sit-uated near the doors to ensure negative pressure, the HEPA filters working double-time overhead. To maintain her sanity, Samantha sang 'Itsy Bitsy Spider' to herself, substituting her own lyrics where she forgot the words.
A short woman-five foot two in sneakers-Samantha had the slightly frazzled air of a mother of three. Having neglected the wash for the past month and a half, she'd shown up to work wearing her daugh-ter's T-shirt featuring the five smiling faces of NVME's members. Fortu-nately, she also fit into her six-year-old son's shoes-green Velcro Adidas with asphalt marks on the white rubber outsoles-as she'd run from the house barefoot that morning only to realize it when she'd pulled up to base. She'd found the Adidas in the back of the minivan, buried in a mound of camping equipment from a trip into the Catoctins that, having been planned for two months and canceled three times, had almost come to fruition the prior weekend, only to be interrupted by the emergency at hand. A pair of wire-frame John Lennon-style glasses perched on her nose, the thin metal arms disappearing back into her curly brown hair.
Having little use for a husband, she'd adopted all three of her children over the past nine years. Earlier in her career, she couldn't have even considered being a mother. She'd been dispatched for months at a time on various projects-bleeding horses in rural Costa Rica for Venezuelan equine encephalitis, chasing Machupo virus up the eastern slope of the Andes, trekking through mosquito breeding grounds in the Nile Delta. But after her stint at CDC in Atlanta, she was given an offer to run DAD at USAMRIID, and she'd vowed to attempt some form of a domestic life. Being a mother, she'd found, had toughened her considerably more than being a major and running a division of testosterone-poisoned, military-sanctioned control freaks. But she liked Fort Detrick nonethe-less, and the seasons in central Maryland.
The stark modern USAMRIID building looked as if it had been dropped into the middle of the base from orbit, so out of place did it look among the conservative, faded-brick buildings. Inside, the sleek, tiled floors and fluorescent lights countered the battleship-gray walls. All work with infectious agents was undertaken in one section, divided into four units, each of which was in turn split into four 'hot suites.' Each hot suite employed a constellation of blowers, vents, and pressure sys-tems to ensure that airborne pathogens could not leak from the area. The filters killed any atomized biohazard before laboratory air was released to the outside. Everywhere in the building, the airflow was directed inward.
It was precisely this inflow of white noise that Samantha sought to combat with her singing. 'The itsy bitsy spider…' Her voice, soft and high like a child's, activated the small microphone that allowed her to communicate with her lab technician, who wore a space suit similar to her own. '… contracted a new strain of aerosol-infectious Bolivian hemor-rhagic fever…' She leaned forward over the cadaver. She'd already made a Y-shaped incision to open the chest and abdomen. Her arm throbbed slightly from the latest battery of inoculations; because of all the shots she received in her line of work, her deltoids were usually sore.
She gestured with her scalpel at the lab tech. 'Retract the small bowel so I can get at the root of the mesentery.' The abdominal cavity was always difficult because it was so full; with all the coils of bowel, there was less room for maneuvering. She reached down and poked at the fattened stomach, knowing from experience it would be filled with clotted, foul-smelling liquid. Unfortunately, the respirators did not screen out odors.
'Down came the virologist, and washed the virus out,' she sang.
The lab tech leaned forward and secured the squishy bowel in his gloved, slightly unsteady hands. 'Don't cut me,' he said.
'Oh really?' Samantha replied. 'Well, there go my plans for the week. I was hoping to watch the effects of the disease take hold in one of my colleagues.'
Starting at the mesentery, she cut away excess tissue and muscle attachments so that she could pull out the organs. The procedure was crassly referred to as 'the pluck.' One 'plucked' out first the thoracic organs, then the abdominal organs.
'Hemorrhaging around the gums, yellow sclera, bloody stool, ecchy-moses, petechial hemorrhages, blood in the urine… ' Samantha grasped the enlarged heart, pulling gently, and began singing again. 'Out came the sun and dried up all the rain…'
The tech nervously regarded the nearby formalin, ready to plunge his hand into the sterilizing agent at the slightest nick. But Samantha's hands were completely steady. She trimmed neatly around her assistant's fin-gers, humming the next bar from the children's song as she sliced through tissue. She stopped suddenly. 'Aha! Look at this.'
The pleural cavity was filled with fluid, and the lungs were scattered with hard patches of red. She took a sample, placing it in a small vial and screwing the lid on tightly before scrubbing the outside with a disinfectant.
'Condom,' she said. Another lab tech stepped forward, holding open an unfurled, nonlubricated Trojan. They'd had to be slightly inventive with their equipment; the last shipment from the supplies company in San Diego hadn't arrived due to a train derailment outside Vegas. Samantha dropped the vial into the condom, and the assistant knotted the end of the latex, placing it into a nylon stocking and lowering it into a tank of liquid nitrogen. He hooked the end of the stocking on the lip of the tank, careful to keep his hands clear of the liquid, which was 195 degrees Celsius below zero.
Samantha turned back to the body. It was a gruesome specimen. A prominent Baltimore businessman had returned six days ago from Cochabamba, Bolivia, in his Gulfstream VII. Previous to his flight, he'd been febrile, with myalgias, weakness, and chills. Though the symptoms had quickly become gastrointestinal-he'd been beset with abdominal tenderness and diarrhea-he'd decided to fly anyway. After takeoff, the man had been stricken with vomiting, and spontaneous bleeding from his nose, gums, and the whites of his eyes. Johns Hopkins Hospital received warning while the plane was midair, the pilot calling ahead to have an ambulance waiting at the airport. The reports worsened as the plane approached Baltimore, and the Chief of Staff at Hopkins had reached Samantha at her campsite in the Catoctins. They'd agreed to have the plane diverted to a stretch of Highway 15 near Fort Detrick, so that the businessman, and his wife, pilot, and flight attendant, who were showing early symptoms, could be quarantined at Level Four.
Samantha had raced home to treat them, but the virus had reached high titers in the businessman's blood, and the coagulopathy had already been far advanced. The antiserums they stored in the banks that coun-teracted other forms of BHF were not working on this mutated strain, nor had ribavirin.
Samantha had taken fluid and tissue samples from the businessman while he was still living and inoculated cell cultures with them, allowing the virus to replicate until the cell cultures contained viral antigens. The pilot's and flight attendant's condition continued to deteriorate, but the wife had recovered from her fever on the second day, which meant she'd probably produced antibodies that had fought off the virus. Sure enough, her serum showed the presence of immunoglobulin G antibod-ies, indicating an older infection from which she'd previously recovered. The IgG had enabled her body to combat her reexposure to the virus.
Samantha drew blood from her to isolate these antibodies, then spun down the blood in a centrifuge to separate the antiserum. The antiserum was added to the inoculated cell cultures, then washed down to remove everything that didn't specifically bind to the antigen. Next, she'd added specially tagged antibodies that allowed her to see, under ultraviolet light, that the antiserum had indeed bound to the antigen, strongly indi-cating that the antibodies in the wife's blood were manufactured to com-bat this specific virus.
Samantha had managed to isolate enough of the antibodies to fight off the virus in six of seven rats she'd infected. Each of the surviving rats had replicated the antibodies, which she'd been able to extract from them, isolate in larger amounts, and, using advanced genetic manufac-turing techniques, replicate on an even larger scale.
Samantha was now awaiting clearance to passively immunize the pilot and flight attendant with the experimental antiserum. Top brass from PHS and the FDA were meeting next door, deciding whether or not to approve the experimental plan of treatment. If the patients had to wait for the antiserum to clear the usual PHS paperwork labyrinth, they would surely die within the week.
Samantha forced herself to concentrate on the task at hand-per-forming a full autopsy on the body of the businessman, who had died that morning. She tried not to think about the decision being made next door that would determine the fates of two people. The body on the autopsy table was grotesque. Old, fading lesions peppered the armpits, and the gums were a bloody, suppurating mess. The mouth was caked with blood.
Samantha dug into the open cavity with renewed vigor. She continued to sing; her lab tech continued to sweat.
