Robin Cook - Outbreak

Marissa opened the chart. There were all the familiar symptoms but no mention of foreign travel, animal experiments or contact with any of the three previous outbreaks. But she did learn that Alexi was the head of ophthalmology! Marissa was amazed; was Dubchek right after all?

Unsure of how long she dared stay in the unit, Marissa opted to see the patient right away. Donning an extra layer of protective clothing, including disposable goggles, she entered the room.

“Is Dr. Alexi conscious?” she asked the special-duty nurse, whose name was Marie. The man was lying silently on his back, mouth open, staring at the ceiling. His skin was already the pasty yellow shade that Marissa had learned to associate with near-death.

“He goes in and out,” said the nurse. “One minute he’s talking, the next he’s unresponsive. His blood pressure has been falling again. I’ve been told that he’s a ‘no code.’ ”

Marissa swallowed nervously. She’d always been uncomfortable with the order not to resuscitate.

“Dr. Alexi,” called Marissa, gingerly touching the man’s arm. Slowly he turned his head to face her. She noticed a large bruise beneath his right eye.

“Can you hear me, Dr. Alexi?”

The man nodded.

“Have you been to Africa recently?”

Dr. Alexi shook his head “no.”

“Did you attend an eyelid surgery conference in San Diego a few months back?”

The man mouthed the word “yes.”

Perhaps Dubchek really was right. It was too much of a coincidence: each outbreak’s primary victim was an ophthalmologist who’d attended that San Diego meeting.

“Dr. Alexi,” began Marissa, choosing her words carefully. “Do you have friends in L.A., St. Louis or Phoenix? Have you seen them recently?”

But before Marissa had finished, he’d slipped back into unconsciousness.

“That’s what he’s been doing,” said the nurse, moving to the opposite side of the bed to take another blood-pressure reading.

Marissa hesitated. Perhaps she’d wait a few minutes and try to question him again. Her attention returned to the bruise beneath the man’s eye, and she asked the nurse if she knew how he’d gotten it.

“His wife told me he’d been robbed,” said the nurse. Then she added, “His blood pressure is even lower.” She shook her head in dismay as she put down the stethoscope.

“He was robbed just before he got sick?” asked Marissa. She wanted to be sure she’d heard correctly.

“Yes. I think the mugger hit him in the face even though he didn’t resist.”

An intercom sputtered to life. “Marie, is there a doctor from the CDC in your room?”

The nurse looked from the speaker to Marissa, then back to the speaker again. “Yes, there is.”

Over the continued crackle of static, indicating that the line was still open, Marissa could hear a woman saying, “She’s in Dr. Alexi’s room.” Another voice said, “Don’t say anything! I’ll go down and talk with her.”

Marissa’s pulse raced. It was Dubchek! Frantically, she looked around the room as if to hide. She thought of asking the nurse if there were another way out, but she knew it would sound ridiculous, and it was too late. She could already hear footsteps in the hall.

Cyrill walked in, adjusting his protective goggles.

“Marie?” he asked.

“Yes,” said the nurse.

Marissa started for the door. Dubchek grabbed her by the arm. Marissa froze. It was ridiculous to have a confrontation of this sort in the presence of a dying man. She was scared of Dubchek’s reaction, knowing how many rules she had probably broken. At the same time, she was angry at having been forced to break them.

“What the hell do you think you’re doing?” he growled. He would not let go of her arm.

“Have some respect for the patient, if not for anyone else,” said Marissa, finally freeing herself and leaving the room. Dubchek was right behind her. She pulled off the goggles, the outer hood and gown, then the gloves, and deposited them all in the proper receptacle. Dubchek did the same.

“Are you making a career out of flouting authority?” he demanded, barely controlling his fury. “Is this all some kind of game to you?”

“I’d rather not talk about it,” said Marissa. She could tell that Dubchek, for the moment, was beyond any reasonable discussion. She started toward the elevators.

“What do you mean, you’d ‘rather not talk about it’?” yelled Dubchek. “Who do you think you are?”

He grabbed Marissa’s arm again and yanked her around to face him.

“I think we should wait until you are a little less upset,” Marissa managed to say as calmly as she could.

“Upset?” exploded Dubchek. “Listen, young lady, I’m calling Dr. Morrison first thing in the morning to demand that he make you take a forced leave of absence rather than a vacation. If he refuses, I’ll demand a formal hearing.”

“That’s fine by me,” said Marissa maintaining a fragile control. “There is something extraordinary about these Ebola outbreaks, and I think you don’t want to face it. Maybe a formal hearing is what we need.”

“Get out of here before I have you thrown out,” snapped Dubchek.

“Gladly,” said Marissa.

As she left the hospital, Marissa realized she was shaking. She hated confrontations, and once again she was torn between righteous anger and guilty humiliation. She was certain she was close to the real cause of the outbreaks, but she still could not clearly formulate her suspicions—not even to her own satisfaction, much less someone else’s.

Marissa tried to think it through on her way to the airport, but all she could think of was her ugly scene with Dubchek. She couldn’t get it out of her head. She knew she had taken a risk by going into the Berson Hospital when she was specifically unauthorized to do so. Cyrill had every right to be enraged. She only wished she had been able to talk to him about the strange fact that each of the index cases had been mugged just before becoming ill.

Waiting for her plane back to Atlanta, Marissa went to a pay phone to call Ralph. He answered promptly, saying he’d been so worried about her that he’d gone to her house when she had failed to answer the phone. He asked her where she’d been, pretending to be indignant that she’d left town without telling him.

“Washington and now Philadelphia,” explained Marissa, “but I’m on my way home.”

“Did you go to Philly because of the new Ebola outbreak?”

“Yes,” said Marissa. “A lot has happened since we talked last. It’s a long story, but the bottom line is that I wasn’t supposed to go, and when Dubchek caught me, he went crazy. I may be out of a job. Do you know anybody who could use a pediatrician who’s hardly been used?”

“No problem,” said Ralph with a chuckle. “I could get you a job right here at the University Hospital. What’s your flight number? I’ll drive out to the airport and pick you up. I’d like to hear about what was so important that you had to fly off without telling me you were going.”

“Thanks, but it’s not necessary,” said Marissa. “My Honda is waiting for me.”

“Then stop over on your way home.”

“It might be late,” said Marissa, thinking that it might be more pleasant at Ralph’s than in her own empty house. “I’m planning on stopping by the CDC. There is something I’d like to do while Dubchek is out of town.”

“That doesn’t sound like a good idea,” said Ralph. “What are you up to?”

“Believe me, not much,” said Marissa. “I just want one more quick visit to the maximum containment lab.”

“I thought you didn’t have authorization.”

“I can manage it, I think,” she told him.

“My advice is to stay away from the CDC,” said Ralph. “Going into that lab is what caused most of your problems in the first place.”