frightened at the thought of her own exposure. Although she hadn’t mentioned it to anyone, she still worried about contracting the disease from the first outbreak. Each day that passed without the appearance of suspicious symptoms had been a relief. But the fear had never completely disappeared.
The other thought that troubled Marissa was the idea of another Ebola case appearing so quickly. If it was Ebola, how did it get to St. Louis? Was it a separate outbreak from L.A. or merely an extension of that one? Could a contact have brought it from L.A., or could there be an “Ebola Mary” like the infamous “Typhoid Mary”? There were many questions, none of which made Marissa cheerful.
“Will you want dinner tonight?” asked a cabin attendant, breaking Marissa’s train of thought.
“Sure,” said Marissa dropping her tray table. She’d better eat, whether she was hungry or not. She knew that once she got to St. Louis she might not get the time.
As Marissa climbed out of the taxi that had taken her from the St. Louis airport to the Greater St. Louis Community Health Plan Hospital, she was thankful for the elaborate concrete porte cochere. It was pouring outside. Even with the overhead protection, she pulled up the lapels of her coat to avoid wind-driven rain as she ran for the revolving door. She was carrying her suitcase as well as her briefcase, since she’d not taken the time to stop in her hotel.
The hospital appeared an impressive affair even on a dark, rainy night. It was constructed in a modern style, with travertine-marble facing, and fronted by a three-stories-tall replica of the Gateway Arch. The interior was mostly blond oak and bright red carpeting. A pert receptionist directed Marissa to the administration offices, located through a pair of swinging doors.
“Dr. Blumenthal!” cried a diminutive oriental man, jumping up from his desk. She took a step backward as the man relieved her of her suitcase and enthusiastically pumped her freed hand. “I’m Dr. Harold Taboso,” he said. “I’m the medical director here. And this is Dr. Peter Austin, the Missouri State Epidemiologist. We’ve been waiting for you.”
Marissa shook hands with Dr. Austin, a tall, thin man with a ruddy complexion.
“We are thankful that you could come so quickly,” said Dr. Taboso. “Can we get you something to eat or drink?”
Marissa shook her head, thanking him for his hospitality. “I ate on the plane,” she explained. “Besides, I’d like to get directly to business.”
“Of course, of course,” said Dr. Taboso. For a moment he looked confused. Dr. Austin took advantage of his silence to take over.
“We’re well aware of what happened in L.A. and we’re concerned that we might be dealing with the same problem here. As you know, we admitted one suspicious case this morning, and two more have arrived while you were en route.”
Marissa bit her lip. She had been hoping that this would turn out to be a false alarm, but with two more potential cases, it was difficult to sustain such optimism. She sank into the chair that Dr. Taboso proffered and said, “You’d better tell me what you have learned so far.”
“Not much, I’m afraid,” said Dr. Austin. “There has been little time. The first case was admitted around 4:00 A.M. Dr. Taboso deserves credit for sounding the alarm as soon as he did. The patient was immediately isolated, hopefully minimizing contacts here at the hospital.”
Marissa glanced at Dr. Taboso. He smiled nervously, accepting the compliment.
“That was fortunate,” said Marissa. “Was any lab work done?”
“Of course,” said Dr. Taboso.
“That could be a problem,” said Marissa.
“We understand,” said Dr. Austin. “But it was ordered immediately on admittance, before we had any suspicion of the diagnosis. The moment my office was alerted we called the CDC.”
“Have you been able to make any association with the L.A. outbreak? Did any of the patients come from L.A. ?”
“No,” said Dr. Austin. “We have inquired about such a possibility, but there has been no connection that we could find.”
“Well,” said Marissa, reluctantly getting to her feet. “Let’s see the patients. I assume that you have full protective gear available.”
“Of course,” said Dr. Taboso as they filed out of the room.
They crossed the hospital lobby to the elevators. Riding up in the car, Marissa asked, “Have any of the patients been to Africa recently?”
The other two doctors looked at each other. Dr. Taboso spoke: “I don’t believe so.”
Marissa had not expected a positive answer. That would have been too easy. She watched the floor indicator. The elevator stopped on eight.
As they walked down the corridor, Marissa realized that none of the rooms they were passing were occupied. When she looked closer, she realized that most weren’t even fully furnished. And the walls of the hall had only been primed, not painted.
Dr. Taboso noticed Marissa’s expression. “Sorry,” he said. “I should have explained. When the hospital was built, too many beds were planned. Consequently, the eighth floor was never completed. But we decided to use it for this emergency. Good for isolation, don’t you agree?”
They arrived at the nurses’ station, which seemed complete except for the cabinetry. Marissa took the first patient’s chart. She sat down at the desk and opened the metal cover, noting the man’s name: Zabriski. The vital- sign page showed the familiar complex of high fever and low blood pressure. The next page contained the patient’s history. As Marissa’s eyes ran down the sheet, she caught the man’s full name: Dr. Carl M. Zabriski. Raising her eyes to Dr. Taboso, she asked incredulously, “Is the patient a physician?”
“I’m afraid so,” answered Taboso. “He’s an ophthalmologist here at the hospital.”
Turning to Dr. Austin, she asked, “Did you know the index case in L.A. was also a doctor? In fact he was an ophthalmologist!”
“I was aware of the coincidence,” said Dr. Austin, frowning.
“Does Dr. Zabriski do any research with monkeys?” asked Marissa.
“Not that I know of,” answered Dr. Taboso. “Certainly not here at the hospital.”
“No other physicians were involved in the L.A. outbreak that I can recall,” said Dr. Austin.
“No,” said Marissa. “Just the index case. There were three lab techs and one nurse, but no other doctors.”
Redirecting her attention to the chart, Marissa went through it rapidly. The history was not nearly as complete as that done on Dr. Richter at the Richter Clinic. There were no references to recent travel or animal contact. But the lab workup was impressive, and although not all the tests were back, those that were suggested severe liver and kidney involvement. So far everything was consistent with Ebola Hemorrhagic Fever.
After Marissa finished with the chart, she got together the materials necessary for drawing and packing viral samples. When all was ready, she went down the hall with one of the nurses to the isolation area. There she donned hood, mask, gloves, goggles and booties.
Inside Zabriski’s room, two other women were similarly attired. One was a nurse, the other a doctor.
“How is the patient doing?” asked Marissa as she moved alongside the bed. It was a rhetorical question. The patient’s condition was apparent. The first thing Marissa noticed was the rash over the man’s trunk. The second thing was signs of hemorrhage; a nasogastric tube snaked out of the man’s nostril and was filled with bright red blood. Dr. Zabriski was conscious, but just barely. He certainly couldn’t answer any questions.
A short conversation with the attending physician confirmed Marissa’s impressions. The patient had been deteriorating throughout the day, particularly during the last hour, when they began to see a progressive fall in the blood pressure.
Marissa had seen enough. Clinically, the patient resembled Dr. Richter to a horrifying degree. Until proven otherwise, it had to be assumed that Dr. Zabriski and the other two subsequent admissions had Ebola Hemorrhagic Fever.
The nurse helped Marissa obtain a nasal swab as well as blood and urine samples. Marissa handled them as she’d done in L.A., double bagging the material and disinfecting the outsides of the bags with sodium hypochlorite. After removing her protective clothing and washing her hands, she returned to the nurses’ station to call Dubchek.
