The mysterious virus killed him before he died ｜ Blood epidemic (serial 2)

Editor’s note: There is only one flight between civilization and virus. A dangerous virus from the tropical rain forest can fly to any city on earth within 24 hours. Air routes connect all cities in the world to form a network. Ebola has entered the network and started to travel around the world. This article is taken from Blood Epidemic and serialized in three times.　 　 　　

January 15th, 1980

Nurses and paramedics came running with a gurney, lifted Charles Monet onto the gurney and pushed him into the intensive care unit of Nairobi Hospital. The announcement of calling the doctor sounded on the radio: there was a patient bleeding in ICU. A young doctor named Shem Musoke rushed to the scene. Dr. Musoke is recognized as the best physician in the hospital. He is energetic, enthusiastic and humorous. He often works for many hours in succession and has a good intuition about emergency treatment. He saw Monet lying on the gurney. He didn’t know what happened to the man, only that the patient was obviously bleeding heavily. There is no time to study the cause of bleeding. The patient has difficulty breathing-then stops: blood is inhaled into the lungs, causing respiratory arrest.

Dr Musoke felt his pulse: the heartbeat was weak and weak. The nurse ran to get a laryngoscope, which is a catheter that can be used to clear the patient’s trachea. Dr. Musoke tore off Monet’s shirt and observed the ups and downs of his chest. He stood at the top of the gurney, bent over Monet’s face and looked Monet’s eyes upside down.

Monet’s red eyes looked at Dr. Musoke, but his eyes were still and his pupils were dilated. Brain injury: loss of consciousness. His nose and mouth are covered with blood. Dr. Musoke lifted the patient’s head backward, opened the tracheal opening, and inserted the laryngoscope. He didn’t wear rubber gloves. He swept his finger around the patient’s tongue to clean up dead cells, mucus and blood. Slippery black blood clots stained his hands. The patient smelled of vomit and blood, but it was not unusual for Dr. Musoke, who concentrated on his work. He lowered his head, and his face was only a few inches away from Monet’s face. He looked into Monet’s mouth to locate the laryngoscope. The laryngoscope slid over Monet’s tongue. He pushed it open and looked at the trachea at the back of epiglottis. This black hole leads to the lungs. He inserted the laryngoscope into the hole and looked close to the eyepiece. Monet suddenly shook and lifted his body.

Monet vomited again.

Black vomit poured through the laryngoscope and gushed out of Monet’s mouth. Black and red liquid splashed into the air and fell on Dr. Musoke. The liquid got into his eyes and spilled on the white uniform and his chest, leaving several red mucus mixed with black patches. The liquid fell into his mouth.

The doctor straightened the patient’s head and cleaned the blood in his mouth with his fingers. Blood stained the doctor’s hands, wrists and forearms. Blood stains are everywhere: on the gurney, on the doctor’s body and on the ground. The nurses in the intensive care unit couldn’t believe their eyes. Dr Musoke looked down the trachea and inserted the laryngoscope deeper into the lungs. He saw bleeding in the trachea.

It seems that the patient went into shock due to blood loss. He lost so much blood that he began to dehydrate. Blood gushed out from every hole in the body. The blood left in the body is not enough to maintain circulation, so the heartbeat is so weak and the blood pressure is almost dropped to zero. He needs a blood transfusion.

The nurse brought a bag of whole blood. Dr Musoke hung the blood bag on the drip stand, picked up the needle and inserted it into the patient’s arm. There seems to be something wrong with the patient’s blood vessels; Blood poured out around the needle. Dr Musoke tried again, inserting the needle into another position of the patient’s arm and sticking it into the blood vessel. Failure. Still bleeding like a spring. No matter where he sticks the needle into the patient’s arm, the blood vessels will burst like cooked macaroni and blood will gush out; Blood emerges from the pinhole in the patient’s arm and cannot be coagulated. There is obviously something wrong with his blood. Dr. Musoke gave up the idea of blood transfusion because he was afraid that the patient would bleed to death because of the pinhole in his arm. The patient’s internal organs are still bleeding and black as asphalt.

Monet fell into a deeper coma and never regained consciousness. The next morning, he died in the intensive care unit. Dr. Musoke is always at the bedside.

Nobody knows what killed him. Cause of death is unknown. The doctor dissected the body and found that the kidney had been damaged, as had the liver. The liver is yellow and even liquefied in some places-just like the liver of a dead body; As if Monet had turned into a corpse before he died. Mucosal decay, that is, the shedding of intestinal wall tissue, is also common in Fang Chen’s corpse a few days later. What was the cause of death? I can’t say clearly, because there are too many possibilities. Everything in the patient’s body is not right, it is really "everything", and any one of them is fatal: blood clot, massive internal bleeding, liver turning into paste, intestines filled with blood. No words, classifications or even words can describe what happened to him. Doctors finally called it "explosive liver failure". His body was put into a waterproof bag-according to a client’s description, it was buried locally. Many years later, when I visited Nairobi, no one remembered where the grave was.

January 24th, 1980

The patient’s vomit splashed into Dr. Shem Musoke’s eyes and mouth. After nine days, his back gradually felt sore. He doesn’t know much about back pain-to be honest, he has never experienced severe back pain-but after all, he is nearly 30 years old and feels that he is approaching the age of low back injury. He has worked very hard in the past few weeks. First, he stayed with a patient with heart problems all night, and the next day he stayed with a bleeding patient from somewhere inland for nearly one night. So he didn’t sleep for several days. He didn’t take vomiting to heart, and the pain gradually spread all over his body, but he still didn’t think much. Then, when he looked in the mirror, he found his eyes turned red.

Eyeball turns red: he suspects that he is infected with malaria. At this time, he began to have a fever, so he must be infected with something. The back pain continues to spread, and the muscles all over the body ache badly. He took antimalarial drugs, but it was useless, so he asked the nurse to inject him with antimalarial drugs.

The nurse gave him an intramuscular injection in his arm. The pain of acupuncture is extremely severe. He has never felt such terrible pain because of a mere needle; This situation is abnormal and deserves attention. He began to wonder why an ordinary injection could bring that level of pain. Next, his abdomen began to ache. He suspected that he was infected with typhoid fever, so he took a course of antibiotics, but his condition did not ease. On the other hand, patients need him, so he is still busy in the hospital. The pain in the stomach and muscles became more and more unbearable, and he began to have jaundice.

The pain made him unable to treat himself, and his work had to be put down temporarily. He went to see Antonia Bagshaw, a physician in Nairobi Hospital. She finished the examination for him and confirmed fever, red eyes, jaundice and abdominal pain, but she couldn’t get a clear conclusion, only suspected that he had gallstones or liver abscess. Acute attack of gallstones or liver abscess can cause fever, jaundice and abdominal pain (but it can’t explain the redness of the eyeball). The doctor gave his liver an ultrasound examination. It can be seen from the imaging that the liver is a little swollen, but there is nothing unusual other than that. At this time, Musoke was seriously ill. The doctor put him in a private ward, and the nurses took turns to look after him 24 hours a day. His face became expressionless.

Acute attack of gallstones can be fatal. Dr. Bagshaw suggested an exploratory operation on Dr. Musoke. A team of surgeons led by Dr. imre loffler opened his body in the main operating room of Nairobi Hospital. The incision was located above the liver, and the doctor pulled open the abdominal muscles. The strange sight seen in Musoke was shocking, and no one could explain it: the liver was swollen and red, showing pathological symptoms, but the doctor could not find the symptoms of gallstones. On the other hand, he was bleeding. Surgery will definitely cut off blood vessels, and the cut blood vessels will bleed for a while and then coagulate; If the bleeding does not stop, the doctor will use a gelatin sponge to stop the bleeding. Musoke’s blood vessels kept bleeding: his blood couldn’t clot, as if he had hemophilia. The doctor put a gelatin sponge on his whole liver, but the blood continued to ooze. The doctor had to suck a lot of blood from the incision, but after cleaning it up, the blood would fill the incision again. Just like digging a hole under the waterline, the speed of water accumulation is as fast as drainage. A surgeon later told others that the surgical team was "soaked in blood". They cut a small piece from the liver for biopsy, soaked the tissue in a fixed solution, and sewed up the incision as quickly as possible.

After the operation, his condition deteriorated rapidly and his kidneys began to fail. He seems to be dying. His doctor Antonia Bagshaw happened to be going abroad, and a doctor named David Silverstein took over. Dr. Musoke may suffer from renal failure, and he can only live on dialysis, which gives the hospital an unusual color: colleagues love him very much and absolutely don’t want to lose this partner. Silverstein suspected that Dr. Musoke was infected with some rare virus. He collected blood samples from patients and extracted serum. Serum is a transparent golden yellow liquid, which can be obtained by removing red blood cells from blood. He submitted several test tubes of frozen serum to major laboratories for testing, including the National Institute of Virology in Sandringham, South Africa, and the Center for Disease Control in Atlanta, Georgia, USA. He began to wait for the result.

This article is excerpted from "Blood Epidemic" by [America] Richard Preston, published by Shanghai Translation Publishing House, translated by Yao Xianghui, published in March, 2016.