Copyright © 2012,
Published by Whiskey Creek
Reviews For THE SENECA SCOURGE
by Carrie Rubin
"‘The Seneca Scourge’ by Carrie
Rubin was impossible to put down.”
— Trudi LoPreto for Readers
"‘The Seneca Scourge’ by Carrie Rubin is a first-rate
medical thriller that includes totally believable science fiction elements.
The story is filled with great suspense and action and characters that
will engage the reader from the story's beginning to its conclusion.”
DiNizo for Readers Favorite
“I highly recommend this book. I would give
it 4 out of 4 stars for the aforementioned reasons. It was just well
written, well thought out, well planned, and just a great book altogether.
I highly recommend it to anyone who wants a fast paced, page turner
who isn't scared of a bit of medical terms and lots of scientific thought!”
The Online Book Club
Sample Chapter For THE SENECA
SCOURGE by Carrie Rubin
The thing about an outbreak is, nothing signals that
first patient, nothing as convenient as a neon sign suspended from
the neck flashing, “Hey, I’m the index case. Stop me before
It’s not until a second case occurs that an outbreak is declared,
and even then suspicions might not rouse. Not until the cells of infection
branch out, gaining momentum in multiple social directions, does the
pattern come into focus.
On a mild Monday afternoon in early November, Dr. Sydney McKnight’s
unenlightened focus centered on Thomas Lamb, her ICU consult. Although
not particularly thin, the gray-haired man looked frail in the white
bed sheets, his face pasty and furrowed. An endotracheal tube coursed
through his mouth, attached by a long tube to a mechanical ventilator,
the body of which produced a steady stream of artificial breaths every
five seconds. Pop, hiss. Pop, hiss.
From his left wrist dangled an arterial catheter for ease of blood
gas collection; from his right shoulder, a subclavian venous line for
IV fluids, medications, and other blood draws. His right index finger
housed the probe for the pulse oximeter, allowing constant measurement
of his oxygen saturation. Above that machine sat the cardiac monitor,
its continuous tracing a result of the sticky leads adhered to his
chest. Sydney had learned from his chart he’d developed an arrhythmia,
thus explaining the additional machine.
As she proceeded through her physical exam, Mr. Lamb either too ill
or sedated to respond, she couldn’t help but wonder how he might
spend the beautiful November afternoon if not held hostage by a hospital
bed and a collection of life-saving machines. A walk through Boston
Common? A long lunch in a neighborhood pub with his wife? Planning
a lecture in his office?
Sydney slipped the stethoscope underneath Mr. Lamb’s gown and
let it rest on his chest, harsh ventilator breaths greeting her in
return. She waited for a spontaneous breath of his own, but when it
came, it wasn’t much better; his lungs were sonorous and coarse.
Her exam shifted to the patient’s heart, the stethoscope rising
and falling with each expansion of his chest, but between the noisy
ventilator pops and the man’s own loud, ineffectual breaths,
the cardiac sounds barely resonated. Then Sydney palpated his belly,
examined his head and neck, and performed a quick neurologic exam,
the best she could, anyway, given Mr. Lamb’s unresponsive state.
When she finished, she felt no more enlightened than when she’d
entered the room, needing mostly to talk to the patient’s wife.
The ICU staff had already completed a thorough history with the woman,
but questions remained, particularly about the geologist’s recent
trip to Africa.
Sydney gave Mr. Lamb a final glance and left the room. She had decided
to walk over to radiology to study his x-rays, hoping that by the time
she returned, his wife would be back, but to her surprise, Dr. Jones,
the new infectious disease attending, sat behind the U-shaped ICU desk,
leafing through the patient’s chart. Despite all the beeping
machines, ringing phones, and simultaneous conversations, he looked
up when she approached.
Hello, Sydney, what’d you learn?”
Sydney hesitated, her blond brows furrowing. “I’m sorry,
I thought Dr. DeWitt was my attending. I planned to finish my workup
and page her.”
No need. I told her I’d take this one. It will be a good way
to get my feet moist. She was grateful, actually. She seems awfully
Oh, okay. Well, I examined Mr. Lamb and was about to go see his x-rays.
I’m hoping his wife will be back soon so I can talk to her and
try to obtain more information.”
Great. Give me a moment to finish examining his chart, and then we’ll
go view his films.”
Sydney nodded, and in a few moments, Dr. Jones stood and indicated
he was ready to go. Sydney eyed his pinstripe suit and black silk tie
and was once again surprised by his formal attire. Standing next to
him in her barely hospital-acceptable chinos and black GAP sweater,
she felt like a lost little orphan.
Once in the radiology department, Sydney escorted Dr. Jones to the
ICU x-ray board, and using a foot pedal, guided the whirring, rotating
panels to bed five, their patient, where four chest films hung, all
taken within the last twenty-four hours and each showing a progressively
worse stage of disease.
Wow, his lungs are almost whited out,” Sydney said, her voice
Dr. Jones nodded, his face registering the same degree of disbelief.
He grabbed an x-ray from the light board and held it in his hands.
Sydney watched as he ran his fingers over the surface, gently flipping
it one way then the other, as if the image was a delicate work of art.
She was about to inquire, when he mumbled something about cavemen beneath
Oh, don’t worry. All x-rays will be digitalized soon.”
Dr. Jones seemed not to have heard her and returned the film to its
place. “Doesn’t look good for Mr. Lamb, does it?”
No, Dr. Jones, it doesn’t.”
Please, call me Casper,” he said, still staring at the x-ray.
Then he stood, smiled, and headed back towards the unit, Sydney following
along like a dutiful student, amused at the thought of calling him
Casper—other than in her own mind—the name no odder than
the man himself. When they returned to the ICU, she was relieved to
see Mrs. Lamb back in her husband’s room.
After reaching for masks and gloves, the two physicians entered the
small space, still as gloomy as it had been minutes before. Sydney
introduced herself to Mrs. Lamb, and Casper did the same. The woman
gave them a polite but transient smile. She looked to be in her late
forties, dark hair, tall, mildly overweight. She wore a Michigan State
sweatshirt and a faded pair of jeans, and her makeup-free face suggested
she’d slept little in the past couple days. After a few moments
of sympathetic exchange, Sydney dived into the history.
Mrs. Lamb, I know from the chart your husband’s been ill for
about a week now, starting with what seemed like a cold and then developing
into fever, chills, and coughing—”
Relentless coughing,” she said, her voice weary.
Right. I was wondering if you could take us through the timeline once
again, particularly in relation to his trip to Africa. As infectious
disease consultants, we’re especially interested in the foreign
My husband was in Kenya. He’s a geologist and was studying soil
samples in a village near Nairobi—Hunchakos I think it was called.
He returned home five days ago but had started feeling ill two days
So he was already sick when he got on the plane?”
Mrs. Lamb gave Sydney a defensive look. “Yes.” She grabbed
a tissue and wiped her nose. This was followed by a brief cough.
Do you know where else he might have landed?”
I know he had a layover in London. Switched planes I think. Then I’m
pretty sure he flew directly into Boston.”
Did he give you any indication as to how he might have caught the illness?”
No. Like I said, it started as a cold, then everything spiraled downhill
after that. His fever spiked and his coughing increased. He felt weak
and shaky. I finally convinced him to go to a clinic three days ago,
where they did some kind of flu test. Even though it was negative,
they gave him a prescription and told him to follow-up if he didn’t
improve. Well, as you can see, he didn’t improve. The next day
we went to the emergency room, where they hooked him up to oxygen right
away and admitted him. We started out on the general ward, but before
I knew it, we were up here in the ICU, my husband hardly able to breathe
and now clinging to life on a ventilator.”
She reached for another tissue and dabbed her eyes, then more sniffling,
nose wiping, and coughing.
Mrs. Lamb, are you okay? You’re not sick as well, are you?”
No, no, I’m fine. Just a little scratchy throat and cough. Probably
my allergies. Stress always makes them worse.”
Hmm.” Sydney felt a wave of unease. “Maybe you better get
yourself checked out, too. Get a prescription like your husband. I
assume it was Tamiflu they gave him?”
Mrs. Lamb nodded. “Lot of good it did him.”
Tamiflu works best if given right away. It can shorten the duration
of illness and help prevent spread of the virus.”
Sydney realized she sounded like a pharmaceutical rep and tried again.
It certainly would be reasonable if you got yourself tested and started
But the ICU doctors said they’re not even sure Thomas has influenza.”
That’s true; his influenza antigen test was negative. But since
his course is still compatible with the disease, they want to wait
for the culture results.”
They said he might have something like Severe Acute Respiratory Syndrome,
some new strain. Isn’t that the one with the high mortality rate?” Mrs.
Lamb’s voice cracked, and she wiped her eyes again.
Yes, and I suppose we need to consider that, but it seems unlikely,
given there’s been no new cases of SARS since 2004.” Sydney
reached a gloved hand to Mrs. Lamb’s forearm and gave the woman
an awkward pat. Then she shot a look at Dr. Jones as if to say, feel
free to jump in anytime.
When he didn’t interject, Sydney turned back to Mrs. Lamb. “I
don’t suppose either of you had a flu shot, did you?”
Mrs. Lamb shook her head.
Sydney didn’t press the issue. The woman was distressed enough.
But it was unfortunate, considering a school teacher like Mrs. Lamb
was a perfect candidate for the vaccine.
They talked a little more, and Sydney reassured her they would do all
they could to find the exact cause of her husband’s illness and
try additional treatments if necessary.
Mrs. Lamb nodded and thanked them, but didn’t look especially
convinced. Sydney turned to Dr. Jones, waiting.
When Casper realized Sydney was staring at him, he said, “I’m
sorry, is there something you need?”
I’m waiting for you to do your exam.”
Oh, right.” He looked around the room as if searching for something.
Here, you can use mine.” Sydney cleaned her stethoscope with
alcohol. “There’s supposed to be a stethoscope left in
all respiratory isolation rooms, but I don’t see one in here.”
Right,” Casper said again, taking the stethoscope. It dangled
in his hands like a dead snake, and for a moment he just stared at
it. Sydney watched as he put the ear tips in his ears—backwards—and
placed the diaphragm of the scope on the patient’s chest. He
slid it from one position to the next, his movements awkward.
Sorry, my scope’s kind of old. Bought it used for a great price
in medical school, but since it still works, I see no need to replace
No, no, it’s fine.” He handed it back to her, seemingly
relieved to have the relic out of his hand. “I trust you completed
the rest of the exam.”
Sydney nodded and once again swiped her stethoscope with alcohol. She
was fastidious when it came to infection control.
Then no need to repeat it,” Casper said.
The comment pleased her. Nothing irked worse than staffing a patient
with the chairman of the department, Dr. Burke. He always had to go
back into the patient’s room and do another complete physical
exam, as if Sydney was a medical student rather than a fully trained,
soon to be board-certified physician who could be practicing medicine
completely on her own were she not doing an infectious disease fellowship.
Thinking of Dr. Burke, a.k.a. “Dr. Tomato Head” to the
residents, Sydney’s mind traveled back to their encounter a few
weeks ago, and she was no less miffed by the exchange now than she
had been at the time, Dr. Burke having asked—ordered, really—Sydney
to forego her current research project and instead team up with Dr.
But I’ve already laid the ground work. MRSA is an important topic
in the field of infectious disease,” Sydney had said, her interest
in methicillin-resistant Staphylococcus aureus strong.
As is West Nile Virus.”
That’s what this new guy is working on?”
Yes, that’s what this new guy is working on. Dr. Jones is a distinguished
physician and researcher. Not only is he board-certified in internal
medicine and infectious disease, he holds a Ph.D. in virology.”
But Dr. DeWitt is planning on me.”
Dr. DeWitt is a very busy researcher herself; she could do with one
less fellow to handhold. After all, you were the one who approached
her. By dropping your research project, she can spend more time on
Sydney steadied her voice. “Dr. Burke, I’ve been planning
this project since my residency.”
You’re only three months into your infectious disease fellowship—”
Four, but who’s counting?”
Okay, Dr. McKnight, four months. No need to raise my blood pressure
any higher than it already is. Now, you have two years and eight months
left of your fellowship. Did I at least get that right? Plenty of time
to start a new project.”
But this isn’t fair. I—”
Fair, Sydney? You want fair? How fair was it when you ordered a five-thousand-dollar
test on my patient? The one I distinctly told you not to. The one his
insurance company didn’t authorize.”
But he needed that study. If—”
And how fair was it when you fudged a diagnosis to justify an admission?”
That woman was clearly suicidal—she needed inpatient care. I
can’t help it if the psychiatry resident didn’t agree.”
There are rules, Dr. McKnight. Rules meant to be followed. By me. By
you. By everyone. It’s not always about you.” He paused
and glared at Sydney from across his desk. “I pulled strings
for you, remember? You’re an excellent clinician, but because
of your shenanigans, I had to fight to keep you here.”
And there it was. That constant reminder of what he’d done for
her. Godly Department Head Spares the Wayward Disciple.
But I know little about West Nile research,” Sydney said, sinking
back in her chair.
And so she would, fractured ego or not. Sydney had relished the chance
to work with Dr. DeWitt and knew nothing about the new guy. Dr. Burke
said Dr. Jones’s references were glowing, but if that were the
case, why had Sydney never heard of him? She was probably more up to
date on medical journals than the faculty, so why had she never come
across his name? And what kind of name was it, anyway? Casper Jones?
It sounded like a stage name. And when she met him for the first time
two weeks ago, she realized it wasn’t just his name that was
suited for Hollywood. The man was in his thirties, six-two, six-three,
maybe two hundred pounds—solid pounds—with closely cropped
hair covering his scalp like a soft blanket of moss. Dark eyes complimented
milk chocolate skin, and when he smiled, his whole face came alive,
highlighted by two perfectly positioned dimples, as if God had hollowed
them out as an afterthought, the finishing touch to a masterpiece.
The Tinseltown package didn’t lesson Sydney’s frustration
by the research exchange, however. Nor her suspicions of the man.
As she heard Dr. Jones’s voice, Sydney’s reverie broke,
transporting her back to the present.
I’m sorry, did you say something?” she asked, her cheeks
I said I think we’re finished with Mrs. Lamb.” Casper smiled
beneath his mask at the two of them.
Sydney nodded and said goodbye to Mrs. Lamb, at which time she and
Dr. Jones discarded their protective gear, washed their hands, and
left the room to discuss the case with the resident on duty, who was
behind the desk, charting on patients, seemingly oblivious to the bustling
ICU around her.
Hey, Crystal,” Sydney said. The second-year resident’s
red hair sported a ponytail, and her green eyes sparkled despite the
long hours she toiled. A muscular medical student named Joe hovered
by her side. “Can we talk about Mr. Lamb?”
Oh, sure.” Crystal smiled and bounded up in her chair. She grabbed
a notepad and pen. “What do you think’s wrong with the
Sydney looked at Casper who indicated with a brief nod of his head
that she continue.
Well, there’s still a good chance this is influenza, a bad case
that’s progressed to Adult Respiratory Distress Syndrome—ARDS.
Even with a negative antigen test.”
But it could be something like SARS as well?” the medical student
Yes, it could.” Frown lines wrinkled Sydney’s usually smooth
forehead. “And if it is SARS, it will be the first case in five
For a moment they were silent, and then Crystal said, “The viral
cultures should be back soon; then we’ll know for sure. Until
that time, is there anything else you think we should add?”
It’s a good idea to continue the antiviral as well as the antibiotics,
in case there’s a bacterial component. It also might be wise
to check some blood work for immune deficiency, including an HIV test.
And whatever you do, don’t stop the respiratory isolation. We
don’t need the pathogen visiting the other wards.” Sydney
eyed Casper. He nodded in agreement.
Crystal added the blood work to her to-do list.
Have you guys considered steroids in case it is ARDS?” Sydney
My attending mentioned it, but he wants to wait for the viral cultures.”
Sydney looked at Casper. “I guess that’s all I can think
of for now. Do you have anything else you want to add?”
No, I think you’ve covered it. The cultures will bear our truth.”
Sydney glanced at Crystal, but if the overworked redhead was similarly
bemused by Dr. Jones’s word play, she didn’t show it, her
gaze locked only on the beautiful man before her. Even the medical
student looked transfixed as Casper continued his instructions.
I want you to be sure to call me if anything develops with Mr. Lamb
tonight. And I especially want to know the results of the culture.”
Sydney nodded and added, “Hopefully with that knowledge, we can
keep this an isolated case.”
At that, Casper’s face darkened, and while Sydney assumed it
was out of concern for the patient, she couldn’t be sure. In
fact, a sudden and unexpected sense of foreboding enveloped her. But
when she looked at him again, the somberness vanished.
Probably just my imagination.