The Virus Page 2

  On the table in the middle of the room was a stack of papers and reports. Kaplan glanced through them quickly. One in particular caught his attention. It was entitled: “PRELIMINARY DRAFT OF REPORT BY THE INTERNATIONAL CAMPAIGN AGAINST VIVISECTION — The Use of Monkeys in Medical Research.”

  Monkeys! He remembered the words Diane Verusio had gasped out during his visit to the hospital. There must be a clue here, he thought. He put the report in his pocket. He would find time to read it later.

  Still with an uneasy sense of being an intruder in another person’s life, Kaplan moved from the sitting-room into the bedroom adjoining. The bed was unmade and clothes were strewn about the room.

  His eyes fell on an airplane ticket lying on the floor. He picked it up and examined the remains of a return coupon: Brussels — New York. The outward flight had been May 5th and the return was dated June 6th. That was twelve days ago. He made a note of the flight numbers and dates and put the ticket in his wallet.

  He stood there for a moment beside the bed, thinking. In his experience, most exotic tropical diseases had relatively short incubation periods. The girl had entered hospital four days ago. She had, according to Dr Graham, experienced the onset of her illness two days before that when she complained of a sore throat and a headache. With an incubation period of, say, six days, Diane Verusio could have become infected on the very day she travelled. Well, thought Kaplan, that figured. Airports, particularly in the summer months of mass travel, were the breeding grounds of diseases. A great tide of humanity flowed through them. With the new standby system, people often packed the terminals waiting for places on overcrowded planes. In the most literal sense, they breathed in each other’s germs.

  He lingered for a few minutes in the bedroom, suddenly overwhelmed by the sadness of it all. The girl was going to die. He was sure of that. Who was going to come and clear up, pack up the clothes, fold away the sheets? Who was next of kin?

  On a small table next to the bed was a framed colour photograph. Two smiling girls stood side by side, their arms about each other. One of them was clearly Diane Verusio. Who was the other? Kaplan wondered.

  He picked up the photograph and studied it carefully. There was a strong family resemblance between the two faces. The other girl was younger and darker than Diane, brunette rather than blond. A younger sister, perhaps? A cousin? Kaplan looked at the picture for a full ten seconds; looked especially at the younger girl. He had a strange, almost psychic feeling that the soft brown eyes were saying something to him, pleading with him almost.

  Later that evening, after he had left the apartment on Bank Street, Kaplan called on Diane Verusio’s medical practitioner.

  Isaac Reuben was an elderly gentleman, well into his sixties. When Kaplan entered the surgery on Washington Square, the doctor took his time in rising to his feet behind a cluttered desk. He walked round to greet his visitor and Kaplan warmed instinctively to what he saw. Isaac Reuben was of short but solid build; he had a pepperpot mixture of black and silver short curly hair. A grey cardigan was buttoned across a generous paunch. The fingers of his hands were short and stubby. Reuben wore a wedding ring, Kaplan noted, but from the general disarray of the doctor’s appearance and surroundings, Kaplan suspected that he was a widower.

  It was the kindliness of Reuben’s expression that struck Kaplan immediately. His eyes, small and black, peered out from beneath black bushy eyebrows and Kaplan’s glance fell on a framed and faded photograph on the mantelpiece. Reuben, noticing, explained.

  “My parents. Isaac and Miriam Rabinowitz, arriving at Ellis Island in 1897. We changed our name to Reuben during the First World War.”

  It was typical of the man that he should put his visitor at ease in this way. There was something so natural and unforced in the doctor’s manner, that Kaplan had no difficulty in explaining who he was and why he had come.

  It turned out that Reuben knew the Verusio family well.

  “Our families were immigrants together. The Verusios came from Southern Italy. We came from Russia. But when we all reached New York, it didn’t make a damn bit of difference where we came from. We all had to pitch in together.” He returned to his seat behind the desk. “I knew the whole family well. It had its share of bad luck, I can tell you. The parents were killed in a plane crash some years back. Now there’s this business with Diane.”

  He sat back to listen while Kaplan elucidated the various hypotheses regarding the source of Diane’s illness.

  “Yes, she did tell me where she had been,” he volunteered, “but it wasn’t Africa or Asia or the Middle East. She only went as far as Belgium.”

  Kaplan nodded in agreement. The air ticket which he had seen gave no indication of an itinerary extending beyond Europe.

  Reuben continued: “I believe in looking first for causes nearer home. We can consider the exotic explanations later.”

  “Did she have any cuts or lesions?”

  “Not as far as I could see.”

  “Did she mention any physical contact?”

  The old doctor leaned forward across his desk.

  “You’re talking about venereal transmission? Frankly, I don’t think she was that kind of girl.”

  Kaplan felt suddenly ashamed. He remembered the homely nature of the apartment he had just visited, full of books and pictures of wildlife.

  “No, of course not,” he said quickly. He changed the subject.

  “One last question, doctor. We are going to have to try and trace her contacts. All her contacts. We’ll get onto the airline, though I’m not sure that will do us much good. You can’t rely much on the passenger manifest nowadays, particularly with these standby flights. In any case, with most exotic diseases, the infectious stage is linked to the first appearance of the symptoms. My guess is that she wasn’t in a position to transmit the infection, whatever it is, to anyone else until after she got back to her apartment. Do you know if she saw anyone there?”

  “I asked her. I think the answer is probably no. There’s no doorman in her building. She told me she went straight to bed when she reached home. When she called me, I went round to her.”

  Kaplan smiled. “You must be one of the last doctors to make house-calls.”

  The old man smiled. “I know I’m a bit old-fashioned. But when someone says they’re ill, I don’t believe in making them drag themselves through the streets.”

  Kaplan stood up to go. He had made a decision.

  “Dr Reuben, I hope you won’t think I’m making a lot of unnecessary fuss, but I think you should come into the hospital yourself. As a precaution.”

  The old man looked surprised. “Whatever for?”

  Kaplan explained. “Look at it this way. On present showing, it looks as though Diane Verusio — somewhere, somehow — has contacted a dangerous exotic disease. The girl is very sick. Very sick indeed. She’s probably going to die. We don’t know, or at least we don’t know yet, what the disease is. And we don’t know how to treat it. We know it’s infectious because Diane Verusio caught it from someone or something. She wasn’t born with it. The likelihood is that you were the only unprotected person with whom she was in contact during the infectious phase.”

  “What do you mean?”

  “I mean that when you had her moved from here five days ago, she was taken by ambulance under sterile conditions to the Columbia-Presbyterian Hospital. At the hospital, she has been in the maximum isolation ward.”

  The old doctor took it well. “Young man. One way or the other I’ve been exposed to almost every disease you can think of in my life. And they haven’t got me yet. I’m pretty tough, you know. I’ve probably got enough antibodies in my blood to sink a battleship.”

  Kaplan looked at him with admiration. This was a man who had probably seen the worst that life had to offer. You didn’t maintain a general practice in Greenwich Village without developing a certain immunity.

  “I don’t doubt that you’re tough, doctor. That’s not my worry. My worry is that we may b
e dealing with something new. Entirely new. Being tough may not be enough.”

  The old doctor scratched his chin. “I’ll come on in to hospital, if you like, but you’ll have to give me time to transfer my appointments.”

  “Thank you doctor. I’ll have an ambulance pick you up. Meanwhile, no contacts of any kind.”

  As they walked to the door, Kaplan had a last thought. “Was Diane Verusio an only child — or did she have brothers or sisters?”

  Reuben stopped in mid-stride. “Didn’t I tell you about Stephanie, Diane’s younger sister?”

  When Kaplan shook his head, the doctor went on:

  “Stephanie Verusio is one of the most remarkable people I have ever met. If I was a younger man, I would have fallen in love with her myself.” A wistful look crossed Reuben’s face. “I almost did fall in love with her when she was growing up in New York. She had such fire and verve. And she was a real beauty too. I don’t think I’ve ever seen such a beautiful young woman.”

  “Where is she now? We ought to let her know about her sister. Do you know where she lives?” Kaplan was aware that his interest in Stephanie Verusio was more than merely professional. He had a brief mental image of a pair of soft brown eyes smiling at him out of a framed coloured photograph.

  Reuben answered his question in the negative. “I heard that Stephanie had gone to live abroad. But I don’t know where. Even the best general practitioner doesn’t know everything.”

  The dreamy moment had passed.

  Kaplan reverted to his normal, brisk matter-of-fact self.

  “Don’t worry, doctor. We’ll track the family down somewhere. We’re used to that kind of thing.”

  They stood in the hall together, talking for a minute or two. Kaplan’s glance fell on a framed photograph of the President of the United States. It was inscribed: “To Isaac Reuben, with best wishes and warm thanks for all your help.”

  Kaplan was intrigued — what had Reuben done that had elicited such a glowing testimonial?

  “That’s nice.” Kaplan nodded in the direction of the photograph.

  Reuben was not to be drawn. “Good luck to you,” he said.

  Kaplan’s last glimpse was of a pair of old black brogues, which looked as though they had seen at least thirty winters, shuffling back into the room, as Reuben closed the door.

  2

  Kaplan called his office before he left New York later that evening.

  “Susan, I’m coming down with some specimens. Can you warn them that I shall need the Hot Lab. And I could use some help. We’re probably in for an all-night session.”

  There was a car to meet him at the airport. He made it to the Center in twenty-five minutes which, thought Kaplan, was probably a record. Susan Wainwright was already waiting for him. There was concern in her voice.

  “Christ, Lowell, you look tired.”

  “I am tired.” Commuting to New York from Atlanta, Georgia, was a far cry from commuting from, say, Westport, Connecticut.

  “The Lab’s clear,” Susan said. “I’ve warned them that we may be working late.”

  Kaplan grunted. For the moment he felt too exhausted to speak.

  The Hot Lab at the Center for Disease Control in Atlanta, Georgia, is, in a literal sense, a world within a world. Its correct title is Maximum Containment Laboratory, though “Hot Lab” is the more customary usage. It was built during the ’seventies to satisfy two major requirements. The first was the protection of the outside world from diseases which were being investigated in the Hot Lab. The second had to do with the safety of personnel working inside the Lab with lethal materials of one kind or another. To achieve these two objectives, the Hot Lab was constructed as a box within a box. An outer building housing the air purification plants, waste disposal units and other necessities was erected over the inner shell. Kaplan had once explained the principle to Susan Wainwright when she had first joined him as his assistant.

  “All the air is airconditioned and cleaned. We retain inside the building itself 99.99% of all particles larger than 0.3 microns. All solid waste is steam-pressured in autoclaves before being removed. All liquid waste is sterilized at ultra-high temperatures.”

  They reached the Hot Lab over some covered metal catwalks which connected it to the main complex of buildings. Kaplan waited while Susan Wainwright went ahead and used the chemical shower.

  When his own turn came, he stood there naked for two or three minutes, letting the water beat the tiredness out of him.

  Susan who had already gone on through the air-lock called to him on the intercom.

  “Lowell, are you okay?”

  “Yeah, I’m just coming.”

  They got into their lab garments. Each of them wore a positive pressure suit made of one-piece flexible urethane plastic with zipper. Each suit was fitted with an air filter and a device which cooled air for breathing; it also carried three minutes’ supply of air in case of emergency. When they were ready they moved on through into the maximum containment area itself. The doors clicked shut behind them and, as they did so, the inflatable rubber gaskets expanded, producing an hermetically sealed airtight fit.

  Their first act, once inside, was to clip themselves onto the airline, their sole umbilical connection with the outside world. The airline was fed by compressed air piped in from cylinders outside the building. Similarly, the air they exhaled through their face-masks was piped away to the service area where it was filtered and sterilized before being released.

  Without this umbilical access to an outside source of air, scientific use of the Hot Lab’s facilities would have been greatly hampered. With it, they had almost complete freedom of movement and could stay in the Lab as long as the outside air supply lasted.

  The Hot Lab itself was divided into two sections. The first was filled with glass cabinets. A line of them ran down the center of the room, and others were ranged along the walls. The air inside the room was under negative pressure in relation to the air outside the Hot Lab. In the same way, the air inside the cabinets was under negative pressure in relation to the air circulating within the lab.

  “We work with the specimens inside the cabinets,” Kaplan had explained during that first guided tour, “using the automatic handling devices. If we make a mistake and there’s a leak from the cabinet, that leak — because of the negative pressure — doesn’t contaminate the room outside. Similarly, if there is a spill in the maximum containment area, that spill should never go beyond the Hot Lab itself. It should automatically be limited to where it occurs, again through negative pressure.”

  A major advantage of the pressurized suit was that the researcher was no longer limited to working on material within the cabinets. Since he had built-in protection, he could move into the second area — again through an air-tight door — where material could be removed from the cabinets and handled in a much more direct way. This was both safer and more convenient. There was always a risk, when handling items with rubber gloves and through arm-ports, of the researcher sticking a needle into his own finger instead of the cell he was seeking to inoculate. Being able to work in the open was an important step forward in toxicological research.

  Lowell Kaplan and Susan Wainwright moved straight on to the “open” area. Their first task was to receive the specimens they had brought down from New York through the double-door autoclave which connected the containment area with the outside.

  Lowell Kaplan carefully removed the watertight metal container from the outer container he had brought on the plane from New York. Inside the sealed watertight container were test-tube specimens wrapped in cotton. Susan Wainwright stood beside him, like a nurse assisting at an operation. She took the outer and the inner wrappings from him and disposed of them; she passed him the tools of his trade; she assisted him with advice and encouragement.

  For an hour they worked in silence, the clear plastic face-plates of their pressure suits making possible the use of instruments requiring accurate vision.

  Through an electron
microscope capable of magnification up to a million times, Kaplan examined blood samples taken from the patient. Hunched over the eye-piece, he saw the strange shapes almost immediately. Susan Wainwright noted down his remarks as he spoke.

  “Unusual morphology.” Kaplan was always laconic when he had his eye to the microscope. “We’ve got pleomorphic filaments here of exceptional length. Straight rod particles. Some are bent into horseshoes or b’s, as well as hooks and loops. The ends are rounded. In some cases one pole is dilated. We have occasional branching.”

  “What’s the present magnification?”

  “One hundred thousand. I’ll take it up to two and then three hundred thousand.”

  At the higher magnifications, the shapes were more clearly apparent. “I think we’re dealing with a virus all right,” Kaplan exclaimed. “But I’ve never seen one quite like it. There seem to be three basic forms. First, there’s the naked helix; then we have coiled structures enclosed by a membrane; finally, there’s a circular form or torus. I think this last must be the mature virus.”

  “Can I have a look?” Susan Wainwright was anxious to see for herself. Over the years she had graduated from being a fledgling assistant into a fully-trusted collaborator.

  For several minutes she observed the peculiar structures in silence. Kaplan stood next to her, watching intently behind his perspex face-plate and breathing steadily from the supply of pure air being piped into the Hot Lab.

  “What about size?” he asked. “It struck me that the mean length is fairly high.”