by Robin Cook
“That’s pure rationalization,” Jack said.
“Time out, you guys,” Chet said, stepping between Jack and Terese for the second time. “You two are getting out of control again. Let’s switch the topic of conversation. Why don’t we talk about something neutral, like sex or religion.”
Colleen laughed and gave Chet a playful swat on the shoulder.
“I’m serious,” Chet said while laughing with Colleen. “Let’s discuss religion. It’s been getting short shrift lately in bars. Let’s have everybody tell what they grew up as. I’ll be first…”
For the next half hour they indeed did discuss religion, and Jack and Terese forgot their emotional outburst. They even found themselves laughing since Chet was a raconteur of some wit.
At eleven-fifteen Jack happened to glance at his watch and did a double take. He couldn’t believe it was so late.
“I’m sorry,” he said, interrupting the conversation. “I’ve got to go. I’ve got a bicycle ride ahead of me.”
“A bike?” Terese questioned. “You ride a bike around this city?”
“He’s got a death wish,” Chet said.
“Where do you live?” Terese asked.
“Upper West Side,” Jack said.
“Ask him how ‘upper,’” Chet dared.
“Exactly where?” Terese asked.
“One-oh-six a Hundred and Sixth Street,” Jack said. “To be precise.”
“But that’s in Harlem,” Colleen said.
“I told you he has a death wish,” Chet said.
“Don’t tell me you’re going to ride across the park at this hour,” Terese said.
“I move pretty quickly,” Jack said.
“Well, I think it’s asking for trouble,” Terese said. She bent down and picked up her briefcase, which she’d set on the floor by her feet. “I don’t have a bike, but I do have a date with my bed.”
“Wait a second, you guys,” Chet said. “Colleen and I are in charge. Right, Colleen?” He put his arm loosely around Colleen’s shoulder.
“Right!” Colleen said to be agreeable.
“We’ve decided,” Chet said with feigned authority, “that you two can’t go home unless you agree to have dinner tomorrow night.”
Colleen shook her head as she ducked away from Chet’s arm. “I’m afraid we’re not available,” she said. “We’ve got an impossible deadline, so we’ll be putting in some serious overtime.”
“Where were you thinking of having dinner?” Terese asked.
Colleen looked at her friend with surprise.
“How about right around the corner at Elaine’s,” Chet said. “About eight o’clock. We might even see a couple of celebrities.”
“I don’t think I can…” Jack began.
“I’m not listening to any excuses from you,” Chet said, interrupting. “You can bowl with that group of nuns another night. Tomorrow you’re having dinner with us.”
Jack was too tired to think. He shrugged.
“It’s decided, then?” Chet said.
Everyone nodded.
Outside of the bar the women climbed into a cab. They offered Chet a ride home, but he said he lived in the neighborhood.
“Are you sure you don’t want to leave that bike here for the night?” Terese asked Jack, who’d finished removing his panoply of locks.
“Not a chance,” Jack said. He threw a leg over his bike and powered out across Second Avenue, waving over his head.
Terese gave the cabdriver the address of the first stop, and the taxi made a left onto Second Avenue and accelerated southward. Colleen, who’d kept her eye on Chet out the back window, turned to face her boss.
“What a surprise,” she said. “Imagine meeting two decent men at a bar. It always seems to happen when you least expect it.”
“They were nice guys,” Terese agreed. “I suppose I was wrong about them being out at the meat market, and thank God they didn’t spout off about sports or the stock market. Generally that’s all men in this city can talk about.”
“What tweaks my funny bone is that my mother has forever been encouraging me to meet a doctor,” Colleen said with a laugh.
“I don’t think either one of them is a typical doctor,” Terese said. “Especially Jack. He’s got a strange attitude. He’s awfully bitter about something, and seems a bit foolhardy. Can you imagine riding a bike around this city?”
“It’s easier than thinking about what they do. Can you imagine dealing with dead people all day?”
“I don’t know,” Terese said. “Mustn’t be too different than dealing with account executives.”
“I have to say you shocked me when you agreed to have dinner tomorrow night,” Colleen said. “Especially with this National Health disaster staring us in the face.”
“But that’s exactly why I did agree,” Terese said. She flashed Colleen a conspiratorial smile. “I want to talk some more with Jack Stapleton. Believe it or not, he actually gave me a great idea for a new ad campaign for National Health! I can’t imagine what his reaction would be if he knew. With his philistine attitude about advertising, he’d probably have a stroke.”
“What’s the idea?” Colleen asked eagerly.
“It involves this plague thing,” Terese said. “Since AmeriCare is National Health’s only real rival, our ad campaign merely has to take advantage of the fact that AmeriCare got plague in its main hospital. As creepy as the situation is, people should want to flock to National Health.”
Colleen’s face fell. “We can’t use plague,” she said.
“Hell, I’m not thinking of using plague specifically,” Terese said. “Just emphasizing the idea of National Health’s hospital being so new and clean. The contrary will be evoked by inference, and it will be the public who will make the association with this plague episode. I know what the Manhattan General is like. I’ve been there. It might have been renovated, but it’s still an old structure. The National Health hospital is the antithesis. I can see ads where people are eating off the floor at National Health, suggesting it’s that clean. I mean, people like the idea that their hospital is new and clean, especially now with all the hullabaloo about bacteria making a comeback and becoming antibiotic-resistant.”
“I like it,” Colleen said. “If that doesn’t increase National Health Care’s market share vis-à-vis AmeriCare, nothing will.”
“I even have thought up a tag line,” Terese said smugly. “Listen: ‘We deserve your trust: Health is our middle name.’”
“Excellent! I love it!” Colleen exclaimed. “I’ll get the whole team working on it bright and early.”
The cab pulled up to Terese’s apartment. The women did a high-five before Terese got out.
Leaning back into the cab, Terese said: “Thanks for getting me to go out tonight. It was a good idea for lots of reasons.”
“You’re welcome,” Colleen said, flashing a thumbs-up sign.
10
THURSDAY, 7:25 A.M., MARCH 21, 1996
As a man of habit, Jack arrived in the vicinity of the medical examiner’s office at the same time each day, give or take five minutes. This particular morning he was ten minutes late since he’d awakened with a slight hangover. He’d not had a hangover in so long, he’d completely forgotten how miserable it made him feel. Consequently he’d stayed in the shower a few minutes longer than usual, and on the slalom down Second Avenue, he’d kept his speed to a more reasonable level.
Crossing First Avenue, Jack saw something he’d never seen before at that time of day. There was a TV truck with its main antennae extended sitting in front of the medical examiner’s building.
Changing his direction a little, he cruised around the truck. No one was in it. Looking up at the front door to the ME’s office, he saw a group of newspeople clustered just over the threshold.
Curious as to what was going on, Jack hustled around to the entrance bay, stashed his bike in the usual place, and went up to the ID room.
As usual Laurie and Vinnie were
in their respective seats.
Jack said hello but continued through the room to peek out into the lobby area. It was as crowded as he’d ever seen it.
“What the hell’s going on?” Jack asked, turning back to Laurie.
“You of all people should know,” she said. She was busy making up the day’s autopsy schedule. “It’s all about the plague epidemic!”
“Epidemic?” Jack questioned. “Have there been more cases?”
“You haven’t heard?” Laurie questioned. “Don’t you watch morning TV?”
“I don’t have a TV,” Jack admitted. “In my neighborhood owning one is just inviting trouble.”
“Well, two victims came in to us during the night,” Laurie said. “One is for sure plague, or at least presumptive since the hospital did its own fluorescein antibody and it was positive. The other is suspected, since clinically it seemed to be plague despite a negative fluorescein antibody. In addition to that, as I understand it, there are several febrile patients who have been quarantined.”
“This is all happening at the Manhattan General?” Jack asked.
“Apparently,” Laurie said.
“Were these cases direct contacts with Nodelman?” Jack asked.
“I haven’t had time to look into that,” Laurie said. “Are you interested? If you are, I’ll assign them to you.”
“Of course,” Jack said. “Which one is the presumptive plague?”
“Katherine Mueller,” Laurie said. She pushed the patient’s folder toward Jack.
Sitting on the edge of the desk where Laurie was working, Jack opened the folder. He leafed through the papers until he found the investigative report. He pulled it out and began reading. He learned the woman had been brought into the Manhattan General emergency room at four o’clock in the afternoon acutely ill with what was diagnosed to be a fulminant case of plague. She’d died nine hours later despite massive antibiotics.
Jack checked on the woman’s place of employment and wasn’t surprised with what he learned. The woman worked at the Manhattan General. Jack assumed she had to have been a direct contact of Nodelman. Unfortunately the report did not indicate in what department she worked. Jack guessed either nursing or lab.
Reading on in the report, Jack silently complimented Janice Jaeger’s work. After the conversation he’d had with her the day before by phone, she added information about travel, pets, and visitors. In the case of Mueller it was all negative.
“Where’s the suspected plague?” Jack asked Laurie.
Laurie pushed a second folder toward him.
Jack opened the second file and was immediately surprised. The victim neither worked at the Manhattan General nor had obvious contact with Nodelman. Her name was Susanne Hard. Like Nodelman, she’d been a patient in the General, but not on the same ward as Nodelman. Hard had been on the OB-GYN ward after giving birth! Jack was mystified.
Reading further, Jack learned that Hard had been in the hospital for twenty-four hours when she’d experienced sudden high fever, myalgia, headache, overwhelming malaise, and progressive cough. These symptoms had come on about eighteen hours after undergoing a cesarean section during which she delivered a healthy child. Eight hours after the symptoms appeared, the patient was dead.
Out of curiosity Jack looked up Hard’s address, remembering that Nodelman had lived in the Bronx. But Hard had not lived in the Bronx. She had lived in Manhattan on Sutton Place South, hardly a ghetto neighborhood.
Reading on, Jack learned that Hard had not traveled since she’d become pregnant. As far as pets were concerned, she owned an elderly but healthy poodle. Concerning visitors, she had entertained a business associate of her husband’s from India three weeks previously who was described as being healthy and well.
“Is Janice Jaeger still here this morning?” Jack asked Laurie.
“She was about fifteen minutes ago when I passed her office,” Laurie said.
Jack found Janice where she’d been the previous morning.
“You are a dedicated civil servant,” Jack called out from the threshold.
Janice looked up from her work. Her eyes were red from fatigue. “Too many people dying lately. I’m swamped. But tell me: Did I ask the right questions on the infectious cases last night?”
“Absolutely,” Jack said. “I was impressed. But I do have a couple more.”
“Shoot,” Janice said.
“Where’s the OB-GYN ward in relation to the medical ward?”
“They’re right next to each other,” Janice said. “Both are on the seventh floor.”
“No kidding,” Jack said.
“Is that significant?” Janice asked.
“I haven’t the slightest idea,” Jack admitted. “Do patients from the OB ward mix with those on the medical ward?”
“You got me there,” Janice admitted. “I don’t know, but I wouldn’t imagine so.”
“Nor would I,” Jack said. But if they didn’t, then how did Susanne Hard manage to get sick? Something seemed screwy about this plague outbreak. Facetiously he wondered if a bunch of infected rats could be living in the ventilation system on the seventh floor.
“Any other questions?” Janice asked. “I want to get out of here, and I have this last report to finish.”
“One more,” Jack said. “You indicated that Katherine Mueller was employed by the General but you didn’t say for what department. Do you know if she worked for nursing or for the lab?”
Janice leafed through her night’s notes and came up with the sheet on which she’d recorded Mueller’s information. She quickly glanced through it and then looked back up at Jack. “Neither,” she said. “She worked in central supply.”
“Oh, come on!” Jack said. He sounded disappointed.
“I’m sorry,” Janice said. “That’s what I was told.”
“I’m not blaming you,” Jack said with a wave of his hand. “It’s just that I’d like there to be some sort of logic to all this. How would a woman in central supply get into contact with a sick patient on the seventh floor? Where’s central supply?”
“I believe it’s on the same floor with the operating rooms,” Janice said. “That would be the third floor.”
“Okay, thanks,” Jack said. “Now get out of here and get some sleep.”
“I intend to,” Janice said.
Jack wandered back toward the ID room, thinking that nothing seemed to be making much sense. Usually the course of a contagious illness could be easily plotted sequentially through a family or a community. There was the index case, and the subsequent cases extended from it by contact, either directly or through a vector like an insect. There wasn’t a lot of mystery. That wasn’t the case so far with this plague outbreak. The only unifying factor was that they all involved the Manhattan General.
Jack absently waved to Sergeant Murphy, who’d apparently just arrived in his cubbyhole office off the communications room. The ebullient Irish policeman waved back with great enthusiasm.
Jack slowed his walk while his mind churned. Susanne Hard had come down with symptoms after only being in the hospital for a day. Since the incubation period for plague was generally thought to be two days at a minimum, she would have been exposed prior to coming into the hospital. Jack went back to Janice’s office.
“One more question,” Jack called out to her. “Do you happen to know whether the Hard woman visited the hospital in the days prior to her admission?”
“Her husband said no,” Janice said. “I asked that question specifically. Apparently she hated the hospital and only came in at the very last minute.”
Jack nodded. “Thanks,” he said, even more preoccupied. He turned and started back toward the ID room. That information made the situation more baffling, requiring him to postulate that the outbreak had occurred almost simultaneously in two, maybe three locations. That wasn’t probable. The other possibility was that the incubation period was extremely short, less than twenty-four hours. That would mean Hard’s illness was a nosocomia
l infection, as he suspected Nodelman’s was as well as Mueller’s. The problem with that idea was that it would suggest a huge, overwhelming infecting dose, which also seemed unlikely. After all, how many sick rats could be in a ventilation duct all coughing at the same time?
In the ID room Jack wrestled the sports page of the Daily News away from a reluctant Vinnie and dragged him down to the pit to begin the day.
“How come you always start so early?” Vinnie complained. “You’re the only one. Don’t you have a life?”
Jack swatted him in the chest with Katherine Mueller’s folder. “Remember the saying ‘The early bird gets the worm’?”
“Oh, barf,” Vinnie said. He took the folder from Jack and opened it. “Is this the one we’re doing first?” he asked.
“Might as well move from the known to the unknown,” Jack said. “This one had a positive fluorescein antibody test to plague, so zip up tight in your moon suit.”
Fifteen minutes later Jack began the autopsy. He spent a good deal of time on the external exam, looking for any signs of insect bites. It wasn’t an easy job, since Katherine Mueller was an overweight forty-four-year-old with hundreds of moles, freckles, and other minor skin blemishes. Jack found nothing he was sure was a bite, although a few lesions looked mildly suspicious. To be on the safe side he photographed them.
“No gangrene on this body,” Vinnie commented.
“Nor purpura,” Jack said.
By the time Jack started on the internal exam, a number of the other staff had arrived in the autopsy room and half of the tables were in use. There were a few comments about Jack becoming the local plague expert, but Jack ignored them. He was too engrossed.
Mueller’s lungs appeared quite similar to Nodelman’s, with extensive lobar pneumonia, consolidation, and early stages of tissue death. The woman’s cervical lymphatics were also generally involved, as were the lymph nodes along the bronchial tree.
“This is just as bad or worse than Nodelman,” Jack said. “It’s frightening.”
“You don’t have to tell me,” Vinnie said. “These infectious cases are the kind that make me wish I’d gone into gardening.”