Robin Cook: Outbreak

The following day when the two doctors pulled into the deserted courtyard of the Yambuku Mission Hospital they were greeted by an eerie stillness. A rat scampered along the balustrade of an empty porch, and a putrid odor assaulted their senses. Holding cotton handkerchiefs over their noses, they reluctantly got out of the Land Rover and gingerly looked into the nearest building. It contained two corpses, both beginning to decay in the heat. It wasn’t until they’d peered into the third building that they found someone still alive, a nurse delirious with fever. The doctors went into the deserted operating room and put on gloves, gowns and masks in a belated attempt to protect themselves. Still fearful for their own health, they tended to the sick nurse and then searched for more of the staff. Among nearly thirty dead, they found four other patients barely clinging to life.

Dr. Bouchard radioed Kinshasa and requested emergency aid from the Zairean Air Force to airlift several patients from the mission hospital back to the capital. But by the time the infectious disease department at the university hospital was consulted about how to isolate the patients during transport, only the nurse still lived. Isolation techniques would have to be excellent, Bouchard pointed out, because they were obviously dealing with a highly contagious and very deadly disease.

The Belgian nurse airlifted to Kinshasa died at 3:00 A.M. despite six days of massive supportive therapy. No diagnosis was made, but after the autopsy, samples of her blood, liver, spleen and brain were sent to the Institut de Médicine Tropical in Antwerp, Belgium; to the Centers for Disease Control in Atlanta, U.S.A.; and to the Microbiological Research Establishment in Porton Down, England. In the Yambuku area there were now two hundred ninety-four known cases of the illness, with a fatality rate of approximately ninety percent.

The Yambuku virus was isolated almost simultaneously at the three international laboratories. It was noted to be structurally similar to the Marburg virus, first seen in 1967 in a fatal outbreak in laboratory workers handling green monkeys from Uganda. The new virus, considerably more virulent than Marburg, was named Ebola after the Ebola River north of Bumba. It was thought to be the most deadly microorganism seen since the bubonic plague.

Two months after the initial outbreak, the unknown disease in Yambuku was considered successfully contained since no new cases had been reported in the area for several weeks.

The quarantine of the Bumba region was lifted and air service reinstated. The Ebola virus had evidently returned to its original source. Where that source was remained a complete mystery. An international team of professionals, including Dr. Cyrill Dubchek of the Centers for Disease Control who had played a big role in localizing the Lassa Fever virus, had scoured the area, searching for a reservoir for the Ebola virus within mammals, birds, and insects. The virologists had no success whatsoever. Not even a clue.

Dr. Rudolph Richter, a tall, dignified ophthalmologist originally from West Germany, and cofounder of the Richter Clinic in Los Angeles, adjusted his glasses and looked over the advertising proofs laid out on the circular table in the clinic’s conference room. To his right was his brother and partner, William, a business-school graduate, who was examining the proofs with equal attention. The material was for the next quarter’s drive for new prepaid subscribers to the clinic’s health-care plan. It was aimed at young people, who as a group were relatively healthy. That was where the real money was in the prepaid health-care business, William had been quick to point out.

Rudolph liked the proofs. It was the first good thing that had happened to him that day. It was a day that had begun badly with a fender-bender on the entrance to the San Diego freeway, resulting in a nasty dent in his new BMW. Then there was the emergency surgery that had backed up the clinic. Then there was the tragic AIDS patient with some weird complication who’d coughed in his face while he tried to examine the man’s retinas. And on top of everything else, he’d been bitten by one of the monkeys used in his ocular herpes project. What a day!

Rudolph picked up an ad scheduled for the L.A. Times Sunday Magazine. It was perfect. He nodded at William, who motioned for the ad man to continue. The next part of the presentation was a slick thirty-second TV spot slotted for the evening news. It portrayed carefree bikini-clad girls on a Malibu beach, playing volley ball with some handsome young men. It reminded Rudolph of an expensive Pepsi ad, though it extolled the concept of prepaid health maintenance as delivered by an organization like the Richter Clinic in contrast to conventional fee-for-service medicine.

Along with Rudolph and William were a handful of other staff doctors, including Dr. Navarre, Chief of Medicine. They were all directors of the clinic and held small amounts of stock.

William cleared his throat and asked if there were any questions from the staff. There were none. After the advertising people had departed, the group voiced unanimous approval of what had been presented. Then, after a brief discussion about the construction of a new satellite clinic to deal with the increase in subscribers from the Newport Beach area, the meeting was adjourned.

Dr. Richter returned to his office and cheerfully tossed the advertising proofs into his briefcase. It was a sumptuous room, considering the relatively low professional salary he drew as a physician in the group. But his salary was just incidental remuneration compared to the profits from his percentage of the outstanding stock. Both the Richter Clinic and Dr. Rudolph Richter were in sound financial shape.

After catching up on his calls, Dr. Richter made rounds on his own postoperative inpatients: two retinal detachments with difficult medical histories. Both were doing well. On his way back to his office, he thought about how little surgery he was doing as the sole ophthalmologist of the clinic. It was disturbing, but with all the ophthalmologists in town, he was lucky to have what he did. He was thankful that his brother had talked him into the clinic idea eight years ago.

Changing his white coat for a blue blazer and picking up his briefcase, Dr. Richter left the clinic. It was after 9:00 P.M., and the two-tiered parking garage was almost empty. During the day it was always full, and William was already talking about the need to expand it, not only for the spaces but for the depreciation; issues like that Rudolph didn’t truly understand, nor did he want to.

Musing about the economics of the clinic, Dr. Richter was unaware of two men who had been waiting in the shadows of the garage. He remained unaware even after they fell in step behind him. The men were dressed in dark business suits. The taller of the two had an arm that seemed permanently frozen into a flexed position. In his hand was a fat briefcase that he held high due to the immobility of the elbow joint.

Nearing his car, Dr. Richter sensed the footsteps behind him as they quickened in pace. An uncomfortable sensation gripped his throat. He swallowed hard and cast a nervous glance over his shoulder. He caught sight of the two men, who seemed to be coming directly toward him. As they passed beneath an overhead light, Dr. Richter could appreciate that they were carefully dressed, with fresh shirts and silk ties. That made him feel a little better. Even so, he moved more quickly, rounding the back end of his car. Fumbling for the keys, he unlocked the driver’s-side door, tossed in his briefcase, and slid into the welcome smell of coach leather. He started to close the door, when a hand stopped him. Dr. Richter reluctantly raised his eyes to what turned out to be the calm, blank face of one of the men who had followed him. The suggestion of a smile crossed the man’s countenance as Dr. Richter looked at him inquiringly.