Chapter 23. Outbreak
Present day. Mackinac Island, Michgan.
Meanwhile, Kelly was growing increasingly frustrated at how long it was taking to research the condition over her phone. It was almost as agonizing as dial-up. She wished she had brought her laptop. She checked some medical sites like Web MD which were not very helpful. Then she typed a Google search for "purple splotches under skin" and got a lot of unrelated skin conditions. That didn't help. Finally she typed in "ruby red eyes black vomit fever". She got three important hits: Marburg Hemorrhagic Fever (Marburg Virus), Yellow Fever, Dengue Fever. She also got a hit for Richard Preston's book The Hot Zone, a true story about the release of the Marburg Virus in a Virginia monkey research lab. Monkeys. Oh, God. She clicked on the links and learned that these diseases had no cure and were typically fatal. Fatal! She ran back to the Triage Nurse and frantically told her that it was imperative that she find Dr. Adams immediately. The nurse looked up from her Oxygen magazine.
"He is busy seeing other patients right now, ma'am. Is there something I can help you with?"
"Unless you know how to cure the Marburg Virus, Yellow Fever, or Dengue Fever, I suggest you find the damn doctor right now!"
"Ma'am, you do not need to use that kind of language with me! The doctor is busy now. I will try and find him soon. Now please return to your room." The nurse returned to her magazine.
The hell I will, thought Kelly Monahan. She began fast-walking down the hall, poking her head into rooms looking for the doctor. This place was not that big. She would find him eventually. When the Triage Nurse noticed what Kelly was doing, she ran after her. "Ma'am! There are other patients back there! You are not allowed to go back there!"
After checking all the way down the hall, with the nurse at her heels, Kelly Monahan finally found a door with a name plate for Dr. Adams. As she began to pound on the door, the nurse grabbed Kelly's arm.
"Ma'am! That is the doctor's office!"
"Get your damn hand off me!" screamed Kelly.
"Ma'am, you need to return to your room!"
Kelly yelled through the door. "Dr. Adams! Dr. Adams! It's an emergency!"
A moment later, Dr. Buzz Adams opened his office door.
"Hey! Hey!" said Adams, trying to calm the two women down. "What's all the fuss?"
"Doctor, this woman stormed down here and tried to barge into your office," protested the nurse.
"That's because you would not stop reading your magazine and get the doctor. Doctor, we have an emergency!"
"OK, nurse, thank you, I will take it from here."
The doctor started to walk in the direction of the husband's room, and in so doing, put his hand on Kelly's shoulder, to turn her back in the right direction. "What's going on?"
Kelly moved her shoulder away from the doctor's hand, clearly uncomfortable--although she was probably more uncomfortable that he was patronizing her than flirting with her.
"Doctor, my husband is vomiting black blood. And I have done some Internet searches, and it seems to me that my husband may have something like the Marburg Virus or Yellow Fever or Dengue Fever."
The doctor smiled, again in a patronizing manner. These stupid women, he thought.
"Kelly," said the doctor. "We doctors have a saying. If you hear hoof beats behind you, it is probably a horse and not a zebra."
"What is that supposed to mean?"
"It means that when a patient presents with symptoms, it is usually the more common illness and not a rare or bizarre illness. The Marburg Virus is like Ebola. It has never appeared on American soil before."
"That's not true," said Kelly. "Didn't you ever hear about the Reston Virginia Monkey House? Marburg was released there from a monkey lab but they were able to contain it. My husband and I are primate researchers. We are around monkeys all the time."
"Kelly, that strain of virus came from the Philippines. It was only harmful to monkeys, not humans. No humans ever died from it. The chances of your husband having the Marburg Virus or something like that is more than a million to one."
"Doctor, what if this is a real zebra? You can't just assume every time it's a horse."
By this time, the two were nearly back at the husband's room.
"I assure you, Kelly, we are taking every step we can to find out what this illness is."
Kelly opened the door to her husband's room. He was bent over the toilet.
"Look at this, doctor." She showed him her husband's black vomit. "Have you ever seen anything like that? What is that?"
"I will have the nurse come in and take a sample of that. In the meantime, let me finish up with the test results and we will see what we have. Bill, how are you feeling?"
Bill looked up with his red eyes, flabbergasted. "How do you think I feel? I feel like I have been run over by a cement truck."
"OK, well, sit tight, we should know more information soon." The doctor took his clipboard and left the Monahans in their hospital room. Black vomit. He had to admit he had never seen anything like that before. But Marburg Virus? In the United States? Surely that was wrong.
Buzz Adams had one conclusion: he was in over his head. He had three choices: first, keep the patient here, and get a G.I. Consult from Dr. Som Depak, who spent summers on the island; second, send the patient to Cheboygan Memorial Hospital; or third, send him to the University of Michigan Hospital in Ann Arbor. Cheboygan was just across the Straits. The patient could be there in no time. But it wasn't the cream of the crop as far as hospitals go. On the other hand, the University of Michigan Hospital was ranked the fourteenth best hospital in the entire country. They had a Life Flight Helicopter which could get here within two hours. They had dozens of specialists in every field. But was the case that serious? He didn't know. He ultimately decided to call Dr. Depak.
After an hour, or what seemed like three days to the Monahans, Dr. Depak showed up. He was an Indian man, short and bald, with a friendly smile. When he arrived at the Monahans' room, he was wearing green doctor's scrubs, a doctor's mask pulled down under his chin, a green cap, and latex gloves.
"Hello, I am Dr. Depak. I am a gastroenterologist. I understand we are feeling a bit under the weather?" He smiled.
"It is a lot more than that, Doctor," said Kelly. "And I have to say, in the last hour, I have begun to feel nauseous too. I may have what my husband has."
Dr. Depak took another history, which the Monahans found quite irritating. Why did they always have to tell their story multiple times?
"Doctor, I think there is a possibility this might be Marburg Virus or Yellow Fever or Dengue Fever."
"Why do you say that?" asked Dr. Depak. "Have you recently been to Africa?"
"Yes, we have. We are primate researchers. We spent the entire summer in Tanzania."
"Did you ever do any cave exploring? Were you ever around bats?"
Kelly thought the question was strange. "No, no cave exploring. No bats. Why do you say that?"
"Although we are not certain, some scientists believe that the original carrier for some hemorrhagic fevers like Marburg and Ebola is the African fruit bat. Other fevers, though, are spread by ticks and mosquitoes. I am certain you probably encountered some of those on your trip?"
"Mosquitoes, definitely. I do not recall any ticks, but I suppose it is very possible."
"Well, I sincerely doubt that is what your husband has, but it is good to have the information. Thank you."
Dr. Depak looked at the husband's glassy, almost zombie-like red eyes, purplish skin, and sickly pallor. He was definitely very sick, that was for sure. Those red eyes and purple star-like skin lesions--he had never seen that before.
"OK, we need to have a look and see what is going on up there, so I will be performing a small procedure called an endoscopy, where we put a snakelike scope up the rectum and we photograph what's going on up there. Mrs. Monahan, you will need to wait outside in the waiting room. We will be ready to go in about fifteen minutes."
A nurse came in and brought a four foot tall stand with a monitor on the top, and various cords winding around from the monitor. Bill got back on the bed and was told to roll over. A local anesthetic was applied, and Bill waited a bit for the anesthetic to take effect. As he waited on the bed, facing downward, his fever began spiking. He began to feel panicked, like he might die. The pain in his gut was excruciating. He tried to move back and forth to get comfortable, but nothing felt right. He suddenly had a bout of excruciating gut pain. He didn't think he was going to make it. After an interminable wait, Dr. Depak came in and, after sterilizing Bill Monahan's anus, took the snake-like endoscope and began the process of inserting the probe through the anal sphincter and into the colon. The insides of the colon would be shown on the monitor. If there was some kind of parasite up there, Dr. Depak would find it.
However, as soon as Dr. Depak inserted the probe, thick, black blood squirted out in a jet all over Dr. Depak's face and neck. He recoiled immediately in shock. Black blood started pouring out of Bill Monahan's anus. Bill Monahan screamed in agony, his anus split, and hot black liquid and parts of intestines began pouring out all over the floor. Bill started heaving and his whole body went into seizure. His heart rate spiraled and crashed. Dr. Depak was stunned and called a Code Blue. Dr. Adams frantically rushed in with the crash cart.
"Clear!" They tried jumpstarting his heart for about five minutes, but it was useless. Bill Monahan died in his hospital bed. His wife was overcome with grief and anger when she was informed by the doctors in the hallway. She called the doctors bastards, accused them of killing her husband, and promised a malpractice suit. But anger and grief was not all that was going through Kelly Monahan's mind that day. She also had a feeling of foreboding, for in her bones she knew she had the same illness as her husband, and it was only a matter of time before she died as well. She pleaded with the doctors to order her a Life Flight helicopter from Ann Arbor. The doctors agreed. Transfer was the best option.
Mackinac Island did not have a coroner. No one had ever died under such strange circumstances before. There was a very tiny morgue at the hospital, which had a locker sufficient to hold two bodies. Bill Monahan's body was placed in one of the lockers until the hospital personnel could figure out what to do with it.
Dr. Adams and Dr. Depak were concerned. Would she really file a malpractice suit? What could they have done differently? Surely there had been no time for the husband. Even if they had called a helicopter the minute Bill Monahan arrived, it would have taken the helicopter two hours to get to the island from Ann Arbor and then another two hours back to Ann Arbor. He would have surely expired before then. But there was a good chance the wife had the same thing. The doctors were determined to get her to the best medical facility they could find.
While they waited for the Life Flight helicopter, Dr. Depak performed Internet research and looked through medical textbooks. This really could be something like Ebola, Yellow Fever, Dengue…. The man had sprayed black blood which was full of virus all over him during the endoscopy. Even if the disease did not spread by air, it would probably spread by bodily fluids. Dr. Depak began to panic. He was probably infected, too. He discussed the matter with Dr. Adams and the nursing staff. He learned about the nurse who had taken the man's blood and had been sprayed with blood. They should order two helicopters from Ann Arbor. Kelly Monahan would go on one. Drs. Adams, Depak, and the three nurses who interacted with the Monahans would go on the second one. They were not going to take any chances.
Dr. Depak took blood samples, vomit samples, and tissue samples from Bill Monahan and packaged them in dry ice. After contacting the Atlanta Centers for Disease Control, he was given the precise protocol on how to package the samples and send them off. Within twenty-four hours, those samples would be under a high-power electron microscope in Atlanta. Late that night, the two Life Flight helicopters landed and the entire medical staff for the island plus Kelly Monahan, left Mackinac. Bill Monahan's body stayed behind in the freezer.
Seven days after that, Cedric, the kid on the hotel golf cart who drove the Monahans to the hospital, drove himself to the hospital. He was very sick. He was surprised to see that no one was working at the hospital. He left the hospital and went to the town grocery store and bought some orange juice and fresh fruit, where he interacted with the cashier. The cashier had never seen eyes that red before.
Centers for Disease Control and Prevention. Atlanta, Georgia.
Two days after the specimens arrived at the C.D.C., on the Biohazard Level 4 Floor, Jacob Roessler, the young pathogen researcher, wearing blue jeans, tennis shoes, an Atlanta Braves hat and a white lab coat, sprinted down the hall to his boss' office, holding test results and a color 8x10 glossy photograph. He burst into the office, interrupting a meeting. Roessler's supervisor, Bjorn Jendel, was irritated.
"What is it?"
"Boss, we need to talk immediately."
The guest in Jendel's office excused herself and Jendel shut the door.
"Now, what is so important that you had to interrupt my meeting?"
The researcher fidgeted, with an edge of panic in his voice. He held up a picture of a long thread with a hoop at the end.
"The Ebola Virus is in Michigan!"
Fredericktown, Maryland. Phone booth.
"I just heard some very disturbing news," said the first male voice on the international phone call. "Our very small friend is already in America."
There was silence on the other end.
Did you hear me?" the first voice repeated.
"I heard you. I don't understand. How could that be? I was told that the entire facility was destroyed."
"I don't know. I am telling you. Our small friend is in Michigan."
"Michigan? How on earth did he get there?"
"You didn't send him?"
"Of course not. That wasn't the plan."
"Well, I know that. Could there be another group doing the same thing?"
"I cannot imagine that."
"How far has our friend traveled?"
"I don't know, but I do not think very far. They are taking steps to isolate him."
The man with the second voice thought a minute.
"That's not good. They will increase security, put hospitals on alert, and get a head start on trying to find a remedy."
"I know."
"Well, it is a setback, but it is nothing we can't handle. Keep me posted on what the Americans do."
"I will. Have you confirmed whether our friend will be available for air travel?"
"Yes, it appears he will be a frequent flier."
"That is very good indeed."
"Have you found a remedy for our friend's ailment?"
"Yes. Using the test animal, we have made a vaccine."
"That is good. I have to go.”
"Talk to you later."
"Bye."