Tom Clancy - Executive Orders

"And what we plan to do is not?" the director asked. Clearly Moudi had been in the bush for too long. But it wasn't worth fighting over. One fully infected Ebola patient was all they needed. "Get cleaned up and we will go up to see her."

Moudi headed off to the doctors' lounge on the second floor. The facility was actually more private than its Western counterparts, as people in this part of the world had higher standards of body modesty. The plastic suit, he saw with some surprise, had survived the trip without a single tear. He dumped it in a large plastic bin before heading into a shower whose hot water was supplemented with chemicals—he hardly noticed the smell anymore—and there he enjoyed five minutes of sanitary bliss. On the flight he'd wondered if he would ever be clean again. In the shower now, his mind asked a similar question, but more quietly. He emerged to don fresh greens—fresh everything, in fact—and to complete his normally fastidious routine. A medical orderly had placed a brand-new suit in the lounge for him, this one a blue American Racal fresh out of its box, which he put on before heading out into the corridor. The director, similarly dressed, was waiting for him, and together they walked down toward the suite of treatment rooms.

There were only four of them, behind sealed, guarded doors. The Iranian army ran this facility. The doctors were military physicians, and the orderlies all men with battlefield experience. Security was tight, as one would expect. Moudi and the director had cleared security on the first floor, however, and the guard at the post touched the buttons to open the doors into the air lock. These opened with a hiss of hydraulics to reveal a second set, and they could see that smoke from the soldier's cigarette was sucked into the secure area. Good. The air system was working properly. Both men had a strange prejudice against their own countrymen. It would have been preferable for this entire facility to have been built by foreign engineers—Germans were popular in the Middle East for such things—but Iraq had made that mistake to its sorrow. The orderly Germans kept plans of everything they built, as a result of which so many of their projects had been bombed to dust. And so while a lot of the building's hardware had been bought elsewhere, the facility had been constructed locally. Their very lives depended on the exact performance of every subsystem here, but that could not be helped now. The inner doors would not open unless the outer ones were locked tight. That worked. The director activated them, and they proceeded.

Sister Jean Baptiste was in the last room on the right. Three medical orderlies were in with her. They'd already cut off all her clothing, revealing a death in progress. The soldiers were repulsed by what they saw, her condition more terrible than any battlefield injury. Quickly, they cleaned off her body, then covered it, respectful of the woman's modesty as their culture insisted. The director looked at the morphine drip and immediately turned it back by a third.

"We want to keep her alive as long as possible," he explained.

"The pain from this—"

"Cannot be helped," he responded coldly. He thought to reproach Moudi, but stopped himself. He was a physician, too, and knew that it was hard to regard one's patient with harshness. Elderly Caucasian female, he saw, stuporous from the morphine, respiration too slow for his liking. The orderlies attached leads for the electrocardiograph, and he was surprised at how well her heart was working. Good. Blood pressure was low, as expected, and he ordered two units of whole blood to be hung on the IV tree. The more blood the better.

The orderlies were well drilled. Everything that had come in with the patient had already been bagged, then double-bagged. One of their number carried the bundle out of the room and off to the gas-fired incinerator which would leave behind nothing but sterilized ashes. The main issue here was management of the virus. The patient was their culture dish. Previously, such victims had had a few cc's of blood drawn for analysis, and the patient in due course would die, and the body was either burned or sprayed and buried in chemically treated ground. Not this time. He would have in his control, in due course, the largest quantity of the virus ever seen, and from that he would grow more, all virulent, all powerful. He turned.

"So, Moudi, how did she contract it?"

"She was treating the Index Patient."

"The Negro boy?" the director asked, standing in the corner.

Moudi nodded. "Yes."

"What did she do wrong?"

"We never found out. I asked her when she was still lucid. She never gave the boy an injection, and Sister was always very careful with 'sharps. She's an experienced nurse," Moudi reported mechanically. He really was too tired to do much of anything but report what he knew, and that, the director thought, was just fine. "She worked with Ebola before, at Kikwit and other places. She taught procedures to staff."

"Aerosol transmission?" the director asked. It was too much to hope for.

"CDC believes that this is the Ebola Mayinga sub-type. You will recall that this strain is named for a nurse who contracted the disease through unknown means."

That statement made the director look hard into Moudi's eyes. "You're quite sure of what you said?"

"I'm not sure of anything at the moment, but I also interviewed staff at the hospital, and all injections were given to the Index Patient by others, not Sister here. So, yes, this may be a case of aerosol transmission."

It was a classic case of good news and bad news. So little was known of Ebola Zaire. It was known that the disease could be passed on by blood and other bodily fluids, even by sexual contact—that was almost entirely theoretical, since an Ebola victim was hardly in a position to engage in such practices. It was further believed that the virus fared poorly out of a living host, quick to die in the open. For that reason it was not believed that the disease could be spread through the air in the manner of pneumonia or other common ailments. But at the same time every outbreak of the virus produced cases which could not be explained. The unfortunate nurse Mayinga had given her name to a strain of the disease which had reached out to claim her life through an unknown means. Had she lied about something, or forgotten something, or had she searched her mind and reported the truth, and thus memorialized a sub-type of Ebola which did survive in the air long enough to be transmitted as readily as the common cold? If so, that would make the patient before them the carrier of a biological weapon of such power as to make the entire world shake.

Such a possibility also meant that they were quite literally dicing with Death himself. The smallest mistake could be lethal. Without conscious thought, the director looked upward at the air-conditioning vent. The building had been designed with that very contingency in mind. The incoming air was all clean, sucked in through a vent located at the end of two hundred meters of piping. The air exiting from the «hot» areas passed through a single plenum chamber before leaving the building. There it was subjected to blazingly powerful ultraviolet lights, since that frequency of radiation destroyed viruses with total reliability. The air filters were soaked with chemicals—phenol was one of them—to achieve the same end. Only then was it ejected to the outside, where other environmental factors also could be depended upon to deny the disease a chance to survive. The filters—three separate banks of them—were changed with religious precision every twelve hours. The UV lights, five times the number required for the task, were constantly monitored. The Hot Lab was kept at intentionally low ambient air pressure to prevent a leak, and that fact enabled the building to be evaluated for structural integrity. For the rest, he thought, well, that was why they'd all trained so carefully in suit-safety and sharps procedures.