“Not as long you’ve been careful,” Kilburn said. “Unless she has pneumonia, she doesn’t require respiratory precautions. Group-A strep spreads only by direct contact. But your patient needs the strictest of contact precautions—gloves, gowns, and very thorough hand washing after any contact with her.”

“Understood,” Wong said. “But Graham, I can only cut out so much of her skin. How do I treat the rest of the infection?”

Kilburn swallowed. “Melanie … I don’t know that you can.”

12 - Portland, Oregon

12

Portland, Oregon

At the Oregon Health Sciences University Hospital’s ER, Cohen and Carol Wilson had to squeeze into the last two available chairs in the corner of the waiting room. Cohen was thankful for the seats. Having watched Carol stumble out of his car and weave the short steps toward the ER doors, he realized she wouldn’t manage standing up.

The waiting room teemed. Old people languished on stretchers. Children cried and shrieked in parents’ arms. Patients with every assortment of sling, cast, and bandage—some bloody and others improvised with T-shirts and rags—sat in chairs or hobbled between them. Doctors, nurses, and other staff ducked in and out. The voices, moans, yells, and other hospital sounds blended into loud white noise that forced Cohen to raise his normally quiet voice so Carol could hear him.

They had been in the waiting room for over an hour. Cohen had intended to leave Carol under the staff’s care, but no one had come for her since registering. Something in Carol’s face kept him from leaving. From her enlarging pupils alone, he knew that her last dose of heroin had begun to wear off. But she appeared even drowsier. She had lost more color, and had turned as pale as the off-white wall above her head. She slumped in her chair, looking as if the work of sitting upright consumed most of her energy. She never mentioned the pain in her swollen right arm, but she braced it rigidly against her with her other arm. The slightest nudge from passersby brought a wince to her face.

Searching for a distraction for both of them, Cohen asked, “Where did you grow up, Carol?”

“Northern California,” she said. “Palo Alto.”

To hear her better, he leaned closer. “What was that like?”

She shivered in the seat and wrapped the hospital blanket, which Cohen had scavenged, tighter around her shoulders with her usable hand. “White.”

Cohen tilted his head. “White?”

Her lips parted in a shy smile, again revealing her broken tooth. “White bread. White picket fences. White people.” She breathed the words in shallow short bursts. “My dad’s an engineer with Hewlett-Packard. Lots of techie types in Palo Alto.”

He cleared his throat. “So how did you end up in Portland?” he asked.