Plague War: Outbreak - Chapter One
Harry rested his chin on one hand while reading a set of medical notes. The text slipped out of focus before eyes blurred by fatigue. He rubbed at them before checking the time and yawning. 1230 AM. He felt like shit. It was his last of seven night-shifts at Randwick Emergency Department, and he was struggling to stay awake. Insomnia had stolen daytime sleep, leaving a soul-destroying exhaustion that blunted his mind and sapped all enjoyment from life.
He stood from the stool and stretched, his lower back cracking. Harry desired wakefulness like a junky lusted for a hit. He pulled out a battered satchel from beneath the bench. Two large cans of energy drink, brimming with unhealthy levels of caffeine and guarana, lay within. He cracked the lid of one, sculling half of the lukewarm contents on the spot. A few drops spilled free onto his chest, soaking into the word “Doctor”, sewn into the threadbare scrubs top.
Only another eight or so hours to go, then he’d be leaving for his next contract ‒ a job in Milton on the state’s south coast. Harry hadn’t completed the exams to qualify as an Emergency Specialist, stalling any chance of career progression. Instead, he’d worked agency contracts between stints abroad with Medecins Sans Frontieres (MSF). With MSF, Harry had provided aid in the aftermath of natural disasters, and treated injured civilians during the Afghan war. Most recently, he’d spent three months in Liberia during the Ebola epidemic, working in clinics and occasionally with a “rapid response team”, tracking new cases to remote villages. The time there had stretched him physically and mentally. Delivering care in 40-degree temperatures, knowing that any mistake could mean exposure to a virus with an eighty percent mortality rate, was exhausting. He had returned to Australia completely drained, so much so, that he was glad of the enforced twenty-one-day quarantine at home alone.
He’d struggled to adapt back to Sydney, feeling claustrophobic in the city. When the hospital had retrenched his job, he’d been glad for the push, seeing an opportunity for escape to a place where he could breathe more freely. The town of Milton fit the bill perfectly. The village straddled a ridge surrounded by farmland, and had a small emergency department that serviced the local population. His application for the role had been approved four weeks ago, and Harry had found himself a rental on the town’s northern approach, a house set two hundred meters from the road, and surrounded by green paddocks. On the highway at the front of the property was the landlord’s business, a heavy machinery hire service. The previous week, he’d picked up the keys to the property and carted most of his stuff down. All he had to do now, was move in.
With can in hand, he headed to the staff base. It was dim, with most lights in the department turned off to keep a semblance of night. Only essential staff were present, and while Harry took another swig of Red Bull, the ambulance phone started to ring. He cradled the receiver against his shoulder as he grabbed a scrap of paper and pen.
‘Randwick Emergency, you have something for us?’
Harry scribbled down the information provided by the dispatch operator, then read it back for confirmation prior to hanging up. Kate, the nurse working in the resuscitation bays with him, was looking over his shoulder at the pad.
‘What’s coming in?’ she asked.
‘A retrieval from the airport, sounds like septic shock.’
‘No worries, are you going to run the show on this one?’
Harry looked over his shoulder to see what other doctors were around. The roster had been short of late. For senior doctors, there was only himself and another Registrar.
‘Yeah, might as well be me.’ Harry pushed himself from the chair and followed Kate into the resus area.
By the time the paramedics arrived five minutes later, the resuscitation bay was ready to go. Harry waited at the bedhead while the paramedics hurried towards them. The patient lying on the trolley looked awful. Her breathing was rapid, and skin pale. While one paramedic relayed the clinical history to Harry, Kate and the other ambo slid the patient across on the sheet. Kate cut up the centre of the t-shirt with trauma scissors, then applied an oxygen mask, blood pressure cuff and monitoring equipment for heart rate and oxygen levels.
‘This is Beth Hazelwood, a 28-year-old woman with sepsis from the airport,’ said the paramedic. ‘A call was made by the flight crew requesting an ambulance on arrival. During the flight from Cairns, Beth became unwell, notifying the airhostess of her condition when the plane was thirty minutes out of Sydney. During the remaining descent, she rapidly deteriorated. There’s a bite mark on her left forearm that appears grossly infected. Before she became confused, a bat was mentioned – not sure if that’s what caused the wound.’
‘Since picking her up, she’s continued to crash pretty quickly. As you can see,’ he said, passing across a chart with vital signs on it. ‘Her pulse is racing and her blood pressure’s bloody low. Her conscious level’s also dropped; she’s not responding to much now. Any questions?’
Harry shook his head, ‘No. Thanks, mate. Make this the last one for the night though, yeah?’
The paramedic gave a half smile as he backed the trolley to the ambulance bay. ‘You can always hope, I guess.’
Harry started to run through a rapid clinical assessment. The patient’s airway was clear for the moment, with reasonable air entry to both lungs. Her heart was beating irregularly, between 130-150 beats per minute, and her blood pressure was so low he couldn’t feel a pulse at her wrist.
Harry shoved a cannula into an arm vein, then twisted on a syringe to obtain a blood sample for pathology. The blood he drained was almost black. Oxygen depleted. Kate attached a line for the intravenous saline and started pumping it in by hand. The latest blood pressure result flashed up on the monitor; 65/35mmHg. Both Kate and Harry grimaced at the poor reading; things weren’t looking good.
Two small puncture wounds, possibly from the incisors of an animal were present on the inner aspect of the patient’s left arm. As Harry touched the edges of the wound, rank brown pus oozed to the surface. The surrounding skin was a swollen, virulent shade of red. Trails of crimson tracked up the inside of her arm to the armpit.
Beads of sweat sat upon the patient’s exposed skin, running in tiny rivulets to the bed sheets below. Abruptly, it was silent. Harry looked up from the arm wound ‒ the patient had stopped breathing. He placed two fingers below the line of her jaw for a pulse. Nothing. Harry felt a spike in his own heart rate, as adrenaline surged in response to the situation. He turned and pressed the emergency button while yelling out to Kate.
He commenced chest compressions. On the third one, he felt a rib snap under hand. Blood misted from her mouth, falling back in a maze of fine, crimson droplets across the patient’s face. Kate appeared at the head of the bed, placing an oxygen mask over the patient’s mouth and defibrillator pads to her chest. At the thirtieth compression, Harry paused while Kate delivered two breaths. Another doctor and two more nurses arrived to help. Harry stood back from the compressions, allowing one of the nurses to take over CPR, and filled the team in on the situation as they worked. After two minutes, he called for a pause in compressions to view the cardiac rhythm; a wavering flat line extended across the defibrillator screen – asystole. A non-shockable cardiac rhythm.
‘Restart compressions. Suz, give her some adrenaline, please.’
Harry’s voice was calm. The team worked quietly, intensely focused on the job at hand. After thirty minutes, it was apparent they weren’t making progress. Harry finally recommended to the team that they stop.
‘Time of death 0130 AM.’
The other doctor and nurses removed their gloves, and drifted back to their own patient loads. It always sucked to have an unsuccessful resuscitation, significantly more so when the patient was young like this lady. Shortly, it was just Kate and Harry again. Harry grasped the body, one hand on a shoulder, the other on her hips, and rolled it towards him so that Kate could push a body bag underneath. A stream of blood-stained drool slid from the corpse’s mouth, soaking into his scrubs while the eyes stared sightlessly ahead. The unnaturally pale skin was still damp, leaving an oily residue on the fingers. Harry paid it scant attention. He was running the events of the arrest through his head, mentally re-checking each step to see if he had made the right calls, while ignoring the blood and saliva oozing through the cotton of his top.
In the next bay, the patient began clawing at his oxygen mask. Harry lowered the body and pulled a sheet up to its neck. Kate and he then moved across to review the patient in distress.
The old man was dry retching. Harry unstrapped the mask and held a vomit bag under his mouth while he heaved up his guts. Kate administered a medication to stop the nausea. Within a few minutes, the patient indicated he was feeling better.
From the corner of Harry’s eye, a movement drew his gaze. The arm of his dead patient had fallen from beneath the sheet, to hang down the side of the bed. The fingers flexed into the beginning of a fist, before falling lax once more. ‘Surely not...’ He rubbed his eyes with a free hand and turned away.
‘What the fuck’s with that?’ blurted Kate. ‘The foot just moved, Harry. I’m not joking…’ she said, indicating the dead patient. ‘I’ve heard of it, I mean muscles contracting post death, but I’ve never seen it – have you? Bloody creepy.’ She started walking over to get a closer look. ‘We didn’t call it too early, did we?’
Kate made her way to the patient’s shoulder and pulled back the sheet, exposing the chest. She leant forward, placing her cheek over the mouth of the corpse to feel for airflow, while looking out across the chest for movement of breathing.
The head of the corpse jerked upward, bringing an open mouth to the side of Kate’s neck. The teeth clenched shut, ripping a mouthful of flesh and carotid artery away. Kate screamed, jerking away from the body. She clamped a hand to her neck, her eyes bulging with agony. An arterial jet of blood spurted between her fingers, crossing three metres between her and Harry. The corpse pushed itself to sitting. The dead woman’s eyes were locked upon Kate, unblinking. Blood drenched its chest, bits of tissue hung from an open mouth that emitted an incoherent rasp. It reached towards her and tumbled from the trolley onto the floor. Harry grabbed Kate by an arm, pulling her out of reach of the hellish creature, and pushed her towards the free resus bed, his other hand clamped over the wound.
Staff rushed into the resus bay, drawn by the screams. One of the nurses hit an alarm to bring hospital security. Three nurses confronted the dead patient; when it didn’t respond, they moved in as a team to restrain it. The corpse flung one nurse aside, while pulling another towards its mouth, biting through exposed muscle of a forearm. Three security guards ran in, gloves on. With two people on each limb, they wrenched the struggling body back onto the emergency trolley. The mouth of the creature snapped rhythmically, teeth exposed, lips snarled back at any body part within reach. Security manacled each limb to the bed frame, keeping the ankles and wrists pinned to the mattress. It wrenched viciously at the ties, threatening to tip the heavy trolley.
Harry tried to block out the events happening five feet away as he scrambled through the corridors of his brain for a solution to save Kate’s life. He had only seconds to stem the haemorrhage. The gouts of blood pulsing in time with her heartbeat were slowing and getting weaker as she reached a critical volume of blood loss. Harry’s front was drenched in scarlet, his scrub top sticking in a congealed mass like a second skin.
With his thumb jammed against her artery to stem the flow, he hooked the procedure trolley over with his foot. In the second drawer, he found a suturing set. He ripped open the packet between one hand and his teeth, pulled free some forceps, and immediately shoved them into the wound to clamp the artery. His thumb moved off the vessel to enable application of the forceps, causing a jet of blood to splatter against his neck. Finding the artery, he clamped it off. Kate’s struggles had eased, her features slackening.
As Harry tried next to stop the haemorrhage from her jugular vein, he realized he was already too late. She had stopped breathing, the bleeding had ceased, but only because most of her blood volume drenched the floor and curtains of the resuscitation bay. There was nothing he could do. There was no point commencing CPR, it wasn’t a clinical problem that could be solved. He backed away from the bed, only now becoming aware of the blood that covered his front and squelched in his shoes. He rubbed at his eyes with the heel of one hand in frustration and loss.
An inhuman snarl emanating from the middle resuscitation bay brought his attention back. The body was thrashing against its restraints, trying to reach the group of clinicians and security surrounding the bed. The team seemed stuck to the spot, unable to process what was happening. They had seen this woman die. Her heart had stopped for over thirty minutes before they abandoned resuscitation. It was not possible. And yet, she had risen. Had killed a loved member of their staff.
Harry unlocked the controlled drug cabinet and withdrew an anaesthetic used for heavy sedation. He drew up a large dose ‒ enough to knock out a man twice her size ‒ screwed on a needle and jammed it into the thrashing body’s thigh.
If anything, its anger and movement increased. An audible snap, like a piece of breaking timber sounded from the left forearm as it wrenched against the restraint. The forearm’s shape deformed upwards at the centre. With the next tug, two broken shards of bone ripped through the skin’s surface.
The dead woman was oblivious to the trauma, jerking harder at the arm as the wrist slowly tore free. No blood pumped from the wound. It was dry, the flesh a dull brown of old meat ready for the bin. A security guard reached forward to clamp his hands onto the forearm to stop her movement. A spiked end of the bone impaled the security guard’s arm in the struggle. He screamed, pulled his arm free and fell backwards clutching the wound against his chest.
They weren’t winning. Harry’s traumatised mind slowly cogged forward. If they couldn’t sedate her with drugs… ‘We need to isolate her before that other arm gets free!’
Harry and one of the nurses kicked off the brakes and steered the bed into an empty room at the end of the resuscitation bays. Staff used this space to contain violent patients until they stopped being a threat to themselves or others. It was devoid of furniture, and had a reinforced door that was lockable from the outside. They shoved the bed through the entrance to the back wall and exited, locking the door behind them.
The room did little to muffle the snarling rage from inside. In their haste to leave, both had forgotten to activate the wheel brakes. Now, a repeated thud accompanied the moans, as the bed frame smacked against the wall in time with its occupant’s frenzied movements.
Harry walked back to the main area and was approached by the nurse manager with an update. Jill looked like she was barely holding it together. Her face was pale and eyes glassy.
‘I’ve called the police, they’ll be here any minute. They’ve asked you to call Public Health – there’s been a similar incident in Cairns this evening after an animal bite.’
Harry grunted an assent, ‘Can I get out of these first though?’ he said, indicating the gore coated scrubs stuck to his chest. ‘How are the staff that were attacked? Is someone treating them?’
‘Yeah, one of the new doctor’s sorting it out.’ Jill glanced down at his uniform. ‘Is it ok if you use the patient shower? It’ll need a scrub out after you’re done. Kind of looks like you stepped out of a horror movie… Sorry,’ she stopped herself, her face crumpling as she released a brief sob. ‘This is fucked, Harry. It’s just shit!’ she said. ‘I still have to call Kate’s family. What the hell am I supposed to tell them? I’m sorry but a patient we thought was dead ripped out your daughter’s throat?’
Harry had no reply. Jill held his gaze for a moment longer, tears escaping in a glistening line down both cheeks. She cuffed them away with the back of her hand and walked off.
Harry remained a few seconds more, staring into space. He didn’t envy her, nor did he have any advice about how to break the news in a less traumatic way to the parents. Finally, he got going again, fished a few towels and a pair of surgical scrubs off the linen trolley, and left for the shower.
* * *
Harry replaced the receiver. Public Health had listened to his outline of events, only interrupting to clarify certain points, such as the presence of an animal bite wound. The health official had ignored Harry’s question when he asked if a similar event had occurred in Queensland. The conversation was closed with a toneless notification that a police/paramedic escort would accompany the patient to a new federal quarantine facility in the city’s south.
When he came out of the back office, six police were already gathered outside the locked room. A near continuous moan persisted from within. There was no further thumping of the bed against the wall as the mindless creature had finally overturned the trolley, pinning itself to the ground. Harry introduced himself to the group, and gave a run-down of events. The officers kept quiet during the relay of information, but a few couldn’t suppress a smirk. They obviously thought he was full of shit. Harry noted it dispassionately; he still didn’t fully believe what he’d seen with his own eyes either.
Two paramedics came through the door of the ambulance bay pulling a trolley. The whole group fell silent as an orderly pushed Kate’s body past into a single room. A sheet had been pulled over her body up to the chin, covering the violent means of her death. Her face was the colour of curdled milk, marred only by a fine network of dark red lines emanating from the bite wound across her face. Her eyes stared at the ceiling, as if surprised at her own death. The orderly pulled the door closed behind him, breaking the spell on the group.
As the police organised how they would approach the restraint, the remaining patients that hadn’t bolted on their own volition were moved to a different area. Harry hung back; his help wasn’t required, and he was quietly glad of it.
The police team opened the door and rushed into the small room. Screams from the dead woman escalated as they pinned the body down, cut the restraints to the trolley and lifted it away. When called for, the paramedics pushed their transport trolley into the room and collapsed it to the ground. The team lifted the flailing body onto the stretcher, and fastened each limb with multiple zip ties to prevent any movement. Harry handed over a copy of the paperwork from the arrest, and the dual police/paramedic team filed out of the department.
* * *
The treatment of the injured nurse and security guard was now complete; wounds washed and dressed. Harry wrote them scripts for antibiotics and analgesia to see them through the next few days. The manager took pity, ushering them out the door with an early mark. Harry joined the remaining clinicians on the staff base where they’d gathered. The police had stretched a blue and white tape cordon across the entrance to the resuscitation area, restricting access to the crime scene. There was still a bunch of junk food lying on one of the desks, but no one was interested in eating. A junior doctor broke the silence by asking the question each was thinking, but reluctant to voice.
‘How do we explain what just happened?’
‘Maybe the equipment failed, and we got the diagnosis wrong,’ offered one of the nurses. ‘What did Public Health have to say, Harry?’
‘They mostly wanted to know about the wound.’ Harry paused as a new thought hit him. ‘There’s been a murmur on the grapevine about a new disease in the bat population up north that’s suspected in some recent human deaths. I wonder if that’s why they were so interested in the bite mark. Do you reckon that’s what she had?’
The other Registrar cut in. ‘We’d have to be unlucky. I think we just stuffed up. She probably had a faint pulse the whole time that was missed.’
‘So how do you explain her attack on Kate?’ asked a nurse.
‘Maybe she was delirious from the infection? Look, I don’t know for sure either,’ he said, giving up.
‘Yeah, you’re probably right.’ Harry sighed; he knew the hospital executives were going to haul him over the coals about Kate’s death. Still, he’d rather deal with that than be staring at the ceiling with a chunk missing from his neck—
A flat smack echoed from the room where Kate lay. Everyone’s head turned. On cue, another thump from the inside of the door caused it to shudder in its frame.
‘What the fuck?’ stammered the Registrar.
Harry lurched to his feet, ‘It’s happening again. Someone call the cops!’ He ran towards the door. ‘We need to keep her in there – she’s fucking dead. She bled out on me...’
He grabbed the handle and placed his weight onto it, his foot braced against the doorframe. One of the nurses joined him and leant their strength. Whatever was left of Kate, heard their efforts. A shriek of anger battered their eardrums as the door bounced from the force of her blows. The minutes dragged on as the unrelenting assault continued.
A police siren escalated in volume as a squad car neared the department, before skidding to a halt in the ambulance bay. Two constables ran in and were directed to the barricaded door. Harry and the nurse were ordered out of the way. One officer stepped forward and turned the handle, pulled open the door and stood back.
Out from the darkness shambled Kate’s body. The limbs moved in an uncoordinated lurching motion. Clot-soaked tendrils of hair matted one side of her face, covering the left eye. The right eye snapped its focus to the first police officer. Her lips peeled back into a snarl as she started towards him. The officer moved backwards slowly. ‘Stop! Get down on the ground!’
The cop pulled out his Taser, and aimed it at her chest. ‘Stop where you are!’
What had once been Kate, lurched forward.
‘Taser! Taser! Taser!’ shouted the police officer in a last warning to the corpse, then fired the pins into her chest to deliver a debilitating shock. Instead of dropping to the floor in an agony of electric charge, her body was unaffected. Her forward motion continued, now accompanied by a maddening groan.
Shaking hands dropped the Taser in preference of a Glock. The officer’s face drained of colour as he provided his last warnings to surrender without effect.
Three shots in rapid succession punched through the corpse’s chest, smashing it off its feet. The clot of hair had flung away from the left eye in the fall, freeing both unblinking eyes to bore a hole through the constable’s head as it pushed itself back to standing and started forward again.
The constable’s hand started to waver as he backed away, firing two more rounds. The first hit her left shoulder; the second entered the right side of her forehead, blowing out a section of her skull to coat the wall behind. The corpse smacked to the ground, lifeless once more. The police officer re-holstered his weapon, took a slow breath and turned around, his eyes searching the people behind until he found his colleague. He maintained a fixed glare at his partner, a “where the fuck were you during that?” expression clearly conveyed while he addressed the rest of the room in a rasping voice.
‘Start transferring any remaining patients to other departments or hospitals. This entire Emergency Department is now a crime scene.’
* * *
Harry grabbed his backpack and headed for the door. It had taken them another two hours to move the remaining patients elsewhere. He’d never seen patients accepted by inpatient medical teams so willingly before. A further two hours followed of interviews with police and the hospital’s General Manager who was desperate to understand what had happened before it was leaked to the media. Harry was beyond tired, scraped to a husk inside after the night’s happenings. He needed to find unconsciousness in sleep without any more dissection of events. There was a half full bottle of scotch at home that he hoped could deliver a dreamless sleep.
End of Chapter
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