Ingvill Berntsen was the only person in Trinity Lutheran Church. She liked praying alone with her God, liked being able to hear the faint echoes of her whispered prayers. Eventually, she braced her three-footed medical cane, stood, and shuffled toward the church doors.
At the arched doorway, she dipped her finger in the water font and blessed herself. And cursed herself as well. Staphylococcus aureus drifted in the limpid, clear water. At her touch, bacterium nestled into the minute skin cracks of her chafed hand and began to propagate.
Despite being 84, Ingvill lived alone in her Eau Claire apartment, relying on home deliveries and community services. As she washed her hands that evening, she spread the flesh-eating bacteria from her right hand to her left. The next morning, gnarled fingers on both hands were inflamed, but she assumed that, like many of her ailments, it would eventually pass.
During the next day and night, the infected sites swelled and changed color from angry pink to the shade of rotten rose petals. Her hands hurt badly, but Ingvill, who most people called Inga, was used to pain. The day after that, three of her fingers developed black spots, and she searched her medicine cabinet until she found a container of three-year-old penicillin tablets and began swallowing them as prescribed.
The bacterium feasted subcutaneously as they invaded her hands, forming blisters and releasing a dishwater-like fluid. Ingvill lost the use of her hands as toxins coursed through her system and a fever left her incoherent. On the fourth day, the frail woman died alone in her apartment.
“Runa, they’ve found a woman dead of what appears to be necrotizing fasciitis.”
“Yes, Doctor Norberg?”
“It happened less than a mile from here. Incredible. This is Wisconsin, we get frostbite cases, not flesh-eating bacteria.”
“Is it one of our patients?”
“No, thank God, but we need to ramp up our cleaning procedures. And gloves. We don’t want to be spreading this to our patients. And a case traced back to our office would cripple my practice before it even gets going.”
“Yes, doctor.” Runa’s tone was firm, assuring him that nothing would get past her scrutiny. In only three months as his nurse-assistant, Runa Berdahl had run a road-grader through his practice, smoothing out the appointments and record keeping into something navigable. Better still, she was willing to occasionally babysit for the Norberg’s two children.
Anders Norberg was an internist who diagnosed and then usually shuttled his patients on to specialists for treatment. The rest of the morning, he hopscotched from one exam room to another, so focused on the complaints that the patients themselves were a blur. As he was eating lunch at his desk, he scrolled through messages on his laptop. One message made him put down his sandwich.
From: Eau Claire Health Department
To: Licensed medical practitioners in the city of Eau Claire
Subj: Further incidences of necrotizing fasciitis
Please be advised that the health department has confirmed two further cases of necrotizing fasciitis, known commonly as flesh-eating disease. Both patients remain alive, although significant portions of an arm and a leg were removed surgically to contain the infections. As of this writing, there is no known common infection vector, but police and medical staffs are investigating both cases, as well as the initial terminal case of an elderly woman. The Centers for Disease Control (CDC) have been notified. Medical professionals are encouraged to practice even more vigilant sanitization procedures, and to report any suspected case immediately to the health department.
“Holy crap,” Anders muttered. “Runa? Runa?” he called out, then remembered that she was shopping at Complete Foods during her lunch hour. Anders mentally reviewed the morning’s cases, but couldn’t recall any instances of inflamed or necrotic flesh, and decided that at this point there was nothing else he could do.
When Runa returned, he filled her in.
“Our congregation will pray for them on Sunday.”
“I’m surprised, Runa. I don’t think of you as a church-goer.”
“I keep to the old ways.” She made a face. “But truth be told, there aren’t very many attending, even on Sunday.”
Anders’ cell phone woke him up at 2:00 a.m. the next morning. There was a message from Eau Claire Public Health.
“This is Doctor Ralph Adams with the Eau Claire Public Health Department. This message is for all medical professionals in the greater Eau Claire metropolitan area. Four additional cases of necrotizing fasciitis have been reported since yesterday’s email report. Two of the patients are in critical condition. Doctors, nurses, and caregivers must immediately report all cases of skin inflammation or infection to this office, and take all epidemiological precautions in treatment.
“The cases reported thus far have occurred in the southwestern quarter of the metropolitan area, and the source(s) of infection are suspected to be in that quadrant. Doctors and nurses are requested to confirm receipt of this message.”
Anders knew Ralph Adams must still be up, and knew him just well enough to call back.
“Ralph? Anders Norberg. Anything I can do to help?”
“Hi Anders. Not right now, but stay ready, because this is ugly. All the cases appear to be a highly contagious strain of Staphylococcus aureus, resistant to the standard antibiotics. We think we’re going to lose two of the patients. In addition to your own patients, appreciate your keeping a trained eye on the people you encounter outside the office. And I wouldn’t shake hands with strangers.”
Anders woke his wife. “Nellie, keep the kids home from school today.”
“Why? They’re fine.”
“And I want to keep it that way. This skin infection that’s going around is getting much worse. Let’s just be careful until we see what’s happening.”
The local television news programs began at 6:00 a.m. that morning, and were whipping the disease news into viewer frenzy. The babbling faces threw in the word plague several times. Terrific, Anders thought sourly, panic will really help to control the infection.
When he reached his office at 8:00 a.m., there was a line of people outside, half of whom Anders didn’t recognize. Runa, uniformed and latex gloved, stood as a stocky but well-curved bouncer in the doorway, keeping the riff-raff at bay.
“We need to get into triage mode, Runa.”
She nodded. “Worst first, patients or not?”
“Yes. Let’s do the initial screening out here so we don’t have to wipe down the exam rooms after every look-see.”
Runa was fearless, ordering those outside the office into groups, and seemingly callous to their complaints about deserved treatment. It’s like she’s done all this before, just another day at the office.
Anders waded into a stream of cuts, bruises, burns, rashes, and in one peculiar case, hemorrhoids. They were all innocuous until he reached Judy.
Judy actually was his patient. Unusually thin, with an admitted cocaine habit and what Anders suspected was a dabbling with heroin. The calves of both her legs had patches of angry red. Anders noticed fine cuts on both legs.
“Judy, did your recently shave your legs?”
“Please describe everything you did yesterday, every little detail.”
“Nothing unusual. Showered and shaved my legs in the morning, went to work, ate lunch at a Gut Brot, more work, worked out a little at the gym, came home, made supper for myself, watched some television, and went to bed.”
“Did you shower at the gym? Swim in the pool?
“Both. I like the pool there, it’s not too heavily chlorinated.”
“Which gym was that, Judy?”
Anders hesitated. “Does somebody else have a key to your place?”
“Judy, you may have a serious infection. I’m going to arrange an ambulance to take you to St. Olaf’s hospital for tests and treatment that I can’t do here. Call your boyfriend and ask him to bring whatever you’ll need.” Anders nodded at Runa. “Ambulance please. Tell them it’s a suspected case of S.A.”
“Dr. Norberg, you’re frightening me. It’s just a rash, right?”
“Let’s hope so, but we’re going to make sure you’re okay.”
Anders got a call from the hospital a few hours later. “Is it S.A.?”
“Yes. We’ve started her on an IV for massive antibiotics, but her immune system is badly compromised. We’ll know more tomorrow.”
“Thanks.” Anders turned to Runa. “She’s got it. Is the exam room clean?”
“Scoured. There’s nothing living left in there.”
“Good. I think it’s going to get worse. Have you ever seen anything like this?”
Runa paused. “No, not like this. Are we done for the day?”
“Yes. Thanks again, you were an incredible help. I need to stop by the nursing home and check on my grandmother—those places are disease hot houses.”
Once at the nursing home, Anders checked in with the staff doctor on duty. “Any cases of the flesh-eating disease?”
“Amazingly, no. We’ve restricted visitors, because most of our patients are so frail that they’d just crumple up and die if they got it. I told your grandmother that you were coming.”
“Thanks.” Up three flights, down two corridors, and he was there.
“Bestemor, how are you?”
“My little Anders, come give me a hug.”
He gently drew her torso off the hospital bed and gave her a soft hug, then kissed her forehead and eased her back down. “You mustn’t let others touch you unless it’s absolutely necessary, Bestemor. There’s a terrible disease in the city now, maybe a plague if we don’t take care of it right away.”
Marte Norberg’s expression seemed to suck back into herself, and then rush back outwards. “Finne Pesten Bjerring!”
“Look for the pest witch. That’s what my grandmother used to say. She believed that plague was spread by vicious hags who were immune to the disease, Sometimes, she said, the hag would act like a rake to spread the plague and only a small percentage would die. Sometimes she was like a broom and almost everyone was dead.”
“That’s an ancient superstition, grandma.”
“I know, but disease is spread by people, Anders. Find who is carrying the disease and you can stop it.”
“Yes, Bestemor.” He provided twenty minutes of detailed news on Nellie and the children, then hugged Marte again and left.
His phone made noises on the way home, and he pulled over to read texts and emails. The Eau Claire health department had sent a long message, but Anders focused in on two paragraphs.
“As of 7:00 p.m. Tuesday, November 16th, the number of cases of necrotizing fasciitis has tripled to eighteen, with new cases being discovered every two to three hours. The CDC has arrived on scene and is setting up their disease control facilities.
“While we have been unable as yet to determine the disease transmission vectors, the CDC suggests that there may be one or more human transmitters who as yet show no symptoms of the disease, but transmit it through direct or indirect contact. This occurred most notably in the case of Mary Mallon, a.k.a. Typhoid Mary, who over time infected and killed a great many people.”
Anders called Ralph Adams again. “Ralph? For Christ’s sake, Ralph. Typhoid Mary?”
“Could be, Anders. Mary Mallon refused to give urine or blood samples, so we’ll never know for sure, but over time, she worked as a cook for a half dozen families and typhoid cases occurred in every family. Nobody’s quite sure what eventually happened to her.
“Anders, you should know that Judy Garrison has gotten a great deal worse. We may have to amputate portions of both legs, and even that might not be enough.”
“Damn. But thanks for telling me, Ralph. I’ll try and stop by.”
On arriving home, Anders showered, scouring his body with antiseptic soap before putting on fresh clothes and joining his family. Despite the howls of the children, he left the television off and confiscated the PlayStation controls, taking an hour to explain to them how dangerous the disease was, and how careful they must be.
Anders reached his office the next morning to see an even larger clot of people, many not seeking treatment, but hoping to be examined and found uninfected so they could for a little while relieve their fears. Runa had already marshaled them into groups.
As they worked, Anders told Runa about the visit to his grandmother. “You’re Norwegian, Runa. Is our folklore so demented that we believed in a pest hag acting like a rake or a broom?”
Runa half-smiled. “I vaguely remember hearing the tale, Doctor, but not for a very long time.”
They worked non-stop until 1:00 p.m., and then Anders had to eat something and Runa used the lunch break to go to her gym. At 5:00 p.m., as the last visitor left, Anders realized that he had ignored everything about his patients except their skin, and that he’d examined more fingers and toes in a day than he’d usually done in a year.
He left Runa to lock up and drove over to the hospital to visit Judy. She screamed when she saw him.
“Dr. Norberg, they’ve cut off my legs! I’ll never walk! How could they for a little infection!”
“Judy, I’m so sorry, but it must have been necessary. They want to save your life. I’m sure you want to stay alive.”
She started sobbing, repeating, “My legs, my legs,” in a tortuous sing-song. Anders examined her chart. Despite the removal of both lower legs at mid-calf, the doctors were not at all confident that the infection could be stemmed.
“You’re alive, Judy, that’s the important part. I’ll try and come back tomorrow or the day after and make sure you’re going well.”
Anders rarely drank during the week, but once he reached home, he found where he’d put the Scotch bottle and poured himself a double. My God, he thought, all our procedures and treatments and check-ups, and we’re still dying off. Maybe it is a curse.
He drained his drink just before his cell phone rang with another pre-recorded message from Public Health.
“The total of those infected has reached 57, with 4 fatalities thus far. St. Olaf’s hospital isolation ward is full, and patients are now being cared for at a temporary facility set up by the CDC. A press release will be provided to media outlets shortly, urging all residents of Eau Claire to avoid public gatherings and unnecessary contact, and to wash their hands several times a day with antiseptic soap.”
Too little, too late, he thought. By tomorrow or the day after, they’ll realize that they don’t want anyone from Eau Claire leaving the city limits, and we’ll all be in quarantine.
There were far fewer patients waiting for Anders the next morning, and he realized that they feared being too close to others who might be sick. At 10:30, he took a call from St. Olaf’s hospital. “Dr. Norberg? This is Grace Sullivan. I’m the charge nurse in the contagious disease ward.”
“Yes? Is this about Judy Garrison?”
“Yes. You asked to be notified. I’m afraid that the trauma from the amputations and the toxins from the necrotizing fasciitis were too much for her. She was pronounced dead twenty minutes ago.”
Anders was silent.
“Yes, I heard you. Has the family been notified?”
“Thank you,” Anders said, and hit the off button. He realized he was in shock, that it was impossible the young woman he’d seen the night before was dead, that it was impossible to be this powerless.
He saw the remaining few patients, and then it was noon. Thankfully, none of the morning’s visitors had appeared infected. Runa looked over at him.
“Doctor, if it’s all right, I’d like to head over to Millennium and work out over lunch.”
“Of course, Runa, you deserve a decent break.”
Anders had brought a sandwich from home and sat at his desk while eating it and scrolling through his emails. Delete, delete, save, Eau Claire Public Health—open.
Locations common to patients having necrotizing fasciitis:
This list has been compiled from interviews with lucid patients identified as suffering from necrotizing fasciitis caused by the Staphylococcus aureus amoeba. The list is fragmentary, but being refined daily. The list includes only those places visited by more than one patient. Numbers in parenthesis show how many victims visited the locations during their period of probable infection.
Oakwood Mall: (25)
Eau Claire High School: (15)
Complete Foods: (11)
Kwik Trip gas station, Edgewater Avenue: (11)
Sam’s Club, Gateway Drive: (7)
Fitness Millennium: (6)
Mayo Clinic Health System pharmacy, Bellinger Avenue: (4)
Trinity Lutheran Church: (2)
Useless, just useless. We may as well just draw names from a hat.
Runa came back in, her body totally a-blush from the workout. Almost like the flesh-eating disease…
Anders jolted upright. “Runa, you just went to Fitness Millennium?”
“Yes, Doctor. Why?”
“And you shop at Complete Foods and attend services at Trinity Lutheran?”
“Yes and yes, but why is that important?”
“These places you go to were also visited by people with the flesh-eating disease. Have you noticed any rashes or infections? Any recent cuts or scrapes?”
“No, Dr. Norberg. Anders. Nothing. I feel fine and I just had a good look at my body in the shower—nothing out of the ordinary.”
“I want you to take the afternoon off and go to St. Olaf’s. Get a complete workup—blood, urine, stools, everything, including a head-to-toe visual inspection.”
“Don’t you trust me to monitor my own health?”
“Of course I do, but we have to make sure before we see more patients.”
Runa’s face was even redder, but from anger rather than exercise. “I’m in perfect health, and I don’t like you ordering me around like this!”
“Runa, I don’t know what to think any more, but I do know that you can’t work here unless you’re checked out. Tell you what, once you’ve been tested clean, I’ll go in myself and get the same tests.”
She looked at him sadly. “Stakkars lille menneske. You’re destroying everything about us. All right, Doctor, I understand your order.” Runa turned and walked out of the office without another word.
Despite her anger, Anders felt relief. At least he’d confirm that his only helper wasn’t spreading the disease. She’ll get over her sense of betrayal, he thought, then muddled through the afternoon’s patients, picking them from the waiting room almost at random.
At 5:00 p.m., he called St. Olaf’s and asked for out-patient. “This is Dr. Norberg. I’d like to see how far you’ve gotten on the work up for Runa Berdahl.”
“Berdahl. Berdahl. Nobody by that name has been here this afternoon, Doctor. Would she have used another name?”
“No, I don’t think so. Thanks.”
Anders called Runa on her cell phone and got a recording. “Runa, it’s Dr. Nordin. Anders. You haven’t been in for your work-up. If I handled it badly, please call so we can get you checked out. I want to make sure you’re all right.”
Then he called home. “Nellie? I’ll be home in less than an hour.”
“That’s fine dear. The most peculiar thing just happened. Runa stopped by. She said she was leaving town and just wanted to say goodbye…”
“What! What else did she say?”
“Some weird things—like that she’d loved working through you. And she hugged me and the kids, and I don’t remember her ever touching us before. And as she was leaving she said to tell you that she always preferred using a broom.”
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