Medical Investigation (2004) s01e08 Episode Script

Lilith! Sheriff! Sheriff Mills! It's okay.
I'm right here.
I'm right here.
You don't have to fight it anymore.
What is it? We lost another one.
I'll go tell Dr.
Forrest.
It was Dr.
Forrest.
This thing's getting too big for us.
We need help.
We've got a bad one on our hands.
- How bad? - Don't bother sitting.
We're leaving for Deering, Virginia in ten minutes.
Never heard of it.
It's a small town two hours from here.
And getting smaller, fast.
Three people dead, 12 more presenting.
What are the symptoms? It's a rapid onset of fever, chills, headache, muscle and eye pain.
Followed by a cough that becomes more productive and blood-tinged until the lungs fill up with fluids and the victims die of respiratory arrest.
So they drown in their own fluids? / Yeah.
Sounds like we're looking for something viral.
Could be, but for now, let's keep all our options open.
What about a toxin? maybe carbon monoxide exposure? Not likely.
It wouldn't produce fever, chills and shaking.
Bacterial? Could be legionnaires'.
Lots of people were down at once from that.
Whatever it is, it's Kick-S with a short incubation period.
Early reports say the onset is rapid, one to two days.
Progression to death, Two to three.
What does the local doctor say? Unfortunately, he was the third to die.
Who called NIH? Town sheriff, named Mills.
From the cracks in his voice, I'd say he's undermanned and overwhelmed.
Deering is pretty isolated from surrounding communities.
Hopefully, whatever this is hasn't spread from there.
Key word.
Hopefully.
I want everyone on prophylactic doses of antibiotics and antivirals.
Load up the SUV with amantadine, a spectrum of antibiotics, I.
V.
solutions, culture materials and protective gear.
Sounds like we're going back into combat.
We are.
But this time, we don't know what we're headed into.
Load up.
DEERING, VIRGINIA Only one thing spreads faster than an outbreak like this Yeah.
Fear.
Where is everybody? Before he died, the town doctor quarantined anyone presenting to an old hospital on the edge of town.
How long has this place been shuttered? Three, four years now.
What happened to it? Same thing happening to small towns everywhere.
Population dwindles, tax base shrinks, malpractice insurance increases.
Couldn't afford to keep it open.
Dr.
Forrest was the only one who stayed.
Lord knows we could've used him now.
I thought you said there were only a dozen sick.
/ There were.
What percentage of the population is down? I'd say less than ten.
Ten percent? / So far.
I want oxygen and masks on all the patients.
I want gloves and gowns on anyone attending.
Miles, triage these patients.
Draw blood.
/ All right.
Powell, get some deputies, go door-to-door, look for anyone who might be presenting.
If they are, get them down here as soon as possible.
- Got it.
- Emily, calm down.
Don't tell me to calm down.
If Dr.
Forrest is dead, then who's gonna look after my boys? Hi, there.
How can I help you? Are you a doctor? From the national institutes of health.
NIH? What's happening, Arnie? That's why we're here to try to find out.
- What's wrong with your sons? - Uh, fever and chills.
They haven't been able to keep their food down for a couple days.
Hey, guys.
My name's Dr.
Connor.
You guys can call me Stephen, okay? You guys look too strong to be sick.
Can I see your hands? - I just want to check something.
- Go ahead.
All right, let me see your hands.
Are you ready? one, two, three, squeeze.
Wow, that's a good, strong grip.
Let's see your arms now.
Come around.
You got some strong biceps, huh? You guys must play a mean game of football.
I quarterback, he tackles.
/ Yeah? My son's a quarterback.
He started playing when he was about your age.
All right, here's what we're gonna do.
Why don't you guys stick around? I'm gonna get a doctor over here to see if we can help you feel better.
Get you back playing on the field again.
Thank you.
Why don't you find a nice comfortable spot for your sons.
I'll have someone come over as soon as possible.
Okay, thank you.
Let's go.
Come on.
Bye, guys.
Their lymph nodes are swollen.
They're burning up with a fever, too.
Stephen, we can't handle this alone.
We need to get these people to a working hospital.
That'd be Riverside memorial.
It's 75 miles of single lane from here.
- We're not moving them anywhere.
- Look at the conditions.
There's not enough equipment in this facility to properly treat a cold.
We don't know what we're up against, but with this percentage of the population down, this thing most likely transfers from person to person.
We have to contain this thing here.
Eva, call the navy.
Get a rapid-response mobile unit to chopper in equipment and more personnel.
- And don't take no for an answer.
- I never do.
We need to see the deceased.
Lucky the AC still worked in here.
What's with the pictures? Thought you might want to see what they looked like before.
That's Dr.
Forrest.
Who's that? Name's Tucker.
Owns the local grocery store.
And down there? Down there, that's William Gulman, lawyer.
You know, if it weren't for these photos, you wouldn't know these men were all white.
The blackening of the skin can happen in the case of severe respiratory distress.
As they struggle for breath, their blood vessels start to rupture and hemorrhage.
The RR unit will be airborne in 30 minutes.
You're a miracle worker.
I do my best.
Oh, my god.
/ Yeah.
- What are we up against? - Could be anything.
There's no way I can do a proper post-mortem here to find out for sure.
I'll have the RR unit chopper the bodies, the patient's culture, the blood samples, and you back to NIH.
I need an I.
D.
on what's killing these people ASAP.
Stephen What do you got? The lawyer's got a good-sized laceration on his left hand, looks like used sutures.
It was infected.
I assume the dead doctor did the sewing.
Who was handing him the thread? Lilith! Donnie I can't breathe.
/ Okay.
I can't breathe.
Just calm down.
It'll, It'll pass, okay? It's okay.
I'm a doctor.
Let him help you, all right? There we go.
Now just try and breathe in slowly, okay? In and out.
That's it.
That's good.
That's good, Donnie.
You're gonna be okay now, okay? Just relax.
Okay, now just lie back, try to breathe normally.
I'll come back and check on you in a minute, okay? Thanks.
That's pretty damn scary.
That's certainly understandable.
I'm sure everyone's scared.
You must be one of the NIH guys.
Sorry.
Uh My name's Miles.
Lilith.
/ Hi.
Are you really a doctor? Yeah, I'm a doctor.
Can you guys figure out what's going on? That's what we're here for.
Well, we're really glad you're here.
Thank you.
By the way, I never would've guessed.
Guessed what? That you were a doctor.
I mean, you hardly look old enough to vote.
Well Lilith.
Dr.
Connor needs to speak with you.
I'm not sure how I can help.
I'm not really a nurse.
I just answered the phone, ran the doctor's office.
Did you transcribe his patients' notes? Sure.
From his dictation.
Then you knew as much about what was going on in his world as he did.
The first patient to die of this disease, uh, Mr.
William Gulman.
Was he a patient of Dr.
Forrest's? Well, most all of us have been, at some time or another.
Mr.
Gulman was in to see Dr.
Forrest just last week.
I think he came in to to get a cut on his hand stitched up.
Yeah.
Do you know where that cut came from or how it happened? The lechwe.
Sorry? Lechwe? It's some kind of antelope.
Mr.
Gulman was big into hunting, all around the world kind of stuff.
Even though the cut on his hand was really painful, he was still was bragging that day about the lechwe he killed in Africa last month.
But the cut on his hand is more recent than that.
Mr.
Gulman was into taxidermy.
Mounted his own trophies.
Said he got his cut in the workroom of his house on the antler of his latest prize.
Did you see any other symptoms of illness on Mr.
Gulman that day? That day, no.
But when he came in a few days later, he had a fever, chills and then it went from there.
Miles, while I'm gone, you're in charge.
A navy RR unit is on its way, but until they get here, administer amantadine and levofloxacin to anyone presenting.
Yeah.
Start Lilith and sheriff Mills some amantadine also.
They've been around this thing since the beginning.
I'll take care of them.
Can you use a hand? I know everybody.
It may make them more comfortable.
That'd be great.
THE GULMAN RESIDENCE You can just settle yourself right there.
This isn't what it looks like.
This is.
Look, I'm a doctor from the national institutes of health.
And I'm the caretaker of this property.
It still doesn't give you reason to steal from a dead man.
I'm not.
I'm trying to find out what killed him, so I can stop it from killing others.
Foolish old man.
Put down that gun.
We've been taking care of this property through three generations of Gulmans.
We've been living out in the guest house since June 3, 1938.
Two days after we got married.
So when did you first notice that Mr.
Gulman was sick? I didn't.
This foolish old man did.
I was visiting my sister over in Jennings for a few days.
Mr.
Gulman started feeling under the weather about a week ago.
Thought he'd caught a bug on his safari.
But what hit him was more than that.
I took him to Dr.
Forrest a couple of times.
but once the chills set in and he couldn't hold his food he didn't want to get in the truck no more, which was fine by me.
The man threw up all over my seat.
and you know that's hard to clean in this heat, if you know what I mean.
He'd been sick for three days when I got home, and Mr.
Gulman was coughing up something awful.
There was even blood in his spit.
The doctor came and took him to the hospital, and the rest you know.
So you both took care of Mr.
Gulman when he was ill? Hell, we changed his diapers as a baby, why wouldn't we? I want you guys to get down to the hospital.
I want to take some tests.
You may have been exposed to what made him ill.
We know what's going on.
And since neither one of us is feeling bad, we'd kind of like to keep it that way.
Excuse me.
Connor.
/ Stephen, I've isolated the same viral particles from the lung tissue of the doctor, the lawyer, and the grocer.
It looks like influenza-A.
This is not just a flu.
No, it's not.
I tested the viral particles against a panel of antibodies to identify the subgroup.
And? / None of the antibodies recognized it.
Are you sure? I ran it three times, Stephen.
Whatever it is, we're up against an incredibly aggressive mutation, one that we have never seen before.
Stanley, Iris I need you both to get down to the hospital.
Excuse me.
Connor.
You've got to get back here now.
Donnie, no! ET tube now.
/ Yeah, I got it.
Let me get in there.
Okay.
Miles, intubator.
Coming in with it.
Hold on.
Give it to mouth.
Come on, come on.
Hold still, Donnie.
Hold still.
Hold on, hold on.
Come on.
Stay with me, buddy.
Stay with us.
Just try to hold still.
Come on.
/ Donnie.
Donnie! Miles Start chest compressions now! Miles It's no use.
He's gone.
A mutated influenza is an epidemiologist's worst nightmare.
I thought the flu mutated every year.
/ It does slightly.
That's why there's a different vaccine every season.
In 1918, an outbreak of influenza swept across Europe and the entire planet like wildfire.
It was called the spanish flu.
As quickly as it erupted, it stopped.
Even though millions around the world died from it, word of its impact was minimal because it happened during World War I.
The spanish flu killed more humans than any other disease of its kind.
To this day, they still don't know where it came from.
Or where it went.
That's why when, SARS flared up, the government in Hong Kong called in the cavalry from around the planet.
They were scared it was back.
Do you think this could be the same disease? We don't know what this is.
No other cases have been reported in any other hospital within a 200-mile radius.
Natalie, what about the wild antelope that infected the lawyer's hand? Could that be the source of it? I'm not sure yet.
The culture from the antelope came back negative for the virus, but positive for brucellosis.
What's brucellosis? It's a bacteria found in animal carcasses.
I found the same bacteria in the hand wound.
A bacterial infection shouldn't have exacerbated the influenza.
Well, Donnie was the last patient to die, and it went through him in less than 48 hours, So that means the incubation period on this thing is shorter than we thought.
A bad flu strain will kill some people in hours.
Others in days, others in weeks.
So we may never know if the doctor, the lawyer or the grocer was patient zero.
But they're still our best shot at finding out the source.
Eva, delve into the lives of these three men, cast a wide net.
I want to see if anything connects them to each other - and everyone else in the town.
- Got it.
Miles, monitor the progression of it.
/ Yeah.
Natalie, call every lab doing viral research.
See if they have anything that can help us.
I'll start with the local labs.
Dr.
Connor she fell ill this morning.
She's burning up.
How are you feeling? I'm 83.
I haven't felt good in 15 years.
But today's worst than most.
Trenton.
/ Yep.
This is Mrs.
Price.
Do everything you can to make her comfortable as she can be.
Yes, sir.
This way, ma'am.
She always says I'm a foolish old man.
She's right.
I should have listened to you and brought her in here yesterday.
If the wife has it, can the husband be far behind? We've got to find the source of this thing and make sure it never leaves this town.
All right, we get a culture and swab the grocer's life.
You start at his store, I'll go to his house.
Find out where he's been.
If he stepped foot out of this town, we're screwed.
All right.
Man.
What? You catching that? Yeah, it's coming from over here.
Flies, lots of them.
That's never good.
Oh, man.
Damn.
What are you thinking? Hong kong flu of '97 mutated from chickens.
Government had to slaughter over a million of them just to shut it down.
The spanish flu? also came from fowl.
Who's to say this didn't start the same way.
Yeah.
Let's bag them and chopper them to NIH.
"Foul's" definitely the key word here.
Hey.
You okay? The oxygen saturation in Emily's two boys is lower than I'd hoped.
And I'm seeing respiratory distress in more patients at this stage than I'd like.
Other than that, everything's cool.
Come on.
I'll show you something that'll make you smile.
Over 90% of the people in this town were born in this hospital.
Donnie was and Emily's boys were.
And you? I spent my first night in this room right here.
This little town must have been nice to grow up in.
I hated it.
In high school, I was so sure I knew more about life than my parents or any of these small-town hicks, that the day I hit 18, I bolted for the big city and swore I'd never come back.
Yeah, I couldn't wait to get away either.
Especially from my dad.
He's always preaching these liberal values but in reality, his whole life was about making money.
I just wanted to make a difference.
Well, maybe, when you grow up, you will.
Yeah, maybe.
So when's the last time you went home? It's been a while.
So what about you? Why'd you come back? Well, my dad got sick and I came back to see him before he died.
He passed away upstairs.
I'm sorry.
You know people who say you can never go back home again? Sure.
They're wrong.
I spent my whole life running from where I belonged.
And it's important that you go before it's all gone.
With all the shots and vaccines and pills we see on TV, I thought this sort of thing was something of the past.
Like the stories of communities getting sick my mama told me when I was a boy.
How's she doing? It's a battle, but she's fighting.
Let me see your arm.
How are you feeling? As useless as tits on a boar hog.
Your pulse is just fine.
So is she gonna? I don't know, Stanley.
We ain't been apart hardly a day in 67 years.
We're gonna do everything we can to help you make 68.
- How they doing? - They're starting to cough.
You think you can help them? Dr.
Connor.
Natalie on line one.
We're doing everything we can.
Connor.
Unfortunately, colonel Sanders has nothing to worry about.
The chickens are not the source.
Are you sure? / Positive.
They died of dehydration.
No one's been home to care for them.
I have tested every experimental antiviral NIH and CDC has against this mutated virus.
Nothing works.
Nothing kills this thing.
You better find something.
Emily Harris has started presenting.
So has sheriff Mills.
They're not the only ones.
Why didn't you tell me you were sick? People been asking me that my whole life.
Yeah.
Listen.
I'm serious.
You were shorthanded.
I wanted to help while I could.
Well, you're done helping.
I want you in bed now.
Whatever happened to dinner and a movie? Come on.
Are you gonna be one of those unruly patients? Maybe.
- Well, at least take these.
- More antivirals? Yes, and something that hopefully will make you feel better.
I'm gonna be okay, Miles.
Yeah.
Now, go do your job.
You do it well.
Miles War room.
We're running out of time and we're back to square one.
I think I may have found something that can help.
Check this out.
I think she's onto something.
Okay.
I did my own version of an autopsy into the lives of the doctor, the lawyer and the grocer.
- Talk to me.
- I looked at everything, billing records, workout schedules, itineraries, romantic and professional lives, patterns, habits, vices, everything.
and I found one commonality that's very telling.
What is it? If their customers couldn't come to their place of business, they'd go to their customers.
Talk him through the details.
Okay, this map represents our sick little town.
These blue dots are homes where people live who are exhibiting symptoms.
The yellow lines represent grocery deliveries made by Kenny Tucker during the last month.
The green lines are house-calls made by Dr.
Forrest during the same period, and the red lines are clients the lawyer dropped papers and contracts off to.
They went house-to-house infecting everyone.
Mutated viruses direct to you.
What's the story with that house up there? That's the only place that all three went in the last month, and they went there frequently.
Who owns it? A woman named Michelle Carpenter.
Let's go pay her a visit.
Can't.
She died three weeks ago, but not of the flu.
She had brain cancer.
People said she was suffering with it for years.
Just because she was dying of brain cancer Doesn't mean she died of brain cancer.
We need an exhumation order.
It's 2:00 in the morning.
Where are we gonna get one? Judge Henry? You know what time it is? My name's Dr.
Stephen Connor from the national institutes of health.
NIH.
There's a potential epidemic in your neighboring town of Deering.
It is vital I get an exhumation order for a woman I need to autopsy.
Can't you wait till morning? It is morning, and four people have already died.
Well, we don't have any protocol.
There's no order to sign.
I can get you protocol in the morning.
But with one phone call, you can order the exhumation tonight.
And who would I call? The cemetery manager.
His name is John.
I already dialed.
Look at her lungs.
There's evidence of fluid.
They're so consolidated, it looks like her liver.
It's consistent with the flu and the lung damage of the other three victims who were on this table.
That's why maybe cause of death is flu or cancer.
If it wasn't the flu, it would've been eventually.
Let's open her skull just to make sure.
Okay.
Surgical area looks normal.
No indication the tumor eroded into the brain vessels.
Or increased pressure to herniate her brain stem.
I'll have to check the lung samples to be sure, but I'm betting cause of death is the flu.
Forceps.
What do you see? Radiation pellet.
Her oncologist must have been using radiation implants to try to cure her cancer.
Wait a second.
There're several of them in there.
You thinking what I'm thinking? Besides attacking the cancer, the radiation was strong enough to mutate the flu virus into a more aggressive virulent form.
Michelle Carpenter is the source of the mutation.
I'll have to run the tests, That's my call.
A mutation we don't know how to stop.
Hey.
Hey, how you feeling? Like going out dancing.
Maybe when you're feeling better.
Rest now.
/ Okay.
Natalie's test proves the cancer victim, Michelle Carpenter, was most likely the source of the viral mutation.
And being good samaritans, the doctor, the grocer and the lawyer all caught it from her as they stopped in to check on her.
Yeah, then they went out and spread it all over town.
All right, so we know what this thing is and where it came from.
But we still don't know how to stop it.
History proves that nature is random.
Influenzas rise and then vanish just as quickly.
Well, luckily we have this one contained.
Are you sure about that? Well, no one left Deering who was infected.
We retraced the three men's steps and all the people they had direct contact with.
And? And they're all here.
We're missing something.
A single mother takes her kids shopping at the end of an exhausting day.
A loyal employee going above and beyond gets infected trying to help others.
A couple that's taken care of a man literally from cradle to grave could end up losing their lives.
It's been right in front of us the whole damn time.
What? / Stanley Price had close contact with William Gulman since the moment he got sick till the time that he died.
He said the guy even puked in his truck.
/ Okay.
His wife comes back from visiting her sister.
She had limited exposure to Gulman, yet she got sick.
Doesn't make sense, does it? Stanley's the frailest, oldest person in there.
Why didn't Stanley get sick? So, Stanley, tell me about your life.
You're looking at it.
Least, this last 67 years.
How you feeling? I ain't feeling sick, if that's what you're asking.
I mean during your life? Tell me about your history of illness.
Well, for a man my age, I've been lucky, I guess.
Coughs, colds, the usual things everybody has.
Suffered with a bit of glaucoma, arthritis in the hands.
Prostate ain't worth a damn.
Left knee's been hurting since 1968.
How about as a child? Well, measles, mumps, chickenpox.
The usual.
Mama said I was very sick though, when I was only two.
Did she say what kind of sickness it was? Something bad swept through.
Said she thought she was gonna lose me because everybody that had the same thing were dying.
Stanley, you were born before 1918? Two years.
I arrived April 1, 1916.
That's why Iris calls me foolish.
Born on April fool's day.
And Iris, she's younger than you? Five years.
Born in '21.
That mean something? Natalie, test Stanley Price's blood.
- I already have.
- Do it again.
This time don't run it for flu virus, test it for flu antibodies.
Antibodies? Mr.
Price, he was exposed as a child to the 1918 pandemic.
The spanish flu? And he's the only person with repeated exposure to this mutated virus that doesn't show any of the symptoms.
I'll call you back.
Connor.
You were right.
Stanley's blood has the antibodies.
Stanley you ever flown in a helicopter? Why? / I need you to go to our lab in Bethesda.
I can't do that.
I can't leave Iris, especially now.
Stanley, you may be the only one that can save her life.
What are you doing? Well, Mr.
Price, this machine's gonna help me take several units of your blood plasma, from which we'll strip your antibodies, purify them, then introduce them into the other victims as a form of passive immunity to the virus.
We'll then immortalize your lymphocytes, the part of your white blood cells that are manufacturing the antibodies to the virus.
so they can be used again, in other patients, as a form of passive immunization.
Do you know what she's saying? It's like chicken pox or the measles, how once you get them, you almost never get them again.
This flu virus is close enough to the one you were exposed to as a child, that there's stuff in your blood that fights it.
Dr.
Durant is gonna take some of it out and give it to Iris and the other people who are sick and hopefully it will make them get better.
Exactly.
Three vials, that's all? Natalie busted her ass to produce this much.
She said she'd have gallons in 48 hours.
We don't have 48 hours, and that's not enough for everyone.
Producing antibodies usually takes much longer.
We're lucky to have this much antiserum.
Lucky for whom? For those who get to live.
Which brings us to the harsh realities of rationing it.
Are you with me, Miles? Yeah.
Rationing.
I don't like the term nor the concept.
We treat the most patients we can with the antiserum we have.
Who gives us the right to decide who gets it? Who gives us the right to play god? This isn't about god or morals.
It's about being doctors.
Our job is to compartmentalize our emotions and rationally save as many patients as possible.
And how do we decide who they are? By being dispassionate scientists.
Look, we know there are those patients in there with low viral loads that will survive until the next batch of antiserum.
That's the easy choice to exclude.
And then there are those in there who are too far gone to save.
Patients that we could give it all to, and they still won't survive.
It's the ones in the middle that we give this to.
And we just ignore every other factor? Like what? / Like age.
Lilith is 24 years old.
She has her entire life ahead of her.
And I'm sorry, but Mrs.
Price is in her 80s, and at best, we buy her a few extra years.
We can't triage based on potential life expectancy or quality of contribution to society.
That can only leads to passing judgment on the value of someone's life.
But how can we ignore a value that's so real? Because we work with finites, facts, measurable quantities.
Because we triage based on medical necessity alone.
Look you've monitored the progression of this illness through these patients more than anyone.
You make the call.
No, you should keep that on.
It messes up my hair.
So I hear there's not enough medicine to go around.
No.
Make sure Emily's boys get some.
They will.
Lilith I'm not afraid, Miles.
You're gonna be a good doctor soon as you start looking a little older.
And you tell your parents you love them before it's too late.
Yeah.
Her fever's come down and her lungs are clear.
So she's gonna be okay? She needs plenty of rest, but yes, I believe she's gonna make a full recovery.
Don't look so surprised, foolish old man.
You did good work, Miles.
Doesn't feel like it.
You ever wonder why I'm such a son of a bitch at times? Me and everyone else.
When I was about your age, I could figure out any disease they showed me.
I was young, invincible, filled with promise and pride.
And then someone very dear to me came down with a bacterial infection in their lungs.
Defied everything the doctors threw at it.
So I flew home, I told the doctors I can fix this.
I had to save this one person.
I couldn't.
See, nature doesn't care about how much training we've had or how smart we think we are.
Nature doesn't give a damn.
So my advice to you is this.
Either learn how to deal with it or quit.
But I think you're too good a doctor to walk away from this.
Dr.
Connor? Thank you.
You're welcome.
Come on, let's go.
Ready to go? Yeah, I'll be with you in a minute.
Hey, Dad.
It's Miles.
Listen, I'm thinking aboutcoming home for a visit.