BLACKWATER FEVER

The malaria organism knew about temperature changes. It knew it liked some degree of warmth. It didn’t know its biological name of plasmodium falciparum and it knew nothing of its more benign relatives, plasmodium ovale, plasmodium vivax, or plasmodium malariae. It just didn’t care. A protozoan parasite didn’t have feelings. It just existed to exist. It didn’t even remember its past different host environments. Sometime in the past it had been an inactive microscopic entity in the salivary gland of a mosquito–a sporozoite. Now it was a larger merozoite and began a more active, proliferative existence in the bigger, warmer organism of the human body.

The falciparum organism in its human host didn’t know how old it was. It could have been a few years old or from a reproducing strain a few linear centuries old. Right now it was nestling in the organ called the liver. From past experience it knew a chemical would be coming to temporarily stop it from being allowed to live in the red blood cells. That was okay. If its host died, the organism would die also unless a mosquito bit into it and injected it into another human. As far as the falciparum knew, this was its definitive living environment and it was content until the next chemical would release it. The falciparum was unaware that it had produced myriads of siblings living snugly within the sick and dying red blood cells.

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Swanson still felt slightly fatigued as he gained entrance to Winn’s apartment foyer. The doorman had received appropriate notification of his expected arrival and confirmed it with Barbara Winn. He knocked on her door with a gift bottle of wine.

“David you didn’t have to bring anything, especially wine. You can’t have anything that’s potentially toxic to your liver. Alcohol is a poison to you. You can’t even have alcohol-containing cough medicines or mouth wash.”

“You make me feel like a culinary cripple.” He handed her the bottle and removed his coat with a gaze at the closed second bedroom door.

“You’re not a culinary cripple,” she replied. “I have a healthy pasta meal. Slow carbohydrates are okay.” She followed his eyes to the closed door. “Samantha’s asleep.”

“I’ve gotten used to seeing her when I visit. Are you sure she’s all right?”

If I open that door she’ll wake up and if she sees you God knows what she’ll come out with.”

“Maybe if I knock before we open the door.” Swanson walked toward the bedroom door.

“Don’t say I didn’t warn you.” Winn smiled.

Swanson knocked and opened the door slowly. “Samantha. Samantha,” he whispered.

Suddenly a loud harsh voice screamed out, “Go away. Go away. Go away.”

“Samantha it’s me–David.” He walked slowly toward the light switch.

“You suck. You suck. You suck.” The same voice pierced the room. It was a man’s voice.

Winn was laughing at the doorway. “There are just some things that trigger her inappropriate vocabulary.” Winn walked toward the large cage with its opened door and extended her hand. The fully grown pure white cockatoo leaped onto her forearm. Winn blew her a kiss.

Samantha bobbed her head up-an-down a few times. “I love you. I love you. I love you.”

“Okay Samantha we love you too. David, scratch under her wings and say something sweet.”

“It’s good to see you Samantha.” Swanson put his hand on the bird’s breast and eased it under her right wing which the bird raised. The cockatoo was as large as some eagles and had a beak that could remove fingers in one bite.

“Go to hell. Go to hell. Go to Hell.” It was a woman’s voice now but not Winn’s.

Winn brought Samantha to a central perch on the kitchen table. The base of the perch looked like two metal salad bowls, one inverted to hold the perch as a base and the other upright and filled with cut newspapers to catch Samantha’s droppings. “She’ll be quiet until we talk to her again.”

“Does Samantha ever mention her old master’s name?”

“No. I’ve had her two-years now but I got to know her the year before that. Her previous owner was a retired Navy seaman and he had her for twenty-years. They have a human life-span. Her master was dying at the VA and he asked me to take care of her. When he died he bequeathed her to me. I’ve taught her civil speech but she still lapses into salty raunchy phrases like a door knocking always brings out ‘go away’.”

Winn sat on the sofa in her combination living room-TV room and motioned Swanson to sit next to her.

“Thanks for seeing me tonight.”

“For God’s sakes David, you make it sound like this is a professional appointment. I’m a woman, a friend and this is a date. Remember what a date is? Remember from college or high school or whatever?” She smiled and touched his hand.

“I’ve never had social graces. I think it’s why the military seemed so logical for me.”

“The Army was three years ago David. We’ve known each other two years now ever since the VA first managed the malaria research study.” She kept her hand on the back of his. “So why tonight? I mean I’m always available to you in almost any capacity.” A hint of seduction formed on her smile. It was lost on Swanson.

“To be honest I’m terrified of going out socially for any reason and with anyone. I’m afraid of getting an attack. Like last night.”

“Tell me about it.”

He told her everything he could remember and gave her a questioning look. He kept silent waiting for an explanation, a look of understanding, or what to do next.

“David, your inability to remember doesn’t fit with having falciparum or any other kind of malaria attacks.” She took a deep breath. “I’m sure Binelli or Krantz have asked you this but have you ever been incontinent or fallen to the ground with these attacks?”

“Krantz has asked me about that. No, I’ve never had any seizures or convulsive episodes, witnessed or unwitnessed.” He reddened at the intimate question. “My bladder and bowel function are okay.”

“It’s very rare to get seizures from cerebral malaria or from the high temperatures with malaria fevers.”

“So why am I such a different…unique case?” He stood up.

“Sit down and relax. I don’t know the answer. Dr. Binelli is the VA infectious disease and malaria consultant to the New York VA system. What answers does she give you?”

He sat down. “She doesn’t know. According to her, I’ve become one of almost a hundred other unusual cases coming back from Iraq with this strain of plasmodium according to her and Krantz.”

“Okay. Tell me about your date last night.” She smiled.

“It wasn’t really a date. Her name is Lisa Feldman and she’s here for a stock broker’s convention. It was a business dinner.”

“Did you feel an attack coming on like the others we’ve talked about in the past?”

“Yes. But Binelli gave me a shot of a new antimalarial to prevent anything like this. And it happened anyway.”

Winn frowned. “Shot? What kind of shot?”

“An experimental drug. I don’t know the name. I think it had a code number.”

Winn stood up. “I have to add the pasta to the boiling water. Dr. Binelli has to document all of your treatments for the VA national malaria program for all veterans. I’ll check your records tomorrow. For now, just try to relax. Oh, and is your urine clearing?”

He blushed again. “How can I relax when you ask such personal questions?” He emerged from the bathroom with his urine sample in a clear plastic cup.

“Yes, it’s just a slight pink now.” Winn smiled.

He watched her work in the tiny kitchen as she threw him an expectant glance.

“So what happened to your date last night? How’d she end up falling down stairs?”

“C’mon, it wasn’t a date. It was a business dinner.” He took a deep breath. “I don’t know. I don’t even remember going to her hotel room.”

“That scares me, David. I mean you don’t remember going to her room? Most men remember such highlights.”

He stared at her. “Highlights? She was found unconscious in the third floor stairwell of the Talbert Hotel.”

She gave him a concerned look.

“Don’t worry; I’m not going to throw you down any stairs.”

“No. I know that. For me, as a falciparum expert, the real problem is the memory thing. It just doesn’t fit with the malaria attacks. So what’s the status of Miss What’s-her-name?”

“Lisa Feldman. She’s in a coma in ICU at New York University hospital.” He looked down as he slowly said the words.

“Oh my God.” Winn put her right palm to her lips.

“Oh my God. Oh my God. Oh my God.” Samantha went on mimicking Winn’s voice and words.