by Robin Cook
“You’re welcome,” Janice said. “I would have called sooner, but we really did think it was the beginning of a dreaded surge. We’re so relieved we’re not going to be overwhelmed.”
“That we’re not going to be overwhelmed with deaths is the good side,” Jack said. “The bad side is that it is going to take the city days to recover.” He disconnected, then stepped back over to Jennifer. “Is there a file on the case I was just talking with Janice about? A male with rapid onset respiratory distress, out of Bellevue?”
“There is.” Jennifer handed the file to Jack. Jack opened it and read the name. He was shocked. It was John Carver. Could it possibly be the John Carver he’d interviewed yesterday after the man had made the identification of Helen VanDam? Jack thought it was possible, if not probable. After all, the John Carver he’d talked with had reputedly been intimate with both subway death victims.
“Vinnie!” Jack called.
“I’m right here,” Vinnie said. “You don’t have to yell.”
Surprised to find Vinnie standing right behind him, Jack slapped him with the Carver file. “Let’s get a jump on the day.”
“It’s only a quarter past seven,” Vinnie whined. “I haven’t finished my coffee or read the sports page. Have a heart!”
“This is another case just like the subway deaths,” Jack said with mounting excitement. He needed something to take his mind off the morning’s disaster, and this new case was perfect. “We’ll do it in the same fashion we did the other two, meaning full moon suits in the decomposed room.”
“If it is like the other two, I wouldn’t be willing to do it any other way,” Vinnie said. He could tell by Jack’s tone that there was no way he was going to be talked out of getting right to work.
“Have one of the other skilled mortuary techs help you with weighing and X-raying,” Jack said. “Then both of you suit up and take some photos for ID purposes and do the fingerprinting. When that’s done, prepare for the autopsy. I should be down there by then. I’m going to go talk with the individual who came in to do the identification. It could be important. I’m starting to get a sense of the viral culprit we’re dealing with.”
Without waiting for Vinnie’s inevitable further complaints about not having had enough coffee or gotten to check out the morning newspaper, Jack headed out to the family ID room. He passed the cubicles used by the identification clerks and walked into the room where he’d spoken with John Carver the day before. Sitting on the same blue couch was a woman Jack thought looked cut from a similar mold. She was about the same age, maybe a little younger, but also slender, well groomed, with blond-streaked hair and form-fitting contemporary clothes, and was rather attractive in a clean, well-scrubbed fashion.
Jack carried over one of the wooden chairs from the round table and sat down. He introduced himself and learned that the woman’s name was Darlene Aaronson, originally from Orlando, Florida. She had a slight southern accent and appeared nervous, like a caged wild bird, crossing and uncrossing her legs and alternately chewing on her cuticles.
“I’d like to ask you a few questions about John Carver,” Jack began. “I imagine this has been a difficult episode for you, and I hope talking about it isn’t too upsetting. I’ve been told you are prepared to formally identify Mr. Carver when photos are available.”
“Photos? Oh, thank goodness,” Darlene said. She appeared to relax a degree. “I was afraid I’d have to look at the body, like they do in the movies.”
“We use photos almost exclusively,” Jack said. “Can you tell me if this was the John Carver who grew up in Seattle?”
“I suppose,” Darlene said. “He did mention he’d gone to high school in Seattle, so I guess he grew up there.”
“Does that mean you haven’t known him for very long?” Jack asked.
“I just met him last night,” Darlene said. “It was in my favorite Lower East Side bar. I had seen him before in that particular bar on several occasions.”
“Were you introduced, or did you just start chatting?” Jack asked.
“He looked depressed and was nursing a drink by himself,” Darlene said. “I went up to him and asked him what was wrong. He said someone he knew had died.”
“He didn’t say who had died or what they had died of?”
“No, and I didn’t ask,” Darlene said. “He didn’t seem to want to talk about it. We talked mostly about music. We were both into music. After a few beers we ended up going back to my apartment to listen to some jazz.”
Bad idea, Jack thought but didn’t say.
“But tell me,” Darlene continued. “What did John die of? No one would tell me at the emergency room. I asked several people. They just put me off.”
“We’re not sure,” Jack said. “That’s what we are trying to find out. How did his illness start?”
“What do you mean?”
“I’m assuming he was acting as if he was healthy when you met,” Jack said.
Darlene gave a short, disparaging laugh. “I’ll say. Very healthy.”
“What I am asking is what were his first symptoms? A headache, or sore throat, or a cough?” Jack said, ignoring Darlene’s last comment and its implications.
“A chill,” Darlene said. “All of a sudden he was shivering for no reason.”
“I see,” Jack said. He considered that significant, as John had described Helen’s episode as having started in the same way. Intuitively, Jack imagined the chill most likely heralded an acute viremia with virus particles suddenly bursting out into the bloodstream, and the idea brought a kind of revelation. For that to happen, the viruses had to be somehow isolated or locked away, and as far as he knew, there was only one way for that to happen. The virus had to be inside cells in a kind of dormant state.
All at once Jack thought he understood why Aretha had had so much trouble making a diagnosis. It wasn’t a typical virus such as those that produced a cold, hemorrhagic fever, or even influenza. They were most likely dealing with an unknown retrovirus like HIV, which took two years to identify. And the moment the idea occurred to him, he wondered why he hadn’t thought of it earlier. It explained why some people saw it with electron microscopy and others didn’t.
“And the next thing I know is he was having trouble breathing,” Darlene continued. “It got worse fast. Then he started turning blue, so I called nine-one-one. It was terrible.”
“Excuse me,” a voice called.
Jack turned and looked up into the face of one of the night-shift ID clerks, who was standing to the side and behind him. She was holding a number of recently printed photos. “If Ms. Aaronson would like to do the identification, we are ready,” she said.
“May I see,” Jack asked.
“Of course, Dr. Stapleton,” the clerk said. She handed the entire stack to Jack.
Jack needed to look at only the top photo and immediately recognized that it was without doubt the John Carver he had spoken with the day before. For a moment Jack felt a tug on his heartstrings. He could remember the man asking if he had to worry about catching what had killed Helen and Carol. Jack hadn’t known what to say, and now the man was dead. Whatever specific virus it was, Jack could now say with reasonable certitude that it was definitely contagious but with low infectivity and most likely spread by body fluids, similar to HIV. But what made it particularly worrisome was its ability to be far more rapidly fatal. HIV killed by gradually weakening the immune system, whereas this new, unknown disease apparently killed by suddenly unleashing the immune system in a totally uncontrolled fashion.
At that moment there was no doubt in Jack’s mind that NYC was dealing with at least an outbreak of a new disease. Whether it would prove contagious enough to become an epidemic and then a pandemic, he had no way of knowing. Suddenly, he was no longer engaged in an undertaking merely as a way to deal with his daughter’s affliction, but rather one that had a potentially
grave public-health impact. For Jack it was a case that clearly demonstrated both the power and importance of forensic pathology, and it certainly justified his switch to the field.
But his work was far from being done. There was still one more major question he needed answered. Of the three victims, who was the index case? Who contracted this unknown disease and then spread it to the others? Carol was his guess, because she was first, but the order of the deaths might or might not be indicative of who got it first, as the illness apparently had a long latent period between contracting the virus and the appearance of the first symptoms. All at once he was pleased the CDC epidemic intelligence team was en route. Epidemiology was their bailiwick, and his crusade had morphed into an epidemiological mystery. One of the biggest questions was whether the disease had anything to do with Carol’s heart transplant.
“Would you like to come back to my office, Ms. Aaronson?” the clerk asked, interrupting Jack’s rapid musings. “We need to get your information and signature.”
“Okay,” Darlene said. “But I’d like to ask Dr. Stapleton a question, if I may.”
“Of course,” Jack said. He’d gotten to his feet. He was now eager to leave. He wanted to see if John’s affliction was the same as Carol’s and Helen’s, just to be sure.
“Should I be worried about what has happened to John?” she questioned. “I mean . . . you know . . . I spent time with him.”
For a moment Jack was unable to speak, as his mind raced in circles in an attempt to come up with an appropriate answer. The question was essentially the same as the one John had asked him yesterday, and Jack felt he’d failed the man. Yet he truly didn’t know what to say. There was no way to make a diagnosis of an unknown disease, nor was there any treatment. Clearly Darlene was at risk, especially if she’d been intimate with John, and Jack was probably correct about the illness spreading by body fluids, but there was no way to assay the risk or do anything about it.
“Well?” Darlene asked. She went back to chewing her cuticles. She had hoped for reassurance. Jack’s silence was doing the opposite.
“To be totally honest, I don’t know,” Jack said, ultimately deciding truth was better than deception. “At this point, I’m concerned we might be witnessing the beginning of a new disease that potentially spreads by body fluids. You might have been exposed, but there is no way to know. Perhaps you should take that into consideration and avoid having intimate contact with anyone else for the time being. As soon as we know more we will be in touch with you. I can promise you that, since we’ll have your contact information from the identification process. That’s all I can say.” It was essentially what he had told John, which didn’t help the man. Yet on the spur of the moment he couldn’t think of anything else.
33
THURSDAY, 8:45 A.M.
Jack hit the button for the third floor in the back elevator of the Public Health Laboratory building. As he did so, he couldn’t help noticing how beat-up the cab was. He knew it was the service elevator, which had to carry a huge assortment of freight over many years, but how that resulted in all the damage, he had no idea. There was not a single surface that wasn’t scarified. As a civil servant himself, he wondered how it was that city property could look so worse for wear. Its battered state seemed fittingly emblematic of the disarray of his own life.
While he slowly ascended, he thought over the autopsy he’d just done on John Carver. It had been an unsettling experience, as there had been a moment at the very beginning that had made him pause. In all his twenty years as a forensic pathologist it had been the first time doing an autopsy that he’d had an emotional response, as it was also the first time he was called upon to eviscerate a person he’d so recently interacted with. He’d considered himself a professional hardened by repetition, but obviously it wasn’t entirely true. The situation had made him realize he was more of a softy than he’d thought.
After that initial psychological bump in the road, the autopsy had proceeded apace. Once again, both he and Vinnie had done the procedure in full moon suits, even though Jack thought that the protection they used against HIV would have been adequate. Most important, the autopsy findings were exactly the same as Carol’s and Helen’s. The man’s lungs were entirely filled with edema, exudate, and near liquefaction such that he had essentially drowned. It made Jack appreciate with striking clarity the human immune system’s power to do harm as well as good.
After the autopsy was over and with Vinnie involved in cleaning up, Jack had taken it upon himself to deliver the lung fluid samples to Aretha, which was why he was currently in the Public Health Laboratory building’s elevator. Yet playing delivery boy wasn’t his only motivation. He also had been eager to hear if she’d made any progress on her identification efforts and to discuss with her his retrovirus idea. Getting there had been easier than he’d anticipated; the horde of reporters and TV trucks had abandoned their stakeout of the old OCME building.
Similar to his first visit on Monday, Aretha was waiting for him when the elevator doors opened on the third floor, just outside the level 3 biosafety laboratory. She was her typical lively self and was happy to relieve Jack of the new samples. Her cornrow hairstyle looked as if it had been recently redone. Jack imagined it took time to achieve, but the end result was a work of art.
“Have you recovered from that weird episode last night?” Aretha said straight off. “That was one strange scene. Did someone really get shot? That’s so bizarre and scary.”
“With everything that has happened today, I haven’t even had time to think about it,” Jack said. “I assume you heard about the pandemic influenza panic this morning.”
“Oh, absolutely,” Aretha said. “We were all called at the crack of dawn to get in here to prepare for what we thought was going to be a surge of samples. I can’t tell you how relieved we were when it turned out to be a false alarm.”
“Did you see the Daily News that started it all?”
“I haven’t,” Aretha said.
“You should take a peek at it. It’s classic irresponsible journalism,” Jack said. “How about your work? Have you made any progress on identifying the virus?”
“Not yet,” Aretha told him. “But now that the influenza panic is over, I’m preparing to run my first BLAST search this morning with the nucleotide sequences the MPS machine has produced. So, fingers crossed. Let’s think positively. I might have something interesting this afternoon. It’s a little bit of a crapshoot. As I’ve said, you’ll be the first to know.”
“I’ve got my fingers crossed,” Jack said. He held his hand up to prove it. He knew that the virus needed to be identified before a test could be created and a possible treatment decided on.
“I also spoke with Connie Moran at the CDC just a few minutes ago,” Aretha said. “She’s at the same point as I am but more experienced. So maybe she’ll have something before I do. She’s promised to call the moment she does, and I’ll let you know.”
“Terrific,” Jack said. “There’s one other thing I wanted to mention to you. I had a kind of revelation this morning. I’m thinking we are dealing with a retrovirus somewhat like HIV, but one that affects the immune system in an opposite fashion.”
“Then we’re on the same page,” Aretha said. “I, too, have been thinking of a retrovirus. And so has Connie Moran, who I shared the clinical information with, including the autopsy findings this morning. I hope you don’t mind. I thought it could help. The moment I did, she shared something amazing with me. She had been in contact with the European Centre for Disease Prevention and Control in Solna, Sweden. Are you familiar with that organization?”
“I’m not,” Jack admitted.
“It’s the European Union’s equivalent of the CDC,” Aretha explained. “She said she had been talking with them this morning and was told that they have had two cases of respiratory death that sounded just like yours. Sudden onset and death within hours.
One in London and one in Rome. They have an official alert out for any more.”
“Really?” Jack questioned. “When did these deaths occur?”
“Both were yesterday,” Aretha said. “I thought you might find it interesting, so I asked for the details. Both were Americans. The one in Rome was a twenty-six-year-old woman who died on a nonstop flight from New York, which caused the entire flight to be quarantined. A ghastly situation for those unlucky enough to be on the flight. The London case was a twenty-eight-year-old male New Yorker who had been in London for a week.”
“Holy crap,” Jack said. He was stunned.
“What the hell does holy crap mean?” Aretha teased. “You generation X’s are too hung up on language. I think having two cases already showing up in Europe justifies at least a holy shit.”
“You’re right,” Jack said, and laughed. He knew he was old-fashioned when it came to strong language, which good old Carlos had challenged on Monday. “This problem is already threatening to turn into a pandemic before it’s even an epidemic. When you talk to Connie Moran again, see if she can get us the names and other details. The epidemic intelligence team that’s on its way from the CDC will need to know, if they don’t already.”
“Do you want to see the electron photomicrographs from the CDC that I mentioned?” Aretha asked.
“I think I’ll pass for now,” Jack said. “I should be getting back to find out how my wife is doing handling the fallout from this morning’s debacle.”
“I could email them to you,” Aretha said.
“Perfect,” Jack said. “Good luck with BLAST!” He now held up both of his hands with his fingers crossed.
* * *
—
When Jack got to the corner of 26th Street and First Avenue, he glanced over toward the entrance of 421 that was set back behind a small patch of greenery. Milling about were a good portion of the horde of reporters who had earlier been camped out in front of 520. Their presence outside meant Laurie had yet to start the news briefing she had promised and was most likely still in her office. Accordingly, Jack headed north up First Avenue.