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keep her blood pressure up.”

“What are you treating her with?”

“The kitchen sink. Three of the most potent antibiotics available for the infection. Multiple cardiac meds to support her blood pressure.”

Lisa glimpses the displays above the patient’s bed that list her vital signs. The dire readings validate the wariness in Edwin’s tone. She nods to the man at the bedside. “The father?”

“Grandfather. Kayla’s parents are dead, apparently.”

Lisa motions to the window. “Can we?”

Edwin opens the door of the outer room with his shoulder and backs through the second, which seals the inner room, allowing the powerful fans and filter above to suck out any airborne germs. Lisa follows him inside. All eyes, except for those of the comatose patient, turn to the new arrivals, but no one says a word over the hum of the fan and the whir of the ventilator.

Even before Lisa reaches the bedside, her gaze is drawn to the scattered blood blisters that range in size from pinpoints to nickels and cover Kayla’s exposed upper chest and arms. Lisa recognizes the skin condition as petechial purpura. The rash is a classic sign of meningococcal infection, and it also tells her that the patient is in septic shock and her blood-clotting system is in disarray.

Edwin introduces Lisa to the nurse and then Kayla’s grandfather.

“Public Health?” The grandfather grimaces. “How… how can that help Kayla?”

“We can’t. Not directly,” Lisa admits. “Public Health is responsible for outbreak control, Mr. Malloy. Can you tell me when Kayla first became sick?”

“This morning, I suppose. She seemed all right yesterday when she came back from camp.”

“Bible camp?” Lisa asks.

“Yeah, that’s the one. Out in Delridge,” he says of the suburb just south of Seattle. “Never been a churchgoer, myself. But Kay somehow stumbled onto Jesus last year or so. Fat lot of good it’s done her.”

“Kayla wasn’t complaining of feeling unwell last night?”

“Nope. Ate a good dinner. Big plate of chops. Seconds, even. Guess they were feeding her more God than food up at that camp.”

“This morning…” Lisa prompts.

“Kay didn’t come down for breakfast. She’s an early riser. So I went to check.” He swallows. “She was in bed. Unconscious, or what have you. Eyes closed and groaning something awful. And the stench! Her sheets were covered in vomit. I called 911 as soon as I saw the blood in it.”

Lisa feels for the older man. She can’t imagine how traumatic it must have been to find his granddaughter semiconscious in a pool of her own bloody vomit. “She hasn’t woken up since?”

He waves a hand over her. “She’s not even moaning anymore.”

“We are keeping her in a medically induced coma with powerful sedatives, Mr. Malloy,” Edwin explains.

Malloy grunts, either unconvinced by or uninterested in the distinction. “This meningitis…” he says. “The nurse told me, but I still don’t understand. What’s it do exactly?”

“Meningitis is an inflammation of the membranes that surround the brain and the spinal cord. Along with the typical headache, nausea, and neck stiffness, it causes a general flu-like illness.” Edwin explains patiently, waiting for the other man to digest his words before proceeding. “There are many different microscopic bugs that can cause meningitis. With viruses, the infection is usually no worse than the flu and resolves on its own. The bacterial infections are much more serious. Unfortunately, Kayla is suffering from the most aggressive form of bacterial meningitis.”

Malloy reaches out and tentatively strokes the back of his granddaughter’s hand, as if handling an antique vase. “Will she make it?” he asks in a small voice.

Edwin inhales before answering. “Kayla has developed what we call septic shock. Her bloodstream has been overwhelmed, and her organs have begun to shut down.”

Malloy’s hand freezes on top of his granddaughter’s. “No, then?” he croaks.

“It’s too early to know, Mr. Malloy,” Edwin says. “But Kayla is in the best place she can be. And we will do everything possible to help her fight off the infection.”

Malloy’s shoulders slump lower. “And in the meantime?”

“All you can do is be here for her. To offer your love and your prayers.” The corner of Edwin’s eye twitches, and Lisa sees that he regrets the last remark.

“Prayers, huh?” Malloy snorts. “Lost my wife to an aneurysm ten years back. Then we lost Kayla’s mom, dad, and her little brother to a drunk driver, not a year after. Kay’s all I got left. And now I just might lose her to this meningitis. From a Bible camp? What kind of God would allow that?”

CHAPTER 4

Lisa is walking toward her car in the Harborview parking lot when her phone buzzes again. Since she doesn’t recognize the number, she considers ignoring it, but intuition tells her to pick up.

“Lisa, it’s Edwin Davis,” the intensivist says. “Sorry to call so soon. But I just heard back from the microbiologist with more news.”

“What is it, Edwin?”

“He ran further PCR tests on the samples. He now believes our cases are the same strain of meningococcus that hit Iceland.”

Iceland. The word stops Lisa dead in her tracks. “The outbreak from last winter?”

“The very same. Thought you should know.”

“Yes, absolutely, thanks,” she mumbles as she disconnects.

Like most epidemiologists, Lisa closely followed developments the previous winter in Reykjavík, where an outbreak of meningitis killed a number of people—mostly teenagers and children—in the span of weeks. Health authorities across the globe braced for a spread of the same virulent strain of the bacteria that hit Iceland, but it did not materialize.

Until now.

How the hell does a microbe travel from ReykjavĂ­k to Seattle without stopping anywhere in between?

Lisa is still mulling over the implications as she parks her car and climbs the stairs to the offices of Seattle Public Health. Inside, she weaves between cubicles, distractedly acknowledging greetings from staff members, on her way to her office in the back corner. She steps inside it to discover that her desk is already occupied.

“About time,” Angela Chow says, glancing up from where she sits, typing at Lisa’s computer.

“Angela!” Lisa approaches the other woman with arms extended.

Her

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