Happy St. Patrick's Day. Have fun but do be safe if you go out.
Damon returns to his motel. Frustrated, he tosses his jacket on the bed, unbuttons his shirt, and plops down into a chair. He twists the cap off of the bottle of bourbon he picked up on his way and pours two fingers worth into a plastic cup. Bringing it to his lips, he savors the liquid in his mouth before swallowing it down.
"I can't believe that woman!" Damon mumbles to himself as he squeezes the glass tighter, cracking the rim.
They're like fire and gasoline and he fucking wants her.
Emptying his glass, he recaps the bottle, slips out of his shirt, and retreats to the bathroom to take a shower.
Arrayed on marker boards around the room are the names of more than 50 suspect germs and toxins: Legionella. Mycoplasma. Chlamydia. Rickettsia. Yersinia. Brucella. Ehrlichia. Influenza. Adenovirus. Herpes. Respiratory syncytial virus. Heavy metals. The pesticides paraquat and phosphene.
"At this time," Damon states, "there is a great degree of anxiety. We have a deadly illness, a large number of possibilities, and no clues," he looks at Elena, and gestures for her to join him.
"I'm Dr. Elena Gilbert," she starts. "Any known environmental toxins such as pesticides seem unlikely because all the victims have had high fevers. People who die of pesticides aren't usually febrile. Is it possible that this could be some new environmental menace?"
"Hemorrhagic fever is more likely but not a perfect fit either. I personally have never heard of a virus causing blood vessels to flood the lungs with serum," Damon adds, as he and the assembled group begin to go through the cases one by one, trying to match the symptoms to the possible causes.
So it goes on for three agonizing days and by the end of the conference, the group has narrowed the list to three possibilities:
1. An unrecognized type of hemorrhagic fever virus, an organism that causes illness marked by high fever and leaking blood vessels.
2. An atypical influenza.
3. An unrecognized environmental toxin.
"It's been productive in that we ruled out some things and came up with some other things to pursue. Thank you for arranging this conference." Elena approaches Damon.
"I'm just doing my job," Damon states dryly as he gestures for one of his colleagues to join them.
"This is Dr. Enzo St. John. He accompanied me to Africa during the most recent Ebola outbreak." Damon turns to Elena, "Have you ever seen a filovirus infection in a human being?"
"No, no, I haven't." Elena shakes her head.
"When you work with filoviruses, it's like working with pure plutonium. A single drop of blood can hold six billion...that's more filovirus than there are people in the world. You get a single one of those inside you, you're infected. Say you're lucky and it's one of the few filoviruses we have antiserum for. Then we can treat you and you'll probably live.
But say you're unlucky. And you get one of those filoviruses we don't have an antiserum for, which is most of them. There's no medicine, no cure, nothing we can do to help you. Your body gets so hot, your liver, your kidney, all your vital organs melt, and your skin turns into tapioca pudding," Damon explains as casually as if he was describing the common cold.
Elena stares in stunned silence for a moment, snapping out of it when Enzo speaks.
"We need to go to some of these victims' homes to look around. Maybe we'll get lucky?"
"You can't go now, it'll be dark by the time you get there. It's well over an hour's drive," Elena states, as she looks at Damon. She feels a shiver at the way his blue eyes bore into her.
"I'm going back to my motel room if that's the case. Meet here first thing in the morning?" Enzo asks as he catches a nod from Damon. "It was nice meeting you, Dr. Gilbert," he shakes her hand and walks out.
"Damon, about the other nig..." the words die on Elena's lips when she's paged overhead to go to the emergency room stat.
"Mask up, Dr. Gilbert," Pete the ER physician cautions as Elena approaches the patient. She nods, slips one on along with a gown and gloves. Damon comes up behind her and quickly grabs PPE, too.
"Fever since last night, chills, flu symptoms but he developed shortness of breath today. His labs show acute renal failure and his chest x-ray looks the others." He points to it on the screen while his team takes care of the man.
"Did any family come with him?"
"Yes, they're in the waiting room," one of the nurses informs Elena.
She notices the cyanosis around his mouth and his nailbeds. "He's 80% on 15L of O's, we need to intubate." Elena takes the laryngoscope and moves to the head of the bed. As soon as the nurse injects a dose of Etomidate. Once she has the patient tubed, she tells the respiratory therapist, Matt to set the machine to deliver the required tidal volume and to adjust the machine to deliver a concentration of oxygen to maintain a normal PaO2.
"Get him an ICU bed," Elena tells Dr. Pete before stepping over to the sink to discard her PPE and wash her hands.
"Can we talk to his family?" Damon washes up when Elena steps away from the sink.
"Yes, this way." Elena leads him out of the emergency department and into the waiting area where they ask for Mr. Cook's family.
"I'm Dr. Gilbert and this is Dr. Salvatore from the CDC. We'd like to ask you a few questions."
"Yes, anything to help Tripp. I'm Ivy, his wife. How is he?" she asks anxiously.
"He'll be going to an intensive care bed. We did put him on a ventilator. He was working too hard to breathe."
"Is he going to be alright?" Ivy asks, concern etched on her features.
"I can't predict that Mrs. Cook. But I can tell you that we'll do everything in our power to help him."
"Okay...you said you had some questions?" she asks as she knots her hands on her lap.
"Yes and I'm going to let Dr. Salvatore in here because this is his area of expertise."
"Do you know if he's been around anything, chemicals, animals, other sick people?" Damon asks as he takes a seat adjacent to the woman.
"Not that I'm aware of. We live on a 200 acre about 40 miles from here," Ivy elucidates.
"Mrs. Cook," Damon queries, "would you consent to me bringing my team out there to look around?"
"Yes, of course. Do you think you'll find something?"
"We don't know yet what's causing this," Elena starts. "We're leaning towards some new strain of flu or environment toxin. Damon, I mean Dr. Salvatore, and his team may be able to identify the pathogen."
"Dr. Gilbert's right. We have a trailer that's filled with state-of-the-art equipment. I don't want you to be shocked when we start looking around with our spacesuits on," Damon explains.
"Should I stay with our daughter?" Ivy looks at Elena confused.
"I'm going to defer to Dr. Salvatore on that."
"Look, Mrs. Cook, we don't even know where your husband came in contact with whatever is causing this illness. However, if you would feel safer with your daughter, that's where you should stay."
Ivy shakes her head no. "I have to feed our animals. I'll stay inside as much as possible."
"Okay but if you feel sick at all, don't hesitate to contact your doctor," Elena tells her firmly.
"Thank you for your help. My place is down on Highway 602 about 30 miles from here. The mailbox is on the right side of the road, our name is on it."
"Thank you, Mrs. Cook. Do we have your permission to look around if you're not there?" Damon asks, steepling his fingers as he looks at her.
"Yes, but I'll try to be home..." she halts her words when a nurse approaches.
"Excuse me, I just wanted to let you know you're husband is in ICU bed five. I'll take you to him."
Ivy nods and follows after the nurse.
"I'm going to go up, too. I'll see you tomorrow?" Elena asks as she draws her lower lip into her mouth.
"I'll be in touch," Damon states and with a nod, he walks out of the sliding doors...
Throwing up a storm of dust as the helicopter sweeps down to the ground on the perimeter of the ranch, Damon, dressed in his BL-4 safety suit stands by the door, ready to hop out as soon as the chopper puts down. As he observes the landscape, his thoughts drift.
Captain Fell has to shout over the sound of the chopper blades. ready to get out as soon as the chopper puts down. "Lt. Parker, if you fail to observe strict decontamination protocol, three things can happen. First, you can be court-martialed. Second, you can die from this horrible disease. Third and worst of all, you will incur my displeasure. You got it?"
"Yes, sir," Parker replies.
"If one of us gets sick, we all get sick," Damon turns to Captain Fell, "And I didn't come here to die," he adds just as he hops out of the chopper.
There are burning huts juxtaposed against the U.S. Army choppers disgorging the U.S. Army and CDC Infectious Disease Teams - blue space-suited figures with the U.S. flag emblazoned on their arms and helmets.
A medicine man remains high on the cliff above the village, chanting and wailing, burning an offering to the gods.
The team approaches the village through the smoky haze, and he sees two different worlds juxtaposed - men in spacesuits and a man in a loincloth. Damon, followed by Fell and Parker moves across the village which now looks devastated and deserted except for a few remaining huts and a small cinder block building up an old van, marked with a red cross.
Damon walks slower taking everything in, appalled at what he sees. His team enters the cinder block hut. A slender, bespectacled black man in his late forties- Dr. Ilunga- head of the Congo Infectious Disease Heath Agency - and his nurse, protected only by a smock, a surgical mask, and gloves, gives comfort to a young woman who's dying.
"Doctor Ilunga? We brought blood, plasma."
"You're too late." He looks at the group.
"We came as soon as we could," Damon responds but there's really nothing he can say to make this any better.
"It wouldn't have mattered anyway. This one is different - worse than Lassa, worse even than Ebola Sudan. It strikes and kills so fast. The young, the healthy, everybody," the doctor informs them.
"Who was the index case?" Damon asks.
"A young villager."
Damon locks eyes with Dr. Ilunga, "Do you know how he got it? The host?"
"We don't know. He died three days ago."
Lt. Parker moves ahead to the next bed and pulls aside the thin mosquito curtain to inspect the patient. Damon is right behind him.
The corpse's eyes are yellow and his flesh, speckled with hemorrhages, looks like pulp. Blood oozes from his nose and his nipples. Damon turns away in horror.
Parker retches. "I'm going to be sick!" He starts to rip off his mask but Damon grabs his arms.
"Keep your helmet on, Goddamnit."
"I can't breathe," he croaks and vomits in his helmet. Lt. Parker rips it off and rushes out, followed quickly by Damon and Captain Fell.
"Put him in quarantine. Now!"
"You don't need to," Dr. Ilunga says calmly.
"Why?" Damon asks, perplexed.
Dr. Ilunga looks at him. "It's not spread in the air."
"How can you know that?"
"There's no cough. Or we'd all be dead. For days we've been working with only these masks. They can't keep out a particle as small as a virus."
"Alright, that makes sense. Could any infected person have left this village and spread it?"
"The incubation period is only one or two days. The mortality is one hundred percent."
"Dr. Salvatore, we've landed," the pilot yells so Damon can hear over the choppy sound of the helicopter blades.
Damon hops out. He approaches the mobile lab where he finds Enzo.
"Finding the host is the only way to control the spread. Our only hope is that this is like most viruses and that it has to live in a host, an animal, to which it's adapted over thousands of years. And that animal host has developed antibodies to protect itself against the virus. If we can identify that animal host, and harvest its antibodies, we can use them to fight the disease in humans," Damon states matter-of-factly.
"There are hundreds of native species of animals and insects in this area," Enzo points out.
"Like always, we have our work cut out for us. Let's get busy." Damon picks up the necessary equipment to collect specimens from the property.
Kirtland Air Force Base. Albuquerque, New Mexico.
Damon's walking briskly down the main corridor. Two M-16 toting security guards salute as he passes by. He reaches six-inch thick metal doors, closed tight. He slides his ID card into the optical reader.
The computer screen above it prints out the words, "Dr. Damon Salvatore, CDC." A digitized voice booms from the wall speaker. Damon's going up in the elevator past the four floors of glassed-in laboratories. At the first level, workers wear civilian clothes. At the second level, they wear respirators. At the third level, they wear bodysuits, and at the fourth level, they wear biosafety suits.
Damon pulls a red air hose down from the ceiling and inflates his spacesuit before he puts it on; this is standard safety procedure. There's no sound other than the filtered air rushing in from a wall jet into the red tubing attached to the back of his helmet. They hang from the ceiling at ten-foot intervals.
He's standing under the negative pressure hood, opening one test tube after another, expertly withdrawing from each only a tiny sample of the virus, then putting it into larger test tubes. When he finishes, he places each in a clear plexiglass container which is contained within a large plexiglass container, each with its own combination lock. Damon twirls the tumblers and they lock into place.
When he finishes for the day, Damon showers and slips into his clothes, and follows Enzo outside.
"Chopper's waiting to take us back to Gallup." Enzo points at the pilot who's hopping in.
And back to Dr. Gilbert... Damon muses. "Let's go," he nods and follows Enzo to the landing pad...
I do not know if Kirtland AFB has a bio lab but for the purposes of this story, it does.
The partial pressure of oxygen, also known as PaO2, is a measurement of oxygen pressure in arterial blood. It reflects how well oxygen is able to move from the lungs to the blood. It is often altered by severe illnesses.
filovirus: a filamentous RNA virus of a genus that causes severe hemorrhagic fevers in humans and primates, and which includes the Ebola and Marburg viruses.
There are four types of Ebola that affect humans. These strains are called Ebola Zaire, Sudan, Bundibugyo, and Mayinga. There is also a strain called Ebola Reston that only affects non-human primates. Ebola Zaire is the deadliest strain of Ebola. It was founded in The Democratic Republic of the Congo in 1976, killing nearly 88% of all its victims.
Thank you all. The DE fanbase is the best.
Thank you, Eva.
Take care and have a wonderful day. We'll see you next week.
