Sunday, March 3, 2013

Patient Zero - Part 1.

As promised, here's my contribution to the Aid Zombies challenge. It's 5,000 words and is pretty quick and dirty, but there was a story to tell so I wrote it down as quickly as I could. It's not grand literature, but I hope you'll get a kick out of it. So without any further ado...

Patient Zero

Dr Hamish Macleod wiped the sweat off his brow. The humidity was stifling and not for the first time since his arrival two months prior he wished he was back home in the Isle of Skye. He washed his face at the tap stand and let the water run over his head, washing off another stressful day. The MSF clinic was full to capacity, with a long line of people waiting at the entrance. “Hamish, I need your help.” He shook the water drops from his head and turned to face Sophia Martinez, the senior nurse. “What’s up?” “We’ve got another one. Anxiety and partial paralysis.” He hurried back into the clinic to examine the patient. They’d been streaming in for days now, all presenting with the same symptoms which made no sense. A woman in her 30s sat on a chair, breathing shallowly her arms slack by her side. “Her husband says she hasn’t been able to move her arms since last night.” Hamish examined her, talking to her in his basic Spanish and trying to keep her calm. “Como te llamas?” “Maria de Silva,” she said quietly. Knowing that her story would be the same as the other 20 cases he’d seen throughout the day, he turned to Sophia and asked, “diabetes?” “Yes, Type 1, just like the others.” “Please explain to her husband that she needs to keep up her insulin, and to come back tomorrow if there has been no change. And take a blood sample.”

He turned and walked to the office at the back of the clinic. “Charles, how are the insulin supplies?” The logistician looked up from his paperwork and his thick Zimbabwean accent replied, “we’re going to need more soon boss. It’s running out pretty quickly. There’s a boat leaving tomorrow so we’ll put our order in on that, but we won’t get any supplies for about 8 days.” “Is there enough to last?” “Yes, we should be ok.”  “All right, put the requisition together and I’ll sign it off in the morning.”

The rest of the afternoon passed in a blur, with Hamish doling out the same instructions to patient after patient. When the clinic was finally empty and the temperature had dropped, he went for a run to clear his head. The jungle was calming and he ran the route connecting the clinic, the school and the market place. Lungs burning, he stopped by the side of the track to take some deep breaths. Hands on his knees he looked into the greenery beside him and saw the carcass.  The coati was on the small side and he could see no sign of attack from another animal. Thinking it was slightly odd, but very keen for a cold bucket shower, he stood up and started to run. “What could be causing the symptoms we’ve seen today?” he asked himself. He rounded a small bend in the track and came to a halt at another coati carcass. Again, no sign of injury or blood. He nudged it with his foot to turn it over, and there were no signs of trauma. “Oh my god,” he said out loud and sprinted back to the clinic.

“Hamish, are you all right?” Sophia called after him as he ran to the supply room. “I can’t be certain, but I think we’ve got a serious situation on our hands.”  “What’s going on?” He grabbed a sample bag, two masks and four pairs of gloves. “Follow me.” Sophia ran after him, her heart pounding with fear. She saw Hamish slow down and came to a stop beside him, and stared at the dead animal in front of them. “It’s a native raccoon. There are loads of them around here.” “Yes, this is the second dead coati I saw on my run, there’s another one further up the track.” “And what’s the problem with a dead coati?” “First things first, put on a mask and double glove.” She followed his instructions and stared at him in confusion. “What is going on Hamish?” “I went on a course to India last year, on rabies.” “You think we've got rabies here? It’s not endemic at all.” “It’s just a suspicion, but the slight paralysis we've been seeing could be a symptom. I need to get this carcass back to the clinic to take a tissue sample. There’s a boat leaving tomorrow so we need to get this tissue and some of the blood samples to the CDC in Atlanta.”

“Oh holy shit Hamish. That’ll take weeks. It’s 4 days on the boat just to get out of here. Then a flight to the States...we’re not going to know for a couple of weeks. But wait, none of the patients we've seen have been bitten by anything. It can’t be rabies.” “I don’t know. It’s extremely strange. But we need to have confirmation one way or another.”

Hamish didn’t sleep too well that night. An outbreak of rabies would decimate the tiny population. He’d checked the supply room and there was no rabies immunoglobulin, no treatment for anyone who may have been bitten. All MSF staff received a full course of vaccinations before deploying on any mission so he wasn’t concerned for his team. But as the only medical facility in the area he had a responsibility for the community. He tossed and turned until he could no longer pretend to sleep.

He prepared the samples to send to the CDC, carefully packaging them to prevent any damage, and made sure to include the sat phone number on every item. When a finding was made, he wanted to know about it immediately. He documented the cases and outlined his suspicions. At 11am a young boy came rushing into the clinic, tears streaming from his face. He spoke in rapid Spanish to Sophia who gasped and turned to Hamish. “One of the women we saw yesterday is dead. Maria. This is her son. He says she screamed all night that the devil was coming for her, that she was looking at the devil. It sounds like she convulsed and then died.” Hamish swore quietly and moved over to the young boy. He crouched down and told the boy that he was very sorry, and asked if he could come to the house. “Sophia, can you please make sure that Maria’s blood sample is included in the package going to CDC and make sure it gets on the boat? I’m going to examine the body.”

The little boy led the way to a small shack. Women were sat outside, wailing the customary cries for the dead. He nodded at them and entered the house. Maria’s body was laid out on the bed, her arms and legs contorted at unusual angles. Her husband, who Hamish had met the day before, sat quietly on a chair beside the bed. “What happened?” Hamish asked. Ramón numbly described the previous evening how her entire body had been thrashing against the bed. He thought she’d been hallucinating as she’d described seeing strange and scary things. Then suddenly, her screaming had stopped and she was still, but her body remained tense and twisted. He’d checked to see if she was still breathing, but she was already gone. Ramón’s head was bowed. Hamish looked over the body, and noticed the fingers clenched tightly together. His suspicions were growing, but there was nothing that could be done for Maria.

“Ramón, has anyone been bitten by a coati recently?” Ramón paused for a second to think. “Maria’s cousin was visiting from the capital a few weeks ago. He mentioned that a coati had bitten his ankle. But he was ok, he went home again and was feeling fine.” Hamish’s brain made a complicated leap that at a later date he could not recall how it had happened. “Did he have diabetes too?” “Yes, most of us do. Can we bury her now?” “Yes. Of course. Please make sure that anyone who touches Maria washes their hands carefully afterwards.” Ramón didn’t ask for an explanation of his wife’s death, and Hamish didn’t really have an answer for him. He left the man to his grief and walked slowly back to the clinic.

“What are the burial rituals here?” he asked Sophia. “Well, death is celebrated by women. They will wash and dress the body and chant for its safe passage to the afterlife. I don’t know a lot about it Hamish, but I think there’s a type of voodoo involved. You look tired, you should call it a day.” “I’ll be in the office.”
Five days passed, with more cases like Maria’s presenting at the clinic. The body count was mounting and the community was getting angry. They’d had to close the clinic early as Charles was concerned there’d be a riot. Hamish grabbed the satellite phone and called headquarters. “The situation is serious. I haven’t heard anything from the CDC and I need to get in touch with them. What’s the number?” He punched in the number and waited for a connection.

Dr Stephanie Rosenberg was at her desk when the call came through. “Hello Doctor Macleod. No, I haven’t seen the results yet. Let me follow up and I’ll call you back within the hour.” She raced through the labs to find Dr James Waldorf. “James, where are the results from the MSF clinic? The rabies case.” “I’ve been looking at the data for the last half hour. It doesn’t make any sense.  The variant strain is not classical human rabies. There seems to have been a mutation in the virus. The documentation said there’d been no bites noticed on any of the patients, but there is a rare transmission route of non-bite exposure. I’m just not sure how it could have happened.” “You need to call Doctor Macleod, he’s got a riot on his hands and he needs to know.” She passed him a small piece of number with the satellite phone number on it and left the room.

“Doctor Macleod? This is Doctor James Waldorf at the CDC. I can confirm that you’ve got rabies present. It’s a mutation that I’ve never seen before and I just don’t understand how it’s spreading if no bites have been reported. Non-bite exposure is extremely rare, but it’s the only explanation.”
Hamish felt a lump in the pit of his stomach. He knew the answer and there was nothing he could do to help the people of the community.

“There was a bite. A few weeks ago. Nobody reported it and no treatment was given, not even tetanus. There are a large percentage of people in the community who have Type 1 diabetes. They share needles. That’s how it’s spreading.” “You mean there was a bite from the infected animal, that has since been transferred to other humans through the sharing of insulin injections?” “That’s exactly what I’m saying Doctor Waldorf.” “What’s the mortality rate?” “We’ve had 13 deaths in the past six days.” “Do you have any immunoglobulin?” “No, nothing at all.”

“We’ll fly some in for you to dispense to everyone who may be affected. It’s not going to help everyone, but it’s the best we can do for you.” “Thank you Doctor, I just hope it isn’t too late.” A scream came from the room next door. Hamish dropped the phone and wrenched open the door. Sophia was staring at the windows. “What the hell is going on?” she yelled. The clinic was surrounded by people, slapping their arms ineffectively at the windows. “Hamish, look at that woman,” she said pointing at the figure seemingly leading the charge. “It can’t be. I saw her body, she was buried...” he was looking at Maria da Silva. Her eyes weren’t focussed, her skin a shade of grey.

“It’s the voodoo. It must be the voodoo. I’ve heard about this from friends who worked in Haiti. People come back from the dead.” “Come on Sophia, you’re a scientist. This isn’t voodoo. The CDC confirmed it’s rabies but it’s a mutated strain.” “A mutated strain that brings people back from the dead?” He shook his head in shock. This was too much to take. A rabies outbreak that was creating zombies.  He approached the window slowly to examine the bodies on the other side. “Maria? Can you hear me?” There was no response, and he counted twelve others. “13 died correct?” he called to Sophia. “Yes, that’s right.” There was pounding on the back door to the clinic. 

He ran to the door and peered out the window beside it. “Doctor, help me.” He stared at the man at the door, eyes wide and pleading. “Ramón, what happened?” “Maria. Oh my god. Maria...” he switched to rapid Spanish that Hamish couldn’t keep up with. “Sophia, come here quickly. What’s he saying?” She listened for a few seconds. “Maria came back into the house. He thought she had recovered so he hugged her. She bit his neck.” Hamish noticed Ramón’s hand clasped over his bleeding neck. “He’s asking us to help him.” Hamish swore. “There’s nothing we can do. He’s already infected with the strain from sharing needles with his wife, and the bite will just speed things up. You need to explain that we don’t have any treatment for him, and that he should just go home. Tell him that we’ve got help coming in a couple of days, he just needs to hold on.” She spoke to him and Hamish watched his face fall. He turned and walked away from the clinic. “Do you think they’ll get here in time?” “No. But there’s no need for anyone else to know that. We just need to figure out what to do.  Get Charles in here, we need to barricade ourselves in, it’s not safe. I need to call the CDC back.”

Patched through to Doctor Waldorf, Hamish outlined the change of events. “My god. This is incredible, unbelievable.” “James, they’re zombies. There’s no other word for it. The dead have risen and are biting people. The infection is going to spread and I don’t know what we can do.” There was silence on the other end. “James?” “I’m still here Hamish, I’m just trying to take this in. Do you have a safe building where you can sequester yourselves?” “Yes, the medical supply room is the clinic is secure. We’ll just need to grab some food and barricade ourselves in.” “Do that. I need to raise this to the highest levels. The outbreak needs to be contained and your team can’t do that. We might need to send the military in.” “Do what you need to do James, but please keep me updated.” “Of course, stay safe Hamish.” 

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