Linksshifter II

A Claim on the Black Ash

Astrid laid the sheet back down, dropping it over the patient's face. "It's done. He's gone – completely catatonic, almost no brain activity. There's nothing more we can do – if the road was in better shape and we could have got here sooner, we might have been able to do something." She shook her head as she stood up, pulling her mask off and crumpling it up with her gloves. "Have you heard anything about where he came from? Wasn't Harpreet going to talk with the priest or the clinician or whoever here?"

SD turned around, carefully setting the stained samples of the patient's sores next to the field microscope, trying to keep them on the cleanest parts of the table. "He was going to, but I haven't heard anything back from him – I think he said he asked around and the guy was out in one of the other villages, so Harpreet was going to go find him. I've got the biopsies stained; if you give it a minute or two, you ought to be able to take a look and maybe get a better idea of what this guy had. If you want, while you're doing the exam I can go try to find a telephone or something in case we need to call a full field team in."

Astrid shook her head again. "No, it's all right. Until we find out where he came from, it's no use calling in – it's a big country back here, and even just getting a field hospital up here from Bilaspur might make it harder to get it where it needs to go. Until Harpreet gets back, the most productive thing we can do is try to find out what this one had, what was causing those lesions." She pulled a new pair of gloves out of the glove box, and started to roll them on as she bent over the microscope. "Are you sure the stain's set? I'm not seeing anything."

SD took another look at the rest of the slides, pulling on a pair of gloves himself. "I'm sure – I did this a lot when I was in Sudan and Somalia with the army, and they always came out in worse conditions than this. Maybe it's something else and the stain isn't picking up because there aren't any giant cells?"

She shook her head, hair flopping as she kept her eyes seated on the microscope. "Maybe – we can't rule anything out. But with the symptoms he's presenting, there's not a lot of options – if this isn't pemphigus or a cytomegalovirus, or something that would show Tzanck cells, there's no telling what it is. His skin's so slack all over, like it's about to detach – if there was anything around here like that scrapyard where they cut up the radiotherapy machine a couple years back, I'd almost think it might be a heavy full-body radiation exposure; he's presenting so many symptoms that I've still got to half think about that. But there's nowhere out in these fields and villages that you'd just run across a high-energy radiation source." Astrid stood up and pushed back from the microscope. "We're not going to get anything here. Go find Harpreet, see if he's got anything yet. I'm going to say with the patient and keep the morphine dose constant, see if anything changes before he passes." She put her mask back on again, and changed gloves as she turned back to the bedside.

SD took his gloves off on the way out, bundling them and Astrid's used supplies into one of their field waste bags, which was going to have to go into the waste locker on the tail of the LandCruiser as soon as he found it and Harpreet again. It would kind of defeat the purpose of MSF being out here, looking out for disease outbreaks before they turned into crises, if the explo teams just threw their medical waste into the village dumps or burn piles. Everything you brought in with you, you brought out. If they had to put in a field hospital here, maybe things would be different, but then they would be gone: other doctors would be working here to stop the spread of whatever the patient inside was about to die from, but Astrid and he and Harpreet would be out beating the bushes in even more remote villages, making sure there wasn't still another pocket of the outbreak unnoticed – that there weren't people dying because nobody bothered to look for them, that whatever this was wouldn't go underground, to come back when the Indian health service and the international aid organizations were the least prepared.