by Robin Cook
A knock on the doorjamb caught both Jack’s and Chet’s attention. They turned to see Agnes Finn, head of the micro lab, standing in the doorway. She was a small, serious woman with thick glasses and stringy hair.
“We just got something a little surprising,” she said to Jack. She was clutching a sheet of paper in her hand. She hesitated on the threshold. Her dour expression didn’t change.
“Are you going to make us guess or what?” Jack asked. His curiosity had been titillated, since Agnes did not make it a point to deliver lab results.
Agnes pushed her glasses higher onto her nose and handed Jack the paper. “It’s the fluorescein antibody screen you requested on Nodelman.”
“My word,” Jack said after glancing at the page. He handed it to Chet.
Chet looked at the paper and then leaped to his feet. “Holy crap!” he exclaimed. “Nodelman had the goddamn plague!”
“Obviously we were taken aback by the result,” Agnes said in her usual monotone. “Is there anything else you want us to do?”
Jack pinched his lower lip while he thought. “Let’s try to culture some of the incipient abscesses,” he said. “And let’s try some of the usual stains. What’s recommended for plague?”
“Giemsa’s or Wayson’s,” Agnes said. “They usually make it possible to see the typical bipolar ‘safety pin’ morphology.”
“Okay, let’s do that,” Jack said. “Of course, the most important thing is to grow the bug. Until we do that, the case is only presumptive plague.”
“I understand,” Agnes said. She started from the room.
“I guess I don’t have to warn you to be careful,” Jack said.
“No need,” Agnes assured him. “We have a class-three hood, and I intend to use it.”
“This is incredible,” Chet said when they were alone. “How the hell did you know?”
“I didn’t,” Jack said. “Calvin forced me to make a diagnosis. To tell the truth, I thought I was being facetious. Of course, the signs were all consistent, but I still didn’t imagine I had a snowball’s chance in hell of being right. But now that I am, it’s no laughing matter. The only positive aspect is that I win that ten dollars from Calvin.”
“He’s going to hate you for that,” Chet said.
“That’s the least of my worries,” Jack said. “I’m stunned. A case of pneumonic plague in March in New York City, supposedly contracted in a hospital! Of course, that can’t be true unless the Manhattan General is supporting a horde of infected rats and their fleas. Nodelman had to have had contact with some sort of infected animal. It’s my guess he was traveling recently.” Jack snatched up the phone.
“Who are you calling?” Chet asked.
“Bingham, of course,” Jack said as he punched the numbers. “There can’t be any delay. This is a hot potato I want out of my hands.”
Mrs. Sanford picked up the extension but informed Chet that Dr. Bingham was at City Hall and would be all day. He had left specific instructions he was not to be bothered since he’d be closeted with the mayor.
“So much for our chief,” Jack said. Without putting down the receiver, he dialed Calvin’s number. He didn’t have any better luck. Calvin’s secretary told him that Calvin had had to leave for the day. There was an illness in the family.
Jack hung up the phone and drummed his fingers on the surface of the desk.
“No luck?” Chet asked.
“The entire general staff is indisposed,” Jack said. “We grunts are on our own.” Jack suddenly pushed back his chair, got up, and started out of the office.
Chet bounded out of his own chair and followed. “Where are you going?” he asked. He had to run to catch up with Jack.
“Down to talk to Bart Arnold,” Jack said. He got to the elevator and hit the Down button. “I need more information. Somebody has to figure out where this plague came from or this city’s in for some trouble.”
“Hadn’t you better wait for Bingham?” Chet asked. “That look in your eye disturbs me.”
“I didn’t know I was so transparent,” Jack said with a laugh. “I guess this incident has caught my interest. It’s got me excited.”
The elevator door opened and Jack got on. Chet held the door from closing. “Jack, do me a favor and be careful. I like sharing the office with you. Don’t ruffle too many feathers.”
“Me?” Jack questioned innocently. “I’m Mister Diplomacy.”
“And I’m Muammar el Qaddafi,” Chet said. He let the elevator door slide closed.
Jack hummed a perky tune while the elevator descended. He was definitely keyed up, and he was enjoying himself. He smiled when he remembered telling Laurie that he’d hoped Nodelman turned out to have something with serious institutional consequences like Legionnaires’ disease so he could give AmeriCare some heartburn. Plague was ten times better. And on top of sticking it to AmeriCare, he’d have the pleasure of collecting his ten bucks from Calvin.
Jack exited on the first floor and went directly to Bart Arnold’s office. Bart was the chief of the PAs, or physician’s assistants. Jack was pleased to catch him at his desk.
“We’ve got a presumptive diagnosis of plague. I’ve got to talk with Janice Jaeger right away,” Jack said.
“She’ll be sleeping,” Bart said. “Can’t it wait?”
“No,” Jack said.
“Bingham or Calvin know about this?” Bart asked.
“Both are out, and I don’t know when they’ll be back,” Jack said.
Bart hesitated a moment, then opened up the side drawer of his desk. After looking up Janice’s number, he made the call. When she was on the line, he apologized for having awakened her and explained that Dr. Stapleton needed to speak with her. He handed the phone to Jack.
Jack apologized as well and then told her about the results on Nodelman. Any sign of sleepiness in Janice’s voice disappeared instantly.
“What can I do to help?” she asked.
“Did you find any reference to travel in any of the hospital records?” Jack asked.
“Not that I recall,” Janice said.
“Any reference to contact with pets or wild animals?” Jack asked.
“Negative,” Janice said. “But I can go back there tonight. Those questions were never specifically asked.”
Jack thanked her and told her that he’d be looking into it himself. He handed the phone back to Bart and hurried back to his own office.
Chet looked up as Jack dashed in. “Learn anything?” he asked.
“Not a thing,” Jack said happily. He pulled out Nodelman’s folder and rapidly shuffled through the pages until he found the completed identification sheet. On it were phone numbers for the next of kin. With his index finger marking Nodelman’s wife’s number, Jack made the call. It was an exchange in the Bronx.
Mrs. Nodelman answered on the second ring.
“I’m Dr. Stapleton,” Jack said. “I’m a medical examiner for the City of New York.”
At that point Jack had to explain the role of a medical examiner, because even the archaic term “coroner” didn’t register with Mrs. Nodelman.
“I’d like to ask you a few questions,” Jack said once Mrs. Nodelman understood who he was.
“It was so sudden,” Mrs. Nodelman said. She had started to cry. “He had diabetes, that’s true. But he wasn’t supposed to die.”
“I’m very sorry for your loss,” Jack said. “But did your late husband do any recent traveling?”
“He went to New Jersey a week or so ago,” Mrs. Nodelman said. Jack could hear her blow her nose.
“I was thinking of travel to more distant destinations,” Jack said. “Like to the Southwest or maybe India.”
“Just to Manhattan every day,” Mrs. Nodelman said.
“How about a visitor from some exotic locale?” Jack asked.
“Donald’s aunt visited in December,” Mrs. Nodelman said.
“And where is she from?”
“Queens,” Mrs. Nodelman said.
/> “Queens,” Jack repeated. “That’s not quite what I had in mind. How about contact with any wild animals? Like rabbits.”
“No,” Mrs. Nodelman said. “Donald hated rabbits.”
“How about pets?” Jack asked.
“We have a cat,” Mrs. Nodelman said.
“Is the cat sick?” Jack asked. “Or has the cat brought home any rodents?”
“The cat is fine,” Mrs. Nodelman said. “She’s a house cat and never goes outside.”
“How about rats?” Jack asked. “Do you see many rats around your house? Have you seen any dead ones lately?”
“We don’t have any rats,” Mrs. Nodelman said indignantly. “We live in a nice, clean apartment.”
Jack tried to think of something else to ask, but for the moment nothing came to mind. “Mrs. Nodelman,” he said, “you’ve been most kind. The reason I’m asking you these questions is because we have reason to believe that your husband died of a serious infectious disease. We think he died of plague.”
There was a brief silence.
“You mean bubonic plague like they had in Europe long ago?” Mrs. Nodelman asked.
“Sort of,” Jack said. “Plague comes in two clinical forms, bubonic and pneumonic. Your husband seems to have had the pneumonic form, which happens to be the more contagious. I would advise you to go to your doctor and inform him of your potential exposure. I’m sure he’ll want you to take some precautionary antibiotics. I would also advise you to take your pet to your vet and tell him the same thing.”
“Is this serious?” Mrs. Nodelman asked.
“It’s very serious,” Jack said. He then gave her his phone number in case she had any questions later. He also asked her to call him if the vet found anything suspicious with the cat.
Jack hung up the phone and turned to Chet. “The mystery is deepening,” he said. Then he added cheerfully: “AmeriCare is going to have some severe indigestion over this.”
“There’s that facial expression again that scares me,” Chet said.
Jack laughed, got up, and started out of the room.
“Where are you going now?” Chet asked nervously.
“To tell Laurie Montgomery what’s going on,” Jack said. “She’s supposed to be our supervisor for today. She has to be apprised.”
A few minutes later Jack returned.
“What’d she say?” Chet asked.
“She was as stunned as we were,” Jack said. He grabbed the phone directory before taking his seat. He flipped open the pages to the city listings.
“Did she want you to do anything in particular?” Chet asked.
“No,” Jack said. “She told me to tread water until Bingham is informed. In fact she tried to call our illustrious chief, but he’s still incommunicado with the mayor.”
Jack picked up the phone and dialed.
“Who are you calling now?” Chet asked.
“The Commissioner of Health, Patricia Markham,” Jack said. “I ain’t waiting.”
“Good grief!” Chet exclaimed, rolling his eyes. “Hadn’t you better let Bingham do that? You’ll be calling his boss behind his back.”
Jack didn’t respond. He was busy giving his name to the commissioner’s secretary. When she told him to hold on, he covered the mouthpiece with his hand and whispered to Chet: “Surprise, surprise, she’s in!”
“I guarantee Bingham is not going to like this,” Chet whispered back.
Jack held up his hand to silence Chet. “Hello, Commissioner,” Jack said into the phone. “Howya doing. This is Jack Stapleton here, from over at the ME’s office.”
Chet winced at Jack’s breezy informality.
“Sorry to spoil your day,” Jack continued, “but I felt I had to call. Dr. Bingham and Dr. Washington are momentarily unavailable and a situation has developed that I believe you should know about. We’ve just made a presumptive diagnosis of plague in a patient from the Manhattan General Hospital.”
“Good Lord!” Dr. Markham exclaimed loud enough for Chet to hear. “That’s frightening, but only one case, I trust.”
“So far,” Jack said.
“All right, I’ll alert the City Board of Health,” Dr. Markham said. “They’ll take over and contact the CDC. Thanks for the warning. What was your name again?”
“Stapleton,” Jack said. “Jack Stapleton.”
Jack hung up with a self-satisfied smile on his lips. “Maybe you should sell short your AmeriCare stock,” he told Chet. “The commissioner sounds concerned.”
“Maybe you’d better brush off your résumé,” Chet said. “Bingham is going to be pissed.”
Jack whistled while he leafed through Nodelman’s file until he came up with the investigative report. Once he had located the name of the attending physician, Dr. Carl Wainwright, he wrote it down. Then he got up and put on his leather bomber jacket.
“Uh oh,” Chet said. “Now what?”
“I’m going over to the Manhattan General,” Jack said. “I think I’ll make a site visit. This case is too important to leave up to the generals.”
Chet swung around in his chair as Jack went through the door.
“Of course, you know that Bingham doesn’t encourage us MEs doing site work,” Chet said. “You’ll be adding insult to injury.”
“I’ll take my chances,” Jack said. “Where I was trained it was considered necessary.”
“Bingham thinks it’s the job of the PAs,” Chet said. “He’s told us that time and again.”
“This case is too interesting for me to pass up,” Jack called from down the hall. “Hold down the fort. I won’t be long.”
5
WEDNESDAY, 2:50 P.M., MARCH 20, 1996
It was overcast and threatening rain, but Jack didn’t mind. Regardless of the weather, the vigorous bike ride uptown to the Manhattan General was a pleasure after having stood all morning in the autopsy room imprisoned inside his moon suit.
Near the hospital’s front entrance Jack located a sturdy street sign to lock his mountain bike to. He even locked up his helmet and bomber jacket with a separate wire lock that also secured the seat.
Standing within the shadow of the hospital, Jack glanced up at its soaring facade. It had been an old, respected, university-affiliated, proprietary hospital in its previous life. AmeriCare had gobbled it up during the fiscally difficult times the government had unwittingly created in health care in the early 1990s. Although Jack knew revenge was far from a noble emotion, he savored the knowledge that he was about to hand AmeriCare a public relations bomb.
Inside Jack went to the information booth and asked about Dr. Carl Wainwright. He learned that the man was an AmeriCare internist whose office was in the attached professional building. The receptionist gave Jack careful directions.
Fifteen minutes later, Jack was in the man’s waiting room. After Jack flashed his medical examiner’s badge, which looked for all intents and purposes like a police badge, the receptionist wasted no time in letting Dr. Wainwright know he was there. Jack was immediately shown into the doctor’s private office, and within minutes the doctor himself appeared.
Dr. Carl Wainwright was prematurely white-haired and slightly stooped over. His face, however, was youthful with bright blue eyes. He shook hands with Jack and motioned for him to sit down.
“It’s not every day we’re visited by someone from the medical examiner’s office,” Dr. Wainwright said.
“I’d be concerned if it were,” Jack said.
Dr. Wainwright looked confused until he realized Jack was kidding. Dr. Wainwright tittered. “Right you are,” he said.
“I’ve come about your patient Donald Nodelman,” Jack said, getting right to the point. “We have a presumptive diagnosis of plague.”
Dr. Wainwright’s mouth dropped open. “That’s impossible,” he said when he’d recovered enough to speak.
Jack shrugged. “I guess it’s not,” he said. “Fluorescein antibody for plague is quite reliable. Of course, we haven’t yet grown it out.”
“My goodness,” Dr. Wainwright managed. He rubbed a nervous palm across his face. “What a shock.”
“It is surprising,” Jack agreed. “Especially since the patient had been in the hospital for five days before his symptoms started.”
“I’ve never heard of nosocomial plague,” Dr. Wainwright said.
“Nor have I,” Jack said. “But it was pneumonic plague, not bubonic, and as you know the incubation period is shorter for pneumonic, probably only two to three days.”
“I still can’t believe it,” Dr. Wainwright said. “Plague never entered my thoughts.”
“Anybody else sick with similar symptoms?” Jack asked.
“Not that I know of,” Dr. Wainwright said, “but you can rest assured that we will find out immediately.”
“I’m curious about this man’s lifestyle,” Jack said. “His wife denied any recent travel or visitors from areas endemic to plague. She also doubted he’d come in contact with wild animals. Is that your understanding as well?”
“The patient worked in the garment district,” Dr. Wainwright said. “He did bookkeeping. He never traveled. He wasn’t a hunter. I’d been seeing him frequently over the last month, trying to get his diabetes under control.”
“Where was he in the hospital?” Jack asked.
“On the medical ward on the seventh floor,” Dr. Wainwright said. “Room seven-oh-seven. I remember the number specifically.”
“Single room?” Jack asked.
“All our rooms are singles,” Dr. Wainwright said.
“That’s a help,” Jack said. “Can I see the room?”
“Of course,” Dr. Wainwright said. “But I think I should call Dr. Mary Zimmerman, who’s our infection-control officer. She’s got to know about this immediately.”
“By all means,” Jack said. “Meanwhile, would you mind if I went up to the seventh floor and looked around?”
“Please,” Dr. Wainwright said as he gestured toward the door. “I’ll call Dr. Zimmerman and we’ll meet you up there.” He reached for the phone.
Jack retraced his route back to the main hospital building. He took the elevator to the seventh floor, which he found was divided by the elevator lobby into two wings. The north wing housed internal medicine while the south wing was reserved for OB-GYN. Jack pushed through the doors that led into the internal-medicine division.