Secret Pestilence: A Mystery Novel of the Aids Outbreak

Copyright © 2013 Blair Beebe.

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ISBN: 978-1-4808-0337-4 (sc)

ISBN: 978-1-4808-0338-1 (e)

Library of Congress Control Number: 2013918214

Archway Publishing rev. date: 10/17/2013

Also by Blair Beebe

NONFICTION

The Hundred-Year Diet: Guidelines and Recipes for a Long and Vigorous Life (2008)

ESSAYS

Doctor Tales: Sketches of the Transformation of American Medicine in the Twentieth Century (2008)

NOVELS

Doc Lucas USN, A Novel of the Vietnam War (2010)

The Nagasaki Cluster, A Historical Novel of Medical Discovery (2013)

SHORT STORIES PUBLISHED IN TANGENTS

The Hero (2009)

Gathering Storm (2012)

Sister (2013)

For the victims and their families

There is no more difficult art to acquire than the art of observation.

—Sir William Osler, MD

(1849–1919)

Table of Contents

Chapter 1

THE GATHERING STORM

Chapter 2

UNIVERSITY HOSPITAL

Chapter 3

A PATIENT SURVIVES

Chapter 4

GRID

Chapter 5

BLOOD TRANSFUSIONS

Chapter 6

SUDDEN DEATH

Chapter 7

AIDS DEMENTIA

Chapter 8

SHARPS

Chapter 9

SEX CLUBS

Chapter 10

MORE FATALITIES

Chapter 11

HIV (HUMAN IMMUNODEFICIENCY VIRUS)

Chapter 12

SCREENING

Chapter 13

HIV UNDERGROUND

Chapter 14

BLACK PATCHES

Chapter 15

DELIRIUM

Chapter 16

THE DOC

Chapter 17

PNEUMONIA

Chapter 18

E. COLI OUTBREAK

Chapter 19

MANHUNT

EPILOGUE

ABOUT THE AUTHOR

CHAPTER 1

THE GATHERING STORM

BERKELEY, 1979

The man lying shivering on the ground at People’s Park hadn’t said a word for several hours. Some of the homeless men who had been sitting on wooden boxes nearby covered him with newspapers and a dirty blanket they had pulled from his shopping cart.

How long has he been that way? Charles asked.

The others shrugged or turned away. Finally, one said, He was sick yesterday, too.

Charles moved closer and knelt to get a better look at his face. You all right? he shouted.

The emaciated man shook so hard that his teeth were clacking, and he made no sign that he had heard. He had a shaggy dark-brown beard and tangled hair, and his withered face was caked with grime. Charles supposed the man was having a seizure—or maybe just chills from spiking a fever—but whatever it was, the trembling wasn’t stopping.

Someone ought to call an ambulance, Charles said.

The men nodded, but they all remained silent. The only pay phone was two blocks away inside a pharmacy, and the employees chased away homeless people who tried to enter. None of the men would have admitted to having money, and besides, they had heard the phone didn’t work most of the time.

Okay, I’ll go, Charles said. He didn’t have any coins for the public phone either, but a secretary in the anthropology department on the campus would sometimes let him use her telephone for local calls. In spite of his unkempt appearance, Charles was rather handsome, with his long hair in a ponytail and a slender build that many young women found attractive. He often stopped at People’s Park to talk with the homeless men and knew many of them by name.

The university had bought the property a few years before and had torn down the existing buildings to make way for student residence halls, but construction had never begun because of a lack of funding. Squatters had taken over the vacant lot, resulting in a confrontation, first with the university president and the police, then with the governor, and finally with the National Guard. One protestor had died of a gunshot wound, and another was partially blinded from tear gas, leading to more outrage toward civil authority by some Berkeley residents, already aroused to anger about the Vietnam War. People’s Park had provided an opportunity to defy the establishment, and the squatters were still there a whole decade later.

Charles had been only a high school student at the time of the original conflict, but he felt a sense of kinship with the people and the park that he associated with the protest. He had hated the war, and his father had helped him obtain a draft deferral to attend the University of California at Berkeley after his high school graduation. His older sister, Lynn, had actually volunteered to join the navy, an act Charles could never understand or forgive. Worse, she still participated in the navy reserves when she didn’t have to.

He left the park and ran the three blocks along Telegraph Avenue toward the campus, past little shops, and entered through Sather Gate, hardly noticing the young woman speaking into a bullhorn from the steps of a nearby building. Demonstrations were daily lunchtime events.

The secretary wasn’t in the department office, but he knew how to obtain an outside line, so he helped himself to the phone and dialed 911 for an ambulance. The voice on the other end asked for the name and address of the patient.

He’s in People’s Park. I don’t know his name, Charles said.

After a short silence, the voice asked, Who are you?

I’m a student.

Do you have a name?

Charles gave his name to the voice.

Why are you calling for an ambulance?

The man is lying on the ground having seizures. They won’t stop.

After another short pause, the voice said, All right. We’ll send an ambulance.

Charles hung up and walked back outside, stopping for a few minutes to listen to the young woman speaking on the bullhorn. She was talking about animal rights and the cruel experimentation that universities and pharmaceutical companies routinely performed to test new drugs. He wanted to hear more, but he also needed to be sure the ambulance came, so he turned around and walked back toward the park.

When he arrived, he found the men sitting on the boxes hadn’t moved and were still staring at the shaking victim. Charles noticed that the sick man’s head was bumping against the bare ground. He stooped over to lift it in order to push some wadded newspapers underneath and noticed that the man’s skin was hot—and he didn’t respond to having his head moved.

The ambulance still hadn’t come, so Charles joined the other men in waiting silently. When he looked closer, he realized the sick man’s age probably wasn’t more than thirty, just a few years older than Charles himself. He had originally thought the man was older because of his wasted body.

After several more minutes, an ambulance eased into a parking space nearby, and two attendants got out. They opened the rear door to retrieve a gurney and rolled it toward the group surrounding the victim. Some of the homeless men moved aside to make room for the attendants.

What’s his name? one attendant asked.

No one answered at first, but then two of the homeless men responded at the same time. Lance, they said.

Is that his last name?

The two men looked at each other, and then one said, Lance isn’t his real name. He told us he was a lance corporal in the marines in Vietnam—so we call him Lance.

An attendant checked the patient’s pockets but found no identification.

Where are you taking him? Charles asked.

The attendants seemed surprised by the question. The county hospital, one answered.

Alta Bates Hospital is a lot closer, Charles said.

The attendants looked at each other, shook their heads, and loaded the gurney and patient into the ambulance. One started an IV while the other set up an oxygen mask.

May I go with him? Charles asked.

You a relative?

Charles shook his head. No.

You can catch up with him later at the hospital, one of the attendants said. The other climbed into the driver’s seat, started the engine, and turned on the flashing red light.

The men in the park continued to watch as the ambulance moved off slowly with the traffic without using the siren.

Charles stared for several minutes after it disappeared and then walked back toward the university. He would be late for his seminar because of his detour at the park, and the professor always made sarcastic remarks about students who arrived late.

When he reached Bancroft Avenue on the edge of the campus, he turned away from the building where the seminar was being held and walked downhill. He slipped his hand into his pocket to be sure he had the BART card his mother bought for him every week for his commute from San Francisco. The station was nearby, on Shattuck Avenue, only a short distance from the campus. He could take BART to the Lake Merritt station and then go on foot the rest of the way to Highland Hospital, the charity medical center for Alameda County. The climb up the hill would be long, but he had grown up walking all over San Francisco and didn’t mind. The weather was perfect as usual, and Charles enjoyed being out in the warm sun.

Since it was early, the emergency room hadn’t yet filled, and Charles had to wait only a few minutes to speak to the medical assistant at the triage desk. He noted the bored people sitting in the waiting room trying to ignore the loud television set hawking detergents and frozen, ready-to-eat meals. Near to a door leading to treatment rooms in the back, a large elderly woman was lying on a gurney under a sheet with her bare feet sticking out. She had turned on her side, facing the wall.

When it was his turn, he told his story to the medical assistant, who eyed him suspiciously and got up to find a nurse.

One appeared almost immediately. You know the unconscious man we received from Berkeley a little while ago? the nurse asked.

No, Charles said, but I was the one who called the ambulance.

Do you know his name?

Charles told her what he knew, including the story about the patient’s Marine Corps service. Maybe you could see if someone from the VA could help identify him.

Thank you. We’ll try. How did you become involved? she asked.

Sometimes I talk with the homeless people in that park.

She squinted and cocked her head, as if trying to get a better look at this Good Samaritan.

Is he going to be all right? Charles asked.

He’s septic, the nurse said. Do you know what that means?

Charles hesitated. No, but it sounds bad.

It means he has a severe infection in his blood, she said. He hasn’t regained consciousness, and his blood pressure is very low.

Will he live?

She shook her head. Probably not.

Charles was beginning to feel lightheaded. He looked down at the floor and in a low voice asked, How did he get sick?

He’s an IV-drug user. You can tell because he has needle marks all over his arms. Didn’t you know?

No, he said. Are the needles the reason that he’s septic?

Yes, she said. Dirty needles can introduce germs into the bloodstream. He probably has bacteria growing in most of his organs, including on his heart valves and maybe in his brain.

He pursed his lips and squirmed. Can’t you treat it?

We have him on three powerful antibiotics, but his chances of survival are slim all the same.

Charles felt himself suffocating and decided to leave. He said softly, Thank you.

As he turned to walk away, the nurse said, Don’t you want to see him?

He couldn’t get enough air but somehow felt obligated to follow the nurse, so he said, Sure. Why not?

She led him into the treatment area, where one patient was vomiting and another was moaning loudly. In the bright lights of the emergency department, Lance looked ghastly, and he struggled for breath. The nurses had cleaned him up a little, so he didn’t seem as old as when he was lying under the newspapers, but his dusky-blue color looked like death. IV fluids ran in both arms, and an oxygen mask covered his mouth and nose.

Charles noticed some raised reddish-blue patches on Lance’s skin. He pointed and asked the nurse, What are they?

We’re not sure, she said. The doctor did a biopsy because he thinks it may be a type of cancer called Kaposi’s sarcoma. Some of our doctors also work part-time at San Francisco General, and the one on duty today said he had seen the same thing there in a gay man with a mysterious fatal disease.

I see, Charles said, not understanding anything.

You can check on him later, but he probably won’t last long.

Charles once more mouthed the words, Thank you. Then he turned and walked toward the door with his head down.

Once outside, he hastened his step to move quickly past an ambulance unloading another patient hidden behind an oxygen mask and a blanket, and soon he had left the confusion and bad smells of the emergency department behind. He began the steep descent back down to the Lake Merritt BART station and took deep breaths, becoming more aware of the bright sky and the intense green of the leaves on the trees lining the streets, but he couldn’t dispel the image in his mind of Lance’s wasted body lying on the gurney.

Rush hour had started, and trains to San Francisco arrived frequently. Most passengers would be commuting out of San Francisco, and trains into the city were relatively less crowded. He was able to collapse into a window seat and stare mindlessly at the derelict buildings of West Oakland and dark walls of the BART tunnel under the bay. He needed some relief and had just the prescription.

He emerged from the BART station at Sixteenth and Mission and headed toward what he had described to his mother as a men’s athletic club. She had thought it would help build up his slender frame and had slipped him the money to buy a membership that included the use of a sauna, a spa, an indoor swimming pool, and private rooms. Inside the entrance, a man in a white T-shirt and tight pants handed him a towel, and Charles went to a cubicle to remove his clothes. Then he wrapped the towel around his waist and joined the other men circulating like shadows in the corridors of the bathhouse.

CHAPTER 2

UNIVERSITY HOSPITAL

SAN FRANCISCO, 1980

Charles’s sister Lynn was staring through her microscope at a slide of what she thought were spores from a fungus. She was an experienced microbiologist and had just returned with her husband, Luke, from the Far East where both had gained a wealth of knowledge about tropical diseases, but she had never before seen a slide quite like this one. She reached for an atlas and found that the microbes were classified as one-celled parasites called Pneumocystis carinii and not as fungi after all. But they looked nothing like the tiny parasites that caused the malaria she had so often seen.

She had earned a master’s degree in microbiology from the university several years before and was now returning as a doctoral candidate. Luke was a physician and had just begun a fellowship in infectious diseases at the same time. Dr. Bernard, the chief of the Division of Infectious Disease, had remembered Lynn from the master’s degree program and had recruited both of them because of their experience in field research. Even though she and Luke were only in their early thirties, the other graduate students, fellows, and even faculty members accorded them more respect than they might have for any other junior members of the professional staff because of the large number of scientific papers they had published on infectious diseases of Southeast Asia.

Lynn had immersed herself in the world of pathogens, potentially lethal microorganisms invisible except under a high-powered microscope. Some of her colleagues thought it odd that such an attractive young woman would have spent so much time working in a research laboratory and exposing herself to the dangers of epidemics in remote areas of the Far East. Her dark-brown eyes always seemed to be smiling and disarmed anyone who first met her, but after she spoke, it became apparent that she was a scientist driven by her work and an encyclopedia of infectious diseases.

The specimen under her microscope had come from a pneumonia patient that Luke had just admitted to the hospital. He had told her that the man was unconscious and critically ill and that obtaining a sputum specimen had been difficult but necessary in order to identify the microbe and select an effective antibiotic. In the end, he had resorted to calling one of the pulmonary fellows, who used a bronchoscope to obtain the sample.

She stared at the slide for a few more minutes and then called Luke. "As far as I can tell from the references on my lab bench, your patient has a disease that doesn’t exist. The slide from the specimen has sheets of microbes called Pneumocystis carinii."

What’s that? he asked.

According to my atlas, it’s a parasite that sometimes shows up in scant numbers in the sputum of patients with chronic bronchitis, but it’s supposed to be harmless by itself.

I’m sure the patient would have welcomed the good news if he weren’t so sick, he said. You’re not seeing anything else on the slide that might be the cause of his pneumonia?

There’s nothing else. Come down and see for yourself.

Three minutes later, Luke arrived in the lab wearing a long white coat, which together with his close-cropped blond hair, gave him a more formal appearance than most of the other fellows and residents on the staff. He lowered the stool in front of Lynn’s microscope, but because of his height, he still had to push it back and bend forward in an awkward position to peer at the slide. He moved the fine-adjust focus knob slightly, and without looking up, he said, It doesn’t look like malaria or any other one-celled parasite I know. I would have called it a fungus.

That’s what I thought too, she said. But whatever it is, I’ve never seen it before, and I can’t find much information about it, except that it’s not supposed to cause disease.

Luke continued scanning the slide and said, The patient’s lungs on his chest X-ray look like a blizzard—almost a complete whiteout—so this harmless parasite must have an evil twin. Your references don’t mention anything about treatment, do they?

I’ve checked only the atlas on my lab bench so far, and it has no information about antibiotic best choices. She added that she was willing to look further but doubted that anyone had ever published anything about Pneumocystis as a cause of pneumonia, and consequently, recommendations about treatment probably didn’t exist. Cultures with antibiotic sensitivity tests on the patient’s specimen would be available the next day, but as they both knew, the results did not always match how well a specific drug would work. The best she could do was to offer him a guess later after looking at the cultures. What are you going to do for now? she asked.

Luke stood up and looked at her. I don’t know. Maybe treat him with drugs we use for malaria.

Or a fungus, she added.

He sighed. It probably doesn’t matter which antibiotics I give him. His pneumonia is far advanced, and he has acute respiratory failure. I have him on a mechanical ventilator to take over his breathing, but I don’t think he’ll survive for long with or without treatment.

Was there any reason for him to develop pneumonia?

Luke shook his head. We don’t have any medical history on him. He was unconscious when the ambulance brought him in, and he had no identification. The paramedics picked him up from a bench in Golden Gate Park.

The page operator was calling Luke on the overhead loudspeaker system, and he answered immediately. It was the nurse taking care of the new pneumonia patient. He listened a few seconds and then said, I’ll be right there. He hung up and turned toward Lynn. He’s terminal. The nurse can’t get a blood pressure on him. I’m going back up.

Luke pronounced the patient dead soon after.

The next morning, Luke and Lynn met with Dr. Bernard for morning intake rounds in a small conference room where the resident staff presented patients they had admitted to the hospital during the preceding twenty-four hours. Dr. Bernard appeared to be only a little older than Luke and Lynn, but he had already become a distinguished member of the faculty and dressed the part, wearing