I was feeling some fear for my own safety, but more concern for Garcia’s and Emert’s, and — especially — for Miranda’s. She was a young woman of childbearing age, and if there was risk from radiation, she was potentially the most vulnerable. She was also my student, and I felt responsible for her safety. “Duane,” I said, “do we need to get out of here? And do we need to evacuate the hospital, or part of it?”
“We’re okay here,” said Duane, glancing at the meter as he said it. “These walls are concrete, and they’re pretty stout down here in the basement, so they’re good shielding. I’d like to figure out what kind of radiation this is, and how hot it is, before we do something as drastic as evacuating patients. If you start moving sick people, you can make them a lot sicker. But let me make sure the folks just above us aren’t at risk. Where’s the nearest phone?” Garcia pointed to the wall behind Johnson, and Johnson dialed a five-digit extension. “Hi, it’s Duane,” he said. “Listen, I’ve got an odd request. I’m one floor below you guys right now. Could you run a survey meter around the offices and labs up there, make sure nothing’s coming up through the floor?” I heard the faint sound of questions bleeding out of the receiver. “The morgue,” Duane said. “I’m down in the morgue.” I heard more faint questions. “Look, just do it, would you? Like, right now? And if your active dosimeter isn’t already on, turn it on before you do anything else.” I saw a look of impatience flash across his face; he paused long enough for me to hear urgency in the voice at the other end of the line. “We may have an incident down here,” said the physicist, “but I don’t have time to talk right now. Check the whole lab area, get people out if you need to, and page me if you see anything worth worrying about. I’ll call you back in a few minutes, but right now I gotta go.” He hung up the phone and turned to the four of us. “We’re right underneath the cyclotron lab,” he said, “where we make radiopharmaceuticals for PET scans. The floor’s really thick, there are no patients in that area, and the staff knows how to make sure it’s safe up there.” He eyed the corner of the hallway. Around it lay the door of the morgue and the danger lurking within. He drew a deep breath. “Okay, let’s see what we’ve got here.”
He went back to the cart and pulled out a bagged garment; as he unwrapped and unfolded it, I recognized it as a biohazard suit like the ones the DMORT team had worn. The DMORT team called the garments moon suits, but Duane called it a “bunny suit,” because its built-in booties and gloves and hood make it look like an Easter-rabbit costume, minus the ears. “Bunny suit” seemed an oddly innocent nickname, though, considering how concerned Johnson now seemed. Once he was zipped in, he took a red and yellow instrument out of the cart’s bin and switched it on. This gadget was similar to the Geiger counter — boxy and about half the size of a car battery, with a wand attached to a flexible cord — but instead of a dial with a needle, this one had a digital display. “So what is that,” asked Miranda, “the all-new, fully equipped 2009 Geiger Counter Deluxe?”
“Sort of,” he said. “It’s an ionization chamber. A Geiger-Mueller counter gives you a yes-or-no answer — it tells you whether or not there’s elevated radioactivity — but it doesn’t tell much more than that. This one tells whether the activity is alpha, beta, or gamma radiation, and it measures the wavelength and energy accurately.”
“Sounds like a better gizmo,” she said. “Why doesn’t everybody use these?”
“These cost about four times as much,” he said. “And usually the Geiger-Mueller counter is good enough, because usually it tells you there’s nothing above background radiation.”
“But not always,” said Emert, who’d had a deer-in-the-headlights look ever since he’d vomited in the morgue.
“Not always,” conceded Johnson. He checked the ionization chamber’s display and seemed satisfied with what he saw there, then handed the instrument to Emert briefly while he rummaged around in the cart. First he dug out a pair of toy-looking plastic rings, which he put on his two index fingers. “Ring dosimeters,” he explained, showing us a small square of metallic foil in the broadest part of the band, where a gemstone would be if the rings were jewelry. He rotated the rings toward the inside of each finger. “To measure how much exposure my hands get.” Then he fished out a lead smock, the sort patients wear while having an arm or leg X-rayed, and put it on. “The body’s core is more vulnerable to radiation than the arms and legs,” he said. “The GI tract and the bone marrow, especially.”
Taking the ionization chamber back from Emert, he stepped around the corner. I saw him reach for the morgue’s door and open it, then extend the wand through the opening. He let out a low whistle just as the monitor clipped to his belt began to shriek again, then scurried back around the corner and rejoined us. He scanned our worried faces. “There’s good news and bad news,” he said. “The good news is, from the reading I’m getting and from what you’ve told me you found in the body, this isn’t something that’s spreading contamination.”
Nobody else seemed to want to ask the logical next question, so I did. “What’s the bad news?”
“The bad news is, the source, whatever it is, is putting out some intense radiation. I’ll need to notify TEMA — the Tennessee Emergency Management Agency — and call the medical folks over in Oak Ridge. They’re some of the world’s best experts in treating radiation exposure.”
“Actually,” said Miranda, “just before you got here, I spoke with Hank Strickland, a health physicist I know at REAC/TS. He’s on his way over now.”
Johnson looked startled, but he quickly recovered. “While I call TEMA, call Hank back. Tell him we’re looking at an intense gamma radiation source. Ask him if one of their emergency physicians could meet you guys up in the ER.” I saw alarm in the faces of Miranda, Garcia, and Emert, and if they were looking, they saw it in mine, too. “It’s a precaution,” Johnson said. “Triage. We need to see how much exposure you’ve gotten, and we’ll need to start taking blood and urine samples for that.”
Just then Eddie Garcia grunted in pain, doubled over, and threw up. From my recent DMORT training, I knew that vomiting was one symptom of radiation sickness. I also knew that the sooner victims began to vomit after being exposed, the worse their condition.
Miranda knew it, too. The cell phone shook in her hands as she struggled to hit the redial button.
* * *
After some quick, back-of-the-envelope calculations, Duane Johnson estimated that the radioactive pellet from Novak’s gut was packing somewhere in the neighborhood of a hundred curies of radioactivity, and it was spewing pure gamma, the most penetrating form of radiation. “Like armor-piercing X-rays,” Miranda said, and Johnson nodded grimly. The image was vivid, but it was far from reassuring.
Hank arrived just as Miranda, Garcia, Emert, and I were heading upstairs to the ER. He offered to help Johnson retrieve the source and get it shielded. Dr. Chris Sorensen, an emergency physician specializing in radiation accidents, was on his way from Oak Ridge as well, Hank said, and would meet us in the ER. Meanwhile, Dr. Sorensen was on the phone with Dr. Al Davies, a UT emergency physician Johnson had paged, briefed, and asked to meet us in the ER.
Never in the history of UT Hospital’s ER had four people been processed so swiftly. Dr. Davies whisked us back to a triage suite, where he assigned a nurse to each of us. In no time, all four of us had tourniquets around our biceps as nurses prepared to draw blood.
Three of us were stuck almost in unison, the blood spurting thick and dark into a series of five vials. Garcia’s arm remained untouched. Garcia was holding his right arm across his belly; his face was tense with pain. His nurse, a thickset and graying woman who appeared to be in her fifties, took a step back. Dr. Davies hurried to her side. “Nurse, is there a problem?”
“I…” she faltered. “I heard it’s something radioactive. Is that true?”
“We’re not certain, but we think so, yes,” said Davies. “That’s why we need the blood samples, so we can tell how severe the exposure is.?
??
“I’m not comfortable doing this,” she said. “I’m afraid. I don’t want to be contaminated.”
“Oh, for God’s sake,” snapped the doctor. Then, seeing the near-panic in her eyes, his tone softened. “This isn’t something he can spread to you,” he said. “It’s not like a virus or a chemical. It’s more like a sunburn, even though it isn’t showing up yet. You can’t catch this from him, any more than you could catch a sunburn.” He laid a hand on Garcia’s shoulder and left it there, showing her there was nothing to fear. “I’d draw his blood myself, but it’s been twenty years since I’ve done it, and it’d be cruel and inhuman treatement if I stuck Dr. Garcia with my rusty skills.” Still she held back, motionless except for her head, which began shaking “no.”
Just as Davies was drawing himself up to his most authoritative physician posture, my nurse — a young woman who had filled my two blood vials with cool efficiency — stepped in, taking the syringe from the hand of the reluctant nurse. “It’s okay,” she said. “I’ve got it.” She tapped her index finger on the inside of Garcia’s elbow to bring the vein up, then eased in the needle.
Garcia raised his head and studied her face. “What’s your name?” His voice sounded reedy and forced.
“Darcy,” she said. “Darcy Bonnett.”
“Thank you, Darcy.”
“You’re welcome,” she said. When she was finished, she gave Garcia’s hand a quick squeeze.
After drawing our blood, they sent us to bathrooms with plastic specimen cups. When I emerged, the cup warm in my hand, I saw a tall, tanned, silver-haired man in civilian clothes — khaki pants, a blue shirt, a red tie — conferring with Dr. Davies. He introduced himself as Chris Sorensen, a radiation-medicine physician from REAC/TS. As Miranda, Garcia, and Emert emerged from other bathrooms and handed off their pee, we all instinctively gathered around Davies and Sorensen. “I just got an update from Hank,” Sorensen said. “He and Duane Johnson think they can retrieve the source and get it into a shielded vessel. So the good news is, this should be contained quickly.”
“I can tell you’re about to drop a bad-news shoe,” I said.
“It’s not great,” he said. “It’s a gamma source, for sure; luckily, it appears to be a sealed, single-point source — that little pellet that came from Dr. Novak’s intestine. Gamma sources don’t spread contamination, they just emit radiation. Like light, from a lightbulb, rather than water from a garden hose.” This sounded like something from a high school science-class talk he’d given a lot of times. “But this source is iridium-192, which is very intense.”
“You mean dangerous,” said Miranda.
He hesitated, but only briefly. “Yes,” he said, “dangerous. Those of you who touched it”—he looked directly at Garcia and Miranda, so I knew Hank had briefed him—“will probably have burns on your hands. My other concern is how much whole-body dose all of you got. We need to know whether it’s enough to damage your bone marrow or the lining of your GI tract. We’ll need to do whole-blood counts again at twelve hours and twenty-four hours to see if your lymphocyte counts are dropping.”
“Excuse me, Doc,” said Emert. “Our what counts?”
“Lymphocytes,” he said. “They’re a type of white blood cells. If they drop significantly, it means the stem cells in your bone marrow have been hit hard. Also means you’re vulnerable to infection.”
“Sort of like radiation-induced AIDS,” added Miranda. I was starting to wish she didn’t have such a gift for grim analogies.
“Sort of,” Sorensen agreed. “Tracking changes in your lymphocytes is one way we estimate the dose you’ve received. Another is to reconstruct the incident timeline. So I’ll need each of you to think back and give me your best estimate of how much time you spent near Dr. Novak’s body, particularly how close you were to the abdominal region, where the source was — three feet away for thirty minutes, for instance, and ten feet away for an hour. Between the incident timeline and the bloodwork, we’ll get a fairly precise idea of what sort of exposure you each got.”
“You mentioned burns,” I said, “but their hands look fine.” As if on cue, Miranda and Garcia held out their palms.
Sorensen and Davies both shook their heads. “Too soon to tell,” Davies said. “Normally the redness doesn’t show up till the next day. We see it occasionally in patients undergoing radiation therapy. Redness. You may have itching or swelling or numbness in your hands, too. The redness generally peaks about twenty-four hours after exposure, then it fades. Same with the symptoms of whole-body exposure — nausea, diarrhea, fatigue: they show up, then disappear, and everything seems fine. Even if it’s not.”
“The ‘prodromal stage’ is the term for that period of initial symptoms,” added Sorensen. “When they disappear, that marks the beginning of what we call the ‘latency stage’ of ARS, acute radiation syndrome. If it is ARS, the symptoms can come roaring back, anywhere from days to weeks after exposure. ‘Manifest illness,’ that stage is called. Radiation does strange things to the body. It damages the DNA in cells, and cells that get replaced more often — like the bone marrow and the lining of the gut — are affected first, and the worst.”
“So the bloodwork helps you estimate the dose and diagnose damage,” I said. “But what about treatment? What can you do for us? What can you do to reverse or minimize the effects of the radiation?”
“Not a lot, unfortunately,” said Sorensen. “If your lymphocytes drop significantly, we’ll start you on growth factors to stimulate the bone marrow. We can treat localized burns to ease pain and fight infection. If your immune system is compromised, we can isolate you.” He hesitated. “We can recommend psychological and psychiatric care, to help deal with anxiety or anger. Beyond that, it’s up to the body to repair and heal itself.”
“Shit,” said Emert. “This sucks.”
“I know,” said Sorensen. “I wish I had a magic pill I could give you.”
The detective puffed out a deep breath of frustration. “So tell me this,” he said. “Novak was a physicist in Oak Ridge, from the moment there was an Oak Ridge. He worked with nuclear reactors and radioactive materials for forty, fifty years. Could this be a bizarre side effect of all those years of radiation exposure?”
Sorensen shook his head. “Not a chance,” he said. “That gamma radiation is coming from that tiny pellet that was in his gut. Iridium-192 is a very unstable isotope, with a very short half-life. You have to work hard to make it radioactive, and once you do, it decays fast. As it emits all that gamma radiation, it’s changing steadily from radioactive iridium into ordinary platinum. A year or two from now, it’ll be relatively safe to handle.”
“So that hot little pellet,” I said, “isn’t some dangerous bit of flotsam or jetsam left over from the Manhattan Project?”
“It was probably created within the past six months,” he said, “and Dr. Novak couldn’t have survived more than a day or two after ingesting it. Within minutes he was doomed. Within hours he was what we call a ‘walking ghost.’”
CHAPTER 6
Armed with pens and notepads, Miranda, Garcia, Emert, and I huddled in plastic chairs in a triage room in the Emergency Department, comparing notes like classmates before a test. We were reconstructing what Sorensen called the “incident timeline”—which Miranda, in classic form, had nicknamed the “path to peril.” How long had I spent chainsawing Novak’s body out of the frozen swimming pool — ten minutes? fifteen? Had Miranda and I spent a full hour driving back to UT with the corpse in the pickup truck? Another fifteen minutes getting it onto the gurney and into the morgue? The next day, when Emert searched the clothing and identified Novak, were the detective and I beside the gurney for thirty minutes, or was it more like forty? How many lifetimes elapsed between the moment the autopsy began and the instant we fled the morgue?
As the four of us debated matters of minutes, Garcia winced and hastily excused himself. Miranda watched him hurry to a restroom, then looked at me. “I’m worried about
Eddie,” she said. “This doesn’t look good. But I don’t understand why his symptoms would be so much worse than anyone else’s. The rest of us were around the body the day it was recovered, and he wasn’t.”
“Maybe it’s just the stress,” I said, but it rang false in my ears even as I said it. Suddenly it hit me. “Dammit,” I said. “The autopsy.”
“But we were there, too,” she said. “Sure, he was closer to Novak, but not that much closer.”
“Not Novak’s autopsy,” I said. “The one Eddie was doing the day we brought Novak in to thaw. Remember? We parked the gurney at the other sink, right behind Eddie. He was two feet away for hours.”
Miranda clapped a hand over her mouth. “Oh God,” she said, “I didn’t even think about that. He did two that day. And another one the next morning, before Novak’s. Oh, this is bad, Dr. B. Very, very bad.” Her chin began to quiver, and her eyes brimmed with tears.
I glanced at the two doctors and saw them huddled with the nurse named Darcy. She nodded, then disappeared behind a curtain. A moment later she reappeared, wheeling a stand with an IV bag attached. Behind the door of the restroom, a toilet flushed with a roar. Miranda wiped her eyes with the backs of her hands and sniffed quickly. She picked up her pen and notepad again just as Garcia opened the restroom door and walked weakly toward us.
I looked at Garcia with sympathy. “Hurling again?”
He shook his head. “Other end,” he grimaced.
Miranda’s eyes darted from Garcia to me at the news of this additional symptom. Sorensen and Davies walked toward us. “Dr. Garcia, we’d like to go ahead and put you on an IV,” Davies said, “since you’re losing fluids.” Garcia nodded; as a physician, he had probably known they’d want to do this. “We’d also like to go ahead and admit you for observation.” If Garcia had seen this one coming, it didn’t show: the look on his face when Sorensen said this was somewhere between shock and despair, but he simply nodded again. We moved back into the ER’s triage area; Eddie disappeared behind a curtain long enough to change into a gown, climb into a bed, and get hooked to the IV. Then the nurse pulled back the curtain and we clustered around his bed to finish reconstructing the incident timeline.