Chapter Thirty-Eight

Sokoto, Nigeria

Six Days Ago

Dr. Hans Koertig banged through the swinging doors of the field surgical suite, tore off his mask and gloves, and threw them into the trash. For two minutes he stood in the center of the scrub room, his eyes bright with fury, his fists balled into knots. He didn’t turn or look when the doors opened and Frieda Jaeger came in and quietly began stripping off her stained scrubs.

“I’m sorry, Hans,” she said softly, but he said nothing. Cartilage bunched at the corners of his jaws. “You did your best, but these things happen—”

Her words died on her tongue as he suddenly wheeled on her. “Did my best? Is that what you think, Frieda? That I did my best?”

He took a step toward her and she backed up.

“What I did in there was superb work. Superb.” Spit flew from his mouth as he shouted. “I’ve done reconstructive surgeries on two hundred noma patients in the four years I’ve been in Nigeria. Two hundred. I have never once—not once—lost a patient on the table.” He pointed at the doors. “That boy in there is the sixth child to die under my knife in eight days. Don’t you dare tell me that these things happen!”

“Perhaps you’re just overworked—” But as soon as she said it Frieda Jaeger knew that it was the wrong thing to say. Koertig’s eyes blazed with dangerous fury and for a moment she thought he was going to hit her, but instead he wrenched himself away, stalked to the sink, and began scrubbing his hands as if he wanted to wash the reality of it from his skin.

“I don’t lose patients, Frieda,” he said over his shoulder. “You can call me an arrogant ass, but the facts are the facts. I don’t lose patients. Not here, not in Kenya, not back home in Munich. God damn I don’t lose patients. Not children with noma. This isn’t the nineteen fifties, for Christ’s sake. This isn’t an aid station treating gangrene with a first-aid kit and a prayer. This is an AWD-Foundation surgical unit. No one on the continent has a better record than us for saving children.”

“I know, Hans,” she said weakly, “but the children are dying. It’s not just you. We’ve lost thirty in six weeks.”

Koertig wheeled on her. He looked stricken. “Thirty? What are you saying?”

Noma was a terrible disease, a severe form of infectious gangrene of the mouth or cheek that affected malnourished children throughout Africa, parts of Asia, and sections of Central America. Nearly all of the patients were between two and six years old and the disease literally ate away at the flesh of their cheeks and mouths, leaving them horribly disfigured and vulnerable to secondary infections. Since the mid-nineties the AWD-Stiftung Kinderhilfe, Dutch Noma Foundation, and Facing Africa has sent medical teams to Nigeria and other afflicted places. The teams, like this one in Sokoto, had done miraculous work in combating the disease and improving living conditions for the people. Plastic surgeons from Interplast had volunteered to do hundreds of reconstructive surgeries for children so they could return to normal lives. So they could live.

The disease was no longer universally fatal unless left untreated . . . but treatments existed, preventive medicines were being distributed, and food supplies were coming in from humanitarian organizations around the world.

And now this. Children dying from a disease that should no longer be able to kill them.

“How are so many dying?” he demanded.

“We . . . don’t know.”

“Have you done tests, for God’s sake?”

“We have. It’s noma . . . but the disease has become more aggressive.”

“Are you talking mutation?”

She shook her head, then nodded. “I’m not sure what to call it.”

Frieda Jaeger was a pediatric nurse in her fourth month in Nigeria. She was clearly out of her depth.

“Who is handling the tests?” snapped Koertig.

She gave him the name of the lab. The doctor finished scrubbing and then hurried out to make some calls. Noma was an old disease. It was vicious but stable, predictable.

Terror gripped his heart as he ran to his trailer and the satellite phone he used for emergencies.

God help these children if it had mutated.

God help the children everywhere.