Taboo Descendants and the Multi-Dimensional War

Death could be felt as sure as life even outside the hospital walls. I parked in the employee garage, got out of my Tesla, and walked at a brisk pace towards the elevator. I could feel the cold breath of death brush past me as I approached the metal doors.

The hospital exuded despair.

I wondered what disaster could have caused the “dozen deaths” Nurse James had alluded to in her message. The hairs on the back of my neck stood on end as I contemplated the possibilities.

So many dead in so few hours.

Alone in the elevator, I hit the number for the Department of Neurology floor. I braced for the worse, though no amount of planning could have prepared me for what followed.

The inside of the hospital smelled sterile, too clean to be real. The calm inside these walls was fabricated, usually a shield against the chaos of the world, but today was different. This was the quiet after the storm.

“Dr. Jerito! I’m so glad you’re finally here!” The elevator doors had barely opened and the night nurse, Shaneequa James, ran towards me in a frenzy.

“What seems to be the problem, Nurse James? Your message sounded urgent.”

“It’s Dr. Queens. She told me to notify you as soon as you got in that she is waiting for you in the main operating room. She says it’s of the utmost importance.”

“Just let me put my things down and I’ll go there straightaway.”

“I’ll take them for you. You’ll want to hurry.”

“Is this about the dozen deaths?”

“Yes. They are trying to prevent number thirteen now.”

Dr. Charnesha Queens, my primary best friend, could be trusted without a doubt. She was loyal to a fault, protective, and nurturing. I would do anything for her whether or not work required me to do so.

My second best friend and former college roommate from undergraduate school, Yesenia Arelys Mansi, worked as a professor for the University of Redlands in California. I did not talk to her as often as I should, but our bond stood the test of time. We could talk for hours after months of not speaking to one another as if no time had passed.

Yesenia, who I called ‘Ary’, now lived in a remote region of Mexico conducting research for her National Science Foundation project. She studied the forestry practices of a coalition of indigenous peoples somewhere in a cloud forest filled with ancient palms.

Who knows when we would met again.

Charnesha and I saw each other almost every day for the past fifteen years. She and I had roomed together in a tiny apartment off campus for six years during medical school at the University of Florida. She had served as the only “father” that JJ knew, playing the role of the bad cop whenever I fell short.

When I graduated from medical and moved back to Miami for my residency, Charnesha, who grew up in Pensacola, decided to move to Miami as well. Charnesha was JJ’s godmother and he loved her very much. She was an invaluable piece of our lives.

Rushing to Charnesha’s aid, I jogged down the hall towards the double doors leading to the General Neurosurgery Clinic, the ‘GNC’ for short.

I checked in at the nurse’s station before heading around the corner to the first operating room, GNC OR-1. I took a deep breath to calm my nerves and pushed through to the double doors determined to be brave.

A scrub nurse was already waiting for me. After I washed, he assisted me with my surgical wear. Once I was sanitized and dressed, I moved over to the sterile field where a huddle of feverish surgeons worked through their tired physical condition and depressed disposition.

The room smelled of iodine, a pungent stench like ammonia mixed with vinegar. The atmosphere inside the room was somber and tense, not unlike a funeral. The only noises were coming from the beeping equipment and the stern commands of the furrowed-browed neurosurgeons, all wrapped up in the same surgical uniform I had donned: sea foam green scrubs, white scrub caps, masks, and shoe covers, purple gloves.

In between the doctors lay an immobile body.

I spotted Charnesha at once. She was the shortest of the engrossed individuals, the only female, and the only African-American. She stood out. I watched her work for a moment, admiring the way she interacted with the other doctors. She was neither demanding nor domineering, but she was no pushover.

The only other people in the room were the circulating nurses and a medical student who, at the moment, was quite pale. Though his skin was a reddish-brown complexion, it appeared chalky and dull. This event likely represented his first experience in the OR. Despite my general amusement with his squeamishness, I turned my attention back on the procedure.

Charnesha looked up. I saw the concern and panic in her eyes as our gaze lingered. She needed my help. I could sense it.

She leaned over to the surgeon adjacent to her and my eyes tracked her movement. The surgeon looked up at me and then back at her. He nodded, giving her the go-ahead.

She signaled for me to come over to the operating table. I obeyed, only getting weak in the knees for a step when I saw the patient’s exposed brain tissue. I greeted the other surgeons, who returned somber salutations.

The patient was a female. She had a pleasant face and was attractive despite half of her long, blond hair being shaved to her scalp. Her skin, and the membrane of her brain, had been cut with a scalpel and held back by large metal clamps. The amount of cerebral tissue exposed alarmed me. I hoped the patient would survive this operation, the largest scale surgery of that type that I had ever seen.

“There’s no cranial damage and the bone flap is so large,” I thought aloud.

“Precisely our concern,” affirmed Dr. Charnesha Queens, not looking up. “They have all been like this.”

“All?” I was puzzled.

What are the odds of that?

“Yes, all twelve.”

“On this scale?”

“Yes.”

She handed me a pair of forceps and I examined the structural integrity of the exposed skull and removed bone flap. The skull appeared to be in a pristine condition despite the magnitude of inflammation and internal bleeding.

What on Earth could cause this much internal damage without leaving a single scratch on the surface?

The other surgeons worked without ceasing to remove all the excess blood through a suction device.

“Absolutely astounding,” I whispered.

“This will be the greatest neurological mystery of the twenty-first century,” she insisted. “There’s more I need to tell you. Let’s go to your office.”

“Are you sure you want to leave her now?”

She sighed. “Unfortunately, there is nothing else that I can do.”

“I understand.”

“Gentlemen,” she said dismissing herself. “I will give Dr. Jerito our full report.”

They nodded in agreement without looking up.

She left without another word. I stared a moment longer at the woman’s brain.

I laid down the forceps, excused myself, and I followed my best friend. We headed back to the exit where the scrub nurse proceeded to disrobe us one at a time. We re-sanitized ourselves and left the room.

“We have a situation,” she exclaimed as soon as the double doors closed behind us. Her eyes were red and her jaw tight.

“Is it about that patient?” I gave a little nod in the direction of the double doors as I spoke, positive of her answer before it was uttered.

“Yes, but we can’t talk here. Come on.” With that, she walked away.

I was a bit confused and became more concerned by the minute, but despite these sentiments, I proceeded to follow my best friend out of the GNC without another word.

We marched back to my office and I contemplated the severity of the situation. It must be serious to cause this much intensity from Charnesha because she was not often or easily disturbed. It came with the territory of her chosen profession.

This must be dire, I thought. But it’s not like it’s Earth-shattering.

How naive I had been when my world was a five-mile urban bubble.

Charnesha walked into my office and turned on the light, her movements rigid and erratic. I watched her with care, my maternal instincts engaged. She had been so focused and steady-handed in the operating room. Something was very wrong.

She sat in the visitor’s chair on the far side of the room, facing my desk. I took a seat in the twin chair adjacent to her, our backs to the closed door. I could smell the vanilla candle I kept behind the ventilation fan of my desktop computer. The scent always reminded me of my mother and never failed to kept my mind at peace when the day became hectic.

Today would be one of those days.

I noticed the large stack of cream colored manila envelopes in her lap for the first time. She must have picked them up from the nurses’ station. Each one was tabbed with brightly colored labels displaying what I presumed to be patients’ names.

“Please, tell me what this is all about, Nesha.” I crossed my legs at the ankles and waited for the urgent news, my body yearning for a second cup of Cuban coffee.

“I got called in shortly after midnight,” she began. “There was a continual stream of critical patients brought into our unit shortly after 6 p. m., causing a shortage in surgeons.”

The holiday season brought with it increased hospital traffic. Most often, our department dealt with cases related to drug use, mental illness episodes increased by stress, or incidents that resulted in traumatic brain injuries.

“Why didn’t they call someone else? You were on call last, weren’t you?” I asked.

“That’s the thing, they did call someone else. In fact, they called everyone else! I was the last one to get called in and it was a madhouse when I got here.”

“That’s terrible. What in the world happened last night?” I shifted anxiously in my seat.

“Death happened,” she answered bluntly. “We lost all of our emergency surgery patients. It seemed like one or two came in every hour until about 7 AM, an hour or so before you arrived. We haven’t gotten any new patients since, but the ones we had started dying—and all in the same way.

“We don’t know why this has happened and we haven’t been able to identify all of the patients yet or notify their next of kin. The patient you saw a few minutes ago was the last one to come in and you could see that she’s barely hanging on. We’re doing everything that we can!”

My mind began to process the information. “Does there seem to be any correlation in the deaths?” I asked, leaning towards her in anticipation.

“That’s just it!” she exclaimed, her tone boisterous. “As far as we know, they all start and end exactly the same.” She took a deep breath, calming herself. “During the neurological exam, we’ve noted that all of the patients had Anisocoria and Cushing’s triad. Most disturbingly, their ICP levels were through the roof. I’m talking sustained IICP at 55 millimeters of mercury!

“We had to resort to performing decompressive craniectomies immediately. All the patients died during the procedure.”

They had done everything we were taught in medical school. Since anisocoria, or unequal pupil size, was so easy to diagnose, it made sense that they had started there.

Cushing’s triad was a predicable second. Defined by a slow heart rate, high blood pressure, and respiratory depression, it was used to corroborate other findings and properly diagnose a TBI patient.

The canary in the coal mine was the IICP, or increased intra-cranial pressure, problematic for patients since their injured brains could swell beyond the capacities for their skulls to house them safely. This was the hammer that nailed the coffin shut.

The only way to pry a patient out of this situation was through a decompressive craniectomy, a neurosurgical operation in which a section of the skull was removed. I thought about the young woman’s brain currently exposed in GNC OR-1. This was necessary to lower her intra-cranial pressure by draining the cerebrospinal fluid and allowing her brain tissue room to swell undamaged.

“These are the kinds of results one would expect from penetrating brain injuries,” I noted. Charnesha and I had studied neurocritical care at UF as well as our fellowship in Jacksonville. This was our specialty.

“Yes,” she concurred. “But if you look at these results, there is no evidence to support that theory. You saw the last patient’s bone flap yourself. The skull is undamaged.”

Charnesha reached into the top folder and handed me several X-rays, MRIs, and CT scans. I sat and reviewed them for several minutes. The results were unprecedented. The magnitude of swelling and the size of the intra-cranial hemorrhaging had never been recorded before.

The magnitude of damage affected the entire brain.

I looked up at her wide-eyed as I spoke, “The midline of the brain is crossed twice.”

“Yes,” she concurred, nodding curtly.

“If they were all like this, these people had no chance to survive!” I leaned back in my chair and rubbed my temples. “Was there any physical damage anywhere on any of the patients’ bodies?”

“No, none. These patients have not shown any signs of significant external injuries. There’ve been no facial or cranial fractures and no entrance or exit wounds.”

My brain tried to come up with logical explanations: significant acceleration and deceleration, sophisticated terrorist attacks; including, but not limited to, superior biological weapons and shock wave weaponry. The more I thought about it, the wilder my ideas became.

How can this be happening? Who or what is to blame?

“What about correlations?” I speculated further. “What are the age ranges of these patients?”

“They’re all fairly young, 25 to 45 years of age.”

“Were they in good health?”

“Some more than others, but yes, generally speaking.

No one tested positive for illegal drugs in the group. And there was no history of neurological disorders for the patients who had medical records on file.”

“And none of them made it through the craniectomy?”

“Correct.”

“What were their occupations?”

“We’re still working on that information, obviously, but—” she flipped through the folders as she spoke, “One guy was a known drug dealer. The EMS found a substantial amount of cocaine on his person, but there was none in his system. There was also a tollbooth operator and a security guard.

“The female you saw a minute ago is an alleged prostitute, but that is an unconfirmed assumption based on her attire.”

I had not seen the woman’s clothing. She was covered with a sheet up to her neck when I got there.

I assumed by Charnesha’s tone that one of the male surgeons had made this suggestion entirely tongue-in-cheek. I wondered how badly she had reprimanded him for that mistake.

“Night owls,” I said more to myself than her.

“What?” She looked at me with one eyebrow raised.

“Night owls,” I repeated more clearly.

“Oh, okay. Sure.” She shrugged. “By the way, there were two detectives here earlier. Apparently, Miami PD suspects foul play. They wanted to ask us a bunch of questions, but I told them we were a little too busy for interrogations at the moment. From what Nurse James told me, they said that there were numerous cases like this blanketing Miami-Dade County last night.”

“‘Numerous?’ How many cases are we talking about?” I leaned towards her just a little, feeling the edge of my chair beneath me.

“About thirty or so,” she said, as if hardly believing it herself.

“Thirty? In one night?” I exclaimed in utter disbelief. “I listened to the radio on my way over here and I didn’t hear anything about this!” I paused, mulling it all over.

“I know,” she said in a defeated tone. “Dr. Martinez contacted the CDC. They are sending a team to evaluate the possibility of this being some bioterror attack or super meningitis. Personally, I’m not buying that angle. There has been no physical evidence, like rashes or lesions, to support either theory. None of the patients thus far have tested positive for any known chemical compound, bacteria, virus, fungus, or parasite.”

“This is highly unusual.” I stroked my chin, deep in thought.

“Look, I don’t want you going all Sherlock Holmes on me.” It was a precursory warning. “Professionally, I need your help in figuring this whole thing out from a medical perspective.”

She put emphasis on ‘professionally’ and ‘medical’ because she knew that if given the chance, I would try and solve the entire case myself, criminal aspects and all. I had grown up a big Sir Arthur Conan Doyle fan and took pride in being considered the Scotland Yard of Jackson Memorial Hospital.

“I hear you. I hear you,” I brushed her concern away with a wave of my hand. “Who are these two detectives?”

She referenced a small, pale blue, sticky note attached to the topmost folder. “A Detective Oscar Jackson and his partner, Detective Simón Marin.

“I’m glad you mentioned them because they want to speak with you.”

“Why is that exactly?”

“They needed to speak to the department’s spokesperson.”

“Why didn’t you direct them to Dr. Martinez?” I felt a set up on the horizon.

“You know exactly why. Dr. Martinez is just a figurehead. He’s nearly 70 years old. Besides, even he told us to give them your name.” She grinned slightly. For the first time that morning, she did not wear the face of a person being chased by impending doom.

“Alright,” I said smiling back a little. “It sounds like I have some work to do.” I stood up and walked towards the door. She mirrored my action. “I’ll catch up with you later. Are you going home any time soon?”

She raised one eyebrow. “I hope that question was meant to be rhetorical.” I took another long look into her exhausted eyes.

“Right. Well, I’ll talk to you tomorrow.”

“I’m going back into the OR for now. I’ll call you before I leave.” She took another step towards the door. “I suggest that you cancel all of your patients’ appointments as you won’t have time for them.”

With that, she handed me the pale blue, sticky note with the detectives’ information scribbled on it and opened the door, manila folders in hand. She took one last look at me and added, “Good luck.”

“Thanks,” I spoke softly.

I gave her another weak smile and shut the door. The sound of the wooden door impacting its metal frame echoed in my ear. Then, there was complete silence.

Alone again at last.

I walked over to my computer chair and sat down. Stretching my hands over my head, I leaned all the way back into my chair and took my third deep breath of the day. My head began to ache as I gave serious thought to all of the facts Charnesha had given me.

Thirty people dead. The cause of death, though the source was unclear, was severe traumatic brain injuries with no structural damage. And they all occurred between 6 p. m. last night and 7 a. m. this morning.

I bit my bottom lip.

This was no theoretical illness happening in a faraway land that I could safely ponder from the comfort of my luxury car. This reality happened in my hometown. If the fatal occurrences continued, the patients could be my neighbors, my friends, or my family.

I must protect them. I must solve this.