The Red Lotus

Alexis Remnick is an emergency room doctor in Manhattan whose high-pressure work helped transform her from a shy, anxious teenager who once cut herself into a confident, adrenaline-driven physician. She meets Austin Harper on a Saturday night when he arrives in the ER with a bullet wound in his right biceps from a stray shot in an East Village dive bar. Austin works in development at the same hospital. While treating him, Alexis notices Band-Aids on his left fingers from what he says was a cat bite. The two feel an immediate connection and begin dating.

Six months later, Alexis and Austin are on a multi-day bike tour in central Vietnam. Austin insists on riding solo to retrace the Hai Van Pass, claiming he wants to visit sites where his father was wounded and his uncle killed during the Vietnam War. When he fails to return and stops responding to calls, Alexis and the guides drive the route but find no trace of him. On a flat stretch of road, she spots bright yellow packets of Psych energy gel, Austin's preferred brand, on the pavement and collects them as potential evidence.

The novel reveals what happened. Two Vietnamese men intercept Austin on the road, and a van arrives carrying Douglas Webber, a tall American whom Austin recognizes. Douglas confiscates Austin's phone, hoods him, and takes him to a house where Douglas and his associate Bao interrogate him. Douglas accuses Austin of coming to Vietnam to sell a pathogen to a buyer. When Austin resists, Douglas slams a dart into the back of his hand, shattering bone. Austin reveals his buyer's name. Douglas decides Austin must die in a staged cycling accident and wonders whether Alexis is involved.

The next day, FBI legal attaché Toril Bjornstad arrives with Captain Quang Nguyen of the Vietnamese police. Toril reveals that Austin's family history was fabricated: His uncle died near Khe Sanh, far from the bike route, and his father served as a lifeguard at a base near Ho Chi Minh City, injured in a go-cart accident rather than combat. That afternoon, a body is found below the Hai Van Pass. At the morgue in Da Nang, Alexis identifies Austin and notices a puncture wound on the back of his right hand with a broken bone underneath. The coroner dismisses it, but Alexis photographs it. Toril tells her neither the Vietnamese police nor the FBI will investigate further.

Douglas returns to New York and meets with Oscar Bolton, a hospital employee he has groomed as Austin's replacement to liaise with university labs. Douglas's travel writing is a cover for arms dealing. His associate Bao confirms Austin's phone and devices have been wiped clean.

Back in New York, Alexis examines Austin's cycling glove and finds no tear or blood corresponding to the puncture wound, confirming the injury preceded the crash. Austin was abducted and tortured before someone staged his death. In his apartment, she discovers printed pages about Vietnamese rats whose descendants, affected by the herbicide Agent Orange, carry antibiotic-resistant diseases. She visits Sally Gleason, Austin's boss, who suggests hiring Ken Sarafian, a retired NYPD cop and Vietnam veteran, as a private investigator. Her best friend Ellie Thomas, a veterinarian, examines photos of Austin's old finger wounds and concludes they resemble rat bites, not cat bites. That night, Alexis struggles with the urge to cut herself but resists. The novel reveals that Douglas and Sally are lovers. Douglas instructs Sally to keep him informed about Alexis's inquiries.

Alexis hires Ken, who discovers Austin's laptop has been wiped to factory settings. Ken traces Douglas to an East Village brownstone after a bartender reveals that Austin and Douglas arrived at the bar together the night of the shooting, contradicting Austin's story. When Ken visits Douglas's apartment, Douglas subtly threatens him. Meanwhile, in Vietnam, Captain Quang's lab technician discovers tiny needle holes in two of the chocolate-flavored gel packets. After analyzing the contents, the technician and a cabdriver both die within hours from an accelerated, antibiotic-resistant strain of plague.

Alexis meets Sara Edens, a doctoral candidate studying hantaviruses, or rodent-borne viruses, in the hospital's bio labs. She discovers through social media that Sally appeared in a photo with Binh Pham, a murdered Vietnamese food chemist, linking Sally to the conspiracy. Douglas meets Oscar and explains the project, called "the red lotus": The university labs are developing transgenic rats with plague-resistant genes from Vietnamese rats spliced into New York City rats that can carry a weaponized plague strain without dying, making them ideal carriers for a biological weapon to be sold to the highest bidder.

Ken contacts Captain Quang and they exchange findings; immigration records confirm Douglas entered Vietnam days before Austin's death. On Saturday, Oscar meets Alexis for brunch and probes her about what she brought from Vietnam. Alexis lies but mentions she has some of Austin's energy gels. Oscar reports to Douglas, who sees a news alert about the energy gel deaths in Vietnam and realizes Austin smuggled the pathogen in the packets. He suspects Wilbur Sinclair, a university plague researcher, helped Austin and decides Alexis must be killed. He has Sinclair invite her to the labs that afternoon. Sensing danger, Alexis calls Ken, who insists on accompanying her. Before leaving, she tucks a scalpel from her cutting kit into her back pocket and eats one of Austin's chocolate-flavored energy gels.

At the seventh-floor elevator bank, Douglas and Sinclair are waiting. When the elevator doors open and Douglas sees Ken, he fires, shattering Ken's right forearm. Douglas orders Sinclair to retrieve the transgenic rats from the lab. Alexis, growing feverish and developing sores from the contaminated gel, pulls the scalpel and lunges at Douglas. On her third slash she severs his carotid artery, and he bleeds out on the floor. Ken retrieves his gun and pursues Sinclair, shooting him in the lower back. The sealed carrier of transgenic rats lands intact beside the fallen scientist.

Alexis calls 911, warning that the floor is a biohazard, then calls her mother, Dina Remnick, to say goodbye, reflecting on her father's death and her mother's fierce love. She survives because the bacteria in the sealed packet had weakened without oxygen, delivering a milder dose than fresh exposure. She wakes in the ICU under quarantine, receiving an intravenous drip of vancomycin 3.0. Ken is less fortunate: His age, blood loss, and plague exposure prove fatal. He dies on the phone with his wife, Taleen.

Four hospital employees are arrested: Sally, Oscar, Sara, and Sinclair. Sally's confession reveals that she and Douglas independently sought to weaponize the plague, while Austin betrayed them both by trying to sell the pathogen to Binh Pham's North Korean contacts. Taleen Sarafian, Ken's widow, visits Dina at the hospital and gives her a pair of her late daughter's silver Armenian eternity earrings for Alexis. The two women, both widows shaped by loss, share a quiet embrace.

In the epilogue, the pandemic begins anyway. A hotel housekeeper gives Austin's abandoned energy gels to her brother, who passes them to a homeless boy. The boy dies by lunchtime. American tourists discover the body, gnawed by Vietnamese rats immune to the pathogen, and fly home to Washington, D.C. The family and nearby passengers fall critically ill. The older teenage girl becomes Patient Zero, and Austin earns the posthumous nickname "the Rat King." The novel ends with the pandemic spreading.