The Deep Zone

“How would a tampon become contaminated with ACE?”

“A very good question. That tampon was sold by a company called FemTech. Manufactured in China, shipped to the U.S. for distribution to all the big-box discounters. Some found their way into the military supply chain as well.”

“So this whole thing started with an accidentally contaminated batch of tampons?”

“That’s one possibility, certainly.”

“There are others?”

“Someone could have contaminated the tampons intentionally.”

“Why would anyone do that?”

“Suppose you could initiate an epidemic against which only one antibiotic on earth would be effective?”

“You mean that old drug, colistin?”

“Yes.”

“Nobody had made it for decades, though.”

“Because there was no market. Suppose you could create a market.”

“You’re suggesting that somebody intentionally infected people with ACE?”

“Here’s what we know. Tampons are not required to be sterile, because the area of the body where they are used is not sterile. At no point in their production are they tested for sterility. So introducing bacteria into them would not be all that difficult.”

“But how would the bacteria live? They need something to feed on.”

“Tampons are mostly cellulose. Perfect bacteria food. Here’s something else. In the year before the first case was diagnosed, one company, MDC Pharmaceuticals, produced a large amount of colistin.”

“Possibly anticipating a sudden need?”

“Possibly.”

“Anything else?”

“Nothing probative. But who do you suppose owns FemTech?”

“No idea.”

“BioChem. And who do you suppose owns MDC?”

“BioChem?”

“None other.”

“My God. Will the government prosecute?” She was becoming tired, her eyes drooping, easing toward sleep.

“Who can say? It’s a long and very complicated way from an incident like this to the courtroom. All kinds of things can happen. I think of the ocean. You can see the surface and everything that’s on it. But beneath the surface, there are countless invisible currents and forces at work.”

Neither spoke for a few moments. Hallie’s chin dropped, came back up. Barnard patted her shoulder. “Well, look. You need to rest, and I need to get back to BARDA.”

“Before you go…”

“Yes?”

“I do want to rejoin BARDA, but not as a staff researcher.”

“No? What, then?”

“Field investigator.”

He hesitated only for a second. “Done. A good fit for you. We’ll take care of all the official stuff once you’re up and around.”

He turned to go, but her voice stopped him again, the words soft, some slurred. “Jus’ one more thing, Don?”

“Of course. What is it?”

“Need to get in touch with Bowman. Cellphone number? Email?”

He slapped his forehead. “My God. I almost forgot. I am getting old, Hallie. His services were needed elsewhere. He left town last night.”

“Uh-uh. The man was shot, Don. Twice.”

“Apparently he has amazing powers of recovery. With some help from his shadowy friends at DARPA, probably.”

She had forgotten. It came back: him in her room, the fake sling, tossing the coin, catching it. “Where is he?”

“I can’t say, Hallie. I mean, I don’t know. Truly.”

She frowned at Barnard. “Is his name really Wil Bowman?”

“That much I can vouch for. It is.”

“I’ll find him, Don. You know I will.”

“Hallie, I suspect that when this new business is finished, he may find you first.”

She smiled, lifted a hand, let it drop. Her head sank into the pillow. In that dim and soft-edged place between sleep and waking, she drifted out of the hospital and back to the blue house awash in the scent of oranges, opened the door, and saw Bowman, white Florida light flowing around him, around them, carrying her into sleep, a fine thing to dream on.

AUTHOR’S NOTE

This is a work of fiction, pure if not simple, so any resemblance between the novel’s characters and real persons is coincidental.

On the other hand, any resemblance between everything else that happens in the book and true life is real.

During the height of the Iraq War, so many wounded soldiers contracted Acinetobacter infections that Army doctors started calling it “Iraqibacter.” Military officials at first said that ACE in Iraqi soil was responsible, but that turned out to be untrue. In fact, soldiers were being attacked by a new ACE in the military’s own hospitals. No one knows, or will admit to knowing, how it came to be there.

Soldiers do routinely use tampons as emergency wound compresses.

According to the National Institutes of Health, two million people acquire bacterial infections in U.S. hospitals every year. Some ninety thousand die as a result, a number that has sextupled since 1992. (And those are only the deaths attributed to such infections; the true total is almost certainly much higher, for the very reasons Mr. Adelheid discussed with Al Cahner in this book.) Each year, more and more such infections occur.

Seventy percent of these infections are resistant to at least one of the drugs most commonly used to treat them. Others are rapidly developing multiple resistances. “Various strains of bacteria that cause serious diseases, like meningitis and pneumonia, could mutate to the point that all of our available therapies are ineffective,” said John Powers, an antimicrobial expert at the Food and Drug Administration, in 2006. And some bacteria are already resistant to all drugs.

Toward the end of the nineteenth century, biologists discovered that bacteria are nature’s counterterrorists: in the proper conditions, some bacteria become able to kill their fellow bacteria. Understanding this, scientists identified, isolated, and distilled these bacterial ninjas into what we today know as antibiotic drugs. Their development was one of the greatest boons science ever delivered to humankind. That was the good news.

The bad was that most antibiotics used today are derived from one soil-based order of microorganisms known as Actinomycetales (Ac-tin-o-my-CEET-al-ees). Relying on this one order produced a generation of miracle drugs, but ultimately that has worked against us. Antibiotics benefit from inbreeding no more than humans do.

Indiscriminate use of antibiotics in everything from soap to sheep to farm-raised salmon has made it easy for bacteria to acquire resistance. And there is something else: perhaps more than any other organism, bacteria have a unique ability to exchange DNA not only with their own species but with others as well.