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Cora stepped out of the sealed compartment she'd traveled in, heard the hiss of air as it automatically purged behind her, and joined the throng of commuters exiting the downtown station. Almost unconsciously, she adjusted her respirator to the settings prescribed by law for persons entering public areas. It was only a short walk to the hospital where she worked, but the journey took her a world away from the skyscrapers and fashionable denizens of the city center. Further on, among low-rent offices, dowdy bargain shops, and cheap cafes, Cora and her fellow commuters found themselves flanked by the unemployed, who simply stood around watching those with someplace to go. It didn't matter whether foolishness, bad luck, or someone else's negligence had caused them to become exposed; the consequences were always the same. Most had lost their protective clothing along with their jobs, though a few had cobbled something together out of discarded cloth, paper, and rubber bands. Others lacked even that much industry, and skulked in the shadows on the outermost fringes of the crowd.
The other commuters quickened their pace and looked away, but a casual glance told Cora's practiced eye that most of the skulkers were seriously ill, although they might not know it yet themselves. Once she would have made the effort to save them all. She would have done her best to persuade each and every one to come into the clinic. She would have promised them help, vaccinations, novel therapies, and, if nothing else, a meal and a hot bath. But eventually she'd learned that such harangues were not merely a waste of time, they took her away from patients who actually wanted her help. Eventually she'd learned to walk away.
A police cruiser crawled along the street next to the wide pedestrian mall. When the window rolled down, she knew the cruiser's occupants had spotted something of interest; they wouldn't have broken their car's seals without a good reason.
"You, in the white," one of the policemen called out to her with an unwelcome familiarity that made her bristle. "Can we speak to you for a moment, please?"
Despite the superficial politeness, Cora knew she should not refuse their request, and she approached the now stationary vehicle. "Yes?"
A black-helmeted head nodded slightly in her direction. Though she could not see through his reflective face-shield, she had the impression the policeman was looking her up and down. A black-gloved finger pointed at her. "You work at the hospital?"
"Yes." That much should have been obvious from her standard hospital-issue protective suit."You're a doctor?"
"Yes."
"Then come closer, please, I need to speak with you."
She leaned in toward the open window.
"Doctor . . . ?" He waited for her to fill in the blank.
"Fenimore. It's right here." She gestured in the direction of her nametag, and resisted the urge to ask if he could read.
"Doctor Fenimore." He nodded. "I'm Officer Logan, and this is my partner, Officer King."
"Could you tell me what it is you wanted to speak with me about? I need to get to work."
Officer Logan didn't respond to her crispness in kind, but lowered his voice to a conspiratorial whisper. "We've had a report that a sick man escaped from the hospital earlier this morning, and he may have stolen some hospital property as well. Were you aware of that?"
"No, Officer, I was not. I left home over an hour ago, and I don't have a radio in my suit."
"Have you noticed any sick people around here?"
She straightened up and spoke without regard for who might overhear. "Everyone who isn't suited up is sick. Didn't you know that?"
"The patient's name is John Monroe," Officer Logan said as Cora turned away from the car. "Ring any bells? They tell us he can't have gotten very far in his condition. If you see him, just let us know." There was a pause before he called out at her retreating back, "Thanks for your help!"
As she walked away, she thought she heard a soft laugh, followed by the hum of the car window rolling back up.
Even before she heard the cries of "Get back! Keep him away!" Cora found herself caught in the amoeboid recoil of those surrounding her. The police car had disappeared, but she heard its siren's volume peak, and then shut off. While the instincts of those around her compelled them to move away from the source of the commotion, Cora was impelled in the opposite direction, and she headed straight into the gradient of increasing panic. Although she sensed they were on the verge of a stampede, people walked quickly but didn't run, and they avoided pushing or shoving. That would have involved physical contact - however attenuated by layers of protective clothing - with persons of unknown health status.
She knew she'd reached her destination when she found people no longer moving away, but standing still, caught by a morbid fascination stronger even than their fear. The two policemen and a team of orange-clad Contamination Control officers made certain that no one came closer than the distance specified by law, but Cora didn't believe a show of force was needed to keep the onlookers back. The scene reminded her of pictures she had seen in old textbooks belonging to her parents. They were pictures of experiments from the days when such experiments still worked: petri plates covered with bacterial lawns, each lawn showing a perfect circle punched out of its lush growth by a tiny bit of antibiotic-soaked filter paper.
A man, pale and stooped from long confinement, was the center of this circle. Hospital issue pajamas and robe, in the obligatory blue-floral pattern, marked him as a patient sentenced to a locked isolation ward. If the racking cough that had him on his knees wasn't evidence enough of his condition, then the pool of bloody phlegm on the ground in front of him certainly was. Cora saw so many patients that she wouldn't have remembered this man's name, but now that she could see him, his case was immediately familiar. She believed John Monroe was a relatively young man - no more than 35 or so - though he looked decades older. Like everyone in the hospital, he was infected with a number of life-threatening illnesses; in his case, fulminating, multidrug-resistant tuberculosis had commandeered the honor of killing him.
She flashed her hospital identification at the nearest Contagion Control officer, and stepped forward into the circle of death.
"John - John Monroe," she called out, "I'm Dr. Fenimore from the hospital."
He looked up at her, seeming to have some difficulty focusing on the spot where she stood. Another fit of coughing overcame him, and bright arterial blood soaked the front of his clothing.
"John. Let us help you. If you come back to the hospital, we can clean you up and give you something for the pain. You can lie down and be comfortable."
He pulled himself to his feet, but could stand only by leaning over and bracing his hands against his knees. His lips moved, but she heard no sound.
Cora suspected that John was unable to speak out loud, his larynx too badly damaged by disease. She took a few steps toward him, quietly directing the Contagion Control officer as she did so, "Keep back, or you'll frighten him. Radio the hospital and ask for a team of ambulance attendants with a stretcher. Please try to keep the police out of it - I'm hoping he'll cooperate with me."
His voice was gruff, and his thanks only tacit, but the officer assured her he would not interfere if she could get the sick man off the street. It might be his job to handle contamination incidents, but Cora wasn't surprised he was happy to let her take charge of a still-living vector. The police, on the other hand, were unlikely to grant her that courtesy, though they might hesitate to overrule both her and Contagion Control.
As if enacting her fears, the taller of the two policemen strode up to confront her.
"Just what do you think you're doing?"
Even minus the friendly veneer he'd affected a few minutes earlier, Cora recognized the voice as belonging to Officer Logan.
The Contagion Control officer earned her eternal gratitude by breaking in on her behalf. "Sir, it will be a lot less messy if she can get him to return to the hospital under his own power."
Officer Logan paused before responding, as if to make sure everyone knew he was the one making the decisions, and that the prospect of "less mess" wasn't necessarily his overriding concern. "It's against regulations to allow civilians to enter contaminated areas."
"I'm a doctor," Cora said. "He's a patient. There's no more risk than my job puts me in every day."
He waited again before giving an answer. Logic might be on her side, but regulations might prevail. "Very well," he said at last, "You have three minutes. No more."
Cora said nothing, but shifted her full attention back to John Monroe. As she approached him, she began talking, saying anything, hoping she could calm the fears that had driven him out into the street in the first place. "John, we're getting a stretcher for you, so you don't have to walk or do anything - just wait for us to come to you."
Again, she saw his lips move, but could hear nothing. She was close enough now to see the beads of sweat pop out on his forehead just from the effort of standing erect and attempting to make himself understood. His chest heaved, as a coughing bout burbled its way up from his lungs.
"Don't try to talk - you need to rest." She moved closer, and held her hands out as if she were prepared to catch him. "Once we're back inside, if you feel up to it, you can make a list of anything you want, and anyone you want us to call for you. We'll do everything we can."
Illness took possession of his body, stripping him of voluntary control. Head bowed, strands of greasy hair swinging forward, he coughed with such force that he vomited up clots of blood.
An approaching siren, which she assumed belonged to another police car, covered the sound of his gagging, and Cora cursed to herself. Time was running out. Still, she paused long enough to check her respirator and suit pressure gauge.
She glanced back in the direction she'd come from, to see that the stretcher had arrived, the two white-suited attendants looking to her for instructions. The second police car had pulled up too, its siren finally silenced, its occupants deep in conversation with Officer Logan and his partner. Their discussion involved gestures in her direction, as well as index fingers pointed at the stretcher crew. She motioned for the latter to come in closer, and stop a few feet behind her.
John Monroe was clearly panicked, but not even a rush of adrenaline could have rendered him capable of running away. She stepped in close enough to hear his breathing, and recognized that, desperate as his body was for oxygen, he was trying to control the coughing by forcing his inhalations to remain shallow.
"Don't worry about the police or Contagion Control, John," she promised him, "Just come back to the hospital with me."
Responding to the plea in his rheumy eyes, she reached out a gloved hand to gently brush the matted hair out of his face. She thought she heard a collective gasp from the watching crowd, but she continued stroking his cheek, looking into his eyes, and murmuring reassurances. It wouldn't be the first time she'd had to go through a class five decontamination sequence, or have everything she wore incinerated.
John moved with far more speed and strength than she could have imagined resided in that wasted body. He grabbed her arm and bent it up behind her back. The action spun her around to end up standing in front of him, facing away. Controlling her with his grip on her arm, he held a stolen scalpel in front of her face. Then, having effectively persuaded her to cease struggling, he lowered the blade to press it into the cloth of her protective clothing just below the hard seal of her helmet.
The effort he'd expended was prodigious for someone in his condition. His breath wheezed and rasped when he pulled her close to whisper into the microphone by her ear. "I'm not going back. I'd rather die right here and make everyone watch. I'm a human being, no different than they are."
Cora was fully aware that she should be terrified, yet in the moment she didn't feel fear. Instead, time slowed around her, and she considered her situation with needle-sharp clarity. "Of course you're human, John, but they're afraid."
He didn't respond to her directly, but kept on with his hoarse whispering, as if listing his accomplishments could give him back the identity he'd lost when he became a patient. "I was a stock broker. I had a good life. I was always careful. I don't know how I ended up like this." He sniffed, and then convulsed with a series of coughs that didn't quite make him let go of Cora or the scalpel.
Cora could see one of the policemen approaching; the others were out of her view. She thought it was Officer Logan, and she stared hard at his opaque face-shield, willing him to have enough sense not to come any closer.
"I'm sorry, John. I know you don't deserve to be sick. Nobody deserves it. But the police will shoot you if you don't let me go, and I won't be able to stop them."
"You tell them." He gave her arm a painful little jerk, and pushed the scalpel into her chest so hard that she could feel the pressure through all the layers separating them.
She held her breath and prayed that the fabric of her suit wouldn't split.
"You tell them to stay back, or I'll slit your suit." He had to pause and take a few desperate breaths. "Don't think I won't do it!"
"Stay back!" she shouted in obedience to John's order.
He spun around, taking her with him, so that they could both see the other policeman who'd been approaching from behind, weapon drawn.
"You see that?" John whispered, chuffing out the words in a series of little coughs. "They think they can save themselves by killing me. But you and I both know it's not true. Tell them, Dr. Fenimore."
"Killing him won't protect anyone," she said.
"Louder!"
"You can't stop it by killing him!" she shouted this time. She knew he was right, just as surely as she knew they wouldn't listen, and that sooner or later John would be disabled by an unsuppressible fit of coughing - and the police would have the opening they needed.
Time sped up to a lightning pace when the coughing finally did take over, and the pressure on her arm let up. The policeman was on them, and Cora pulled free, leaving the two men to grapple for the scalpel. It would have been no contest at all, except that the policeman had to avoid even a small cut from the scalpel. Cora saw a black-gloved hand encircle and immobilize John's bare, scalpel-wielding arm. She expected to hear the scalpel clatter to the pavement; instead, John managed to shift it to his other hand. He slashed down viciously at the policeman's wrist, but it seemed John's effort was too weak to be effective, and the officer didn't even flinch in response to the attack.
Belatedly, it struck her just how lethally close she had been to that naked blade. She took a few deep breaths to keep from shaking, and almost missed the sight of John Monroe's body arching back in reaction to the discharge from a stun pistol. The weapon would only have briefly knocked out a healthy man, but John Monroe had been anything but healthy. Now he was dead.
The Contagion Control officer approached her, but kept a wary distance. "We'll follow you to the decontamination entrance at the hospital, if you'll just give us a minute to take care of things here."
Cora nodded, and turned to Officer Logan, who now waited near her. "I guess it makes sense for you to come to the hospital with me. We can both go through decontamination there, and I can get you a loaner hospital suit for you to wear back to your station. The one you're wearing will have to be destroyed."
"You're welcome," he said.
Her cheeks grew hot at his judgment of her as ungrateful. "I had nearly succeeding in talking him into returning to the hospital - alive. If you and your partner hadn't cornered him like a frightened animal, he wouldn't have lashed out at me."
"In your opinion." He turned away from her, as if he were bored with their conversation, and appeared to be watching the activities of the Contamination Control team.
The clean-up crew drew on an extra layer of heavy-duty rubber gloves, and then proceeded to encase John Monroe's earthly remains inside three layers of impermeable body bags. The resulting package was tossed into the back of a waiting biohazard van, which would take it for incineration. The place on the street where a man had lost his life, and where Cora and Nathaniel Logan had struggled to keep theirs, was flooded with disinfectant, and then flamed with a blowtorch.
"It's like some pathetic joke," Cora said, hardly realizing she was speaking out loud, "killing a man for spitting on the sidewalk."
"Felony expectoration is hardly 'spitting on the sidewalk,'" Officer Logan answered her. "Starting when he left the hospital, his actions demonstrated a wanton disregard for the law, not to mention the health of innocent citizens."
She looked up at him, but saw only her own features reflected in his face shield. "So you think penal code violations are the root of all evil?" she asked him far more acidly than she had reason to. "I've always thought it was ignorance."
He sighed with the defensive weariness of a public servant who'd had a career-long bellyful of taking abuse for trying to do his job. "Look, you can think what you like, but I tried to disarm that man without killing him. My partner shot him because he was armed, and had proven himself dangerous by taking a hostage and by threatening me. You should ask yourself how he got his hands on that scalpel in the first place, and what he wanted it for. Whatever tragic events in his life brought him to that place. . . . Well, I'm sorry, but that's not my concern."
Evidently he had no intention of pursuing their conversation, as he turned away from her again. She could hear him speaking softly, but could not understand what he said. Presumably he was either conferring with his partner, or making some sort of verbal report. He raised a hand to adjust the volume control of his helmet's built-in radio, and the movement caught her attention. Something she saw held it. Without hesitating, she reached out her hand and encircled his wrist. Leaning in close to his helmet, she spoke for his ears alone, "Did you realize your suit was torn?"
His arm went rigid under her hand, and although she couldn't see his face, she could well imagine that it was pale with fear. While she could reassure him that his prospects of contracting TB, HIV, or hepatitis were minimal, the prospect of actually getting ill was only the least of what he now faced. It was in her power to strip this complete stranger of everything he held dear. Strictly speaking, as a public health officer, it was her duty to report him to his superiors as well as her own.
"Come with me," she said, "We'll go to the hospital, decontaminate, and get rid of your suit." She carefully arranged a fold of his sleeve as a temporary cover for the tear. I'll do a few tests, and we'll see how bad it really is."
Contagion Control had finished with the site clean up, and even the gawkers had, for the most part, moved on. The stretcher-bearers went first, as they had never actually come in contact with John Monroe or any of his bodily fluids. Cora and Officer Logan were next, walking in silence, maintaining exactly the interpersonal distance prescribed by law for casual contact in public places. Last but not least, followed the decontamination team, scorching their footsteps behind them.
Marlissa Campbell is a physical anthropologist by training, a toxicologist by profession, and a writer by inclination.
Julia Kuhl has done illustrations for the New Yorker and the New York Times, among others. She now lives in Heidelberg, Germany, with her neurobiologist husband and is working on a comic book - a Fulika atra (coot) version of Shakespeare's Hamlet.
Microbiology Network - offers a resource center, discussion group, user group, and software. Its editors also maintain the Microbiology and Virology section of the WWW Virtual Library.
Bacterial Infections and Mycoses - an extensive collection of links from the Karolinska Institute.
All the Virology Servers in the World - the Garry Lab at Tulane University has put together an extraordinary collection of information and links.
Tuberculosis: Prevention and Control - provides a fact sheet, control strategies, reports on global incidence and control, and other documents. From the World Health Organization.
Division of Bacterial & Mycotic Diseases and Division of Tuberculosis Elimination - two divisions of the Centers for Disease Control and Prevention that offer a wealth of information.
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Molecular Epidemiology of Antibiotic Resistance - a review of methods used to track the spread of antibiotic-resistant microorganisms. From the International Journal of Antimicrobial Agents, 2000, 13(3):143-153. Full text available through BioMedNet.
Drug-Resistant and Multidrug-Resistant Tubercle Bacilli - a review from the International Journal of Antimicrobial Agents, 1999, 13(2):93-97. Full text available through BioMedNet.
What Is Antibiotic Resistance and How Can We Measure It? - a review of how antibiotic resistance can be defined and measured and the limitations of current approaches. From Trends in Microbiology, 2000, 8:12:554-559. Full text available through BioMedNet.
Antibiotic Use in Humans and Bacterial Resistance - a review of how antibiotics are used and how their use affects the evolution of antibacterial resistance. From Current Opinion in Microbiology, 1999, 2:494-498. Full text available through BioMedNet.
Antimicrobial Use and Bacterial Resistance - reviews strategies to control antibiotic use. From Current Opinion in Microbiology, 2000, 3:5:496-501. Full text available through BioMedNet.
Epidemiology of Emerging/Re-emerging Antimicrobial-Resistant Bacterial Pathogens - a review of emerging antimicrobial-resistant organisms worldwide. From Current Opinion in Microbiology, 1998, 1:125-129. Full text available through BioMedNet.
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