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She reached up to check that her mask was in place over her nose and mouth, then cut through the line and into the medical spaces. She saw a few of the sickest heaving into trash cans they had brought with them, but that had become so commonplace that she barely even noticed. Of course, she had been up all night, treating the sick, so maybe it was just her exhaustion that prevented her from focusing on what she had come to accept.

We’re in big, big trouble.

She stepped into the ward and saw Diona leaning over Andy with a worried look on her face. She waved off a few of the ship’s company corpsmen and made a beeline for the sleeping COD pilot. “What’s going on?”

“His blood pressure has been dropping,” Diona said, reaching up to affix a 1000-milliliter bag of 0.9 % sodium chloride solution to the tree above his bed. “And his heart rate has been increasing.”

Doc knew what the petty officer was thinking, and she admitted that an intravenous injection of saline solution was exactly what she would have ordered. Andy needed extracellular fluid replacement and treatment for metabolic alkalosis in the presence of fluid loss and mild sodium depletion. In short, he was severely dehydrated, and Diona was doing precisely the right thing.

She glanced at the vital signs monitor and saw that the pilot’s temperature was 104 degrees — well above what she would have expected for someone who was only dehydrated. Even for a person who was recovering from an infection that had triggered gastroenteritis, it was far higher than she was comfortable with.

“Anybody else with this high of a fever?”

Diona glanced at the monitor and shook her head. “It was less than one hundred just a minute ago.”

Doc reached down and placed her hand on Andy’s arm. It had been clammy when they brought him down from his stateroom, but now it was red and hot and dry to the touch. “Andy? Can you hear me?”

His eyes twitched behind closed lids, but he didn’t respond.

She looked up at the monitor and saw his heart rate top 130 beats per minute. “Maybe the saline will help.”

Diona opened the valve to allow the fluid into the IV port, then turned to Doc. “This is the third bag,” she said, with just a hint of worry intruding on her normally calm demeanor.

“Has it helped?”

The corpsman shook her head.

Doc knew a good rule of thumb was 30 milliliters of fluid per 2.2 pounds of body weight, so it wouldn’t be unexpected for it to take three bags of saline solution to counter the effects of extreme hydration. But she would have at least expected his pulse to stabilize closer to one hundred beats per minute and for his blood pressure to rise to within an acceptable range.

“I don’t like this,” Doc said.

“What should we do?” The corpsman was looking for reassurance, but Doc wasn’t sure she had any to give. They were doing everything they could to keep him comfortable and replenish his fluid loss, but it didn’t look like it was helping much.

“I don’t…”

Andy’s eyes opened. “Doc?”

“I’m here,” she said, reaching down again to gently rest a hand on his chest.

“I don’t feel so good,” he said.

Suddenly, his body went rigid. Doc froze when she recognized the tonic phase of a seizure, but she kept her hand on the pilot’s chest as she looked down into his pleading eyes. “You’re okay, Andy.”

She hadn’t realized it, but she had been counting the duration while she waited for it to progress to the next stage of seizure, known as the clonic phase.

Six… seven… eight…

Andy’s muscles relaxed, then he started twitching. Each jerking movement of his body seemed like an electric shock that underscored the dire situation the USS Ronald Reagan had found itself in. Doc kept her hand on his chest while he thrashed on the gurney, and she looked around the ward at the other sailors who had come in looking for medicine to make them well. Would they all burn hot with fever and become so severely dehydrated that they also seized?

“What do we do?” Diona asked.

At last, Andy’s body fell still, and his heart rate slowed. It was only a few beats lower, but it was enough to give Doc hope.

Again, she surveyed the other patients. There were a handful who had come in not long after they brought Andy down, and she could already tell that they would follow a similar trend as the virus cooked them from the inside out. Even more were only showing the early signs of infection, but she knew that would soon change. If they didn’t get help soon, the ship would be dead in the water without a crew to run it.

“Doc?”

Sierra looked up at the corpsman and shook off her paralysis. She saw that Andy had slipped back into unconsciousness and that his vitals appeared to have stabilized. “Electrolytes.”

“What?”

She spun away from the COD pilot and looked for the pharmacy technician. The second class petty officer was the only one on the ship authorized to dispense medication, but it wasn’t medication she was after.

“Salt tabs,” she said. “Everyone on the ship needs to start taking salt tabs.”

* * *