by Robin Cook
Ignoring further pleas to reconsider, Jack left and rode uptown. He arrived in less than fifteen minutes and locked his bike to the same signpost as the day before.
The first thing Jack did was take the hospital elevator up to the seventh floor and reconnoiter. He saw how the OB-GYN and medical wards were completely separate without sharing any common facilities like lounges or lavatories. He also saw that the ventilation system was designed so as to preclude any movement of air from one ward to the other.
Pushing through the swinging doors into the OB-GYN area, Jack walked down to the central desk.
“Excuse me,” he said to a ward secretary. “Does this ward share any personnel with the medical ward across the elevator lobby?”
“No, not that I know of,” the young man said. He looked about fifteen with a complexion that suggested he had yet to shave. “Except, of course, cleaning people. But they clean all over the hospital.”
“Good point,” Jack said. He hadn’t thought of the housekeeping department. It was something to consider. Jack then asked which room Susanne Hard had occupied.
“Can I ask what this is in reference to?” the ward clerk asked. He had finally noticed that Jack was not wearing a hospital ID. Hospitals all require identification badges of their employees, but then frequently do not have the personnel to enforce compliance.
Jack took out his ME’s badge and flashed it. It had the desired effect. The ward secretary told Jack that Mrs. Hard had been in room 742.
Jack started out for the room, but the ward clerk called out to him that it was quarantined and temporarily sealed.
Believing that viewing the room would not have been enlightening anyway, Jack left the seventh floor and descended to the third, which housed the surgical suites, the recovery room, the intensive-care units, and central supply. It was a busy area with a lot of patient traffic.
Jack pushed through a pair of swinging doors into central supply and was confronted by an unmanned counter. Beyond the counter was an immense maze of floor-to-ceiling metal shelving laden with all the sundry equipment and supplies needed by a large, busy hospital. In and out of the maze moved a team of people attired in scrubs, white coats, and hats that looked like shower caps. A radio played somewhere in the distance.
After Jack had stood at the counter for a few minutes, a robust and vigorous woman caught sight of him and came over. Her name tag said “Gladys Zarelli, Supervisor.” She asked if he needed some help.
“I wanted to inquire about Katherine Mueller,” Jack said.
“God rest her soul,” Gladys said. She made the sign of the cross. “It was a terrible thing.”
Jack introduced himself by displaying his badge, then questioned whether she and her co-workers were concerned that Katherine had died of an infectious disease.
“Of course we’re concerned,” she said. “Who wouldn’t be? We all work closely with one another. But what can you do?
At least the hospital is concerned as well. They have us all on antibiotics, and thank God, no one is sick.”
“Has anything like this ever happened before?” Jack asked. “What I mean is, a patient died of plague just the day before Katherine. That suggests that Katherine could very well have caught it here at the hospital. I don’t mean to scare you, but those are the facts.”
“We’re all aware of it,” Gladys said. “But it’s never happened before. I imagine it’s happened in nursing, but not here in central supply.”
“Do you people have any patient contact?” Jack asked.
“Not really,” Gladys said. “Occasionally we might run up to the wards, but it’s never to see a patient directly.”
“What was Katherine doing the week before she died?” Jack asked.
“I’ll have to look that up,” Gladys said. She motioned for Jack to follow her. She led Jack into a tiny, windowless office where she cracked open a large, cloth-bound daily ledger.
“Assignments are never too strict,” Gladys said. Her finger ran down a row of names. “We all kinda pitch in as needed, but I give some basic responsibility to some of the more senior people.” Her finger stopped, then moved across the page. “Okay, Katherine was more or less in charge of supplies to the wards.”
“What does that mean?” Jack asked.
“Whatever they needed,” Gladys said. “Everything except drugs and that sort of stuff. That comes from pharmacy.”
“You mean like things for the patients’ rooms?” Jack asked.
“Sure, for the rooms, for the nurses’ station, everything,” Gladys said. “This is where it all comes from. Without us the hospital would grind to a halt in twenty-four hours.”
“Give me an example of the things you deal with for the rooms,” Jack said.
“I’m telling you, everything!” Gladys said with a touch of irritation in her voice. “Bedpans, thermometers, humidifiers, pillows, pitchers, soap. Everything.”
“You wouldn’t have any record of Katherine going up to the seventh floor during the last week or so, would you?”
“No,” Gladys said. “We don’t keep records like that. I could print out for you everything sent up there, though. That we have a record of.”
“Okay,” Jack said. “I’ll take what I can get.”
“It’s going to be a lot of stuff,” Gladys warned as she made an entry into her computer terminal. “Do you want OB-GYN or medical or both?” she asked.
“Medical,” Jack said.
Gladys nodded, pecked at a few more keys on her terminal, and soon her printer was cranking away. In a few minutes she handed Jack a stack of papers. He glanced through them. As Gladys had suggested there were a lot of items. The length of the list gave Jack respect for the logistics of running the institution.
Leaving central supply, Jack descended a floor and wandered into the lab. He did not feel he was making any progress, but he refused to give up. His conviction remained that there was some major missing piece of information. He just didn’t know where he would find it.
Jack asked the same receptionist to whom he’d shown his badge the day before for directions to microbiology, which she gave him without question.
Jack walked unchallenged through the extensive lab. It was an odd feeling to see so much impressive equipment running unattended. It reminded Jack of the director’s lament the day before that he’d been forced to cut his personnel by twenty percent.
Jack found Nancy Wiggens working at a lab bench plating bacterial cultures.
“Howdy,” Jack said. “Remember me?”
Nancy glanced up and then back at her work.
“Of course,” she said.
“You guys made the diagnosis on the second plague case just fine,” he said.
“It’s easy when you suspect it,” Nancy said. “But we didn’t do so well on the third case.”
“I was going to ask you about that,” Jack said. “What did the gram stain look like?”
“I didn’t do it,” Nancy said. “Beth Holderness did. Do you want to talk with her?”
“I would,” Jack said.
Nancy slid off her stool and disappeared. Jack took the opportunity to glance around at the microbiology section of the lab. He was impressed. Most labs, particularly microbiology labs, had an invariable clutter. This lab was different. It appeared highly efficient with everything crystal-clean and in its place.
“Hi, I’m Beth!”
Jack turned to find himself before a smiling, outgoing woman in her mid-twenties. She exuded a cheerleader-like zeal that was infectious. Her hair was tightly permed and radiated away from her face as if charged with static electricity.
Jack introduced himself and was immediately charmed by Beth’s natural conversation. She was one of the friendliest women he’d ever met.
“Well, I’m sure you didn’t come here to gab,” Beth said. “I understand you are interested in the gram stain on Susanne Hard. Come on! It’s waiting for you.”
Beth literally grabbed Jack by the sleeve and pulle
d him around to her work area. Her microscope was set up with Hard’s slide positioned on its platform and the illuminator switched on.
“Sit yourself right here,” Beth said as she guided Jack’s lower half onto her stool. “How is that? Low enough?”
“It’s perfect,” Jack said. He leaned forward and peered into the eyepieces. It took a moment for his eyes to adapt. When they did, he could see the field was filled with reddish-stained bacteria.
“Notice how pleomorphic the microbes are,” a male voice commented.
Jack looked up. Richard, the head tech, had materialized and was standing to Jack’s immediate left, almost touching him.
“I didn’t mean to be such a bother,” Jack said.
“No bother,” Richard said. “In fact, I’m interested in your opinion. We still haven’t made a diagnosis on this case. Nothing has grown out, and I presume you know that the test for plague was negative.”
“So I heard,” Jack said. He put his eyes back to the microscope and peered in again. “I don’t think you want my opinion. I’m not so good at this stuff,” he admitted.
“But you do see the pleomorphism?” Richard said.
“I suppose,” Jack said. “They’re pretty small bacilli. Some of them almost look spherical, or am I looking at them on end?”
“I believe you are seeing them as they are,” Richard said. “That’s more pleomorphism than you see with plague. That’s why Beth and I doubted it was plague. Of course, we weren’t sure until the fluorescein antibody was negative.”
Jack looked up from the scope. “If it’s not plague, what do you think it is?”
Richard gave a little embarrassed laugh. “I don’t know.”
Jack looked at Beth. “What about you? Care to take a chance?”
Beth shook her head. “Not if Richard won’t,” she said diplomatically.
“Can’t someone even hazard a guess?” Jack asked.
Richard shook his head. “Not me. I’m always wrong when I guess.”
“You weren’t wrong about plague,” Jack reminded him.
“That was just lucky,” Richard said. He flushed.
“What’s going on here,” an irritated voice called out.
Jack’s head swung around in the opposite direction. Beyond Beth was the director of the lab, Martin Cheveau. He was standing with his legs apart, his hands on his hips, and his mustache quivering. Behind him was Dr. Mary Zimmerman, and behind her was Charles Kelley.
Jack got to his feet. The lab techs slunk back. The atmosphere was suddenly tense. The lab director was clearly irate.
“Are you here in an official capacity?” Martin demanded. “If so, I’d like to know why you didn’t have the common courtesy to come to my office instead of sneaking in here? We have a crisis unfolding in this hospital, and this lab is in the middle of it. I am not about to brook interference from anyone.”
“Whoa!” Jack said. “Calm down.” He hadn’t expected this blowup, especially from Martin, who had been so hospitable the day before.
“Don’t tell me to calm down,” Martin snapped. “What the devil are you doing here, anyway?”
“I’m just doing my job, investigating the deaths of Katherine Mueller and Susanne Hard,” Jack said. “I hardly think I’m interfering. In fact I thought I was being rather discreet.”
“Is there something in particular you are looking for in my lab?” Martin demanded.
“I was just going over a gram stain with your capable staff,” Jack said.
“Your official mandate is to determine the cause and the manner of death,” Dr. Zimmerman said, pushing her way in front of Martin. “You’ve done that.”
“Not quite,” Jack corrected. “We haven’t made a diagnosis on Susanne Hard.” He returned the infection-control officer’s beady stare. Since she wasn’t wearing the mask she’d had on the day before, Jack was able to appreciate how stern her thin-lipped face was.
“You haven’t made a specific diagnosis in the Hard case,” Dr. Zimmerman corrected, “but you have made a diagnosis of a fatal infectious disease. Under the circumstances I think that is adequate.”
“Adequate has never been my goal in medicine,” Jack said.
“Nor mine,” Dr. Zimmerman shot back. “Nor is it for the Centers for Disease Control or the City Board of Health, who are actively investigating this unfortunate incident. Frankly your presence here is disruptive.”
“Are you sure they don’t need a little help?” Jack asked. He couldn’t hold back the sarcasm.
“I’d say your presence is more than disruptive,” Kelley said. “In fact, you’ve been downright slanderous. You could very well be hearing from our lawyers.”
“Whoa!” Jack said again, lifting his hands as if to fend off a bodily attack. “Disruptive I can at least comprehend. Slanderous is ridiculous.”
“Not from my point of view,” Kelley said. “The supervisor in central supply said you told her Katherine Mueller had contracted her illness on the job.”
“And that has not been established,” Dr. Zimmerman added.
“Uttering such an unsubstantiated statement is defamatory to this institution and injurious to its reputation,” Kelley snapped.
“And could have a negative impact on its stock value,” Jack said.
“And that too,” Kelley agreed.
“The trouble is I didn’t say Mueller had contracted her illness on the job,” Jack said. “I said she could have done so. There’s a big difference.”
“Mrs. Zarelli told us you told her it was a fact,” Kelley said.
“I told her ‘those were the facts’ referring to the possibility,” Jack said. “But look, we’re quibbling. The real fact is that you people are overly defensive. It makes me wonder about your nosocomial infection history. What’s the story there?”
Kelley turned purple. Given the man’s intimidating size advantage, Jack took a protective step backward.
“Our nosocomial infection experience is none of your business,” Kelley sputtered.
“That’s something I’m beginning to question,” Jack said. “But I’ll save looking into it for another time. It’s been nice seeing you all again. Bye.”
Jack broke off from the group and strode away. He heard sudden movement behind him and cringed, half expecting a beaker or some other handy piece of laboratory paraphernalia to sail past his ear. But he reached the door to the hallway without incident. Descending a floor, he unlocked his bike and headed south.
Jack weaved in and out of the traffic, marveling at his latest brush with AmeriCare. Most confusing was the sensitivity of the people involved. Even Martin, who’d been friendly the day before, now acted as if Jack were the enemy. What could they all be hiding? And why hide it from Jack?
Jack didn’t know who at the hospital had alerted the administration of his presence, but he had a good idea who would be informing Bingham that he’d been there. Jack entertained no illusions about Kelley complaining about him again.
Jack wasn’t disappointed. As soon as he came in the receiving bay, the security man stopped him.
“I was told to tell you to go directly to the chief’s office,” the man said. “Dr. Washington himself gave me the message.”
As Jack locked his bike, he tried to think of what he was going to say to Bingham. Nothing came to mind.
While ascending in the elevator, Jack decided he’d switch to offense since he couldn’t think of any defense. He was still formulating an idea when he presented himself in front of Mrs. Sanford’s desk.
“You’re to go right in,” Mrs. Sanford said. As usual she didn’t look up from her work.
Jack stepped around her desk and entered Bingham’s office. Immediately he saw that Bingham wasn’t alone. Calvin’s huge hulk was hovering near the glass-fronted bookcase.
“Chief, we have a problem,” Jack said earnestly. He moved over to Bingham’s desk and gave it a tap with his fist for emphasis. “We don’t have a diagnosis on the Hard case, and we got to give it t
o them ASAP. If we don’t we’re going to look bad, especially the way the press is all stirred up about the plague. I even went all the way over to the General to take a look at the gram stain. Unfortunately, it didn’t help.”
Bingham regarded Jack curiously with his rheumy eyes. He’d been about to lambaste Jack; now he demurred. Instead of speaking he removed his wire-rimmed spectacles and absently cleaned them while he considered Jack’s words. He glanced over at Calvin. Calvin responded by stepping up to the desk. He wasn’t fooled by Jack’s ruse.
“What the hell are you talking about?” Calvin demanded.
“Susanne Hard,” Jack said. “You remember. The case you and I have the ten-dollar double-or-nothing bet on.”
“A bet!” Bingham questioned. “Is there gambling going on in this office?”
“Not really, Chief,” Calvin said. “It was just a way of making a point. It’s not routine.”
“I should hope not,” Bingham snapped. “I don’t want any wagering around here, especially not in regard to diagnoses. That’s not the kind of thing I’d like to see in the press. Our critics would have a field day.”
“Getting back to Susanne Hard,” Jack said. “I’m at a loss as to how to proceed. I’d hoped that by talking directly to the hospital lab people I might have made some headway, but it didn’t work. What do you think I should do now?” Jack wanted the conversation to move away from the gambling issue. It might divert Bingham, but Jack knew he’d have hell to pay with Calvin later on.
“I’m a little confused,” Bingham said. “Just yesterday I specifically told you to stay around here and get your backload of cases signed out. I especially told you to stay the hell away from the Manhattan General Hospital.”
“That was if I were going there for personal reasons,” Jack said. “I wasn’t. This was all business.”
“Then how the hell did you manage to get the administrator all bent out of shape again?” Bingham demanded. “He called the damn mayor’s office for the second day in a row. The mayor wants to know if you have some sort of mental problem or whether I have a mental problem for hiring you.”