Robin Cook: Outbreak

Yet despite the handicaps, Marissa was well aware that the CDC worked. It had delivered phenomenal medical service over the years, not only in the U.S., but in foreign countries as well. She remembered vividly how the Center had solved the Legionnaires Disease mystery a number of years back. There had been hundreds of such cases since the organization had been started in 1942 as the Office of Malaria Control to wipe out that disease in the American South. In 1946 it had been renamed the Communicable Disease Center, with separate labs set up for bacteria, fungi, parasites, viruses and rickettsiae. The following year a lab was added for zoonoses, diseases that are animal ailments but that can be transmitted to man, like plague, rabies and anthrax. In 1970 the organization was renamed again, this time the Centers for Disease Control.

As Marissa arranged some articles in her government-issue briefcase, she thought about the past successes of the CDC, knowing that its history had been one of the prime reasons for her considering coming to the Center. After completing a pediatric residency in Boston, she had applied and had been accepted into the Epidemiology Intelligence Service (EIS) for a two-year hitch as an Epidemiology Intelligence Service Officer. It was like being a medical detective. Only three and a half weeks previously, just before Christmas, she’d completed her introductory course, which supposedly trained her for her new role. The course was in public-health administration, biostatistics and epidemiology—the study and control of health and disease in a given population.

A wry smile appeared on Marissa’s face as she pulled on her dark blue overcoat. She’d taken the introductory course, all right, but as had happened so often in her medical training, she felt totally ill-equipped to handle a real emergency. It was going to be an enormous leap from the classroom to the field if and when she was sent out on an assignment. Knowing how to relate to cases of a specific disease in a coherent narrative that would reveal cause, transmission and host factors was a far cry from deciding how to control a real outbreak involving real people and a real disease. Actually, it wasn’t a question of “if,” it was only a question of “when.”

Picking up her briefcase, Marissa turned off the light and headed back down the hall to the elevators. She’d taken the introductory epidemiology course with forty-eight other men and women, most of whom, like herself, were trained physicians. There were a few microbiologists, a few nurses, even one dentist. She wondered if they all shared her current crisis of confidence. In medicine, people generally didn’t talk about such things; it was contrary to the “image.”

At the completion of the training, she’d been assigned to the Department of Virology, Special Pathogens Branch, her first choice among the positions available. She had been granted her request because she’d ranked number one in the class. Although Marissa had little background in virology, which was the reason she’d been spending so much time in the library, she’d asked to be assigned to the department because the current epidemic of AIDS had catapulted virology into the forefront of research. Previously it had always played second fiddle to bacteriology. Now virology was where the “action” was, and Marissa wanted to be a part of it.

At the elevators, Marissa said hello to the small group of people who were waiting. She’d met some of them, mostly those from the Department of Virology, whose administrative office was just down the hall from her cubicle. Others were strangers, but everyone acknowledged her. She might have been experiencing a crisis of confidence in her professional competence, but at least she felt welcome.

On the main floor Marissa stood in line to sign out, a requirement after 5:00 P.M., then headed to the parking area. Although it was winter, it was nothing like what she’d endured in Boston for the previous four years, and she didn’t bother to button her coat. Her sporty red Honda Prelude was as she’d left it that morning: dusty, dirty and neglected. It still had Massachusetts license plates; replacing them was one of the many errands that Marissa had not yet found time to do.

It was a short drive from the CDC to Marissa’s rented house. The area around the Center was dominated by Emory University, which had donated the land to the CDC in the early ’40s. A number of pleasant residential neighborhoods surrounded the university, running the gamut from lower middle class to conspicuously rich. It was in one of the former neighborhoods, in the Druid Hills section, that Marissa had found a house to rent. It was owned by a couple who’d been transferred to Mali, Africa, to work on an extended birth-control project.

Marissa turned onto Peachtree Place. It seemed to her that everything in Atlanta was named “peachtree.” She passed her house on the left. It was a small two-story wood-frame building, reasonably maintained except for the grounds. The architectural style was indeterminant, except for two Ionic columns on the front porch. The windows all had fake shutters, each with a heart-shaped area cut out in the center. Marissa had used the term “cute” to describe it to her parents.

She turned left at the next street and then left again. The property on which the house sat went all the way through the block, and in order for Marissa to get to the garage, she had to approach from the rear. There was a circular drive in front of the house, but it didn’t connect with the rear driveway and the garage. Apparently in the past the two driveways had been connected, but someone had built a tennis court, and that had ended the connection. Now, the tennis court was so overgrown with weeds it was barely discernible.

Knowing that she was going out that evening, Marissa did not put her car in the garage, but just swung around and backed it up. As she ran up the back steps, she heard the cocker spaniel, given to her by one of her pediatric colleagues, barking welcome.

Marissa had never planned on having a dog, but six months previously a long-term romantic relationship that she had assumed was leading to marriage had suddenly ended. The man, Roger Shulman, a neurosurgical resident at Mass. General, had shocked Marissa with the news that he had accepted a fellowship at UCLA and that he wanted to go by himself. Up until that time, they had agreed that Marissa would go wherever Roger went to finish his training, and indeed Marissa had applied for pediatric positions in San Francisco and Houston. Roger had never even mentioned UCLA.

As the baby in the family, with three older brothers and a cold and dominating neurosurgeon for a father, Marissa had never had much self-confidence. She took the breakup with Roger very badly and had been barely able to drag herself out of bed each morning to get to the hospital. In the midst of her resultant depression, her friend Nancy had presented her with the dog. At first Marissa had been irritated, but Taffy—the puppy had worn the cloyingly sweet name on a large bow tied around its neck—soon won Marissa’s heart, and, as Nancy had judged, it helped Marissa to focus on something besides her hurt. Now Marissa was crazy about the dog, enjoying having “life” in her home, an object to receive and return her love. Coming to the CDC, Marissa’s only worry had been what to do with Taffy when she was sent out in the field. The issue weighed heavily on her until the Judsons, her neighbors on the right, fell in love with the dog and offered—no, demanded—to take Taffy any time Marissa had to go out of town. It was like a godsend.

Opening the door, Marissa had to fend off Taffy’s excited jumps until she could turn off the alarm. When the owners had first explained the system to Marissa, she’d listened with only half an ear. But now she was glad she had it. Even though the suburbs were much safer than the city, she felt much more isolated at night than she had in Boston. She even appreciated the “panic button” that she carried in her coat pocket and which she could use to set off the alarm from the driveway if she saw unexpected lights or movement inside the house.