We all fall down, p.10
We All Fall Down, page 10
She brushes her teeth, ducks in and out of the shower barely long enough to lather and rinse, and then throws on the same outfit she wore two days earlier. She had come to Genoa with only clothes enough for three days. She hadn’t expected to stay. Then again, she never expected any of this.
Outside, a taxi is idling near the entry. Alana climbs inside and the young driver greets her with an over-the-shoulder grin. But his expression turns from welcoming to wary when she informs him that she’s heading to the Ospedale San Martino. Only after she manages to convey that she is a dottore, not a potential patient, does he agree to drive her there at all.
As soon as the cab pulls away, Alana phones Sergio Fassino. She spent much of the previous day with the intelligence officer after the search for the missing Yasin Ahmed intensified. By day’s end, they still hadn’t found him, but AISI agents had rounded up the imam at the Al Halique Mosque along with two other men from the mosque who were on the Italian equivalent of a no-fly list.
Despite the early hour, Sergio answers on the second ring, sounding as if he has been up for hours. Alana has little doubt that his blazer is buttoned and his tie already knotted. “The imam and the two others from the mosque claim they know nothing of Yasin Ahmed’s whereabouts or any of his recent activity,” Sergio offers, before she can even inquire. “The imam was the only one to admit being even familiar with Yasin.”
“Do you believe them?”
“Not necessarily,” Sergio says. “We searched their homes overnight. We discovered militant propaganda on one of the computers. But we have not found anything to connect any of them to Yasin or this outbreak. Still, we will keep an eye on them.”
“No other leads on Yasin’s whereabouts?”
“We’re interviewing more friends and family, but nothing so far,” Sergio says. “His cell phone has not been active in over a week. The last traceable signal came from the construction site where he was last seen.”
“His mother and Emilio both say Yasin was already sick that day,” Alana thinks aloud. “Yet he still worked at the site?”
“Apparently.”
“Why would you do a day of hard labor if you were trying to spread an infection as a weapon of mass destruction?”
“To expose as many people as possible?” Sergio suggests.
“All right, then why not go somewhere crowded? A concert? A soccer game? Or just board an airplane?”
“Perhaps he didn’t want to draw attention.”
“Isn’t that the whole point of terrorism?” It was one of the inconsistencies that had been gnawing at her overnight. “If Yasin is our Patient Zero—our bacterial ‘suicide bomber,’ as it were—he couldn’t have done any of this without support. A lot of it. And if other terrorists are involved, why has no group stepped forward to claim credit?”
“Maybe they are waiting for the damage to increase? Until the body count is high enough to draw even more attention.”
“I suppose,” she says, but something doesn’t sit right.
Alana hangs up just as the driver pulls up to a curb. He points to the front window and indicates the hospital, which is at least two blocks away. She accepts the premature stop with a simple “Grazie” and pays in cash.
Alana can’t blame the driver for his reticence. Fear of the unknown is instinctual for humans and, probably, healthy in this instance. She has been following the incessant coverage on TV and online when she can. Dread of the plague has already crawled into public consciousness. Cafés are less crowed. The usually tactile locals are less willing to kiss, hug, or even shake hands. And, in the most telltale sign of all, a number of people wear surgical masks in public—a common sight on the streets of Shanghai but extremely unusual in Italy. Once word of the new surge in cases leaks out, she imagines it will be difficult to find a cabbie who will be willing to venture within a couple miles of the hospital.
The usual media mob gathers out front of the hospital, their nervous energy manifesting itself in their loud chatter and the faint stench of cigarette smoke and body odor. Alana squeezes her way through the throng without responding to their questions.
Security has been heightened. At the entrance, the guard scrutinizes the photo on her ID badge and then runs the card through a scanner. Two young cops with rifles slung over their shoulders and glares fixed to their faces oversee the checkpoint. One of them keeps a hand on the barrel of his weapon as he vigilantly monitors his surroundings. Alana suspects that the local authorities must have already been alerted to the potential of a terrorist threat.
Inside the hospital, the process is equally rigorous. Alana slips into her gown, gloves, and hood in the makeshift change room in the lobby while a plump nurse stands, with arms folded, and watches every step of the process to ensure that there are no breaches in protocol.
As Alana trudges down the corridor toward the ICU, her PPE suit feels more constrictive than ever. Inside the unit, it’s the quiet that disturbs her most. Staff move about purposefully, but no one is talking. It reminds her of Liberia at the height of the Ebola crisis. The hopeless silence in those hospitals was almost tangible, as well.
Byron meets her at the nursing station, holding a sample bag in his gloved hand. Alana gestures to the rooms. “How many of these are plague victims?”
“Six.” He nods to the right. “They’ve separated the unit, as best they could, for infection control. All the patients on this side have the plague, and all the rooms have negative pressure ventilation.” She knows that means that air is being sucked into the potentially contaminated room and blown safely out of the hospital through filtered pipes.
Alana glances through the window into the room beside her. A woman lies motionless on the bed with a ventilator tube fed through her lips. Her face is ashen, and her exposed legs are mottled in a lacy deep purple indicative of severe shock. Two tubes that are each the size of a garden hose and engorged with blood run from her groin to an elaborate machine at the head of the bed. Alana recognizes the device for an ECMO—extracorporeal mechanical oxygenation—apparatus, meaning that the patient’s heart is failing so badly the doctors have had to place her on a heart-lung bypass circuit. Even still, the blood pressure on the monitor above her reads so low it’s barely compatible with life.
“Six of sixteen new cases have already ended up in the ICU?” Alana asks.
“Five others have already died overnight,” Byron says.
“Five more? Already?”
“Probably even more since I last checked an hour ago,” he says. “It’s chaos in the ER. Not just here. The other hospitals in the city, too. So many real cases, but we’re also being flooded with mimics in terms of colds and flus.”
“We have to assume it’s the plague until we know otherwise.”
“We’re advising doctors to treat all patients with any fever as potential plague, regardless of how unlikely.”
“How is the supply of antibiotics holding up?”
“So far, we have enough. What we don’t have enough of is time. This strain kills people faster than anything I’ve ever seen. Faster than the antibiotics can work, in some cases.”
“Even faster than necrotizing fasciitis?” she asks, referring to the feared flesh-eating bacterial infection. “I once saw a woman lose her whole arm within twelve hours of getting a paper cut on her finger.”
“Even faster.”
“Can we connect the dots in the new cases back to Vittoria?”
“No. We’ve done extensive contact-tracing. The two cases yesterday from the east side of the city have no connection to Vittoria or any of her collateral spread.”
She breathes out heavily enough that her face mask fogs momentarily. “So Vittoria isn’t our Patient Zero, then.”
“Probably not, no.” Byron eyes her intently. “Can we say the same of Yasin Ahmed?”
“How can we know? He’s disappeared.”
“We have to release his name and photo to the media.”
“It’s too early, Byron. Even Sergio agrees. And he’s the lead Italian agent on this.”
“What’s the point of waiting?”
“One, we still don’t know if Yasin is involved. And two, if he’s the source, publicizing his name might only spook him and make him and his network that much harder to trace.”
“We don’t have to announce he’s a terrorist. Only that he might be infected.”
“People will put it together. Imagine the fallout.”
“I don’t give a flying fuck about fallout!” The sudden outburst is a departure from his usual more composed defiance. “More people are going to die. Plenty more. You know this as well as I do, Alana. If anyone out there can help us find Yasin . . .”
She sees his point. It’s also a rare glimpse into the passion that lurks behind his cool, at times arrogant, exterior. “Okay. Give me a few hours to discuss it with Brussels and Rome. Please, Byron.”
“All right,” he says, making a visible effort to calm himself. “I see your point.”
“Thank you.”
His shoulders slump. “I have worse news, Alana.”
She braces herself. “Which is?”
He points to the patient on ECMO behind the glass. “Marianna Barsotti.”
“Who is she?”
“She’s not just any other plague victim.” He reaches into the bag and extracts a disc-shaped container. It’s an agar and petri plate, which labs use to grow bacterial samples to test for antibiotic resistance. The plate is gray with bacterial growth. There are small white dots demarking where the antibiotic samples were placed around the outside, resembling numerals on a clock face. Alana knows that on a normal culture plate there would be dark halos surrounding the antibiotics where the bacteria had been killed off. But on this plate there are no such “kill zones.”
Alana feels the dread crawling up her spine. “Is that her Yersinia culture plate?”
Byron nods. “Ms. Barsotti might be the first-ever case of multi-antibiotic-resistant plague.”
“Jesus.”
“Not even sure He could help us.”
“But it does make some sense, Byron.”
“How so?”
“If we are dealing with a genetically engineered bioweapon, it would have been programmed to accumulate resistance.”
“Regardless of where it comes, if the antibiotic-resistant strain of the plague continues to spread beyond the walls of this hospital . . .”
He doesn’t need to finish the thought. Alana knows all too well that, if that were to happen, containment might be impossible.
Chapter
Twenty-One
Today is the ninth day of February. It will also likely be my last one on this earth.
In whatever time I have left, I will attempt to record my final struggles in the clutches of this pestilence. However, I do fear that my penmanship has grown so tremulous that these last pages might not be legible to anyone who were to chance upon them.
The fevers pounce upon me like nothing I have ever imagined. First comes the deep chill, a cold that is colder than snow. My teeth clatter and my bones shake similarly to the convulsions we see when the regulars from the tavern go too long without ale or wine, except, unlike them, I am awake throughout my fits. I yearn for warmth that is not attainable even through layers of blankets. Invariably, the fever follows. It is so intense that I can only compare it to the hottest of kilns. My elixirs and my salves offer no relief, and no wet compresses or exposed skin suppress the fire that rages to my very core.
What demonic force must this pestilence possess, to take a man from the coldest of cold to the hottest of hot in a matter of moments? It defies any science I understand.
New buboes have also developed in my armpits. They make it impossible for me to extend my arms above the level of my waist. There is no possibility that I can drain them myself, were I to possess the strength or resolve to do so.
A day has passed since the brothers of the San Giovanni Monastery collected six live rats for me in a satchel and then carried me home on the back of a mule. Upon returning to my room, once I had mustered strength enough, I grabbed the biggest of the rats. I suffered his scratches and bites, for I needed his heart to be still beating as I turned him toward me and slit his throat. The warm foul blood spurted into my mouth in pulses. I drank it like the lowest of savages might. It took every modicum of the strength I had left in me to keep the contents of my stomach down. However, hard as I tried, I could not swallow down his raw flesh. After two bites, I vomited repeatedly, uncertain after a time whether it was his blood or mine that was spewing forth.
I washed my mouth with wine and waited several minutes before I repeated the barbaric procedure with a second rat. This time I consumed only the blood. With great effort, I warded off the vomiting.
Several minutes passed before I had strength to sit down at the table and dissect the second rat. My study confirmed what Don Marco had told me to be true. The creature’s organs, from his heart to his intestines, had been spared from the ravages of the plague. But the secrets of his imperviousness remained invisible to me. I could only hope, now that I had consumed his blood, those protective humors would invisibly transfer to me.
However, I awoke this morning to the realization that it was not to be. I was more afflicted than ever and barely strong enough to get out of bed. In the name of experimentation, I killed a third rat and drank its blood. Aside from that and two or three sips of water, nothing has passed my lips since.
Death hovers near. The fever and chills take turns assailing me, with no reprieve in between. My body aches to the bone, whether I boil or freeze. My breathing has become ragged. Before, I only struggled for breath when I moved, but now even lying still winds me.
My last wish and prayer is for this diary to survive and provide some utility to those who follow, be there any, in understanding how this miasma toppled our great city and, perhaps, all of civilization.
Most Sacred Heart of Jesus, I accept from Your hands whatever kind of death it may please You to send me this day with all its pains, penalties, and sorrows, in reparation for all of my sins, for the souls in Purgatory, for all those who will die today and for Your greater glory. Amen.
Your humble servant, Rafael Pasqua
Chapter
Twenty-Two
The moment Alana steps into Claudio Dora’s hospital room, she notices the improvement in Nico’s friend. A pair of nasal prongs under his nostrils has replaced the bulky oxygen mask that he wore the last time she saw him. His hair is combed back and he wears a navy silk robe over his gown. But his cheeks are still gaunt, and his eyes sunken. And he has to struggle just to sit up at the side of the bed to greet her.
“So now we have antibiotic-resistant plague on our hands?” Claudio says.
“Nico told you, huh?” Alana stands at his bedside in the full PPE gear. “This plague kills fast enough as is. But if it’s resistant to antibiotics . . .”
“Mio dio! Perhaps it’s an ideal time for a career change. For us both, Alana.”
“In a way, resistance was inevitable,” she says, battling the urge to tell him about the possible human genetic manipulation of the bug. “With all the different bacteria in the hospital trading their DNA among themselves.”
“Ah, yes, hospitals. The world’s breeding grounds for antibiotic resistance. Grouping all those sick patients together. It’s not so different from filling a children’s pool with piranhas.” He shifts in his bed. “But to happen so quickly?”
“This strain of plague does everything quickly.”
“Reminds me of another strain.” Claudio reaches for the bedside stand and lifts up a book. The cover is filled with a medieval depiction of a hooded grim reaper, scythe held menacingly overhead. In blood-red dripping letters the title reads: La Grande Mortalità d’Italia.
Alana takes a stab at translation. “The Great Death of Italy?”
“Close, yes. It tells how the Black Death leveled Italy, including Genoa. For some twisted reason, your friend Nico thought it would make for light reading during my recuperation.”
Alana laughs. “Most thoughtful of him.”
“Actually, it’s fascinating. Terrifying, too. The descriptions of the spread . . . how quickly the plague jumped from town to town and country to country. In a time with so little travel.” He lowers the book.
“What about you, Claudio? You are getting better?”
“Almost fully recovered,” he says, but his pallor belies the remark. “The antibiotics have worked on me, thank God. I would have been released home already if they did not still consider me to be a modern-day Typhoid Mary.”
“You’ve been lucky.”
“This kind of luck I can do without.”
“Nine people have already died. Six more are on life support and may not make it.”
“And that was before the antibiotic resistance emerged.”
“You don’t have to remind me.”
“Alana, if this reaches critical mass. A tipping point . . .” He raises the book again. “Like what happened during the Middle Ages.”
“That was a primitive time. Long before modern medicine.”
“Maybe so, but . . . one-third to a half of all of Europe was wiped out in only three years. The worst natural disaster in all of recorded history. It took five hundred years just to repopulate the Continent back to the same level as before the plague. Can you imagine?”
“We won’t let that happen,” she says, though she realizes how hollow the words sound.
Claudio nods noncommittally. “Nico says there have been other cases across Genoa that have no possible connection to our original case here.”
“It’s true. Vittoria wasn’t the index case.”
“Then who?”
“We don’t know for sure.”
“You have someone in mind, though?”
