The emergency room at Brooklyn Medical Center was already at capacity.
All morning, nine patients with respiratory symptoms of unknown cause had been brought in.
All residents of Brooklyn. All with similar symptoms.
Dr. James Lee came out of the negative-pressure isolation room and removed his N95 mask and face shield. His pale, haggard face was revealed.
“Are the test results back?”
“It’s the multiplex PCR results. Influenza A/B negative, COVID negative, RSV negative. Adenovirus, metapneumovirus, parainfluenza—all negative.”
The nurse handed him a tablet.
James was at a loss for words. He had twenty years of experience as an emergency physician, but he had never seen respiratory failure collapse this fast.
“Doctor! Bed 3’s oxygen saturation dropped to 83!”
An alarm blared. James checked his gear again and ran.
“Prepare high-flow oxygen. Sixty liters, maximum concentration.”
The nurse turned up the oxygen, but the reading rose to 86, then fell back to 82.
“No. We’re intubating. Prepare the meds! Etomidate, succinylcholine. 7.5 tube.”
“Yes, starting now.”
Right beside them, the alarm at Bed 5 began to sound as well.
“Doctor, respiratory rate 38, severe accessory muscle use. It’s only been two hours since admission…”
“Switch to an oxygen mask and draw arterial blood. Two sets of blood cultures. One more IV line.”
The nurse shouted.
“I see conjunctival hemorrhage in the eyes. The gums are bleeding too.”
“Suspect coagulopathy. Add platelets, coagulation studies, D-dimer, ferritin, liver enzymes, and lactate. Chest X-ray?”
“Just taken. Infiltrates throughout both lungs. Platelets are 68,000, D-dimer is elevated, and CRP and ferritin are high too.”
A short while after the tube went in, the waveform stabilized.
“Add viral testing on the secretions.”
James’s brow furrowed.
It would take forty-eight to seventy-two hours for the requested genetic analysis results to come back.
The nurse reported.
“Of the nine who came in this morning, three are on high-flow oxygen, two have been intubated, and one had blood pressure drop to 86 over 52, so we started vasopressors.”
“Push fluids 30 milliliters first, and if there’s no response, maintain the vasopressors. Let me know when the blood gas comes back.”
“Doctor. We have the CDC on the line.”
James took the call.
“This is James Lee from the Department of Emergency Medicine at Brooklyn Medical Center.”
A calm voice came through the receiver.
—I know you’re working hard on-site. Could you summarize the situation?
“High fever over 39 degrees Celsius, rapid drop in oxygen saturation. On average, within three to four hours of admission, they fall below 90%. There’s also a bleeding tendency. Conjunctival hemorrhage, gum bleeding. Decreased platelets, elevated D-dimer. Chest X-rays show infiltrates throughout both lungs. Multiplex PCR came back negative for influenza, COVID, and RSV. We’ve requested genetic analysis, and results will take forty-eight to seventy-two hours.”
—Are all the patients from the same area?
“Yes, all from this area. Two or three more keep coming in every two hours.”
—Have there been any deaths?
James swallowed briefly.
“The patient in Bed 6 went into cardiac arrest an hour ago. It was ten hours after admission. It progressed to acute respiratory failure and circulatory failure. We considered ECMO, but the multiple organ failure progressed too quickly to initiate it.”
Perhaps shocked by the severity of the situation, the receiver went quiet for a moment.
—Understood. We’ll send the city health department’s epidemiological investigation team first and immediately notify the state health department of the current situation. What about isolation measures?
“We’re operating negative-pressure isolation, and N95 masks with face shields have been standardized. We’ve also separated a dedicated PPE doffing area.”
—Good work. If new patients arrive or severity changes, give us updates every thirty minutes. Minimize patient movement as much as possible.
The moment he hung up, another alarm sounded.
“Bed 5’s oxygen saturation is dropping to 78! Severe cyanosis!”
James immediately gave orders.
“Prepare intubation. Low tidal volume under the ARDS protocol. Set up propofol and fentanyl. Blood cultures were sent, right?”
“Yes, two sets completed.”
He briefly looked around at the team.
“Good. From now on, update patient count, oxygen therapy stage, and platelet count every thirty minutes and report simultaneously to the infection control team and the health department. Classify patients with colored labels.”
A nurse asked,
“Doctor, could this be a highly contagious new virus?”
James nodded, but did not jump to conclusions.
“It’s possible. But speculation isn’t our job. The data will give us the answer. For now, let’s focus on stabilizing patients, preventing infection, and reporting.”
The medical staff conference room.
James sat facing four fellow doctors. All of them were exhausted from caring for patients through the night.
James reported.
“Current patient count, twenty-one. Deaths, two. Case fatality rate, 9.5%. But most of the patients haven’t been admitted for twenty-four hours yet. The final fatality rate will likely be much higher.”
“Has anything come out about the cause?”
When Dr. Susan Park asked, James shook his head.
“Not yet. Every known pathogen has come back negative. We have to wait for the genetic analysis results…”
“Which means patients will keep increasing in the meantime.”
Dr. Mark Smith spoke with a dark expression.
“Even if we transfer some patients to other hospitals, the rate of increase is too fast. Our hospital only has eight ventilators. Five are already in use, and three remain. If patients keep increasing at this rate…”
He stopped speaking. But everyone knew.
After that, they would have to choose. Who to save.
James said weakly,
“The CDC will send guidelines. We have to hold out until then.”
“Hold out?”
Susan raised her voice.
“We could get infected too! We don’t even know what this is. How are we supposed to treat it? We don’t even know how high the fatality rate is!”
“Susan, calm down.”
“Calm down? It’s even showing hemorrhagic fever symptoms! If this is something like Ebola, all of us…”
The conference room fell silent.
Mark said in a low voice,
“I remember the 2020 COVID outbreak. Back then, we didn’t know the cause at first either. But we held out.”
“COVID had a fatality rate of 2%.”
James said,
“This is at least 10% among what we’ve seen so far. And the speed of progression is too fast. It worsens to severe disease within twenty-four hours, and the probability of death is high within forty-eight.”
He stopped speaking.
Susan covered her face with both hands.
“Can we handle this?”
No one could answer.
Urgent footsteps sounded in the hallway. A nurse opened the door and shouted.
“Doctors! Four more patients just arrived in the ER!”
The doctors rose from their seats. But there was no longer any certainty in their eyes.
Only fear remained.
Outside the window, the night view of New York was visible.
As if wishing all of this were nothing more than a nightmare, the city was emitting glittering lights.
***
The Blue House executive office.
The president was seated before a large screen with the chief of staff and the commissioner of the Korea Disease Control and Prevention Agency. The situation in New York was being transmitted in real time.
Commissioner Park Seonyeong reported.
“The current number of patients in New York is twenty-eight. Three dead, seven in critical condition. The CDC has activated its emergency response system.”
“Where is Director Kang now?”
When the president turned and asked, the chief of staff answered with an awkward expression.
“We’re still checking, but we haven’t been able to reach him.”
Just then, the chief of staff’s cell phone rang. He checked the screen, and his eyes widened.
“Mr. President! It’s Director Kang!”
“Put him on speaker immediately.”
The call connected. But the background noise was strange.
The commotion of people and the sound of announcements.
The president asked,
“Director Kang Taeho? Where are you now?”
—Mr. President, I apologize. My report is late.
Taeho’s voice sounded a little distant.
—I’m at JFK Airport right now. I arrived twenty minutes ago.
“What did you say?”
Everyone present was startled.
“You mean JFK Airport in New York?”
—Yes. I departed yesterday afternoon.
“Director Kang, what on earth…”
Commissioner Park Seonyeong cut in.
“Director, did you coordinate with the American side? Whether the CDC will accept outside personnel…”
—I came here at their request.
The president nodded.
“Director Kang, since you’ve already arrived on-site, do your best. If you need anything, contact us directly through this line.”
—Thank you, Mr. President.
“But promise me one thing.”
—Please tell me.
“Come back alive and healthy. Without you, your homeland will be uneasy as well.”
Taeho’s brief laugh came through the call.
—I promise.
The call ended.
The president looked at the chief of staff.
“Contact the Consulate General in New York. Tell them to support Director Kang. Also brief the Minister of Foreign Affairs so we can respond immediately if the American side raises any issues.”
“Yes, Mr. President.”
After finishing his instructions, President Min gave a hollow laugh.
“He predicted this situation seventy-two hours in advance, and this time, he went ahead of everyone entirely.”
“He is an extraordinary man.”
Commissioner Park Seonyeong nodded in agreement.
***
After leaving the arrivals hall, Taeho pulled his suitcase and headed toward the pickup area. Gihwan, Sophie, and Jeong Minsu followed him, all with tense faces.
“Director, should we get a taxi?”
The moment Jeong Minsu asked, a black Mercedes stopped in front of them. The rear-seat window rolled down.
“Dr. Kang!”
An elegant silver-haired woman waved from beyond the window. She looked to be in her mid-seventies, but her eyes were full of charisma.
Taeho approached in surprise.
“Catherine? I didn’t think you’d come in person.”
“Get in. Are you going to your accommodations first?”
“I’m going straight to the hospital. But I have team members with me.”
“Don’t worry. The car behind us will take your team.”
Catherine pointed behind her. Another vehicle was waiting.
Taeho nodded to Gihwan and got into Catherine’s car.
The car began to move.
Catherine spoke first.
“Dr. Kang, now that you’re married, your face looks even brighter.”
“Thank you. I was already grateful that you attended the wedding, but the gift you gave was far too much.”
Catherine had attended the wedding in Abu Dhabi and had given them an apartment in Manhattan, New York, as a wedding gift. Taeho had thought it was too much and tried to refuse, but Catherine said she had already handled even the tax matters and would not take it back.
Catherine smiled and shook her head.
“Too much? Dr. Kang, aren’t you the benefactor of our family? And your bride is a princess of the UAE. When the benefactor of the Tisch family marries into the royal family of the UAE, of course we must give a gift befitting the occasion. Ah, Emily asked me to send her regards. These days, she’s completely obsessed with playing princess because Dr. Kang’s bride is an Arabian princess.”
“I’ll visit with my wife sometime.”
“You promised! Emily will be so happy.”
Once they had exchanged enough pleasantries, Catherine looked at Taeho with a serious gaze.
“Do you know the current situation?”
Through Rema, Taeho had been receiving real-time updates.
Twenty-eight patients. Three dead. Seven critical.
Case fatality rate, 9.5%. Bleeding tendency, multiple organ failure. Average time to death, ten hours.
Taeho answered with a grave expression.
“I understand that the number of patients is increasing rapidly.”
“That’s right. They say the medical staff are in a state of panic right now.”
Catherine’s voice lowered.
“The CDC still hasn’t found the cause, and there’s no treatment protocol. More than anything, at this rate, all of New York will know within forty-eight hours. Once the media starts moving… it will be uncontrollable.”
“I know.”
“During COVID, New York was hell. Even if people went to the hospital, there were no beds, so countless people died at home. Ambulances didn’t come for three hours at a time, and many patients breathed their last in corridors. The morgues overflowed, so we had to pile bodies in refrigerated trailers. Over the course of one year, 3.57 million people left New York. New Yorkers still haven’t escaped that trauma. Dr. Kang.”
Catherine took Taeho’s hand. Her hand was cold.
“You are our last hope. I will open everything for you. Hospital facilities, laboratories, medical staff, budget. Anything you need. Please save this city. The city Emily lives in, the city my grandchildren live in.”
Taeho looked into Catherine’s eyes. There was desperation there. A United States senator and the head of one of New York’s most prestigious families. But right now, she was simply a grandmother.
“I’ll do my best, Catherine.”
“I can’t tell you how grateful I am that you’re by my side at a moment like this. I’ll guarantee it in the name of the Tisch family. Whatever decision you make, I’ll shield you from behind.”
“Thank you.”
The car began crossing the Brooklyn Bridge. Beneath the bridge, the East River flowed darkly.
Catherine looked out the window and murmured,
“I remember 9/11, twenty years ago. Back then, this city almost collapsed too. But we survived. We can survive this time too, can’t we?”
“We will survive.”
Taeho answered firmly.
“But it won’t be easy. If we can’t set a course within seventy-two hours, patients will increase exponentially. We have to stop it before then.”
“Seventy-two hours.”
Catherine looked at her watch.
“Is the countdown starting now?”
“Yes. Starting now.”
The car stopped in front of Brooklyn Medical Center. The emergency room entrance was brightly lit. The sound of ambulance sirens could be heard.
Catherine gripped Taeho’s shoulder.
“Dr. Kang, you are not alone. The Tisch family is behind you, and I am behind you.”
“Thank you, Senator.”
“No, I’m the one who’s grateful.”
Tears gathered in Catherine’s eyes.
“For coming to save New York now.”
Taeho got out of the car, and Gihwan and the research team got out of the car that had followed behind.
Taeho looked up at the sign for Brooklyn Medical Center and said,
“Let’s go in.”