Selections from the New World


Selections was originally published by InterText, and was subsequently picked up by eScene for a "year's best" anthology.

The characters are three of my friends.

The recurrent thought, looping over and over again like a mantra: Of all the stupid ways to die.

I come back to myself abruptly when it dawns on me that I'm clutching shards of blood-slick glass in my hand. It seems that somehow I managed to completely forget the beer I was holding until the slender pilsner flute collapsed under my grip.

"Fuck!" Oblivious to the neighbors, I eloquently express my discontent as the pain hits. I've cleverly cut myself to ribbons — though some remote part of me clinically notes that there's not really anything deep enough to merit sutures. For the life of me, I can't tell if I'm irritated more that I've wasted most of an excellent beer, which to my mind represents alcohol abuse, or because I've opened up my hand to the possibility of infection. The fact that the glass was fine crystal is irrelevant.

Not that it matters though. I wipe my bleeding hand on my Levi's and laugh. It doesn't really matter either way.

I kick the broken pieces into one of the corners of my third floor balcony and reach for the bottle, which is fortunately still roughly one third full. After three long swallows, that's no longer the case, and I toss it over with the shattered glass.

I blot my hand again on the bloodstained jeans as I walk into the house to grab a six-pack to restock the outside fridge. I pry the cap off one with an elegant opener that Vicram gave me a while back — one of the first to be made out of those insanely strong ceramics they started coming out with a few years ago. He had thought it hysterically funny that a technology which could spin bridges from thin silken strands was being used to make trinkets to open beer-bottles.

Back on the balcony, reclining in the bristling wet summer heat on a teak deck-chair, I thumb the system's remote so music from inside washes out over me. I'm imagining my friends here milling about in endless varied conversation, leaning against the rail to torment passers-by or maybe seduce them into joining us: "Hey you - yeah, you. Wanna beer? No no, you gotta come up and talk to us while you drink it." No drink and run here, no sir.

There, squatting by the railing, should be Francois, fucking with one of the candles. Frankie of the dry dangerous wit, was fresh out of a prestigious fellowship in cardiothoracic surgery. In spite of the unpredictable schedule of transplant work he always managed to find enough time to make the Fearsome Foursome complete at least once or twice a month.

Dean would be sitting in one of the chairs or sprawled out on the balcony's decking with his back to the three-story drop, doling out beers from the weathered little fridge he rested his feet on. He was a master of the absurd, helping all of us to avoid the grim pitfall of taking ourselves too seriously.

Finally there was Vicram, laughing and harsh. He would be needling one of us about something or other, leaning up against the building's exterior wall with his legs stretched out before him on the wide rail on which he perched. Vic always pushed his assault right up to the line but only rarely beyond. Paradoxically, he was strangely astute and gentle when any of us was upset about something that was actually important, like women or work.


Francois bit the big one because of some obscure strain of strep that a patient who happened to be a smack addict was cultivating on the valves of his heart.

I remember Frankie joining us that night down on South Side, observing in numb shock that the resident working under him that day had slipped spectacularly with a cutting needle while they were closing the chest after a valve-replacement. He had managed to breach the wonderfully thin but resilient gloves that the surgeons were using back then, reinforced densely with strands of kevlar. Later that night he'd joked about it, showing us the line of sutures marking the deep laceration the cutting edge of the heavy needle had opened in the web of his thumb.

"I'm probably going to come down with that new strain of Hepatitis G - you know, the one they couldn't isolate well enough to cover in the vaccine," Frankie had said, looking at Dean. "And one of you goddamned internal medicine fleas is gonna end up filling me with gunk up to my yellow eyes so my liver doesn't fry my brain."


It's drizzling now, rain dropping on the roof of my carefully restored townhouse on Pittsburgh's North Side and falling into the alleyway. That was what, '04? We barely had a fucking clue, even that far into it. Viruses? Ebola had been a name to conjure with, especially after the fiasco in Cairo, and bible-thumping assholes were agitating to set up quarantined ghettoes for victims of HIV. Prions were nasty to be sure, but turned out to be almost impossible to transmit unless you were eating infected meat. Still, we remained blindly panicked about the so-called scourge of immunology even then. We were idiots, all of us, even those of us who knew.

Frankie had been just fine until he developed some kind of vicious streptococcal heart disease about the same time he came down with intractable pneumonia. Strep—the very same bug that kids everywhere had been getting penicillin or amox for at first sign of a scratchy throat for the past forty years. Apparently the bug had been sitting there semi-comatose, probably on one of the valves of his heart, for the three months since the needle-stick. It had waited patiently for his immune system to sag for a moment, and then it seeded his lungs.

After that, Frankie DuBois started dying aggressively of a grim combination of pneumonia and heart failure, which even ten years before would have been cured with a simple course of antibiotics. Hell, the cardiac part wouldn't have happened at all, or at least not that soon, but the bug had somehow found a way to make itself look even more like heart tissue to the body's own defenses. As a result, his own immune system chewed up his heart in the process of trying to beat the infection.

So at the tender age of thirty-four Frankie had been hacking up bloody gobbets of lung, rattling obscenely with every breath. We snuck beer into his bay in the intensive care unit daily in an attempt at forced good cheer until the morning the unit team decided that he needed a tracheostomy tube so he could be placed on a ventilator.

The next afternoon Frankie had mimed for pen and paper and scribbled in tortured letters "KCl, 40 mEq IV push." He looked up at us in naked feverish pain, begging. Two and a half hours later he suffered cardiac arrest when a tragically mislabeled vial of potassium chloride was pushed into his circulation entirely too quickly. We looked on obliviously, three visiting attending physicians, as the residents and students on the unit team tried futiley to revive him.

We spent the rest of the day back here on my balcony, profoundly drunk. It turned into one of those startlingly mild late October evenings, and my candles finally remained unmolested. Dean had gone on a tirade about the laissez-faire street economy which made antibiotics available for people to use indiscriminately.

"They are taking away everything I have, dammit!" he said with the precise diction of the thoroughly impaired. "War on drugs? Jesus!" He stopped and turned such an ugly glare toward us that I had to remind myself forcibly that this was one of my best friends; that it wasn't meant for us. "If they're so hell-bent on keeping us from killing ourselves with drugs, then why the fuck don't they interdict the dangerous shit, like Keflex and Biaxin?" He lapsed into silence then, staring morosely at his beer.

It was an old complaint even then. As far back as the early '80s it was widely known that the unrestricted use of antibiotics in Asia, Africa and Central America was selecting out some frighteningly vicious strains of common bugs like strep and TB. It was also happening in our own inner cities, but no one wanted to think that we might somehow share the blame. It had proven impossible of course, to get people in positions of power to take any notice of it. When the nets reported that a small hospital in Sioux Falls had isolated a strain of vancomycin-resistant staph from a patient's wound back in '98, surgeons and infectious disease people all across the country collectively soiled themselves. The world as they knew it was over, their last line of defense against this ubiquitous organism blown to hell in the time it took them to read one preliminary journal abstract.

Even then, the Fed turned a blind eye, busy as they were with isolationist economic policy and internal power struggles. Besides, it was all taking place in shitty third-world countries and American inner cities. Their unspoken policy was along the lines of, "whatever thosepeople get is their own fault anyway, right?"

We used to joke about it in school. Dean observed one evening that a lot of it was ourdoing as well: "I figure North Philly is like my own private petri-dish. I'm doing an experiment— figure I'll create a nice resistant strain of, oh I dunno, gonorrhea or uh, pneumococcus. 'Cause I'm a humanitarian. Yeah, that's it, I adore the human race. Yeah. So here's some pink stuff for you, some biaxin for you, and for this lucky dog over here, unasyn. Big guns, kiddies. You can have the biggest, nastiest antibiotic I've got, even though you don't need it. Heh. Enjoy."


Eighteen months after we buried Frankie, Dean responded to the Deep South's desperate call for docs to help manage the epidemic of Blackwater Shakes. He steadfastly refused to let Jan go along, finally resorting to dumping her cruelly so she wouldn't try to follow him. He had picked up a masters in Public Health during his residency and had studied quite a bit of epidemiology; he knew exactly what he was getting into, and damned sure didn't want to subject anyone he loved to it, even of their own free will.

Three days after he left, I took a leave of absence and followed him down, figuring I could finally put my mostly theoretical training in disaster medicine to some practical use. The flight into New Orleans was unremarkable until I woke with a start, realizing how unusual it was to be able to stretch out across three seats to sleep on a morning flight into that particular city. As the cab from the airport approached the Claiborne Avenue exit, it edged over to the shoulder and stopped.

"This is as close to the city as I get, brother," the cabbie said.

I paid him there on the side of the highway and climbed out shaking my head in disgust. The fucking idiot probably would have been better off in the city, with the mosquito foggers going day and night.

I hiked the three miles to the Garden District, where Dean was staying. Not one of the passing cars even slowed down to look at my outstretched thumb.

Blackwater Shakes, or Mekong Flu as some of the media was calling it, was a strain of falciparum malaria that the microbiologists labeled Burma IV. So many names for such an old disease. This particular variety had been bred out of the jungles of North Thailand, Laos and Burma, and was resistant to every anti-malarial drug known. Therapy was mainly supportive, in the hopes that victims would survive initial bouts to gradually bolster their own immunity over the course of several years. That the disease was transmitted by mosquito rather than by casual contact with other people was ignored by the greater fraction of the populace in their panic, as marked by the black X's I saw spray-painted on the entries of several houses.

"We might as well be back in 1907 for all the good we're doing," Dean said one evening as we sat in a French Quarter courtyard bar. The Quarter was strangely quiet, robbed of the tourist traffic that kept it alive. We had worked all afternoon and most of the evening in a vast tent that had been set up in Charity Hospital's parking lot to handle to the added volume of patients. "We're going to run out of packed red cells for anemic crises sometime tonight, and that military fluorocarbon shit isn't going to cut it for more than a couple of days."

All I could do was nod. I'd been at the same morning meeting as he had, called so officials from the Red Cross, the CDC and the city government could meet with some nervous-looking representatives from the Federal government. It seemed the Fed wanted to know what needed to happen so the situation could be brought under control in the next few weeks. Me, Dean, and the dude from the CDC looked at each other in astonishment. The CDC guy was working desperately to stifle a laugh

Dean scowled and leaned ponderously over the table. "Have you listened to a single word we've said?" he asked.

It was too much of a straight line to ignore. "No man, he's an administrator," I said. "You know better than that. They specialize intalking."

Dean ignored me while the poor bastard from the CDC tried to keep from falling out of his chair in hysterics. He hadn't slept in days. "Let me try to make it simple," Dean continued. "This is going to take years, and that's just to control it locally. The foggers are going non-stop and we already have some of the best water-control in the world, but the mosquitoes just don't drop like they used to. This place will never be safe for people who haven't been through it already." The Federal rep tried to interrupt him, but Dean plowed on relentlessly. "There is no medicine now in existence that will kill this parasite.None. Do you understand me now?"


Six weeks later, I figured that they had as much of a system in place as they ever would, and took off back north. Dean remained behind, proclaiming his sick joy in being back in New Orleans, crippled though it was.

He had done okay actually, surviving his initial infection and several relapses. He lived to see all the Interstate highways leading out of Florida and Southeast Louisiana blockaded by National Guard reserves and then regular Army troops. The Coast Guard had set up off the Gulf Coast and around the Florida peninsula with air and sea support from the Navy. It was idiocy, of course: the species of mosquito that harbored the parasite couldn't survive outside the affected areas anyhow. The good people of the United States had taken notice however, prodded by the horror show broadcast daily out of Miami and New Orleans. They demanded that the government Do Something, and damned well do it immediately.

Gibbering politicians, in defiance of every recommendation from the CDC and other groups, responded to the mandate of the people by laying down the largest and most effective quarantine the world had ever seen.

Dean was killed in the New Orleans Riots.


My hand has more or less stopped bleeding, but it smarts like hell. The music changer stutters once, and strains of Dvorak's New World symphony pour out into the damp heat.

It doesn't really strike me at first, but suddenly I start laughing and very quickly find myself utterly incapable of stopping. Doubled over in hysterical giggles, I reach into the little fridge and grab another beer. I struggle for sips of air, finally managing to stop so I can take a hit from the bottle that leaves it less than half-full.

New World. Christ, that's sick.

I start laughing again.


With Vicram it was almost anticlimactic, lost as he was in the local media hype that surrounded the whole affair.

It seems that mucormycosis had somehow found its way into the ventilation system of the hospital he was working in. It used to be one of those fungi that only infected people who were pretty badly immunosupressed, like AIDS patients and folks getting chemo for cancer or transplants. But like so many other opportunistic pathogens, it had inadvertently been bred for aggressive resistance to antibiotics for nearly half a century. Candidiasis was bad, but people can live with a recurrent yeast infection on their skin and ah - other moist places, as long as its not injected into their bloodstream. Mucormycosis, on the other hand, was invasive as hell.

Aggressive as it was however, investigators later came to the very public conclusion that few if any of the 372 patients and hospital employees who died would have been susceptible had they not been subjected to huge innoculi of airborne spores for weeks at a time. The fact that the same problem was cropping up in other places on a smaller scale didn't seem to sway their judgment in the slightest.

I went to see him in isolation at Pittsburgh General. Vic was dark to begin with, but now he was sunburned from the UV lights they had pouring down on him day and night — PGH's administration was taking no chances on a repeat of the disaster that had taken out their competition across town.

Vicram looked up from a tissue that held a macabre mess of clotted blood and dark fungal hyphae. "What's the matter triage-boy, you scared of hanging with sick folks?" he asked, laughing. I guess I'd gone pale when I saw what came out of his head. "The Foursome is looking pretty fucking anemic these days, eh?" He turned serious. "This shit's gonna cross out of my sinuses and into my brain in two days max. Listen bro, I don't want you to take this the wrong way or anything, but how about you don't come back upstairs to visit me any more after this, alright?"

As it turned out, he became septicemic that night and died the next day while I was working a shift in the e/r.


The rain is over. I lean back in my chair and look down at the remote.

Program finished, it says. Select another or # for random play.

I toss it over my shoulder so it lands on the carpet inside. I guess it hits hard enough to push a key, because a Delta Blues piece with a funky Hammond organ starts playing from the depths of my library.

The pain from my hand has calmed down enough that I notice the angry welt on my forearm once again. The TB test has been sort of a ritual for me: every six months on the solstice I get a nurse or a medical student to hit me with the subcutaneous PPD injection. Up 'til now, it has always been negative.

It itches, but I resist the urge to scratch. I cough, and wonder if it's the cigarettes or the first manifestation of the infection that is sure to blossom in my lungs.

Tomorrow of course, I'll start the standard six-drug regimen. Ain't gonna help much though. Multi-drug resistant TB, probably brought here on a bus from Manhattan, made it to Pittsburgh about a year ago. Its been at least three months since any of the hospitals in town have treated a case that was even slightly responsive.

I drop the bottle to the balcony floor. It rolls on its side, beer slowly spilling away.

Aw hell. What an incredibly stupid fucking way to die.