by Robin Cook
Jack tried vainly to peer through Laurie’s plastic face mask to get an idea of whether she was being serious or just mocking him. Unfortunately with all the reflections from the overhead lights, he couldn’t tell.
Leaving Laurie, Jack stopped briefly at Chet’s table. Chet was not in a good mood.
“Hell,” he said. “It’s going to take me all day to trace these bullet paths the way Bingham suggested. If he wants to be this particular, I wonder why he doesn’t do the case himself.”
“Yell if you need any help,” Jack said. “I’ll be happy to come down and lend a hand.”
“I might do that,” Chet said.
Jack disposed of his protective gear, changed into his street clothes, and made sure his ventilation charger was plugged in. Then he got the autopsy folders for Lopez and Lagenthorpe. From Hester’s folder he looked up her next of kin. A sister was listed whose address was the same as the deceased. Jack surmised they were roommates. He copied down the phone number.
Next Jack sought out Vinnie, whom he found coming out of the walk-in cooler where he’d just deposited Lagenthorpe’s corpse.
“Where are all the samples from our two cases?” Jack asked.
“I got ‘em all under control,” Vinnie said.
“I want to take them upstairs myself,” Jack said.
“Are you sure?” Vinnie asked. Running up the samples to the various labs was always an excuse for a coffee break.
“I’m positive,” Jack said.
Once he was armed with all the samples plus the autopsy folders Jack set out for his office. But he made two detours. The first was to the microbiology lab, where he sought out Agnes Finn.
“I was impressed with your diagnosis of tularemia,” Agnes said.
“I’m getting a lot of compliments out of that one,” Jack said.
“Got something for me today?” Agnes asked, eyeing Jack’s armful of samples.
“I do, indeed,” Jack said. He found the appropriate sample from Lopez and put it on the corner of Agnes’s desk. “This is another probable tularemia. Another sample will come up from a case Laurie Montgomery is doing as we speak. I want them both tested for tularemia.”
“The reference lab is very eager to follow up on the Hard case, so that won’t be difficult. I should have results back today. What else?”
“Well, this one is a mystery,” Jack said. He put several samples from Lagenthorpe on Agnes’s desk. “I don’t have any idea what this patient had. All I know is that it’s not plague, and it’s not tularemia.”
Jack went on to describe the Lagenthorpe case, giving Agnes all the positive findings. She was especially interested that no bacteria had been reported on the gram stain of the sputum.
“Have you thought of virus?” Agnes asked.
“As much as my limited infectious disease knowledge would allow,” Jack admitted. “Hantavirus crossed my mind, but there was not a lot of hemorrhage.”
“I’ll start some viral screening with tissue cultures,” Agnes said.
“I plan to do some reading and maybe I’ll have another idea,” Jack said.
“I’ll be here,” Agnes assured him.
Leaving microbiology, Jack went up to the fifth-floor histology lab.
“Wake up, girls, we have a visitor,” one of the histology techs shouted. Laughter echoed around the room.
Jack smiled. He always enjoyed visiting histology. The entire group of women who worked there always seemed to be in the best of moods. Jack was particularly fond of Maureen O’Conner, a busty redhead with a devilish twinkle in her eye. He was pleased when he saw her round the corner of the lab bench, wiping her hands on a towel. The front of her lab coat was stained a rainbow of colors.
“Well now, Dr. Stapleton,” she said in her pleasant brogue. “What can we do for the likes of you?”
“I need a favor,” Jack said.
“A favor, he says,” Maureen repeated. “You hear that, girls? What should we ask in return?”
More laughter erupted. It was common knowledge that Jack and Chet were the only two unmarried male doctors, and the histology women liked to tease them.
Jack unloaded his armful of sample bottles, separating Lagenthorpe’s from Lopez’s.
“I’d like to do frozen sections on Lagenthorpe,” he said. “Just a few slides from each organ. Of course, I want a set of the regular slides as well.”
“What about stains?” Maureen asked.
“Just the usual,” Jack said.
“Are you looking for anything in particular?” Maureen inquired.
“Some sort of microbe,” Jack said. “But that’s all I can tell you.”
“We’ll give you a call,” Maureen said. “I’ll get right on it.” Back in his office, Jack went through his messages. There was nothing of interest. Clearing a space in front of himself, he set down Lopez’s and Lagenthorpe’s folders intending to dictate the autopsy findings and then call the next of kin. He even intended to call the next of kin of the case Laurie was doing. But instead his eye caught sight of his copy of Harrison’s textbook of medicine.
Pulling out the book, Jack cracked it open to the section on infectious disease and began reading. There was a lot of material: almost five hundred pages. But he was able to scan quickly since much of it was information he’d committed to memory at some point in his professional career.
Jack had gotten to the chapters on specific bacterial infections when Maureen called. She said that the frozen section slides were ready. Jack immediately walked down to the lab to retrieve them. He carried them back to his office and moved his microscope to the center of the desk.
The slides were organized by organ. Jack looked at the sections of the lung first. What impressed him most was the amount of swelling of the lung tissue and the fact that he saw no bacteria.
Looking at the heart sections, he could immediately see why the heart had appeared swollen. There was a massive amount of inflammation, and the spaces between the heart muscle cells were filled with fluid.
Switching to a higher power of magnification, Jack immediately appreciated the primary pathology. The cells lining the blood vessels that coursed through the heart were severely damaged. As a result, many of these blood vessels had become occluded with blood clots, causing multiple tiny heart attacks!
With a shot of adrenaline coursing through his own circulation from the excitement of discovery, Jack quickly switched back to the section of lung. Using the same high power he saw identical pathology in the walls of the tiny blood vessels, a finding he hadn’t noticed on his first examination.
Jack exchanged the lung section with one from the spleen. Adjusting the focus, he saw the same pathology. Obviously it was a significant finding, one that immediately suggested a possible diagnosis.
Jack pushed back from his desk and made a quick trip back to the micro lab and sought out Agnes. He found her at one of the lab’s many incubators.
“Hold up on the tissue cultures on Lagenthorpe,” he said breathlessly. “I got some new information you’re going to love.”
Agnes regarded him curiously through her thick glasses.
“It’s an endothelial disease,” Jack said excitedly. “The patient had an acute infectious disease without bacteria seen or cultured. That should have given it away. He also had the faintest beginnings of a rash that included his palms and soles. Plus he’d been suspected of having appendicitis. Guess why?”
“Muscle tenderness,” Agnes said.
“Exactly,” Jack said. “So what does that make you think of?”
“Rickettsia,” Agnes said.
“Bingo,” Jack said, and he punched the air for emphasis. “Good old Rocky Mountain spotted fever. Now, can you confirm it?”
“It’s as difficult as tularemia,” Agnes said. “We’ll have to send it out again. There is a direct immunofluorescent technique, but we don’t have the reagent. But I know the city reference lab has it, because there’d been an outbreak of Rocky Mountain spotted fever in
the Bronx in eighty-seven.”
“Get it over there right away,” Jack said. “Tell them we want a reading as soon as they can get it to us.”
“Will do,” Agnes said.
“You’re a doll,” Jack said.
He started for the door. Before he got there Agnes called out to him: “I appreciate you letting me know about this as soon as you did,” she said. “Rickettsias are extremely dangerous for us lab workers. In an aerosol form it is highly contagious. It’s as bad or worse than tularemia.”
“Needless to say, be careful,” Jack told her.
17
FRIDAY, 12:15 P.M., MARCH 22, 1996
Helen Robinson brushed her hair with quick strokes. She was excited. Having just hung up the phone with her main contact at National Health’s home office, she wanted to get in to see Robert Barker as soon as possible. She knew he was going to love what she had to tell him.
Stepping back from the mirror, Helen surveyed herself from both the right and the left. Satisfied, she closed the closet door and headed out of her office.
Her usual method of contacting Robert was merely to drop in on him. But she thought the information she now had justified a more formal approach; she’d asked one of the secretaries to call ahead. The secretary had reported back that Robert was available at that very moment, not that Helen was surprised.
Helen had been cultivating Robert for the last year. She started when it became apparent to her that Robert could ascend to the presidency. Sensing the man had a salacious streak, she’d deliberately fanned the fires of his imagination. It was easy, although she knew she treaded a fine line. She wanted to encourage him, but not to the point where she would have to openly deny him. In reality, she found him physically unpleasant at best.
Helen’s goal was Robert’s position. She wanted to be executive director of accounts and could see no reason why she shouldn’t be. Her only problem was that she was younger than the others in the department. She felt that was the handicap that her “cultivation” of Robert could overcome.
“Ah, Helen, my dear,” Robert said as Helen demurely stepped into his office. He leaped to his feet and closed the door behind her.
Helen perched on the arm of the chair as was her custom. She crossed her legs and her skirt hiked up well above her knee. She noticed the photo of Robert’s wife was lying facedown as usual.
“How about some coffee?” Robert offered, taking his seat and assuming his customary hypnotic stare.
“I’ve just spoken with Gertrude Wilson over at National Health,” Helen began. “I’m sure you know her.”
“Of course,” Robert said. “She’s one of the more senior vice presidents.”
“She’s also one of my most trusted contacts,” Helen said. “And she is a fan of Willow and Heath.”
“Uh-huh,” Robert said.
“She told me two very interesting things,” Helen said. “First of all, National Health’s main hospital here in the city compares very favorably with other similar hospitals when it comes to hospital-based infections, or what they like to call nosocomial infections.”
“Uh-huh,” Robert repeated.
“National Health has followed all the recommendations of the CDC and the Joint Commission on Accreditation,” Helen said.
Robert shook his head slightly, as if waking up. It had taken a moment for Helen’s comments to penetrate his preoccupied brain. “Wait a second,” he said. He looked away to organize his thoughts. “This doesn’t sound like good news to me. I thought my secretary told me you had good news.”
“Hear me out,” Helen said. “Although they have an overall good nosocomial record, they’ve had some recent troubles in their New York facility that they’re very sensitive about and would hate to be made public. There were three episodes in particular. One involved an extended outbreak of staph in the intensive-care units. That gave them a real problem until it was discovered a number of the nursing staff were carriers and had to be given courses of antibiotics. I tell you, this stuff is frightening when you hear about it.”
“What were the other problems?” Robert asked. For the moment he tried to avoid looking at Helen.
“They had another kind of bacterial problem originate in their kitchen,” Helen said. “A lot of patients got serious diarrhea. A few even died. And the last problem was an outbreak of hospital-based hepatitis. That killed several as well.”
“That doesn’t sound like such a good record to me,” Robert said.
“It is when you compare it with some of the other hospitals,” Helen said. “I tell you, it’s scary. But the point is that National Health is sensitive about this nosocomial infection issue. Gertrude specifically told me that National Health would never in a million years consider running an ad campaign based on it.”
“Perfect!” Robert exclaimed. “That is good news. What have you told Terese Hagen?”
“Nothing, of course,” Helen said. “You told me to brief you first.”
“Excellent job!” Robert said. He pushed himself up onto his long, thin legs and paced. “This couldn’t be better. I’ve got Terese just where I want her.”
“What do you want me to tell her?” Helen asked.
“Just tell her that you have confirmed National Health has an excellent record vis-à-vis nosocomial infection,” Robert said. “I want to encourage her to go ahead with her campaign, because it will surely bomb.”
“But we’ll lose the account,” Helen said.
“Not necessarily,” Robert said. “You’ve found out. in the past that they are interested in ‘talking heads’ spots with celebrities. We’ve communicated that to Terese time and time again and she has ignored it. I’m going to go behind her back and line up a few of the stars from some of the current hospital-based TV dramas. They’d be perfect for testimonials. Terese Hagen will bomb and we’ll be able to step in with our own campaign.”
“Ingenious,” Helen said. She slid off the arm of her chair. “I’ll start the ball rolling by calling Terese Hagen immediately.”
Helen scooted back to her own office and had a secretary put in a call to Terese. As she waited, she complimented herself on the conversation she’d just had with Robert. It couldn’t have gone any better had she scripted it. Her position in the firm was looking better and better.
“Miss Hagen is downstairs in the arena,” the secretary reported. “Do you want me to call down there?”
“No,” Helen said. “I’ll head down there in person.”
Leaving the carpeted tranquillity of the account executive area, Helen descended the stairs to the studio floor. Her pumps echoed loudly on the metal steps. She liked the idea of talking with Terese in person, although she’d not wanted to go to Terese’s office, where she’d feel intimidated.
Helen rapped loudly on the doorjamb before entering. Terese was sitting at a large table covered with storyboards and tissues. Also present were Colleen Anderson, Alice Gerber, and a man Helen did not know. He was introduced as Nelson Friedman.
“I’ve got the information you requested,” Helen said to Terese. She forced her face into a broad smile.
“Good news or bad?” Terese asked.
“I’d say very good,” Helen said.
“Let’s have it,” Terese said. She leaned back in her chair. Helen described National Health’s positive nosocomial record. She even told Terese something she hadn’t told Robert: National Health’s hospital infection rates were better than AmeriCare’s at the General.
“Fabulous,” Terese said. “That’s just what I wanted to know. You’ve been a big help. Thank you.”
“Glad to be of service,” Helen said. “How are you coming with the campaign?”
“I feel good about it,” Terese said. “By Monday we’ll have something for Taylor and Brian to see.”
“Excellent,” Helen said. “Well, if I can do anything else, just let me know.”
“Certainly,” Terese said. She walked Helen to the door, then waved as Helen disappeared into th
e stairwell.
Terese returned to the table and sat back down.
“Do you believe her?” Colleen asked.
“I do,” Terese said. “Accounts wouldn’t risk lying about stats that we could presumably get elsewhere.”
“I don’t see how you can trust her,” Colleen said. “I hate that plastic smile. It’s unnatural.”
“Hey, I said I believed her,” Terese said. “I didn’t say I trusted her. That’s why I didn’t share with her what we are doing here.”
“Speaking of what we are doing here,” Colleen said, “you haven’t exactly said you like it.”
Terese sighed as her eyes ranged around at the scattered storyboards. “I like the Hippocrates sequence,” she said. “But I don’t know about this Oliver Wendell Holmes and this Joseph Lister material. I understand how important washing hands is even in a modern hospital, but it’s not zippy.”
“What about that doctor who was up here with you last night?” Alice asked. “Since he suggested this handwashing stuff, maybe he’ll have more of an idea now that we’ve sketched it out.”
Colleen glanced up at Terese. She was dumbfounded. “You and Jack came here last night?” she asked.
“Yeah, we stopped by,” Terese said casually. She reached out and adjusted one of the storyboards so she could see it better.
“You didn’t tell me that,” Colleen said.
“You didn’t ask,” Terese said. “But it’s no secret, if that’s what you are implying. My relationship with Jack is not romantic.”
“And you guys talked about this ad campaign?” Colleen asked. “I didn’t think you wanted him to know about it, especially since he’d been kinda responsible for the idea.”
“I changed my mind,” Terese said. “I thought he might like it since it deals with the quality of medical care.”
“You’re full of surprises,” Colleen commented.
“Having Jack and Chet take a look at this is not a bad idea,” Terese said. “A professional response might be helpful.”