Hillerman, Tony - [Leaphorn & Chee 13]

THE BODY OF ANDERSON NEZ lay under a sheet on the gurney, waiting.

From the viewpoint of Shirley Ahkeali, sitting at her desk in the Intensive
Care Unit nursing station of the Northern Arizona Medical Center in Flagstaff,
the white shape formed by the corpse of Mr. Nez reminded her of Sleeping Ute
Mountain as seen from her aunt's hogan near Teec Nos Pos. Nez's feet, only a
couple of yards from her eyes, pushed the sheet up to form the mountain's peak.
Perspective caused the rest of the sheet to slope away in humps and ridges, as
the mountain seemed to do under its winter snow when she was a child. Shirley
had given up on finishing her night shift paperwork. Her mind kept drifting
away to what had happened to Mr. Nez and trying to calculate whether he fit
into the Bitter Water clan Nez family with the grazing lease adjoining her
grandmother's place at Short Mountain. And then there was the question of
whether his family would allow an autopsy. She remembered them as sheep camp
traditionals, but Dr. Woody, the one who'd brought Nez in, insisted he had the
family's permission.

At that moment Dr. Woody was looking at his watch, a black plastic digital
job that obviously hadn't been bought to impress the sort of people who are
impressed by expensive watches.

"Now," Woody said, "I need to know the time the man
died."

"It was early this morning," Dr. Delano said, looking surprised.
It surprised Shirley, too, because Woody already knew the answer.

"No. No. No," Woody said. "I mean exactly when."

"Probably about two A.M.," Dr. Delano said, with his expression
saying that he wasn't used to being addressed in that impatient tone. He
shrugged. "Something like that."

Woody shook his head, grimaced. "Who would know? I mean, who would know
within a few minutes?" He looked up and down the hospital corridor, then
pointed at Shirley. "Surely somebody would be on duty. The man was
terminal. I know the time he was infected, and the time he began registering a
fever. Now I need to know how fast it killed him. I need every bit of
information I can get on processes in that terminal period. What was happening
with various vital functions? I need all that data I ordered kept when I
checked him in. Everything."

Odd, Shirley thought. If Woody knew all that, why hadn't Nez been brought to
the hospital while there was still some hope of saving him? When Nez was
brought in yesterday he was burning with fever and dying fast.

"I'm sure it's all there," Delano said, nodding toward the
clipboard Woody was holding. "You'll find it there in his chart."

Now Shirley grimaced. All that information wasn't in Nez's chart. Not yet.
It should have been, and would have been even on this unusually hectic shift if
Woody hadn't rushed in demanding an autopsy, and not just an autopsy but a lot
of special stuff. And that had caused Delano to be summoned, looking sleepy and
out of sorts, in his role as assistant medical superintendent, and Delano to
call in Dr. Howe, who had handled the Nez case in ICU. Howe, she noticed,
wasn't letting Woody bother him. He was too old a hand for that. Howe took
every case as his personal mano-a-mano battle against death. But when death
won, as it often did in ICU units, he racked up a loss and forgot it. A few
hours ago he had worried about Nez, hovered over him. Now he was simply another
of the battles he'd been fated to lose.

So why was Dr. Woody causing all this excitement? Why did Woody insist on
the autopsy? And insist on sitting in on it with the pathologist? The cause of
death was clearly the plague. Nez had been sent to the Intensive Care Unit on
admission. Even then the infected lymph glands were swollen, and subcutaneous
hemorrhages were forming their splotches on his abdomen and legs, the
discolorations that had given the disease its "Black Death" name when
it swept through Europe in the Middle Ages, killing tens of millions.

Like most medical personnel in the Four Corners country, Shirley Ahkeah had
seen Black Death before. There'd been no cases on the Big Reservation for three
or four years, but there were three already this year. One of the others had
been on the New Mexico side of the Rez and hadn't come here. But it, too, had
been fatal, and the word was that this was a vintage year for the old-fashioned
bacteria—that it had flared up in an unusually virulent form.

It certainly had been virulent with Nez. The disease had gone quickly from
the common glandular form into plague pneumonia. The Nez sputum, as well as his
blood, swarmed with the bacteria, and no one went into his room without donning
a filtration mask.

Delano, Howe, and Woody had drifted down the hall beyond Shirley's
eavesdropping range, but the tone of the conversation suggested an agreement of
some sort had been reached. More work for her, probably. She stared at the
sheet covering Nez, remembering the man under it racked by sickness and wishing
they'd move the body away. She'd been born in Farmington, daughter of an
elementary schoolteacher who had converted to Catholicism. Thus she saw the
Navajo "corpse avoidance" teaching as akin to the Jewish dietary
prohibitions—a smart way to prevent the spread of illnesses. But even without
believing in the evil
chindi
that traditional Navajos knew would
attend the corpse of Nez for four days, the body under the sheet provoked
unhappy thoughts of human mortality and the sorrow death causes.

Howe reappeared, looking old and tired and reminding her as he always did of
a plumper version of her maternal grandfather.

"Shirley, darlin', did I by any chance give you a long list of special
stuff we were supposed to do on the Nez case? One thing I remember was he
wanted a bunch of extra bloodwork. Wanted measurement of the interleukin-six in
his blood every hour, for one thing. And can't you just imagine the screaming
fit the Indian Health Service auditors would have if we billed for that?"

"I can," Shirley said. "But nope. I didn't see any such list.
I would have remembered that interleukin-six." She laughed. "I would
have had to look it up. Something to do with how the immune system is working,
isn't it?"

"It's not my field either," Howe said. "But I think you're right.
I know it shows up in AIDS cases, and diabetes, and the sort of situations that
affect immunity. Anyway, we shall let the record show that the list didn't
reach your desk. I think I must have just wadded it up and tossed it."

"Who is this Dr. Woody anyway?" Shirley asked.

What's his specialty? And why did it take so long to get

Nez in here? He must have been running a fever for days."

"He's not a doctor at all," Howe said. "I mean he's not a
practicing physician. I think he has the M.D. degree, but mostly he's the Ph.D.
kind of doc. Microbiology. Pharmacology. Organic chemistry. Writes lots of
papers in the journals about the immune system, evolution of pathogens,
immunity of microbes to antibiotics, that sort of stuff. He did a piece for
Science
magazine a few months ago for the layman to read, warning the world that our
miracle medicines aren't working anymore. If the viruses don't get us, the
bacteria will."

"Oh, yeah," Shirley said. "I remember reading that article.
That was his piece? If he knows so much, how come he didn't see that
fever?"

Howe shook his head. "I asked him. He said Nez just started showing the
symptoms. Said he had him on preventive doxycycline already because of the work
they do, but he gave him a booster shot of streptomycin and rushed him right
in."

"You don't believe that, do you?"

Howe grimaced. "I'd hate to," he said. "Good old plague used
to be reliable. It'd poke along and give us time to treat it. And, yeah, that
was Woody's article. Sort of don't worry about global warming. The tiny little
beasties will get us first."

"Well, as I remember it, I agreed with a lot of it," Shirley said.
"It's downright stupid the way some of you doctors prescribe a bunch of
antibiotics every time a mama brings her kid in with an earache. No wonder—"

Howe held up a hand.

"Save it, Shirley. Save it. You're preaching to the choir here."
He nodded toward the sheet on the gurney. "Doesn't Mr. Nez there just
prove we're breeding a whole new set of drug-resistant bugs? The old
Pas-teurella
pestis
, as we used to call it in those glorious primitive days when drugs
worked, was duck soup for a half dozen antibiotics. Now, whatever they call it
these days,
Yersinia pestis
I think it is, just ignored everything we
tried on Mr. Nez. We had us a case here where one of your Navajo curing
ceremonials could have done Nez more good than we did."

"They just brought him in too late," Shirley said. "You can't
give the plague a two-week head start and hope to—"

Howe shook his head. "It wasn't two weeks, Shirley. If Woody knows what
the hell he's talking about, it was more like just about one day."

"No way," Shirley said, shaking her head. "And how would he
know, anyway?"

"Said he picked the flea off of him. Woody's doing a big study of
rodent host colonies. National Institutes of Health money, and some of the
pharmaceutical companies. He's interested in these mammal disease reservoirs.
You know. Prairie dog colonies that get the plague infection but somehow stay
alive while all the other colonies are wiped out. That and the kangaroo rats
and deer mice, which aren't killed by the hantavirus. Anyway, Woody said he and
Nez always took a broad-spectrum antibiotic when there was any risk of flea
bites. If it happened, they'd save the flea so he could check it and do a follow-up
treatment if needed. According to Woody, Nez found the flea on the inside of
his thigh, and almost right away he was feeling sick and running a fever."

"Wow," Shirley said.

"Yeah," Howe agreed. "Wow indeed."

"I’ll bet another flea got him a couple of weeks ago," she said.
"Did you agree on the autopsy?"

"Yeah again," Howe said. "You said you know the family. Or
know some Nezes, anyway. You think they'll object?"

"I'm what they call an urban Indian. Three-fourths Navajo by blood, but
I'm no expert on the culture." She shrugged. "Tradition is against
chopping up bodies, but on the other hand it solves the problem of the
burial."

Howe sighed, rested his plump buttocks against the desk, pushed back his
glasses and rubbed his hand across his eyes. "Always liked that about you
guys," he said. "Four days of grief and mourning for the spirit, and
then get on with life. How did we white folks get into this corpse worship
business? It's just dead meat, and dangerous to boot."

Shirley merely nodded.

"Anything hopeful for that kid in Room Four?" Howe asked. He
picked up the chart, looked at it, clicked his tongue and shook his head. He
pushed himself up from the desk and stood, shoulders slumped, staring at the
sheet covering the body of Anderson Nez.

"You know," he said, "back in the Middle Ages the doctors had
another cure for this stuff. They thought it had something to do with the sense
of smell, and they recommended people stave it off by using a lot of per fume
and wearing flowers. It didn't stop everybody from dying, but it proved humans
have a sense of humor."

Shirley had known Howe long enough to understand that she was now supposed
to provide a straight line for his wit. She wasn't in the mood, but she said:
"What do you mean?"

"They made an ironic song out of it—and it lived on as a nursery
rhyme." Howe sang it in his creaky voice:

"Ring around with roses, pockets full of posies. Ashes. Ashes. We all
fall down."

He looked at her quizzically. "You remember singing that in
kindergarten?"

Shirley didn't. She shook her head.

And Dr. Howe walked down the hall toward where another of his patients was
dying.