The Three Fevers

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THIS IS A WORK OF FICTION

The old man coughed against my face shield, and something warm and grainy landed between my lips.

I spat into my glove.

Blood.

A grain of rice.

No.

A tooth.

Not a whole tooth. A rotten brown triangle from the root of one, slick with blood.

The man stared at my glove.

Then he touched his mouth.

“Mine?”

I told him not to talk.

He laughed.

That was the first thing that bothered me. Not the tooth. People lose teeth. Sick people bleed. Old people from villages sometimes arrive at hospitals with bodies held together by faith, paracetamol, and decisions made ten years too late.

What bothered me was the mosquito sitting on his lower lip.

It was feeding.

I slapped it.

It burst under my thumb.

Too much blood came out.

It ran across the glove in three narrow streams.

The old man said, “Appointment today?”

His name was Abdul Karim. Sixty-eight. Khulna. He had come to Calcutta for follow-up treatment after lymphoma. His hospital appointment had originally been September 30.

Then October 2.

Then October 4.

Durga Puja.

Consultant unavailable.

Road closure.

Reduced staffing.

Emergency cases only.

Please cooperate.

He had been cooperating for six days.

He and his son were staying in a cheap guesthouse near the Eastern Metropolitan Bypass. Since they were already in Calcutta and the doctor was never available, they had done what almost everyone else was doing.

They went out.

Bagbazar.

College Square.

Santosh Mitra Square.

Deshapriya Park.

Two smaller neighborhood pandals whose names his son could not remember.

They had eaten rolls, phuchka, biryani, and kulfi.

They had stood in crowds for hours.

Karim had developed fever on the second night.

Then a rash.

Then shaking chills.

Then bleeding gums.

Someone at the guesthouse suggested dengue.

Someone else said malaria.

The son bought him doxycycline, azithromycin, paracetamol, an ayurvedic liver syrup, two strips of a drug he could not identify, and coconut water.

None helped.

Now Karim sat in my phlebotomy chair with a temperature of 104.2°F and red spots running from his hairline down his neck.

I had seen measles twice in my career.

Both times in children.

Karim was sixty-eight and immunocompromised.

I pulled my mask tighter.

“Did you get measles vaccine?”

He looked at me as if I had asked who repaired his bicycle in 1967.

His son answered.

“No idea.”

I drew blood.

Karim watched the syringe fill.

Then he whispered, “Brother.”

“What?”

“Your mouth is bleeding.”

I touched my lower lip.

My glove came away red.

I had bitten myself when the tooth hit me.

That was all.

I threw the gloves away and washed my mouth for five minutes.

I did not tell anyone.

I wanted to go home.

That was the entire plan.

Finish the shift.

Go home.

Shower.

Turn off my phone.

Sleep for twelve hours.

I had already worked twenty-seven.

By midnight we had eleven suspected dengue patients, seven malaria positives, four people with obvious measles rash, and three patients whose blood results made no sense.

Karim was one of them.

His dengue NS1 antigen was positive.

His malaria smear showed Plasmodium falciparum.

His measles PCR later returned positive.

Three infections.

The infectious disease registrar stared at the screen.

“That’s unlucky.”

Then another result arrived.

A forty-two-year-old woman from Barisal.

Same three.

Then a teenage boy from Dhaka.

Same three.

The registrar stopped calling it unlucky.

At 12:40 a.m. we notified infection control.

At 12:55 infection control said the responsible consultant was at a Puja dinner.

At 1:10 someone called the municipal surveillance number.

Nobody answered.

At 1:18 the emergency department ran out of isolation rooms.

At 1:26 somebody taped a handwritten sign to the fever corridor:

MASK REQUIRED.

At 1:31 someone stole the box of masks.

This is how civilization ends in hospitals.

Not with a trumpet.

With stationery.

By two in the morning the waiting room had forty-three people in it.

Some were from Bangladesh.

Most were not.

A taxi driver from Behala had a rash.

A seventy-four-year-old woman from Lake Gardens had platelets of 29,000 and falciparum parasites in her blood.

A college student who had spent three nights pandal hopping was vomiting into a plastic shopping bag while his girlfriend searched Google for “dengue malaria together survival percentage.”

A child coughed continuously.

Every time he coughed, people moved away.

There was nowhere to move.

I began tasting metal.

I checked my gums in the staff bathroom.

There was blood between two lower teeth.

I rinsed again.

When I pulled my cheek outward, I saw three white dots inside it.

Tiny.

Like salt stuck to wet skin.

I knew what Koplik spots looked like.

I also knew what losing fourteen days of work would do to my salary.

I turned off the bathroom light and went back downstairs.

At 2:17 a nurse screamed.

Not loudly.

That made it worse.

I found her beside Karim’s bed.

Karim was asleep.

His fever had dropped to 102.8.

His mouth hung open.

Six mosquitoes were inside it.

Not near it.

Inside.

One clung to his tongue.

Two were feeding from the gum above his front teeth.

Another stood on the wet inner surface of his cheek, abdomen swelling dark red.

The nurse said, “How the fuck—”

One mosquito lifted off Karim’s tongue.

It flew directly at her face.

She slapped it away.

Then we noticed the ceiling.

There were hundreds.

We had mosquito problems in the hospital every monsoon.

Everyone did.

Aedes mosquitoes bred in flowerpots, drains, discarded cups, air-conditioner trays, construction sites, anything that held clean water for a few days.

Anopheles came from other breeding sites.

But mosquitoes normally scattered around a room.

These were clustered above the fever patients.

Dense black patches.

Every few seconds one dropped.

Straight down.

They ignored us.

They landed on mouths.

Eyelids.

Nostrils.

Bleeding gums.

A man with dengue started crying when three settled on the white of his left eye.

We switched on electric rackets.

The corridor began snapping.

Patients shouted.

Mosquitoes burned.

The smell was faintly sweet.

Someone brought pesticide spray from housekeeping.

We sprayed until people started coughing harder.

The mosquitoes kept feeding.

The hospital administrator arrived at 3:05 wearing a cream kurta and a red Puja tilak.

He looked at forty sick people, a ceiling full of mosquitoes, nurses waving electric rackets, and a man bleeding from his ears.

He said, “We should avoid creating panic.”

The registrar told him to go fuck himself.

That improved morale for approximately thirty seconds.

Then Karim woke up.

He opened his mouth.

Something translucent was hanging from his gums.

He grabbed it between two fingers.

Pulled.

A strip of tissue peeled away from the inside of his mouth.

It came off in one piece.

About six inches long.

Wet.

Pink.

Full of tiny red channels.

Karim stared at it.

So did we.

Then three mosquitoes landed on it while he was still holding it.

The registrar vomited into a waste bin.

Karim began screaming.

His gums underneath were raw and bright red.

Blood filled his mouth so quickly he started choking.

We suctioned him.

His platelet count had fallen to eleven thousand.

His blood pressure collapsed.

His oxygen saturation dropped.

His son stood against the wall saying, “Baba, Baba, Baba,” with the flat voice people use when the world has stopped negotiating.

Karim died at 4:03.

At 4:11 the first local child tested positive for all three infections.

That should not have been possible.

He had malaria parasites.

Dengue antigen.

Measles.

He lived in Ultadanga.

He had never left India.

His parents had taken him pandal hopping on Saptami.

The father showed me photographs while the boy was being admitted.

The kid smiling under lights.

The kid eating ice cream.

The kid on his father’s shoulders.

The kid asleep in a taxi.

In one photo there was a mosquito on his forehead.

The father zoomed in.

“Could one bite do this?”

“No,” I said.

At that time I still believed that.

By morning the city had started calling it the Puja Fever.

Television channels loved the name.

Three Fevers was better.

Short.

Terrifying.

Easy to fit under a photograph of a crowded pandal.

The government asked people not to panic.

Then asked people with fever not to attend public gatherings.

Then clarified that there was no reason to cancel Puja celebrations.

Then urged vulnerable people to exercise caution.

Meanwhile hospitals filled.

The terrible part was not how fast people died.

It was how normally everyone behaved before dying.

They ordered tea.

They complained about waiting times.

They asked whether insurance covered ICU.

They argued over who had stolen a phone charger.

They called relatives.

They watched reels.

One man with a platelet count of nine thousand wanted to know whether he could leave for two hours because his wife had never seen the Tala Prattoy pandal.

Around noon my temperature reached 101.6.

I deleted it from my employee screening form and entered 98.9.

I felt ashamed.

Then relieved.

That was worse.

My teeth had started feeling loose.

Not moving.

Just wrong.

Every time my tongue touched them I expected one to tip backward.

I stopped checking after the fiftieth time.

At 2 p.m. the microbiology department called us downstairs.

Dr. Maitra had collected mosquitoes from the fever ward.

He had separated Aedes from Anopheles.

Then tested them.

He looked as if he had not slept.

“Dengue is in the Aedes.”

Nobody reacted.

We knew that.

“Falciparum is in the Anopheles.”

Again, normal.

Then he said, “Measles RNA is in both.”

The registrar shook his head.

“Contaminated blood meal.”

“That’s what I thought.”

Maitra put an image on the monitor.

Mosquito salivary gland.

Fluorescent staining.

Measles proteins.

Nobody spoke.

“That cannot happen,” the registrar said.

“Yes.”

“You’re saying mosquitoes are transmitting measles?”

“No.”

Maitra changed the image.

Another mosquito.

Then another.

“I’m saying something worse.”

The room went quiet.

In mosquitoes that had fed on patients carrying all three infections, falciparum was appearing where it should not survive.

In Aedes.

Dengue viral particles were appearing in Anopheles salivary tissue.

And measles was replicating in both.

Not contamination.

Replication.

The three pathogens were not merging.

There was no magical supervirus.

That would almost have been comforting.

They remained three different organisms.

They were simply changing each other’s environment enough to cross barriers that had kept them separate for millions of years.

One bite could now deliver all three.

We stared at the screen.

The registrar finally said, “How many mosquitoes?”

Maitra laughed.

It was a dry sound.

“Calcutta?”

Nobody answered.

“During Puja?”

He laughed again.

By evening the ambulance queue reached the main road.

The pandals were still open.

You could hear drums from the hospital entrance.

Dhak.

Car horns.

Ambulance sirens.

Dhak.

Firecrackers.

Sirens.

Somebody died in the parking lot while a group twenty meters away took selfies under decorative lights.

Police began closing major pandals after midnight.

Too late.

People had already moved through the city by the millions.

Mosquitoes had moved with them.

Inside taxis.

Buses.

Metro stations.

Guesthouses.

Hospitals.

Apartment elevators.

Under tables.

Behind curtains.

In bathrooms.

In the folds of clothing.

The new behavior frightened entomologists most.

They had stopped feeding mainly on exposed arms and ankles.

The triple-infected mosquitoes preferred faces.

Specifically mouths.

Carbon dioxide.

Heat.

Moisture.

Blood from inflamed gums.

Sleeping people became feeding stations.

People woke with mosquitoes between their lips.

A woman in Kasba crushed one between her teeth.

A child in Salt Lake inhaled two and coughed one back alive.

A nursing-home patient aspirated an insect into his lung.

By the third night people were sleeping in motorcycle helmets.

Someone posted a video explaining how to tape mosquito netting over your face.

Someone else sold “antiviral mosquito mouth guards” for ₹1,499.

They sold out.

I worked through all of it.

Because I was already sick.

Once you have made one stupid decision, every decision afterward becomes an employee of the first.

My rash began under my shirt.

I hid it.

My gums bled whenever I spoke.

I wore two masks.

My fever reached 104.

I took paracetamol and continued drawing blood.

At some point I stopped caring whether I survived.

I cared whether anybody noticed.

That is the humiliating thing about shame.

You can be dying and still worry that someone will think you are disgusting.

On the fourth morning I fainted beside the centrifuge.

I woke in an isolation bed.

The registrar stood over me.

“You stupid bastard.”

I tried to answer.

Blood ran down my chin.

My test results were already back.

Measles.

Dengue.

Falciparum.

Platelets seventeen thousand.

Parasitemia rising.

My chest tightened.

“How?”

The registrar looked at me for a long time.

Then said, “We checked the CCTV.”

The first night.

Karim.

The mosquito on his lip.

I had slapped it.

It had burst across my glove.

Then I had touched my own mouth.

There had been a tiny split in the glove between thumb and index finger.

The registrar showed me the enlarged footage on his phone.

There I was.

Holding the glove.

Blood shining across it.

Touching my lip.

Then walking away.

I remembered the warm grain between my lips.

The tooth.

The blood.

I had thought the story began with Karim coughing on me.

It had not.

The mosquito had already bitten me before I killed it.

The itching between my fingers that night had not been sanitizer.

I had been infected before I drew his blood.

Before I hid my fever.

Before I walked through three floors of the hospital touching elevator buttons, keyboards, specimen bags, door handles.

Before I leaned close to frightened patients and told them not to worry.

I asked the registrar how many people I had exposed.

He did not answer.

He did not need to.

I survived.

Karim did not.

Neither did the registrar.

Neither did Maitra.

By October 19, the emergency phase was officially described as stabilizing.

That word appeared on television repeatedly.

Stabilizing.

The crematoria were running around the clock.

Hospitals had stopped counting mosquito bites.

Entire apartment buildings hung nets over stairwells.

People stopped sleeping with their mouths open.

The city smelled of insecticide, smoke, bleach, sweat, and bodies.

I went home after seventeen days.

I had lost nine kilograms.

Two teeth.

Most of the hearing in my left ear.

My hands shook.

My apartment looked exactly as I had left it.

Cup in the sink.

Laundry on the chair.

Unpaid electricity bill under the door.

The ordinary things were unbearable.

I locked the windows.

I checked them twice.

I checked under the bed.

I checked behind the curtains.

I sprayed the bathroom.

I plugged in two mosquito vaporizers.

Then I stood in front of the mirror and opened my mouth.

The gums were healing.

The white spots were gone.

The bleeding had stopped.

I touched the inside of my cheek.

Something moved under my finger.

I froze.

Touched it again.

A small hard bump.

I pinched it.

Pain shot through my jaw.

I squeezed harder.

The skin inside my cheek split.

A black mosquito pushed its head through the opening.

Not from my mouth.

From inside the tissue.

Its front legs unfolded first.

Then its body.

Wet.

Blood-red.

It crawled onto my tongue.

I did not scream.

I stared at it.

Then I understood why the recovered patients had started testing negative for mosquito exposure while their apartments remained full of them.

The mosquitoes had not learned only how to feed from us.

I closed my mouth and swallowed.