row of window and falls across a table heaped with soiled magazines, and makes rectangles on a pebbled gray floor that has a drain in the center. The room smells vaguely of woodsmoke and sweat, and it is jammed with bleary- eyed people, Africans and Europeans sitting shoulder to shoulder. There is always someone in Casualty who has a cut and is waiting for stitches. People wait patiently, holding a washcloth against the scalp, holding a bandage pressed around a finger, and you may see a spot of blood on the cloth. So Charles Monet is sitting on a bench in casualty, and he does not look very much different from someone else in the room, except for his bruised, expressionless face and his red eyes. A sign on the wall warns patients to watch out for purse thieves, and another sign says:
YOUR COOPERATION WILL BE APPRECIATED.
NOTE: THIS IS A CASUALTY DEPARTMENT.
EMERGENCY CASES WILL BE TAKEN IN PRIORITY.
YOU MAY BE REQUIRED TO WAIT FOR SUCH CASES BEFORE RECEIVING ATTENTION
Monet maintains silence, waiting to receive attention. Suddenly he goes into the last phase. The human virus bomb explodes. Military biohazard specialists have ways of describing this occurrence. They say that the victim has “crashed and bled out”. Or more politely they say that the victim has “gone down”.
He becomes dizzy and utterly weak, and his spine goes limp and nerveless and he loses all sense of balance. The room is turning around and around. He is going into shock. He leans over, head on his knees, and brings up an incredible quantity of blood from his stomach and spills it onto the floor with a gasping groan. He loses consciousness and pitches forward onto the floor. The only sound is a choking in his throat as he continues to vomit while unconscious. Then come a sound like bedside being torn in half, which is the sound of his bowels opening and venting blood from sloughed his gut. The linings of his intestines have come off and are being expelled along with huge amount of blood. Monet has crashed and is bleeding out.
The other patients in the waiting room stand up and move away from the man on the floor, calling for a doctor. Pools of blood spread out around him, enlarging rapidly. Having destroyed its host, the agent is now coming out of every orifice, and is “trying” to find a new host.
JUMPER
1980 January 15
Nurses and aides came running, pushing a gurney along with them, and they lifted Charles Monet onto the gurney and wheeled him into the intensive care unit at Nairobi Hospital. A call for a doctor went out over the loudspeakers: a patient was bleeding in the ICU. A young doctor named Shem Musoke ran to the scene. Dr. Musoke was widely considered to be one of the best young physicians at the hospital, an energetic man with a warm sense of humor, who worked long hours and had a good feel for emergencies.
He found Monet lying on the gurney. He has no idea what was wrong with the man, except that he was obviously having some kind of massive hemorrhage. There was no time to try to figure out what has caused it. He was having difficulty breathing—and then his breathing stopped. He had inhaled blood and had a breathing arrest.
Dr. Musoke felt for a pulse. It was weak and sluggish. A nurse ran and fetched a laryngoscope, a tube that can be used to open a person’s airway. Dr. Musoke ripped open Monet’s shirt so that he could observe any rise and fall of the chest, and he stood at the head of the gurney and bent over Monet’s face until he was looking directly into his eyes, upside down.
Monet stared redly at Dr. Musoke, but there was no movement in the eyeballs, and the pupils were dilated. Brain damage: nobody home. His nose was bloody and his mouth was bloody. Dr. Musoke tilted the patient’s head back to open the airway so that he could insert the laryngoscope. He was not wearing rubber gloves. He ran his finger around the patient’s tongue to clear the mouth of debris, sweeping out mucus and blood. His hands became greasy with black curd. The patient smelled of vomit and blood, but this was nothing new to Dr. Musoke, and he concentrated on his work. He leaned down until his face was a few inches away from Monet’s face, and he looked into Monet’s mouth in order to judge the position of the scope. Then he slid the scope over Monet’s tongue and pushed the tongue out of the way so that he could see down the airway past the epiglottis, a dark hole leading inward to the lungs. He pushed the scope into the hole, peering into the instrument. Monet suddenly jerked and thrashed.
Monet vomited.
The black vomit blew up around the scope and out of Monet’s mouth. Black-and-red fluid spewed into the air, showering down over Dr. Musoke. It struck him in the eyes. It splattered over his white coat and down his chest, marking him with strings of red slime dappled with dark flecks. It landed in his mouth.
He repositioned his patient’s head and swept the blood out of the patient’s mouth with his fingers. The blood had covered Dr. Musoke’s hands, wrists and forearms. It had gone everywhere—all over the gurney, all over Dr. Musoke, all over the floor. The nurses in the intensive care unit couldn’t believe their eyes, and they hovered in the background, not knowing quite what to do. Dr. Musoke peered down into the airway and pushed the scope deeper into the lungs. He saw that the airways were bloody.
Air rasped into the man’s lungs. The patient had began to breathe again. The patient was apparently in shock from loss of blood. He had lost so much blood that he was becoming dehydrated. The blood had come out of practically every opening in his body. There wasn’t enough blood left to maintain circulation, so his heartbeat was very sluggish, and blood pressure was dropping toward zero. He needed a blood transfusion.
A nurse brought a bag of whole blood. Dr. Musoke hooked the bag on a stand an inserted the needled into the patient’s arm. There was something wrong with the patient’s veins; his blood poured out around the needle. Dr. Musoke tried again, putting the needle into another place in the patient’s arm and probing for the vein. Failure. More blood poured out. At every place in the patient’s arm where he stuck the needle, the vein broke apart like cooked macaroni and spilled blood, and the blood ran from the punctures down the patient’s arm and wouldn’t coagulate. Dr. Musoke abandoned his efforts to give his patient a blood transfusion for fear that the patient would bleed to death out of the small hole in his arm. The patient continued to bleed from the bowels, and these hemorrhages were now as black as pitch.
Monet’s coma deepened, and he never regained consciousness. He died in the intensive care unit in the early hours of the morning. Dr. Musoke stayed by his bedside the whole time.
They has no idea what had killed him. It was unexplained death. They opened him up for an autopsy and found that his kidneys were destroyed and that his liver was dead. His liver had ceased functioning several days before he died. It was yellow, and parts of it had liquefied—it looked like the liver of a three-day-old cadaver. It was as if Monet had become a corpse before his death. Sloughing of the gut, in which the intestinal ling comes off, is another effect that is ordinarily seen in a corpse that is days old. What, exactly, was the cause of death?
It was impossible to say because there were too many possible causes. Everything had gone wrong inside this man, absolutely everything, any one of which could have been fatal: the clotting, the massive hemorrhages, the liver turned into pudding, the intestines full of blood. Lacking words, categories, or language to describe what had happened, they called it, finally, a case of “fulminating liver failure”. His remain were placed in a waterproof bag and, according to one account, buried locally. When I visited Nairobi, years later, no one remembered where the grave was.
