Newman's Notions | October 2020 | FREE
Most ACP Hospitalist content is available exclusively to ACP Members. This article is free to the public.

The face mask of the red death

A tale of plague and class suits this Halloween.

In 1842, Edgar Allan Poe published a short story, “The Masque of the Red Death.” It is a tale of plague and class and death. If Poe had been a 21st-century hospitalist, perhaps this story would have joined other classics like “The Tell-Tale Pacemaker” and “The Fall of the Hospital of Usher” in the canon. If you are faint of heart, you dare not read this recently discovered alternative telling of his tale. You have been warned.

Illustration by David Rosenman
Illustration by David Rosenman

So it came to pass that sickness swept the countryside. Waves of illness came one upon another to the suffering denizens of an overheated planet. Whenever it seemed that a trace of normalcy had returned, the newest variation of some vicious viral plague would wash across the mortal human shore, scouring lives away from loved ones. Respiratory, gastrointestinal, and hemorrhagic fevers killed whole populations. Society collapsed, advanced pharmaceuticals went unproduced, vaccines failed or were refused, but still humanity persisted. Then came the greatest scourge. A disease so deadly that a touch of a hand, a wisp of a breath, the merest brush with an insect could lead to exsanguinatory death; a bloody triad of hemolysis, hemoptysis, and hematochezia. It was a landscape that easily matched the scenes from Hieronymus Bosch. The Red Death circled the globe, save only for a few small havens.

Down below the surface of the earth, in giant complexes made from converted fallout shelters, a few humans, the richest and most powerful, lived on, protected from the horrors of the upside world. They sat in their subterranean compounds, untouched by pestilence. They continued to pursue life without regard to the rest of humanity's suffering. They traded worthless stock and commented on bizarre fashion trends and blogged and vlogged and jogged to keep their health. They had supplies for a decade, including nuclear energy, antibiotics, antivirals, antiaging genetic modifications, and their own belief in their imperviousness to disease.

Their cameras showed images of the dying above their heads, and in a perverse sport, they gambled on survival rates and decimation. Death became a game that could not beat them. They lived a virtual existence. They had no moral compass, no right or wrong, no faith in anything but the god of longevity. There were no churches or synagogues or mosques, only a single temple of health, a hospital, for despite all their technologies, people still fell and broke limbs and incurred other forms of minor trauma.

To celebrate the anniversary of the most recent plague that had decimated the globe, they held a grand event. It was a chance to show off their fashions, to physically gather together, and most important, to show their lack of fear of death. It would be a masquerade ball. The organizers chose the theme: Permutations of Personal Protection. For months citizens planned their costumes, many based on physician garb, from 16th-century plague doctors to more recent looks. Others went as phantasmagorical beasts or chimeric creatures. No two costumes were alike.

On the night of the masked ball, all of the residents donned their elaborate costumes and headed toward the grand ballroom. It was the largest of the underground structures, at 1,540,000 square feet per floor over seven floors, with an enormous grand ballroom. Each floor was painted a separate color to orient its denizens. The entirety of the community was bedecked in feathers and fur, silk and satin, a spectrum of bright colors.

As the band began to play, the back door of the ballroom swung open and the willowy figure of a woman dressed completely in white glided in. Head to toe, the costume was a wrap of simple gauze. Covering her face was a plain white cotton mask. The attendees thought it was an odd and boring choice and turned back to their festivities, failing to notice that the doors had locked on her entry. As the white-clad woman stepped forward, the slightest red tinge crept across her face. She glided forward and wrapped her arms around a young woman dressed as a yellow unicorn, leaving red handprints on the saffron material. The shriek of the unicorn's friend pierced the room as the girl fell to the floor. The white-wrapped woman passed quickly through the crowd, each touch spreading a vermillion coating from one attendee to the next. Meanwhile, her own costume turned slowly from white to red, leaving red footprints in the carpet behind her, and a blood-soaked smile appeared on her mask.

The guests ran down the stairs, level by level, fleeing the specter. Trapped on the lowest, red-colored level, one brave member of the organizing committee grabbed a chair and swung it at the woman's head. As it passed though where her skull would have been, a fountain of blood splashed across the room. The gauze fell to the floor, revealing that the costume was empty.

Many years later, when humanity had regained a foothold on the surface of the planet, anthropologists opened a giant underground room that had been hidden by dense foliage. They found a crowd of skeletons, dressed in outlandish blood-stained costumes, and, in the center of the floor, a pile of pure white cotton gauze in the shape of a woman.