Marburg is a close cousin to the Ebola virus, and is extremely lethal. Dr. Ustinov had been wearing a spacesuit in a Level 4 hot lab, injecting guinea pigs with Marburg virus. He pricked himself in the finger with a needle, and it penetrated two layers of rubber gloves.

Nikolai Ustinov exited through an air lock and a chemical decon shower to Level 3, and used an emergency telephone to call his supervisor. The supervisor decided to put Ustinov into a biocontainment hospital, a twenty-bed unit with steel air-lock doors, like the doors of a submarine, where nurses and doctors wearing spacesuits could monitor him. He was not allowed to speak with his wife and children. Ustinov did not seem to be afraid of dying, but, separated from his family, he became deeply depressed.

On about the fourth day, Ustinov developed a headache, and his eyes turned red. Tiny hemorrhages were occurring in them. He requested a laboratory notebook, and he began writing a diary in it, every day. He was a scientist, and he was determined to explain how he was dying. What does it feel like to die of Marburg virus? What are the psychological effects? For a while, he maintained a small hope that he wouldn't die, but when his skin developed spontaneous bruises he understood what the future held. Dr. Sandakhchiev's cryptograms to Alibek were dry and factual, and didn't include the human details. Alibek would later learn that perhaps twice Ustinov had broken down and wept.

Alibek was frantic to get help to Ustinov. He begged the Ministry of Defense for a special immune serum, but bureaucratic delays prevented its arrival in Siberia until it was too late. When Ustinov began to vomit blood and pass bloody black diarrhea, the doctor gave him transfusions, but as they put the blood into him it came out of his mouth and rectum. Ustinov was in prostration. They debated replacing all the blood in his body with fresh new blood -- a so-called whole-body transfusion. They were afraid that that might trigger a total flooding hemorrhage, which would kill him, so they didn't do it.

ALIBEK did not know exactly which strain of Marburg had infected his colleague. It had been obtained by Soviet intelligence somewhere, but the scientists were never told where strains came from. The Marburg virus seems to live in an unknown animal host in East Africa. It has been associated with Kitum Cave, near Mt. Elgon, so the Soviet strain could have been obtained around there, but Alibek suspected that it came from Germany. In 1967, the virus had broken out at a vaccine factory in Marburg, a small city in central Germany, and had killed a number of people who were working with monkeys that were being used to produce vaccine. One of the survivors was a man named Popp, and Alibek thought that Ustinov was probably dying of the strain that had come from him. I have seen a photograph of a Marburg monkey worker taken shortly before his death, in late summer, 1967. He is a stout man, lying on a hospital bed without a shirt. His mouth is slack, his teeth are covered with blood. He is hemorrhaging from the mouth and nose. The blood has run down his neck and pooled in the hollow of his throat. It looks spidery, because it's unable to clot. He also seems to be leaking blood from his nipples.

The final pages of Dr. Nikolai Ustinov's scientific journal are smeared with unclotted blood. His skin developed starlike hemorrhages in the underlayers. Incredibly -- the Vector scientists had never seen this -- he sweated blood directly from the pores of his skin, and left bloody fingerprints on the pages of his diary. He wept again before he died.

[...]