Anemia
Bruce Kilstein
Near Arusha, Tanzania.
After the screaming stopped, the villagers waited a few hours before pulling Dr. Nathan Harper from the hut. Just to be safe.
It would be several days before he would regain consciousness. Arms expertly bandaged by the team from Doctors Without Borders that had finally found him. Strange that no one from the village had contacted the mission.
The mission. Nathan had traveled to Africa in search of something. What he was searching for hadn’t been quite clear although there was no doubt that something was missing. After six years of surgical residency and a year as attending trauma surgeon at Camden University Hospital, it was clear that there was a void in his life. On the surface things seemed to be going well. He had finished his training, had a promising new career, and a new girlfriend. Maybe it was all the hours spent in the artificial glow of the OR lights of the urban trauma center that made him crave some time outdoors. Seven years of just about living in the hospital was enough time to make anyone sick. You began to think the whole world consisted of a relentless flow of gunshot wounds, car accidents, surgery and transfusions.
The blood was everywhere. The pressure was enormous. This was an anemia of the soul.
He hated to leave Carolyn just when the relationship was getting hot but he was burning out. The medical mission seemed an obvious escape. He wasn’t all that religious. Hadn’t had all that much time to think about it lately but he supposed medicine had become his religion. He would leave the preaching to the true missionaries while camping out, providing some healthcare to people who really needed it and perhaps spend some introspective time out with the giraffes.
It had worked. The job was interesting. He was learning more about diseases he had only read about before. He was learning about a people who surprised him with their genuine capacity for warmth. Westerners thought of them as poor. Economically there could be no doubt. In terms of tradition and spirituality they lacked for nothing. Away from pagers and phones, he began to relax. He kept a journal of letters to Carolyn that he hoped would help her appreciate his reasons for leaving.
The last call came near dusk. The messenger from the outlying village had made it seem urgent. You didn’t have to speak Swahili to see that, but Nathan’s guide seemed reluctant to want to go. Freddie mumbled some explanation about tribal superstitious nonsense and how it wouldn’t be safe to travel at night. Nathan looked at the villager and then at Freddie and realized that under Freddie’s indifferent exterior there was fear.
After some brief words Harper gathered his medical sack and headed off for the Land Rover with the villager. Freddie had little choice but to grab a rifle and follow. They drove west as a huge sun started to dip below the horizon, the day rippling away in waves of dying heat. The air became still and the night animals began to stir, dim silhouettes skirting the edge of the bush. They rattled over a track that suggested a road as clouds of insects rose before them in search of the night’s first blood meal.
Over the noise Freddie translated the patient’s symptoms to the doctor. Fever, bleeding from the nose and eyes, delirium. Not a rapid nosebleed but a slow, steady drip that would not stop. Now Harper began to worry. What if this was Marburg or worse Ebola? Deadly viruses that killed just about everyone that came into contact with them. If that was the case he should have listened to Freddie and not rushed off with such zeal. This would be a job for a better-equipped organization like the WHO or CDC. Well, he would be careful and investigate. If this were one of the filoviruses then acting quickly and setting up quarantine would save hundreds of lives.
They came to a dusty stop about an hour later at the outside of a ring of mud and thatch huts. The air was still warm but a group of men sat by a fire, faces staring orange fixed on the sheltering flames as the darkness shrunk their world. Even in this wild place there was protocol. Nathan politely waited by the Rover while Freddie approached the elders to ask permission to enter. Harper took his bag and a flashlight from the vehicle. Something was wrong with this place. In his few months he had been to enough villages to know that there was always some noise, some bustle at the end of the day. Children and dogs would run to herd chickens or livestock. There would be smells of cooking and rough tobacco. Laughter. Here nothing moved. The stillness seemed unnatural. From far off the low trumpet of an elephant sounded. He played the light around the perimeter. There were no children. No dogs. No livestock. No one laughed.
Freddie motioned Harper to come forward. They were directed to a hut at the edge of the circle. None of the men around the fire followed. A talisman hung on the doorframe. Feathers and shells. When he came to Africa, Nathan would have said that tribal medicine was just superstition. A few months observing the shaman that operated in the area quickly changed his mind. There was no doubt that they often had the ability to heal. Maybe the herbal medicines that they brewed were potent drugs. Maybe their incantations had real magical power. Maybe both, but the key ingredient seemed to be that they believed in themselves and the patients believed in them. Nathan had learned long ago that a patient’s outcome had just as much to do with their wanting to recover and trusting in the treatment as the treatment itself. The fact that they had called him meant that this was something unusual.
Trust.
Hearing no sound they ducked and entered the low room following their narrow beam. The fading light hid most of the blood on the walls. The woman was clearly dead. She lay on a mat in the middle of the floor. Not breathing. Staring blankly at the ceiling.
Nathan approached her but Freddie stayed by the door. He glanced back quickly over his shoulder. “C’mon Freddie, there’s nothing to be afraid of.” Freddie didn’t move. “Trust me.” He inched forward.
Harper knelt by the body. Strange. A thin trickle of blood still seeped from the corner of her eye. It ran down her cheek over tribal scars, through her beaded necklace and made a tiny pool on the ground. There should have been flies. He fumbled in his bag for a pair of rubber gloves and then reached out tentatively for her neck. No pulse. He grasped her wrist and moved her arm. It was limp and pliable. No sign of rigor yet, but if she had just died why was she so cold? Why hadn’t the blood clotted?
He found a culture tube and removed the swab. He touched the swab to the corner of her eye to get a sample and flinched when the eye moved. He jerked back in response.
“What is it Dr. Harper?” Freddie called moving closer and shining his light in Nathan’s eyes.
“Nothing Freddie. I just got spooked.” He uttered a little laugh. Of course the eye didn’t move. It had just appeared to change position when he tugged at the lid. Silly. Best to get a larger sample if this was something unusual. He removed a syringe and two glass tubes from his bag. “Freddie, I really could use your help. I can’t hold my light and draw blood at the same time.”
Freddie moved a few steps closer and aimed his beam on the woman’s arm. The sun had nearly set and the harsh artificial light made her arm seem pale, in spite of her dark skin. Thin veins snaked blue toward her hand. With practiced ease Harper pierced her vein and thick fluid filled the syringe. As he withdrew the needle, a spray of blood jetted from the small wound. He flinched as it hit him on the cheek. Freddie dropped the flashlight.
“Damn!” Harper yelled. He wiped his face with his sleeve. He was astonished. There couldn’t be that much blood pressure in a dead woman’s arm. He felt his skin burning where the blood had landed. He tore open an alcohol gauze pad and wiped hard at the area. The vapor made his eyes tear.
The movement was almost imperceptibly swift. As he turned his head to see where Freddie had gone, the woman was at his exposed throat. As he fell back the needle drove through his wrist. He dimly would remember screaming before the world went black.
Camden, New Jersey.
Six months later Dr. Harper stood on the roof of CUH with his trauma team awaiting the helicopter that banked low over the river from Philadelphia. The sunlight bothered his eyes. Too much time indoors, he thought. He turned his back in shade and let the nurse assist him in gowning. She tried not to be obvious but it was clear that she noticed the scars. They had healed well. The doctors who had saved him had done well but in close quarters it was easy to see the jagged line on his neck, the marks on his cheek like frozen tears and wound on his wrist as she slipped the glove over his outstretched hand.
He hadn’t minded coming back to work after his recovery. He had been getting bored. He had hated to leave Africa so soon but it was clear that he could no longer stay. He needed a more sophisticated medical facility. His lack of a clear explanation as to what had happened to Freddie and the Land Rover did little to reassure the folks at the mission and, besides, no other guide would agree to work with him.
He did feel tired though as he pulled his mask over his face and slid the plastic protective eyewear into place. Once the novelty of returning to surgery had worn off, the pace of the hospital had caught up with him. He would get some blood work and see Cripps for an exam. The helicopter landed in a spray of dust and grit.
Paramedics unloaded the patient. Each member of the trauma team had a specific job. They worked as a unit with Harper at the head directing the show.
“Gunshot to the left chest,” the paramedic yelled over the noise of the blades.
They moved quickly, wheeling the victim away from the helicopter. A technician cut the man’s shirt off exposing the wound. His skin a blue pale shade that told them he was hypoxic. The bullet had punctured the lung and blood was filling the chest. Harper couldn’t be sure that it hadn’t hit the heart as well.
The scene would look chaotic to an outsider but they remained calm. Harper calmly gave orders. The ABC’s came first. Airway. Breathing. Circulation. If you had no airway, you had no patient. “Let’s intubate, get a central line in his neck, same side as the wound. I need a chest tube.” The helicopter powered down and Harper placed a stethoscope on the patient’s chest. No breath sounds on the side of the injury. Weak pulse. An anesthetist grabbed her blade, inserted it into the man’s mouth and slid the endotracheal tube between the vocal cords. She attached the tube to oxygen and assisted breathing with a bag. Through a tattoo on the neck that identified the man as a gang member, a resident plunged a large needle into the jugular vein. He inserted a catheter and attached tubing to a bag of fluid. He squeezed on the bag to try to replace the fluids as rapidly as possible. A nurse poured antiseptic solution over the patient’s chest and everyone’s hands that were working nearby. Harper took a scalpel and made a transverse cut between the ribs. He spread the muscles of the chest wall with a clamp and then inserted his finger into the chest cavity. Warm blood flowed over the opening and down his arm and over his feet. He felt the blood through his sock oozing between his toes. With his other hand he took a plastic tube and, using the finger in the chest as a guide, slide the tube over his own hand into the chest. The blood took this detour through the tube and away from Nathan’s socks. The nurse handed him a suture and he sewed the tube in place. This would allow the lung to expand and give them time to get the patient to the ER where he would receive a transfusion and x-rays.
Nathan tore off his bloody gown and gloves and saw that the blood had soaked through his scrubs. He left the younger doctors to care for the stabilized patient and headed to the locker room to change. As he undressed, the room began to revolve. He didn’t feel well. He staggered into the shower. He kept the lights off and felt a bit refreshed as the blood washed down his legs in the dark. He would have to see Scripps later. When had he eaten last? He didn’t remember. He wasn’t hungry though. He needed a nap.
Dream.
He was in a small hospital in Africa. Small room, plaster peeling the walls. Intense sun through a broken window blew cold air. Wrists hidebound to the icy bedrails. The woman from the hut enters, dressed as a nurse, carrying a tray. Eyes bloody she smiles and removes the cloth covering the tray revealing the needles, the tubing, the glass, and the flowers. She makes him sip the river water the dead drink to forget life. Before he can speak, to warn her of the contamination, she crams his mouth with flowers. She smiles, wiping the blood from her eyes so that she can better see him struggle He drowns in the sweet aroma of the flowers and her rotting skin. He strains at the bonds that now hold him, trying to free himself from this dark hospital, this nightmare, this rough beast.
She whispers in his ear and he is calm, understanding words she breathes in some dead language- the words fill him. It made strange sense to surrender- he now knew what he needed to become fulfilled and he moaned as she kisses him and plunges the needle into his heart.
Carolyn.
From the journal of Nathan Harper, M.D:
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April 2, 2005
Near Arusha, Tanzania
Dear Carolyn,
Hello from Africa! I never thought I’d make it. So much to tell I don’t know where to start. Long flights- Newark to Amsterdam to Dar es Salaam to Arusha. Huge jet lag. Traveling through the night it felt like we snuck into Africa and then dawn rose on a whole new world. Scenery is breathtaking- low savannah dotted with acacia trees. Plains of grass waving to the horizon, animals ride the waves like ships in a sea of grass. Giraffes are the best. How can something so big move so gracefully?
Getting to know the people. You know how bad I am with names. Most are friendly. Out to work in surrounding villages the first day with two nurses, a doctor from Belgium and a guide named Freddie.
I don’t know when this will reach you but I hope you are still talking to me. Please know that my leaving had nothing to do with you or us. In fact, because I grew so fond of you so fast, I almost decided not to take this trip. I hope you can come to appreciate that I had to leave. I had come to a point of maximum burnout, stress and, frankly, depression. This for me isn’t so much time away as it is an attempt to draw myself together. I hope that when I come home you will be there for me- and find me changed. You wouldn’t have wanted to spend very much time with me the way I was heading. Trust me. I hope I will be worth the wait but certainly understand if you feel that I am holding you back in any way.
With fondness,
Nathan
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At first, Carolyn Blanchard had not understood. Nathan had flirted with her for a whole year before finally asking her out. Soon after she agreed he left. As a social worker at the hospital, they often crossed paths to discuss helping patients make arrangements for care after discharge. She knew she wasn’t the prettiest woman in the hospital but she was by no means ugly. Her personality quickly charmed most of the young doctors, Nathan included, and offers for dates were never in short supply. She was attracted to Nathan immediately. He was cute, confident and always seemed to have time to talk to his patients. The problem with working so many hours, they had mutually lamented on their first date, was that they never had the opportunity of meeting people their own age out in the “real world.” Carolyn was wary of dating the residents because she knew that CUH was only an arduous way station on the long academic road. Most would be leaving when they finished their training. She was attracted to how confident he could be at work and how shy, vulnerable, and introspective he was outside the hospital. She had only accepted Nathan’s offer because he had decided to stay on and accept an appointment to the medical staff. She was then ready to take a serious interest.
Then he left. There was no way to get in touch with him. She brooded. She was unsure of what to do, but when she heard of his (what did you call it? accident?) injury, she had found herself worried and scared. The feeling had surprised her. She cared more for him than she had expected. When he returned he did seem different. Changed by his experience.
The journal had arrived a month before Nathan’s return. Battered, stained, but mostly legible, Carolyn read with tears Nathan’s narrative, all addressed to her. He described his life, experiences, fears, and feelings for her. He wrote twice a week for ten weeks, and then nothing. A final letter was written on separate stationery and taped inside the back cover of the journal.
She watched him sleeping on her sofa. He looked pale. Always tired at the end of the day but after his naps, he seemed much better by late evening. She let him sleep, poured a glass of merlot, and reread the final letter written in a female hand.
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Hospital du Virgine
Systeme du Sante Misericordia
Lourdes, France
30 June 2005
Dear Carolyn,
I hope this finds you well. I had asked one of the sisters to transcribe this letter and send it along with a journal that I kept for you these last few months. My recovery is going well but this should still arrive well ahead of my return.
Tough to talk now Ð wanted to tell you there has been an accident. The good doctors of Doctors without Boarders can be thanked and credited with my survival. The details aren’t all that clear to me and certainly beyond the scope of description in this note Ð but know that they expect me to recover from my injuries and the illness that followed (not really sure what to call it Ð some kind of infection maybe) that left me apparently mostly delirious for two weeks. I don’t remember much of that time. Dreams, mostly of you. According to the sisters I did my best to resist their most dedicated ministrations of faith. They have not given up on saving my soul but so far they seemed to have made more progress with my physical side. They should all be made saints.
Will be glad to see you soon. Hope this journal will describe what I have been through and how you have been in my constant thoughts.
With love,
Nathan
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Carolyn looked up from the letter, startled to find Nathan awake and staring at her. She dropped the glass. It shattered on the edge of the coffee table, staining her legs red. Nathan just stared.
“I didn’t know you were awake,” she said, kneeling to sop up the mess on the hardwood floor. She cut her hand picking up one of the shards. She wrapped her hand in a towel, a spreading purple stain soaking through. “Damn,” she said.
“I could hear your reading,” Nathan said, “It woke me.”
“I think I may need stitches.”
“Let me see,” he said, not moving from the sofa. He edged back into the cushions so that she could sit by him. He unwrapped the towel and held her hand in his. “Amazing,” he said, tilting her hand so that a trickle of blood ran down the scar on his wrist. “So much we can learn from a little fluid.”
“Are you sure you’re really awake?” she asked, attempting to pull away. He wouldn’t let her.
She began to feel dizzy at the sight of her own blood. The wine had probably contributed but when he brought her hand to his lips she found the sensation erotic. He pulled her to him and heard, as if from afar, a low moan that seemed to come from somewhere within her. He sucked on her hand and moved slowly up her arm to her collarbone tracing the sleek curve with his tongue, nibbling with his teeth, pausing at her neck, she felt on fire wanting him to (what?)
“Fill me,” he finished the thought in her ear. It was the last thing she would remember for three days.
From the medical record of Nathan Harper.
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Lucien Cripps, M.D.
Camden County Internal Medicine and Hematology
Progress Note
Patient: Harper, Nathan DOB 8/30/75
30-year-old white male complains of fatigue, decreased appetite, muscle aches, and strange dreams (?). Other medical history non-contributory except for travel to east Africa and trauma with subsequent febrile delirium after encounter with patient (Hemorrhagic fever?). No records available.
Exam: BP 98/64 HR 66 temp 95.7
Heart regular with ectopy. Lungs clear. Abdomen soft, non-tender, no organomeglay
Skin pale Ð scars wrist, neck, face with eccymosis. Extremities decreased capillary refill fingers.
Lab: WBC 8.2, Hemoglobin 7.1, HCT 25, platelets 92,000. Microcytic indices suggest iron deficiency.
Impression:
Anemia of uncertain etiology. Suspect exposure to hemorrhagic fever ex. Dengue/Breakbone fever. Doubt Marburg/Ebola virus. Doubt neoplastic. Abnormal cardiac response.
Hallucinations/ depression; posttraumatic stress?
Plan:
Supplement iron.
Consider colonoscopy, bone marrow biopsy.
ELISA to rule out adneo or filo virus exposure.
Psychiatric evaluation.
Signed electronically/LCMD
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Nathan.
The realization was slow. Harper let the soapy water ooze down his arms at the scrub sink. In the time he usually reserved for thinking about the surgery he was about to perform, he reflected on the last few days.
His visit with Cripps had been enlightening. The blood test had been a surprise. He knew he was tired but just how anemic he was had been startling to both Nathan and his doctor. He told Cripps everything, well almost everything, that had happened and how he had been feeling. The explanation had made some sense. The lady who had attacked him in Africa certainly did manifest many of the symptoms of hemorrhagic fever. All except the part where she didn’t have a fever or a pulse but he didn’t think Cripps needed to know that part. He already seemed to think that Nathan was crazy, or at least “mentally affected by his traumatic experiences,” as Cripps put it. He had told him about the dreams. He didn’t blame Cripps for cooking up a diagnosis. Sometimes you had to ram a square peg down a round throat. So what if all the information didn’t add up to exposure to hemorrhagic fever? What he had did seem oddly viral. Boodborne. The alternate explanation that Nathan was kicking around privately would have sounded clinically absurd in the white light of the exam room. He gazed up at his refection in the window to the OR.
In the blacklight of the bedroom things made sense in the way segments of dreams connect. He had been longing for something when he went to Africa and maybe he had gotten it. The chance to know a hunger deeper than any he could have previously imagined and with it, the deeper fulfillment satisfying that desire. He had staggered around for days slipping in and out of dreams, odd sensory hallucinations. The anemia, the lack of blood, made sense in explaining how tired he was and, with that fatigue, perceptions altered. What Cripps couldn’t say, and would not be able to no matter how many tests he ran, was where half of Nathan’s blood volume had gone. Nathan smiled beneath his surgical mask. He couldn’t really say either, other than to suppose that what was lost in Africa was lost for good. When the blood left his body in a certain way (he hadn’t been able to name it even to himself yet) it had to be replaced in the manner in which it had been removed. He wasn’t even sure how he knew this. Instinct probably. The way a spider knows how to make a web.
He finished his scrub and backed in through the OR door, hands held away from his body to avoid contamination. He put on his gown and gloves. The nurse handed him the scalpel. He traced a red line with cold steel though warm skin and thought about his long weekend with Carolyn. How she had filled him so warmly, tasting her again and again. How it left him with more and more energy, as she grew steadily pale. He had to stop at some point of course. He didn’t want to kill her. She was falling in love with him and he didn’t know if that was a good thing given the circumstances. Maybe being in love made the exchange of body fluids more meaningful. Sacred. It felt good to feel so dominant. He felt guilty that it didn’t bother him.
He shook off the thought. What their little weekend had left him was enlightened. He knew his hemoglobin would be higher now if Cripps drew another blood test. His color was better and he was sleeping very well. At least for the time being. He had no idea how long it would last. How long it would be until he needed to be refilled. He held out his hand and the nurse passed the long scissors with the reassuring wet smack that instruments made on latex. He deftly reflected the patient’s intestines, placed retractors for his assistants and exposed the leaking aorta. He stopped the bleeding, wrapping his hand around the throbbing vessel like an old friend.
Carolyn.
The dream
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Of the lady in the beads, hovering over her bed, whispering to Nathan in private consultation. The smell the close constriction of, a sickroom full of flowers
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ended with her alarm clock. She struggled to consciousness, barely able to read the day. Monday. Had she been in bed all weekend? She stared at the ceiling recalling fragments: wine, a shattered glass-
She held up her neatly bandaged hand.
Nathan, kissing her-
She absently touched the spot on her neck, surprised to find it painfully hot.
And the fever.
She rolled toward the nightstand: pitcher of water, bottle of Tylenol and a note:
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Monday-called in sick for you. Don’t dehydrate.
Replace your lost fluids. Will check on you later. Ð N
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She remembered feeling sick, and managed a smile, thinking how caring Nathan must have been. Tending her fever, bandaging (binding?) hand. Had it become infected? Probably too soon for that. She drank some water and was swallowing two pills when the thought closed on her like a lid. Could Nathan have given her whatever he had caught in Africa? Some kind of virus?
She began to sweat. Morning light leaked through the window slats. She found it painful. Maybe if she slept some more. She pulled the bloody quilt over her face only to resume the dream.
Lucien Cripps
found Nathan, after a bit of a search, at the bedside of his trauma patient. Nathan watched the man dying in a lonely room at the end of a long hospital corridor. The room was darkened, low glow of late afternoon and high glow green of the monitor that recorded the last erratic, slow churn of an ebbing pulse.
Cripps leaned into the room. “Nathan. I need to talk to you.” He motioned at the man in the bed, “He conscious?”
“I doubt it,” Nathan said. He joined Cripps in the hall.
“Sad,” was all Cripps could say. They had seen the results of gang violence all too often to be overly affected. He looked down the hall to make sure they could not be heard. “I didn’t want to give you the results on the phone.” He handed Nathan a lab report. It was a positive test for the Marburg virus.
“False positive,” Nathan said. “If that lady in Africa had Marburg, I would be dead by now.” The thought took him by surprise. Something he was missing. He tried to manage a smile for Cripps.
“Maybe. I took the liberty of sending your blood sample to the CDC.”
“The CDC!” Nathan shouted. Nurses from the station down the hall looked up. “The CDC,” Nathan repeated in a harsh whisper. “Shit, Lucien.”
“Look, Nathan. We can’t take chances. If it is Marburg you could be a carrier. I know all of your symptoms, the anemia, don’t make sense but I need some outside help.”
“You know what they’ll do don’t you? They’ll be here with a helicopter full of men in space suits. They’ll stick me in isolation. Probably shut down the whole hospital.”
“Better than killing everyone in the hospital.” Cripps tried to sound reassuring, “Nathan, I think it’s best if we admit you as a patient. Maybe have Lillian Mueller look in on you as well.”
“Sure, the CDC and a psychiatrist. I thought you were my friend.”
“I am also your doctor. It’s what’s best.”
“What’s best is that I get back in there with my patient.”
“He’ll be dead soon. I want to make sureÉ” he trailed off.
“That I’m not dying,” Nathan finished the sentence.
“Yes.”
Nathan had a sudden clear moment of understanding. Now he had to keep himself from laughing. “If it is Marburg, there is nothing you can do anyway.” He tried to sound appreciative, “Lucien, I know you are trying to do what’s best. I know that I haven’t exactly been myself lately. And, you’re right, the stress of this illness and getting back to work has been tough. I’ll take a few days off and if I’m not better, then I’ll check myself in and you can unleash Lillian and the rest of them on me. Right now I’m going back to my patient.” He didn’t give Cripps the chance to respond. Nathan went back into the room and shut the door behind him.
He sat in the dark watching the sun set behind the skyline. He was hungry again, but remained calm. His conversation with Lucien had confirmed what he had suspected. All the legends, the movies and books had it wrong. It was virally transmitted. Whole villages died (from what? Exposure? Contact? Blood loss?). Didn’t matter. Some survived. The health organizations looked for some mysterious vector, cave bats or monkeys or mice that seemed to vanish with the suddenness of the outbreak. They would never find the host because it was something that they could not accept. The real hosts, the carriers, were invisible to them. (The Church had some idea, but people stopped believing them a thousand years ago.) They could be lying dead and dormant or working as charitable nuns. Thank (whom, God? Maybe not.) for Sister Marcella. He had a lot to learn but was suddenly excited by the possibilities. He knew what he had to do.
He watched the monitor as the patient faded. Eyes already staring at the emptiness that the dead seem to enjoy. Before the nurses could notice on the remote monitor, Nathan rose to the bedside, unbuttoned his shirt and pulled the leads off the man’s chest. He attached them to his own failing heart, an organ that he now knew he had outgrown. He wound a blood pressure cuff around his arm as a tourniquet, opened a new IV catheter with his teeth and inserted it into a vein below the inflated cuff. He checked the blood type on the bag that hung above the bed. Probably didn’t matter if it matched his. He removed the tube from the patient’s arm and inserted into his own IV.
Soon he felt the warm rush fill his veins and spread like a blanket over his whole body, he knew what a drug addict felt like after a fix, his fingers flexed, his head fell back, eyes gone ash as the sun disappeared behind the city.
Harper
spent the next few days with Carolyn. He took just enough blood to keep her semiconscious and keep him adequately fed. She wouldn’t remember anything. While she slept, he spent much time on the phone making arrangements. He checked in with Cripps who told him that the CDC was sending a team at the end of the week. Nathan agreed to be admitted to the hospital.
He considered taking Carolyn with him, but he knew better than to take someone on a journey he knew so little about. There would be time to visit her later. He felt he had centuries of time. He felt sorry that they would probably subject her to thousands of medical tests once they realized the connection to him. They would find nothing. She would recover.
He felt suddenly sad for Lucien, but Nathan could see no other way. If he chose to just leave, disappear, there would always be people looking for him. No matter how cold the trail grew, he would always have to watch his back. Better there was no trail at all. He could at least explain everything to Cripps. Give him the satisfaction of closing the lid on a medical mystery.
Newark International Airport
Two days later.
The two men took a coffee break in a quiet part of the terminal customs area before resuming the tedious loading of the planes. One sipped coffee as the other scanned a copy of The Currier Post:
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Camden- Dr. Lucien Cripps, 41, of Camden University Hospital medical staff, was found brutally murdered in the morgue of the hospital yesterday. Parts of the body were badly torn. Police sources speculate that Cripps was attending the body of his colleague, Nathan Harper, M.D., 36, who had recently died of a rare blood disorder. Harper’s body was missing from CUH. Blood at the scene matched that of Cripps and an unidentified person assumed to be that of the assailant. Blood on the floor and walls suggested a struggle. Authorities suspect that the intruder, intent on stealing a body for some deranged purpose, surprised Cripps in the morgue and killed the doctor in the struggle. A single set of bloody footprints in the hall led to an emergency exit, suggesting that the intruder carried the body of Harper barefoot to a waiting vehicle. Police are questioning hospital personnel and will not discuss developing leads.
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He sat back on a large crate. “Can you believe that?” he said to himself. He put the paper down and checked his manifest against the label on the crate. “Newark to Amsterdam to Paris, Orly. KLM flight 4233. Supplies, Sisters of Mercy, Lourdes, France. Cleared customs routing number 39A322x. Looks good.” The men slid the heavy crate on the forklift. They heard the contents shift unpleasantly.
Nathan felt his weight lift; free of gravity in the blanketing dark, glad that he had remembered a pillow.
