As Dr. Gabrielle Gale reviewed the patient files from the night before, the shrill voice of the intake nurse, Martha, rose from the emergency room lobby. The lobby was typically quiet, as the public had learned to avoid emergency rooms. The University of Pennsylvania hospital had not had a single emergency walk-in for the past two months. On rare occasions, a new patient would be brought in by ambulance, but most new patients were transfers from other hospitals or medical centers.

Gabby set the small stack of files down, grabbed her mask, and made her way toward reception. Since the recent string of severe viral outbreaks, people had been avoiding crowded places, and hospitals had become an absolute last option. The business of virtual doctors had taken over a few years ago for regular medical needs. There were also infectious disease centers that handled most infections.

“Sir, you have to put a mask on and sit down. We have protocols to follow,” barked Martha.

“I—can’t—breathe, I … heart. Please—help me,” pleaded a weak voice.

As Gabby pushed her way through the containment curtains into reception, she saw an elderly, unkempt, white-haired male. It was unusual to see someone’s face not covered by a mask—Gabby could see the grip of pain across his tight, wrinkled expression. She guessed his age to be somewhere in his late seventies. He was gripping his shoulder. While his clothes looked like rags, he wore Cartier eyeglasses and clean New Balance sneakers.

“Martha, what’s going on?” Gabby asked.

“I paged decon, but all three units are busy. He has to wait. He has to sit down and put a mask on,” Martha said with panic rising.

Gabby secured her mask and eye shield; she already had her gown on, and added an extra pair of gloves. She grabbed a vitals cart, a dose of aspirin, and three doses of sublingual nitro and started toward the waiting room.

“Dr. Gale, you can’t go out there. He hasn’t been cleared yet. You can’t treat him!”

“Martha, I have my gear on. Order an IV with morphine and heparin. Have it ready as soon as decon is able to clear him.”

Gabby quickly made her way to the waiting room. The man was sweating profusely, even though the hospital’s ambient temperature had been lowered in an attempt to slow the rapid rise in bacterial infections. Gabby gently guided him to the closest seat, where she took his blood pressure.

“Sir,” Gabby said, while making sure that he was able to make and maintain eye contact, “what’s your name?” She was momentarily struck by the clearness of his azure-hued eyes behind the turtle-rimmed glasses. His gaze was strong.

He cleared his throat. “Harold,” he gritted in pain, “Mullen.”

“I have a small dose of aspirin and a dose of nitroglycerine. Both will dissolve in your mouth. Are you able to take these?” Gabby asked, then glanced at the wall clock.

Though his jaw was clenched in pain, he was able to open his mouth and Gabby placed the tablets under his tongue.

She checked his pulse, which was erratic. His blood pressure was slightly elevated.

“Sir, have you ever had a heart attack?” Gabby asked.

He shook his head no. “I—” The man coughed and gritted his teeth. “I have high cholesterol and prediabetes,” he said.

“Are you on any medications?” Gabby asked.

“I was, but since my wife died I … I haven’t taken them like I should.”

“Have you taken anything today or last night?”

Harold shook his head no.

“When we get you to a room, we will need a full list of your medications. Are you feeling any better?”

Harold shook his head ‘no’ again.

She checked the clock. “Mr. Mullen, it’s been five minutes, so I’m going to give you another small dose of nitroglycerine, okay?”

Mr. Mullen opened his mouth, and Gabby placed another small tablet under his tongue. A minute later she asked, “How about now, are you feeling any better?”

“A little.” The man rubbed his head.

The curtains to the waiting room swung open. Two individuals held the drapes aside while a third pushed in a cart filled with swabs and tinctures. All three figures wore white hazmat suits, goggles, and blue gloves, erasing any human characteristics.

“Sir, we are going to swab your nostrils, your throat, your ears, and your fingernails. Then take your temperature,” a monotone voice stated from behind a masked face.

Mr. Mullen sat back as the three decontamination agents swabbed, doused, poked, and tested him.

“Sir, your tests were all negative for antibiotic-resistant bacterium as well as influenza and pandemic-related viral pathogens. You are cleared for intake. Oh, and doctor, please be advised that we will have to report your break in protocol.”

With that, the decon team quickly vanished through the curtains, replaced by a team of nurses dressed in scrubs, covered in impermeable blue gowns, faces and eyes protected, wheeling a gurney.

“Get an EKG while you’re getting his medical history and doing intake. I will be right in,” Gabby instructed.

The nurse staff nodded and wheeled Mr. Mullen away.

Gabby followed them back, then headed to the sterility room. The small chamber glared with fluorescent light. Lifting the lid to the bio-hazard bin, she carefully removed her top layer of gloves from the wristband and dropped them into the bin. Next, she grabbed her face shield, careful to only touch the band that went behind her head, and dropped that in as well. Her protective gown was next, followed by her secondary face mask and gloves.

She pushed the foot pedal to close the bio-hazard bin. A pump of sanitizer and she rubbed her hands clean. She unzipped the plastic shield over the clean rack, labeled “A”, pulled her thick, wavy brown hair into a tight ponytail, and began the process over again.

Although Gabby had only been the attending E.R. doctor at the hospital of the University of Pennsylvania for the past nine months, there was something about the containment protocols all hospitals had initiated three years ago that placed a seed of dread in the pit of her being. The world had been living in a state of panic following the first global pandemic of the 20th century, COVID-19, eight years ago, which ironically was actually very mild, with a mortality rate of around 3%. The new normal felt anything but.

For nearly a decade the world had been waiting to go back to normal, only things just kept getting worse. Much of her studies at Harvard Medical School and her dual-residency at Johns Hopkins in internal medicine with a focus on medical genetics and emergency medicine dealt with how to seamlessly institute these new and still-developing protocols.

In the past decade, the world had seen seven consecutive extreme influenza seasons that resulted in nearly three million deaths, an international spike in viral pandemics that accounted for close to another five million deaths, and localized outbreaks of fungal activity. Additionally, several outbreaks of antibiotic-resistant CRE bacteria across the country had resulted in the infection of nearly a million individuals with a mortality rate of 96.4%. With this, the practice of medicine had changed dramatically, particularly over the past five years.

The intercom in the sterility room buzzed. “Dr. Gale, this is Taylor. A patient in D-wing is coding, and you’ve been requested in level-C protection.”

Gabby quickly unzipped the rack labeled “C”. There were approximately a dozen white suits hanging there. She stepped on the sanitizing floor mat and started to slide the protective foot and leg covers on.

“Taylor,” Gabby asked, “do you have a status on patient Mullen?”

“He had a heart attack, which was probably stopped with the nitro. We paged cardiology. They are prepping a room and admitting him.”

“Thank you,” Gabby said as she continued dressing.

Next came the full body suit with the connected hood that left only her large, almond-shaped, green eyes, her petite, slightly upturned nose, and her cupid’s-bow mouth visible. Gabby was beautiful by any standard, though she had never paid much attention to her appearance. She placed the face mask on over her nose and mouth. Next came the external hood with a large plexi-face shield. Over that, the secondary apron, and finally the second pair of surgical gloves.

Gabby had this process down, and was able to safely dress in under forty-five seconds. D-wing was technically a quarantine unit—each room had individualized staff who had zero contact with any other patients. However, Gabby found that most of the patients in that unit were either indigent or had previously been in state-run facilities and now suffered from a variety of unusual ailments. Not a single case of the feared influenza strains, novel viral pathogens or antibiotic-resistant bacterial infections had been admitted to this unit.

Gabby had only been called into that unit two other times, both for cardiac arrest. As she approached the room, she saw that this time was different. Two nurses stood outside the door, leaning against the wall. Gabby could see the remnants of vomit clinging to the outside of their shielded hoods.

As she walked into the room, she saw that the patient was in the grip of a full-body, grand mal seizure. The patient, a morbidly obese, middle-aged man, shook uncontrollably, his eyes glazed. Gabby noticed small ruptures speckling the patient’s skin as she joined the doctor and nurse working at his side.

“What’s the status? Has he been administered Cerebyx yet?” Gabby asked.

“There’s a dose on the tray. I’ve never seen anything like this,” explained Dr. Chan, the attending doctor for the unit. “We have been trying to address the skin ruptures. The patient complained of severe abdominal pain, three times since yesterday afternoon. He was administered morphine. Then …” Dr. Chan’s voice broke off.

Gabby quickly grabbed the dose as well as an alcohol swab. When she attempted to hold down the patient’s leg, her finger broke through his tender flesh. Her brain struggled to accept what was going on. The patient’s flesh quivered with the consistency of jelly. The slightest touch broke the surface. Each jerk of his seizure created another tear in his flesh. Gabby looked at Dr. Chan and his assisting nurse, whom Gabby didn’t recognize; both were focused on delicately trying to tape flesh ruptures on the patient’s arm and chest. They seemed to have shut down to the situation as a whole, focusing in on such a small effect.

Another jerk created a rupture in the patient’s abdomen. Gabby stepped back, as did Dr. Chan and the assisting nurse. Her pounding pulse sent vibrations of terror ping-ponging through her core, wedging in her throat. Another jerk created a rupture that covered the patient’s entire trunk and, with that, each jerk sent blood and flesh pouring out in tsunami-style waves of expulsion. The patient stopped moving, reduced to an almost shapeless, oozing, crimson mass. It was only then that Gabby noticed the blaring flat-line beep that brought her back to the present.

“Gabrielle,” said a voice from the entrance to the room. Searching for anything to hold on to, Gabby stumbled back against the wall and turned toward the voice.

“Trent? What … what are you doing here?”

“My lab was called to test and seal this room and patient due to the unusual and severe circumstances. We have set up a special decontamination unit and holding room. I will meet you there.”

“Wait, what—I mean, how—” Gabby struggled to get her words together. Nothing made sense. Her fiancé, Dr. Trent Martins, was a lead geneticist for AmCorps Labs in DuPont, Delaware, and had only worked at the UPenn hospital one other time. Several years ago, Trent had created a virus that was able to cure a rare form of relapsing leukemia in a young girl.

“Gabrielle, some of my staff are right outside, they will take care of you,” Trent said.

“Are we being quarantined?” Gabby asked.

“No, nothing like that. We’re just taking every precaution. I will be there soon.” With that, Trent pushed past Gabby, holding some sort of small machine in his hand. She managed to get her feet to carry her past the threshold.

All Gabby could see were yellow curtains. They must’ve been set in place in a matter of seconds.

“Dr. Gale,” came a voice, “please stand still. We are going to spray you with a decontamination formula. It’s completely harmless to you. It’s basically a liquid copper spray that kills a wide variety of pathogens.”

Within seconds, a gray mist filled the curtain tunnel. The mist cleared, and as an opening at the far end was unzipped, two agents pulled back the curtain for Gabby.

“Dr. Gale, we are going to spray you with a second solution. It’s a sanitizer made from thymol.” The two agents sprayed Gabby in unison.

She was then directed to the next tent. Her protective clothing was removed and she was guided to the doctors’ lounge. Soft lighting, comfortable gray recliners, dark wood tables, floral-patterned chairs, and beige walls were a welcome departure from the harsh white fluorescence of the rest of the hospital. But it could not erase from her mind what she had just witnessed.