Time. It inched forward, slow as a sloth. Sid’s bacteria took longer than she wanted to reproduce in the incubator. The shipment of Petri dishes was late. She dropped a flask full of bacterial growth medium, and it shattered on the floor, so she had to start over with a new batch. She’d jammed the end of the inoculation loop into an agar plate with so much oomph that it had snapped, and she had to borrow one from Raven until a new one arrived. All because she was distracted.
Her mind sizzled with images from Brazil: the gathering at Luiza’s grave site, Gilberto cavorting around Cibele’s living room, Dr. Alancar thumping on little Izabel’s chest, the blank stares in the eyes of Mariana’s father and grandmother, Cibele as she sank to her knees on the clinic floor and screamed.
As the hours and days trudged along, she thought of the Earth turning 360° in one day, and of its immensity. The world was too big for her to change, and the hopelessness of that depressed her. A car bomb at the US Embassy in Beirut slaughtered twenty-four people. The Beauty Queen Killer raped and murdered his way across America. A PEMEX oil storage tank exploded in Mexico and killed hundreds. Motorcycle gangs massacred each other in Australia. A female cop in London was shot by a Libyan diplomat. Typhoon Ike drowned thousands in the Philippines. Children were dying from a mysterious illness in backcountry Brazil.
Promissão was much smaller than the rest of the world, more manageable. Surely she could do something to keep those kids from dying.
It was dark when she reached her apartment. At that time of year, it was always dark when she left work. And cold. The fall chill in Michigan always bit into her like a mad dog, but now even more so. She remembered Brazil with its September spring, the silky air, the swaying palms. Her thoughts swung back, again, to the dead babies, and stalled. As she walked from the parking area to her front door, she watched the blue-gray clouds drift across the silvery full moon. That same moon hung high in the sky over Promissão. Those children would never grow up to know the awe of the moon.
A gust of hot air greeted her in the entryway. She hung her coat in the closet. The day’s mail—this week’s issue of The New England Journal of Medicine, a Horchow Collection catalogue, the electric bill, and a letter from the National Democratic Party—lay scattered on the floor below the letter slot. Beneath them, she found another letter, an onion-skin aerogram. Foreign stamp. Lady-like handwriting in navy blue ink in the upper left corner said “Cibele Barbosa.” She must have gotten the address from River. Sid tore open the letter.
My dear Sidonie,
I write to bring you greetings from Promissão. It was a treat to meet you during your visit, and I truly appreciate your being with us when Gilberto died. I hope your return travel was safe.
My sister Ana spends several hours every day at Gilberto’s grave. This is very hard for her. She can’t sleep. Neither can I. Everyone in our town is terrified that another baby will die.
We’re still passing out the fliers you and I made. I had to print 100 more copies yesterday. Even though they didn’t help Gilberto, maybe they will help another child. We want no more deaths. It’s a horribly bad thing when precious children have to die.
I hope you will return to Brazil soon. I look forward to seeing you then.
My warmest blessings,
Cibele
In her reply letter, Sid again thanked Cibele for her kind hospitality and tried to comfort her in her grief.
Two weeks later, Sid received another letter.
My dear Sidonie,
Thank you so much for your recent letter. I read it to Ana, and she sends her greetings. She still goes to the cemetery every day, but, instead of crying the whole time she is there, now she sings to Gilberto. She says she doesn’t want him to ever forget her songs.
Another baby died yesterday. Same sickness as the others. He had the red eye and then developed a high fever. By the next day he was dead.
I’ve been speaking with the mothers of Promissão. They know you are an American doctor who studies infections, and they ask me, over and over, what they can do to protect their children from dying. Should they feed them special food? Keep them indoors all day? They’ll do anything you suggest.
Please, Sid, tell us what to do.
My warmest blessings,
Cibele
At lunch, Sid settled into the lounge’s easy chair. Raven sank into Long Green and once again picked at the coffee stains on the couch’s arm.
“It’s impossible to get rid of them,” Sid said about the couch’s stains as she cut up her apple. “I suggest you quit trying.”
“I don’t believe in the word ‘impossible.’” Raven unwrapped her sandwich and then offered Sid a Fig Newton.
“No, thanks. Your naiveté is charming, Raven, and totally unrealistic.” Yes, Raven was naive about many things, including her twin brother’s biggest secret. Sweet ignorance. Raven chewed her sandwich without a clue.
“That’s what Eliot says. He thinks I was raised in Shangri-La instead of northern California.” The lounge door opened. Eliot walked in. “Well, speaking of impossible,” Raven laughed. “There he is.”
He leaned against the frame of the doorway and stared at Sid. “I’ve been hunting for you.”
“Well, I’m here, eating my lunch.”
“So I see. Where’s the big rotor for the centrifuge?”
“I have no idea.”
“It’s on my bench,” Raven said. “Go ahead and take it.”
He stomped out, slamming the lounge door shut.
“What’s bugging him?” Raven asked.
“I have no idea,” Sid again said.
They ate in silence until Raven looked up from reading a notice that lay on the lunchroom table. “Say, did you see this? Looks interesting.”
Sid glanced at the paper.
Grand Rounds, 8 a.m.
Wednesday, October 10, 1984
“The Magic of Cephalosporin Antibiotics”
Dr. Joseph Miller, University of Pennsylvania
She read it again. October 10—tomorrow.
The auditorium was packed by the time Sid arrived. During the course of the lecture, she heard about older cephalosporin antibiotics, how they killed many bacteria but not some of the most dangerous, how they were generally safe, how they were only available in pills. The most exciting information, though, was about a new cephalosporin drug. Cefotaxime. Dr. Miller flipped to the figure on his next slide and explained how well it killed the bacteria that caused bad infections in children. He flipped the slide again. “The most valuable feature of this drug,” he said, “is that it is given by vein, thus providing very high blood levels, much higher than was possible with older, similar drugs given by mouth.”
Thoughts raced through the circuits of her mind as if they were sparks jumping from one live wire to the next. A new drug. Designed especially for children. Effective against a broad range of bacteria. Images of Izabel as she lay dying. High levels in the blood of the patients. Would it work in Promissão?
In the afternoon, the phone in the lab rang. Sid answered.
“River here. How are you, Sid?”
She reached for her stool and sat down. His voice sounded metallic and very far away. But it was gentle like a warm summer evening with candles and cheesecake. “I’m fine. Where are you?”
“In Promissão…”
She pictured him at his office, imagined his lanky body pacing the floor and his trim fingers twisting the phone cord as he wandered.
“I’m calling for Raven, but I can tell you. We had another child die here.”
“Oh, no.” Her pulse was now racing. “Cibele wrote to me about the death of a little boy. Is this yet another?”
“Yes, a little girl from south of town. I thought you’d want to know. Apparently, this child’s illness was like the others.” He told her what he knew. Three years old. Pink eye several days earlier. Died within a day of getting sick. He paused and then continued. “I know her father. He’s one of the farmers who use our new seeds.”
“Was Dr. Alancar able to care for her?” she asked.
“He never saw the child alive. Cibele said the little girl died in the truck on the way to the hospital.”
She wondered if the parents had seen the flier she and Cibele made, and if they knew to bring the girl to the hospital at the very first sign of illness. River wouldn’t know the answer to that.
“This has gotten utterly awful, Sid. So many people dying. And they’re all little kids.”
They seemed to line up before her, the row of dead children. Now, seven.
“Is my sister there?” He sounded worn out.
“Tell her I called. Oh, and Cibele sends her greetings.” He paused, then added, “One more thing.”
Sid reached for the handle to shut off the gas to the Bunsen burner. River’s call was getting long, and her lab bay was getting warm.
“Have you ever heard of something called the GHA?”
“Well, yeah. If you mean the Global Health Alliance.”
“Maybe. One of the farmers—you remember Marcelo, the fellow whose daughter was the first child to die—told me that someone from an international agency by that name—I think he said GHA—had been asking him and his wife questions about their daughter and that mysterious illness.”
What were they doing there? “What kind of questions did they ask? Do you know?”
“No, but I could probably find out. What is GHA anyway?”
“A group of epidemiologists who track new and unusual diseases all over the world. It’s headquartered in Madrid. Probably Dr. Alancar notified the Brazil National Health Agency of the illnesses and deaths, and they contacted the GHA to help figure out what’s going on.”
“So that’s good.”
She didn’t know what to say. She’d never worked directly with the GHA but had heard they sometimes were myopic in thinking about illnesses and used heavy-handed tactics to get what they wanted.
Before she could respond, he said, “I’m not sure I know what an epidemiologist does.”
“Well, they analyze patterns of diseases among large numbers of people—as in epidemics. In Promissão, they were probably interviewing the families of the deceased children about illnesses in other family members, about exposures to insects and animals, about travel to other counties or to other regions of Brazil, about the food they ate—that kind of stuff. They’re not medical doctors who diagnose and treat illnesses in individual people like I am.”
“Okay. Ask Raven to give me a call.”
She wished she had heard River wrong about the new death. She listened to the freezer compressor, to Eliot’s booming voice from the far end of the lab. The children kept dying, a nonstop march of toddlers to the grave, and no one knew what was going on or how to stop it. Whatever the BPF strain turned out to be, it was wicked.
An idea budded and then bloomed to full flower in her head. Would it work? Could she pull it off? She had to do something. Even if it was unconventional. She got the phone number she needed from the chief hospital pharmacist and dialed it.
“Good afternoon. You’ve reached Hoechst Pharmaceuticals.”
“This is Dr. Sidonie Royal. I’m trying to reach Dr. Lewis Hatton.” This call had a low probability of success, but, to her, it was worth a try. After all, the probability of growing the BPF strain from Izabel’s blood had also been low, but it had happened.
“He’s on another line. He’ll be with you in a moment.”
While she waited, Sid listened to moody music, then to a nasal voice describing the newest drugs from Hoechst Pharmaceuticals. Cefotaxime was on the list, except that the recording called it by its brand name Claforan, easier to pronounce, easier to remember, easier to write on an order form. Then more music.
“This is Lewis Hatton. Good to hear from you, Sid. It’s been awhile.”
In fact, it had been five years since she’d last spoken to him on the day they graduated from medical school. She remembered him as the most social member of their class, handsome, cagey, and smart. “I hope Hoechst is treating you well.”
“Working for the pharmaceutical industry has its benefits.”
Indeed. A big salary would be one, she thought. “I’m interested in your company’s new antibiotic, cefotaxime. I understand it has great promise for serious infections, particularly in children.”
“We’re pretty excited about Claforan.” He paused for a moment, and before she could get to the reason for the call, he started talking again. “The clinical trials were even better than we expected.”
She took a deep breath and began her pitch. “Well, I’ve stumbled upon several children with fatal infections in rural Brazil and am worried we may see more. I’m wondering if you could provide some of the drug for us?”
“What was the pathogen?”
“We don’t know. We grew bacteria from the blood of only one of the kids; the sample was drawn as she was dying. We’re not sure how reliable that culture is, and the organism—a Gram-negative rod—is strange. Any chance we could get several courses of cefotaxime?”
“Well…”
“I know this is an unusual request, but it’s an unusual situation, Lew. All they have at the local clinic is ampicillin, and I understand that cefotaxime has a broader spectrum.”
“Indeed, it does. It probably kills at least 25% more Gram-negative rods than ampicillin.” He cleared his throat. “The problem is this: while it’s licensed for adults, Claforan isn’t licensed yet for children in Brazil. It’d be highly irregular to send it there for use in pediatric patients.”
“You needn’t send it to Brazil. My hope is that you would send it to me, and I’ll do what I think is appropriate with it. You know, things like antibiotic susceptibility tests and animal protection studies, once we finish identifying the bacteria that caused the deaths. And possibly, we’d give it as emergency care to a dying child.”
He sighed. “Okay. I’ll get some to you. How much do you need?”
She did the math in her head. How many children could Dr. Alancar conceivably treat, considering that so far, he had treated none? Maybe eight. The amount of drug per dose, the number of doses per day, the number of days of treatment, times eight children. “Eighty two-gram vials should do it.”
Lew said nothing but emitted a low whistle.
She heard papers rustle in the background. He said nothing. “We could start with half of that, and if we need more, I could let you know,” she said.
He cleared his throat, again. “So, forty vials …”
She adjusted her glasses and finally said, “That would work.”
“It’ll take at least a week for me to get it. Where should I send it?”
She gave him the lab address. “Thanks a lot. I really appreciate it. Let me know how I can repay the favor.”
“You can treat me to a cocktail and a game of golf at our next med school reunion,” he laughed. “Or better yet, a cocktail at the International Microbiology Society meeting. Will you be there, in Amsterdam?”
“As a matter of fact, yes. I’m presenting a paper.”