In the bathroom, the mirror over the sink had been covered with a towel, and other towels on the linoleum floor were soiled and bloody. She had run out of toilet paper, and the box of baking soda on the side of the tub told me she had tried her own remedy in her bath to relieve her misery. Inside the medicine cabinet, I found no prescription drugs, only old dental floss, Jergens, hemorrhoid preparations, first-aid cream. Her dentures were in a plastic box on the sink.

Pruitt had been old and alone, with very little money, and probably had been off this island few times in her life. I expected that she had not attempted to seek help from any of her neighbors because she had no phone, and had feared that if anyone had seen her, they would have fled in horror. Even I wasn’t quite prepared for what I saw when I peeled back the covers.

She was covered in pustules, gray and hard like pearls, her toothless mouth caved in, and dyed red hair wild. I pulled the covers down more, unbuttoning her gown, noting the density of eruptions was greater on her extremities and face than on her trunk, just as Hoyt had said. Itching had driven her to claw her arms and legs, where she had bled and gotten secondary infections that were crusty and swollen.

“God help you,” I muttered in pain.

I imagined her itching, aching, burning up with fever, and afraid of her own nightmarish image in the mirror.

“How awful,” I said, and my mother flashed in my mind.

Lancing a pustule, I smeared a slide, then went down to the kitchen and set my microscope on the table. I was already convinced of what I’d find. This was not chicken pox. It wasn’t shingles. All indicators pointed to the devastating, disfiguring disease variola major, more commonly known as smallpox. Turning on my microscope, I put the slide on the stage, bumped magnification up to four hundred, adjusted the focus as the dense center, the cytoplasmic Guarnieri bodies, came into view. I took more Polaroids of something that could not be true.

Shoving back the chair, I began pacing as a clock ticked loudly from the wall.

“How did you get this? How?” I talked to her out loud.

I went back outside to where Crockett was parked on the street. I didn’t get close to his truck.

“We’ve got a real problem,” I said to him. “And I’m not a hundred percent sure what I’m going to do about it.”

My immediate difficulty was finding a secure phone, which I finally decided simply was not possible. I couldn’t call from any of the local businesses, certainly not from the neighbors’ houses or from the chief’s trailer. That left my portable cellular phone, which ordinarily I would never have used to make a call like this. But I did not see that I had a choice. At three-fifteen, a woman answered the phone at the U.S. Army Medical Research Institute of Infectious Diseases, or USAMRIID, at Fort Detrick, in Frederick, Maryland.