Alana has never before visited the Istituto Giannina Gaslini, Genoa’s renowned children’s hospital, but she wishes she didn’t have to come today, especially not to the pediatric ICU. She stands with Nico and their host, Dr. Lina Montaldo, beside a wall painted in an ironically cheerful pastel color near the nursing station. With her freckled unlined face, Montaldo doesn’t look much older than a child herself, but according to Nico she is already one of the most well-respected pediatric infectious diseases specialists in the city.
The hood of Alana’s PPE suit feels particularly constrictive today, and sweat beads along her upper lip. The warmer temperature alone doesn’t account for her overwhelming urge to bolt, nor do the children inside the unit, who are barely clinging to life with the aid of ventilators. No, it’s the parents who trouble her so much. She can’t begin to imagine their degree of anguish and helplessness as they hover at the bedsides, separated from direct contact with their critically ill children by layers of rubber and latex.
Montaldo leads them to the first of the rooms, where they gather outside the glass door. “Rosa is only three and a half,” Montaldo announces.
Inside, two nurses busily attend to lines and tubes attached to a little girl on a stretcher. Her skin is pale to the point of gray. Her long dark hair is pulled back in braids and tied at the ends with blue and pink bows. Her mother sits on a stool at the bedside, hunched over and motionless. Her gloved hand clutches her daughter’s as if hanging on to it for life.
“Rosa acquired her chest infection from her father,” Montaldo explains. “We have added gentamicin, a third antibiotic, to her treatment regimen. She only began to cough yesterday. Just hours after her father died. But now Rosa is the most critically ill of all the patients.”
Alana looks back over to the mother. There’s such defeat in her slouched shoulders that she has trouble taking her eyes off the woman, even as Montaldo moves on to the next room.
Inside, a boy lies on his back with arms outstretched in an almost biblical pose. He is also connected to a ventilator, and even more lines and tubes crisscross his body than Rosa’s. A nurse adjusts the intravenous infusion pump on one side of him. On the other side, the boy’s mother strokes his hair while his father paces up and down in the narrow gap beside the bed.
“This is Angelo. Eight years old.” Montaldo turns to Nico. “He is the reason I consulted you, Dr. Oliva.”
“The sputum cultures?” Nico asks.
“Yes. The preliminary bacterial culture results are concerning, most concerning. It’s Yersinia, of course, but so far it is resistant to all the antibiotics we have tested.”
“Not another one,” Alana murmurs.
Montaldo’s jaw drops. “There are other cases of antibiotic resistance?”
“At least one other, at the Ospedale San Martino,” Nico says. “A patient of mine.”
“How does a new strain of bacteria develop antibiotic resistance so rapidly?”
“We aren’t certain,” Alana admits. “It must have a particular affinity for developing resistance through genetic mutation or by ‘borrowing’ DNA from other resistant bacteria inside the hospital.”
“Perhaps,” Montaldo says, unsatisfied, before turning to Nico. “How did you treat your patient with antibiotic resistance, Dr. Oliva?”
“We could not, Lina. She died.”
Montaldo turns from the window without comment. She starts toward the next room but is stopped by the screech of an alarm. Her head jerks toward the nursing station, and she calls out, “Quale stanza?”
“Il primo!” someone shouts back to her.
Montaldo rushes back to the first room and bursts through the door. Alana and Nico follow. The nurse is already leaning over Rosa’s stretcher, her two palms interlocked as she rapidly pumps the girl’s chest up and down in piston-like compressions. The overhead monitor wails its alarm, while its warning lights flash like a strobe.
Other suited staff members storm into the room. Alana recedes back against the glass wall, aware she has nothing to contribute to the little girl’s resuscitation. She glances over at the mother, who sits bolt-upright, still clutching her daughter’s hand. One of the staff speaks soothingly to the woman as she tries to free her grip to gain access to the girl’s arm. But the mother refuses to relinquish hold of her daughter. She just keeps muttering, “Rosa, Rosa, Rosa . . .”
Nico says a few words to the nurse, who moves away. He kneels down beside the mother’s stool and, without saying a word, lowers an arm gently over her shoulder. Still clinging to her daughter’s hand, the woman turns and buries her hooded face into Nico’s neck, breaking into a heavy sob.
The silence in Nico’s car is broken only by the gravelly Italian voice on the radio. Alana tries to focus on the broader picture—an overall impression of where this outbreak stands and where it might head—but she cannot shake the mental image of little Rosa. She can still hear the soft crunch of each chest compression accompanied by the desperate sobs of her mother, as the ICU team worked frantically but futilely to restart the girl’s heart.
“Tale stronzate!” Nico grunts, pulling Alana from her despondent thoughts. “Such bullshit!”
“What is?”
Nico shakes a finger at the radio panel. “Such an idiot. This Tommaso Crispi!”
“Who is he?”
“A local politician with the Leagua Nord—the Northern League—the anti-immigration party here in Liguria. Crispi is the worst of the lot. He’s defending the vandalism of that mosque. He calls it self-defense.”
“You can’t be serious.”
“Crispi doesn’t just blame Yasin Ahmed for the spread of the plague. No. He’s says all Muslims are to blame. And they should all be deported. The Northern League is holding a rally later today. They are expecting thousands.”
“Thousands? The threat of the plague turns this city into a ghost town, yet thousands of people are willing to turn out to protest its imaginary source?”
“Ignorance.”
Alana experiences a pang of guilt over not having done more to the delay the publication of Yasin’s name, which after all has whipped up this racist rancor, but she keeps it to herself.
They drive a few miles farther, until Nico slows the car to a stop in front of a tree-lined park. “Parco Serra Gropallo,” he announces. “I was here only last week with little Enzo. He loves the big slide in the playground.”
Alana can picture Nico horsing around with his son on a playground. She has little doubt he would thrive as a dad, he’s so loving and playful. It raises the specter of what might have been.
As soon as they step onto the grass, Alana spots the commotion in the clearing between the trees. People stand inside a ring of yellow barrier tape secured around trees. Armed police guard the perimeter. As Alana nears, she can see that it’s not a typical crime scene. Byron and Justine are wearing masks, gowns, and gloves. Justine holds a branch in her hand. At her feet lies a grayish black blob the size of a large bread roll. It’s not until they reach the barrier that Alana recognizes it for a partially decomposed rat covered by a clear plastic bag.
“Another senseless victim of gang violence,” Justine jokes as they reach the barrier.
Alana leans over the tape but knows better than to cross it. “What have you got?” she asks, dreading the answer.
Justine points with the branch to the rat’s mouth, which is encrusted with dark blood. “Hemorrhagic shock.” She runs the stick along the animal’s hind limbs. “Buboes. This little fella died of the plague.”
“Who found him?” Nico asks.
“Who do you think? This is what I do, McDreamy.”
Nico motions to her mask and gown. “Is that the only protection you have been wearing?”
“Yeah.”
“You’ll need to start on prophylactic antibiotics. Immediately.” Nico turns to Byron. “And anyone else who was exposed to that rat before he was covered.”
“This is not our first time in the field, Nico. All of us took doxycycline and cipro before even coming out here.”
“Is this the only rat you found?” Alana asks.
“The only dead one,” Justine says.
“You’ve trapped live ones, too?”
“Two of them.”
“Healthy?”
“I mean, I didn’t check their cholesterol or blood pressure or anything . . .” Justine pokes the carcass with a stick. “But unlike this poor little fella, they don’t look like they’ve come down with the plague.”
“You will test them, of course?” Nico asks.
“More helpful advice,” Byron says.
Nico shoots Byron a withering stare but holds his tongue.
“I’m far more interested in testing the fleas we found on them,” Justine says.
“You sure they were carrying fleas?” Alana asks.
“Hundred percent. The male rat we trapped—aggressive little guy, total alpha male—he was scratching up a storm.”
“Justine knows her stuff,” Byron says with a touch of pride. He turns to Alana. “I heard from Don Arturo. He sent me the address of that monk you wanted to speak to.”
“Let’s go see him,” she says.
“Soon as I decontaminate.”
Nico glances from Byron to Alana. “I better get back to the hospital,” he says as he turns away.
Minutes later, Byron meets Alana on the other side of the tape and they cross the street to his rental car, a nondescript dark sedan. He plugs the address into the car’s GPS, which guides them deep into the distinctly working-class district of Sestri Ponente. He parks in front of a drab yellow and gray four-story building. They climb a flight of stairs to a second-floor apartment.
The same tiny monk from the construction site opens the door to them dressed in a traditional black habit. His eyes are hooded and the skin over his bald scalp is blotchy from sun damage. He could be anywhere from seventy to ninety years old.
Alana makes introductions. Brother Silvio ushers them inside his small apartment, speaking English in an almost musical cadence. The vanilla-and-must scent of old books permeates the room, reminding Alana of the old college library where she loved to study during med school. There’s hardly any furniture, aside from a few chairs stacked with papers and a small wooden desk that supports a laptop computer. Leather-bound books cram the bookshelves and spill out onto piles on the floor.
“Too early for a grappa?” Silvio asks merrily.
“For me, I’m afraid,” Alana says with a smile, and Byron shakes his head.
Silvio clears a stack of papers off two chairs and insists they sit down. Once seated, Alana motions around her. “Quite the collection, Brother.”
“Sì, sì. My little passion. I was the librarian at our monastery. We monks love to collect writing! Hoarders, you might call us.” He chortles. “The diocese, they took away the most precious volumes. But the bishop, he trusts me to sort and catalog the rest.”
“How long did you live at the monastery?” Alana asks.
“For more years than either of you have walked on this earth. I had a good run—is that not how you say it in America? So did San Giovanni. Six more years, and she would have seen her eight hundredth birthday.”
“It’s amazing the Church let them tear it down,” Alana says.
“Yes, but like me, San Giovanni was not in very good shape.” Silvio smiles. “During the war, she was hit by a stray bomb. Part of the arcade collapsed. Besides, she was always a basic working monastery with none of the architectural charm of, say, the Cervara Abbey up north. Or the old San Fruttuoso Abbey in Camogli.” His eyes light. “Have you ever been? Now, there is a structure that pays proper tribute to God in her—”
“Brother Silvio,” Byron interrupts. “Do you remember a young carpenter at the construction site? His name is Emilio.”
“With the angry skin, yes? A nervous boy, but very respectful.”
“Exactly,” Alana says. “He told us that you had warned him about the site.”
“Perhaps”—Silvio smiles, amused—“Emilio is being a little dramatic, no? I told him the grounds were hallowed. I still believe this to be so.”
“As in cursed?”
“I am a simple man of the church,” Silvio replies vaguely. “As such, I am quite superstitious.”
“How so?”
“I do not believe it can be such a good thing to tear down a house of worship to build a skyscraper.” His smile falters for a moment. “Can it really be what God intended?”
Alana has no interest in a theological debate. “How about rodents? Were they ever an issue at San Giovanni?”
“An issue? How do you mean?”
“Any infestations of mice or rats? Do you remember seeing many of them inside the monastery or on the grounds?”
“I would hear the patter of the odd mouse sometimes. But I do not remember encountering any rats.”
“What about another construction worker, Yasin Ahmed?” Byron asks. “Do you remember him?”
“I do not believe so,” Silvio says.
“A boy of about Emilio’s age,” Alana prompts. “North African. His family is from Tunisia.”
“Sì! I do remember him. He was with Emilio. The boy, he said nothing. But his color was not good. Sweating. He did not look so well. Not well at all. I even offered him aspirin, but he would not take it.”
“When was this?” Byron asks.
“Last week.” Silvio stops to think. “I cannot remember precisely, but it was two or three days before the woman in charge collapsed. This boy, Yasin? He looked just the same as her. It was the plague for both of them, no?”
Byron shoots Alana a warning glance. “The woman, yes,” she says. “We still don’t know about Yasin.”
Silvio shakes his head gravely. “The plague, she has visited Genoa before. And she left a mark on San Giovanni then, too.”
“You mean the Black Death?” Alana asks.
Silvio nods vigorously. “In 1348. The plague nearly wiped out the monastery.”
Alana stiffens. “As in San Giovanni? Your same monastery?”
“Sì. Long before the bulldozers and cranes visited.” Silvio waves to the volumes squeezed into the bookshelf. “It is all documented there. In the history books and journals. Some of them are even written by eyewitnesses.”
Alana is still digesting the news after they part ways with Silvio. Outside, in the stairwell, she grabs Byron by the arm. “It’s a big coincidence, don’t you think?” she says.
“You mean that the plague was in Genoa before?”
“Not just Genoa, Byron, but at the San Giovanni Monastery.”
“The Black Death was everywhere back then, Alana.”
“Maybe so.”
“You’re not thinking . . .”
“There’s no living sample anywhere in the world of the strain of Yersinia that caused the Black Death. Not even in a Level Five lab. I checked.”
“But . . .”
“Scientists in England have reconstructed its ancient genome from bone marrow found in a burial site in Hereford. They’ve cracked its full genetic code, Byron.”
“And you want us to compare the DNA of our current outbreak to the strain that caused the Black Death? Like we just did for the bioweapons?”
The implications of what she is suggesting suddenly sink in, and she almost shudders. “I think we have to.”
He studies her for a moment as if he might argue, but then he nods. “I think so, too.”