Contagion

by Robin Cook

  Laurie shrugged and picked up her phone. A few minutes later she had her friend on the line. She asked the question, then waited. While she waited she looked up at Jack. She was worried about him. His face was not only scratched up, it was now flushed.

  “No cases,” Laurie repeated into the phone when her friend came back on the line. “Thanks, Sue. I appreciate it. Talk to you soon. Bye.”

  Laurie hung up the phone. “Satisfied?” she said.

  “For the moment,” Jack said. “Listen: I asked George to assign you two particular cases this morning. The names are Holderness and Winthrope.”

  “Is there some specific reason?” Laurie asked. She could see that Jack was trembling.

  “Do it as a favor,” Jack said.

  “Of course,” Laurie said.

  “One thing I’d like you to do is look for any hairs or fibers on the Holderness woman’s body,” Jack said. “And find out if homicide had a criminologist at the scene to do the same. If there are any hairs, see if there is a DNA match with Winthrope.”

  Laurie didn’t say anything. When she found her voice, she asked: “You think that Winthrope killed Holderness?” Her voice reflected her disbelief.

  Jack looked off and sighed. “There’s a chance,” he said.

  “How would you know?” Laurie asked.

  “Let’s call it a disturbing hunch,” Jack said. He would have liked to tell Laurie more, but with the new pact he had with himself, he didn’t. He wasn’t about to put anyone else at risk in any form or fashion.

  “Now you really have my curiosity going,” Laurie said.

  “I’d like to ask one more favor,” Jack said. “You told me that you had a relationship with a police detective who’s now a friend.”

  “That’s true,” Laurie said.

  “Do you think you could give him a call?” Jack said. “I’d like to talk with him sorta off the record.”

  “You are scaring me,” Laurie said. “Are you in some kind of trouble?”

  “Laurie,” Jack said. “Please don’t ask any questions. The less you know right now the better off you are. But I think. I should talk to someone high up in law enforcement.”

  “You want me to call him now?”

  “Whenever is convenient,” Jack said.

  Laurie blew out through pursed lips as she dialed Lou Soldano’s number. She’d not talked to him in a few weeks, and she felt it was a little awkward calling about a situation she knew so little about. But she was definitely worried about Jack and wanted to help.

  When police headquarters answered and Laurie asked for Lou, she was told the detective wasn’t available. She left a message on his voice mail for him to call her.

  “That’s the best I could do,” Laurie said as she hung up. “Knowing Lou, he’ll be back to me as soon as he can.”

  “I appreciate it,” Jack said. He gave her shoulder a squeeze. He had the comforting sense she was a true friend.

  Jack went back to his own office just in time to run into Chet. Chet took one look at Jack’s face and whistled.

  “And what did the other guy look like?” Chet asked jokingly.

  “I’m not in the mood,” Jack said. He took off his jacket and hung it over his chair.

  “I hope this doesn’t have anything to do with those gang members who visited you Friday,” Chet said.

  Jack gave the same explanation he’d given to the others.

  Chet flashed a wry smile as he stowed his coat in his file cabinet. “Sure, you fell while jogging,” he said. “And I’m dating Julia Roberts. But, hey, you don’t have to tell me what happened; I’m just your friend.”

  That was exactly the point, Jack mused. After checking to see if he had any phone messages, he started back out of the office.

  “You missed a nice little dinner last night,” Chet said.

  “Terese came along. We talked about you. She’s a fan of yours, but she’s as concerned as I am about your monomania concerning these infectious cases.”

  Jack didn’t even bother to answer. If Chet or Terese knew what had really happened last night, they’d be more than concerned.

  Returning to the first floor, Jack looked into Janice’s office. Now he wanted to ask her about the influenza case that was being posted by Bingham, but she’d left. Jack descended to the morgue level and changed into his isolation gear.

  He went into the autopsy room and walked up to the only table in operation. Bingham was on the patient’s right, Calvin on the left, and Vinnie at the head. They were almost done.

  “Well, well,” Bingham said when Jack joined them. “Isn’t this convenient? Here’s our in-house infectious expert.”

  “Perhaps the expert would like to tell us what this case is,” Calvin challenged.

  “I’ve already heard,” Jack said. “Influenza.”

  “Too bad,” Bingham said. “It would have been fun to see if you truly have the nose for this stuff. When it came in early this morning there was no diagnosis yet. The suspicion was some sort of viral hemorrhagic fever. It had everybody up in arms.”

  “When did you learn it was influenza?” Jack asked.

  “A couple of hours ago,” Bingham answered. “Just before we started. It’s a good case, though. You want to see the lungs?”

  “I would,” Jack said.

  Bingham reached into the pan and lifted out the lungs. He showed the cut surface to Jack.

  “My God, the whole lung is involved!” Jack commented. He was impressed. In some areas there was frank hemorrhage.

  “Even some myocarditis,” Bingham said. He put the lung back and lifted up the heart and displayed it for Jack. “When you can see the inflammation grossly like this, you know it’s extensive.”

  “Looks like a virulent strain,” Jack said.

  “You’d better believe it,” Bingham said. “This patient’s only twenty-nine years old, and his first symptoms occurred around six last night. He was dead at four A.M. It reminds me of a case I did back in my residency during the pandemic of fifty-seven and fifty-eight.”

  Vinnie rolled his eyes. Bingham had a mind-numbing habit of comparing every case to one that he’d had in his long career.

  “That case was also a primary influenza pneumonia,” Bingham continued. “Same appearance of the lung. When we looked at it histologically we were amazed at the degree of damage. It gave us a lot of respect for certain strains of influenza.”

  “Seeing this case concerns me,” Jack said. “Especially in light of the other diseases that have been popping up.”

  “Now, don’t head off into left field!” Bingham warned, remembering some of Jack’s comments the day before. “This isn’t out of the ordinary, like the plague case or even the tularemia. It’s flu season. Primary influenza pneumonia is a rare complication, but we see it. In fact we had a case just last month.”

  Jack listened, but Bingham wasn’t making him feel any more comfortable. The patient in front of them had had a lethal infection with an agent that had the capability of spreading from patient to patient like wildfire. Jack’s only consolation was the call Laurie had made to her internist friend who’d said there were no other cases in the hospital.

  “Mind if I take some washings?” Jack asked.

  “Hell no!” Bingham said. “Be my guest. But be careful what you do with them.”

  “Obviously,” Jack said.

  Jack took the lungs over to one of the sinks, and with Vinnie’s help prepared some samples by washing out some of the small bronchioles with sterile saline. He then sterilized the outside of the containers with ether.

  Jack was on his way out when Bingham asked him what he was going to do with the samples.

  “Take them up to Agnes,” Jack said. “I’d like to know the subtype.”

  Bingham shrugged and looked across at Calvin.

  “Not a bad idea,” Calvin said.

  Jack did exactly what he said he would. But he was disappointed when he presented the bottles to Agnes up on the third floor.


  “We don’t have the capability of subtyping it,” she said.

  “Who does?” Jack asked.

  “The city or state reference lab,” Agnes said. “Or even over at the university lab. But the best place would be the CDC. They have a whole section devoted to influenza. If it were up to me, I’d send it there.”

  Jack got some viral transport medium from Agnes and transferred the washings into it. Then he went up to his office. Sitting down, he placed a call to the CDC and was put through to the influenza unit. A pleasant-sounding woman answered, introducing herself as Nicole Marquette.

  Jack explained what he wanted, and Nicole was accommodating. She said she’d be happy to see that the influenza was typed and subtyped.

  “If I manage to get the sample to you today,” Jack said, “how long would it take for you to do the typing?”

  “We can’t do this overnight,” Nicole said, “if that’s what you have in mind.”

  “Why not?” Jack asked impatiently.

  “Well, maybe we could,” Nicole corrected herself. “If there is a sufficient viral titer in your sample, meaning enough viral particles, I suppose it is possible. Do you know what the titer is?”

  “I haven’t the faintest idea,” Jack said. “But the sample was taken directly from the lung of a patient who passed away from primary influenza pneumonia. The strain is obviously virulent, and I’m worried about a possible epidemic.”

  “If it is a virulent strain, then the titer might be high,” Nicole said.

  “I’ll find a way to get it to you today,” Jack promised. He then gave Nicole his telephone number both at the office and at home. He told her to call anytime she had any information.

  “We’ll do the best we can,” Nicole said. “But I have to warn you, if the titer is too low it might be several weeks before I get back to you.”

  “Weeks!” Jack complained. “Why?”

  “Because we’ll have to grow the virus out,” Nicole explained. “We usually use ferrets, and it takes a good two weeks for an adequate antibody response which guarantees we’ll have a good harvest of virus. But once we have the virus in quantity, we can tell you a lot more than just its subtype. In fact, we can sequence its genome.”

  “I’ll keep my fingers crossed that my samples have a high titer,” Jack said. “And one other question. What subtype would you think was the most virulent?”

  “Whoa!” Nicole said. “That’s a hard question. There are a lot of factors involved, particularly host immunity. I’d have to say the most virulent would be an entirely new pathological strain, or one that hasn’t been around for a long time. I suppose the subtype that caused the pandemic of 1918 to 1919 that killed twenty-five million people worldwide might get the dubious honor of having been the most virulent.”

  “What subtype was that?” Jack asked.

  “No one knows for sure,” Nicole said. “The subtype doesn’t exist. It disappeared years ago, maybe right after the epidemic wore itself out. Some people think it was similar to the subtype that caused that swine-flu scare back in seventy-six.”

  Jack thanked Nicole and again assured her he’d get the samples to her that day. After he hung up, he called Agnes back and asked her opinion on shipping. She told him the name of the courier service they used, but she said she didn’t know if they shipped interstate.

  “Besides,” Agnes added, “it will cost a small fortune. I mean overnight is one thing, but you’re talking about the same day. Bingham will never authorize it.”

  “I don’t care,” Jack said. “I’ll pay for it myself.”

  Jack called the courier company. They were delighted with the request and put Jack through to one of the supervisors, Tony Liggio. When Jack explained what he wanted, Tony said no problem.

  “Can you come to pick it up now?” Jack asked. He was encouraged.

  “I’ll send someone right away,” Tony said.

  “It will be ready,” Jack said.

  Jack was about to hang up when he heard Tony add: “Aren’t you interested in the cost? I mean, this is not like taking something over to Queens. Also, there’s the question of how you plan to pay.”

  “Credit card,” Jack said. “If that’s okay.”

  “Sure, no problem, Doc,” Tony said. “It’s going to take me a little while to figure out the exact charge.”

  “Just give me a ballpark figure,” Jack said.

  “Somewhere between one and two thousand dollars,” Tony said.

  Jack winced but didn’t complain. Instead, he merely gave Tony his credit card number. He’d envisioned the cost would be two or three hundred dollars, but then he hadn’t thought about the fact that someone might have to fly round-trip to Atlanta.

  While Jack had been engaged in giving his credit card information, one of the secretaries from the front office had appeared at his door. She’d handed him an overnight Federal Express package and departed without saying a word. As Jack hung up from the courier service he saw that the parcel was from National Biologicals. It was the DNA probes he’d requested the day before.

  Taking the probes and his viral samples, Jack went back down to Agnes. He told her about the arrangements he’d made with the courier service.

  “I’m impressed,” Agnes said. “But I’m not going to ask how much it’s costing.”

  “Don’t,” Jack advised. “How should I package the samples?”

  “We’ll take over,” she said. She called in the department secretary and commissioned her to do it with appropriate biohazard containers and labels.

  “Looks like you have something else for me,” she said, eyeing the vials containing the probes.

  Jack explained what they were and what he wanted, namely to have the DNA lab use the probes to see if they reacted with the nucleoproteins of the cultures taken from any of the four recent infectious disease cases he’d been working on. What he didn’t tell her was why he wanted it done.

  “All I need to know is whether it is positive or not,” Jack said. “It doesn’t have to be quantitative.”

  “I’ll have to handle the rickettsia and the tularemia agent myself,” Agnes said. “I’m afraid to have any of the techs working with them.”

  “I really appreciate all this,” Jack said.

  “Well, it’s what we’re here for,” Agnes said agreeably.

  After leaving the lab Jack went downstairs to the scheduling room and helped himself to some coffee. He’d been so frantic since he’d arrived that he’d not had much time to think. Now, as he stirred his coffee, he realized that neither of the homeless men that he’d inadvertently run into in his flight from Reginald had been brought in. That meant that they were either in some hospital or they were still out there in the park.

  Carrying his coffee back upstairs, Jack sat down at his desk. With both Laurie and Chet in the autopsy room, he knew he could count on some peace and quiet.

  Before he could enjoy his solitude, the phone interrupted. It was Terese.

  “I’m mad at you,” she said without preamble.

  “That’s wonderful,” Jack said with his usual sarcasm. “Now my day is complete.”

  “I am angry,” Terese maintained, but her voice had softened considerably. “Colleen just hung up from talking with Chet. He told her you were beaten up again.”

  “That was Chet’s personal interpretation,” Jack said. “The fact is, I wasn’t beaten up again.”

  “You weren’t?”

  “I explained to Chet that I’d fallen while jogging,” Jack said.

  “But he told Colleen…”

  “Terese,” Jack said sharply. “I wasn’t beaten up. Can we talk about something else?”

  “Well, if you weren’t assaulted, why are you sounding so irritable?”

  “It’s been a stressful morning,” Jack admitted.

  “Care to talk about it?” she asked. “That’s what friends are for. I’ve certainly bent your ear about my problems.”

  “There’s been another infectious death at
the General,” Jack said. He would have liked to tell her what was really on his mind—his sense of guilt about Beth Holderness—but he dared not.

  “That’s terrible!” Terese said. “What is wrong with that place? What is it this time?”

  “Influenza,” Jack said. “A very virulent case. It’s the kind of illness I’ve been truly worried we’d see.”

  “But the flu is around,” Terese said. “It’s flu season.”

  “That’s what everybody says,” Jack admitted.

  “But not you?”

  “Put it this way,” Jack said. “I’m worried, especially if it is a unique strain. The deceased was a young patient, only twenty-nine. In the face of what else has been popping up over there at the General, I’m worried.”

  “Are some of your colleagues worried as well?” Terese asked.

  “At the moment, I’m on my own,” Jack admitted.

  “I guess we’re lucky to have you,” Terese said. “I have to admire your dedication.”

  “That’s kind of you to say,” Jack said. “Actually, I hope I’m wrong.”

  “But you’re not going to give up, are you?”

  “Not until I have some proof one way or the other,” Jack said. “But let’s talk about you. I hope you are doing better than I.”

  “I appreciate your asking,” Terese said. “Thanks in no small part to you, I think we have the makings of a good ad campaign. Plus, I’ve managed to have the in-house presentation put off until Thursday, so we have another whole day of breathing room. At the moment things are looking reasonable, but in the advertising world that could change at any moment.”

  “Well, good luck,” Jack said. He wanted to get off the phone.

  “Maybe we could have a quick dinner tonight,” Terese suggested. “I’d really enjoy it. There’s a great little Italian restaurant just up the street on Madison.”

  “It’s possible,” Jack said. “I’ll just have to see how the day progresses.”

  “Come on, Jack,” Terese complained. “You have to eat. We both could use the relaxation, not to mention the companionship. I can hear the tension in your voice. I’m afraid I’m going to have to insist.”

  “All right,” Jack said, relenting. “But it might have to be a short dinner.” He realized there was some truth to what Terese was saying, although at the moment it was hard for him to think as far ahead as dinnertime.