I have endeavored to keep detailed notes on his progression and have instructed the staff to take pictures on the hour. Frankly, documenting the disease is perhaps the only useful thing I can do. I have also dedicated much of my time to recording the details of the two Americans’ travel, including where they visited and whom they talked to. Additionally, I have asked Lucas about his friend’s history of symptoms. I believe it will prove quite helpful to epidemiologists investigating this outbreak. I will forward my notes as I have time.
The British patient, who was brought in from the airport, remains in critical condition. I’m not optimistic that he will survive the night.
Lastly, we face a new crisis here at MCRH: personnel. I arrived this morning to find that over half of the hospital’s staff did not report for work. I cannot blame them. As I have said, we are ill equipped to deal with these patients. I have instructed nurses to wear gowns, boot covers, facemasks, goggles, and double gloves, but I fear these measures may prove inadequate, and our supplies of protective equipment will very soon run out.
I ask you again:
Outside his office, a nurse yelled, “Dr. Kibet!”
Seconds later, the door swung open. The man was bent forward, his hands on his knees, catching his breath. “More infected,” he said between pants.
Elim grabbed his coat, and the two men raced down the corridor to triage. Elim stopped in his tracks, taking in the horror.
Ten people, all local villagers, all very sick. Sweat and vomit stains covered their clothes. A few stared with yellowed, bloodshot eyes.
A nurse drew a thermometer from a man’s mouth and turned to Elim. “A hundred and five.”
It had spread to the villages. Elim wondered if help would be too late—for all of them.
Chapter 11
When the Air Force transport reached cruising altitude, Peyton stretched out across several chairs, strapped herself in, and slept.
She had gotten only four hours of sleep the night before and had been going as hard as she could all day. Still, she set her alarm for only thirty minutes later. She wanted to be fresh but not groggy for what came next.
Perhaps the most valuable skill she’d acquired while working at the CDC was the ability to sleep nearly anywhere. It had taken her years to master the practice. For her, thinking was the greatest enemy of sleep. When she was battling an outbreak, her mind never stopped working; thinking became a compulsion. But during her second year of fieldwork, she had learned a sleep technique she’d used ever since. When she needed to rest, she closed her eyes, refused to let her mind think, and instead focused on her breathing. She first forced herself to draw her breaths into her belly, allowing her abdomen to expand, not her chest. With each exhalation, she focused on the tip of her nose, where the breath touched as it flowed out of her, and counted the breaths. She rarely got past forty.
When her phone alarm buzzed in her pocket, she rose, stretched, and did a few light exercises.
She had been given the option of flying on the air ambulance instead of the Air Force transport. She would have been more comfortable there, but she’d wanted to remain with her team. To Peyton, it was a matter of principle. Besides, they had work to do. She had insisted that three of the older CDC employees take the seats on the air ambulance. They would be working in Nairobi, in support positions, and all three had thanked her for the more comfortable accommodations.
Elliott had chosen the Air Force transport as well. It had a large compartment for cargo and a separate area for passengers. The passenger section had twelve rows, each with five seats in the center, plus a single row of seats lining each of the right and left walls. At the head of the compartment were two narrow openings beside a wide wall that held a whiteboard.
Peyton imagined that the whiteboard was routinely used to brief military personnel and hammer out mission details. She was about to do the same. In fact, to an outside observer, the scene might have looked like a US Navy mission briefing.
Her audience included men and women dressed in tan service khakis identical to the uniforms worn by the US Navy, with similar rank insignias. Her troops, however, were not naval officers. They were officers in another uniformed service, one every bit as important.
Peyton was a CDC employee, but she was also a Commissioned Corps officer of the US Public Health Service. The Commissioned Corps was an elite team of highly skilled health professionals and one of the United States’ seven uniformed services (the other six being the Army, Navy, Air Force, Marines, Coast Guard, and National Oceanic and Atmospheric Administration Commissioned Corps). Over six thousand men and women served in the Public Health Service Commissioned Corps, and they wore uniforms similar to the US Navy’s: service dress blues, summer whites, and service khakis. Commissioned Corps officers held the same ranks as the Navy and Coast Guard: ensign to admiral.
Commissioned Corps officers served at the EPA, FDA, DOD, NIH, USDA, Coast Guard, CDC, and many other organizations. They were often the first responders during national disasters, and had deployed in response to hurricanes, earthquakes, and outbreaks. In 2001, over one thousand PHS officers deployed to New York City after the 9/11 attacks. In 2005, in the aftermath of three hurricanes—Katrina, Rita, and Wilma—more than two thousand PHS officers deployed to set up field hospitals and assist victims.
Over eight hundred Commissioned Corps officers worked full-time at the CDC. Visitors often mistook them for Navy officers.