patient should be asked. The other doctors rose to the challenge and began giving suggestions. When they were done, Marissa added as an afterthought that they might ask if any of the patients had attended the eyelid surgery conference in San Diego that had been held about three months before.
Before the group disbanded, Marissa reminded everyone to adhere carefully to all the isolation techniques. Then she thanked them again and went to review the material that was already available.
As she had done in L.A., Marissa commandeered the chart room behind the nurses’ station on one of the isolation floors as her command post. As the other doctors finished their history taking, they brought their notes to Marissa, who had begun the burdensome task of collating them. Nothing jumped out of the data except the fact that all the patients worked at the Medica Hospital, something that was already well known.
By midday, fourteen more cases had been admitted, which made Marissa extremely fearful that they had a full-blown epidemic on their hands. All the new patients, save one, were Medica subscribers who had been treated by one of the original forty-two sick physicians before the physicians developed symptoms. The other new case was a lab tech who had done studies on the first few cases before Ebola was suspected.
Just as the evening shift was coming on duty, Marissa learned that the other CDC physicians had arrived. Relieved, she went to meet them. She found Dubchek helping to set up the Vickers Lab.
“You might have told me the damn hospital was quarantined,” he snapped when he caught sight of her.
“You didn’t give me a chance,” she said, skirting the fact that he had hung up on her. She wished there was something she could do to improve their relationship, which seemed to be getting worse instead of better.
“Well, Paul and Mark are not very happy,” said Dubchek. “When they learned all three of us would be trapped for the length of the outbreak, they turned around and went back to Atlanta.”
“What about Dr. Layne?” asked Marissa guiltily.
“He’s already meeting with Weaver and the hospital administration. Then he will see if the State Health Commissioner can modify the quarantine for the CDC.”
“I suppose I can’t talk to you until you get the lab going,” said Marissa.
“At least you have a good memory,” said Dubchek, bending over to lift a centrifuge from its wooden container. “After I finish here and I’ve seen Layne about the isolation procedures, I’ll go over your findings.”
As Marissa headed back to her room, she mulled over a number of nasty retorts, all of which only would have made things worse. That was why she had said nothing.
After a meal of catered airplane food eaten in an area of the outpatient clinic reserved for staff in direct contact with the presumed Ebola patients, Marissa returned to her chart work. She now had histories on most of the initial eighty-four cases.
She found Dubchek leafing through her notes. He straightened up on seeing her. “I’m not sure it was a good idea to use the regular hospital staff to take these histories.”
Marissa was caught off guard. “There were so many cases,” she said defensively. “I couldn’t possibly interview all of them quickly enough. As it is, seven people were too sick to speak and three have subsequently died.”
“That’s still not reason enough to expose doctors who aren’t trained epidemiologists. The Arizona State Health Department has trained staff that should have been utilized. If any of these physicians you’ve drafted become ill, the CDC might be held responsible.”
“But they—” protested Marissa.
“Enough!” interrupted Dubchek. “I’m not here to argue. What have you learned?”
Marissa tried to organize her thoughts and control her emotions. It was true that she’d not considered the legal implications, but she was not convinced there was a problem. The quarantined physicians were already considered contacts. She sat down at the desk and searched for the summary page of her findings. When she found it, she began reading in a flat monotone, without glancing up at Dubchek: “One of the initial patients is an ophthalmologist who attended the same San Diego conference as Drs. Richter and Zabriski. Another of the initial cases, an orthopedic surgeon, went on safari to East Africa two months ago. Two of the initial cases have used monkeys in their research but have not suffered recent bites.
“As a group, all eighty-four cases developed symptoms within a six-hour period, suggesting that they all were exposed at the same time. The severity of the initial symptoms suggests that they all received an overwhelming dose of the infective agent. Everyone worked at the Medica Hospital but not in the same area, which suggests the air-conditioning system was probably not the source. It seems to me we are dealing with a food- or waterborne infection, and in that regard, the only commonality that has appeared in the data is that all eighty-four people used the hospital cafeteria. In fact, as nearly as can be determined, all eighty-four people had lunch there three days ago.”
Marissa finally looked up at Dubchek, who was staring at the ceiling. When he realized that she had finished speaking, he said, “What about contact with any of the patients in the L.A. or St. Louis episodes?”
“None,” said Marissa. “At least none that we can discover.”
“Have you sent blood samples to Tad?”
“Yes,” said Marissa.
Cyrill headed for the door. “I think you should redouble your efforts to associate this outbreak with one of the other two. There has to be a connection.”
“What about the cafeteria?” asked Marissa.
“You’re on your own there,” said Dubchek. “Ebola has never been spread by food, so I can’t see how the cafeteria could be associated…” He pulled open the door. “Still, the coincidence is curious, and I suppose you’ll follow your own instincts no matter what I recommend. Just be sure you exhaust the possibilities of a connection with L.A. or St. Louis.”
For a moment Marissa stared at the closed door. Then she looked back at her summary sheet and the huge pile of histories. It was depressing.
Almost as if Cyrill’s last words had been a challenge, Marissa decided to visit the cafeteria, which had been built as a separate wing over a garden courtyard. The double doors leading to the large room were closed, and on the right one a notice had been tacked up stating: CLOSED BY ORDER OF STATE HEALTH COMMISSIONER. Marissa tried the door. It was unlocked.
Inside, the room was spotlessly clean and furnished in stainless steel and molded plastic. Directly ahead of Marissa was the steam table, with stacks of trays at one end and a cash register at the other.
A second set of double doors, with little round windows, was located behind the steam table and led to the kitchen. Just as Marissa was deciding whether to go through or not, they opened, and a stout but attractive middle-aged woman appeared and called out to Marissa that the cafeteria was closed. Marissa introduced herself and asked if she could ask the woman a few questions.
“Certainly,” replied the woman, who explained with a faint Scandinavian accent that her name was Jana Beronson and that she was the cafeteria manager. Marissa followed her into her office, a windowless cubicle whose walls were filled with schedules and menus.
After some polite conversation, Marissa asked to see the lunch menu for three days ago. Miss Beronson got it out of the file, and Marissa scanned the page. It was a usual cafeteria menu, with three entrees, two soups and a selection of desserts.
“Is this all the food offered?”
“Those are all the specials,” answered Miss Beronson. “Of course we always offer a selection of sandwiches and salads and beverages.”
Marissa asked if she could have a copy of the menu, and Miss Beronson took the paper and left the office to Xerox it. Marissa decided that she would go back to each of the initial cases and ask what they had eaten for lunch three days ago. She would also question a control group made up of people who ate from the same menu but who did not become ill.
Miss Beronson returned with the copy. As she folded the paper, Marissa said, “One of your employees was stricken, wasn’t she?”
“Maria Gonzales,” said Miss Beronson.
“What was her job here?”
“She worked either the steam table or the salad bar,” answered Miss Beronson.
“Could you tell me what she did on the day in question?” asked Marissa.
Getting up, Miss Beronson went over to one of the large scheduling boards on her wall. “Desserts and
