The Premonition

stop it. The book is called The Premonition, and we got him to read a chapter of it just for you a heads up. It contained some salty language and a somewhat graphic medical see Anyway, here's Michael The Premonition, Chapter one Dragon. By the time Charity heard about the young woman, it was too late to help. The woman was on life support in the Santa Barbara County Hospital. The doctors had just found tuberculosis in her brain. Before they could find anything more, she was dead and that

was just the start of the problem. Doctor Charity Deane was the newly appointed chief Health Officer for Santa Barbara County. A health officer was a stopper of things, and the most important thing Charity was meant to stop, in her view, was people from giving diseases to their fellow citizens. Michael Bacterium tuberculosis moves through droplets in the breath of the infected person and is able to hang in the air

for impressive stretches. The vast majority of the risk is in the first hour, but it may be there for two, three or four hours, said Charity. No one actually knows. That's Charity re enacting herself. There were other things about TB that no one knew. Some TB patients infected no one, and others infected huge numbers. No one knew why. No one knew why some people were super spreaders was at their behavior, their biology, the biology of their particular case

of TB. The disease had been around basically forever. At the turn of the twentieth century, it was the leading killer of human beings and it remains in many ways a mystery. It's the most intriguing infectious disease, said Charity. My favorite infectious disease. It can do anything or be anywhere in the body. We've had TB of the uterus, of the eye, of the finger. Once in Niesare, she treated a man whose TB had started in his lungs, wormed its way through his chest wall, and finally oozed

in hus down the side of its torso. To move from one person to another, however, TB needed to invade the lungs. The young woman in the Santa Barbara County Hospital had been diagnosed with tuberculosis of the brain, and had the bacteria confined itself to her brain, it would have threatened no one. If it had found its way into her lungs, it had the power to kill, and thirty percent of the people who had TB in their

brain had it also in their lungs. Santa Barbara County had become almost famous, at least in disease control circles, for both the number and sheer terror of its tuberculosis cases. When people heard this, they didn't quite believe it. At first glance. The county was a tranquil eden of beige boulders and golden grass and California oaks. Oprah lived there, Ellen lived there. The great estates in the foothills overlooking the sea blended into one another to form a single

tapestry of American affluence. Even the ocean felt private. But Santa Barbara County was both bigger and more complicated than it seemed. It had the highest rate of child poverty in the state. It sheltered maybe fifty thousand non citizens in abject squalor plus. All hell could break loose at any time. Wildfires and mudslides and oil spills and mass shootings scratched the surface of paradise, and you were plunged

into the book of job. The chief health officer of Santa Barbara County never knew exactly where, or when or how the next TB outbreak might occur. The young woman who just died in the county hospital illustrated the point. No one had any idea she even had tuberculosis until she was on her deathbed. She'd had a husband and children, She'd lived in a crowded neighborhood. She'd worked inside a

massive open plan office alongside three hundred other people. If the TB had reached her lungs, anyone should been anywhere near was now in mortal danger. That was Charity Deane's immediate problem. To figure out who, if any one, might be infected. She'd need to test tissue from the woman's lung.

If the test came out positive, she need to call the company that employed the young woman and shut it down for long enough to test all three hundred of its employees, along with anyone they might have infected, along with anyone they might have infected, and on and on. In short, she might need to alert and alarm a big chunk of Santa Barbara County. But who was she? A nobody. Hardly any one in Santa Barbara County knew who she was or what she did all day She

was invisible. Three years earlier, in two thousand and eleven, Charity had been a thirty two year old resident in internal medicine, pregnant for the third time in five years, when the Santa Barbara County medical director had asked her if she consider feeling an opening he had for a deputy health officer. The county required its health officers to possess both a medical degree and a master's in public health,

and she had both. He also mentioned in passing, but so that Charity heard it loud and clear that the luxury she had of being married to a rich surgeon meant that she could afford to take the job. The job had no obvious appeal, at least to a normal young doctor. It paid a third of what she could earn starting out in the private practices that had already asked her to work for them. Doctors of Santa Barbara

already referred to themselves as the working poor. Being a doctor in Santa Barbara without being paid like one, well, that was insane. Everyone tried to talk me out of it, said Charity. People couldn't believe it. They were like, you aren't seriously thinking of going to work for the county. They thought it meant that I was going to be a doctor down in the shiitthole basement of the County Clinic. The County clinic was where poor people without health insurance

went for treatment. It was housed inside a decrepit facility erected a century earlier on the outskirts of Santa Barbara as a sanatorium for tuberculosis patients. Charity still found herself drawn to the job. I couldn't figure out why my heart strings were tugged. The medical director handed her a thick binder whose pages described the job in detail. The Health Officers Authority in California it was called She read

it closely. Health officers in California, like health officers across the United States and the rest of the free world, had a long list of responsibilities registering births and deaths, inspecting restaurants, counting bacteria in ocean water and swimming pools, managing chronic disease. None of that really interested her. Then she saw the phrase communicable disease controller. It was an official state role played by local health officers. Her mind

lit up. I don't really care about obesity or diabetes. I actually don't give a shit about chronic disease. What I like is a crisis. What she more than liked was the kind of crisis that might be created by a communicable disease. She knew it sounded odd, but she had been consumed by this interest since she was a small child. Disease had shaped history, disease had crippled societies, but that's not why, at the age of seven, she'd become obsessed with it. It was gruesome death, it was

the human powerlessness over it. In middle school, she'd created styrofoam models of viruses and hung them from her bedroom ceiling, just so I could stare at them and think about them. She taught herself French so that when the time came to move to West Africa to chase disease, as she assumed she one day would do, she'd have the ability to communicate. In college, as a microbiology major, she stay up late reading about yellow fever, tuberculosis in Spanish flu.

My favorite microbes in college were the human pathogens that caused horrific disease, she recalled. I mean, nobody cares about plant viruses. In medical school at Tulane University, she'd ignored the derision of her fellow doctors and studied at the same time for a master's degree in public health, but only because Tulane unusually offered a degree with a focus

on tropical disease. After that, she'd gone to Gabone and Niger to work as a doctor, in part because the odds seemed to her pretty good that whatever disease was going to replicate the destruction of past plagues would come from Africa. She knew that her obsession with pandemic disease was unusual, even off putting. I learned not to talk about it because when I talked about it, people thought I was crazy. But the fact remained that from a very young age, when she was feeling low, she had

cheered herself up by reading books on bubonic plague. The ones with the grisly drawings she liked best. She read more of the fine print in the binder describing the role of the local public health officer. One sentence struck

her as more important than all the others combined. Quote Each health officer, knowing or having reason to believe that any case of the diseases made reportable by regulation of the department, or any other contagious, infectious, or communicable disease exists or has recently existed within the territory under his or her jurisdiction, shall take measures as may be necessary to prevent the spread of the disease or occurrence of additional cases, to minimize horrific death, and to chase disease.

The State of California had bestowed upon local public health officers extraordinary legal powers. Charity accepted the job. She typed out that one sentence of law and taped to the wall of her new office. Once a t B quarantine room, her office still had the original grates in the wall used to get fresh sea air into the patient's lungs. Sitting at her desk in Building four, she could hear the screams of the psychiatric patients from across the courtyard

in Building three. In the halls, cabinets as old as the building stored medical instruments that belonged in a museum. The stairs led to a dank tunnel under the building that went to the old morgue. It was her kind of place. She had, in theory, incredible legal powers to prevent disease. She soon realized how few people in practice

knew the law. Most to the citizens of Santa Barbara, including nearly all of the public officials, didn't even really understand what a public health officer was supposed to do. The public health officer had somehow come to be a recessive character. The other officials and the public expected her to lie low until called upon, usually to make some brief ceremonial appearance. The law's words felt strong, but their

spirit felt weak. By her second year on the job, she found herself quoting the laws so often that she asked her assistant to laminate a copy of that one passage so that she might carry it with her in her briefcase. I'm in a meeting, trying to explain to people that I actually do have the authority to do something I need to do. She said, I really tried hard not to whip it out, but I pulled it

out once a week. By the time she got the call about the young woman with tuberculosis in her brain, she'd read that one sentence aloud more than just about any other in her life. Lines weren't as easily performed to say, the verses of the twenty third Psalm, which she also loved, but she could bring them equally to life. Each health officer, knowing or having reason to believe what does that mean, should cry and point her finger in

the air. It means suspicion. You only need to suspect that any case of the diseases made reportable by regulation of the department, or any other contagious, infectious or communicable disease exists or has recently existed within the territory under his or her jurisdiction. Any disease should cry and then parse the adjectives. Contagious isn't really a medical term, so ignore that they just tossed in the kitchen sink there. But you really need to understand the distinction between infectious

and communicable. All communicable diseases were infectious, but some infectious diseases were not communicable. Communicable men a person could give it to another person. You could get lyme disease, for instance, but you couldn't give it to somebody else. Communicable diseases were the diseases that created crises. In an adjective, she'd

found a vessel for her life's purpose. Shall take measures as may be necessary to prevent the spread of the disease or occurrence of additional cases, Shall, She'd exclaim, not a may A shall not think about it, not consider it, not maybe get around to it one day. If you feel like it, it's your duty. If you suspect disease, you can do whatever the hell you want. Now. She had a corpse with TB in a hospital and hours

drive north. She'd ask them to move the body to the Santa Barbara Coroner's office, then call the coroner to ask him to send her a sample of the lung tissue. That's when the real problem started. At first, he wouldn't even come to the phone. Once she'd telephone him into submission, and he finally picked up. He simply refused to do it. Yet the law was the coroner was meant to do with any corpse whatever she told him to do. Instead,

he explained to her why he wouldn't. To her growing incredulity, this seventy something coroner, who had contracted with the county to work part time and who clearly had only the vaguest idea of what he was talking about, began to lecture her about tuberculosis, saying that it was both dangerous and unnecessary to extract the young woman's lung, citing some study that purported to show that TB in a corpse subjected to surgery could become aerosolized and infect the surgeon.

Charity Deane was at this point the chief health officer of Santa Barbara County. She was the youngest chief health officer in the history of California. She'd also spent three years running the county's TB clinic. She was legally responsible for every single case of TB in the county. Fancy doctors who had supervised her residency now called her to ask for advice about the disease, for crying out loud. She was about to be named president of the Tuberculosis

Controllers Association of the entire State of California. She tried to be civil with the old coroner, but it was hard. I knew the study, it was a bullshit study, but the douchebag said he wouldn't do it, would not even allow someone else to come into his office and do it. She hung up and called the sheriff. She explained the situation sweetly and asked the sheriff to require the coroner to cut the young woman open and extract her lung.

The sheriff didn't know the law either, it seemed as he said he wouldn't interfere with the coroner's authority, at which point Charity lost her patience. I couldn't believe he wasn't doing what I told him to do. She wrote out a legal order and delivered it to the sheriff in person. Then I waited for the phones to blow up. The sheriff couldn't simply ignore a legal order. He phoned up the Chief council for the Board of Supervisors to confirm his belief that a legal order issued by a

local public health officer carried no authority. Santa Barbara's Chief Council looked into it, and to his surprise, discovered that the sheriff was mistaken. The woman was right. The only person whose authority trumped the health officers in cases involving disease was the governor of California, and then only if the governor had declared a state of emergency. With that, Charity considered the matter settled, but the coroner's office called

her the next day to say that it wasn't. They said, okay, we'll do it, she recalled, but we won't do it inside the office because the building's old and lacks proper ventilation. I said, okay, could you do it outside? They said, okay, but only if you are here. Not for the first time, she wondered what would happen in Santa Barbara County if there was ever a serious outbreak of communicable disease. They won't even do an autopsy because there are worried about

arioslised TV. She said, what the fuck are they going to do if it's arioslis ebola. It didn't help that this was all going down over Christmas. She just turned thirty seven, was newly divorced from the rich surgeon, and was a single mother to three young boys. As she drove to the County Morgue on the day after Christmas, she was unsure what awaited her. She sensed that the coroner and the sheriff and maybe some other people had

grown irritated with her. Just how irritated became clear only as she rolled into the parking lot beside the Coroner's office. Seven people were waiting for her. Outside the morgue, all men, the coroner, the sheriff, and a bunch of his deputies. They had clearly come for the show. She'd driven straight from cleaning up the mess under the tree, and so she wasn't in her usual battle armor of Talbot's suit, pencil skirt and grandma heels, just attacky Christmas sweater and

blue jeans. All the men wore full on hazmat suits. They look like they're about to walk on the moon, the whole team. You'd have thought this wuzzy bullet. The morgue itself was even more appalling than the public health office. Poking up from scrub oaks and dirt fields. It resembled more of the bathrooms at a highway rest stop than an official public office. Not for the first time, she wondered where they put the bodies. If ever, there were

lots of gruesome deaths at once. At some remove on a picnic table lay a body bag with the young woman inside. The coroner was now just angry. He explained all over again that the entire operation was unsafe and that he was not going to risk opening up the body indoors. He sighted the bullshit paper again, this time to explain why he hadn't even brought his bonesaw with him, as the one known case of a surgeon becoming infected with TB by a corpse had involved a bone saw.

Instead of the bone saw, he had brought along a pair of garden shears. Now he offered to her garden shears. They were brand new in Gleaming, with the word Ace on the red handles for the hardware store. If the new chief health officer wanted to cut open the young woman and remove a piece of her lung, she'd need to do it herself with garden shears. I had thought I was just there to watch, said Charity, and he

turned it into a game of chicken. Medicine had always felt to her a man's world, especially in the places like here where it touched government. It was then charity. Deane realized, the real problem is that this man is frightened. She'd been around terrifying diseases most of her adult life, and it made a pact with herself not to fear them. If you're a truck driver, you know you're going to get into an accident sooner or later, so you just learn what to do if you are in an accident.

She said. That's how you get over the fear. You just accept that you'll get the disease one day. Men weren't so accepting. She'd noticed, especially the big and supposedly brave ones. As a medical student, she'd seen the fear in the eyes of the New Orleans cops in the trauma center. They'd haul in some guy with a gunshot wound, but when they found out he had HEPSI or HIV, they'd squeal and go take a shower in chlorox from

head to toe. Over and again. She's seen mesomorphs with crew cuts who'd happily run into a burning building to save a dog turn uncertain and uneasy in the presence of disease. Airborne diseases in particular seemed to spook them. That was the number one reason I could not get t be patients arrested. She said, the police would turn into these squeamish little girls. They'd sit in the car and let a nurse go get them. Charity was not

without her own fears, both real and imagined. The walls of her office and home bedroom were plastered with post it notes, there is no shortcut to courage. Courage is a muscle memory. The tallest oak in the forest was once just a little nut that held its ground. Like most everyone else, she needed reminding. Unlike most everyone else.

She reminded herself constantly. Her realization that the men outside the coroner's office were afraid in a way that she was not led to a thought, they don't think I'm going to go through with this, Then another, they don't think I will do it because I don't look like a person who would do it. Even in heel. She was only five foot six and slender. She had mixed feelings about her own looks, but men did not appear

to share them. She'd gotten used to cat calls. She created a rule for herself when entering a meeting with a certain kind of mail, allow a thirty second recovery period before attempting to convey information upon which that mail might need to act. Men judge her by appearance and were badly deceived. The inside doesn't match the outside, she sometimes said of herself. She unzipped the body bag and

looked at the corpse. A bone saw would have allowed her to cut right down the middle of the young woman's sternam, but with garden shears, she'd have to snap the ribs at the ends. She felt for the edge of the first rib snip. It was a sharp, thin sound, like a crab shell cracking snip. As she cut, she sensed the eyes inside the hazmat suits looking away. They had left the young woman's face uncovered. That was the most unsettling part. Normally, a surgeon saw only the tiny

patch of flesh upon which she operated. The sight of the young woman's face made the operation feel personal, disturbing. She felt woozy and nauseous. I was just saying over and over in my head, don't faint, don't faint. And I was mad. This was such disrespect for her and for her family. But they were like, you want to see it, you get to do it. Snip. The crab shell finally cracked. She tossed the garden shears to one side of the body and pulled apart the woman's ribs.

At that moment, I had this feeling, this feeling of such grief for her husband. She didn't show any feeling at all to the men, though she didn't want to give the douchebag the satisfaction. She needed a chunk of the woman's lung tissue to take back to Manny in the lab for testing. But as she reached into the woman with the garden shears, the coroner reached in too. He wanted to help. Should we look in her belly, he asked gently, Right, thought, Charity. If it was in

her belly, then it was in her blood. And if it was in her blood, it was probably on her lung She felt around for signs of tuberculosis. Her internal organs were perfect, lovely. If the lungs were speckled and bumpy, I would know, and they weren't. Her hands, sensed with the would later find the TV hadn't ever left the brain. In the end, the coroner saved her the trouble of cutting out a piece of the lung with the garden shears by showing her how to release the lungs. They

did it together. It was as if her nerve had changed his view of the situation. Now she held the young woman's lungs in her hands. This jello outside the human body, lung tissue didn't hold its form, and now she could see just how sure the coroner had been that none of this would ever happen. He had nowhere to put them. The only container in sight was an

orange plastic bucket from home depot. She grabbed the woman's lungs and placed them into it, then tossed the bucket into the car and drove away to the men she left behind. The entire scene would remain a vivid memory to her. It was almost just another day in the life of the local health officer. They had no idea of the things she had done or what she was capable of. The coroner obviously hadn't even considered the possibility that she was a trained surgeon. Men like that always

underestimate me, she said. They think my spirit animal is a bunny, and it's a fucking dragon. You've been listening to chapter one of Michael Lewis's new book, The Premonition, But we have more of Michael still to come. Stay with us after the break for an exclusive author interview. We're back with one more extra for you ATR listeners. In a very COVID safe interview, the author Michael Lewis agreed to talk about his new book The Premonition with

the author Michael Lewis. Here's their hard hitting conversation. Good to see you, Michael. It's been too long. So look, I like dudes to ask you the kind of questions that you don't get asked that often. You get asked all the same questions on a book tour, and you get sick of answering them my bed and so first

kind of insulting. We know from your biography that you got a d in biology your sophomore year in high school, and that you wiggle through the science requirement college by taking a course called Physics for Poets, and you were so insecure about it that you took it past fail and you flunked. So you have established that you aren't the go to guy for matters of science. What business do you think you have writing a book about a virus? You don't know me as well as you think you

know me. All right, Yes, I did poorly in high school. Alogy and I didn't do well in physics and college, but I actually got my start as a writer on the science pages of The Economist. It's true that I'm nobody's idea of a scientist. No one would hire me in their lab. But there's a funny kind of advantage to having no clue about the subject when you enter it, because you're in the state of the mind of many readers.

And I think my problem with science back in high school and even in college, it wasn't that I couldn't grasp it. It was just it was presented to me in the most mind numbingly boring way as kind of a fat, all complete rather than a search or request or a tool for curiosity. So in my defense, my

attitudes towards science have changed, all right, next question. You wrote a book called Fifth Risk, and it seemed to be all about how horrible Donald Trump was and that Donald Trump was going to kill everybody because he wasn't managing the government properly, and so on and so forth. And in this book Trump hardly appears. He's kind of a shadowy presence, but it isn't certainly not about Donald Trump. And in this other book you wrote the fifth risk.

You were holding out all these public servants as heroes, and in this book there's some ones who are clearly not heroes, like they're clearly making a hash of things. In particular, people at the CDC, Could you reconcile all this for us so we can at least delude ourselves that there's some coherence to your work. Well, thanks for

putting it that way. I'd say two things. One is that as I dug into the material that became the premonition, it became really clear to me that the causes of our horrible response to the pandemic ran much deeper than just one president. I didn't think of the government employees

who performed badly in the pandemic as like villains. I thought of them as people who were trapped in a horrible system, and that the villain and in in this story is really a broken system, and that the heroes in this story, the people, were inside the system kind of trying to fight the system. I don't think the two things contradict each other in the way you described. I think your question is a little stupid. All right, that's one way to charm an interviewer. Let's see what else

I have here for you? What do you expect to be the biggest mistake that readers meg about the story you were trying to tell, Like, what do you expect is going to happen after the book comes out where you're going to say, whoa, whoa, whoa whoa. That wasn't the point. You're missing the point. Well, that's funny you asked that because I've been thinking about that, and I've been thinking about it because after the big short was published.

I mean, I can't tell you how many calls I had from like people on Capitol Hill who wanted me to come testify or will you come speak to the Democratic Caucus or the Republican Caucus. But what the book was trying to say is it's these people I wrote about. I found the people who can explain the thing that was my only job. I was their stenographer. And that's

what's happened again. And I know what's going to happen is that I'm going to get calls from like a senator saying, Wow, could you talk to me about what actually happened and what we need to do to I don't know, change disease control in the United States, And I'll say to them. You know, I know it's in the book, and I got a d in biology my sophomore year in high school. Why you asking me call those people? That's what I'll say. It's nice to see you hid and rare note of modesty and humility in

that answer to the question. There's this kind of a false modesty, but I guess false modesty is better than no modesty at all. Why don't we end with this? I'm actually not all that curious about this, but the producers of Against the Rules asked me to ask you this question, and it's how does your book connect with the next season of Against the Rules? I am so glad you asked that. Finally asked me something as useful.

There is a connection, a very deep connection. One of the things that became very clear when I was working on The Premonition was that the United States had an expert problem. So like newspaper reporters, when they needed to know something about epidemiology, we call a virologist and they treat them all the same. And if they need to know something about virology, they call the epidemiologists, or they just be these talking heads on TV who happened to

have gotten somewhere near someone who knew something. We're presenting themselves as pandemic experts. At least part of the story in The Premonition is a story about experts that is not fully explored in the book, because the book really is a story, but that we will explore in the next season of Against the Rules. Thank you for your time, Michael, It's been my pleasure. If it's okay with you, I'm

going to read the credits now. Against the Rules is written and hosted by me Michael Lewis and produced by Katherine Girardo and Lydia Gencott, edited by Julia Barton and Audrey Dilling, with music by Stellwagen Sinfonett. Mia Lobell is

our executive producer. Thanks also to Jacob Weisberg, Heather Fain, John Snars, Carli Miliori, Christina Sullivan, Eric Sandler, Maggie Taylor, Nicole Morano, Emily Rosnick, Maya Kaney, Jason Gambrel, Kadija Holland, and special thanks to Charity Deane for lending her story and her voice to the Premonition. Against the Rules is a production of Pushkin Industries. Sign up for Pushkin's newsletter

at Pushkin dot fm. To find more Pushkin podcast listen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Against the Rules, we'll be back with our new season this fall. The Premonition is out now. You'll find it wherever books are sold.