“Dad. We have to block the door.”

Over the noise of the TV he thought he heard the sound of another gunshot, but from this distance, through so many doors, he couldn’t be sure.

“Dad! I need you to listen to me.”

His father slowly shook his head. “It’s happening again,” he said.

The handle rattled, and then the door opened a few inches and bumped against the back of the dresser drawer. “It’s okay Paxton,” Aunt Rhonda said, sounding exasperated. “It’s safe to come out now.”

It took him a minute to shove the furniture out of the way. Rhonda came into the room with a paper mask held over her nose. The cuff of her sleeve was stained with dark blood. Her hair was in disarray.

“We aren’t dead, in case you were wondering,” she said, her voice muffled.

“Are they?” Pax asked.

“They ought to be.”

“I think you should see what’s on the news,” he said.

He moved out of the way so Rhonda could see the screen. His father said, “It’s bigger this time. A whole city.”

“What’s bigger?” Rhonda asked.

“The Changes,” Pax said.

A TRIO OF beta girls stood awkwardly on the sidewalk, pinned in place by cameras and lights and microphones. One of them answered a question while the other two looked on. They didn’t seem to want to speak to the reporters, but they didn’t move away either. They may have been blanks, but they were also teenage Americans; they didn’t know how to say no to television.

Pax stepped off the sidewalk to avoid the clump of media people surrounding them. He’d tried to drive to the clinic, but the downtown streets were packed. He’d been forced to park down on Bank Street, a quarter mile from the center of town. News vans, television trucks, and rental cars lined the street ahead of him; strange faces crowded the sidewalks. All this, just to cover the “local angle.”

Before the Changes, the world had never heard of Switchcreek, Tennessee. And until yesterday, not many more had ever heard of Babahoyo, Ecuador. Now they were sister cities, united in disaster, death, and acts of God. Sodom and Gomorrah separated by two thousand miles and thirteen years.

At least a thousand were dead in Babahoyo, and who knew how many more were stricken. The exact numbers varied by news channel, but every hour the estimates climbed.

After Clete’s botched kidnapping yesterday, Pax had sat in his father’s room for most of the afternoon, watching the news. When he went home that night he kept the TV on, unable to look away: the cameras panning over rows of the sick laid out in hospital beds or across the floors of churches and schools; the close-ups of brown faces bleaching to chalk; the repetitive soundtrack of grunts and moans and cries in Spanish. And then, like a bizarre commercial break, a word from our previous victims, the people of Switchcreek. He saw Rhonda interviewed twice, and no one could have guessed that a few hours before she’d been duct taped to her chair and held at gunpoint. Back in the studios, scientists and special correspondents described the nature of TDS, charted its three variants, predicted that the current wave of TDS-A would give way to strains of B and C, and speculated baldly on the disease’s causes and probable vectors of transmission. It was painfully clear that in thirteen years no one had made much progress in understanding the disease.

The cameras always returned as soon as possible to South America, to shots of Ecuadorians twisting in agony as bone and muscle frantically tried to outrace each other. He wondered if they’d call themselves argos or choose a Spanish name.

He reached the clinic, but the front door was locked. He pressed the doorbell, waited. A plaque next to the door declared the building to be THE PHILIP MAPES MEMORIAL MEDICAL CENTER. Philip had been Rhonda’s husband, if he remembered correctly.

After half a minute he pressed the doorbell again just as a shadow moved behind the glass. He stepped back as Dr. Fraelich worked the keys in the lock and pushed the door open a few inches.

“Is this an emergency, Mr. Martin?”

“Why, are you closed?”

“I’m a little short on staff.” She saw something in his face. “What?”

“Is it Doreen? I was hoping you’d heard from her. Or from Rhonda.”

Dr. Fraelich glanced over his shoulder. “You better come in before the reporters notice. They keep asking for interviews.”

She locked the door behind him, then led him down the hallway.

“I saw you on CNN,” Pax said. “All two seconds.”

“I was hoping no one had seen that.”

“I’ve been watching too much TV,” Pax said. “I couldn’t stop watching. All those people…”

“I thought you looked a little shell-shocked.” She pushed open the office door. The room looked as crowded and messy in daylight as it had that night. He sat on the same chair he’d used before. Dr. Fraelich turned off her computer monitor and sat opposite him, her legs crossed. She wore a wrinkled, French-blue shirt and charcoal slacks. Her black shoes were scuffed at the toe.

“It just seems so much worse than what I remember from the Changes,” Pax said. “Our Changes.”

“It’s a lot more people,” she said.

“Yeah, there’s that. But it’s just that this time I know what’s coming, you know?” He’d seen Deke and Jo and his father transform. He’d watched his mother die. In the space of a few months he’d attended the funerals of dozens of friends and relatives.

“So this is bringing it all back to you. The trauma.”

“What? No.” He shook his head. “Look, I’m not saying it wasn’t terrible. People in Lambert screaming at us, and then when those boys were murdered… but it didn’t wound me for life or anything. I moved on, even if other people couldn’t let it go. A year after it all I’d still catch my cousins looking at me all misty-eyed-oh, the poor boy from Switchcreek.”

“You sound awfully pissed for a guy who’s over it.”

“Well, yeah. It annoyed me. It wasn’t me they should be sorry for-I came through fine. It was like they wanted to feel bad. Like all these reporters, glomming onto us. They want somebody to break down on camera.”

“And clearly that won’t be you,” she said.

He looked up. He could never tell when she was being sarcastic.

“So,” she said. “Doreen. She didn’t make another pass at you, did she?”

“Not exactly,” he said. He told her about Doreen and Clete and Travis grabbing him at home, then attempting to kidnap his father and rob Rhonda. When he got to their ten-point plan Dr. Fraelich stood and moved across the room. She crossed her arms, uncrossed them, then picked up a pen.

“Rhonda wouldn’t let that happen,” she said.

“Everett-her driver, bodyguard, whatever he is-stopped them,” Pax said. “Then we were interrupted by the news about Ecuador.”

“Where are they now?” she asked.

“Doreen and them? I don’t know. I stayed in my father’s room. Rhonda left to go downtown. When I finally went home, the lobby was cleaned up, there was nobody there but the security guard, Barron.”

“You didn’t ask him?”

“I was a little freaked out. I thought… I don’t know what I thought.” Pax breathed in, then exhaled shakily. “I was hoping you’d heard from Doreen.”

“Damn it.” She went to her desk, took out a pack of cigarettes. “I’m going outside for a minute.”

He followed her out and she didn’t object. They walked around to the side of the building, where a plastic patio table and a couple of chairs were hidden from the highway by a row of bushes. She didn’t sit down. She reached into her pocket and came up with a book of matches. He liked that she carried matches. The smokers he knew-and in the restaurant business, that was pretty much everybody-only used lighters.

“You think she killed them?” he said.