Thursday, November 29, 2012

Virestorm Chapter 7


Chapter 7

September 10, 2001 NYC

“Ok, everyone wake up” Alan looked at the two girls still sleeping. Alan had been up for two hours already, he had showered, dressed, read the first section of the Times, mapped out a strategy for the day, and now was waiting for his two lovely comrades to join him.
“Dad, come on, we’re on a vacation, give me five more minutes.”
“Yeah right, at this rate we’ll be eating breakfast at dinnertime. Kimberly, how about you take the shower and that will give Alex a couple more minutes of beauty sleep?”
Kimberly rolled over and looked at Alan through half closed eyes. She had been running a little slowly the last couple of months. She slowly raised herself out of bed and made a long stretch. She smiled and reached over to Alan and gave him a gentle morning kiss. She grabbed a few clothing items and headed to the bathroom.
Finally, at ten in the morning everyone was just about ready to go. There was a brief episode of tension when Kimberly and Alex faced off over the hair dryer. Alan scowled and Kimberly decided to save the day, “Oh Alex, you take it, it’s so warm outside today my hair will dry in five more minutes anyways.” With the tension defused, the outfits selected, and everyone finally dolled up to their satisfaction they headed out to conquer the city Part 2.
“Alright ladies, here is my suggestion. It’s still a bit early for the stores, I suggest we walk down to Battery Park, grab some coffees and pastries and sit out looking at the Ellis Island and the Statue. We can take a few photos and by the time we’re done we can head over to the taxi stand and head off to SoHo. I figure we can hit SoHo and Greenwich and grab a sandwich before the matinee at two o’clock. Deal?”
In unison both Kimberly and Alex high-fived Alan and shouted “Deal!”
Everyone was feeling good and Alex and Alan began to skip down the street, something they had been doing since she was probably three years old. Kimberly started to laugh and pulled out her camera to catch a few action shots. Under later review that day Kimberly could see the perplexed scowls on the faces of the native New Yorkers observing the silly display.
They shot around the corner and stopped. “Decisions, decisions,” said Alan. In front of them were two Starbuck’s across from each other. Randomly, one was picked and they got their morning stimulants. For Alan a “grande mocha non-fat no whip”, same for Kimberly, and Alex “white mocha with everything”. They also purchased a few scones and headed for the park. Who would believe that in September one could experience such a lovely day in New York. The sky was a perfect blue, faint clouds hovered in the distance, and they could see the Statue of Liberty overlooking the entry to America.  Pigeons pecked at the crumbs around them and Kimberly began taking pictures of the daddy-daughter duo. She convinced a young couple traveling from Iowa to swap cameras for pictures and so the three were able to get their first photo of the day together.
They finished up and headed over to the taxi stand. Alan waived down a taxi and they took off to SoHo. Once disembarking they began hiking the streets. Alan confirmed that everyone had their cell phone and so they were able to ramble into different shops.
“If we lose each other we need to rendezvous in an hour.”
“Dad, that’s not enough time to buy anything.”
“I know Alex, today just look around, I figured that you and Kimberly will pick your favorite spots and come back tomorrow for a more ‘intense’ experience.” Alex pouted a little and flashed Alan a pathetic little girl look. The same look she had been using since before she could walk or even talk. Promptly she looked down at her cell phone and began stamping in a text. A few moments later Alex read the reply and smiled.
“Ok Dad, I got confirmation of where to go. See ya later alligator!” And off she took went to her left. Alan and Kimberly joined hands and began in the opposite direction. They walked along the cobblestones and looked into the floor windows of the dozens of cast iron buildings. Kimberly pulled out her camera and snapped a few shots looking down the narrow streets and Alan caught one of her posing in an alley that could have been 1951 as easily as 2001. Alan pulled out his notes and aimed them in the direction of a row of art galleries he had his eyes on since before they left on the trip.
After an hour of wandering into small galleries and a rapid race through one of the museums of contemporary art it was time to rendezvous and head off to Greenwich Village. Alan sent Alex a text to meet at their starting point. As Alan and Kimberly turned the corner they caught site of Alex galloping at them with a big smile on her face.
“Oh my god dad you will not believe what I found.” Her eyes were wide like saucers and beaming. “There is a whole street of designer outlets carrying things right out of Vogue and I’m not talking TJ Maxx, these places are completely awesome. Dad,” she looked straight into Alan’s eyes with the most serious expression, “I have to move here! This place is amazing.” Alan and Kimberly started laughing. One thing about Alex is that when she found something she liked her enthusiasm was overwhelming and contagious.
“Okay Alex, sounds like you found teenage Nirvana, now let’s investigate our next destination. I don’t think you’ll be disappointed.” And with that Alan waived down a taxi and they took off.
They exited at Washington Square and began their tour. Instantly Alex was roped into an impromptu act as an extra for two mimes both of which were one upping each other in marriage proposals. Everyone began to laugh as Alex’s cheeks turned a deep crimson and she kept on trying to escape but every time she took a step back one of the two mimes would be there waiting on bended knee with imaginary flowers and rings and a most expressive face of pleading. Kimberly took a slew of photos and Alan was laughing so hard the tears were running down his face. Eventually a young red headed girl of three was noticed by the two performers and they began to fight over the young child’s heart. Alex noticed an opportunity for escape and grabbed Alan and Kimberly by the arms.
“I am so embarrassed, oh my god, get me out of here,” Alex was also laughing as she said this and her blue-green eyes were wet with laughter as well. They crossed the square and Alex headed over to the plaque for the entry to New York University. “Dad, what do you think? I know that Michigan is your Alma Mater and all, but how about here? Don’t you think NYU would be perfect for me?”
“Now Alex, I agree that the academics of NYU are on par with U of M, but I fear that not even Bill Gates would be able to afford your first semester’s shopping ventures.” Alex made a pout as Alan chuckled and they headed towards the brownstones and twisting streets of the West Village.
As they walked the twisted streets and poked their noses in the various cheese and wine specialty shops they all became hungry. All of the sudden all three of them heard a rumble from Alex that started a frenzy of laughter.
“Well Alex, I couldn’t have said it better myself. Time for lunch!” They headed over to an Italian restaurant that was recommended by a good friend of Alan and Kimberly. They took seats outside and ordered a carafe of white wine and iced teas. Moments after the drinks arrived Kimberly excused herself to use the restroom.
“Dad, is something wrong with Kimberly? This whole weekend it seems like she is going to the bathroom every two minutes. I hope everything is alright.”
Alan pondered the comment for a moment before replying. “Well Alex, there is something that we have been wanting to tell you this weekend but we were waiting for the appropriate moment.” Alex started to look nervous, her lips compressed into a thin line and she began to look downward.
“Is it bad?” Just as she said this Kimberly stepped out of the doorway and pulled up her chair. She could see the sudden change on Alex’s face.
“Is there something wrong, I just stepped away for a minute and you two look all serious.”
“Kimberly, Alex was just asking me why you keep on going to the restroom every two minutes. I think now is as good a time as any.” Kimberly nodded and Alan went on. “Alex, we have some very exciting news to share with you this weekend. We were going to wait until after the show when we were eating dinner at Tavern on the Green but now seems the right time.” Alan was smiling, and all of the sudden Alex’s eyes opened widely.
“No way! Kimberly, you aren’t…?”
Kimberly nodded her head as her eyes pooled with happy tears and she nodded. Alex jumped out of her chair and wrapped her arms around Kimberly.
“Yes Alex, I’m pregnant. Can you believe it?”
Alex hugged hard, “No, I can’t believe it, I am so excited. This is amazing. I told you guys for like, forever, how much I’ve wanted a little brother or sister. So, how long, or soon, or whatever it is before we have a baby?”
Kimberly pulled out a tissue and wiped her eyes, at this point though everyone was teary eyed. “We’re about thirteen weeks and everything is going perfectly. I just got back the news from all of my tests and she is perfect. No health or genetic problems. She’s doing great.”
Alex’s eyes got even wider if it could be possible, “Did you say she? Do you know for sure I’m going to have a baby sister?”
“Yep” Alan chimed in, “the genetic testing doesn’t lie. And now that we’ve told you we can tell everyone else. We’ve been waiting to be with you to share the news. So, now we can send out emails to all!”
They all smiled, Alan poured Alex a small glass of wine and an even smaller portion for Kimberly, and they all toasted the news.

Virestorm Chapters 1 to 6

For those of you new to the story I have placed the first 6 chapters here so you don't have to look back in the blog
-Dan

Prologue

September 22, 1918, Vilosplad,  Russia

The gray air filled with the moans of those still alive. The barely surviving were carrying the dead, as they were coughing and wheezing through the rain. The old and the young already gone. Those lucky enough to pass in the early days were buried with respect. Now, large unmarked holes marred the landscape. Filled with the dead in the tattered clothes they ended their lives in. No one left to clean them and dress them. No one left to attend to their final religious rites. The town priest, old and weak before the plague, died soon after the second wave of disease. The third wave though, was the worst. Now they we’re losing the healthy ones. The ones who were supposed to rebuild the community, write about their lives and to remake their future. Just one more blow after a decade mostly filled with war and hate.
Anatoly gazes upon his fellow villagers, or rather, what was left of them and thought “Will there even be one to remember who we were?” The pain felt too great. In the past weeks he had buried his wife, his children, even his grand children. And now he could feel the disease coursing through his own body. And now, even he shakes with fevers, a racking cough, and fatigue. Oh the fatigue. He used to be able to carry two sacks of flour on each shoulder and walk miles. Now, even the weight of his wasted self he can barely carry. No, it can’t be long before it’s his turn for that big hole of hell in the ground. Maybe, if there is something resembling a god, he will be with his lovely Ana once again.
From a hilltop little Ivan watches. No, he won’t go near them. His mother sent him away when she heard about the disease from the next town. She sent him away with bags of barley, dried meat and fruit. She told him not to come down to the village. No matter how loud the people screamed, no matter how much he missed his family and friends. He was to stay away, hide, and she implored him don’t come back until the winter comes. After the ground has frozen it might be safe. “But not a moment sooner.”
Ivan can see an old man shuffle to the graves. He stands over them for a long minute. Swaying to and fro. The rain picks up and its hard to see and then the old man is gone. Ivan turns around and hikes back into the hills, to his makeshift home, to wait for winter to come.

Spring 2008
Chapter 1

Siberia
Two men step out of a black Mercedes sedan. One, very Russian looking. He is heavy, short, thick necked and thick waisted. He scans the horizon with his small dark eyes and permanent scowl. The other man is  tall and very thin. Olive skin and large brown eyes set him apart from the usual visitors here. He is very Middle Eastern looking and very out of place. He walks around to the trunk and removes a heavy sack. He turns to the Russian and with a tilt of his head gestures toward an old man, stoop shouldered in tattered brown clothing. The Russian walks over to the old man and they begin to talk in Russian. They seem to be negotiating. There is some finger pointing. The Russian looks at the old man, angry now. He looks as if he might break him in two. Finally, with a grunt the Russian pulls out a fold of bills. The old man stares at the crisp American dollars as Russian peals off a few and hands them to the old man. The old man seems wary but gestures them forward.
All three depart the road and hike along a meadow path. The grass is bright green, the meadow erupting in wild flowers. They travel over a hill. Down below is a collection of crumbling buildings. The old man stops. He will not go any further. He points to what is left of the old village. His rheumy eyes look up at the two men. He waits. The Russian reaches into his pocket. He begins to remove his wallet when a loud crack erupts. The old man falls backward with a hole between his eyes but instead of surprise he has a look of total acceptance. The Middle Eastern man puts his gun away, puts the strap of the sack on his shoulder and begins to hike down the hill toward the abandoned village.
The two men enter the remains of a very old village. The buildings have been abandoned long ago, the roofs caved in and the fences collapsed. They continue down what must have been at one time the main road. The road makes a turn to the right and behind a crumbled fence is a barely visible marker. They begin hiking through brush and bramble over ancient and toppled headstones. Toward the back is a large mound. There is no marker. The Russian turns to the Middle Easterner and nods. The slender man sets down the sack, unzips it and begins pulling out items. He puts on a plastic suit, gloves, mask and goggles. Next he removes a shovel and begins to dig.  The earth is soft now that the frost has melted and the ground is still moist. He digs rapidly through the soft earth and then the ground becomes hard again. He has reached the layer where the frost never melts. He pulls out a pick and swings at the ground to loosen the earth. Hard clumps come up and after toiling for a little while he starts to see shreds of gray and brown cloth. He slows his pace and begins to pick at the earth with finer tools. Soon he has uncovered two bodies one lying across the other. He gets very serious now. He carefully removes the clothing from the torso of a man. He gently cleans the soil away.
For Ahmed knows that great respect must be paid to the dead. Even the infidels are to be treated with respect, even those abandoned and mistreated by their own. He turns to the East and makes a nearly silent prayer before resuming his task. He removes a scalpel and makes an incision on the dead man’s right side. He cuts through the rib cage and inserts a device to spread the ribs. Next he reaches into his sack and removes a thermos looking container. He opens the container by releasing two latches and inside is a second container with a screw top.
Next he changes his gloves and dons two layers. He reaches into the chest and feels the hard frozen lung tissue. Perfect, he thinks to himself. He removes a new knife with a long serrated edge and cuts into the tissue. He is able to remove a piece the size of a tennis ball. He looks at it in the light and can see that the dark brown tissue is filled with a thick frozen yellow liquid. He carefully quarters the flesh and places it in the container. He screws the cap on and applies an adhesive tape around the lid. Next he washes the receptacle down with pure alcohol. Again he changes his gloves. He then places the container into its parent and seals the latches. He reaches into his bag and removes an object that looks like a squat cylinder with a thread top. He screws this into the thermos and twists a valve. A hiss is emitted and the exterior of the thermos quickly frosts over. He puts on a pair of insulated gloves and places this into a collapsible insulated bag that he removed from the sack. Next he gently places a white sheet over the body and says a prayer for Allah to accept the soul of this infidel for the sacrifice he has made for the nation of G-d.
He then covers the bodies with the dirt. When he is done he removes his protective gear. He asks the Russian to turn away and he then removes his clothing. He puts all of this in a pile and soaks it with lighter fluid and ignites it. When the fires is out and he has put on fresh clothes he lays down a prayer mat and facing East prays thanks to Allah for this great day.
The men hike back to the Mercedes and depart.

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 pokes her head out the door of their small one room home and reaches over and takes 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, who ran in the front of the single room house now race 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 strolls 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 looks up at the older boy and just as he does he sees 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 complies and passes 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. Just then his mother steps out into the alley, “Ok, the show is over, time to go home!” And with  a flurry of arm movememt 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. Until they get touched close by the insanity they will never know..." Alex has that faraway look in her eyes than Angelo has seen before. Before Alex can drift into the darkness he booms out with his deep baritone voice, "Anyway, too much misery for such a beautiful day, Alex, I say we save the world with your smile." Alex starts to smile again, her blue green eyes begin to soften and she pulls back in to the moment. "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, the thoughts of her past fading 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 for the last several years now 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. “I think our boy here may have finally pulled things off”, Dr. Zack was eyeing a poster on his door of a slender black man with short cut hair smiling in front of the American flag. “I think my buddy Barry may just bag this nomination today, did you vote?” Alex had been harassed regarding the upcoming vote for the candidates for President for weeks now. She had developed a firm policy of voting for absolutely nobody in any election. She was certain that no President would ever truly understand her needs and losses and she couldn’t muster the drive to vote for them. Despite this she knew that Dr. Zack wouldn’t rest until he heard the answer he was looking for. So through a falsely wide smile she nodded her head, “Sure, taken care of.”
“Excellent then, so I imagine your ready for another day in the zoo. 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 started 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 they live in close contact with birds." Next slide shows a dirty market in China, you can see sewage running down the center of the street and a shopkeeper has dead chickens hanging from hooks and just behind a stack of cages with obvious irate 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."
Alex pops up a slide diagramming animal to human transmission. "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.

Chapter 4

September 9, 2001 NYC
Text: Alex, meet me at luggage, can’t w8 2 c u. Dad
Reply: Ok me 2

“Hey hon, I feel like it’s been forever!” Alex runs up to her dad, long blond hair swinging back and forth, a sparkle in her blue eyes.
“I know what you mean, Dad. Hey, Hi Kimberly.” “Hi Alex!” Kimberly and Alex embrace with a hug. They all turn, grab their bags and head for the taxi line.
“Well you two, I think it’s about time to share a little fun in the Big Apple. Last time I was here was about fifteen years ago. I hear the town has changed a lot. Still a bit grumpy but cleaner with a lot less crime. So you ladies want to chance the subway a little this trip?”
“Sure Dad, just, you know, don’t be cheap the whole time.”
“Hey you, I may resemble that remark but I am very sensitive to teasing.” Alan shows an exaggerated pout. “Ok, here’s the itinerary. I got us a place right near the Trade Center and financial area. Today we can take one of those double decker tour buses.” Alex let’s out a groan. “Come on Alex, it’ll be just a couple of hours and gives us the lay of the land. Tonight we’re on our own. Tomorrow I have tickets to “Phantom” for the matinee and we can walk around Time Square after. Monday my meetings start and you guys are on your own.”
Alex, anxiously asks “So when do I go shopping. I promised everyone in Tampa that I would check out the styles and bring a bunch of things back.”
Alex had moved with her mom to Tampa Bay a year ago and she still felt like she was caught in some bizarre time warp. Every time she saw her dad she sensed an opportunity to enhance her wardrobe. Being a complete daddy’s girl had worked well to her advantage and Alan’s medical practice had been doing well lately anyways. Kimberly usually went along but sometimes the manipulation would make her cringe. Just now the look in her green eyes suggested that Alex was just about to cross the line. Alan caught the look and to smooth things out decided a little diversion was in order.
“Ok, I’m sure we’ll all have plenty of time to spend your father’s hard earned cash. How about we check out the town first?”
They all headed into the awaiting taxi and started toward downtown Manhattan. About thirty seconds into the ride Alex pulled out her cell phone and began dialing.
“Hey Tony, so we’re here. What are you up to this weekend? Uh huh, sounds cool. No, my dad has planned out the first two days to do a bunch of touring and shows.” Leaning into the phone and whispering, “I’m gonna try and get hold of my cousin and see if she can save me.”
“Hey Alex, is your mom ok with you using the phone here?”
“Yeah dad, Tony’s on the same carrier, the whole things covered”
Alan and Kimberly rolled their eyes toward each other and Kimberly leaned in to Alan’s shoulder. As usual he was sitting in the middle, between his two girls. The weekends always started out this way. He would try to keep both girls feeling like they were equally important. Eventually, they would push him to the outside and the two girls would start sharing secrets and giggles. That was perfect to Alan, but he still relished the attention and jealousy he triggered during those first hours.
They arrived at the hotel, unloaded and rode the elevator to their room on the 44th floor overlooking the Brooklyn Bridge. They all unpacked, the girls traded time in the bathroom and changed for the days travels. Once all were ready, Alan grabbed the travel books, they went to the subway and began to navigate the underground maze.
“Ok Alex, I want to show you this stuff so if you decide to take off on your own you’ll know what you’re doing.” Alan went over the subway map and showed Alex how the trains were color coded and numbered and lettered. He explained the uptown downtown directions and what to do if you get disoriented. Kimberly leaned in to hear the explanation as this was her first time to New York City as well and she had plans to check things out without Alan. She also had overheard Alex’s reference to her cousin and figured she might be on her own on Monday and Tuesday.
Next, they were off on the Metro. Exiting 49th Street they quickly found the tour buses. They found an available open double decker and headed to the top just as Alex let out a groan of embarrassment. Kimberly turned and gave Alex “the eye” and they move on to find some seats. Alan breathed in the warm late summer air as the tour bus headed down the street. Landmarks were progressively identified and the history of each area was explained. Kimberly was jotting notes into the guidebook for later revisits. Alex leaned over the bus and pointed out the various shopping areas that enticed her. After a while she looked at her father and asked, “So how much longer dad? I thought you said we could get out and walk around.”
“Yeah Alex, but the rides only two hours and you have all weekend to walk around.”
“I know, but there are some places here I really want to check out. Like how are we going to find these places again. Can’t we just get off the bus and walk around? You know dad I didn’t meet you here just to get stuck on tour buses all day long.”
Alan knew exactly what the issue was. He could see Alex’s look, she was beginning to pout and her voice was starting to whine. Obviously, there was something Alex wanted and she couldn’t relax. She had been like this since she was little. In fact, Alan knew this was really a trait she inherited from him. Once an idea was in his head he couldn’t relax until it was dealt with, purchased, resolved, whatever. Now Alex was starting to act the exact same way.
“Hey Alex, here’s the deal. Stick with me on this bus for forty five minutes more. I know exactly the place to go to. I promise you’ll love it. If I’m wrong you can control all of the plans for tomorrow, no questions asked. Deal?”
“Fine.”
The bus continued the tour through the village, into Soho and Chinatown and began to work its way uptown again. Once they crossed Fifth Avenue Alan called to the girls “Time to go,” and the three departed. They took a turn uptown and Alan marched them right into Saks, then Tiffany’s and then Burberry. Alex’s eyes were the size of billiard balls. She went through the racks at Saks, tried on jewelry at Tiffany’s and compared the purses at Burberry. After two hours of intensive comparison shopping interrupted by brief calls to her supervising girlfriends in Florida she began to smile again. Alan made sure to keep Alex from spending all of her money, reminding her that there was a long weekend ahead and every store she went into would be a new opportunity.
“Remember Alex, you have the high end traditional things around here, but tomorrow were going to walk around the Village and Soho and those areas are trendy and edgy.  Just keep control, check things out and most of all have fun. Heck, hon, we’re in New York. Now I just have one thing we have to do today. I’ve been wanting to do this since I booked this weekend. Follow me.”
The three headed out and Alan walked them toward Central Park. As they got there Kimberly new exactly what was on Alan’s mind. Alan checked out the horses and chose a horse and carriage dressed in beautiful floral bouquets for a ride around the park. They settled into the carriage, Alan in the center, and they rode through the park on this stellar fall day. Halfway into the ride the driver took a photo of the three of them on Alan’s digital camera framing the horse and carriage and its three passengers. The two girls with their heads on Alan’s shoulders and in the background the sun breaking through the leaves on the trees.

Chapter 5

Lahore, Pakistan

“Oh Mastouf, what is wrong?” His mother cried. She looked up to heaven with heavy eyes. “What is wrong with my son” she thought to herself. For two days Mastouf had been acting irritable, then he began coughing with a runny nose. This wasn’t alarming but then this morning he barely woke up. His skin looked dull and he was hardly breathing. She could hear the raspiness in his chest and every now and then he would have a violent coughing fit and shaking chills. She had sent Ahmed to get the doctor an hour ago but he hadn’t returned. All she could do was hold her small boy to her chest and sing to him. Suddenly she heard noises at the door.
Finally, in walked Dr. Abed and her older son. She grabbed Dr. Abed’s hand and led him over to Mastouf. Dr. Abed took a look at the small child and the one room house he was living in. He could hear chickens chirping in the coup in the alley. These weren’t the best conditions in Lahore but they could hardly be described as the worst. The room, although dark and aged was clean. He leaned into the child and listened with his stethoscope. He could hardly hear the air move with each breath. Mostly what he heard sounded like rales of fluid. He shined his light in the boy’s mouth and could see that his gums were a dusky blue.
The only chance of survival for this child would be at the main hospital, and that was if they could get him there quickly and if there was room in the wards for the child. He looked over to the mother, “He is very ill, his lungs are hardly working, he has caught a very bad bug. We must take him to the hospital immediately.” The mother broke out in sobs as the doctor picked up the child and carried him out the door.

Chapter 6

Ann Arbor, MI

“Alright Dr. Zack, I’ve got the paperwork for this one and this time the CDC sent it with the history. Do you want to take a look while I begin processing the specimens?” “No, that’s ok, just take a look at the timeline and names and let me know what you come up with.”
Alex grabbed the box and went over to the containment area. She slit open the card board box with a cutter and lifted off the plastic folder with the manifest. Next, she lifted out the Styrofoam case enclosed in the airtight plastic bag. This she took over to a large plastic case with a drop down door. She opened the door and slid the Styrofoam case inside and closed the door. Next she activated a button that initiated a vacuum in the containment cell. She pressed another button and the Styrofoam case was carried down a short conveyor belt to a work station. Alex slid her hands into a pair of gloves through the wall of the plastic containment cell. Next she grabbed a scalpel and slit the plastic case. She gently opened the Styrofoam case and vapors escaped briefly coating the inside of the containment cell and obscuring her view of the contents. Inside were two containers filled with biologic material and marked with biohazard warnings on the outside. She placed the packaging back on the conveyor where it was carried to a mechanized door. Once the packaging entered the door it would be incinerated at 2000 degrees Celsius.
She took the vials placed them on another belt where they were carried into a controlled temperature cooling room. Alex thought to herself that the vials would be safe for a while and she turned her attention to the manifest.  She carried the paperwork over to her work station. She placed her right hand over the finger print reader and her computer came to life. She entered her password and logged into the labs data site. She read off the manifest and reviewed the identifying information. The CDC organized the tissue sent to her with  a series of  words and numbers. Each vial was sequentially numbered in the series. They always started with the virus identification. In this case H5N1-Pakistan-Lahore-051208-MS the second vial was nearly the same H5N1-Pakistan-Lahore-051408-AS. Next she entered the summary findings from the CDC. For some reason technology had not gotten to the point where they could receive the manifest information electronically into their system. Probably a fear of someone hacking the transmission. Either way, Alex was stuck once again reentering the historical information.
MS admitted to Children’s Hospital and Institute for Child Health Lahore (CHICHL) 05/10/08. This six year old child had purchased a chicken with his older brother 3 days before admission from the local farmer’s market. He developed cold and cough symptoms over the next 24 hours. This progressed to congestion, fever, cough and chills. He was admitted to the hospital on 05/10/08. Initial Influenza A screen positive. He was immediately isolated and his symptoms rapidly deteriorated. He was intubated and placed on respiratory support. Intravenous fluids and antivirals were instituted. He rapidly progressed to kidney failure. Over his final 24 hours he had fulminant organ failure developed petechial hemorrhages over his skin. He finally succumbed to the disease at 4:08 p.m. 05/12/08. Due to the rapid progress of his death and the history of bird exposure a suspicion of bird flu was entertained. The CDC in Atlanta, Georgia was notified. H5N1 was confirmed on 05/12/08 and appropriate specimen containment was performed. Once confirmation was achieved the Lahore Department of Health was notified for appropriate quarantine procedures.
Alex proceeded to enter the sequential laboratory values from the hospitalization. Once this was complete she went on to the second vial’s manifest.
AS admitted to CHICHL 05/11/08 with initial symptoms of fever and cough. Due to suspicion of H5N1 this ten year old child, who is the older brother of MS, was immediately placed in isolation.
Alex continued to read essentially the same story of progressive symptoms in the older brother. What a shame, Alex thought. Some mother lost both of her children in just a few hours of each other. Alex pondered the situation, she couldn’t comprehend losing a child but she definitely understood losing two of your most important family members in just a blink of time. Yes, she definitely understood. Alex pulled her mind away from her past and focused on the task at hand. She now had hours of work to go and she would have to work hard to even catch a glimpse of Paula tonight.
After completing the entry of data Alex focused on her main task of the day. She walked over to the bio-containment lab. The lab was very high security and required both fingerprint and voice recognition. Once she entered the lab she donned her “moon suit”. Alex usually enjoyed the complete peace and quiet of the lab although she was always a bit annoyed with putting on the protective suit. Alex had long, and currently blonde, hair and she was slender. Her hair tended to get wrapped into everything in the protective suit and she always felt like she was swimming inside the thing. But, once she was geared up and entered the pressure lock she would practically enter a trance. Alex placed the earbuds of her iPod in her ears and hit the play button. The mellow and melodical music of Joe Jackson’s Night and Day album began to play. For a brief moment she remembered listening to that album for her first time while riding with her father and his wife, Kimberly, on one of their first trips together to the Lake Tahoe ski resorts. As the sounds of the album filled her ears and the hypnotic overhead fluorescent lights bathed the room in a uniform glow Alex’s mind became super focused in the absence of visual and auditory distractions.
Alex went to the specimen cooler and retrieved the two that she had sent into the cooler earlier that morning. Next she retrieved six fresh chicken eggs each labeled with a bar code for identification. She used a sterile needle and syringe and sequentially drew a few milliliters of the turbid fluid in the specimen container and injected it into each of the eggs. After each transfer she used a barcode scanner on both the egg and the specimen. Fortunately, the eggs came pre-stamped with a unique barcode for identification. In her first year in the lab she was tasked with stamping the eggs, a potentially very messy process for someone new at the task and one she did not recommend when nursing a hangover. She then placed the eggs in their own isolated incubation chambers.
Next Alex went into the room that housed the animals for testing. Usually several tests were done for both virulence and transmissibility. The first was to see if a test animal could be infected and then to see if the infection would spread from one animal to the next. Alex took a look at the cages, twelve in all, each had it’s own ferret. All of them looked healthy. Next she checked to make sure that all of the monitoring equipment for each cage was in good order. Each cage had sensors for heart rate, body temperature and weight. They also had automatic delivery of air, food, water and even nitrous oxide for anesthesia. They also each had their own video camera and were able to be monitored from the main lab. Even though there was a person in charge of the ferrets Alex never trusted the lab techs. She went through each cage in detail. After all, this was her study and if she didn’t want to be wasting her time she needed to make sure all was well. Finally, before leaving she checked to make sure the simulated daylight timer was set correctly. If the ferrets were given the wrong amount or timing of daylight they tended to be pretty stiff by morning.
By the time all was done and Alex had changed out of the bunny suit and gear and had shut down and logged off all of the computers it was only three o’clock in the afternoon. Good, plenty of time to make the show and maybe even lay out on the deck of her studio apartment in the sun. Paula was on at 9 and Alex thought she should have plenty of time to change and get ready.
As Alex stepped around the corner of the lab Dr. Zack came running out, “ Alex, we have another urgent delivery coming. Seven more specimens from Lahore. They should be arriving any second. They were given top priority from the CDC and they want us to start the cultures ASAP! This is now the largest outbreak since last year. I need the cultures run and then when complete we need to get everything over to the electron microscopy lab to analyze all nine specimens for mutations in the virus structure and I need you to run gel’s on all of these and compare the RNA sequences to last year’s outbreak.”
Alex let out a grunt and rolled her eyes but none of this was visible to Dr. Zack since he was yelling all of this to her from inside his lab. “Great,” she thought, if she was incredibly lucky and everything really did arrive in the next few seconds and she got all of the specimens into cultures she would be lucky to get out by seven o’clock. There goes her chance at catching the first real rays of sunshine Michigan had to offer since October. Sometimes she wondered why she moved here at all. She could have stayed in Florida with her mom and gone to a state school or she even could have moved back to California. She still had a few friends there. Somehow, here she was working in this lab, no real forward progress for years, and far off of her original path. And, that original path was probably flawed from the start. It was probably just a way to earn daddy’s approval and maybe pull a little attention away from his new wife, the “beautiful and perfect” Kimberly. And then, just as things started to slide into place and Alex began to figure out where she fit in “the tragedy” struck.
A knock was heard at the door and Alex walked over and let in the delivery man from FedEx. After signing off on all three forms as well as the little tablet computer she took the box over to her containment area and started working. First step, like always, rubber gloves, open box, remove manifest and set to side. Next step pull out the Styrofoam case in plastic and place it into the door to the containment cell. Just like before she placed her hands into the articulated sleeves and opened the case. Inside there were seven slots for specimens. Oddly, there were only six specimens though. Well, Alex hoped it would all flesh out in the end. Maybe they miscounted somewhere along the way. “Typical foreignors!” Alex thought to herself. Alex finished up this portion and sent the respective items in their appropriate directions. Styrofoam case and packing material to the incinerator and specimens to the storage cooler.
Next she pulled out the manifest and went to her work station. At least the initial work had already been entered. If she was lucky then everything would be in sequence and the data wouldn’t take too long.
Alex took a brief look at all of the included paperwork. Indeed, there were seven people. Six children and an adult. Everyone appeared to have expired on the fifteenth. The six children all were treated at the same children’s hospital. The only standout was the one adult female thirty-one years old. She never even made it to the hospital. She was found dead in her one room house. There appeared to have been some sort of a struggle which was attributed to psychosis from the hypoxic effect of the virus on the lungs. There was a great deal of blood. The sheets were soaked in it. She had a knife in her hand and had stabbed herself in the chest three times. Due to the fear of contagion no one in Lahore wanted to touch her or anything in the room. The local coroner apparently did a cursory look over the body and brought her to the morgue. Ironically, the local Department of Health official was in a home across the alley talking to the parents of the other six victims. He had heard the commotion across the alley but hadn’t paid much attention at the time. By the time word got to him about the adult he raced over to the morgue and placed the whole area under quarantine. He then talked to his superiors who then arranged for the harvest of specimen to be added to the shipment of the six children’s.
All of this was in the manifest. The whole sequence of events appeared very strange but who knew what was “normal” in a Third World country. The six children made considerably more sense. Apparently, all of them had played with the same bird brought home by the original two victims. They all started coughing and sneezing that night. The next day the local Department of Health official was walking through the neighborhood to inform the neighbors of the outbreak and to watch out for just such symptoms. As soon as he talked to the mother of the six children he had all six sent to the children’s hospital. All six were placed in isolation and all six died. Basically, an identical death of sneezing, then cough, then fever and chills, followed by labored breathing, hypoxia and eventual death. No supportive measures helped, all children had received antiviral medication but it was too little and too late. The respirators only briefly prolonged their very short lives.
As Alex read through the manifest and entered the data into the computer she felt a twinge of sadness for the tragedy that affected these two families. She also wondered whether this would be “the one” the outbreak that finally raced through world causing the chaos and death the CDC had been so worried about. The good news so far was that all of the victims had physical contact with the bird. There was no mention of airborne transmission. The only other oddity about this is that there was no mention of the bird. Usually, the entire bird came in a separate shipment frozen. But, so far no mention of the bird and whether it was being shipped. Once again, Alex chalked this up to the relative incompetence of foreign nations when it came to these issues. “After all” Alex thought to herself, “if they can’t even keep track of a disease outbreak and a bird how are they ever to be trusted for everything else?”
Dr. Zack shouted around the corner, “So Alex how’s it all coming?”
“Well, at least everything arrived on time. I just finished entering the data and I’m getting ready to go into the Cave. I’m hoping I can be done in the next couple of hours. After I get the rest of this cooking I’m going to take off. I think by tomorrow morning we should be able to start the analysis.”
Dr. Zack stepped around the corner, “That was pretty quick. How’d you get that data entered so fast?”
“Well, basically the six kids had identical stories so I did a lot of copy and paste. The only one that doesn’t fit is the adult mother of the first two children. She had a kind of weird death. Also, I only got six specimens, I’m not sure which is missing and won’t know until I get in the cave and start the cultures. Also, did you know that we haven’t got a bird?”
“Hmmm, well I can send out a couple of emails after you tell me which one is missing. Maybe it’s just a screw up at the health department in Lahore.”
“Yeah, that’s what I was thinking as well. Do you remember that outbreak last year when the Chinese health department flipped around all of the ID information for the specimens and it took like a week to figure out which person belonged to which specimen?”
“Oh yeah, just punch away and we can catch up tomorrow. I also have a proposition I need to talk to you about, but it can wait. I’m outta here. See you in the morning.”
“Ok, see you then.”
Once again the underling stays late while the boss heads out. Probably to join his buddies to a smoke a joint in the arboretum. Thoughts began to tumble through Alex’s head again, she was frustrated and pretty annoyed. Maybe she should reenroll in the medical school. They offered her an open opportunity to rejoin at any time. Alex knew that eventually they would close that door she just wasn’t sure when. They gave a lot of breathing room to the “flexies”.
Alex was one of a select few who was given the opportunity in high school to enroll in Michigan’s special program of accelerated medical training. In six years they combined undergraduate and medical school curricula. In addition, they placed you in a research lab during the first three summers. The hope was that the ultra-bright who entered the program would use the shortened program to add on a Ph.D.. Some did, but the program was so intense that a lot of kids didn’t finish in six years or sometimes ever. Alex fit into the latter group at this point. She still wasn’t sure what her destiny really was. Ironically, Paula, who took forever to declare a major and couldn’t decide what she wanted to do with her life was now nearing the end of her second year of medical school and was getting ready to start her clinical rotations. Soon, she would be well ahead of Alex.
Alex pulled on the protective suit and put in her ear buds. This time she decided to honor the sunny day outdoors with a little Jimmy Buffett. Another tribute to daddy, who turned her onto the music one day on a surf safari. As “Margaritaville” filled her ears her mind turned away from her past and she began to focus on the task at hand. Carefully she worked with each of the specimens, injecting tissue into the chicken eggs, scanning the data, and placing them into the incubator.
Finally, Alex finished up, double and triple checked the incubators, cleaned up and disposed of the needles and syringes, changed out of the protective gear and reentered the main laboratory. She stretched long and hard and took a look at the wall clock. Seven o’clock, plenty of time to get home and maybe even hit the tanning salon on the way. Alex headed out of the lab, turning off the overhead lights and proceeded down the hall. She exited the stairwell and stepped outside.
The sky was already dusk and the air temperature had dropped about twenty degrees. She walked over to the bus stop and took the University bus down to South University Street. She got off the bus and went down the street. She turned into an old wooden door and ascended a narrow wooden staircase, she then entered through an even older wooden door and came into a paneled room. Around the room were neon signs and images of palm trees, waves, and over a small counter a rather too large neon sign saying “Paradise Tanning”. This place must have housed dozens of different businesses catering to different students tastes over the decades. She even heard that it was a pinball arcade in her father’s years. Alex looked at the student behind the desk. A young girl with long blonde hair and an obvious indoor tan wearing a tank top and shorts. The room was warm, as it was all year long, and a ceiling fan rotated overhead to create a gentle breeze. The music playing over the stereo was an old Bob Marley recording. Alex presented her the frequent user card, and the girl, Stephanie, punched one of the marks on the card and indicated to Alex to use room three.
Alex went into room three and began to undress. Since Alex didn’t really trust the cleanliness of the tanning unit she did her usual thing and sprayed her own disinfectant on the tanning bed and wiped it down. Just before she went to lie down she remembered she was supposed to meet Paula for food across the street at Charley’s upstairs restaurant, fondly referred to by Alex as “Up Chucks”. Alex quickly typed out a text, “Sorry, ran late, at work, will meet at Union at 9.” Alex lay down on the tanning bed and once again put in the earbuds, she clicked play and pulled down the clamshell top of the tanning bed over herself. The warm tanning lights clicked on and the tropical music of Chris Isaaks played into her ears. Alex began to relax and the stress of the day began to dissipate. Her mind drifted as she fell into a deep relaxing sleep.

Sunday, November 18, 2012

My Lucky Penny

In my recollections of the many things I have done over the years there is one story that is a real stand out because not only did it impact the life of a small child it also ultimately had a great impact on myself.

About ten years ago a pretty 35 year old blonde haired woman came in my office with her two-and-a-half year old son. He had a few problems including recurrent ear infections but of additional concern was that he had been having significant gastrointestinal symptoms for over a year. He would have episodes of vomiting that were so severe he would throw up  all of his gastric contents from a meal. The symptoms were odd because they were intermittent.


In children there are a few things we think of when they have swallowing and vomiting symptoms. The problem could be esophageal and if it is the most concerning issue is that it may represent a stricture of congenital origin. Another common cause could be an episode of esophageal trauma from a caustic agent or a foreign body. These causes are usually linked to a specific event and timeline usually esophageal strictures give consistent near daily symptoms. There also are issues that can occur in the stomach such as a narrowing at the gastric junction with the small intestine. These symptoms develop very early, usually around a few months of age and the children have difficulty with weight gain.

In front of me was this cute black haired olive skinned boy who was a little pudgy and normal appearing in every other way. He certainly wasn't wasting away nor was there a specific event that preceded his symptoms. Oddly his symptoms would come in waves sometimes separated by weeks or months. He had seen other doctors including pediatricians and even another ENT doctor without any resolution. He was seeing a speech therapist for his speech delay and she had raised some concern about this. I did a thorough ear, nose and throat exam which was normal except for a pair of functional myringotomy tubes (ear tubes).

Because his symptoms were sporadic I suspected an issue in the stomach  but I was unsure. I ordered a barium swallow examination with the expectation that I would need to send him to a pediatric gastroenterologist once I ruled out an esophageal abnormality. So, you can imagine my surprise when I received an urgent call from the radiologist at Dominican Hospital that there was a penny lodged in his esophagus.

We urgently went to the operating room and I placed a scope into the child's esophagus and after removing old food particle I was able to extract a penny that was so adherent to the lining of the esophagus it had lost some of it's copper coating and was showing the metallic zinc center. The boy did great and went home the next day.

A few days later I received a call from his speech pathologist who happened to be a woman I new from a couple of years previously who had dated a friend of mine. We talked for a bit and again later that evening and learned that we had a lot in common. Shortly after that phone call we got together and realized we also had a mutual attraction for each other.

By now, some of you may realize that this is the story of how my beautiful and wonderful wife and I met and started a life together. So that little penny was truly my "lucky penny".

Tuesday, November 13, 2012

Virestorm Chapters 5 and 6


Chapter 5

Lahore, Pakistan

“Oh Mastouf, what is wrong?” His mother cried. She looked up to heaven
with heavy eyes. “What is wrong with my son” she thought to herself. For two days
Mastouf had been acting irritable, then he began coughing with a runny nose. This
wasn’t alarming but then this morning he barely woke up. His skin looked dull and he
was hardly breathing. She could hear the raspiness in his chest and every now and then
he would have a violent coughing fit and shaking chills. She had sent Ahmed to get the
doctor an hour ago but he hadn’t returned. All she could do was hold her small boy to her
chest and sing to him. Suddenly she heard noises at the door.

Finally, in walked Dr. Abed and her older son. She grabbed Dr. Abed’s hand and
led him over to Mastouf. Dr. Abed took a look at the small child and the one room house
he was living in. He could hear chickens chirping in the coup in the alley. These weren’t
the best conditions in Lahore but they could hardly be described as the worst. The
room, although dark and aged was clean. He leaned into the child and listened with his
stethoscope. He could hardly hear the air move with each breath. Mostly what he heard
sounded like rales of fluid. He shined his light in the boy’s mouth and could see that his
gums were a dusky blue.
The only chance of survival for this child would be at the main hospital, and that
was if they could get him there quickly and if there was room in the wards for the child.
He looked over to the mother, “He is very ill, his lungs are hardly working, he has caught
a very bad bug. We must take him to the hospital immediately.” The mother broke out in
sobs as the doctor picked up the child and carried him out the door.

Chapter 6

Ann Arbor, MI

“Alright Dr. Zack, I’ve got the paperwork for this one and this time the CDC
sent it with the history. Do you want to take a look while I begin processing the
specimens?” “No, that’s ok, just take a look at the timeline and names and let me know
what you come up with.”
Alex grabbed the box and went over to the containment area. She slit open the
card board box with a cutter and lifted off the plastic folder with the manifest. Next, she
lifted out the Styrofoam case enclosed in the airtight plastic bag. This she took over to
a large plastic case with a drop down door. She opened the door and slid the Styrofoam
case inside and closed the door. Next she activated a button that initiated a vacuum in the
containment cell. She pressed another button and the Styrofoam case was carried down a
short conveyor belt to a work station. Alex slid her hands into a pair of gloves through the
wall of the plastic containment cell. Next she grabbed a scalpel and slit the plastic case.
She gently opened the Styrofoam case and vapors escaped briefly coating the inside of
the containment cell and obscuring her view of the contents. Inside were two containers
filled with biologic material and marked with biohazard warnings on the outside. She
placed the packaging back on the conveyor where it was carried to a mechanized door.
Once the packaging entered the door it would be incinerated at 2000 degrees Celsius.
She took the vials placed them on another belt where they were carried
into a controlled temperature cooling room. Alex thought to herself that the vials would
be safe for a while and she turned her attention to the manifest. She carried the
paperwork over to her work station. She placed her right hand over the finger print reader
and her computer came to life. She entered her password and logged into the labs data
site. She read off the manifest and reviewed the identifying information. The CDC
organized the tissue sent to her with a series of words and numbers. Each vial was
sequentially numbered in the series. They always started with the virus identification. In
this case H5N1-Pakistan-Lahore-051208-MS the second vial was nearly the same H5N1-
Pakistan-Lahore-051408-AS. Next she entered the summary findings from the CDC. For
some reason technology had not gotten to the point where they could receive the manifest

information electronically into their system. Probably a fear of someone hacking the
transmission. Either way, Alex was stuck once again reentering the historical information.
MS admitted to Children’s Hospital and Institute for Child Health Lahore
(CHICHL) 05/10/08. This six year old child had purchased a chicken with his older
brother 3 days before admission from the local farmer’s market. He developed cold and
cough symptoms over the next 24 hours. This progressed to congestion, fever, cough and
chills. He was admitted to the hospital on 05/10/08. Initial Influenza A screen positive.
He was immediately isolated and his symptoms rapidly deteriorated. He was intubated
and placed on respiratory support. Intravenous fluids and antivirals were instituted. He
rapidly progressed to kidney failure. Over his final 24 hours he had fulminant organ
failure developed petechial hemorrhages over his skin. He finally succumbed to the
disease at 4:08 p.m. 05/12/08. Due to the rapid progress of his death and the history
of bird exposure a suspicion of bird flu was entertained. The CDC in Atlanta, Georgia
was notified. H5N1 was confirmed on 05/12/08 and appropriate specimen containment
was performed. Once confirmation was achieved the Lahore Department of Health was
notified for appropriate quarantine procedures.
Alex proceeded to enter the sequential laboratory values from the hospitalization.
Once this was complete she went on to the second vial’s manifest.
AS admitted to CHICHL 05/11/08 with initial symptoms of fever and cough.
Due to suspicion of H5N1 this ten year old child, who is the older brother of MS, was
immediately placed in isolation.
Alex continued to read essentially the same story of progressive symptoms in the
older brother. What a shame, Alex thought. Some mother lost both of her children in just
a few hours of each other. Alex pondered the situation, she couldn’t comprehend losing
a child but she definitely understood losing two of your most important family members
in just a blink of time. Yes, she definitely understood. Alex pulled her mind away from
her past and focused on the task at hand. She now had hours of work to go and she would
have to work hard to even catch a glimpse of Paula tonight.
After completing the entry of data Alex focused on her main task of the day. She
walked over to the bio-containment lab. The lab was very high security and required both
fingerprint and voice recognition. Once she entered the lab she donned her “moon suit”.
Alex usually enjoyed the complete peace and quiet of the lab although she was always
a bit annoyed with putting on the protective suit. Alex had long, and currently blonde,
hair and she was slender. Her hair tended to get wrapped into everything in the protective
suit and she always felt like she was swimming inside the thing. But, once she was
geared up and entered the pressure lock she would practically enter a trance. Alex placed
the earbuds of her iPod in her ears and hit the play button. The mellow and melodical
music of Joe Jackson’s Night and Day album began to play. For a brief moment she
remembered listening to that album for her first time while riding with her father and his
wife, Kimberly, on one of their first trips together to the Lake Tahoe ski resorts. As the
sounds of the album filled her ears and the hypnotic overhead fluorescent lights bathed
the room in a uniform glow Alex’s mind became super focused in the absence of visual
and auditory distractions.
Alex went to the specimen cooler and retrieved the two that she had sent into the
cooler earlier that morning. Next she retrieved six fresh chicken eggs each labeled with a
bar code for identification. She used a sterile needle and syringe and sequentially drew a

few milliliters of the turbid fluid in the specimen container and injected it into each of the
eggs. After each transfer she used a barcode scanner on both the egg and the specimen.
Fortunately, the eggs came pre-stamped with a unique barcode for identification. In her
first year in the lab she was tasked with stamping the eggs, a potentially very messy
process for someone new at the task and one she did not recommend when nursing a
hangover. She then placed the eggs in their own isolated incubation chambers.
Next Alex went into the room that housed the animals for testing. Usually several
tests were done for both virulence and transmissibility. The first was to see if a test
animal could be infected and then to see if the infection would spread from one animal
to the next. Alex took a look at the cages, twelve in all, each had it’s own ferret. All of
them looked healthy. Next she checked to make sure that all of the monitoring equipment
for each cage was in good order. Each cage had sensors for heart rate, body temperature
and weight. They also had automatic delivery of air, food, water and even nitrous oxide
for anesthesia. They also each had their own video camera and were able to be monitored
from the main lab. Even though there was a person in charge of the ferrets Alex never
trusted the lab techs. She went through each cage in detail. After all, this was her study
and if she didn’t want to be wasting her time she needed to make sure all was well.
Finally, before leaving she checked to make sure the simulated daylight timer was set
correctly. If the ferrets were given the wrong amount or timing of daylight they tended to
be pretty stiff by morning.
By the time all was done and Alex had changed out of the bunny suit and gear
and had shut down and logged off all of the computers it was only three o’clock in the
afternoon. Good, plenty of time to make the show and maybe even lay out on the deck
of her studio apartment in the sun. Paula was on at 9 and Alex thought she should have
plenty of time to change and get ready.
As Alex stepped around the corner of the lab Dr. Zack came running out, “ Alex,
we have another urgent delivery coming. Seven more specimens from Lahore. They
should be arriving any second. They were given top priority from the CDC and they want
us to start the cultures ASAP! This is now the largest outbreak since last year. I need
the cultures run and then when complete we need to get everything over to the electron
microscopy lab to analyze all nine specimens for mutations in the virus structure and
I need you to run gel’s on all of these and compare the RNA sequences to last year’s
outbreak.”
Alex let out a grunt and rolled her eyes but none of this was visible to Dr. Zack
since he was yelling all of this to her from inside his lab. “Great,” she thought, if she
was incredibly lucky and everything really did arrive in the next few seconds and she got
all of the specimens into cultures she would be lucky to get out by seven o’clock. There
goes her chance at catching the first real rays of sunshine Michigan had to offer since
October. Sometimes she wondered why she moved here at all. She could have stayed in
Florida with her mom and gone to a state school or she even could have moved back to
California. She still had a few friends there. Somehow, here she was working in this lab,
no real forward progress for years, and far off of her original path. And, that original path
was probably flawed from the start. It was probably just a way to earn daddy’s approval
and maybe pull a little attention away from his new wife, the “beautiful and perfect”
Kimberly. And then, just as things started to slide into place and Alex began to figure out
where she fit in “the tragedy” struck.

A knock was heard at the door and Alex walked over and let in the delivery man
from FedEx. After signing off on all three forms as well as the little tablet computer
she took the box over to her containment area and started working. First step, like
always, rubber gloves, open box, remove manifest and set to side. Next step pull out
the Styrofoam case in plastic and place it into the door to the containment cell. Just like
before she placed her hands into the articulated sleeves and opened the case. Inside there
were seven slots for specimens. Oddly, there were only six specimens though. Well, Alex
hoped it would all flesh out in the end. Maybe they miscounted somewhere along the
way. “Typical foreignors!” Alex thought to herself. Alex finished up this portion and sent
the respective items in their appropriate directions. Styrofoam case and packing material
to the incinerator and specimens to the storage cooler.
Next she pulled out the manifest and went to her work station. At least the initial
work had already been entered. If she was lucky then everything would be in sequence
and the data wouldn’t take too long.
Alex took a brief look at all of the included paperwork. Indeed, there were seven
people. Six children and an adult. Everyone appeared to have expired on the fifteenth.
The six children all were treated at the same children’s hospital. The only standout was
the one adult female thirty-one years old. She never even made it to the hospital. She was
found dead in her one room house. There appeared to have been some sort of a struggle
which was attributed to psychosis from the hypoxic effect of the virus on the lungs. There
was a great deal of blood. The sheets were soaked in it. She had a knife in her hand and
had stabbed herself in the chest three times. Due to the fear of contagion no one in Lahore
wanted to touch her or anything in the room. The local coroner apparently did a cursory
look over the body and brought her to the morgue. Ironically, the local Department
of Health official was in a home across the alley talking to the parents of the other six
victims. He had heard the commotion across the alley but hadn’t paid much attention
at the time. By the time word got to him about the adult he raced over to the morgue
and placed the whole area under quarantine. He then talked to his superiors who then
arranged for the harvest of specimen to be added to the shipment of the six children’s.
All of this was in the manifest. The whole sequence of events appeared very
strange but who knew what was “normal” in a Third World country. The six children
made considerably more sense. Apparently, all of them had played with the same bird
brought home by the original two victims. They all started coughing and sneezing that
night. The next day the local Department of Health official was walking through the
neighborhood to inform the neighbors of the outbreak and to watch out for just such
symptoms. As soon as he talked to the mother of the six children he had all six sent
to the children’s hospital. All six were placed in isolation and all six died. Basically,
an identical death of sneezing, then cough, then fever and chills, followed by labored
breathing, hypoxia and eventual death. No supportive measures helped, all children had
received antiviral medication but it was too little and too late. The respirators only briefly
prolonged their very short lives.
As Alex read through the manifest and entered the data into the computer she felt
a twinge of sadness for the tragedy that affected these two families. She also wondered
whether this would be “the one” the outbreak that finally raced through world causing
the chaos and death the CDC had been so worried about. The good news so far was that
all of the victims had physical contact with the bird. There was no mention of airborne

transmission. The only other oddity about this is that there was no mention of the bird.
Usually, the entire bird came in a separate shipment frozen. But, so far no mention of the
bird and whether it was being shipped. Once again, Alex chalked this up to the relative
incompetence of foreign nations when it came to these issues. “After all” Alex thought to
herself, “if they can’t even keep track of a disease outbreak and a bird how are they ever
to be trusted for everything else?”
Dr. Zack shouted around the corner, “So Alex how’s it all coming?”
“Well, at least everything arrived on time. I just finished entering the data and I’m
getting ready to go into the Cave. I’m hoping I can be done in the next couple of hours.
After I get the rest of this cooking I’m going to take off. I think by tomorrow morning we
should be able to start the analysis.”
Dr. Zack stepped around the corner, “That was pretty quick. How’d you get that
data entered so fast?”
“Well, basically the six kids had identical stories so I did a lot of copy and paste.
The only one that doesn’t fit is the adult mother of the first two children. She had a kind
of weird death. Also, I only got six specimens, I’m not sure which is missing and won’t
know until I get in the cave and start the cultures. Also, did you know that we haven’t got
a bird?”
“Hmmm, well I can send out a couple of emails after you tell me which one is
missing. Maybe it’s just a screw up at the health department in Lahore.”
“Yeah, that’s what I was thinking as well. Do you remember that outbreak last
year when the Chinese health department flipped around all of the ID information for
the specimens and it took like a week to figure out which person belonged to which
specimen?”
“Oh yeah, just punch away and we can catch up tomorrow. I also have a
proposition I need to talk to you about, but it can wait. I’m outta here. See you in the
morning.”
“Ok, see you then.”
Once again the underling stays late while the boss heads out. Probably to join his
buddies to a smoke a joint in the arboretum. Thoughts began to tumble through Alex’s
head again, she was frustrated and pretty annoyed. Maybe she should reenroll in the
medical school. They offered her an open opportunity to rejoin at any time. Alex knew
that eventually they would close that door she just wasn’t sure when. They gave a lot of
breathing room to the “flexies”.
Alex was one of a select few who was given the opportunity in high school to
enroll in Michigan’s special program of accelerated medical training. In six years they
combined undergraduate and medical school curricula. In addition, they placed you in
a research lab during the first three summers. The hope was that the ultra-bright who
entered the program would use the shortened program to add on a Ph.D.. Some did, but
the program was so intense that a lot of kids didn’t finish in six years or sometimes ever.
Alex fit into the latter group at this point. She still wasn’t sure what her destiny really
was. Ironically, Paula, who took forever to declare a major and couldn’t decide what she
wanted to do with her life was now nearing the end of her second year of medical school
and was getting ready to start her clinical rotations. Soon, she would be well ahead of
Alex.

Alex pulled on the protective suit and put in her ear buds. This time she decided
to honor the sunny day outdoors with a little Jimmy Buffett. Another tribute to daddy,
who turned her onto the music one day on a surf safari. As “Margaritaville” filled her
ears her mind turned away from her past and she began to focus on the task at hand.
Carefully she worked with each of the specimens, injecting tissue into the chicken eggs,
scanning the data, and placing them into the incubator.
Finally, Alex finished up, double and triple checked the incubators, cleaned
up and disposed of the needles and syringes, changed out of the protective gear and
reentered the main laboratory. She stretched long and hard and took a look at the wall
clock. Seven o’clock, plenty of time to get home and maybe even hit the tanning salon on
the way. Alex headed out of the lab, turning off the overhead lights and proceeded down
the hall. She exited the stairwell and stepped outside.
The sky was already dusk and the air temperature had dropped about twenty
degrees. She walked over to the bus stop and took the University bus down to South
University Street. She got off the bus and went down the street. She turned into an old
wooden door and ascended a narrow wooden staircase, she then entered through an even
older wooden door and came into a paneled room. Around the room were neon signs
and images of palm trees, waves, and over a small counter a rather too large neon sign
saying “Paradise Tanning”. This place must have housed dozens of different businesses
catering to different students tastes over the decades. She even heard that it was a pinball
arcade in her father’s years. Alex looked at the student behind the desk. A young girl with
long blonde hair and an obvious indoor tan wearing a tank top and shorts. The room was
warm, as it was all year long, and a ceiling fan rotated overhead to create a gentle breeze.
The music playing over the stereo was an old Bob Marley recording. Alex presented her
the frequent user card, and the girl, Stephanie, punched one of the marks on the card and
indicated to Alex to use room three.
Alex went into room three and began to undress. Since Alex didn’t really trust the
cleanliness of the tanning unit she did her usual thing and sprayed her own disinfectant
on the tanning bed and wiped it down. Just before she went to lie down she remembered
she was supposed to meet Paula for food across the street at Charley’s upstairs restaurant,
fondly referred to by Alex as “Up Chucks”. Alex quickly typed out a text, “Sorry, ran
late, at work, will meet at Union at 9.” Alex lay down on the tanning bed and once again
put in the earbuds, she clicked play and pulled down the clamshell top of the tanning bed
over herself. The warm tanning lights clicked on and the tropical music of Chris Isaaks
played into her ears. Alex began to relax and the stress of the day began to dissipate. Her
mind drifted as she fell into a deep relaxing sleep.

Tuesday, November 6, 2012

The Simplest Things...

The past week has had many interesting problems to solve and while taking care of people I have been debating what would be the best to share. Cynthia suggested a very special story from several years ago but I'm going to save that one for later. I think it can be incredible how in the course of a given day we can influence peoples lives with what seem to be some of the most mundane and uninteresting facets of our work. I constantly sift through the stories that pass through my life trying to find one that meets what I consider the merits of exciting and dramatic. The Hollywood story so to speak. But I think that glory and gory isn't always necessary.

So, today a twelve year old boy came in to see me. He was clearly bright and very self aware. Unfortunately, he was suffering from a cold, which was not the cause of his visit, and in a very nasally voice explained to me his concerns. He was concerned because he couldn't hear on his right side. When I asked him to explain he related that he had hearing loss for over four years on his right side. He also had constant ringing in the ears. He was unaware of anything that may have happened four years ago to cause the hearing loss. As far as he knew he was healthy and had no other complaints except for that cold.

His mom was able to expand on his history a little bit more. She handed me school screenings for hearing done in the third and seventh grades. Both showed about a 30 decibel hearing loss on the right side which translates to about a 30% decrease in function. She also was unaware of any history of ear infections or trauma. The only concern she had was that she had told the pediatrician that he had a tendency to accumulate wax. She was counseled to keep Q-tips out of the ear. You know what we say "Nothing smaller than your elbow goes in your ears!"

On examination he did indeed have wax in both of his ears but the right side was like concrete. So we began working. Usually removing wax is pretty simple but every now and then it presents a heavy duty challenge and this was one of those situations. Believe it or not I worked on that poor child for 45 minutes using every tool I could think of. Eventually we had success and I could see a completely normal eardrum on each side.

He was pretty convinced that things were better but he also looked a bit out of sorts from the experience so just to be sure we did a hearing test and... His hearing was perfect! The first comment from his mom was that she thought this might be a big help in the classroom. Apparently, he had been having some challenges there as well. My guess is that after four years of hearing only on one side the world was going to be much different in stereo.

It's funny how something that we don't think much about could have such an impact on one of our most important senses. I have read that for Helen Keller she felt that hearing was far more important of a sensory input than blindness. For with blindness we can ask for help and we can be a part of society but with deafness we can be stuck on the outside and despite the best vision we're just looking in.

I'm sure that you're thinking the same question that I was, "Why did mom wait four years to bring her son in and where was the pediatrician's input in his care?" I suspect that because he could hear on the left side it didn't ring a very loud alarm bell that he needed treatment. I have seen this many times in patients of all ages that develop a loss in one ear but don't do anything about it at first. Sometimes you miss out on a window of treatment. I have many more stories in that direction to share in the future.

In the meantime, I like to think that today a life was changed at least a little.