Altered Genes - Omnibus (Books 1,2,3): Altered Genes, #4

By Mark K. Kelly

This volume contains all three books in the Altered Genes series.

To save the world, first they have to save themselves…

When an unconscious British businessman arrives at New York City's Bellevue Hospital, Dr. Mei Ling unwittingly finds herself in the midst of an infectious outbreak.

Meanwhile, Professor Tony Simmons, her ex-lover, and a world-renowned geneticist at Georgetown University receives an enigmatic telephone call that hints at a genetic threat, unlike anything the world has ever seen.

As the pandemic spreads, governments close their borders and quarantine cities. Simmons is taken to a secret military laboratory to search for a cure. But it's the truth he finds instead, and now he, Ling, and an odd group of survivors are on the run as civilization collapses around them.

A superb action-packed thriller based on frighteningly realistic science. Perfect for fans of Michael Crichton, Robin Cook or William R. Forstchen.

Get a copy today and immerse yourself in an apocalyptic future you'll hope won't ever happen.

Contains the full Altered Genes Trilogy:

Altered Genes : Genesis

Altered Genes : Revelations

Altered Genes : Resurrection

• Language: English
• Publisher: Mark K. Kelly
• Release date: Nov 27, 2018
• ISBN: 9780994740540

Book preview

1

Prologue

Tilly O’Keefe leaned against the desk, the rough fabric of her navy blue uniform tight against her chest. Bloody hell, I’m too old for this, she muttered as she stretched for the telephone that was barely within reach of her stubby fingers. The number came from memory and she punched the digits without thinking.

It's me again. I need more bedding. Keeling ward this time.

Tilly, we're going as fast as we can, the voice at the other end of the phone said, sighing in exasperation.

Soon, please. It’s a wee bit of a mess up here.

She hung up, annoyed by the delay, but sympathetic to the plight of her friends in the basement. She knew the laundry well, had worked there right out of secondary school, nearly forty years earlier. She smiled, remembering the words of her first boss, a gentle giant of a man.

Lass, it's a special thing we do here. We bring 'em into the world on fresh bedding, and we send 'em out on the same.

Tilly was sixty-two-years-old and head nurse of the dementia ward at BurnsHouse General Hospital in Glasgow. Her elderly patients usually slept through the night, their troubled minds not willing or able to overcome a lifetime of habit. But not this evening—tonight it seemed like half the floor was sick with an illness that soiled their clothing and stained their bedsheets.

The patient monitoring console chimed, and she walked to the other side of the nurses station, her white shoes squeaking against the newly waxed floor. The console flashed red—room 523.

Oh, Mr. Muir, what ails you this evening? Not another case of the skitters, I hope.

Muir was a gentle old man, one of her favorites. Stage four cancer had ravaged his body and Alzheimer's often left him confused, stealing away the jokes he loved to tell when he was lucid. His room was at the far end of an L-shaped hallway directly across from the stairwell. As she headed towards it, Tilly grabbed a laundry cart from beside the wall. The emptiness chilled her, and she whispered a poem as she plodded down the dimly lit hallway.

O whistle, an' I'll come to ye, my lad,

Tho' father an' mother an' a' should gae mad,

O whistle, an' I'll come to ye, my lad.

She froze as the clang of the stairwell door closing filled the air. It was just around the corner, a few steps down the hallway.

Hello? she said tentatively. Then more firmly. Who’s there?

Hearing nothing but the buzz of the fluorescent lights above her, she waited for a moment. The silence made her brave, and she pushed hard on the cart, rolling it around the corner, ready to meet whatever was there. Nothing. Then she heard the faint sound of footsteps from within the stairwell.

Probably a doctor or another nurse, she thought, crossing the hallway to the stairwell door. She swallowed once and took a deep breath before thrusting it open.

HELLO?

The sound of her own voice echoed off the unpainted concrete walls. Startled, she jumped back and turned to find a face, hollow and yellow with jaundice leering at her.

Lord O'Mighty, Mr. Muir, she gasped. You gave me quite the scare. Let’s get you back to bed.

The old man’s eyes were empty at first, then brightened as he recognized her. I told him to go away, he said angrily. I told him I wasn't hungry, but he bloody well wouldn’t stop.

Who did you tell, Mr. Muir? Tilly asked, taking him gently by the arm and steering him back to his room.

He pulled away and stared at her. The Chinaman…I told the Chinaman.

2

Take a flight

Alasdair Muir fidgeted as he waited in the queue at the priority check-in counter. Delayed by the cursed fog, his flight from Glasgow had arrived in London late the night before and he had overslept. Another reason to hate that damned city, he thought as he stepped out of line and counted the number of passengers in front of him. There were eight, including the geezer in the wheelchair.

Muir’s personal assistant had booked the flights believing he was traveling on business, but he wasn’t, at least not for the trip to Glasgow. It wasn’t that he had lied, she just never asked. He had gone to see his father at BurnsHouse General. The hospital had called the day before to tell him the old man’s cancer had spread. It was in his liver and he didn’t have much longer. Muir didn’t like his father much, but felt he owed the old man one last visit—a final goodbye, so to speak, but there was no damn way he was going to pay for the ticket out of his own pocket.

The queue lurched forward, and the breeze from an air conditioning unit blew across Muir’s forehead cooling his clammy skin. He removed a red silk handkerchief from his pocket and wiped his face and the nape of his neck. The handkerchief came away damp. He touched the back of his hand to his forehead. He was hot. Damned hospital…I was healthy before I went to Glasgow. He put the handkerchief away, not noticing it was the same one he had taken with him to the hospital the day before.

The ticket agent at the counter motioned to a family in the economy line. Pushing their bags with their feet, the young couple and their three children slowly shuffled to the front of the priority queue.

Incensed, Muir stepped from his place in line and pointed to the travelers in front of him as he shouted at the ticket agent.

Oi…Oi…we’ve all booked first class.

Her lips pursed, the agent gave him a tight smile and turned to greet the young family.

Bloody hell…British Airways, what a bunch of tossers, Muir thought as he stepped back into line, seething from the perceived slight.

While Muir fumed in line, Saanvi Chopra’s eyes flitted about nervously as she took in the crush of humanity filling Heathrow Airport’s terminal five. She scanned the departure area, looking for a quiet spot to spread out and wait for her flight.

An empty row of seats at one end of the cavernous hall fit her needs perfectly; close to the toilets with an unobstructed view of the departure board.

There was no way she was going to miss her flight to India. The ticket was a gift, solemnly presented by her father who had stood on a chair at her fourteenth birthday and lectured her—and her friends—on the importance of her Indian heritage. She knew her parents had scrimped and saved for months to buy the ticket. It was a big deal to them, and to her.

But that was months ago and now it was Easter break. The adventure was just beginning. It was her first trip on an airplane; her first time away from home. For the next two weeks, she would be in India with her aunt and uncle. I wonder if I should be sadder, she thought, deciding she could be both sad and excited, that they weren't contradictory.

She stepped into an empty row of seats, dropped her carry-on bag, and sat. After fishing around in her purse for a moment, she pulled out her cell phone and earbuds and toggled to her favorite playlist. With her eyes closed, she stretched out, letting the music mask the clamor of the airport.

On the other side of the terminal, Chen Gong shifted uncomfortably as he sat on a stool at the counter waiting to be served. Even at the unnatural time of 6:20 a.m., the Caviar House & Prunier seafood restaurant in terminal five was busy hosting a steady stream of well-to-do travelers all looking for nourishment.

Gong was hungry, tired, and in dire need of a smoke. His flight wasn’t scheduled to leave until 5:40 p.m. It would be an almost unbearable twenty-four hours before his next cigarette. He sighed at the prospect and popped another piece of nicotine gum into his mouth.

Gong was a Business Attaché at the Chinese embassy but also a captain in the People's Liberation Army. It was the latter role that had brought him to terminal five. He had received an encrypted email the night before, directing him to the airport to collect a package for delivery to Beijing, but it didn’t say from whom.

While he waited to be contacted, he looked at the menu and placed his order. A plate of smoked salmon, thinly sliced and garnished with lemon and a sprig of dill arrived a short while later, accompanied by a cup of Jasmine tea. The dark green leaves and white flowers swirled in the steaming water.

He took a small bite of the salmon, surprised by how chewy it was; and salty, so very salty. He discreetly spat the chewed fish into his napkin. Even after all his years in the West, first Paris, then Berlin and now London, he still didn't like western food.

A young man wearing a charcoal coat over a white button-down shirt with blue jeans sat down beside him. There was an Asiatic look to the young man’s appearance. Maybe Korean—but not pure, Gong thought with a sideways glance. My contact?

How's the salmon? his new counter-mate asked.

It's all right, but I've lost my appetite, or perhaps it's just too early for fish, Gong replied, pushing the plate away.

The young man reached down and retrieved a small travel-size tube of toothpaste from the outer pocket of his carry-on luggage.

Here, he said, sliding it across the counter to Gong. For your trip to Beijing…keep it safe. Don’t open it. It’s dangerous.

Cupping the tube in his hand to hide it, Gong swiveled in his chair and watched as the young man stood and quickly walked away, blending into the crowd before he disappeared from sight.

Then Gong spun back around to face the counter. He carefully inspected the tube of toothpaste, turning it over in his hands as he studied it. It was unremarkable in every way. The cap was tightly fastened and the brand’s logo clearly displayed. Being careful not to disturb it, he slipped the tube into his toiletries bag and placed two twenty-pound notes under his plate. With a few hurried steps, he too disappeared into the crowd.

After circling the terminal to ensure he wasn’t being followed, Gong searched for a spot to wait out the time until his flight. He spotted a seat, away from the crowd and near a teenage girl. It was perfect. He watched her for a few seconds as she sat, eyes closed, her head bobbing gently to the music that played in her ears.

Gong smiled. She was just like his daughter, Chao-xing, who he hoped to see this trip. It had been almost a year since his last visit. He walked up to the girl and touched her on the shoulder.

Excuse me, Miss.

She opened her eyes, looked up, and removed the ear buds.

Yes?

Is that seat taken?

She shook her head and reached down to move her luggage out of his way. Gong held out his hand, waving her off.

No need, he said with a smile as he stepped over her bag and took a seat two down from where she was sitting. With one last quick glance to ensure he hadn’t been followed, he leaned back and closed his eyes.

Alasdair Muir scooped his passport and boarding pass off the counter and ran for the security queue. Screw you, he thought with a smile as he passed the family of five who had butted in front of him earlier.

A few minutes later, he stood on the other side of the metal detector, winded and feeling sick. He leaned against the conveyor belt and slipped into his patent leather shoes before heading into the departure area.

Elbowing his way through the crowd, Muir created a path for himself and the rollerboard luggage twisting and turning behind him. A pair of women and their brood of whining brats blocked his passage. Annoyed, Muir looked for a faster route to the first-class lounge on the other side of the departure area.

Spotting a shortcut, he stepped into a nearly empty row of seats, but his passage was blocked by a Chinese man and an Indian girl. Muir scowled to himself. Damn Chinks and Pakis filling the aisle with their rubbish.

He lifted his bag and stepped over the girl’s luggage at the exact moment she kicked out her legs to stretch. Her feet became entangled with his and he fell heavily to the floor in front of her.

Startled by the loud ‘Oomph’ he made when he hit the ground, the girl’s eyes shot open.

Are you alright? she asked, pulling out her earbuds and offering him a hand.

He grimaced and struggled to his feet. Of course I’m not all right, you stupid girl. You were blocking the aisle and tripped me. He brushed her hand away, picked up his bag and pushed past the Chinese man.

At the sound of the commotion, Gong cracked open his eyes and pulled in his legs, allowing a portly businessman with a black Samsonite rollerboard to pass. He watched as the girl sitting next to him leaned forward and picked up a red handkerchief off the floor. When she realized what it was, she scrunched up her face in disgust and quickly dropped it.

Gong turned away to hide his smile. He’d seen that look a million times before on his daughter’s face. And he was looking forward to seeing it again soon.

3

What do we have?

Alasdair Muir landed in New York City with a bad case of diarrhea added to the fever and stomach cramps he had had before boarding. He pressed his hand against his stomach and winced in agony. During the flight, he’d made so many visits to the airplane lavatory that one of the attendants had asked if he was all right. He wasn’t. He felt awful, worse than he could ever remember.

After clearing immigration, he left the terminal, ignoring the shysters who scurried from one hapless tourist to another as they solicited rides for the gypsy cabs circling the airport.

Piss off, he muttered as he pushed past them and joined the queue at the taxi stand. For a moment, he considered taking one of the gypsy cabs—just to avoid the wait—but the line moved quickly and he soon found himself in the back of a yellow cab.

Where to? the cabbie asked with a thick accent as he turned on the meter and floored the accelerator. Muir felt his body press back in the seat. He gulped repeatedly as he stared at the dirty rubber mats and fought off the urge to vomit.

C'mon buddy—where to?

West 57th street, Muir said after swallowing the bile in the back of his throat. He closed his eyes and prayed for the cab ride to end quickly.

When he finally arrived at the hotel, he made it through check-in, but not all the way to his room.

Where’s the bloody toilet? he cried out to the clerk at the front desk.

The clerk nodded to his right, and Muir ran, stiff-legged and panicked, desperately searching for the sign on the door. He found it just in time. His pants had barely hit the floor before the liquid shit ran from his body in a never-ending stream. Relieved, even if just temporarily, he hobbled to his room and fell onto the freshly made bed, writhing in agony before he lapsed into unconsciousness.

What do we have, Dr. Ling?

Mei Ling glanced at the man who addressed her. Dr. James Robinson was Chief of Emergency Room Medicine at Bellevue hospital, a faculty member at NYU, and if the truth be told, a bit of a pompous ass.

Huddled around him were a group of first-year interns, their egos filled with the conceit that came from believing they were doctors. They weren’t, and part of his job was to teach them that. It was a job he did well, but didn’t make many friends doing.

Mei scanned the chart and began to speak. Alasdair Muir—white male, fifty-five years old, found unconscious in his hotel room, brought to the ER by ambulance, signs of vomiting and involuntary bowel movement. She continued, stating Muir’s heart-rate, blood pressure, and other vital signs.

Robinson nodded and cast his eyes over the group of interns. Okay folks, what tests should we run?

The suggestions came quickly.

CBC.

BMP.

Electrolytes.

Amylase.

Robinson nodded his approval and moved to the side of the gurney to press down on the sick man’s abdomen.

He’s distended, anything else?

EIA?

At the suggestion, he tapped his fingers lightly on the patient’s bloated stomach. There are signs of gastroenteritis, so an enzyme immunoassay is appropriate.

A timid voice from the back of the group asked, What about an RT-PCR?

Mei cringed.

Reverse Transcription Polymerase Chain Reaction testing was used to detect and study RNA viruses. It was expensive and reserved for special situations—not something to be used lightly.

Robinson’s eyes turned hard as he spoke. Who said that?

The other interns stepped aside. A chubby young man in the middle of the group slowly raised his hand. The look on his face made it clear he knew what was coming.

Robinson stared at him for a second before asking, What’s your name?

Jason…Jason Grant, the young man stammered.

Are you a doctor?

No, sir…I mean yes, sir.

Was that a difficult question, Dr. Grant?

The group tittered. That’s enough, Mei thought, annoyed at the entertainment the other interns were having at the expense of one of their own. It wasn’t that long ago that she too, as a new intern, had been on the receiving end of the chief’s sarcasm. It came with the territory, but sometimes he went a little overboard.

Robinson peered over the top of his glasses and asked, What else would you test for, Dr. Grant?

Ebola?

Mei cringed again.

Ebola, really? Is there any history of travel to affected areas? You do know where Ebola is prevalent, don’t you, Dr. Grant? It’s mostly in West Africa in case you’ve forgotten.

Okay…you’ve made your point, Mei thought. She stepped forward with the patient’s chart open, hoping to deflect some of Robinson’s ire, but he continued to focus his attention on the intern. Motioning Grant closer, he asked, "Is there any sign of hemorrhaging?

It took the strength of both men to turn and hold Muir’s limp body. Grant ran his eyes up and down the sick man’s torso. No signs of bleeding, he said quickly.

Robinson’s eyes sparkled with amusement. Probably not Ebola then, wouldn’t you agree?

Eager to escape, Grant nodded and stepped back, releasing his grip on the patient’s shoulder. Muir’s body flopped sideways trapping Robinson’s hand beneath it. The older man pulled free, grimacing when he saw the dark runny mess on his fingers.

Mei held back a smile as he rushed to the box of Kleenex on the counter. She watched him wipe the diarrhea off his hand, amused by the fastidious manner in which he ran the tissues up and down each finger. Serves you right for not wearing gloves.

When he finished, he scrunched the Kleenex into a ball and tossed it towards a garbage pail, missing. He quickly looked away before walking to the dispenser on the wall to squeeze a couple of dollops of sanitizer onto his hands.

Furiously rubbing his palms together, he addressed the group. Based on what we have seen, it would appear the patient has viral or bacterial gastroenteritis. Let’s move on to the next patient, shall we?

What about a GDH A/B toxin test? Mei asked, surprised Robinson hadn’t mentioned it.

Robinson stopped, turned slowly, and lowered his glasses, a peevish look on his face. What about it, Dr. Ling?

Mei stiffened. "The patient might have a C. diff infection. He has a slight fever, diarrhea...possibly cramps—"

Cramps, really? How do you know, Dr. Ling? He's unconscious. Are you psychic? Robinson walked back to the gurney and pointed. Look at the patient. Does he look elderly? Do you know if he's recently taken any antibiotics?

Annoyed by his sarcastic tone, Mei forced the emotion out of her voice and spoke carefully. No, I don’t know if the patient has recently taken any antibiotics, but a number of his symptoms appear to match with a C. diff infection, don’t they?

She could tell from Robinson’s pinched expression it pained him to agree.

Yes, Dr. Ling, some of the symptoms do match a C. diff infection, but they also match a number of other diagnoses.

He paused for a moment, looked at Grant, and then turned back to her with a devilish smile on his face. That aside, Dr. Ling, do you think Dr. Grant would benefit from learning more about the GDH test protocol?

I think everyone would benefit, she said, unsure where Robinson was going with the question.

Yes, of course they would, but space is limited. Since it was your suggestion, would you be so kind as to show Dr. Grant how to do the test?

Before she could respond, Robinson turned and walked away with the group of interns following him like a school of pilot fish on a tiger shark.

What a pompous ass…

Grant walked over to stand beside her. He gave her an apologetic look. You don’t have to stay, Dr. Ling. I know how to do it. I can collect the stool sample myself.

Knowing it wasn’t his fault, Mei offered him a half-smile. I don’t mind. I’ll give you a hand. She motioned towards Muir’s limp body. Besides, he’s a big man. It’ll take both of us to move him.

She left Grant by the gurney and went to the supply closet, returning moments later with a test kit and two pairs of gloves. Grant took the gloves she offered and tucked them into the pocket of his white lab coat.

Put them on, she said. If the patient has C. diff, the spores could have spread.

They rolled Muir onto his side, and she swabbed a minuscule sample of his diarrhea onto a collection stick, placed it into a vial full of buffer solution from the test kit and shook the mixture.

What next? Grant asked after she finished applying a few drops from the vial onto each of the test strips.

We wait.

Unable to wait in silence, he babbled incessantly about the trials and tribulations of life as a first-year intern; the long hours, the lack of respect, the utter fear of making a mistake.

We all went through it, Mei thought, staring at the clock and half-listening as he droned on and on.

The large digital clock clicked over to 12:23 p.m.

One minute, she announced.

He stared at her blankly. Pardon?

One minute to go, then we can check the results.

He followed her back to the table where the test kit sat. She lifted the small plastic device up and studied it. All three bands were red.

What is it? he asked, looking over her shoulder.

Positive, she answered, For both A and B toxins. Nothing to panic about, but we need to get him into an isolation room and schedule a PCR assay to confirm the diagnosis. Go get an orderly—and two surgical masks. Hurry.

Lucia Sanchez cautiously stepped into the lobby of Bellevue Hospital, tensing at the sight of the police officers who stood by the side of a wheelchair, their radios squawking as they guarded an injured prisoner. When the younger cop narrowed his eyes and studied her, she looked away, pretending to search for something.

Emergencias para los niños—the words were painted on the wall above a pair of doors.

Through there, she said to Alejandro, her eleven-year-old son. Take Blanca and sit. I will wait in line.

Alejandro glared sullenly at her and stomped towards a pair of empty seats with his sister following. Lucia didn’t know why he was angry at her. It wasn’t her fault he had fallen and hurt his arm. She sighed and walked over to wait in the admitting line. Forty-five minutes later, she returned to her children with a stamped form in her hand. The seat next to her son was empty.

Where is Blanca?

I don’t know, Alejandro answered with a shrug. She was here a minute ago.

Lucia clenched her jaw and gave him a withering look. She scanned the waiting room, her eyes darting from one corner to the other as she searched for her daughter. Blanca was nowhere to be found. Lucia’s panic grew. Stay here and do not move one inch, she hissed at Alejandro.

She rushed from the waiting room, stopping in the doorway as the two cops passed. The younger one gave her a second look, more suspicious this time. She ignored him and stepped into the busy corridor, turning her head from left to right as she looked for her daughter.

Blanca could be anywhere, Lucia thought. Out in the street, or taken by someone. Her throat tight with panic, she began to run. She had almost reached the main entrance when a cry from behind filled her ears.

Mamá!…Mamá!

She stopped mid-step and turned as her daughter broke free from the doctor who was holding her hand. Lucia swept the little girl off her feet and held her tight against her chest.

You scared me, don't stray again, she said, kissing Blanca on the forehead and brushing the hair from her eyes. The little girl giggled and tugged at the back of Lucia’s blouse as she struggled to free herself.

The doctor, an Asian woman, smiled. I’m Dr. Ling, we found her playing near one of the examining rooms. I figured she belonged to someone over here in Pediatric Emergency Services.

"Gracias…thank you so much for bringing my daughter back, Lucia said, lowering Blanca to the floor. I am sorry if she caused you any trouble."

She didn’t, but the hospital isn’t a playground.

Dr. Ling, the room’s ready, a voice called out.

I have to go, Dr. Ling said to Blanca. Be good and stay with your mother.

Lucia watched the doctor remove a surgical mask from her coat pocket and place it over her mouth. Then she walked down the corridor and joined another doctor and an orderly who were standing beside a gurney with a patient on it. When they disappeared around a corner, Lucia squatted down beside her daughter.

Do not do that again. It is very dangerous.

Blanca gave her a wicked grin and threw a crumpled piece of tissue paper at her. Lucia sighed and grabbed her daughter by her other hand and dragged the little girl back to where her brother sat, still sulking.

A little more than six hours later, Lucia and her children returned to their dilapidated apartment in Queens. She glanced at her cell phone and panicked.

Mierda…Estoy tarde!

She was late.

Sit and be good, she said to the children before dashing to the bedroom they all shared. A pair of black meshed stockings and a short red skirt lay on the floor. Leaving her blouse on, she quickly changed into the skirt and stockings, and then applied a thick coat of garish red lipstick. She looked in the mirror, ashamed of what she saw—not a mother, just a filthy puta.

With a heavy heart, she walked to the rickety nightstand that sat beside the bed and gently removed a set of rosary beads from a small wooden box. Cupping the beads in her hands, she knelt, taking comfort in their familiarity. The beads were a gift from the family's priest in Santa Ana. They gave her strength and helped her accept the ungodly things in her life.

She ran her fingers over the small wooden cross at the end of the string of beads and began to pray.

In the name of the Father, and of the Son, and of the Holy Spirit. Amen. I believe in God, the Father almighty, creator of heaven and earth; and in Jesus Christ, His only Son, our Lord...

After she finished praying, she left the bedroom to find the children sitting quietly at the kitchen table drawing pictures on Alejandro's cast. Blanca had used a red marker to fill in the outline of a dragon her brother had carefully drawn.

Lucia stood silently for a moment watching them as they played together, the troubles from earlier in the day long forgotten. They were her life, her reason for being. She wanted to stay and watch her children be children, but couldn’t. She stepped from the doorway and spoke.

"Alejandro, there are Pupusas in the refrigerator. Please heat them for you and your sister." She had made the cheese-filled tortillas earlier that day. They would fill the children’s stomach until the morning when she returned.

After lovingly kissing both of them on the top of their head, she whispered, Be good...lock the door behind me.

A few minutes later, she stood in the graffiti-filled lobby. A drunk lay curled up on the floor half-blocking the door. His pants were wet and he smelled of urine. As she stepped over him, he grabbed at her leg and with his leering eyes, he stared up her short skirt and grinned.

"Pervertido!"

She kicked free and then gave him a second kick for good measure before rushing out to the street where a jet black Chevy impala low-rider waited for her, its eight-cylinder engine rumbling with impatience.

The driver, a bald Latino man with the number eighteen tattooed on his skull, leaned across the seat and motioned her into the back of the car with a flick of his finger.

"Lo siento...I'm sorry—"

Shut up and get in, he snapped.

She opened the rear door and squeezed in next to the other women. The door had barely closed when the car sped away, its tires squealing as it rounded the corner.

She knew she would pay in one way or another for her lateness. She and her children were mojados, illegal aliens from El Salvador, smuggled into the country by the Calle 18 gang. She was a slave to the gangsters until they deemed her obligation paid.

A short while later, the driver stopped in front of a semi-abandoned housing project. She and the other women climbed out of the car and entered the building. Each had her own space in an apartment on the second floor. Privacy, or what passed for it, was provided by a handful of ragged blankets that hung over ropes strung across the room. The soiled mattresses lying on the floor had no sheets.

Her first client of the evening arrived. His breath smelled of cigarettes and rotten teeth; a stench so putrid she almost gagged. Using his meaty hands, he squeezed the flesh of her breasts and pulled up her skirt.

She bit her lip to stop from crying out. She knew if she made any noise, her keepers would stomp in, their tattooed faces tense with anger. They would pull the man off, kicking and punching him before they emptied his wallet and sent him away. Then, they would do the same to her, but not as hard, she was property. She closed her eyes and withdrew, letting the hours pass.

When she returned to the apartment the next morning, the children were still asleep. she stood in the doorway quietly watching them as the tub filled with hot water. She returned to the bathroom and turned the tap off. A single fluorescent bulb hung from the ceiling casting its harsh light on her. As she removed her blouse, she noticed a small brown stain on the back. Curious, she raised the garment to her face and cautiously sniffed.

It smelled of shit. One of those dirty animals.

The anger welled up inside her. She threw the blouse down in disgust before climbing into the tub. She would wash the blouse, and the rest of her clothing, later.

Mei wearily closed the door to her locker. It was late, nearly midnight, and she was exhausted from her double-shift—sixteen straight hours without a break. Every night at Bellevue was busy, but tonight more so than ever—a couple of shootings, three stabbings and a handful of overdoses.

Her route out of the hospital took her past the isolation rooms. She stopped to look at the Englishman’s chart. It had been eight hours. He was still unconscious with no improvement in his condition. She scanned the chart for his meds—250 mg of metronidazole, four times a day.

The antibiotics will help, she thought, making a mental note to check on him in the morning.

4

Not feeling well

Saanvi cringed as her aunt moved to the front of the dark brown wicker chair. I’m going to look ridiculous , she thought, anticipating the worst.

Hold still, dear, I’m almost finished, the older woman said, pressing her finger against Saanvi’s forehead to touch up the bright red bindi. Now, you look like a true Hindu girl, come see.

Saanvi stood and followed her aunt to the mirror, wincing with each step. She didn’t feel well. The stomach ache and embarrassing trips to the toilet had started just after her arrival in India.

She studied herself in the mirror. The red dot didn't look nearly as silly as she thought it would, but the blue sari, trimmed with garish gold thread was another story. It was two sizes too big and made her look like she had been draped in a giant blue bed sheet.

As she moved her head, the gold hoop earrings hanging from her ears glistened in the sunlight. Saanvi flipped her long black hair to the side to admire them. The earrings were an arrival gift from her aunt and uncle. I hope they didn’t cost too much, she thought, reaching over and touching her aunt gently on the arm.

Thank you so much, Tayi.

The older woman beamed and pulled at the sari’s loose fabric. It fits perfectly. You look beautiful, but you need a purse.

As her aunt left, her uncle stepped into the room. You do look wonderful, but we should go. They'll be waiting for us at the restaurant and we can’t be late, you’re the guest of honor. He took her by the arm and led her to the front door.

The suffocating humidity from the late afternoon rain slammed into her like a hot damp blanket. She wrinkled her nose at the unbearable stench accompanying it.

"What’s that horrible smell?

The garbage dump. They burn it every day. You’ll get used to it.

Not likely, she thought, forcing herself to breathe through her mouth. It stunk of wet ashes and burning plastic and was unlike anything she’d ever smelled before.

After a short drive on the ring road surrounding Ahmedabad, they arrived at a nearly empty restaurant to find a handful of guests milling about in the lobby. Saanvi opened her purse and glanced at her cell phone. They were twenty minutes late. Where was everyone?

Her uncle saw the worried look and said, The traffic was light, we're early.

She smiled at the irony. That's India—twenty minutes late, but still early.

Soon, the other guests arrived and the restaurant filled quickly. Everyone was interested in meeting the young woman from England. A crowd grew around her and she found herself lost in a sea of names she couldn’t remember and overwhelmed by the constant touching.

Lightheaded, she gripped the top of a chair with one hand and focused on the elaborately carved backrest to keep from fainting.

I don't feel well, she said, grimacing at her aunt who hovered protectively nearby. The older woman guided her to an empty table where she pulled out a chair and turned it so Saanvi could sit.

Rest…drink some water.

Saanvi nodded, afraid to speak as the room began to spin, slowly at first, and then faster and faster. She closed her eyes, but the dizzying sensation got worse. Saliva flooded her mouth.

I’m going to be sick!

Panicked by the thought, she placed her hands on the tabletop and pushed herself up. A spasm of pain shot through her stomach. Her knees buckled and she fell forward, hitting her head on the edge of the thick wooden table with a heavy clunk.

The last thing she saw was the glass of water her aunt had offered, lying broken in pieces on the floor beside her.

5

The American

Chen Gong looked up from his chair at the sound of the door opening. Colonel Tao Jiali stood in the doorway staring at him. The three stars on the sleeve of her uniform signified a rank of importance. She was not only the youngest female colonel in the People’s Liberation Army, but also the granddaughter of the President of the People's Republic of China—and now, Gong’s new commander. His reassignment to her was a clear indication of how important the Ministry of State Security viewed the package he had brought with him from London.

Come along, captain, we have work to do, she said and marched down the hallway without waiting.

Where are we going, colonel? he asked the back of her head.

The research facility.

Gong stopped mid-step. A brave man in most matters, the thought of visiting the lab made him uneasy. He shook off his apprehension and ran after her.

A few hours later, they reached their destination, the Shahezhen Army base on the outskirts of Beijing.

Gong saw security was tight, much more so than the last time he had visited the top-secret military installation. Bright metal halide lamps on tall masts illuminated the night, and razor-sharp concertina wire ran along the top of an electric fence. On the other side of the fence, armed soldiers with Kunming Wolfdogs patrolled the grounds. And there’s more that I don’t see, Gong thought as two soldiers stepped forward, motioning the driver to halt.

If the guards recognized Colonel Jiali or her car, it didn’t show with their abrupt manner.

Identification, one of them demanded while the other stood watch with his weapon pointed directly at the car.

Gong and Jiali handed over their MSS identity cards and waited. A few minutes later, their cards were returned and they were waved on with a grunt. The car took them deeper into the bowels of the gigantic base until it came to a stop in front of a windowless gray concrete building that looked like a bunker. The only entrance Gong could see was a nondescript metal door opening to an empty parking lot. A pair of surveillance cameras mounted on the wall, panned back and forth.

Remain in the car, Jiali said.

As she approached the building, the door opened and two soldiers stepped out. One carried a small electronic device, the other, an assault rifle. Jiali stepped towards the soldier with the device. After a moment, she turned towards the car and motioned Gong to advance.

Your turn, she said when he reached her.

Gong studied the device in the soldier’s hand. It was a small black box with an LCD on top and a marble-sized circular opening on the side. Wondering what he should do, he looked to the guard, who motioned at him to insert his finger in the hole. Gong did as he was directed, assuming the device would verify his fingerprint.

The sharp prick on the tip of his finger came without warning, and he yanked his hand away. The soldier holding the machine scowled while the other stepped back and raised his rifle.

It will extract and verify your DNA, Jiali explained. Once your identity is confirmed, we will be allowed entry.

Gong re-inserted his finger, clenching his teeth as he waited for the inevitable prick. This time, he didn’t flinch. Seconds later, his name showed on the display and the soldier nodded. Gong withdrew his finger from the device, expecting to see a drop of blood, but there was none.

The door opened and they went inside the building. It was empty except for a small room in the middle and a series of catwalks spanning the ceiling. Gong looked up to see armed soldiers watching them.

A man emerged from the inner room and approached them. Welcome Colonel Jiali and Captain Gong. I'm Dr. Zhào. This way, please.

Their footsteps echoed in the empty space as they followed him across the concrete floor to a door where he swiped an access card through a reader. The door to the inner room opened with a hiss, and a gentle breeze blew across the top of Gong’s head. He rubbed the nape of his neck reflexively.

Negative pressure, Zhào explained, to keep the lab isolated.

Isolated.

That single word brought the anxiety Gong had worked hard to suppress to the surface. He rubbed his sweaty hands on his pants and followed Jiali and Zhào through the door.

The inner vestibule was brightly lit and constructed of sterile plastic and stainless steel. Lockers lined one wall and two change-rooms, separated by a floor-to-ceiling barrier, lined the other wall. Each room had an opaque plastic curtain for privacy.

Jiali retrieved articles of clothing from a locker and stepped into one of the change rooms, closing the curtain partially behind her. Gong looked away as she began to disrobe, but not before catching a brief glimpse of the outline of her body.

Get changed, captain, she said through the curtain with no sign of embarrassment or anger.

These should fit you, Dr. Zhào said, handing Gong a white t-shirt and cotton underwear.

Gong raised an eyebrow and looked at the two pieces of clothing. Where are the rest?

Downstairs, Zhào said with a smile, pointing to an elevator at the end of the vestibule. The lab is sixteen stories below us.

After changing, they boarded the elevator, and Gong felt his ears pop as they descended deep into the earth. When the elevator stopped, they emerged into another room similar to the one above but slightly smaller. Bright orange containment suits lined one of the walls and a door large enough for a single person was located on the other.

The lab is through that airlock, Zhào explained to Gong, but before you enter, you must put on one of the containment suits. He reached up and carefully pulled one down, handing it to Gong.

This is a BSL4 clean room, Zhào explained. When you put on your containment suit and lock the helmet, you will have a small amount of air available from an internal tank. Once we are inside, you will need to connect to the air supply in each room. It is a straightforward procedure—take one of the hoses hanging from the ceiling and plug it into the socket on the side of your suit. When it is connected, you will feel a puff of air and the suit will expand slightly. Do you understand?

Gong nodded, and Zhào continued his lesson. "In the extremely unlikely situation where a tear or breach in your suit occurs, you must immediately enter the nearest decontamination shower. Every room in the facility has one. The showers are airlocks that seal as you enter. They will not unlock until decontamination is complete.

Lastly, the suits are not soundproof but it is difficult to hear when you are wearing one. Each suit has a microphone and headset built into the helmet. Above the entrance to each room in the lab, you will see a number. That number is the channel used by the communication system in the room. In the corridor, we use channel zero. To switch from one channel to another, turn the dial on your suit sleeve. Do you have any questions?

Plenty, Gong thought as he watched Colonel Jiali take a suit from the rack and step into it with practiced ease. But they will have to wait for later. He shook his head.

Good, suit up.

In a matter of minutes, and after Zhào had checked their suits one final time, they entered the lab. The main corridor was lined with windows looking into rooms filled with workbenches and unrecognizable scientific equipment. Gong paused and watched a scientist carefully remove a small lifeless monkey from a wire cage.

Marburg virus, Zhào said. It causes a form of viral hemorrhagic fever. It is one of the most dangerous viruses in the world.

What are they doing? Gong asked.

Testing a vaccine, but it does not appear to have worked, Zhào replied wryly. He took Gong by the arm and guided him toward an increasingly impatient Colonel Jiali who waited further down the corridor in front of another door.

When they reached Jiali, Zhào entered a code on the door’s digital keypad, and the door opened with a hiss. As they stepped into the room, Jiali and Zhào immediately connected their suits to air hoses hanging from the ceiling. Gong fumbled as he mimicked their actions. When the connector finally sealed, a relieving puff of cool air blew into his suit.

What if it comes loose?

He decided not to move.

Zhào and Jiali approached one of the scientists and began to talk. Gong turned the audio selector dial on his sleeve to the room’s channel. What is the status? he heard Jiali ask.

There was a quiver in the scientist’s voice as she answered. No change, but we have completed sufficient tests to confirm the strain has a high mortality rate.

How high? Jiali asked.

One hundred percent once the infection reaches the exponential stage.

Treatment?

It’s a…it’s a chimera, the scientist stammered. There are genetic markers from different strains—genes we’ve never seen before…genes that we don’t understand.

Tell me, Jiali demanded. Is there a treatment?

Gong didn’t know the specifics of what they were talking about, but the tone of the conversation, and Jiali’s voice in particular, worried him. He stared at the scientist, willing her to say, yes.

There is no cure. We are at a complete dead-end.

Would the American be of assistance? Jiali asked.

The scientist gave a barely perceptible nod.

Come along, captain, Jiali said to Gong. You have another job to do. I will brief you on the way to the airport.

Gong followed her out of the lab, wondering who the American was and what he had to do with the deadly package from London.

6

It’s something new

Professor Tony Simmons stood at the podium and counted the handful of students in the lecture hall.  Eighteen, if he included the two guys in the top row, but he wasn't even sure if they were in his class, or asleep and left over from the one before. He had his answer a few seconds later when they woke and left the hall. Depressed, he looked down at the class list. Sixteen out of thirty-nine. That might just be a new record. Am I that boring?

Simmons, the youngest Assistant Professor of Biochemistry in Georgetown University’s history, was a world-renowned expert on bacterial genetics, but not particularly knowledgeable when it came to sports. He had forgotten that the Hoya’s—Georgetown’s NCAA basketball team—had a pep rally that morning and the entire campus was virtually empty.

He reached down and pulled a laptop out of his briefcase. Let’s get started, he said, plugging the projector’s cable into the back of his computer. You won’t have to listen to me drone on today. I have a video for you.

A smattering of applause greeted his announcement and he smiled. He dimmed the lights and fiddled with the computer until the National Science Foundation video he had found on the internet began to play on the large screen behind him.

September 3rd, 1928:

Merlin Pryce followed Alexander Fleming into the laboratory. The two men made their way to a workbench crowded with glassware. A light coating of dust covered the petri dishes in the furthest corner of the bench while a handful lay submerged in a tray of Lysol.

Was your holiday enjoyable? Pryce asked Fleming, who had spent the month of August in the countryside.

It was, but I’m happy to be back, Fleming answered as he ran a finger across the dust-covered workbench and frowned. Look at this mess, it will take the entire day to clean up. I’ll tidy the desk, you start with the glassware.

Pryce frowned and looked at his pocket watch. Very well, but I only have two hours before I’m needed in the main wing. He strolled to the furthest corner of the workbench and began scraping the agar and bacterial culture off each petri dish before placing it in disinfectant.

The two men worked without talking. Pryce cleaned while Fleming sat at his desk, reading his journals and refreshing his memory on the research he had done prior to summer vacation.

After an hour, only a handful of petri dishes remained. Pryce grabbed one from the pile, ready to scrub it, but stopped when he noticed the spots of bluish-green mold with no bacterial growth around them. He turned towards Fleming with the petri dish in his hand.

Alexander, there's something odd.

Fleming looked up. Bring it here.

Pryce placed the dish on the desk next to Fleming’s lab journal and pointed at the mold.

I see it. What's the label on the dish? Fleming asked impatiently.

127-A

Fleming flipped through his journal until he found the entry. 127-A, Staphylococcus aureus. He slid the petri dish under the microscope on his desk and adjusted the lens while he squinted into the eyepiece.

Hmm…there's a halo around the growth. It’s quite extraordinary…almost as if the bacterial growth was inhibited by the mold. Fleming looked up at Pryce and smiled broadly. I think this warrants more study.

The video ended and Simmons turned the lights on. He leaned lazily against the podium, a mischievous grin on his face and said, Sorry, that didn’t take as long as I thought it would. We still have ten minutes left, you’ll have to listen to me lecture.

When a series of groans greeted his announcement, his grin widened. Be forewarned, I’m paid by the spoken word.

Pulling up a presentation on his laptop, he started to lecture. The discovery of Penicillin, arguably one of the most important medical discoveries of all time, was a happy accident. Happy for Fleming, of course, he won a Nobel prize, but even happier for the rest of us. Millions of lives have been saved by antibiotics, but it isn’t all good news.

He clicked to the next page of the presentation. A quote in block letters appeared on the lecture hall’s large screen.

…there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant…

Simmons stepped around to the front of the podium a few feet away from the students in the first row and pointed to the screen. Does anyone know who said that?

Blank stares all around. He answered for them. Alexander Fleming, a few months after the end of the second world war and during his Nobel prize acceptance speech on December 11th, 1945.

A couple of knowing nods but mostly blank looks. That might have been a little hard, Simmons thought. Let’s try something more obvious.

Any idea what he was talking about?

Professor Simmons…Professor Simmons! a young woman with her brown hair tied up in a ponytail shouted. She wore horn-rimmed glasses and looked studious but the hand waving furiously in the air was anything but.

Yes, uh…Miss…uh?

Emma, Emma Rice, she said, sounding disappointed that he didn’t remember her name. I applied for one of your student lab assistant positions this year.

He smiled as if he remembered. He didn’t. Okay, Emma, what was it that Fleming was talking about?

She squinted through her glasses. Resistance to antibiotics?

Very good, but what was it that specifically concerned him? He addressed the question to her and then looked at the other students when she didn’t answer.

Anyone?

Silence and blank stares. Come on you guys, the answer is right there on the screen. He waited a few more seconds and then answered his own question.

Fleming was concerned that over an extended period of time, bacteria would acquire resistance to antibiotic treatment if the dosage used wasn’t high enough to kill them. Was his concern justified?

Emma Rice tentatively raised her hand again. It was, right?

He nodded and clicked on the powerpoint slide deck.

…Drug-resistant infections are already responsible for more than half a million deaths globally each year…

---

—Review on Antimicrobial Resistance, 2015

You should be worried—I am, Simmons said. Antibiotic-resistant bacteria are arguably one of the greatest medical threats facing mankind and Fleming predicted this nearly seventy-five years ago. In a post-antibiotic world, more people will die from infections than cancer.

Emma Rice’s mouth fell open. He looked right at her and said, "Emma, can you imagine a world where an under-cooked hamburger with E. coli bacteria doesn’t just make you feel lousy, it kills you?"

Her eyes widened and she asked, Professor Simmons, what causes the bacteria to become resistant?

He began to count on his fingers. Prophylactic antibiotic premedication, use of antibiotics as growth enhancers in food animals, horizontal gene transfer. He stopped at three as her eyes glazed over.

Sorry, I’ll explain. Prophylactic use of antibiotics is when you give small doses of an antibiotic to healthy food animals as a preventative measure to keep the animal healthy. It sounds good in principle—right?

She nodded tentatively and he looked around the lecture hall. A few more heads were nodding.

Good—they’re listening.

He shook his head. Wrong! What actually happens is that the bacteria the farmer is supposedly protecting his animals from slowly develops resistance to the antibiotic, and after a while, a few years or a decade perhaps, the antibiotic stops being effective…but that isn’t the worst part of it.

He walked back to the podium and pulled up an article on his computer. It appeared on the lecture hall’s large screen behind him.

Here’s a research report that talks about an antibiotic called Colistin. Colistin was discovered back in the late 40s and has been around for a long time, but it isn’t widely used in humans because it’s toxic at the effective dosage rates. But Colistin is also cheap, and not toxic in small quantities, so it’s been used as a prophylactic in animal feed for years. Can anyone guess what happened over time?

The room was silent. He had their attention.

The first thing that occurred was E. coli bacteria in pigs developed resistance to Colistin. Then that resistance started showing up in other bacteria—harmful bacteria that affect humans.

Professor Simmons, is that how superbugs are created? Emma asked. I read about them appearing in a hospital in California. I think they had to close the hospital because a bunch of people got sick.

Superbugs—he hated the term, but the media loved it.

Yes, that’s one of the ways they develop. Bacteria are incredible organisms. Part of their adaptive survival mechanism is the ability to transfer genes from one strain to another. That’s called horizontal gene transfer and what can happen is these antibiotic resistance genes develop first in bacteria that affect animals, and then transfer to bacteria that affect humans—and when we get sick, there’s nothing we can do to fight the infection because the strain is resistant to the antibiotics we would normally use.

The sound of a throat being cleared reminded him he was holding up the next class. He nodded to the other professor and turned back to his students.

Time’s up, folks. This material won’t be on the exam but I strongly encourage you to read up on it. If you’re interested in discussing it further, stop by my office during the hours posted on my website.

Anxious to leave, most of the class were already in the middle of packing up. Simmons packed his laptop away and followed them out of the lecture hall.

By the time he reached Regents Hall, the location of his office and lab, the lecture was forgotten, but his morning cup of coffee and bagel with cream cheese wasn’t. He darted into the building’s bagel shop and was standing at the cash register when the muffled trill of his cell phone sounded from deep inside his briefcase.

Damn it…it never fails.

He looked for an empty table to park himself and his food at, but the small cafe was jammed packed. Spotting his department head, John Thompson, a crusty old man in his early seventies sitting alone reading a newspaper. Simmons dashed over and unceremoniously deposited his coffee and bagel on top of Thompson’s newspaper. He mimed an apology and fished his cell phone out of his briefcase.

Hello?

Dr. Simmons? a voice with a British accent asked.

Yes, speaking.

Dr. Simmons, my name is Edward Gore, Dr. Edward Gore. I'm a researcher at the Cambridge Institute for Medical Research. We met two years ago at the infectious disease symposium in Budapest.

Simmons paused and searched his memory. The symposium was a busy event. He didn’t recall Edward Gore, but he had met a number of people from the Cambridge institute.

What can I do for you?

I apologize for imposing, Gore said, but I have a favor to ask. I've been looking at what I believe are mutations in ribotype 027 and would appreciate a second set of eyes. I've read your work and can't think of anyone more suited.

RT 027 was a virulent strain of Clostridium difficile bacteria. It was responsible for a worldwide epidemic in hospitals around the world. First seen in the 1980s, it disappeared only to reappear twenty years later in an even more virulent form. Simmons wasn’t just familiar with it, he was an expert on it having done groundbreaking research studying its genetic structure.

The mutations are in the tcdR and tcdC genes, the Brit added.

Simmons doubted it. If the C. diff bacteria was likened to a car, the tcdR gene was the accelerator and the tcdC gene, the brake. One increased toxin production while the other slowed it down. Both genes were relatively stable.

A significant mutation in those genes isn’t likely, Simmons replied skeptically. How do you know it's mutated? Have you compared it to the reference genome? He tried not to sound critical.

If the other man took offense, it didn’t show in his voice. I’ve compared it and it does appear to have mutated, Gore said, but a second look by a more experienced pair of eyes would confirm it. With your expertise, you're the first person I thought of.

Still dubious, Simmons paid no attention to the compliment. Where did the sample come from?

I'd rather not say, Gore said apologetically. I hope you understand.

Simmons wasn’t surprised by the man’s reluctance to share. Publish or perish wasn’t a myth, it was a reality. No one wanted to risk giving away too much too soon, in case the competition got a jump on them.

I'm quite busy right now, he said, but if you send me the DNA sequence data, I'll take a quick look.

Thank you. There may also be mutations in the tcdA and tcdB genes, Gore added, but I haven’t had time to look more closely.

Simmons doubted that as well. The probability of all four genes mutating at the same time was low, but the Brit didn’t sound incompetent. It might be