Sierra Peaks

The medical resident in the emergency department at University Hospital studied the abnormal chest X-ray and immediately called Dr. Lucas. “I have a patient with a cough you can hear three rooms away, and he has moderate-sized cavities in both lungs on his chest X-ray.”

Luke could hear a crowd of voices in the background over the phone mixed with the sound of a baby crying and an anguished nurse yelling that her patient was having trouble breathing. The medical resident sounded calm and matter-of-fact as if all of this was routine, and for him it was.

“Have you looked at his sputum yet?” Luke asked.

“No, but your wife has. She says it contains a whole zoo of pathogens including swarms of red snappers.” The medical resident meant red-stained tuberculosis bacteria, not the fish. He was using archaic slang that was now back in popular use as a result of the recent surge of new cases. In this patient, the tuberculosis was far advanced since the large red bacteria appeared in great numbers and had eaten away part of his lungs.

“Do you have him isolated?” Luke had grasped that the patient was critically ill, but he also understood that the patient would be highly contagious as well.

“Yeah, but we’d like to move him out. We need the space. Where do you want us to send him?”

“He’ll have to go up to an isolation room next to the ICU. I’ll see him as soon as he arrives. What’s his story?”

“He doesn’t speak English, but he has a passport from Uzbekistan, wherever that is. He’s got some old needle tracks on his arms, so he’s been an IV drug user. An ambulance picked him up at San Francisco International.”

“My god!” Luke swore under his breath. He knew Uzbekistan was famous for three things: ancient archeological ruins, a stopover by Alexander the Great, and large numbers of AIDS patients with multidrug-resistant tuberculosis. Uzbekistan bordered on the “Golden Crescent” centered in Afghanistan immediately to the south, the world’s largest source of heroin. Although some Afghans were heroin users, addiction had not spread there to the extreme degree that it had in the countries of the former Soviet Union to the north. Intravenous drug addicts in Uzbekistan had easy access to the heroin imported from the other side of the border and risked acquiring HIV each time they used a contaminated needle, which was why so many of them were showing up in the “AIDS Hot Zone” across Central Asia. Because of their immune deficiency, they were more vulnerable to tuberculosis and were rapidly spreading the treatment-resistant variant of the disease among themselves.

Luke’s wife Lynn was a microbiologist, and she and Luke were familiar with exotic emerging diseases in Asian countries. Few experts in the world knew more about Asian epidemics than they did, having seen several together first hand. They had participated in on-site research in Southern China in 2003 during the outbreak of SARS (severe acute respiratory syndrome) in which 744 people died, most of them in Hong Kong. The Chinese government had suppressed news of the epidemic for several months before taking preventive steps and enforcing quarantine of infected people.