Author:Michael Palmer

    “Humans possess a vast array of defense systems to guard against such foreign intruders,” the entomologist went on, “and yet, despite all our impressive advances in science and medicine, we still have not unlocked the secret to the body’s abilities to defend itself. The step from genetic response to antibacterial effect remains as mysterious to us now as the origins of life itself. You may be impressed with our body’s capabilities, but I am here to tell you that frightening as it may seem, there are very few battles that bacteria are not equipped to win.

    “How can an organism like B. pseudomallei remain hidden inside the human body for years, undetected by the immune system, as though a prowler has taken up residency within a burgled home, and then suddenly and without warning, become active and spread throughout the body until the victim’s life-giving blood turns to poison? This”—Scupman held up a single finger—“is but one of the questions our researchers are working to answer. For the very fate of our planet, our ultimate survival, depends on gaining access to this knowledge—of separating out the bacteria essential to our well-being from those bent by their genetics on destroying us. We are at war each and every day against an armada of microscopic enemies—enemies without consciences, whose only purpose is to multiply and metabolize; enemies genetically determined to achieve complete and total victory, even at the expense of the life of their hosts.”

    In the dimly lit room, Lou could almost see Scupman perspiring from his own enthusiasm. A weighty silence ensued, nobody sure of how to respond to the man’s rant. It was Brenda who eventually broke the tension.

    “Dr. Scupman, is there a genetic component that could explain why the bacteria remain dormant in some people?”

    Scupman appeared pleasantly surprised, perhaps by the literateness of her question. He turned up the lights.

    “Dr. Banks, would you like to handle this one?”

    Scupman’s associate looked as if she would prefer to listen. But when she did speak, her answer was delivered with confidence, and with none of the bravado of her boss.

    “You’re all familiar with Toll-like receptors?” she asked.

    The three physicians nodded.

    “Then you know these proteins are what initiate the fight against deadly bacteria. TLRs are like ten-digit alarm codes. For any pathogen that comes into contact with an immune cell, a code is entered, and if the germ is not benign, an alarm gets triggered, activating the body’s defenses. And yet, B. pseudomallei, like a microscopic magician, tricks the system by entering the code of a harmless bacterium, leaving the body unaware of the intruder’s presence. So to answer your question, yes, we believe there is a genetic reason why some people become infected but never get ill. Still, we are far from using that knowledge to develop an effective vaccine or antibiotic.”

    “Thank you, Vicki,” Scupman said.

    Banks smiled demurely, and looked to Lou even more attractive than on first impression. In spite of himself, he noticed that she wore no wedding ring—no jewelry of any kind, in fact.

    “This is for either of you,” Lou said. “Do scientists believe that bacteria like B. pseudomallei normally mutate after infecting the host or do their properties stay fairly constant?”

    “And you are?” Scupman asked.

    “Welcome. Lou Welcome. I’m an ER doc from Eisenhower Memorial in D.C., but I have my boards in internal medicine as well.”

    “Good question, Dr. Welcome. One thing I have learned during the course of my twenty-five-year career studying bacteria is that nature is constantly grooming and furbishing them to be the ultimate warriors. As I said, these are soldiers going to war without a conscience and without fear. In the battle for species survival, they are the most powerful threat mankind will ever face. Trying to account for and combat the in-host mutations of bacteria is like pitting a child’s soccer team against a Manchester United team that is not only more powerful at the opening whistle, but ever-changing during the game, and playing by different rules. Put another way, bacteria are much better at surviving than we are at developing effective vaccines or antibiotics.”

    Lou pulled his eyes from Vicki.

    “Thank you for underscoring my point,” Scupman was saying. “Humans are messy, whereas microbes are perfect—a perfect society largely invisible to our eyes and yet existing all around and within us. As I said, there is no reasoning in a microbe, no hesitation, nothing to delay the inevitable attack. When threatened, these mindless killing machines transform, mutating seemingly at will into something that cannot be defeated. They act instantaneously without regret or regard for others.

    “You see, Dr. Welcome, a single bacterium contains all the necessary components for growth and multiplication. They do not contemplate their existence. They are neither impaired nor well. The simple state of being is their life’s sole purpose. With a blind, singular ambition to produce more of themselves, these magnificent organisms exist unburdened by man’s frivolities. In many cases, we are helpless to defend against their might.”

    The room took on the oppressive atmosphere of a midsummer day, weighty and dense. Even Vicki Banks looked a bit ill at ease. Scupman broke the mood with a wan smile.

    “Let’s continue with our slideshow, shall we?” Vicki said.

    For the next twenty minutes, she ran through a series of slides depicting the functions of the laboratory and the work being done to develop effective antibacterial treatments. Several minutes were dedicated to an explanation of the different types of agents that had been declared by the government as having the potential to pose a severe threat to public safety.

    The two scientists made quite a pair. Vicki was calm and academic, Scupman utterly passionate.

    If Filstrup’s speech conveyed even a tenth of the fervor Scupman demonstrated for his work, Lou was thinking, the man would have more than a decent shot at winning the election. But that simply wasn’t the case. Lou risked another glance at Vicki Banks, and just caught her looking at him.

    Easy, buddy, he said to himself. Easy.

    “I have a question,” Harvey Plimpton said when Scupman had finished.

    “Yes, of course, then I really must be off.”

    “You’ve shown us a number of frightening bacteria. Is there one species in particular that you are most terrified of contracting?”

    “That’s an easy one,” Scupman said, his hands now clasped together beatifically. “Many of my colleagues might argue that any of several virulent strains of carbapenem-resistant enterobacter are the most lethal of all. It’s true that these are certainly terribly powerful bugs. For me personally, though, without question, to contract the newest strain of Streptococcus pyogenes, cause of the condition known as necrotizing fasciitis; to be eaten alive from the inside out; to go from one limb amputation to another, would far and away be the worst death imaginable.”


    It takes discipline to confront the most horrible truths.

    —LANCASTER R. HILL, A Secret Worth Keeping, SAWYER RIVER BOOKS, 1941, P. 110

    This was it.

    For the foreseeable future, Jennifer Lowe vowed, this was the last time she was going into an operating room. It had been eight days since Becca Seabury’s right arm had been amputated. Now, the teen was back in the OR. This time it was going to be her right leg.

    Becca was toxic. Really toxic. In addition to her leg, there was evidence of infection in her core—her lungs and heart, and the structures surrounding them. It had been horrible to watch. Jennifer had been at her side every day—ten- or twelve-hour shifts. No days off. Jennifer’s supervisor at White Memorial had warned her against making any other schedule changes with the other nurses, but she went ahead and did it anyhow. She had been on two- or even three-week medical missions to the Congo where she essentially worked twenty-four-seven.

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