Virestorm-Chapter 2 and 3

Chapter 2

Lahore, Pakistan Farmer’s Market

Ten year old Ahmed runs through the market with his younger brother Mastouf close behind. Ahmed is laughing as he rounds the corner nearly sliding on the banana peels on the ground. He skids to a halt and Mastouf runs into him right in front of the bird cages. In front of the boys a cacophony of chirps and shouts break out among the chickens. The boys carefully look through the cages, like diamond merchants scrutinizing a collection of rare gems. The chickens are of various color combinations, some deep red, others white. Most of the birds look malnourished and weak. One is barely moving. Mastouf puts his small hand between the wires of the cage and gives the bird a poke. The bird barely moves and he pokes again. This time the bird breaks out in a riot of chirps and hisses and Ahmed yells at his younger brother, “Get your hand out of there! Are you crazy, that one looks sick.” Mastouf pulls his hand back out quickly and looks down at his feet. He is embarrassed that he disappointed his big brother. Ahmed can see it in his eyes and feels sorry. “Hey, don’t worry, I got a nice one here.” Ahmed shows his brother the big bird with bright eyes and a plume of red and yellow feathers. He gestures to the shop keeper who nods his ok and the boys take the bird out of the cage. “This one looks healthy, I think she can make us some good eggs. We’ll take her.” Ahmed reaches into his pants and pulls out a crumpled pile of colorful bills. He quickly concludes the negotiations with the shopkeeper and they bring the bird home in a burlap sack, squawking the whole way.

As soon as the boys get home they run in the door yelling “Mama we got a perfect chicken, she’s gonna make perfect eggs, come look!” Their mother poked her head out the door of their small one room home and reached over and took a look in the sack. “Perfect, my children, you have found us the perfect chicken. Now go get her into her cage and we can hope for an egg in the morning.” The boys ran in the front of the single room house and straight out the back into an alley. Against the house was a stack of rusty and empty cages. Just as they were getting ready to put the bird in, one of the neighbor boys strolled over. “So, what have you got there Ahmed? Going to give it another try? Birds can’t live here, it’s too dirty and cold back here.” Ahmed looked up at the older boy and just as he did he saw the boy’s younger brothers and sisters form into a large circle around him and Mastouf. “Well why don’t you at least let us see her?” Hesitantly, Ahmed complied and passed the sack around for all of the children to see. After the bird was given a complete tour of all six brothers and sisters Ahmed placed her into her cage with a small cup of corn and a tin filled with water. His mother stepped out into the alley, “Ok, the show is over, time to go home!” And she shooed the other children away.

Chapter 3

Ann Arbor, MI

Alex sits down at the counter of Angelo’s Café with her cup of coffee, in the background just audible over the noise of the small and bustling restaurant she can hear National Public Radio. She bites into her French toast as the news begins to unfold. “Today is the 1835th day since the President declared victory in Iraq. Three more service men killed by IED’s in Basra and scores of Iraqis die in a suicide bomb attack in central Baghdad.  The President says the surge is working…” Alex rolls her eyes. Fortunately, Angelo’s locally famous cinnamon raisin French toast makes the news more palatable. Angelo wanders over to the counter and smiles at Alex. He’s a large man, round with thinning gray hair. He smiles at Alex “More of the same, eh?” Alex looks up at Angelo, his white apron with the patches of grease stains, the warm brown eyes, and his thin gentle smile. “The candidates in this upcoming election don’t have a clue either, Angelo. This war is more ancient than our leaders will ever know and is more complex than they can ever comprehend. Anyway, too much misery for such a beautiful day. Take care Angelo.” Alex takes a look at the check, pulls some bills out of her wallet and lays the money on the counter. As she walks out she can overhear the newscasters, “President Ahmadinejad refuses to back down to nuclear inspections, President Bush irate and threatens action.”

Alex stands, looks out through the old wooden café door and steps out into the sunshine. Well at least today is a glorious spring day. The green leaves on the trees have that intense fluorescent green, the cherry trees visible across East Ann Street have blossoms and all the birds are shouting to their potential mates. Alex smiles to herself as she begins to think of her own potentials when a yell from behind stops her in her tracks. She turns to see her close friend Paula all laughs and giggles. “So, any plans for tonight? I thought we might check out the comedy show down at the union.” Paula has long brown hair, big almond eyes, and an infectious smile. She’s a little heavier than she would like but she this is offset by her generous figure which is on display in her tight low cut brown shirt. “Sure Paula, and are you going to finally stand up and try  out your routine, or do we have to wait for some talent scout to catch you trying your lines out in your bathroom?”

Paula has been a wannabe comedienne since the two became best friends in grade school. She has always been the funny one and Alex the serious one. Paula gives Alex balance and without her Alex would have easily lost herself after going through “the tragedy”. Fortunately, this best friend has always been by her side to cheer her up and keep her social. And Alex has done her part for Paula as well. Back in high school when partying was all the rage there were some close calls. If Alex hadn’t yanked her out of those parties and hadn’t pushed her Paula probably never would have finished high school, let alone been accepted to Michigan.

“Ok, I’ll come by around 7:30 and we can grab some food upstairs at Charlie’s before the show”. Paula smiles and with a twinkle in her eyes she takes off in the opposite direction, “Awesome Alex, see you then!”

Alex heads around the corner and into the Med Sciences building. The building was probably modern and clean looking when her dad was in school twenty-something years ago, but now the white-yellow exterior looks a bit sad and shabby under the watchful eye of the new gleaming University Hospital addition. She swipes her ID card and heads in. Medical students are scurrying around looking for labs and lecture halls. The smell of formaldehyde wafts out of the Gross Anatomy lab around the corner. Alex turns into the stairwell and begins her three story climb up to the microbiology floor. The stairwell railings are black painted iron and probably have their own microflora that could represent it’s own publication. She always avoids those railings, who knew what nasty critters had been innocuously carried out of a lab by a careless and sloppy assistant. At the third floor door she swipes her card again and enters the stained linoleum hallway to her lab. A finger print reader and she’s in. The whole thing seamed ridiculous. Ever since 9/11 they added security to all of the labs. This was before Alex’s time but apparently back then they did background checks on everyone, issued secure ID’s and fingerprinted everyone. Alex wasn’t quite sure what of value could have been taken from the Gross Anatomy lab that would bring terrorism to the hills of Ann Arbor but the laid back atmosphere in the labs was quickly replaced by apprehension and paranoia and more than one post doc left to go into a different line of work. Apparently the stress level had relaxed a bit and now the only labs requiring intensive scrutiny and security were those either working with infectious disease or those using radioactive substances. Both were present in Dr. Zack’s lab and so they gave him a secure floor. Funny thing was that any first year engineering student could probably outsmart the security anyways. Most of this stuff was off the shelf at Best Buy.

As Alex walked in she could hear the news again coming from Dr. Zack’s office. The news now was about Iran and nuclear weapons. The Americans were angry that the Europeans couldn’t get Iran to guarantee to stop enrichment and a lot of posturing was going on. The Vice President, “The Dick” as he was affectionately referred to by Dr. Zack, was pushing for a military strike. The Presidential candidates were split, and the lame duck president was equivocating. As Alex turned the corner she could hear Dr. Zack shouting at the radio. She stepped into his office and he smiled. Dr. Zack was true Ann Arbor. Raised by two Ph.D. parents he had been here all of his life. He was a certified genius and perpetually stuck in the 1960’s despite the fact he was about ten years old when they ended. He always has on a tie dyed shirt, a collection that would be the envy of Jerry Garcia. His wiry gray hair is tied back in a pony tail and he wears gold wire rimmed glasses. He had taken Alex under his wing a few years ago when her world collapsed around her and between Paula and him her ship has been slowly righted.

His blue eyes look Alex up and down and he smiles widely. “Well dear, ready for another day in the trenches? We have another sample of lung tissue from that most recent avian flu outbreak in Pakistan. We need new cultures set up and we need to do another trial for lethality and transmission.” Alex lets out a groan. This was going to be another marathon and there was a very good chance she would not make the show tonight.

Whenever the tissue came in from these Asian countries the shipping was usually very sloppy. Last time the specimen was fully rotted because the cooling packs leaked. Dr. Zack’s lab was one of only three in the U.S. entrusted with these cultures. There was a lot of pressure to identify what mutation would make the virus more contagious. The first lab to figure this out would get a lot of PR not to mention that they would be on the front line of the vaccine program. Even though Dr. Zack seemed like a mellow guy, he was an academician and he relied on grants. No product, no money. His last big success was over five years ago when he helped define the strain of virus that was causing Mad Cow in the US and was able to help the CDC trace the source to cattle from Canada. That little discovery put him in the driver seat for a while, but the departments of infectious disease and immunology were giving him a lot of heat lately for no recent breakthrough on the “avian flu”.

Alex starts to recall the lecture she gave to Dr. Zack’s medical students last term. She was in charge of power point slides in the lab along with just about all the other grunt work. After putting the presentation together Dr. Zack asked her to just go ahead and do the presentation. The whole idea was a bit unorthodox but everything about Dr. Zack is.

The first slide went up on the screen and Alex began the show. “Avian flu” so named because it is influenza virus that is endemic in the bird population but people have been dying from it for a few years now. The virus is scary because the mortality rate can be 80%. We have seen it mostly in Asia because the populations there live in close contact with birds. Every now and then a person or group is exposed to an infected bird, they themselves become infected and more often than not die. There isn’t any treatment except supportive care and no vaccine has been developed yet.

Historically, every twenty years or so, one of the viruses endemic to a different species mutates and enters the human population. Usually the sick, elderly and very young are quite susceptible and die. This is why a cure for the flu is so difficult. New virus types keep on entering the population. Even more scary is that about every eighty years a super flu comes out and kills huge numbers of people. That’s what happened in 1918 and therefore Dr. Zack, the CDC and military have been focusing our research on this bug because we think it is the best candidate for the next bad event.

After the forty minute lecture the students filed out. A couple raised hands with questions but most just quietly moved on. Alex remembers leaving the room, wondering if she was on the correct side of the podium. Her life would have been very different except for one very bad day.

A Great Return

I just returned from nearly two weeks in Mexico. I was fortunate to be able to spend such a long and vital time with my family. Usually when I return I'm afraid of what has happened while I was traveling. So, as per usual pattern I had a few anxiety nightmares a couple nights before my return home. The day before I awakened with a rapid heart beat. "What was Monday going to be like?"

I never know if on my return I will be crushed with disaster. The hard part about being a physician is the worrying. Before I leave I want everything tidy. All my patients in good shape. If anyone is sick or not recovering well from surgery I put in extra hours to get them straightened out. Luckily, I work with two excellent doctors that I have enormous trust for. Still, I don't want them to be upset that I left them a bunch of unfinished work. So, before this trip I had everyone in good shape. But, life is unpredictable and the healing arts are just that, art work. So, like I said earlier I get nervous before my return.

But this time was great. I walked in to my office and popped open my laptop to review all of my messages and patient files. Whew! No disasters. I made a few calls, updated people on their test results and renewed a bunch of prescriptions. Lucky for me Monday was a short day of paper work only. I wondered, "What will Tuesday be like?" Tuesday arrived and I started to see my patients. It seemed like everything was working. Everyone seemed to be in great shape. Postsurgical patients were healing, infections were going away, headaches and dizziness were better. A fluke? Nope! Wednesday has been the same. Everyone is doing great. New challenges arrived today but nothing I couldn't tackle. But best of all is that some of my most challenging patients are feeling better, happy and enjoying their regained health.

A great return! These vacations do more than just give me rest. I return with a new set of eyes and a fresh and energetic attitude. And the payback is great. It's hard to explain how much pleasure there is in seeing people responding to my treatment. Sometimes this is the greatest job and today is one of those days!

Bin laden and me, the doctor

I woke up and turned on NPR and discovered the world's most wanted criminal was dead. I listened as they talked about celebrations at Ground Zero and in Washington, D.C.. I didn't have the drive to celebrate, but rather to reflect. For me that fateful day led to the end of my first marriage. I know, that sounds impossible, but I am quite certain it was true.

My wife at the time and I watched those towers fall and the ensuing chaos. We didn't say much. I'm pretty sure that like the rest of the world we were in shock. I felt true fear that some great force was trying to create an overthrow of our government. The whole thing was practically right out of a Tom Clancy novel. I guess it's strange but when the terror stopped that day and we later on found out it was perpetrated by this man and his acolytes from training camps in Afghanistan I felt relieved.

I know that the real terror that was committed wasn't the death of all of those people. The real terror is how each of us dealt with the tragedy. For me I immersed more intensely in work. For my wife, she reevaluated her life and decided I wasn't going to be a part of it. For the past 11 years I have dealt with that terror, the disruption and destruction of my original family unit.

That day in 2001 and the ones that followed were interesting in the office. Either nothing was said about the disaster  or people needed someone to talk to . Most were quiet. A few needed me to sit and listen. They asked me questions that were mostly about the future. Future of healthcare, government, our lives. I would reassure them that our country was strong, our people were good, and somehow we as a nation and world would end up stronger and better from this.

Fast forward to the last couple of days. I could sense a change in the office and in people's attitudes but I couldn't exactly identify it. Two of my older patients wanted to talk. Interestingly, they both had similar viewpoints. They didn't feel celebratory. They even thought that we were kind of gloating as a nation about the death of this terrorist. And neither of them felt it would make a significant change in the grand scheme of things.

Once again, I listened, I talked about how disturbing it was that Pakistan was probably not the ideal partner. But, mostly I talked about how this showed that we as a nation were growing and maturing in some ways and in others we were still like children. All this time, in the back of my mind was the havoc that was wreaked on my life from that fateful day.

But, also in my mind was the wonderful change my life had taken. For now I have the most beautiful and wonderful wife who loves me and cares for me. We have an absolutely phenomenal child who is bright, beautiful and a joy to be with. And, my relationship with my eldest daughter is now stronger than I can remember.

So, in retrospect, I cannot celebrate the death of this monster for I have very mixed feelings from what he did to me and my country and my world. But, I do know that I and we are stronger and better than we were.