staring at the scene in wild-eyed amazement.

  Duncan jumped on top of Alex and held his arms down. He was screaming and spitting and biting. He had drifted away on a cloud of terror and was not responding to any commands. The two men each grabbed an arm and looked to each other. “UP,” Taylor yelled.

  They lifted the man and began to drag him to the door. Janice ran over and unlocked it. He was dragged across the lab and to the first of the chemical showers. The chemicals washed down his head and into the opening of the space suit at the neck. Duncan tried to shield Alex’s eyes with his gloved hand. He was now calming down, embarrassment and horror coming into his eyes in equal parts.

  “COME ON,” Taylor said, taking the man by the arm and into the next chamber.

  Duncan stepped into the shower next as Janice stepped out of the laboratory. They glanced at each other and a moment passed between them where they didn’t say anything. They both understood that Alex was to be placed in quarantine for double the length of the incubation period of the Ebola virus. It would be a type of solitary confinement and it would be Duncan and Janice’s job to ensure he didn’t go insane.

  Janice leaned against the wall. They both wanted to say something, but the only thing Janice thought of was, “SHIT.”

  Duncan couldn’t think of anything to add to that.

  CHAPTER 7

  Samantha Bower sat on the white sand beach and absorbed the sun. She had been in the hospital collecting blood samples for two hours and figured she had earned this. Collecting blood samples for a viral infection that was suspected to be unknown was not an easy task.

  She had to find vacu-containers in the supply closet with a nurse that had no intention of making her job easy. Then she needed anticoagulants and sodium hypochlorite. The hypochlorite was to wash the outside of the plastic bags the blood would be contained in. The risk of even a droplet of blood on the outside of the bags typically made the extraction of blood the most dangerous part of her job.

  She had also taken throat swabs from both Erin and Clifford. Everything had been sent back to the labs at the CDC and would be analyzed by one of the most brilliant men she had ever met: Stephen W. Pushkin.

  Stephen had begun work at the CDC as an undergraduate and returned every summer while completing his degree in biological engineering and microbiology at Harvard. He worked briefly at New Day Systems, designing heart valves and artificial limbs and whatever else caught his fancy, the company recognizing his brilliance and giving him free reign. He soon grew bored designing limbs and became obsessed with disease after being present in Guadalajara, Mexico, after a particularly brutal strand of dysentery killed over thirty people. That, and his background as an intern at the CDC, made him an ideal candidate for work in the laboratory.

  Sam lay back on her towel and let the sun wash the stress out of her. She still felt the knots in her belly but the heat, at least, made her muscles relax. She was drifting off to sleep when she felt her iPhone buzz next to her. She picked it up, her eyes still closed behind her sunglasses.

  “This is Sam.”

  “Dr. Bower, it’s Jerry Amoy. From Queen’s.”

  “Yes, hi.”

  “Um, hi. I was calling because two more patients exhibiting symptoms came into the ER in the past hour.”

  “What symptoms?”

  “Fever, a rash, vomiting blood. One of the patients is having bloody diarrhea. He doesn’t seem to be able to control it. I noticed some dark splotches on his back that resembled the other two patients’.”

  “Okay, I’ll be right down.”

  Samantha changed and was at the hospital in less than twenty minutes. She went directly to the ER and had Amoy paged. He arrived a short while later and said, “They’re upstairs.”

  The two of them rode the elevator up together and went through the procedure of cleaning and scrubbing themselves. Sam wasn’t as nervous this time and she couldn’t decide whether that was a good thing or a bad thing. Barricade nursing had been put in place and there was little chance of an exchange of bo
dy fluids. Samantha remembered another field agent at the CDC named Melissa who had been leaning over a patient with a suspected Marburg infection in Washington, DC, some three years ago. The man had suddenly vomited blood into her eyes. Luckily—or miraculously, Sam thought—the woman had not been infected with the virus, and the patient had survived.

  The two new patients were set up in rooms across the hall from each other. Sam chose the one on the right and went in. He was a young man, no older than thirty, and was reading a paperback novel as he lay in bed. He looked up and she could see the discoloration in the conjunctiva of his eyes. The whites of his eyes had turned a dark red. A clear plastic sheet hung over his bed like a canopy except that it went all the way underneath the bed and wrapped around. The man was running his toes along it near the bottom.

  Sam glanced down at the chart that Dr. Amoy had placed in her hand. She flipped through a few pages and said, “How are you doing, Jake?”

  “Not so good.”

  “What’s going on?”

  “I’ve been throwing up blood.”

  “When did it start?”

  “Yesterday. It comes in waves, like, it’ll come every half hour and then stop for a few hours and then come again.”

  “It says here you had a fever. When did you notice that?”

  “Like two days ago. It wasn’t bad, though. I got headaches then too.”

  “Jake, have you been to Africa or South America recently?”

  “No.”

  “Have you had any interactions with animals in the past few weeks?”

  “Like what kinda animals?”

  “Wild animals. Monkeys, birds, swine…”

  “No, nothing like that. I got a dog. But that’s it.”