As Lisa's eyes adjusted to the gloomy interior, she noted the numerous wall paintings and intricately carved wooden mandalas, depicting scenes that in the flickering light seemed demonic. She glanced upward. Raftered tiers climbed two stories, supporting a nest of hanging lamps, all dark and cold.

Ang Gelu called again.

Somewhere above their heads, something creaked.

The sudden noise froze them all. The soldier flicked on a flashlight and waved it above. Shadows jittered and jumped, but nothing was there. Again the creak of planks sounded. Someone was moving on the top floor. Despite the positive sign of life, Lisa's skin pebbled with goose bumps.

Ang Gelu spoke. "A private meditation room overlooks the temple. There are stairs in back. I will check. You stay here."

Lisa wanted to obey, but she felt the weight of both her medical backpack and her responsibility. It wasn't the hand of man that had slain the livestock. That she was certain. If there was a survivor, anyone to tell what happened here, she was best suited for this task.

She hefted her pack higher on the shoulder. "I'm coming."

Despite her steady voice, she let Ang Gelu go first.

He crossed around behind the Buddha statue to an arched doorway near the back. He pushed through a drape of gold-embroidered brocade. A small hallway led deeper into the structure. Shuttered windows allowed a few slivers of light into the dusty gloom. They illuminated a whitewashed wall. The splash of crimson and smear along one wall did not require closer inspection. Blood.

A pair of slack naked legs stuck out of a doorway halfway down the hall…resting in a black pool. Ang Gelu motioned her back into the temple. She shook her head and moved past him. She didn't expect to save whoever lay there. It was plain he must already be dead. But instinct drew her forward. In five strides, she was at the body.

In a heartbeat, she took in the scene and fell back.

Legs. That's all there was left of the man. Only a pair of chopped limbs, cleaved midthigh. She stared deeper into the room—into the slaughterhouse. Arms and legs lay stacked like cords of firewood in the center of the room.

And then there were the severed heads, neatly aligned along one wall, staring inward, eyes wide with the horror of it all.

Ang Gelu was at her side. He stiffened at the sight and mumbled something that sounded like half prayer, half curse.

As if hearing him, something stirred in the room. It rose from the far side ofthe pile of limbs. A naked figure, shaven-headed, drenched in blood like a newborn. It was one of the temple's monks.

A guttural hiss rose from the figure. Madness shone damply. Eyes caught the meager light and reflected back, like a wolf at night.

It lumbered toward them, dragging a three-foot-long sickle across the planks. Lisa fled several steps down the hall. Ang Gelu spoke softly, palms raised in supplication, plainly trying to placate the ravening creature.

"Relu Na," he said. "Relu Na."

Lisa realized Ang Gelu recognized the madman, someone he knew from an earlier visit to the monastery. The simple act of giving the man a name both humanized him and made the awfulness all that more horrific.

With a grating cry, the monk leaped at his fellow brother. Ang Gelu easily ducked the sickle. The figure's coordination had deteriorated along with his mind. Ang Gelu bear-hugged the other, grappling him, pinning him to one side of the doorframe. Lisa acted quickly. She dropped her pack, tugged down a zipper, and removed a metal case. She popped it open with her thumb.

Inside lay a row of plastic syringes, secured and preloaded with various emergency drugs: morphine for pain, epinephrine for anaphylaxis, Lasix for pulmonary edema. Though each syringe was labeled, she had their positions memorized. In an emergency, every second counted. She plucked out the last syringe.

Midazolam. Injectable sedative. Mania and hallucinations were not uncommon at severe altitudes, requiring chemical restraint at times.

Using her teeth, she uncapped the needle and hurried forward.

Ang Gelu had the man still trapped, but the monk thrashed and bucked in his grip. Ang Gelu's lip was split. He had gouges along one side of his neck.

"Hold him still!" Lisa yelled.

Ang Gelu tried his best—but at that moment, perhaps sensing the doctor's intent, the madman lashed forward and bit deep into Ang Gelu's cheek. The monk screamed as his flesh was torn to bone.

But he still held tight.

Lisa rushed to his aid and jammed the needle into the madman's neck. She slammed the plunger home. "Let him go!"

Ang Gelu shoved the man hard against the frame, cracking the monk's skull against the wood. They backed away.

"The sedative will hit him in less than a minute." She would have preferred an intravenous stick, but there was no way to manage that with the man's wild thrashings. The deep intramuscular injection would have to suffice. Once quieted, she would be able to finesse her care, perhaps glean some answers.

The naked monk groaned, pawing at his neck. The sedative stung. He lurched again in their direction, reaching down again for his abandoned sickle. He straightened.

Lisa tugged Ang Gelu back. "Just wait—"—crack—

The rifle blast deafened in the narrow hall. The monk's head exploded in a shower of blood and bone. His body fell back with the impact, crumpling under him.

Lisa and Ang Gelu stared aghast at the shooter.

The Nepalese soldier held his weapon on his shoulder. He slowly lowered it. Ang Gelu began berating him in his native tongue, all but taking the weapon from the soldier.

Lisa crossed to the body and checked for a pulse. None. She stared at his body, trying to determine some answer. It would take a morgue with modern forensic facilities to ascertain the cause for the madness. From the messenger's story, whatever had occurred here hadn't affected just the one man. Others must have been afflicted to varying degrees.

But by what? Had they been exposed to some heavy metal in the water, a subterranean leak of poisonous gas, or some toxic mold in old grain? Could it be something viral, like Ebola? Or even a new form of mad cow disease? Shetried to remember if yaks were susceptible. She pictured the bloated carcass in the courtyard. She didn't know.

Ang Gelu returned to her side. His cheek was a bloody ruin, but he seemed oblivious to his injury. All his pain was focused on the body beside her.

"His name was Relu Na Havarshi."

"You knew him."

A nod. "He was my sister's husband's cousin. From a small rural village in Raise. He had fallen under the sway of the Maoist rebels, but their escalating savagery was not in his nature. He fled. For the rebels, it was a death sentence to do so. To hide him, I secured him a position at the monastery…where his former comrades would never find him. Here, he found a serene place to heal…or so I had prayed. Now he will have to find his own path to that peace."