Michael Palmer: Fatal

It had started with a sore throat.

Nattie Serwanga remembered the exact moment. She had been having dinner with her husband, Eli, when some green beans hurt her going down. At the time, the two of them were talking about whether Nadine would be a better choice to name their daughter than Kolette. The discomfort was the beginning of a cold, she thought. Nothing more.

But despite treatment from the doctors in the clinic, the sore throat had gotten progressively worse. Now, nine days after that first scratchy pain, Nattie knew she was sick — really sick. The pounding headache told her so. So did the chills and the sweats and the fiery swelling in her throat that the antibiotics had done nothing to help. And beginning at three this morning, there was the cough.

Across the raised glass counter, the kids from the hospital day-care center were lined up for lunch. Chicken nuggets and spaghetti. Pudding for dessert.

"Hi, Nattie Smattie."… "Me first, Nattie. Me first."… "Ugh, not spanetti again."

Winking at an adorable four-year-old named Harold, Nattie forced a few drops of saliva past the burning in her throat and filled his plate. A moment later, without enough warning even to raise her hand, she was jolted by a vicious, racking cough — the worst yet. Droplets of her saliva sprayed over the contents of the trays in front of her. She stumbled back but caught herself before she actually fell. Each hack drove a six-inch spike into her brain.

"Damn," she muttered, regaining her equilibrium. She was tough — tough as nails, one of her sisters liked to say. But this infection was tough, too. Instinctively, she slid her hands beneath her apron and pressed them against her womb. For a few horrible, empty seconds, there was nothing. Then she felt a sharp jab on her right side echoed immediately by one on the left. Despite the headache and the cough and the hot coals in her throat, Nattie Serwanga smiled.

At forty, married seven years, she had begun to believe it was her sad destiny to remain childless. Eli, who came from a family of ten children, desperately wanted kids. He had all but given up, though, and had begun talking about taking in foster children or even adopting. Then the miracle.

"Nattie, are you okay?"

Supervisor Peggy Souza eyed her with concern. Nattie's smile this time was forced. A piercing ache had materialized between her shoulder blades.

"I'm… I'm fine," she managed. "It's just a cold that doesn't want to dry up. I been to my obstetrician — twice."

"He give you something?"

"First penicillin, then something stronger."

She decided to leave out the part about sending her to an infections specialist if she wasn't better soon, or all the questions about the trip she and Eli had just taken to see his family in Sierra Leone.

"You wanna go home?"

Nattie gestured to the crowd on the other side of the counter. A number of nurses and doctors were now lined up behind the kids.

"After the rush, maybe."

The trip to Africa had used up the last of her vacation. She had been saving up her sick days to use in conjunction with maternity leave. With any luck she would be able to work until the last week and then take almost three months off. There was no way she could leave work just now.

"Well, I tell you what," Peggy said. "Why don't you wear one of these surgical masks until you're ready to leave? That was some nasty coughin' you were doin'."

Nattie turned so that Peggy couldn't see her fumbling with the strings of the mask.

What in God's name is happening to me?

The next ten minutes were a blur of pain and poorly suppressed coughing. Still, Nattie managed to finish serving the children and even to make a dent in the staff, each of whom, she knew, had almost no time at all for lunch. Now, in addition to the unremitting pain, she was experiencing spasms and fullness in her rectum.

Please God, take care of my baby. Don't let anything happen to her.

"Nattie?… Nattie!"

"Huh? Oh, sorry, Peggy. My mind just wandered."

"You were just standing there starin' off into space. I think you need to stop for the day an'… Nattie, look over here at me."

"What?"

"Your eyes. They're all spotted with blood."

"What are you talking about?"

"The white part of your eyes. There's, like, patches of blood all over them. Nattie, you'd better get to a doctor right now."

A sudden, strangulating tightness in her rectum made it impossible for Nattie to speak. Panicked, she nodded, then hurried as best she could to the rest room. The masked face staring back at her from the mirror looked monstrous. From under her paper hair-covering, clumps of her ebony hair were plastered to the perspiration on her forehead. Below that, the whites of her dull, almost lifeless eyes were nearly obliterated by splashes of bright crimson. She untied the top strings of her mask and let it flop over onto her chest. The inner surface of the mask, spattered with blood, looked like some obscene piece of modern art.

Another spasm from below — a white-hot spear thrusting up inside her.

This is bad. Oh, this is bad.

She hobbled into the stall. Her clothes were drenched with sweat. A viselike cramp in her lower belly was followed immediately by explosive diarrhea. Heavy drops of perspiration fell from her forehead.

Eli… oh, honey, I'm so sick…

Nattie struggled to her feet. Behind her, in the bowl, was a hideous mix of stool and curdled blood. More blood. All she could think of was the baby. She tried again to feel the kicking in her womb, but she was shaking so hard, she couldn't tell. Eli would know what to do, she thought. He was always the calm one. She fumbled in her pocket for some change to call him at work. Nothing. The phone in Peggy's office. She could call him from there.

Lurching from side to side, unbalanced by her pregnancy, Nattie braced herself against the wall and moved ahead. Sweat was pouring down her now, stinging her eyes and dripping off her nose. Twice she was stopped by rib-snapping salvos of coughing. Her hand and the wall beyond it were speckled with crimson.

"Nattie?… Nattie, just lie down! Right there. I'll call the ER. Jesus, look at her!"

Peggy's voice seemed to be echoing through a long tunnel.

"My baby…"

Nattie sank to one knee as pain exploded in her head. A white light bathed the inside of her eyes. She felt her bowels and bladder give way at the moment her neck jerked back. She knew she was falling, but there was nothing she could do about it.

"She's having a seizure! Call the ER!"

Peggy's words were the last thing Nattie heard before a darkness mercifully washed away the pain.

Belinda, West Virginia

Matt, this is Laura in the Er…Matt?"

"Yeah."

"Matt, you're still asleep."

"I'm not."

"You are. I can tell."

"Time zit?"

"Two-thirty. Matt, please turn on a light and wake up. There's been an accident at the mine."

Matt Rutledge groaned. "Friggin' mine," he muttered.

"Dr. Butler has activated the disaster protocol. Team B is it tonight. Matt, are you awake?"

"I'm awake, I'm awake," he pronounced hoarsely, fumbling with the switch on his bedside lamp. "Nine times seven is fifty-six. The Miami basketball team is the Heat. The fifth president — "

"Okay, okay. I believe you."

From college, through medical school and residency, and now into his life as an internist, it had always been a chore for Matt to shut his mind down enough to fall asleep — but not nearly the challenge of subsequently waking up. Laura Williams knew this trait of his as well as any nurse, having worked with him in the ER of Montgomery County Regional Hospital for two years before his decision to switch over to private practice. She and all the other nurses had adopted the policy that Dr. Matthew Rutledge wasn't definitely awake until he could prove it beyond a reasonable doubt.