Command and Control

Stephen Russell's Command and Control

Mackie’s Back!

Doctor Cooper “Mackie” McKay’s plans for a peaceful retirement are once again derailed when a man with Ebola-like symptoms passes out on a flight from London. Mackie calls on his surgical skills – and a dose of creativity – to save the young man’s life. Instead of gratitude, however, he ignites the suspicions of the U.S. government.

After masked military responders forcefully remove Mackie from the plane, he finds himself in the middle of an investigation by the Centers for Disease Control. As a deadly pathogen spreads through health centers across the U.S., Mackie learns that the most promising cure is embargoed by the FDA. He soon suspects domestic terrorism rooted in Big Pharma and sanctioned by public health officials.

In the struggle for command and control of the outbreak, Mackie is caught in the cross-hairs of a governmental cover-up, where the only clear solution seems to be silencing the whistle blower.

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Chapter 1

THIRTY-FIVE THOUSAND feet above the Atlantic Ocean and half an hour from Washington, D.C., a first class passenger on an inbound flight from London began to sweat. Subtle at first; almost imperceptible. A fine sheen on his forehead followed by a trickle down his cheek. The young man shifted in his seat. He zipped up his jacket. His sweating intensified. He gripped the arm rests and began to mumble to himself. Silent words spoken in a foreign language. The passenger across the aisle didn’t recognize the words. They sounded Arabic to Dr. Cooper McKay, but he couldn’t be sure. Success in Dr. McKay’s medical specialty hinged on close observation, and on this early morning flight, he recognized that something was wrong.

He looked closer at the distressed passenger. Early twenties. Well-groomed. Middle Eastern descent. Probably a student. Dr. McKay set aside his iPhone and leaned across the aisle.

“Can I help you?” he asked.

The passenger stiffened. He continued to stare, trancelike, at the seat in front of him. His mumbling intensified. Repeating a cadence, as if reciting a prayer. He began to rock in his seat to the rhythm of his words.

Dr. McKay glanced around the half-empty first class cabin. A lone flight attendant, obviously overworked, cleared breakfast trays from the front row. She didn’t notice the distressed man. The nearest passenger sat two rows ahead, headphones firmly fixed over her ears. Behind McKay, three empty rows. A curtain sequestered the first class passengers from the rest of the plane.

McKay reached across the aisle. He touched the rocking passenger’s hand. Cold fingers. Clammy palms. Racing heartbeat. He recognized the signs. This man was sick. Probably infected. “Let me get you some help,” he said.

The passenger didn’t pause. He continued to pray. McKay withdrew his hand, unclipped his seatbelt, and depressed the call button for the flight attendant. She didn’t acknowledge it. Stepping into the aisle, McKay hustled toward the front of the aircraft, brushing past the woman with the headphones. Past the remaining half-dozen passengers in first class. A bearded man sitting in the first row noticed his approach with interest. The flight attendant looked up at him from her station. Her weary eyes betrayed her smile.

“Excuse me,” McKay said. “There’s a sick passenger sitting across from me. Young male. Uncomfortable. Probably febrile.” He lapsed back into the clipped speech of medical summaries etched into his subconsciousness from thirty years of patient presentations. “I need your first aid kit.”

The flight attendant straightened. “And you are…”

“Dr. Cooper McKay.”

She ignored his outstretched hand, obviously annoyed by his intrusion. “Please take your seat, sir. I’ll be with you in a moment.”

He scanned the bulkhead behind her. Piles of refuse stacked from the overnight flight. Steam rising from the carafe of the coffee maker. No visible first aid kit. McKay persisted. “I need your medical kit. This kid can’t wait until we reach Nashville. He needs help now.”

“You can help me, sir, by returning to your seat. I’ll be right there.”

McKay paused. He wasn’t being an alarmist. He had only recently retired and could still spot an unstable patient when he saw one. Infectious diseases were not his medical specialty, but he knew he could help this man. Secretly, he relished the opportunity to be of use again. He retraced his steps down the aisle, keeping an eye on the sick passenger. He left his seatbelt unbuckled when he sat down. Just in case.

The young passenger continued to rock.

Continued to sweat.

And continued to pray.

The flight attendant completed her work. Only then did she leave her post. She checked on the passenger in the front row. The bearded man in a blazer spoke to her, but she shook her head. The man leaned into the aisle and watched as the flight attendant approached McKay, empty handed. Two rows away from them, she finally looked at the rocking passenger.

She stopped short.

She glanced at his ski parka. Saw his trance. Heard his mumbling. She turned and strode back to the bulkhead. McKay thought she was getting the first aid kit. Instead, she picked up a phone near her station while signaling to the bearded man in the blazer.

The man stepped into the aisle. A moment later, the flight attendant trailed after him.

The bearded man carried himself with the self-importance of a surgeon. McKay knew the type. A sense of purpose emanated from him, as if he finally had a chance to enact his training. Like he’d been waiting for such an occasion. His blazer billowed as he marched toward the ailing passenger, stopped one aisle away, and bent forward. McKay saw the butt of a harnessed SIG Sauer pistol beneath his blazer. Without bothering to touch the passenger, the bearded man announced, “Federal Air Marshal. Unzip your jacket and stand up.”

McKay rose from his seat. “This man is sick.”

“The pilot’s notifying MedAssist,” the flight attendant said to him from behind the Federal Air Marshal. “One of their doctors will be in radio contact shortly. If we need them.”

The Federal Air Marshal tensed at McKay’s movement, but he didn’t turn around. “Sit down, sir. I don’t need your help.” He stepped closer to the passenger, forcing McKay back into his seat. He landed on the arm rest as he fell back into his chair. He felt the faceplate of his phone crack from the impact, which irritated him further.

The Federal Air Marshal fingered his weapon. He kept one hand on the gun while he grabbed the passenger’s jacket with the other. He jerked him up from the seat. The passenger didn’t resist. His head rolled back. His eyes glazed over. He stopped his prayer. He then proceeded to vomit. Even the Federal Air Marshal’s wide body couldn’t block the splatter from reaching McKay. The Federal Air Marshal recoiled, releasing his grip on the man’s jacket.

The sick man slumped back between the seats. McKay heard the passenger gurgling. Struggling to breathe. Asphyxiating.

Dr. McKay had had enough. He shoved the Marshal out of his way. “Get me the first aid kit,” he called to the flight attendant. “Now!”

He dragged the ill passenger by his ankles into the aisle and knelt beside him. When he flopped him onto his side to clear his airway, he heard the high-pitched wheeze of sucking secretions. He pounded on his back. To no avail. His airway remained clogged.

The flight attendant returned, carrying a cordless headset, a blood pressure cuff, and a bright orange medical kit no bigger than a purse. “Put this on,” she instructed, handing McKay the headset. “A doctor from MedAssist is on the line.”

McKay grabbed the headset and cuff. He explained the predicament to the stateside physician. Following the physician’s instructions, he situated the cuff on the passenger’s arm. Moments later, the MedAssist physician had the vital signs radioed to him.

“Open the medical kit the stewardess will give you and find the oropharyngeal airway,” the doctor on the phone instructed. “This is a curved plastic device—”

“I’m an orthopedic surgeon,” McKay snapped. “I know what an O.P.A. is. That’s not going to help. He’s suffering from laryngeal spasm.”

McKay sat back on his heels to grab the orange medical kit. He felt cracked glass on his phone give way even more. He removed his damaged iPhone from his hip pocket and tossed it onto the seat cushion. He snatched the orange purse from the stewardess and opened the first aid kit, dumping the contents onto his vacated seat. Bandaids, gauze pads, and alcohol swabs scattered on the cushion. A blue rubber bulb of an artificial resuscitator tumbled from the orange bag. He recognized the Ambu bag and its two accompanying face masks. Finally, he found the plastic shepherds crook of the O.P.A. He shoved the plastic airway stabilizer into the passenger’s mouth, following the MedAssist protocol. No response.

“It’s not working,” he said.

“Stay calm,” the absentee physician coached. “Try to reposition the O.P.A.”

The passenger continued to gasp for air, each breath more shallow than the last. McKay rolled him onto his back. His eyes rolled back in a lifeless retreat. “There’s no time for this,” McKay said. He ripped off the headset and tossed it back to the stewardess. His advanced cardiac life support training kicked in. He ripped open the young man’s jacket, then his shirt. The passenger’s pale brown chest appeared recently shaved, his skin slick and rubbery to the touch. His heart thrummed beneath his hands.

“What’s his name?” McKay asked the flight attendant.

She bent to pick up the headset at her feet. “Sir, you need to follow the instructions of MedAssist.”

“Find out this passenger’s name!” he barked.

The flight attendant stared at the scene unfolding before her. Clearly out of her element. She made eye contact with McKay. A terrified gaze eclipsed her annoyance. Without answering, she fled to the front of the cabin. The Federal Air Marshal, still soaked in vomit, stepped over Dr. McKay and the prostrate passenger. He dialed his cellphone.

The airplane began its descent.

Gripping the back of one hand with the other, McKay jammed his fists into the soft spot of the passenger’s stomach just beneath the rib cage. The young man’s body lurched.

The airway didn’t clear.

McKay grabbed the blue bulb of the Ambu bag and snapped the face mask on the end. He jammed the resuscitator against the passenger’s mouth. Cupping his hand around it, he created a seal. He began artificial respirations. With each squeeze of the bulb, the passenger’s cheeks ballooned before air leaked out from the seal around his mouth. His chest wall remained motionless.

McKay recognized the situation for what it was. Spasm of the muscles of the larynx. The O.P.A. would not reach far enough to solve the problem. With the top of the airway blocked, the diaphragm and all of the supporting muscles of the chest wall could not suck air into the lungs. Suffocation resulted. The young passenger was drowning in his own secretions.

The flight attendant returned. “Omar,” she said. “His name is Omar Shahani.”

Dr. McKay felt a thready pulse in the passenger’s neck. Time was running out. He began chest compressions. “Hang on, Omar,” he said, looking for any signs of life in the passenger. “Mackie’s going to take care of you.”

“Mackie?” the flight attendant said.

“Mackie McKay. It’s what I go by.”

The flight attendant scoffed. “I’m sure he can’t hear you.”

Mackie cut his eyes at her, never losing the pace of his chest compressions. “We’ll see.” He returned his attention to Omar. “We’ve got to get him to a hospital.”

“The pilots are making an emergency landing.”

“Dulles airport?” Mackie asked.

She didn’t respond.

With chest compressions ineffective and the Ambu bag unable to force air into Omar’s lungs, Mackie reexamined the medical supplies. Still straddled over Omar Shahani’s legs, he fanned through the contents of the bag on the seat, bumping his hand against his cracked iPhone. Meager supplies at best. He needed a scalpel. Something sharp to relieve the blockage. His eyes darted from the scattered contents to Omar’s dwindling condition and back. His gaze snagged on his shattered iPhone. It might work, he thought. Not standard care, but better than a body bag. He performed a dozen more chest compressions before reaching for his phone.

He looked at the fractured web of glass at the site of impact. A transverse crack extended from it, scarring the faceplate. Mackie gently lifted the phone. He pressed his thumb into the web of broken glass. With selective pressure over the weakest part of the screen, the glass collapsed. He removed a sharp shard of glass almost four inches long and set it down on top of the other supplies.

“You have a cappuccino maker on board?” he asked the flight attendant as he resumed chest compressions.

She blinked in surprise. “Two of them.”

“Unscrew the heating wand and bring it to me.” Mackie repositioned his hands to ease the fatigue settling into his arms. “I also need some chewing gum—as much as you can get—and a roll of tape.”

“I hardly think this is the time…” the flight attendant began.

“Just do it!” He snapped on a pair of rubber gloves and reached for his supplies.

Ripping into a stack of alcohol pledgets, he swabbed Omar’s neck. With two fingers, he pressed into the ridge to the side of Omar’s trachea. The pulse continued its frantic dance, even weaker now. Omar’s blood pressure was dropping. The plane wouldn’t land in time for emergency personnel to intervene.

Mackie offered the only lifeline.

He interrupted the compressions long enough to retrieve the shard of glass. The cabin lights overhead winked off the cut edge of the glass faceplate.

Mackie steadied his breathing, as he’d done countless times in a medical crisis, and gripped the makeshift scalpel. He heard the flight attendant return down the aisle. She carried a fistful of supplies. The sun streaming through the cabin window glinted off the metal cappuccino wand. Behind her, the cockpit door opened. Mackie saw the Federal Air Marshal relaying information to the crew, gesturing toward Mackie with one hand while cradling his cell phone with the other.

The flight attendant placed the supplies on the seat close to Mackie. Two packs of bubble gum. A sleeve of breath-freshening Chiclets in a blister pack. Two slender silver wands, unscrewed from their moorings with crusted milk clouding one end. A roll of duct tape. And a spool of cellophane adhesive.

Mackie lifted the first cappuccino wand and handed it back to the flight attendant. “Unscrew the end of this. Remove the outer casing. Then wipe it down.” He handed her a stack of alcohol swabs.

He shucked two wads of bubble gum from their wrappers and popped them into his mouth. He positioned his thumb and fingers around the sharp edge of the glass faceplate. With a steady hand and a sure stroke, he pressed the impromptu blade firmly into Omar’s neck, aiming for the skin just below his Adam’s apple. The neck split open.

The inch-long incision oozed blood. Nothing more than a trickle. Mackie pressed a wad of sterile gauze over the wound. He placed the glass sliver on the seat atop a mound of more gauze. He held out his hand, palm up. The stewardess-turned-scrub-nurse offered the sparkling metal tube.

“Pull off three lengths of duct tape, six inches each,” Mackie ordered through the wad of gum in his mouth. “Tear each length halfway down the center to look like legs on a pair of pants.”

He transferred the makeshift endotracheal tube to the gauze next to the sharp glass. With his gloved hands, he pried open the incision, probing his way to the thick band of tissue separating Omar’s airway from the spasmed muscles above. The cricothyroid membrane. Identifying it with his fingers, Mackie positioned his fingertips against it. With his other hand, he lifted the sliver of glass, the shard poised above his finger. With surgical precision, he nicked the membrane with the tip of the glass. Air rushed into the neck. Omar’s chest heaved. Mackie immediately fed the metal tube through the tiny opening.

Air flooding the tube caused a high-pitched wheeze like the sound of air sucked through a straw. Needing to secure the airway, Mackie reached for the duct tape. He pressed the top edge of the tape along the tube near the skin, as if straddling it with a six-inch pair of pants, and then wrapped the legs in opposite directions. One leg folded around the tube then stuck to the neck, then the other. He reinforced the anchor with a second strip of tape.

“Hand me the Ambu bag,” Mackie said.

The flight attendant bent to grab the blue bulb, but the plane banked hard right, dipping into its descent. Mackie’s shoulder smacked into the armrest of his own seat. His hand slipped from the taped tube. The bulb of the artificial resuscitator rolled under the seat.

The flight attendant gripped a nearby seat cushion to steady herself. Overhead, the captain’s voice spoke from the intercom to prepare the cabin for an emergency landing.

Mackie pinched his free fingers around the E.T. tube. He leaned his chest across Omar and reached for the Ambu bag. At full extension, his arm could just touch it, but it rolled away with the next bank of the plane. He heard nervous murmurs as other passengers in the first class cabin leaned into the aisle to watch. Seeing the blue plastic bulb rolling nearby, the lady with the earphones unclipped her seatbelt and knelt in the aisle. She reached for the Ambu bag, then turned to hand it to Mackie. Obviously horrified by the scene, she turned her head as she held out the mask.

Mackie repositioned Omar on his back and adjusted his own position atop him to anchor his legs. “Tape,” Mackie said.

The flight attendant, now back on her feet, clutched a wadded strip of tape. Useless. Mackie grabbed the roll, ripped two lengths off with his teeth, and stuck them to the tray table. He removed the face mask from the resuscitator, exposing the nub of plastic tubing almost twice as large in diameter as the metal E.T. tube. Mackie wrapped a length of tape around the cappuccino wand now extending from Omar’s neck. Once he judged it to be thick enough, he positioned the tube from the respirator over the newly taped end.

A close fit, but not perfect.

Mackie worked the chewing gum into the front of his mouth. Ripping off his latex gloves with his teeth, he grabbed the gum and began to work it around the tube connection, creating a seal. He gave two squeezes of the bulb. Omar’s chest wall rose with each compression of the Ambu bag. Tiny bubbles formed in the gum seal. Mackie used the last piece of duct tape to cover the seal between the two tubes.

The flight attendant, bracing herself against the plane’s descent, worked her way back to the bulkhead. She spoke to the Federal Air Marshal first, then to the pilots. Moments later, the cockpit door closed.

What should have been an easy task of depressing the Ambu bag became that much harder as the plane descended. Mackie pressed his knees against Omar’s chest as he wedged his shoulders against the arm rest. Once he secured his own position, he squeezed the Ambu bag again. Omar’s chest rose with each artificial respiration. Mackie felt for his carotid artery. He found a steady pulse, slam dancing against his fingers. Improved blood pressure, Mackie thought. Omar’s eyes remained closed. His skin still felt clammy. Every five seconds, Mackie squeezed the Ambu bag. Twelve times a minute. Normal respirations.

The flight attendant’s voice came over the intercom.

“Ladies and gentlemen, due to a medical emergency in the first class cabin, we will soon make an emergency landing.”

Mackie unwrapped one more piece of bubble gum. He began to chew, preparing for landing.

He continued to squeeze the Ambu bag. Every five seconds. Breathing for Omar.