Louis did not open the laptop on his first day off.

  He told himself it was intentional - maybe even strategic. He never signed notes on the first day off; especially if it had been a busier stretch of work. It gave his mind to decompress and relax, though on the flipside, it meant that he had to think harder about what happened when he went back. It was a double-edged sword he was happy to wield.

  So, on the first day, he slept.

  It wasn't quite the kind of sleep that necessarily restored anything - just the heavy, unceremonious collapse of someone who had been upright for too long. He woke up in fragmented pieces; once at noon, again at three in the afternoon. The first time, he felt groggy. The second time, he felt worse. When he blearily blinked at the dull glow of his phone, he groaned as he rolled onto his back. Even on his day off, his body could only tolerate five or so hours of sleep.

  Reluctant to get up, but feeling a pang of hunger, he hauled himself out of bed, trying to blink past the drowsiness that still clouded his vision. Working nights paid well - but it cost him a portion of sanity and health, namely in the form of a routine sleep schedule. The sunlight - midday and high - flittered in through the windows as he stepped into the hallway, his brain already trying to figure out why it was so bright and what day it even was.

  A yawn pierced the silence of the house, nobody around to greet him. Just like every other morning. Or rather, afternoon.

  He glanced back toward his bedroom, debating if a shower was in order; but he'd already taken one when he'd gotten off shift only a few hours ago. As much as he liked feeling clean, he also hated the dry skin that came from his preferred scalding temperatures. As another pang of hunger bit at his brain, he made up his mind: brunch first, then figure out everything else.

  There was nothing extravagant in the fridge - unfortunately, a byproduct of having been on a long string of shifts. Which meant he was having questionable leftovers.

  As he peered through the fridge, he grumbled to himself, wishing he was more of a grocery-shopper. Leftover pasta it is, he decided with a glum sigh.

  He flipped on his television in the living room, flopping onto the couch with the steaming bowl of leftover pasta on his lap, grateful for some sort of noise. He didn't care what was on - he wouldn't remember it, anyways. It was filler; something to add to the bland taste of the pasta, steaming on the edge of his fork.

  He did not open his laptop.

  On the second day, he cleaned.

  Laundry was washed, dried, folded, and put away. The dishes that had slowly been piling up in the sink were finally washed and dried. He even went and vacuumed the floors, though there wasn't much of a hint of dirt collecting on the tile. At some point, he was almost positive he ended up cleaning the same room twice because he'd lost track midway through; but, such was the way he was. Once the house chores were done, he found himself with nothing left to distract him from inevitable.

  And so, he sighed heavily and shambled over to his laptop with all of the enthusiasm of a cat being taken for a bath. The device didn't react; but he could've sworn it seemed to flicker brighter when he finally opened the screen.

  It only took a few moments to power up and sign into the electronic medical system; it was muscle-memory at this point. A monotonous routine that he was sure would consume his soul one day. The first thing he saw was the ER patient board, and he held back a dry snort as the number in the waiting room eclipsed 50. His eyes flickered to the inbox notification, only 14 unsigned charts left. Not bad.

  His eyes flickered to the clock in the bottom right of his computer. He still had four hours before someone from billing called him to ensure compliance. Forty-eight hours; that was the policy. After that number passed, a notice was sent to the department chair and several executives, who would almost certainly be sending him a text or e-mail - then, he'd be doing them with a write-up staring him down.

  "Let's be responsible..." he mumbled to the empty room.

  For a moment, he did nothing - then, he finally clicked on the inbox and opened the first chart.

  The first three or four were all routine.

  Viral syndrome with unrelenting vital signs. Dehydration with mild kidney injury. Hypokalemia requiring IV transfusion.

  Admit to medicine. Admit to medicine. Admit to medicine.

  He signed them quickly and efficiently, skimming his documentation with a hint of embarrassment at the clipped tone he'd started using as the night had been wearing thin. He could always tell when he'd hit that ninth hour of a shift - his sentences got shorter, his ED course notes were more abbreviated, and his empathy condensed. It was a habit he was trying to improve on. Clearly, it still needed a lot of work.

  When he got to the fifth note, he paused briefly, intrigued flared.

  58-year-old male with fever, myalgias, headache, arrived via EMS. This was the first medical yellow he'd had during the shift - when he was still fresh on the shift. While he remembered most of his patients, he really remembered this one. They'd been the first of the slew of 'flu-like symptoms' that had refused to improve after medications. They'd tested negative for everything, though their labs were just... not great. Mild kidney injury. Dehydration. Non-specific increases in inflammatory markers. Borderline lactic acidosis.

  He'd admitted this one, just like the other dozen or so.

  It wasn't the admission or their case that had him pause, though. It was the note a few hours after his that read: Rapid Response - ICU/Critical Care.

  Subconsciously, he straightened in his chair as he leaned in a hair. His brow furrowed as he slowly scrolled through the progress note, meticulously reading the author's impression.

  "Called to bedside for increased confusion and acute respiratory decline. Patient saturating mid-70s on room air; attempted Bi-PAP with no improvement in condition. Patient became unresponsive, requiring emergent intubation and subsequent transfer to ICU."

  He frowned, respiratory decline?

  That hadn't been part of the picture at any point.

  He had recalled the chest x-ray; it was clear as day. Wondering if he made a mistake in interpretation, Louis toggled over a tab and re-opened the chest x-ray that he'd ordered. But, as the image appeared on-screen, Louis's frown deepened. It was clear; no pneumonia, no evidence of fluid build-up. It was clean; not a thing stood out. The Radiologist had agreed; their report was the same as his.

  "So... what happened...?" Louis muttered, taking a second to sip some water.

  He scrolled further, opening the radiology report for a CT chest that had been ordered after intubation.

  Impression: Suggestive of mild atelectasis in the left lower lobe. No pneumonia. ET tube visualized in appropriate position. No pneumothorax. Unremarkable CT.

  "The fuck...? So, why...?" The silence said nothing in return as Louis stared at the report in blank thought. "Why did they suddenly decline?"

  He peered through the rest of the chart - reviewing labs that had processed after admission, been repeated, and added onto. Their organ function had further declined - likely result of the respiratory distress episode. Their blood cultures remained negative, though, which was a good thing. Their full respiratory panel was negative... as was the sputum test, collected after the intubation. Amidst all the new changes, there was nothing that explained the sudden decline.

  "Okay... just... a weird case," Louis said, though it was more for his own racing thoughts. He let out a thick breath and went back to his note, double-checking everything was in order, before signing it.

  Then, his eyes lingering on the patient's chart, he finally clicked out of it, trying to purge the case from his mind. It would make for an interesting resident lecture; but right now, he had others charts he needed to get done.

  When the next chart opened, he couldn't help the way his eyes widened.

  Rapid Response - ICU/Critical Care.

  Again.

  Louis felt his jaw tighten as his eyes darted to the patient's name; this one had been younger. 31-year-old female. Her medical history was limited, as she came in alone; but previous visits had been clear. She, too, had been the same initial presentation. He admitted her for the same reasons. And she'd been subsequently upgraded to the ICU, too.

  "Called to bedside for seizure-like activity with failure to protect airway. Following multiple administrations of benzodiazepine, it was decided to emergently intubate the patient for airway protection. Neurology consulted; patient will be transferred to ICU for management post-intubation."

  Two notes below, Louis immediately saw the Neurology consult and clicked it without hesitation. He skimmed it; mostly, the note highlighted the seizure-like activity they'd been consulted for, but given the lack of subsequent seizures and the timing of everything, nothing further had been done or catelouged. CT of the head had been normal. But they'd done a lumbar puncture with...

  He paused, then sighed.

  CSF cultures still pending.

  Dammit.

  They'd started a spry of empiric care, though. Antivirals, antibiotics - even antifungals, which Louis raised an eyebrow at. Typically, antifungals were reserved for cases of high suspicion versus immunocompromised patients. To his knowledge, she'd been neither.

  Closing the Neurology note, Louis hesitated as the mouse highlighted his note.

  Two ICU patients in one shift? That was... high. Even weirder, neither of them had very clear-cut reasons they'd sudden decompensated so sharply. He'd had sick patients he'd admitted before and seen them inevitably moved to the ICU when their condition continued to worsen. It was the undesired, but necessary part of admission - to monitor their condition and make sure interventions were taken when needed. But those patients had all shown signs they were at-risk for complication.

  Royal Road is the home of this novel. Visit there to read the original and support the author.

  These two? They'd been sick, sure; but not... not like that.

  He took a shaky sip of water, trying to push down the rising questions. He would find no answers; he knew that. But it didn't stop the budding curiosity that stirred at the back of his brain.

  He finally opened his note, read it slowly, and finally signed it with an ounce of hesitance. Then, he moved on reluctantly.

  The notes... didn't get better.

  By his eighth chart, there had been four ICU upgrades.

  By the twelfth, there were seven.

  Nearby, the fridge began to hum, the motor breaking the thick silence that had fallen around Louis. "Alright. What am I missing here...?"

  He looked at the remaining charts, then froze: Hannah Reed. Room 40.

  There was the smallest part of him that didn't want to open the note. Somewhere inside, he knew it wouldn't be good. Every single atom in his body hoped it was good news - that she'd improved rapidly, maybe even been discharged home, safe and sound. But the weight in his chest was too heavy - too familiar. As he gnawed on his bottom lip, he finally clicked.

  Rapid Response - ICU/Critical Care.

  "Fuck..."

  The first was the nurse's note. "During assessment, it was noted that patient was minimally responsive to verbal and physical stimuli. Sternal rub without changes in status. This RN called physician to bedside; no new orders. Pending CSF studies from ED collection. Patient's condition: guarded."

  "Hospitalization day 1, 2100: Significant agitation noted; tachycardic to 180s. Hypertensive episodes noted, 200 systolic."

  Then, there was the Critical Care note. "Called to bedside for acute neurological change with failure to protect airway. Lateral, leftward gaze deviation noted. Nonverbal, nonresponsive. Decision to emergently intubate for airway protection. Neurology consulted, STAT CT Head/Brain ordered."

  Agitation? Hypertensive spikes?

  That wasn't really consistent with meningitis or encephalitis. Louis strained his brain, trying to recall some of the most bizarre things he'd ever heard in residency; but the harder he thought, the less he came up with. There wasn't an answer that was so easily found, it seemed. And, judging by the lack of answers provided by various specialties, including Infectious Disease, Louis had a sinking feeling that the answer was far more complex than anything he could come up with.

  Slowly, still lost in thought, he turned to the Neurology consult note, hoping that maybe there'd be some grain of an answer in their assessment.

  "Patient with profound encephalopathy that is inconsistent with imaging findings. MRI brain largely unremarkable upon review. There are no focal lesions identified. EEG was successfully performed, with diffuse slowing. No epileptiform activity captured. CSF results as collected by ED physician have been reviewed. Opening pressure was noted normal; appearance was noted as clear. White blood cell count with mild elevation. Protein count also mildly elevated. Glucose within normal limits. However, glutamate levels are markedly elevated."

  Louis paused, blinking several times.

  He re-read the line again, his frown growing. Glutamate?

  Why were they even running a glutamate? He hadn't added that - had he?

  He toggled to the lab section, finding his CSF order - then made a low sound of understanding as he saw a comment. "CSF excitatory animo acid panel added due to concern for atypical encephalitis."

  "So... they're clearly thinking something, but what?" Louis said, leaning back in the chair. His water all but forgotten, he leaned forward again, scrolling through the remaining cerebrospinal fluid results. "Glutamate... so they're thinking something that causes increased excitation within the brain? But..."

  Louis paused again, tilted his head upward as he pondered. "That's not really... a viral or bacterial thing. Especially with the glucose and white blood cells all being close to normal..."

  He skipped down to the culture part - potentially the most telling of the story.

  Which were... all negative.

  The fungal stain was negative, the gram stain was negative, the viral PCR panel was negative - everything was negative. Louis couldn't help the scoff of frustration as he let his hand slap onto his thigh. "No way - what the hell? I don't g--"

  Beta-glucan fragments detected!

  If possible, his brow furrowed deeper.

  Beta-glucan fragments meant fungal cell wall material. But yet, the fungal stain was negative?

  "Did I fuck something up...?" Louis muttered lowly. "Did I... contaminate something?"

  He thought back - he'd properly sterilized the skin, he'd worn sterile gloves, hadn't broke sterile field as far as he could recall, and had a perfect, clean tap. Nothing had been amiss. He hadn't made a mistake - right?

  "Did I...?"

  Down a few boxes, there was a small symbol representing a piece of paper - usually a lab note, or something that someone had written to add to otherwise automated results. When his mouse hovered over the paper, he saw it labeled: microbiology note. Without a second thought, he clicked on the label, leaning in rather close to the screen as it populated.

  "Repeat assay confirms presence of beta-glucan fragments. No viable fungal organisms identified."

  "That's impossible," Louis said to nobody. "How the hell are there fungal fragments without an actual fungus?"

  Maybe it was silence that became too much, or maybe it was the confusing nature of the lab studies, but Louis found his hands reaching for his phone, scrolling through his list of contacts. His eyes skimmed the screen until he found the one he was looking for - a colleague of his, and good friend.

  Dr. Lydia Kessler.

  He dialed without hesitance - he wasn't sure if she was on-shift. Hell, he didn't know if she was busy with her kids, either. But he knew that if she saw her phone, she'd answer. He barely ever called.

  And, sure enough, she answered on the second ring, a bit of hastiness in her voice.

  "Hello? Louis, what's up?"

  "Hey, Lydia. Sorry, um, you busy?" He tried to keep the hurried tone from coming across - he wasn't sure if he was successful.

  Judging by how the edge in her voice didn't fade, he'd say he wasn't. "I'm heading to work now; I'm mid-shift today. What's up?"

  "Just..." Louis paused, his eyes tracing the computer screen again. "Look, mind if I run something by you?"

  "Uh... sure..." Her voice was uneasy - and he couldn't blame her. He never asked for help. "Are you okay?"

  Was he? That was a good - and very valid - question.

  "Yeah... yeah, I think so. Just, reviewing some notes from the other night, and..."

  "Oh. You saw the ICU-upgrades, huh?" Her tone changed; it became softer, almost... comforting. The same tone that he recognized they both used when breaking bad news to patients and families. So, she knew? "Look... you didn't do anything wrong. I reviewed your stuff - I was actually one of the ones that was called to the inpatient unit; they've had a lot of upgrades. Way too many, to be honest. I think I saw one of yours. But it's been happening to us all."

  "W-wait," Louis said, scratching at his forehead. "What... what's been going on?"

  There was a brief moment of silence on the other end, and for a moment, Louis wondered if he'd dropped the call. Then, "we... don't know. The volume has been... high - everyone's got that bug, you know? But everyone admitted with those symptoms is deteriorating fast. I think the ICU was handling it okay at first, but they've been overwhelmed by the volume; so, administration was asking the ER to help out for any rapid responses that occur near nighttime hours."

  "In two days, it changed that much?!"

  Lydia let out a humorless laugh. "Yeah, I guess so. Looks like it's becoming a pandemic - I'm surprised the CDC hasn't come out with any official guidelines. But the media won't shut up about it."

  "About... what? The sickness?" Louis winced; it was times like this that he somewhat regret his nature of ignoring the news like it was a wildfire.

  She laughed again - this time, though, it was lighter. Genuine. "You seriously don't watch the news, huh? I envy you a little bit. They're calling it some iteration of the flu or something. Essentially - telling everyone to stay indoors and avoid people. Not really working, of course. But you really should try to watch the news - I think they'll be declaring a state of emergency if this keeps up."

  "So other hospitals are dealing with it, too?"

  "Definitely. Some are doing a lot worse, though. I heard that there was some big issue at Hudson General across the city; some nurse got, like, mauled by a patient. Several others were bit trying to get the lady down, but it was a whole thing. They... kind of warned us when we started responding to these rapid responses."

  Louis's eyes drifted toward the shelf of movies he hadn't touched in what felt like years. "Like a zombie movie?"

  "Ha! Funny, but no. Just some weird, delirious patients, Louis," Lydia said easily enough, like nothing strange was going on. Like nothing of this bothered her.

  "...yeah."

  There was a pause in the conversation, where a weight seemed to hang ominously above them. It almost felt suffocating, if Louis was honest - which, in a way, was ironic. He was known for being cool and collected. The unflappable Dr. Fleming, as the nurses had dubbed him. Yet now? He felt... lost in the void of the unknown. When he'd stared in the darkness, he'd seen everything and nothing, and couldn't make sense of either.

  "So..." Lydia mercifully broke the silence, her voice droning through the speaker. "What did you want to ask me?"

  "O-oh, yeah." He blinked, resetting mentally. "I was looking at some of the LP results from my patients - I did one of them myself, and... there's some weird stuff."

  "Oh, yeah, the LPs... they were kind of strange. I think I saw a report of one of them - Carla was talking about it. The one that had super high glutamate and something fungal?"

  Louis clicked back to the CSF results on his computer. "Kind of, yeah. Except, it wasn't fungal - not really. It was beta-glucan fragments. The fungal stain itself was negative."

  "That's weird. Why would there be beta-glucan in the sample but no fungus?" There was the sound of a car door opening in the background, followed by a change in the audio quality. "Also, I'm pulling in, sorry if you hear a bunch of noise. It's been really busy here, as you probably know."

  "It's fine - but, yeah. It is weird. That's not... really standard for a virus or anything," Louis pointed out.

  "No... but I'm also not a microbiologist. Or with Infectious Disease. Or the CDC," Lydia said with an airy laugh. "Point is, yeah, it is weird. But until they say something, I couldn't tell you what any of that means."

  Louis sighed. 'So much for help...'

  The background suddenly picked up on Lydia's end, the faint, but unmistakable noise of the bustling ER setting filling the silence between the two. Sensing that the call was coming to an abrupt end, Louis suppressed a heavy sigh that bubbled in his chest. His fingers found his cup of water from earlier, and he eagerly sipped, hoping the now-room temperature liquid would do something for his nerves.

  "Look - it's strange. No lies there. But weird infections pop up every few years. Then, once the hysteria passes, we move on. Right now, we just have to be safe when working, and follow what guidelines come up. And you," Lydia said pointedly. "You should really go on a date or something. Well, maybe not now, but at some point. I think you're getting too sucked into work."

  Louis rolled his eyes, knowing she couldn't see him. "Whatever - see you, Lydia. Have a good shift."

  "It won't be," she said in return, though her tone sounded no different than if she were talking about the weather. "But all shifts end eventually."

  When the line went dead, Louis barely reacted. His eyes still stared at the computer screen, as if the haunting results would speak to him - maybe tell him what they were trying to say. But, like the rest of his house, they were silent, and there were no answers.

  The house felt impossibly still. Even in the midst of the day, sun shining through the windows innocently, it felt... dark. Like something unknown was lurking, stalking him. His eyes flickered to the television that sat dormant. Maybe... should he watch the news...? Get caught up?

  Part of him didn't feel like getting any more riled up. He already felt enough on edge as it was. Adding to that burden would do nothing. His gaze settled back on his laptop, which had dimmed in the time it hadn't been acknowledged. He gently moved the mouse, bringing the screen back to bright, where he simply stared through it once more.

  Glutamate, an excitatory neurotransmitter... beta-glucan fragments, strongly suspicion for fungal cell wall presence - but no evidence of fungus present...

  He slowly moved his mouse back to his chart and read through it. His eyes moved agonizingly slow, as if every word contained something hidden within them - trapped in a language he couldn't read. By the time he'd finished reading the procedure note, he found himself at the bottom of the note, with the sign button staring back at him with a smirk. The mouse slid over the button, where he hesitated.

  Sign it, Louis. There's nothing going on. It's weird. But things are weird.

  Sign it.

  Sign it.

  He clicked.

  Louis Fleming, DO.

  Authenticated. Yet the words made his stomach twist uncomfortably.

  He pushed through the remaining notes, his brain all but shutting down as he clicked sign multiple times. An uncomfortable numbness had taken over; perhaps his brain overtaxed. Outside, in the distance, he heard a siren wail faintly; something he was certain he'd heard over a million times. But right now? In the forty-eight hours since he'd left his shift? Everything had changed in a way he couldn't decipher.

  And he wasn't entirely sure how it would end.