The Cobra Event (9 page)

Dudley looked at her. “Fine. We have an unknown brain virus that caused a nosebleed. Is that what you’re trying to tell me?”

“This scares me. I’ve never seen anything like it. I want to section this brain,” she said.

“The brain’s a mess,” Dudley said.

“I want to try.”

“Go ahead.”

She dipped her knife in the water of the rinsing tank, to wet it and make it slippery. She laid the edge across the brain, in a coronal section, as if going from ear to ear, and she sliced downward crisply in a smooth motion. She sliced again and again, her knife moving quickly, making slices that were about the thickness of slices of bread.

The brain slimed apart. As her knife hit it, it slumped into a kind of glassy, red-gray mush. Austen ended up with a slippery jumble of bloody-wet brain tissue that seemed to gleam with a pearlescent color under the lights. It spread out in a soupy mess on the cutting board.

“You’ve ruined it!” Dudley said.

Austen said nothing. She was tempted to warn him to back off.

“You’ve turned the kid’s brain into roadkill!”

“I’m sorry, I’m doing my best.” She sliced through the deep brain structures. Again, the tissue almost melted under the knife. Inside the girl’s midbrain and pons medulla, she found what she was looking for: small weeping hemorrhages. These secondary weeping bleeds were areas of bloody discoloration, the result of tearing and crushing of the brain structures as the brain squeezed down upon them.

Ben Kly carried a glass jar over to the table. It was full of formalin. Using her knife as a paddle, she scraped and scooped the pulpy brain off the cutting board while Kly held the jar under it. The brain coddle plopped and splashed into the liquid, and floated in distorted fragments.

“Something destroyed the girl’s central nervous system,” she said.

The Chief

“
SO HOW DID IT GO
?” Lex Nathanson asked, half an hour later. Austen had found him in the death-reporting area, reviewing some new cases.

“It was bad,” she said. She had changed out of her scrubs and back into her street clothes, but she noticed—in a vague kind of way—that she smelled like Kate Moran. That would last for hours, unless she took a shower, and she did not have time for a shower.

They went into Nathanson’s office, and he slid open a drawer of his desk and took a cigar from a box and put it in his mouth, and then rummaged around for something. “Where in the hell is my cutter?” He held up a second cigar. “You want one?” he said.

Austen grinned. “No, thanks.”

“Yeah? You’re sure? These are twenty-buck cigars. If this vice of mine bothers you, please say so, okay?”

“It’s not a problem.”

He had found his cutter, and he notched the end of the cigar. He struck a wooden match, and, not holding the cigar in his mouth, but in his fingers, he toasted the end, rolling it gently in the match flame until the end of the cigar turned gray. “I’m afraid I am not an example to young people. Not only are these cigars a vice, but I have too much yellow abdominal fat. When they autopsy me—and I will insist on it—they will find a rat’s nest of problems, I’m sure. It is true that pathologists do not always learn from the lifestyle disasters they see on the autopsy table.” He drew on the cigar. A soft and mellow tobacco smoke infused the room. “Anyway, Winston Churchill smoked approximately sixty thousand cigars during his lifetime, and he lived to be ninety-one. Tell me what you found.”

Austen described the findings: blood blistering in the external openings of the body, including the mouth, nasopharynx, and eyelids. Golden streaky damage to the kidneys. Fatal brain swelling.

Nathanson looked at her quizzically. “Go on. Tell me about the C.N.S.” The central nervous system.

“The destruction was massive.”

“How so?” he asked.

“The brain was devastated.” She tried to summarize it. “The brain was puffed and swollen and had lost its physical integrity. It almost literally collapsed when I sectioned it. It had a shiny, glassy, reflective coloration that I’ve never seen before. The brain had turned into a kind of—how can I describe it?—like some kind of glassy pudding. She had a severe nosebleed, and she bit her tongue and mouth and lips very severely. She also showed signs of a common cold—streaming mucus exudate from the sinuses. There were golden pupillary rings in the irises of the eyes, with flamelike offshoots. It made the pupils look as if they were on fire. The total effect was—well—frightening. It made me think of a virus infection involving the central nervous system and possibly the tissues of the mouth and eyes and other openings of the body.”

“We don’t have the capability to test for a virus here.”

“You don’t have a lab for that?”

“No. We send biosamples over to the city health department’s lab. They test for
bacteria
. They don’t test for viruses.”

“We can do it,” Austen said. “May I send some samples down to C.D.C.?”

“Sure. Give them to Walt with my regards.” He gave her a sharp look. “How are you getting along with Glenn?”

Austen took a moment to reply, and she framed her answer carefully. “He’s straightforward in his views.”

“Boy—you’re quite a diplomat.” Nathanson drew on his cigar. “Glenn’s being a pain in the neck. If he gets to be too much of a pain, let me know and I’ll kick his ass for you. But I imagine you can handle yourself, Dr. Austen.”

She nodded and said nothing.

He went on, “Glenn’s having a bad time in his personal life. His wife recently left him. She took the children with her. He had been having an affair with a younger woman. But Glenn is a colleague and a valued member of my staff.”

“Of course.”

“Do you want to continue with this investigation?”

“Yes, I do.”

“Really, I don’t want to impose on you. I could turn this over to the health department.”

“You’re not imposing on me, Dr. Nathanson.”

He smiled broadly. “All right, enough of this ‘my dear Alphonse.’ Whaddaya need?”

“Well—I’d like to look at all your recent case files.”

“Sure. What else?”

“I’ll need a telephone. Also a map of New York City.”

There was a pause while he smoked his cigar. “That’s all you need?”

“Epi work is pretty simple,” she said. She looked out the window of his office. There wasn’t much to see, only the brick wall of the next building, but she observed that it had begun to rain. “I forgot to bring a raincoat.”

“I’ll get you one of our slickers. And you’ll need an office, won’t you?”

“I guess so.”

THEY GAVE HER
a tiny office, almost a closet, on the third floor. Someone brought her a bright yellow rain slicker. Across the back in black letters it said, “
OFFICE OF CHIEF MEDICAL EXAMINER
.” It was a disaster raincoat, meant for protecting workers from blood and body fluid splashed around a disaster site, as well as from rain. It smelled of sweat.

The room was the office of a staff pathologist, a woman who was away on maternity leave. The office’s one window looked out on the blank wall of a parking garage some feet away. It was a nicer room than her digs in the C.D.C., anyway. She wondered why epidemiologists inhabited the world’s worst offices. She taped a map of New York City to the wall. With a pencil she marked an X on the map: at the location of the Mater School on Seventy-ninth Street, where Kate Moran had died. She marked another X on Times Square, where Harmonica Man had collapsed. The marks showed the
location
of death. They did not show where the victims had been exposed. If indeed they had been exposed to anything. If this was an outbreak of an infectious disease or a rash of poisoning, Harmonica Man was the first identified case. He was therefore what was known as the index case. Kate Moran, who died less than a week later, was the second case. There was no obvious connection between the two cases. It was not necessary for Austen to know what had killed them in order for her to begin an investigation. As Dr. John Snow knew, epidemiology can proceed without any knowledge of the nature of the disease-causing agent.

Deeper

KATE MORAN’S TISSUES
were being processed in the O.C.M.E. histology lab, and they would not be ready for viewing for about a day. In the meantime, Harmonica Man’s tissues could be examined, and Austen called for samples, giving the case number to a technician. “Those slides have been checked out by Dr. Dudley,” he said. So she went down to Glenn Dudley’s office on the third floor and found Dudley sitting at a small table, staring into the eyepieces of a doubleheaded microscope. This is a microscope with two sets of binocular eyepieces, so that two people can look at a specimen at the same time.

“What do you want?” Dudley said without looking up.

“I wanted to take a look at the tissues of the first case.”

He grunted and kept staring into his microscope.

Austen sat down across from Dudley, facing him, and looked into the other set of binocular eyepieces. She saw a field of brain cells. It was a thin slice of Harmonica Man’s brain tissue.

“It’s from the underside of the temporal lobe,” Dudley said. “The area of the hippocampus. It seems damaged.”

She let her gaze relax. She wandered through fields of cells. She saw threadlike neurons, which are the nerve cells that send signals in the brain. She saw other types of brain cells, and she saw white matter, which is a fatty substance in the brain. She came to a damaged area, where she began finding red blood cells. “I think I’m getting into a bleeding spot.”

“Nothing else? Okay, I’m zooming.”

The scene jumped. The cells were magnified more strongly. “Look at these cells,” he said. “Zooming again.” The scene jumped forward. They were on a voyage, running deep into the brain of Harmonica Man.

There was something wrong with the cells. A neuron, a nerve cell, is a long thread with branches. Somewhere in the middle of the thread there is a bulge. Inside the bulge there is a dot. The dot is the cell’s nucleus, where the cell’s genetic material is stored, its DNA. The nucleus of a cell looks like the yolk of a fried egg. It contains the chromosomes, which are pods of coiled protein that hold the cell’s DNA intact. Austen did not like the way these brain-cell nuclei looked.

“The cell nuclei are abnormal,” she said. “Would you zoom again, please?”

The scene jumped. The nuclei were bigger.

“That’s the highest magnification,” Dudley said.

It was hard to know what you were looking at. Life at the cellular level is complicated. There seemed to be structure in the cell nuclei—structure that didn’t belong there. Then she saw something. It was something she had never seen before, not even in a textbook. There were
objects
sitting in the cell nucleus.
Things
. Maybe this was something normal. Maybe the stain in the cells had brought out some feature that was explainable. It was hard to tell.

“What is this, Dr. Dudley?”

He grunted. He didn’t have any answers either.

The objects in the nucleus were shiny, glittery, angular crystals. They had a mathematical shape. They were bulging with many facets, like angular soccer balls. They were far too large to be virus particles. Virus particles are invisible in a regular microscope.

The light broke apart in the crystals and seemed to shimmer.

“This is like nothing I’ve ever seen before, Dr. Dudley,” Austen said.

“It’s weird,” Dudley replied, sounding unsure of himself. “This must be some kind of chemical compound. There’s some new drug hitting the street.”

“Maybe these crystals are lumps of virus in a crystallized form,” Austen said.

“Lumps!
Lumps of virus
. Don’t be an idiot,” he snapped. And he continued to stare into the microscope in silence.

Union Square

A COOL AND GENTLE
April rain was passing over New York City. Alice Austen stared out the window of her office at the O.C.M.E., watching water run down the blank wall. Then she put on the yellow disaster raincoat, shouldered her knapsack, and took a taxi to Union Square.

A television van from Fox Channel 5 was double-parked on the street in front of the Morans’ building. A young woman reporter spotted Austen’s yellow raincoat as she rang the buzzer. “You’re from the medical examiner’s office? What happened to Kate Moran? Was she poisoned? Was it a murder? Can you tell us anything?” Behind her trailed a video man.

“I’m sorry, but you’ll have to talk to the chief medical examiner,” Austen said. The buzzer sounded, and she slipped inside.

The girl’s parents, Jim and Eunice Moran, sat holding each other’s hands on a couch in the living room. They seemed devastated. A large black-and-white photograph in a steel frame—a portrait of Eunice Moran by Robert Mapplethorpe—leaned against the wall across from the couch. In the photograph Mrs. Moran was wearing a soft white wool turtleneck sweater, and she looked thoughtful and elegant. In real life she was haggard, her eyes red from crying.

The housekeeper, an older Irish woman, retired to the kitchen, her footsteps padding on the oak floor. Austen heard sounds of her weeping.

Austen knew that people who are in the throes of grief can have unpredictable reactions to an epidemiologist asking questions, and she very gently identified herself as a doctor with the Centers for Disease Control in Atlanta, working with the city medical examiner’s office. When Kate’s parents understood that Austen had been dispatched to New York to investigate the death of their daughter, they spoke freely with her. The conversation was difficult, because at times Jim and Eunice Moran lost their ability to speak. Kate had been an only child. The parents’ life stretched ahead of them into a future that was more empty than they could have imagined.

They knew there had been an autopsy—in a case of sudden unexpected death an autopsy is required by law, and they had been notified. Austen chose not to tell them that she had performed the autopsy. “Your daughter’s body was released to the funeral home an hour ago,” she said. “However, because of the risk of possible infection, the city has ordered a cremation. The funeral home was instructed to take universal biohazard precautions. I called them myself and spoke with them, and they know how to do that.”