Blood disease

Blood disease is the second great wave of mortality after the flu: a prolonged, poorly understood illness that weakens survivors and kills members of the Mennonite community year after year. Its presence shapes daily life through loss and uncertainty, but also exposes a conflict between Bangley’s strict self-protection and Hig’s decision to keep helping the families nearby.

A Second Wave After the Flu

Nine years after the flu, Hig distinguishes the original pandemic from the disease that followed it. The flu killed almost everybody; blood disease then killed more of those who remained. The distinction matters to the survivors’ sense of time: the first catastrophe has receded, but its aftermath continues to take lives.

The community south of Hig and Bangley numbers about thirty Mennonites. Hig understands its illness as slow-burning rather than sudden. Adults become sick and weak, children are born with the disease, and each year some members of the community die. Bangley estimates that even the luckiest may have only a few years, though this is his judgment, not a confirmed prognosis. The recurring deaths are visible to Hig in their effects on the people left behind, and they make the disease an ongoing presence rather than a crisis that has passed.

The scale of that loss sits within a broader breakdown of medical and civic support. St. Vincent’s Hospital, across the lake, had buildings taken over and filling with the dead. The account does not identify all those deaths as caused by blood disease; the hospital instead marks how little functioning care remains amid the larger aftermath. The disease persists in a world where reliable treatment, public-health systems, and clear information are difficult to find.

Transmission and Uncertainty

The exact means of transmission are not established. Bangley fears that the disease can pass through bodily fluids and treats even a cough as a possible danger. When he drinks from a bottle, he forces himself to stop before finishing it, recalling the warnings made during the epidemic. Hig counters that cough transmission was never proven. The disagreement does not resolve the medical question: Bangley considers proof less important than the possibility of dying after surviving this long.

That uncertainty becomes a practical rule for contact. The Mennonite families know to remain fifteen feet away, a distance Hig has trained them to observe. The arrangement enables limited assistance while recognizing Bangley’s fear of exposure. It is not evidence that the families are infectious at that distance, or that the procedure prevents transmission; it is a negotiated precaution in a setting where survivors do not have dependable answers.

Bangley had encountered the families before he learned that Hig helped them. During an aerial reconnaissance in the first week after arriving, he said he had met people with blood sickness on the way in and had shot two who came too close. Hig identified those people as Mennonites, not the hostile group Bangley’s description implied. The encounter establishes that fear of the illness can merge with fear of strangers: a perceived health risk becomes part of the armed logic by which survivors judge who may approach.

Care, Risk, and Conflict

Hig’s assistance is modest and practical. He repairs a pump and shows members of the community how to make a fish trap for the creek. He insists that the families have shown no aggression and are no threat to him and Bangley; their response has been gratitude. Their vulnerability does not erase the precautions, but neither does the disease make them enemies in Hig’s eyes.

Bangley objects that the families may have little time left and asks what can be gained by helping them. Hig’s answer is not a promise of recovery. He holds open the possibility that some may survive, citing rumors of survivors, and argues that their effort to stay alive day by day is reason enough to treat them as people. This leaves the medical outcome uncertain while making the ethical disagreement plain: Bangley measures action by its contribution to their own survival, whereas Hig accepts risk for assistance whose benefit cannot be guaranteed.

The argument also reveals what the work does for Hig. He says that helping the families loosens something in him that had nearly frozen up. Care therefore has a consequence even without a cure: it gives him a way to remain responsive to other people in a life organized around patrols, weapons, and the expectation of attack. Bangley does not share this understanding and reacts to Hig’s explanation with incomprehension. The disease thus strains their partnership not only through the possibility of contagion, but through incompatible ideas about what survival is for.

Medical Knowledge and the Disease’s Meaning

The evidence offers descriptions and hypotheses, not a definitive account of the disease’s cause or treatment. Hig compares it to AIDS while qualifying that it may be more contagious, but that comparison is his uncertain impression, not a diagnosis. Bangley’s concern about transmission is similarly a fear rather than a demonstrated mechanism. The narrative keeps those distinctions visible: what the characters suspect, what they have been told, and what has actually been proven are not the same.

Cima identifies herself as an internist and public-health doctor. In a later discussion, she describes a proposed explanation in which the onset of an autoimmune disease was accelerated by the body’s reduced ability to produce vitamin D. She calls the mechanism curious and invokes AIDS and T cells as a possible point of comparison, while leaving the analogy unresolved. This account supplies a medical possibility, not a settled explanation of every symptom or death attributed to blood disease.

That restraint is central to the disease’s significance. Its effects are concrete: weakness, repeated illness, children born affected, and deaths that continue years after the flu. Its biology remains uncertain. In the absence of reliable institutions, that gap between lived consequence and incomplete knowledge becomes a daily condition. Blood disease does not only reduce the number of survivors; it makes contact, obligation, and trust matters of risk, and forces Hig and Bangley to choose what kind of community—if any—they will maintain around them.