MICROBE

“I need you to lie on your side, Mr. James. Can you do that for me? Good, good. Now, pull your knees up towards your chest and relax.” Mr. James complied. It was his sixth day here, and he was now willing to do anything in order to get out. Well, perhaps not anything, but, this was not the kind of place where he would want to linger long. A short while ago, the consent form for the procedure had been hastily signed and handed back to the doctor with a hesitant “let’s get this over with,” and now, it was time.
Feeling the doctor’s tough hands palpating his back and then a cold dampness rubbing onto his skin, he broke a sweat.
“You know,” mumbled Mr. James, “I never liked needles when I was a kid.”
“I don’t think you like them any better now, old man. You are sweating like a little girl.”
“That thing is going into my spine! What on earth could be worse than that?”
“Stay steady, Mr. James. It’s just a lumbar puncture, there’s plenty that could be worse. Just relax and breathe deeply, this will be over before you know it.”
“Ha! Just a lumbar puncture, of course,” echoed Mr. James, with no attempt to conceal his sarcasm.

Soon after, he felt a localized sensation of pressure building sharply at a point on his lower back. Biting onto his lip and shutting his eyes, he groaned, but the stinging pain soon went away, leaving behind a mild burning sensation that vanished faster than the warmth of a withdrawn hand upon the skin. The anesthesia had done its job, and now the patient’s spinal fluid could be collected.
“Hmmm, I see,” the doctor mumbled unconsciously.
“What? Is there a problem? What’s going on back there?”
“No…no, it’s nothing,” he lied. The elevated opening pressure had not gone unnoticed, and the strange yellow tincture of the spinal fluid was definitely not a good sign. Something was amiss.
While trying to turn his head towards the doctor behind him, the patient probed, “Come on, Doc, what’s up?”
“It’s nothing,” he swore. “ Don’t move about Mr. James, a little slip of my hand and you’ll be wearing diapers for the rest of your life.” Petrified into immobility, the middle-aged professor of literature grew silent, and forced his mind to wander elsewhere.

*          *           *           *

          Having been renovated a few general elections ago, the hospital reminded him of the cells of a mob-run South American prison wherein he had been detained briefly in his youth. The floors were a dull gray composite of concrete and bodily fluids, and half of the light fixtures were either broken or didn’t work. The ward bristled with old and unserviced equipment whose functions had gradually become more ornamental over the years, save for those that the nurses had insisted were ‘German’.

He tried to imagine the hospital being worse than it currently was, but he couldn’t. Groups of ill men were huddled in every corner, with only the women and children occupying the beds: the men, of course, were relegated to the floor unless their appointment with the coroner was almost due. He had heard that this Hospital was an infamous one, regarded as a place where the sick were taken in order to hasten their death. Indeed, after a cursory glance around, one could be forgiven for mistaking it for an internment camp. Here, it was with the ill as on the beggar’s lane, where only the most grotesquely deformed people are deemed worthy of aid. After all, the philosophy that enjoyed widest acceptance in this country was profit over ethics, which was why, by the help of the mighty American dollar, he was able to secure a warm, comfortable bed for himself, with clean sheets and a blanket, while hundreds of other patients who were in greater suffering couldn’t.

The hot and humid equatorial weather was harsh this time of the year and seemed to be in perfect harmony with the turmoil that he felt within. At a distance, a thick, steady pillar of smoke billowed from the incinerator, snarling its way up into the blue skies undisturbed.

From his pockets, Mr. James drew out a small, red, linen cloth. Pressing it against his face, he inhaled deeply, searching for the familiar, feminine scent that had clung onto it before but found nothing. Even the harsh smell of the unholy union of medicines that rent the hospital air had vanished, and in its place was the barren scent of nothingness. He exhaled, and then inhaled deeply again, unconvinced by the previous result, but it was pointless. His sense of smell was gone. With the edge of his sheet, he wiped the beads of sweat from his brow and bellowed for the nurse.

A visibly irritated woman of indeterminate age soon appeared. Despite her wobbly features and piercing eyes, she was a woman to whom a few men would give an appraiser’s eye, and more still would after a good number of beers. In addition, she exuded the mannerisms of a woman that would give herself to a rich man as if by divine injunction. Her uniform was faded but well pressed, and her dark hair was neatly secured into a little ponytail. Standing half in at the door of the ward, as if allowing herself to be briefly interrupted from her usual sedentary pursuits would be more than enough courtesy shown to an ailing man, she sneered, and with unconcealed annoyance, made her presence known by a strident, “Ni nini! (What is it!)” Hoping that a gentle word may mollify her, he paid her a compliment for her quick response and asked her to come in.

“Unataka nini wewe (What do you want), ” she barked.
“I need the doctor. Something is wrong with me,”
“You are in a hospital ward, Mr. James, of course, something is wrong with you,” she smirked.
“But I can’t smell anything,” he pleaded, bringing to his nose his linen souvenir of sins long past. She snatched it from his weak clasp and gave it a sniff. Puzzled, she gave the man a curious look and sped off.

*           *           *           *

          The doctor was a withdrawn man. Quiet and thoughtful, he peered through his smudged and dusty lenses with the kind of mind that bothered with the excesses of society only when absolutely necessary. He was tall, dark and small-eared, with an aristocratic nose and a lantern jaw attached to a carefully coiffured head. His enviably lean musculature and chiseled chest made his patrician good looks almost irresistible. Now in his late fifties, he had a handsomeness that age had failed to wither, which always came in handy when he needed a few favors, especially from the female nurses. His brow, however, had been furrowed by decades of laboring for the living who were at the precipice of death.

          Hours later, when he returned for his evening rounds, the talc of recently discarded gloves still stained his hands. Mr. James, propped up on an elbow, had let his head loll back as if he were in deep sleep. He stirred and sat up as soon as the doctor reached his bed.

The salutations were brief, and the doctor got straight to business.
“Is the cannula comfortable? Do you feel any pain?”
“It’s alright, but I wish I didn’t have a needle in my arm all day.”
“You are dehydrated Mr. James, you need it.”
“What drugs are you giving me?”
“You are on Miltefosine until we figure out what is going on. Come on now, why don’t you take your pills.”
Reluctantly, the patient took a large swig from the water bottle on his tray and flung the pills to the back of his mouth, hoping that they would be washed down quickly. However, the acrid pills touched his tongue and flooded his mouth with their foul taste, forcing him to cringe in disgust. He then remembered that he hated pills more than he hated needles, and now he had to deal with both.

“Have you called your wife or should we call her for you?” continued the doctor.
“What wife?”
“Oh, there’s a ring on your finger. Is she…deceased?”
“Divorced. Two years. She now lives with another halfwit in Nanyuki, draining his accounts faster than she drained mine. I keep the ring to keep her type at bay. Call her if you want, and tell her that I’m dying. It’ll be the best news of her entire life.”
“Oh, okay. No wife. Kids?”
“No.”

“Alright then, anyone else I can call? I must admit that I am terrible company, and the nurses here don’t like wazungus so much. You know how it is, they are probably spitting in your food right now. Don’t you have a close relative? A friend? Besides, you might need something that we can’t provide… ”
“No no, I’m fine,” interrupted Mr. James. “I…I had a bag, right? A ‘Weekender’, when I was brought in. Can I have it back?”
“Sure, in a moment.”

The doctor cocked his head to the side and yelled out a few words in Swahili. Soon after, a familiar pair of dark hirsute legs appeared under the blue ward drapes. It was the large, wobbly woman that he had seen earlier. He hated her guts. She pushed the drapes aside and handed the bag over to him without as much as a single word. He opened it quickly and inspected its contents. Satisfied that everything was accounted for, he put it aside and allowed the mean nurse to dismiss herself.

“So, you live here, in the city?” the doctor continued. A little conversation, he knew, could always go a long way.
“I used to, but only for a while, until the divorce. Then I flew back home to put all that behind me. It wasn’t an amicable affair, you know.” A good, compassionate man, Mr. James loved children, and it pained him deeply that he had been incapable of acquiring one. It was the lack of children that had torn him and his beloved wife apart, he hoped, rather than the affairs that it was rumored she was having with his friends. The sight of abandoned children wandering about the streets had always filled him with anguish. It was the pursuit of a life that would better content him that had brought him back, and even losing almost everything that he had long cared for was not enough to convince him to leave.

Suddenly, caught mid-sentence, the patient shrieked and jumped, knocking his bag onto the floor. It seemed like a surge of electricity had been sent through every fiber within him. The agony was sharp and abrupt, striking him with the viciousness of a heavy, calculated fist bearing the might of an unsettled score. The pain ran through his skull from temple to temple, bouncing back and forth before barreling down through his spine. Arching his back like one in the throes of a demonic possession, he clenched his fists and bit hard into his tongue, twisting his face in a dark glow of despair. He was a man suspended above the dark pits of hell. Just then, the agony ebbed away as fast as it came. Mr. James, winded and out of breath, was soon calm, motionless, and fast asleep.

 *           *           *          *

          The following day, the doctor’s face was marked by a touch of dread as he examined his patient’s file. Much to his dismay, heavy vomiting had been added to his patient’s unusual list of symptoms. The nurses had also noted that the man had grown sleepier than usual. His left hand trembled slightly but ceaselessly throughout the night and his speech had started to suffer. After taking his temperature and blood pressure, and after the brief struggle of ensuring he took his medication, the nurses had let the man sleep in, awaiting the doctor’s morning rounds.

As the day slowly drifted on, more miseries began to afflict him. He perspired heavily under the soft light, and threw away his bedding onto the floor, demanding that the windows be constantly left ajar. In the night, even a brief flicker of the lights would fill him with dread, and he would kick and claw ferociously while lost in the jungle of his dreams. In his wakefulness, while the hours rolled on, he’d suddenly burst into a fit of mania and give a long, eloquent lecture to an audience that only he could see, welcoming a petrified nurse to join in after chiding her for being ‘late’.

“Of greatest value in poetry is form, by which it is chiefly distinguished from prose,” the patient would exclaim, returning to the material of his lecture. “As a common word receives a finer quality when employed in verse, so do the verses receive a touch of elegance when cloaked in structure.” From a distance, the doctor would watch on as if witnessing the events of a terrible dream unfold.

As he watched him lying motionless in his bed, curled up like a little child, or going through the motions that animated him like a mad man, the doctor wished that he could do more for the man. In what other ways could a man of his trade prove his worth? However, it seemed that this mystery was insoluble. The blood tests had revealed nothing and the urinalyses were clean. If he had never laid an eye on the man, he would have thought Mr. James of exemplary health purely by the normalcy of his test results. But the man was visibly fading fast, and the more he wondered about his condition, the more it seemed that the cause of his suffering would only be uncovered by a pathologist. Pulling a cold, metallic hospital chair close enough to his patient, he touched the man’s forehead lightly and woke him.

“G..g..go aw..aw..away,” his patient slurred and stammered, pulling the covers over his head. In his defense, it was not merely to wakefulness that he was being stirred, but to the awareness of his suffering. Sleep, it seemed, was his only source of repose.

It was no easy matter to converse with one whose responses are voiced in almost indiscernible garbles, but converse they did, as one would with an infant who had mastered merely a few syllables. The doctor had always wondered whether he had been asking the wrong questions, but the new ones had yielded little. His patient had suffered no brain injury in the recent past, and one by one he began to eliminate even the wildest conjectures from his list. He knew, more intimately than most, that the loss of life was inevitable within those walls. After years of practice and the death of dozens under his care, he had come to accept that he was not God. However, never had a patient’s potential cause of death eluded him so greatly, so much that it filled him with dread. Had Mr. James in his family a certain genetic trait that was now manifested as this strange disease? Had he contracted a pathogen, a virus perhaps, or a prion? If only he had access to better machines, better tools, maybe…just maybe.

Lost within the tidings of thought, he heard the nurse’s call.
“Ah, finally!” he thought. The CSF analysis was the final bullet he had left. Surely a thorough septic screen could not disappoint him completely. As Mr. James drifted back into his sleep, the doctor rose from his chair and marched quickly towards the waiting nurse.

“How are the results, Abby?” he started, impatiently.
“Bad. Very bad. Severe polymorphonuclear pleocytosis. Mostly neutrophils. And look, high protein and very low glucose, and then that CK, it’s crazy. What’s happening to him? ” she babbled, handing over the lab report to him. After a long glance, he handed it back to her.
“Hmmm, interesting,” he hissed, “this looks like some form of Meningitis. Tell Kim to hurry with the microscopy. I’ll be in my office.” Turning around to walk away, he added, “and tell Jane to bring me the thing that I had sent her.”
“What thing, Doc?” inquired the large woman with suppressed suspicion.
“Just tell her what I’ve told you, word for word, got it?
“Okay, Doc. Tell Jane to bring the thing, you’ll be in your office. Got it.”
“Thanks, Abby,” he added, before fleeing as fast as he could, almost breaking into a sprint.

Hardly halfway across the hallway, his foot landed on a wet patch on the floor and skid, throwing him off balance, but his flailing hands chanced upon a man’s shoulder, by whose quick aid he steadied himself. The slimy pool of vomit that he had stepped into seemed fresh, and released a putrid smell so strong that it overwhelmed him. He wrinkled his nose at the harsh smell and dashed away in disgust. Was he the only one ever doing his job around here? he wondered.

Finally, within the serenity of his office, he peeled off his lab-coat and draped it over his chair. Then he turned his attention to the box that lay conspicuously on his table. “Ah, bless you!” he exclaimed as his suspicions were confirmed: Jane hadn’t delayed this time. After ensuring that his door was bolted shut, he quickly opened and extracted a crystal clear bottle of Absolut Vodka from the box. Without much delay, he poured himself a large drink that befits a troubled man.

Reflecting upon his new conjectures, he let his mind sink into the calmness that many have often sought for at the bottom of the glass. One hand scratched unconsciously at the friable edges of his table as the other delicately nursed the potent drink. As his thoughts began to grow clearer, he cursed, realizing that the drugs he had been giving his patient would mar the microscopic examination by lowering the parasite density in the CSF. However, there was nothing that he could do about that now. He pondered upon the plausible patterns of transmission of the agents of this strange malady, but nothing could come to mind. Rational and systematic, the doctor knew that no definitive answers should be presumed in the absence of evidence. All that he could do for now was wait.

    *          *          *          *

          Unknown to the doctor, the mighty American dollar has recently afforded Mr. James an exquisite extravagance that was the genesis of his troubles: a visit to a newly opened, untreated geothermal spa, or as the magazines liked to call it, a ‘luxurious, state-of-the-art, open-air balneotherapy circuit’, situated in the heart of a government-owned stretch of geothermal land. With the promise of absolute relaxation in the warm water, he had quickly disrobed and dived in with the gay abandon of a high-school girl. Having never heard of diseases that were contracted from a wellness spa, the visit was a triviality to him and he had failed to mention it to his doctor. Unknown to many, much occurs in the microscopic realm that is hidden from the unaided eye, including the mutation and multiplication of a recently harmless pro-mitotic microbe, little known even in the developed world, into a virulent creature that would now take its first human life.

The microbe did not possess the courtesy of familiar foes, like Plasmodium or Salmonella, that stay their hand in their invasions. Though notable for the exquisite suffering that they inflict upon us, these architects of common maladies are merciful creatures. They often allow us to live in order for their colonies to thrive within us, affording us a miserable life but a life nonetheless. This microbe, however, was a monster that knew not the limits of its strength.

Using a special set of newly acquired virulence genes, the eukaryote had discovered a shortcut into the human brain while foraging around for food, through the millions of nerve endings in epithelial tissues that are easily exposed to contaminated water. Using its fimbrial organelles, the eyes, ears, nostrils, mouth, and every other cavity that came into contact with the contaminated water was quickly attacked. Faster than a healthy immune system could mount a decent primary response, the microbe had employed a Blitzkrieg attack, deploying a host of effector proteins to facilitate their survival. The colony reached the subarachnoid space and the central nervous system in seven days. Now home free, the microbes immediately began their final assault. Wrapping their pseudopodia around chosen brain cells, they punctured and drained them of all their contents, one by one, before scurrying off in search of other ones. They were eating his brain from within.

The drugs employed by the doctor, sadly, were of no use. When faced with this artillery, the microbes simply employed an old and common evolutionary trick from their past, which they often used while living free in the harsh external world. They constructed an impenetrable, hermetically sealed capsule around themselves – a cyst, impervious to almost any chemical and physical agents that could be thrown at them – and waited for the concentration of the drugs to fall, before reverting back to their normal aggressive form. This microbe had become a merciless pathogen that could snuff out its host like small candle caught in a violent wind.

*          *          *          *

          “Doc! Doc! Come and see this!” yelled the young microscopist, Kim, a few doors away. Jolted from deep thought, the startled doctor almost dropped his glass, but he managed to place it on the table gently without spilling a drop. Bursting out of his office, he almost collided head-on with Kim, who couldn’t wait for the doctor to take his sweet time to come to him. Almost dragging him by the hand, he led the doctor out of the office and into his lab.

“It’s in focus, look,” the young man added. “It was hard to find, but there it is. Is that what I think it is?” The doctor eased his aging frame onto the stool and coughed deeply, swallowing the sputum noisily as there was no receptacle into which it could be expelled. Though he leaned forward slowly, his elbow knocked over a box of Eppendorf microcentrifuge tubes which clattered noisily onto the floor. Maybe he was a little more than tipsy, or maybe not. Ignoring it, he clasped the microscope’s frame delicately and looked into the scope. For a moment, he was motionless, lost within the vast little world at which he now peered. He seemed to sink into a calm atmosphere of thought, and all the tension seemed to depart from him. He sighed.

“I’ve seen it only once before, and there’s only one micrograph in that book,” he continued, pointing at a large, old, tattered copy of an old laboratory manual an arm’s reach away, opened to the relevant page. The doctor remained silent. Without withdrawing his gaze from the eyepiece, he reached for another slide and mounted it almost robotically onto the stage. As he fiddled with the adjustment knobs, soon, the sparse, motile blobs came into view, and his heart was filled with dread. His trembling hand switched intermittently between the high and low power objectives with the hesitance of a supervised intern fumbling with an unfamiliar tool. Switching to high power again, he examined the vivid outlines of the stained creature, pondering the scales and forms of its parts, its hues, its shades, its peculiar amoeboid form. Its slug-like, eruptive movement was all too familiar. Beside him, the young microscopist trembled in anticipation, half hoping that his fears will be confirmed, and half hoping that they won’t. If the creatures were what he thought they were, then by God Mr. James was a dead man. In a slow, tremulous voice, the doctor gravely announced, “Oh shit.”