The joint CDC-FEMA teams who had been playing whack-a-mole with the Ebola outbreaks in Minneapolis and San Diego were justifiably proud of the job they had been doing. Not only had the contained the outbreak but they had kept the news out of the public eye. It had not come cheaply. They had burned through 85% of the vaccine in the western hemisphere.
Clara waited for the city bus outside the Section 8 block where she lived. She carried two infants in a shawl and held the hand of a small boy with a runny nose.
Her name was really not “Clara” but her given name was incomprehensible to anybody who was not from her tribe in Somalia. She happily traded her name for a better life in Minneapolis.
The boy was six and small for his age. He had a deep, hacking, liquid cough that welled up from deep in his gut. Clara was worried because tribal lore was that his condition was nearly always ended in death. But this was America, land of miracles.
The trip across town was a major expedition for Clara. She had seventeen children in her apartment. Eight were her’s. Seven belonged to her sister who had been raped and murdered in the refugee camp. The extra two were her grandchildren. Most of the kids went to school or Head Start. Clara had parcelled out the youngest ones across several Somali families.
Not being very familiar with the bus system, Clara was not able to choose the most efficient path. She took her children to the downtown transfer center and it took her an hour to figure out which one went to the clinic that she thought would best be able to handle the problem.
Workers and University students streamed around her and her coughing child. Like most things in Minnesota in the winter, the bus depot was inside.
After figuring out which bus she needed, she boarded a bus crowded with the morning shift heading to the hospital.
The triage nurse tried to send Clara home. The nurse took an IR temperature read and the child barely had a temperature. The nurse dismissed it as a common cold. Clara would not be dissuaded. She mentioned her concern but the staff did not recognize the tribal term as anything alarming.
Cases deemed to be more critical than her son were queued in front of her as she and her three charges waited
More than seventy “John Does”, homeless men shuffled back out through the waiting room. They had spent the night in the hospital to get out of the cold. It was trash and recycling day on the south-west side of town and like migratory possum they followed the trash. They would not be back to this particular hospital for three days.
The City Mission did not allow people with alcohol on their breath into the facility but hospitals had to take them. If anybody had bothered to chart the number of homeless in any given hospital they would have found it tracked trash pickup and free church dinner nights.
Medical students new to the Emergency Room would badger them about their symptoms. The nurses would roll their eyes. They would learn soon enough. The nurses privately called the homeless men "dirty-ankles" or DAs.
The dirty-ankles knew what symptoms forced the hospitals to hold them. Sharp pain on the lower right side of abdomen. Chest pains. Shortness of breath. If the doctor persisted after running expensive diagnostics and tried to discharge the patient the dirty-ankle simply dredged up another symptom. A dirty-ankle could easily rack up $100,000 of unbillable tests in a night.
The newbies quickly learned to simply put the dirty-ankles on a gurney, give them a blanket and a baby aspirin and a cup-of-soup and they would miraculously be cured in the morning. If there was something actually wrong with them they would be hollaring bloody murder.
The six year old boy “coded” in the Emergency Waiting Room after a particularly violent, racking cough. The small boy’s aorta had split longitudinally and he bled out internally within seconds.
That smugness of the CDC-FEMA team evaporated after the labs on the six year-old were finally run and confirmed. The results were what nobody wanted to hear. Unfortunately the results were communicated twenty minutes after the first shift had left for the day and that vastly complicated the response.
That is also when the last 15% of the Ebola vaccine that was not staged in Minnesota and San Diego was flown to Washington D.C. and administered to the highest level government functionaries.