Chapter 1
“Sandy! Sandy! You’ve got to come here right away! Something horrible is happening to the guy in bed three. I have no idea what's up with him, but I think he is going to die," Kelsey Saunders exclaimed, her voice shrill with anxiety as her vivid green eyes exploded with anxiety.
Sandy Pilsner, emergency department nurse manager of Crescent City Medical Center’s level one emergency department, looked up from the nurses' station, and said, "What's up, Kelsey? I saw him twenty minutes ago when I was making rounds."
Kelsey's face was white with fear. "It's awful. He has blood coming out of his eyes and his blood pressure is low. He’s also shaking all over. I don’t know if it’s a seizure or his fever. He’s having trouble breathing too.
Sandy rose from her seat so she was eye level with the almost hysterical Kelsey, her new nursing graduate intern from LSU, and said gently, “Kelsey, it’s okay. I just checked on him a few minutes ago. He seemed fine, except for his fever and the fact his blood work is screwed up.”
“I know, I know. But I'm telling you that things have changed quickly.”
Kelsey shook her head emphatically. “Hurry up. I think he’s gonna die any minute. There’s just something very wrong! He is totally going bad.” Her green eyes were huge and Sandy could see anxiety and worry reflected in them.
“All right, let’s go check him out,” Sandy said as she thought of the ideal teaching moment they would have.
An urgent voice barked over the hospital voice system, “CODE BLUE, CODE BLUE, ED, Bed 3.”
Sandy grimaced and said, “Well, Kelsey, you called that one right! Let’s see what we can do.” Both nurses rushed toward the opposite end of the ED, pushing an extra crash cart.
The code team was in action, and two amps of bicarb had already been administered with no response. The patient was blue, with circumoral cyanosis surrounding his mouth. His nails looked as though someone had painted them with a pearly blue nail polish. His eyes, open and staring, were blood red from petechiae and broken blood vessels. A bloody drainage seeped from the right eye, staining his cheek.
Sandy noticed the flat red rash on his chest. She could swear he hadn’t had that rash thirty minutes ago.
The ED doc in charge, Dr. Fred Patterson, saw Sandy and hollered, “What the hell is happening to this guy? He’s bleeding from everywhere and I have no idea what’s wrong with him! Give me a history and for God’s sake, get us some protective gear in here."
Sandy stood quietly, transfixed. She’d never seen Dr. Patterson anxious or even tense. She panicked for a moment but didn't know why. A dark sense of foreboding fell over her and she was afraid.
Dr. Patterson glared at her. "For God’s sake, Sandy! Move. Give me something. What’s the history? He’s bleeding out and I don’t know why. This is, at the very least, malaria, typhoid, or perhaps one of the hemorrhagic viruses - maybe even something worse. Holy Shit, I don’t like this! Get us some protective gear, NOW!”
Sandy’s stress soared exponentially. Fred Patterson was their calmest ED doc and he was freaked. She grabbed the chart from the medication nurse and said, “Fred, not much to tell. The guy came in several hours ago from the Hotel Burgundy in the Quarter. He’s part of the staff for the Democratic Caucus that starts tomorrow. The friend who bought him here said he starting feeling sick last night, had some nausea, some vomiting and a sore throat. Then, this morning, his temperature got higher and he couldn’t stop vomiting, so he brought him in. We started some IV fluids and gave him some Zofran for his nausea. That was several hours ago. He was okay an hour ago.”
“Well, he sure isn’t okay now. I think he’s in liver failure at the very least and probably multi-system failure. Any recent blood work? Does he have any friends or family here other than the guy who bought him in? Any idea where he’s been? Do you know if he has been traveling?”
Sandy shook her head, and watched the Code Team continue CPR compressions as the Respiratory therapists intubated the patient. There was no cardiac response at all. Flat line! A nurse rolled the defibrillator closer.
“I’ve no idea. His friend stayed about thirty minutes and took off. Said he had a bunch of stuff to do. You know the politicians are here for the next few days, right? They’re trying to clean up their act in Washington, you know, Operation Fix America,” Sandy added in explanation.
“Yeah, goody, goody and the president is coming over the weekend, right?”
Sandy could detect the sarcasm in Fred’s voice. She really couldn’t blame him for his jaded and sarcastic nature. Just this year his twin brother, Ron, also an ED doc for CCMC, had died while working in the ED. No one had recovered from it, particularly Fred. Nevertheless, he was a great ED doc and he knew his stuff. Besides, almost everyone in America had lost respect for the politicians in Washington D.C., and Fred wasn't any different.
“Yep, that’s what the papers say,” Sandy responded as she addressed Fred’s remarks and continued, “I think a food service worker from the same hotel was admitted earlier with similar symptoms. I’ll need to check.”
“Find out where he’s been from his friend that brought him in. Call the hotel too. I think he has some kind of lethal virus. Get the infectious disease people in here too. I'm bringing in Tim Smith from Tropical Medicine over at Tulane as well. Those people over at the Tropical Medicine department are experts with this stuff.”
Sandy could hear the tension in Fred's voice. She paused for a second to respond.
He glared at her and said, “STAT, Sandy, we need to know what we are dealing with. If it’s bad, we need to contain it. Be sure we’ve gathered all available blood samples for diagnostic testing. Get a tube of everything.”
Sandy, an old hat ED nurse who thought she had seen everything working while in New Orleans, was disturbed and frightened by Fred’s behavior and the wild look in his eyes. She could feel her anxiety escalating, something she hardly ever experienced as an expert practitioner.
“Got it, Fred, I’ll take care of it,” she calmly replied, pushing a reluctant Kelsey forward so they could get to work. Sandy could feel the slow, increasing thud of her heart. Oh my God, she thought, suppose we have an outbreak of Ebola or some unknown hemorrhagic virus.
She looked at Kelsey, who was, once again, white with fear, and said, "Have central supply bring in full gowns, masks, and booties for all staff in the ED. Get face shields as well. We need to start isolation on all patients and close the ED to further traffic. We’ll have to close down, and transfer what we can, and divert to other local EDs. I'll call and let administration know. This could be bad. We don't know what this guy's got."
Kelsey recovered and responded quickly. “I’ll take care of the gear, call the CCMC infectious disease docs here at the hospital, and report back to you.”
“Thanks, Kelsey. You’re the best,” Sandy said as she patted the shoulder of the young graduate and rushed toward her office to call administration and report a potentially biological threat to the medical center. En route, she had a near-collision with general surgeon, Robert Bonnet, the interim chief of medicine at CCMC.
Robert smiled brightly at Sandy, “Whoa! What’s up, girl! Why all the rush? I heard the CODE BLUE so I came down. What’s going on?"
Sandy’s face was gray with fear. “Come into my office, Robert, so we can talk.” Robert followed her quickly.
“We have a guy, the code, who looks like he has some type of weird virus. Fred said typhoid or malaria at the best and perhaps something much worse. Maybe even a hemorrhagic virus of some kind. The patient works for the Democratic Party. He was bleeding out, has a significant trunk rash, and high fever. Also, his kidneys and liver are shutting down."
Robert’s smile disappeared as he processed the information Sandy gave him. His handsome face reflected his concern and he said, “This could be bad. Get me Dave Broderick, head of infectious disease here at CCMC. If it looks like a hemorrhagic fever, we’ll need to call the CDC as well. Has anyone else been admitted with similar symptoms?”
"Yeah, but he was transferred to Intensive Care, which is where this guy was headed before he coded. I think the guy in the ICU is South African and I believe he is food service staff at the Hotel Burgundy. He had a temp of 103.2, as well as nausea and vomiting. His blood platelets were whacked and WBCs were way up. Short of breath, too, but we treated that with oxygen. Just like the guy that coded… but the South African guy stabilized and was transferred to ICU an hour or so ago.”
“Find out how he is and call me. I think we have a serious situation, a viral outbreak at the very least."
Sandy nodded, noting the etched lines of concern on Robert’s face as he left her office and started down the hall. She’d just picked up her phone to call infectious disease when Robert returned.
Robert stood in her doorway and asked, “Sandy, when does the political convention start, Operation Fix America? Do you know?”
Sandy shrugged her shoulders and said, “I don’t know, sometime this weekend. I think it's mainly Friday and Saturday, but I think the president speaks on Saturday.” She gave him a reproachful look and added, "Really, Dr. Bonnet, you should know. Your father is a senator!"
Robert cracked a half smile. “Find out,” he said as he stared at her steadily, his eyes unwavering and holding hers.
After several seconds, Sandy got the message and asked, "Dr. Bonnet, you don’t think someone is—”
Robert interrupted her, “I don’t know, Sandy, but we have to think proactively. There are gonna be a lot of very powerful people in the city this weekend. We've got to consider it."
“Oh my God, Robert. We’ve had enough this year, please not this.” Sandy's voice was shrill with fear.
“Yes, we have, but I have a bad feeling that this may be the worst. Close the ED to further traffic, have everyone wear protective gear, and for God’s sake, don't allow anyone to leave until we figure out what we are dealing with. Implement our full biocontainment protocol and close the ED to all incoming traffic, except patients with flu-like symptoms. It's better to be safe than sorry," Robert added.
Sandy stared at him, her eyes wide. She nodded and said, "I've already closed the ED and we are transferring everyone out that we can. I just need to contact administration."
Robert smiled and said, "You’ve already contacted them. These days I am administration and trust me, I'd much rather be in the operating room. I'll talk to Alex. We're the administrators in charge while Don is away on vacation. Keep this viral thing under your hat. It may be nothing more than a bad bug. But just to be safe, I'm calling CDC.”
Sandy watched Robert leave for the second time as a dark, ominous feeling of dread permeated her body. Oh my God, what are we in for? she thought as she wiped the chill bumps from her arms.
Chapter 2
In the back of a shotgun house off Chartres Street in the Faubourg Marigny, a colorful revitalized neighborhood close to the French Quarter and the Mississippi River, Ali, a thin, frail, twenty-three-year-old Muslim graduate student stared at his older brother, thirty-one-year-old Nazir. Ali asked, “Nazir, are you sure we know what we are doing? I don’t trust Vadim at all." Ali's hair was a mess of tousled dark curls and his expressive brown eyes were intense.
Nazir glared at him but remained silent.
"Ever since I hacked into his email and saw the exit plans he sent to his comrades in Russia, I have been suspicious,” Ali continued. “Maybe you should abort this mission or at least, postpone it." His young face looked scared and uncertain.
Nazir's face remained unchanged and he rolled his eyes with impatience. He looked at his little brother and said condescendingly, “Ali, stop it. I thought you were ready for this. I thought I could trust you to be strong. We are doing the work of Allah.”
Ali seemed to shrink in stature, to retreat into his skin, at his brother's criticism and impatience. He felt very small as he stared at his feet. “I am ready, I really am,” he replied with all the bravado in his voice he could muster. “I just don’t like working with others, those that are not dedicated to our cause."
Nazir’s impatience continued and it was clear in his voice. “You have trained for over three years, and I have been planning for a mission such as this for many more. Sometimes, in order to get the job done, we have to work with others. This is one of those times.”
Ali still looked doubtful, uncertain. His brother's words did not sway him.
Nazir moved toward his little brother and put his arm around his thin shoulders. Ali certainly wasn’t a warrior, but he was a brilliant scientist and computer genius. “Vadim is okay. He’s just different from us. He is Russian, just as we are, and people from his part of Russia act differently,” he said, as he flashed Ali a meaningful look. But he is a Muslim and worships as we do. He is one of our highest, most revered leaders in the Red Jihad movement in Eastern Europe," he said gently.
Ali nodded as Nazir continued, "Remember, we needed Vadim and his connections to get us the virus. The Russians have been holding that strain for decades. It would have taken us years to produce a similar strain with the same kill rate. In fact, as I may have told you, the virus was mutated here in New Orleans in the 1960s. The Russians stole it, so the story goes.”
Ali nodded. He remembered the story well. There was even information on the famous virus in the archives in the schools of Medicine and Tropical disease at Tulane University.
“You, more than anyone, know we haven’t been able to produce the more virulent strain in our laboratories.”
“I know, I know,” lamented Ali. “But we are very close. If you had just given me six more months, I could have had the very same thing or perhaps something even better, with an even higher kill rate. Maybe even a virus that would be harder to detect. Nazir, you have to understand these things take time, believe me. I haven’t been doddering.” Ali’s dark eyes were brooding and angry.
"No, of course not, my little brother. I certainly don't think that at all." Nazir continued to talk softly and reassure his brother how much he and the local jihad cell appreciated his talents and contributions. “I know that, I know that, little one. But you know how the Americans are. Very seldom are there so many of them from all parts of their leadership gathered together in an iconic, easily compromised city such as New Orleans. This Operation Fix America meeting is a perfect time for us to strike. Washington is just too difficult to infiltrate. It is a fortress. But New Orleans? What can I say? It lives up to its name as The Big Easy for a terrorist attack.”
Ali stared at his brother but remained silent.
“Ali, the place is a sewer, and half-underwater. It cannot be secured. Besides, they’ll have a hard time figuring out if the virus is endemic to New Orleans.”
Nazir smirked to himself and continued, "They have so many bacterial and viral samples growing over there in Tulane’s lab, not to mention all that stuff they’re growing since Katrina, they’ll never detect us. Besides, we have hundreds of places where we can hide here, for years if needed."
Ali listened and nodded his head, but he was not in agreement with his brother's message.
"The time was right and the place perfect. Imagine the terror and fear it will cause in the hearts of Americans when we are successful so soon after Boston.” Nazir smiled and rubbed his hands together in anticipation of killing thousands of Americans, not to mention senior Congressional leadership and the President of the United States. “This mission will make 9/11 seem like child's play."
Ali was being stubborn. “I like New Orleans. I like our friends here and where we live. I have fun. I am happier here than I have been anywhere since we left home after our parents died. I like going to school at Tulane, too, and studying with Dr. Smith. I like being his lab rat, and he says he can get me financing for my PhD if I decide to continue my studies. He’s taught me a lot, and, in some ways, he has been helpful to our cause.”
Nazir’s face had darkened and he shook his younger brother violently until Ali’s teeth chattered and his dark curls danced in the sunlight. He gritted his teeth and barked at the slightly built young man in a hoarse voice, “Ali, for the last time, don't you remember that it was the Americans who killed our parents and all of our friends? It was their drone that killed them. These people are our enemy. We are here to KILL them, not become their friends, and help them in their labs. Do you get it, or do you need to go back to the Cadesus?”
Ali was shocked at his brother's words. “I get it. I get it, Nazir. I am sorry. Now let me go. I must get to work. My shift starts in less than an hour.” Ali pulled back and shuffled out of his brother's arms, terrified, but tried hard not to show it. He left his Marigny apartment, quickly walking toward Canal Street and Tulane Medical Center.
As Nazir watched his brother leave the house, he shook his head in exasperation. What could he do to make his brother understand their cause? Perhaps he was too young to remember the death of their parents.
Ali's heart was heavy on his way to work. He didn't like the business of hurting others, even though his parents had been killed. Hadn't the Taliban killed the parents of many American children during 9/11 attack? Weren't the Jihadist being just as destructive as the Americans had been over the years? He guessed his western education had made him question his supposed “mission.”.
He was startled when his phone sounded, signaling a text. The text was from Dr. Smith. It read, “ALI, CAN YOU COME ASAP? WE HAVE A VIRAL OUTBREAK IN ONE OF THE HOSPITALS. Tim.”
Ali quickly texted back, “I AM ON MY WAY. Ali.” He didn’t feel good about this at all. There was nothing about a viral outbreak that could be good for Nazir, Ali, or even Vadim, for that matter. At least, not today. He wondered what was up. His heart began to thud with anxiety. Things were just not right and that bothered him. It bothered him a great deal.
Chapter 3
Alex could hardly contain her excitement as she stared across the table at her dear friend and head of CCMC psychiatric services, Dr. Monique Desmonde. Monique was sitting quietly in her wheel chair, her shoulders surrounded by the big, beefy arm of Police Commander Jack Françoise. Only six weeks ago, Monique had been in a coma, having sustained a potentially terminal head injury when a psychotic CCMC employee attacked her with a lead pipe. But, that was six weeks ago, and Monique’s recovery was amazing. She was even better than last week when Alex had taken her to dinner and spent the evening with her while Jack was working.
Monique was alert and seemed almost normal. By her own admission, she was still a bit forgetful and knew she couldn’t return to her position as chief of psychiatry at the Pavilion, CCMC’s psychiatric facility for several more months, and frankly, that was fine with her. Her luxurious long dark hair was beginning to grow back from her craniotomy and her face was unblemished from the massive trauma she had sustained. She looked beautiful, happy, and content. Alex was thrilled with Monique’s progress and anxious to have her back full time at the hospital.
Jack was happy as well. The lines of worry, anxiety, and fatigue were temporarily erased from his face as he moved closer to protect Monique. In the background, Chef Henri, the executive chef of the Cajun Café, hovered to meet their every need. Henri loved to have Alex and her friends at the Café for lunch. Jack motioned to Chef Henri, who immediately appeared at the table.
“Commander, Dr. Monique, Alex, it is wonderful to have you back. Dr. Monique, you look very lovely. My heart is happy for you and the commander,” Henri gushed and continued, “No one would ever know you had been ill!” Henri’s sincere voice exuded warmth as he welcomed them to his café.
“Thank you, Henri,” Monique was gracious, but her speech was slow and focused, her smile a little crooked. “It is wonderful to see you, too,” she said in a halting voice. “I am so happy to be able to come in for lunch.”
Alex loved Henri’s subtle French accent and his long slender fingers, which could have been those of a great pianist. Instead, she could picture Henri slicing and dicing vegetables for his renowned French dishes.
Henri touched her shoulder warmly. “Dr. Monique, when will you return to work? We all miss you here.”
Monique appeared a little hesitant as she responded, “I don’t know for sure. I am still a little slow talking and remembering things. I hope by the end of the year.”
Jack glanced over and said, “Don’t worry, Henri, she will be back before you know it. Look at how well she has done and how quickly she has gotten better.”
Monique glared at Jack and said impatiently, "Jack, you know it may be a while. I won’t continue to get better as quickly as I have so far. I believe I still have quite a lot of work to do on my speech and ambulation, not to mention my memory. I cannot practice psychiatry without a short-term memory and who knows if that will ever come back.”
Although Monique was matter–of-fact, Alex could detect anxiety in her voice.
Alex nodded her head but was startled by Monique’s impatience. Prior to her injuries, Monique had been the most patient woman on earth, spending hours of time carefully listening to every word in group sessions of her acutely and chronically ill psychiatric patients. After listening to just one group session, Alex had wanted to shoot herself in the head.
“I know, honey,” the commander said with assurance, “but it won’t be that long. We’ll continue to work on it every day and we’ll get there."
Monique brightened a bit and nodded, “Sure we will, Jack, but just remember that it will take some time.”
Jack nodded and squeezed her hand in response.
Alex stared at the two of them and shook her head. “Wow, you all freak me out. Even now, I still have a hard time thinking of you guys as a couple. Remember, I had only known for several days when you got sick, Monique.”
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