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clear ventilator tubing that passes between his chapped lips, indicating that his blood-clotting system is failing as badly as or worse than the rest of his organs.

Dr. Edwin Davis stands close enough for Lisa to pick up on the floral scent of his shampoo. Unlike their previous encounter, the veteran intensivist no longer seems fazed. “Zeke arrived at the ER about six this morning,” he says dispassionately. “He had a headache and a fever, but he was conscious and alert. Within half an hour, his blood pressure plummeted, and he went into full septic shock. He’s barely hung on since.”

Lisa’s gaze drifts to the gobs of blood flickering inside the ventilatory tube with each forced mechanical breath in and out of Zeke’s lungs. “Can he survive this?”

“Used to be, I had a sixth sense for who was likely to make it out of here. But with this meningitis?” Edwin’s shoulders twitch. “We’re averaging almost fifty percent mortality among the first twenty cases.”

“Similar to Iceland’s experience.”

“Deadly similar,” he says with a note of defeat.

“Does the speed of onset and/or progression of symptoms matter?”

“The quicker they go into septic shock, the worse it is. But every one of them gets so sick so fast with this infection, even that’s hard to tell.”

Lisa goes cold with the morbid realization that if Zeke dies, the death toll for this outbreak will reach double digits. “I understand he got antibiotics almost as soon as he got to the ER,” she says. “Maybe the ultra-early administration will make a difference?”

“These patients just can’t seem to survive long enough to give the antibiotics a chance to work.”

“Even more reason to vaccinate.”

“With what? The available ones don’t work.”

Lisa nods, biting back her frustration. She thinks of her meeting with the representatives from Delaware Pharmaceuticals. They might not be ready to distribute Neissovax in Seattle, but as she stares down at Zeke’s ashen face, she realizes the city might be literally dying for access to it.

“You have to choke off the source, Lisa.”

“We hoped we had. We’ve tracked down every attendee of that camp. We’ve started all of them on prophylactic antibiotics. And we’ve covered as many of their household contacts as we’ve been able to reach.”

He motions to the patient. “Then how do you explain this?”

“Zeke is a piano teacher for the Mitchell family.”

“As in Noah Mitchell?”

“Yes, the third victim,” Lisa says of one of the patients who was lucky enough to survive the infection and has already been discharged from the ICU. “Zeke gave Noah a piano lesson the day he got back from camp.”

“A piano lesson? That was enough for this thing to spread into the community?”

“Apparently,” she mumbles, struck again by the relatively casual nature of the contact.

Edwin opens his mouth to reply, but he’s cut off by the shrill wail from the overhead monitor.

Lisa’s eyes dart to the chaotic squiggly line running across the screen, signaling ventricular fibrillation.

Edwin shoots a gloved hand up to Zeke’s neck. “No pulse!”

Lisa reacts instinctively. She lunges forward and clamps her interlocking palms onto Zeke’s breastbone. She rhythmically pumps her arms, aiming for a hundred thrusts per minute, feeling the rubbery spring of his chest with each compression.

Other staff members flood into the room. A woman nudges Lisa out of the way and assumes the role of chest compressions. Lisa steps back and presses herself against the wall to make space for the expanding team.

Edwin directs the others with concise words and gestures as each person occupies a space without being told where to go. Soon Zeke is surrounded. Defibrillator conducting pads are slapped to his chest on either side of the hands of the woman performing CPR, without her breaking her rhythm.

“Shock at two hundred joules!” Edwin orders.

As soon as the woman’s hands are free of the chest, another nurse presses defibrillator paddles to the pads on Zeke’s chest. “All clear!” she cries. With a quick scan to establish no one else will be in contact with the current, she depresses both red buttons on the paddles’ handles.

Zeke’s body jerks from the shock. But after a moment, the tracing line on the monitor reverts to its helter-skelter course. “Resume CPR!” Edwin says.

A husky man wordlessly takes over, compressing Zeke’s chest even deeper than the woman had.

“One milligram of epinephrine push,” Edwin orders. “And three hundred milligrams of amiodarone.”

A nurse injects medications through the syringe into the intravenous line in Zeke’s neck while another holds a second loaded syringe out ready for her.

Someone else calls, “Two minutes!”

The CPR is paused while Zeke is shocked again. But the jerky tracing on the monitor refuses to budge from that of ventricular fibrillation.

More shocks are applied. More meds ordered. The CPR is never stopped for more than seconds at a time.

Lisa silently admires the calm choreographed dance of the attempted resuscitation. But none of the interventions make a difference.

She feels it in her bones. Zeke is already gone.

CHAPTER 14

It’s hard to remember how many times this experiment has been repeated over the past six months. But practice makes perfect, and in this case, perfect is a necessity. Especially, since the next time, it won’t be a dry run.

The powder floats briefly on the surface but then begins to dissolve with a minimal shake of the vial. Soon, the clear liquid inside the vial rolls smoothly back and forth. Nothing precipitates out, no matter how hard it’s shaken. It could pass for water. It looks identical to the other vials.

Perfection in a bottle.

CHAPTER 15

It’s been a good streak by Pacific Northwest standards, Lisa thinks as raindrops spit across her windshield. It hasn’t rained for over two weeks, which isn’t that unusual for August. Unlike the rest of the year, when a week without precipitation in Seattle would be newsworthy, the summer often brings protracted dry spells. Still, Lisa’s mood reflects the charcoal skies above. It’s been a while since anyone died in front of her eyes, which is disturbing enough, but Zeke’s case also represents

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