Living with the Plagues

killing at least 200 and injuring thousands. Shock, agony, anger, and fear spread from the clouds of smoke and debris. Then came corrosive anxi-ety—the hallmark of our age. Belief in fate and karma kept us going as we learned to live and cope with terrorism. Then, just as monsoon follows Indian summer, another tragedy came. In September, an earthquake near Latur, Maharashtra, flattened villages, killed thousands, and spawned bubonic plague. We drowned our sorrows in festivals , cricket matches, and movies, and we lived on. I was in medical school when the next disaster struck in 1994. They came with their faces covered with handkerchiefs. Luggage in hand, they rushed from buses or trucks outside the hospital into the emergency room, where I was an intern. The first few masked patients did not attract much notice, but a roomful of them clamoring for attention and begging for tetracycline created a ruckus. Torrential rains had flooded the city of Surat on the bank of the river Tapti, and mystery pneumonia gripped the population, killing them quickly with respiratory failure. The word " plague " was all over the streets and the news. The local doctors were among the first to flee. " Diamond City " lost its luster as immigrant workers scrambled on to trains, buses, and trucks, toward their hometowns. Surat was desolate. Flights and exports from India were banned, garbage and rats ruled the streets, and panic settled in. Then, the floodwaters of the river receded, and the outbreak subsided as quickly and mysteriously as it had erupted. The reemergence of Black Death caused much soul-searching among the intelligentsia. They blamed it on the earthquake in Maharashtra, monsoon floods, poor sanitation , and angry gods. " Foreign hand " alarmists raised the specter of bioterrorism. According to the Hindustan Times, a highly placed official, on condition of anonymity, said, " We already know that the Surat strain was not Indian. We cannot rule out the possibility of militants purchasing the organisms from a Kazakhastan company and releasing them in Surat. " Somehow, believing a disease is exotic and imported is comforting. This outbreak left 56 dead; malaria and tuberculosis, which kill thousands daily, do not generate half as much excitement or introspection—with familiarity comes tolerance. This was my first encounter with the plague. Three years later, an internal medicine resident and first responder to a disease outbreak, I did …