Lisa flipped open the folder and saw the patient's name listed as John Doe. She quickly scanned the history, the little that there was. The patient, man in his late sixties, had been found five weeks ago wandering naked through the rain forest, clearly suffering from dementia and exposure. He could not speak and was severely dehydrated. He subsequently slipped into an infantile state, unable to care for himself, eating only if fed by hand. They sought to identify him by fingerprint and by searching through missing person records, but nothing had turned up. He remained a John Doe.
Lisa glanced up. "1 don't understand . . . what does this have to do with what happened here?"
Sighing, Lindholm stepped next to her and tapped the chart. "Under the list of presenting symptoms and physical findings. At the bottom."
" 'Moderate to severe signs of exposure,'" she mumbled, reading down the list. The last line stated deep dermal second-degree sunburn to calves, with resultant edema and severe blistering.
She glanced up. She had treated similar symptoms all morning. "This wasn't just a sunburn."
"The island's clinicians jumped to that conclusion," Lindholm said with evident disgust.
Lisa could not blame the island's doctors or nurses. At that time, no one was aware of the environmental disaster brewing. She again checked the date.
Five weeks ago.
"I believe we may have found Patient Zero," Lindholm said pompously. "Or at least one of the earliest cases."
Lisa closed the folder. "Can I see him?"
He nodded. "That was the second reason I came down here." There was a grim waver in his voice at the end that disturbed Lisa. She waited for him to explain, but he simply turned on a heel and headed out. "Follow me."
The WHO leader crossed the dining room to one of the ship's elevators. He hit the button for the Promenade Deck, third level.
"The isolation ward?" she asked.
He shrugged.
A moment later the doors opened into a makeshift clean room. Lindholm waved for her to don one of the bio-suits, similar to the one Monk had taken to collect samples.
Lisa climbed into a suit, noting the slight body odor as she pulled the hood over her head and sealed her seams. Once both were ready, she was led down a passage to one of the cabins. The door was open and other clinicians were crowded at the entry.
Lindholm bellowed for the others to clear a path. They scattered, well trained by their leader. Lindholm led Lisa into the small room, an inside cabin, no windows. The only bed stood against the back wall.
A figure lay under a thin blanket. He looked more cadaverous than alive. But she noted the shallow rise and fall of the blanket, a panting weak breath. Intravenous lines ran to an exposed arm. The skin on the limb so wan and wasted as to the point of translucency.
She instinctively looked to his face. Someone had shaved him, but hastily. A few nicks still oozed. His hair was gray and wispy, like a chemo patient, but his eyes were open, meeting hers.
For a moment she thought she noted a flash of recognition, the barest startle. Even a hand lifted feebly toward her.
But Lindholm strode between them. Ignoring the patient, he peeled back the lower half of the blanket to expose the man's legs. She was expecting to see scabbed skin, healing from a second-degree burn, like she had been treating all day, but instead she saw that a strange purplish bruising stretched from the man's groin to toe, pebbled with black blisters.
"If you had read further into the report," Lindholm said, "you would have discovered these new symptoms arose four days ago. The hospital staff surmised tropical gangrene, secondary to the deep infection in the burns. But it's actually—"
"Necrotizing fasciitis," she finished.
Lindholm sniffed tightly and lowered the blanket. "Exactly. That's what we thought."
Necrotizing fasciitis, better known as flesh-eating disease, was caused by bacteria, usually beta-hemolytic streptococci.
"What's the assessment?" she asked. "A secondary infection through his earlier wounds?"
"I had our bacteriologist brought in. A quick gram stain last night revealed a massive proliferation of Propionibacterium."
She frowned. "That makes no sense. That's just an ordinary epidermal bacterium. Nonpathogenic. Are you sure it wasn't just a contaminant."
"Not in the numbers found in the blisters. The stains were repeated on other tissue samples. The same results. It was during these second studies that an odd necrosis was noted in the surrounding tissue. A pattern of decay sometimes seen locally. It can mimic necrotizing fasciitis."
"Caused by what?"
"The sting of a stonefish. Very toxic. The fish looks like a rock but bears stiff dorsal spines envenomed by poison glands. One of the nastiest venoms in the world. 1 brought Dr. Barnhardt in to test the tissue."
"The toxicologist?"
A nod.
Dr. Barnhardt had been flown here from Amsterdam, an expert in environmental poisons and toxins. Under the auspices of Sigma, Painter had personally requested the man's addition to the WHO team.
"The results came back this past hour. He found active poison in the patient's tissues."
"I don't understand. So the man was poisoned by a stonefish while wandering in delirium?"
A voice spoke behind her, answering her question. "No."
She turned. A tall figure filled the doorway, a bear of a man squeezed into a contamination suit too small for his girth. His grizzled and bearded face fit his size, but not the delicacy of his mind. Dr. Henrick Barnhardt pushed into the room.
"I don't believe the man was ever stung by a stonefish. But he is suffering from the venom."
"How is that possible?"
Barnhardt ignored her question for the moment and addressed the WHO leader. "It's what I suspected, Dr. Lindholm. I borrowed Dr. Miller's Propionibacterium cultures and had them analyzed. There is no doubt now."
Lindholm visibly blanched.
"What?" Lisa asked.
The toxicologist reached and gently straightened the blanket over the John Doe patient, a tender gesture for such a large man. "The bacteria," he said, "the Propionibacterium ... is producing the equivalent of stonefish venom, pumping it out in quantities enough to dissolve this man's tissues."
"That's impossible."
Lindholm snorted. "That's what I said."
Lisa ignored him. "But Propionibacterium doesn't produce any toxins. It's benign."
"I can't explain how or why," Barnhardt said. "Even to begin any further assessment, I would need a scanning microscope at least. But I assure you, Dr. Cummings, this benign bacteria has somehow transformed into one of the nastiest bugs on the planet."