Johnson put on a surgical scrub suit and rubber gloves, and carried the box into the Level 3 staging area of the Ebola suite, where he opened the box, revealing a mass of foam peanuts. Out of the peanuts he fished a metal cylinder sealed with tape and marked with a biohazard symbol. Along the wall of the staging area was a row of stainless-steel cabinets with rubber gloves protruding into them. They were Biosafety Level 4 cabinets. They could be sealed off from the outside world while you handled a hot agent inside them with the rubber gloves. These cabinets were similar in design to the safety cabinets that are used to handling nuclear-bomb parts. Here the cabinets were designed to keep human beings from coming into direct contact with Nature. Johnson unscrewed some wingnuts and opened a door in the cabinets, and placed the metal cylinder inside. He closed and tightened the door.
Next, he put his hands into the gloves, picked up the cylinder and, looking through a window to see what he was doing, peeled the tape off the cylinder. The tape stuck to his rubber gloves, and he couldn’t get it off. Damn! he swore to himself. It was now eight o’clock at night, and he would never get home. Finally he got the cylinder open. Inside it was a wad of paper towel soaked in bleach. He pulled apart the wad and found a Ziploc bag. It contained a couple of plastic tubes with screw tops. He unscrewed them and shook out two very small plastic vials containing golden liquid: Peter Cardinal’s blood serum.
The boy’s mother and father worked for a Danish relief organization Kenya, and lived in a house in the town of Kisumu, on Lake Victoria. Peter had been a student at a boarding school in Denmark. That August, a few weeks before he died, he had gone to Africa to visit his parents and his older sister. She was a student at a private school in Nairobi. She and Peter were very close, and while Peter was visiting his family in Kenya, the two young people spent most of their time together—brother and sister, best friends.
The Cardinal family went on vacation after Peter’s arrival, and traveled by car through Kenya—his mother and father wanted to show him the beauty and sweetness of Africa. They were visiting Mombasa, staying in a hotel by the sea, when Peter developed red eyes. His parents took him to the hospital, where the doctors examined him an concluded that he had come down with malaria. His mother did not believe it was malaria. She began to perceive that her song was dying, and she became frantic. She insisted that he be taken to Nairobi for treatment. The Flying Doctors, an air-ambulance service, picked him up, and he was rushed to Nairbori Hospital, where he came under care of Dr. David Silverstein, who had also taken care of Dr. Musoke after Charles Monet had spewed the black vomit into Musoke’s eyes.
“Peter Cardinal was a blond-haired, blue-eyed guy, a tall, thin guy, a fit-looking ten-year-old,” Dr. Silverstein recalled as we drank coffee and tea at a table in the shopping mall near his house outside Washington. A small girl sitting burst into wails, and her mother hushed her. Crowds of shoppers passed by our table. I kept my eyes on Dr. Silverstein’s face—steel-rimmed glasses, mustache, eyes that gazed into space—as he recalled the unusual death he had seen, which he spoke of a matter-of-face way. “When Peter came to me, he was febrile, but he was very with it, very alert and communicative. We gave him an X-ray. His lungs were fluffy.” A kind of watery mucus had begun to collect in the boy’s longs, which caused him difficulty in breathing. “It was a typical ARDS picture—acute respiratory distress syndrome—like early pneumonia,” Dr. Silverstein said.
“Shortly afterward, he started turning bluish on it. He had blue in his fingertips. Also, he had little red spots. I had everybody glove up before they handled him. We suspected he had Marburg, but we didn’t have the paranoia we had with Dr. Musoke. We just took precautions. In twenty-four hours, he was on a respirator. We noted that he bled easily from puncture sites, and he had deranged liver functions. The small red spots became large, spontaneous bruises. He turned black-and-blue. Then his pupils dilated up on us. That was a sign of brain death. He was bleeding around the brain.”
He swelled up, and his filled with pockets of blood. In some places, the skin almost separated from the underlying tissue. This happened during the last phase, while he was on a respirator. It is called third spacing. If you bleed into the first space, you bleed into you lungs. If you bleed into the second space, you bleed into your stomach and intestines. If you bleed into the third space, you bleed into the space between the skin and the flesh. The skin puffs up and separates from the flesh like a bag. Peter Cardinal had bled out under his skin.
The more one contemplates the hot viruses, the less they look like parasites and the more they begin to look like predators. It is a characteristic of a predator to become invisible to its prey during the quiet and sometimes lengthy stalk that precedes an explosive attack. The savanna grass ripples on the plains, and the only sound in the air is the sound of African doves calling from acacia trees, a pulse that goes on through the heat of the day and never slows and never ends. In the distance, in the flickering heat, in the immense distance, a herd of zebras gaze. Suddenly from the grass comes a streak of movement, and a lion is among them and hangs on a zebra’s throat. The zebra gives out a barking cry, choked off, and the two interlocked beings, the predator and the prey, spin around in a dance, until you lose sight of the action in a billow of dust, and the next day the bones have a surface of flies. Some of the predators that feed on humans have lived on the earth for a long time, far longer than the human race, and their origins go back, it seems, almost to the formation of the planet. When a human being is fed upon and consumed by one of them, especially in Africa, the event is telescoped against horizons of space and time, and takes on a feeling of immense antiquity.
Peter Cardinal’s parents and sister were stunned as they watched him being slowing torn apart by an invisible predator. They could not comprehend his suffering or reach him to give him comfort. As the blood poured into his third space, his eyes remained open and dilated, staring, bloody, deep, dark, and bottomless. They didn’t know if he could see them, and they couldn’t tell what he saw or thought or felt behind the open eyes. The machines hooked up to his scalp were showing flatlines in his brain. There was little electrical activity in his brain, but now and then the flatlines gave a spooky twitch, as if something continued to struggle inside the boy, some destroyed fragment of his soul.
They had to make a decision about whether to turn off the respirator. Dr. Silverstein said to them, “We’re much better off not letting him survive, because of brain death.”
“If they had only brought him in sooner from Mombasa,” the mother said.
“I’m sorry, but that would not have helped. There was nothing that anyone could have done,” Silverstein replied to her. “He was doomed from the beginning.”
Working with his hands in the rubber gloves protruding into the cabinets, Gene Johnson took a little bit of the boy’s blood serum and dropped it into flasks that contained living cells from a monkey. If anything lived in Peter Cardinal’s blood, it might begin to replicate in the monkey cells. Then Johnson went home to get some sleep. The procedure had taken him until three o’clock in the morning to finish.