Peyton listened intently to the story of a county that was making its best effort to improve the situation for its people. The outbreak had come at the worst time.
The convoy stopped at Mandera Referral Hospital, which was centrally located. Two bus stops were nearby, as were the town hall and post office. The facility itself was a collection of run-down single-story buildings connected by breezeways. A wooden sign painted blue with white letters hung over the courtyard entrance.
The Kenyan Ministry of Health had sent in a team shortly after the outbreak was reported, and they had brought with them a military escort to protect their team from al-Shabaab terrorists and to prevent local residents from entering the hot zone. From the looks of it, the Kenyans had done an excellent job: army troops in PPE patrolled the perimeter, assault rifles at their sides. To Peyton, the place looked more like a prison than a hospital, but she knew this was for the best, as it would keep the uninfected far away.
The Kenyans had set up a tent complex just outside the hospital, and Peyton and Jonas made their way there. At a long folding table, the head of the Kenyan Ministry of Health’s mission, Nia Okeke, gave her report. She was a little older than Peyton, her black hair slightly graying at her temples. She spoke without emotion, describing the situation succinctly.
Peyton was impressed with how much the Kenyans had done in such a short amount of time. On whiteboards that lined the walls of the tent, contact trees spread out in blue and red ink. Maps were marked. Numbers were tallied with times beside them.
When Nia finished her briefing, Peyton asked to see Lucas Turner.
“Of course. And there is someone else I believe you should also speak with,” Nia said.
Peyton suited up, doused her PPE with chlorine, and headed toward the hospital. Jonas was close behind her, as was Hannah Watson, a physician and first-year EIS agent. Peyton had never worked with Hannah during a deployment, but in reviewing her file, she had learned that the young physician hoped to work as a field epidemiologist for the CDC after her EIS fellowship.
Peyton didn’t envy what Hannah was about to go through. She could remember her first deployment similar to Mandera; she figured every field epidemiologist did. But it had to be done: Hannah had to learn, and reading and classroom instruction could only take her so far. She needed field experience, and Mandera was the perfect opportunity.
Peyton allowed Jonas to enter the hospital ahead of them.
“You clear on what you’re doing?” Peyton asked Hannah, who held a refrigerated box at her right side.
The young physician nodded. Through the clear plastic goggles, Peyton could already see the drops of sweat forming on her strawberry-blond eyebrows.
“If you get too hot or need a second, just walk outside and breathe. If you need to take a break, don’t hesitate. There’s nothing wrong with stepping back for a minute.”
Hannah nodded again, and Peyton thought she saw some of the tension drain out of the young physician. She hoped so.
Inside the suit, Hannah could feel her entire body starting to sweat. It felt twice as hot inside the hospital as it had outside.
Nia led the three of them—Peyton, Jonas, and Hannah—to a large room where at least forty patients lay on mats, blankets, and pillows on the floor. Hannah felt her pulse accelerate. She had seen pictures of Ebola treatment units, but they hadn’t prepared her for this moment. Time seemed to stand still as every detail leapt out at her. Plastic buckets labeled for vomit, feces, and urine lined the narrow walkways between the makeshift beds. Empty bottles of ORS were strewn across the floor. The buzzing ceiling fans fought a futile battle with the heat that seeped through the closed windows and rose from the bodies on the floor. Jaundiced eyes turned to stare at the newcomers.
With each step the thin rubber suit seemed to collapse in upon Hannah like a plastic bag whose air was being sucked out. The sensation of the PPE clinging to her sweaty forearms and thighs only reminded her that the thin layer was all that separated her from the pathogen that was killing these people. Any break, even the smallest tear, could let the pathogen in. She could be infected, relegated to fighting for her life in this place.
She could hear her own breathing inside the suit. Outside, she heard the moans and crying of the patients. But amid the sounds of agony, a beautiful sound cut through: singing. Groups in clumps performed church hymns and folk songs. The contrast of pain and beauty and courage was inspiring—and unnerving.
The box Hannah carried had seemed light at first. Now it felt like an anvil. She set it down next to a young woman lying in the corner.
“I’m Dr. Hannah Watson. I’m with the CDC. I need to take a small sample of your blood for testing.”
The woman slowly opened her yellow, bloodshot eyes but said nothing. A black fly landed on her face, causing her to turn her head, sending the insect back into the air.
Hannah drew out the ReEBOV test kit, took a drop of blood from the woman’s finger, and placed a small bandage over the place she had pricked. She slipped the sample in the cooler and lifted the bottle of ORS by the woman’s side. It was half full.
“How many bottles have you been drinking per day?” Hannah asked.
The woman just shook her head.
“You need to stay hydrated. Can I get you anything else?”
After a labored breath, the woman said, “No, Doctor. Thank you.”
Glancing around, Hannah noticed that on one wall someone had written the letters A through F to mark the rows, and along another wall, the numbers one through twelve marked the columns. She made a mental note that A1 was not taking enough fluids and that she had no other requests.
She took out another test kit, lifted the cooler, and moved to A2.
Twenty minutes later, Hannah exited the hospital. She was so hot she felt like clawing the PPE off. It clung to her sweaty skin, a hot plastic film that felt like it was melting onto her. But Dr. Shaw’s warning was fresh in her mind. She took her time doffing the suit, then hurried into the tent where an EIS agent was testing her samples from row A.
The agent looked up. “All negative for Ebola.”
Hannah nodded. Dr. Shaw had told her to expect that. But even though the Kenyans had already tested the patients and found them negative for Ebola, the prudent course of action had been to run their own tests with kits from another manufacturing batch, just to be sure.
Hannah also knew that Dr. Shaw had likely planned this as part of her training. Hannah would be testing more patients in the field soon, in the villages around Mandera. She’d be on her own. And she was thankful for the opportunity to learn the procedure here, where she had help close by.
Nia led Jonas and Peyton to the back corner of the large treatment room, where a middle-aged man was propped against the yellowing plaster wall. His eyes were closed, and he wore a sweat-soaked tank top. A folded white coat lay by his side.
“Doctors Shaw and Becker, this is Dr. Elim Kibet, Chief of Physicians here at Mandera.”
Dr. Kibet opened his eyes, looked up at his visitors, and wiped the sweat from his forehead. He smiled weakly. “In the interest of full disclosure, I was the only physician here at Mandera.” He focused on Peyton. “We did everything we could for the young Americans. I’m sorry. It was not much.”
Peyton squatted down, bringing herself close to eye level with the doctor.
“All of us appreciate your efforts, Dr. Kibet. The CDC, the American government, and especially those boys’ parents.”
Dr. Kibet reached under the white coat and brought out a spiral-bound notebook. He handed it to Peyton.
“Before the ministry arrived, I talked at length with Mr. Turner.”
Peyton ensured her gloves were dry, then flipped through the notebook, scanning the ruled pages filled with neat handwriting. Dr. Kibet had been extremely thorough. Peyton hoped his notes might contain a clue that would lead them to the index case.
“Thank you, Doctor,” she said. She looked up at Nia, who was studying her intently
. Peyton got the impression there was something more going on here, but she wasn’t sure what.
“Are you ready to see Mr. Turner?” the Kenyan woman asked.
Inside the orange Tyvek suit, Peyton felt as though the temperature had suddenly increased five degrees. She was aware of her breath, and of the weight of the decision she would soon have to make. It was a call that could determine the fate of the young man—and possibly millions of others.
Chapter 23
Lucas Turner felt like he had been in the hospital room in Mandera for years. He knew it had only been a few days, but those days had been the longest of his twenty-three years on Earth.
The disease had started with a pain in his neck, and a fever. He had felt fine otherwise. But a few hours later, his body was turning itself inside out. He vomited nearly everything he ate. The diarrhea emptied his bowels the moment any morsel reached them, then reached for more, like a hose sucking his insides out.
He was weak and constantly tired. It was impossible to concentrate. He drifted in and out of sleep, never knowing if it would be night or day when he awoke. He drank the rehydration salts, which grew more heinous with each bottle. He had no appetite, but at Dr. Kibet’s insistence, he forced himself to eat. He dreaded it; he knew his body would reject the nourishment in some way. He felt like he was fighting a losing battle, his own body now set against him.
The smell of chlorine in the small room was overpowering. Dr. Kibet had left several paperback novels and a Bible by his bed, but he couldn’t muster the energy to read them, despite his boredom. His thoughts were of his parents and his sister. They would be devastated. At one point he wished he had never come to Africa; he cursed himself for being so naive. Dreamers die foolish deaths. He was instantly ashamed of the thought. He refused to live his life that way—with regret, second-guessing himself. He had followed his dream, it had led here, and that was that. Life is uncertain; in the end we control only a single thing: our own thoughts. He set his mind to controlling those thoughts. He would stay positive, even if it was his fate to die here, in this place.
At some point, when exactly he didn’t know, Dr. Kibet stopped coming to his room. There were new personnel, in better containment suits. They were extremely cautious with him. Unlike Dr. Kibet, they asked him no questions and never stayed in the room a second longer than they had to. Dr. Kibet had treated him like a human being. These people treated him with clinical detachment.
The sun was setting. Through the narrow window, Lucas saw a group of the new personnel gathered around a bonfire, tossing their suits upon the blaze. The fire belched heavy black smoke, releasing plumes as more rubber shells were piled onto the inferno. He turned to the small mirror on the wall, which reflected bloodshot, watering eyes and pale skin. It was the face of a stranger. A monster.
With Jonas close behind her, Peyton followed Nia into Lucas Turner’s patient room. Lucas was asleep, and Peyton hated to wake him, but it had to be done. The clock was ticking—and they needed answers if they were to have any chance of stopping the pathogen’s spread.
Nia reached out to shake the young man, but Peyton placed her hand on the woman’s shoulder and moved in front of her. She sat on the edge of the bed, clasped Lucas’s hand, and gently shook his forearm and said his name until his yellow-tinted, bloodshot eyes opened. Peyton forced a smile. Seeing this young American in the prime of his life so sick broke her heart. He had come here to try to make the world a better place. And that path had led him here—to this room, where he was dying.
Lucas looked down at her hand holding his, seeming surprised that she was touching him. Peyton knew he was scared and had probably been treated with an abundance of caution—and rightly so. Still, it always amazed her how humanizing a touch could be. Seeing the hope that formed in his eyes at that moment made her proud of the work that she did—and more sure than ever that she was exactly where she was supposed to be, doing what she was meant to do.
She leaned closer and spoke softly.
“Lucas, can you hear me?”
He nodded.
“My name is Peyton Shaw. I’m a doctor with the CDC. We’re going to do everything we can to help you, okay?”
“Thank you,” Lucas said. The words were barely audible.
Peyton picked up the bottle of ORS from the side table. “Drink a little. I know it tastes bad.” She held it to his mouth, and Lucas drank, wincing slightly.
She set the bottle back on the table and waited for him to swallow.
“I read in Dr. Kibet’s notes that Steven got sick about seven days ago. Can you tell me where you all were then?”
Lucas closed his eyes, trying to think. He shook his head. “I’m sorry. The days run together.”
“That’s okay. Can you remember the last time you two were healthy? Maybe a time when you were happy?”
A moment later, he said, “Mount Kenya. In the park.”
“What happened there? Did you come into contact with any animals? A bat? Maybe a monkey?”
“No.” He paused. “No, definitely not. It was our last stop before going to the villages.” He smiled. “We had barbecue. And beer.”
Peyton bunched her eyebrows up. “A local barbecue? What kind of meat was it?”
“No. North Carolina barbecue. From home. And local beer. Brewed in Raleigh.”
“How?”
“A package from a sponsor.”
“A sponsor?”
“Icarus Capital. Desmond Hughes. He’s on our board.”
Peyton stopped cold. The idea that Desmond could be involved both shocked and scared her. She was reminded of his words from the call. I think you’re in danger.
She tried to keep her voice even. “Was anything else in the package?”
“Yeah, the food was just an extra. Mainly he was shipping us our video cameras. We had decided not to bring them in our airport luggage in case they got stolen along the way—plus we didn’t want to have to lug them around until we were ready to go into the villages. We weren’t even sure how many we needed. Desmond offered to ship them to us when we reached Mount Kenya. He sent the package to the lodge where we were camping. The barbecue and beer was unexpected. Desmond’s note said good luck, and here’s a taste of home.”
“That was it?” Peyton asked. “Cameras, barbecue, and beer?”
“Yeah.”
Lucas held a shaky hand up and massaged his throat. Peyton again brought the ORS bottle to his lips and let him drink a bit.
“How was Desmond Hughes involved in your company?”
“He’s an investor,” Lucas said, his voice a little clearer. “We only met him a few times. He’s a technology investor and philanthropist. Kind of intense. Really smart. Into some crazy stuff.”
“Like what?”
“Change-the-world type projects. Everything from AI to medical research to quantum physics. He said the only thing humanity hasn’t upgraded is itself. He thinks it’s time. He said the next version would be a quantum leap forward. He was even using himself as a guinea pig.”
“Why was he interested in CityForge?”
“He said building better cities was the third world’s only chance.”
“Chance of what?”
“Surviving.”
That got Peyton’s attention. “Surviving?”
“His words, not mine. He believes if the third world doesn’t catch up to the rest of the world, there will be a major catastrophe—an extinction-level event. He said that’s why our work is so important.”
“Interesting,” Peyton said. “Why does he think that?”
“The absence of space junk.”
“Space junk?”
“Probes from other civilizations. This was over dinner, so maybe he was drunk.” Lucas thought for a moment. “Actually, I don’t think he was drinking. Anyway, he said that the most disturbing revelation in human history is the existence of two seemingly impossible facts: one, that the universe is billions of years old; and two, that the moon is not covered
with wrecked space probes from other advanced civilizations that came before us.”
Peyton was confused. “How is any of that related to an impending extinction-level event?”
“I don’t know. He said he and a small group of people knew the real truth about why there’s no space junk. He said they would soon test their theory. He was pretty cryptic about the whole thing, to be honest, and I guess we were sort of blown away by him, so we weren’t really asking a lot of questions. He’s kind of larger than life. And his check for $150,000 cleared, so, you know, we listened and nodded.” He paused. “Why all the questions about Desmond? Is he somehow connected to this? Is he sick?”
“Not that we’re aware of,” Peyton said, deep in thought.
“Was the food contaminated? Are people back in North Carolina infected?”
“No,” Peyton said. “We still believe this is an isolated outbreak. I’m just covering all the bases. Listen, you’ve been very helpful, Lucas. I’ll be right back, okay?”
Outside the hospital, Peyton, Jonas, and Nia washed off their suits and carefully doffed them. They entered the next tent, where Peyton pulled off her soaking T-shirt and toweled the sweat from her body. When she looked up, she saw Nia, standing naked as well, her body still coated in sweat, staring at her. Jonas was turned away, avoiding looking at the two women as he slipped on dry clothes.
“Are you going to administer ZMapp to Mr. Turner?” Nia asked. She stared at Peyton without blinking.
Peyton returned her stare. “Maybe.”
“I’d like doses for Dr. Kibet.”
In that moment, Peyton realized why the Kenyan Ministry of Health official had insisted she meet Dr. Kibet. It was already difficult to deny treatment to a person in need, and even harder when you had met the person.