Contagion

by Robin Cook

  All of Jack’s anxiety came back in a rush. His fear of a major epidemic soared. His only hope was that if he was right about the humidifier being the source, all of these cases represented index cases in that all had been exposed to the infected humidifier. Hence, none of these deaths represented person-to-person transfer, the key element for the kind of epidemic he feared.

  Jack rushed from the room, ignoring more questions from Vinnie. Jack didn’t know what he should do first. From what had happened with the plague episode, he thought he should wait to talk to Bingham and have Bingham call the city and state authorities. Yet now that Jack’s worry about a potential epidemic had increased, he hated to let any time pass.

  “Dr. Stapleton, you’ve had a lot of calls,” Marjorie Zankowski said. Marjorie was the night communications operator. “Some left messages on your voice mail, but here’s a list. I was going to take them up to your office, but since you are here…” She pushed a stack of pink phone messages toward Jack. Jack snatched them up and continued on.

  He scanned the list as he went up in the elevator. Terese had called several times, the last time being four o’clock in the morning. The fact that she’d called so many times gave Jack a stab of guilt. He should have called her from the hotel, but in truth he hadn’t felt like talking with anyone.

  To his surprise there were also messages from Clint Abelard and Mary Zimmerman. His first thought was that Kathy McBane might have told them everything he’d said. If she had, then Clint’s and Mary’s messages might be of the unpleasant sort. They had called one after the other just after six a.m.

  Most intriguing and worrisome of all the calls were two from Nicole Marquette from the CDC. One was around midnight, the other at five forty-five.

  Rushing into his office, Jack stripped off his coat, plopped himself at his desk, and returned Nicole’s call. When he got her on the line, she sounded exhausted.

  “It’s been a long night,” she admitted. “I tried to call you many times both at work and at home.”

  “I apologize,” Jack said. “I should have called to give you an alternate number.”

  “One of the times I called your apartment the phone was answered by an individual called Warren,” Nicole said. “I hope he’s an acquaintance. He didn’t sound all that friendly.”

  “He’s a friend,” Jack said, but the news disturbed him. Facing Warren was not going to be easy.

  “Well, I don’t know quite where to begin,” Nicole said. “One thing I can assure you is that you’ve caused a lot of people to lose a night’s sleep. The sample of influenza you sent has ignited a fire down here. We ran it against our battery of antisera to all known reference strains. It didn’t react with any one of them to any significant degree. In other words, it had to be a strain that was either entirely new or had not been seen for as many years as we’ve been keeping antisera.”

  “That’s not good news, is it?” Jack said.

  “Hardly,” Nicole said. “It was very scary news, particularly in light of the strain’s pathogenicity. We understand there now have been five deaths.”

  “How did you know?” Jack asked. “I just found out myself there’d been four more victims last night.”

  “We’ve already been in contact with the state and local authorities during the night,” Nicole said. “That was one of the reasons I tried so hard to get ahold of you. We consider this to be an epidemiological emergency; I didn’t want you to feel you were out of the loop. You see, we did finally find something that reacted with the virus. It was a sample of frozen sera we have that we suspect contains antisera to the influenza strain that caused the great epidemic in 1918 and 1919!”

  “Good God!” Jack exclaimed.

  “As soon as I discovered this, I called my immediate boss, Dr. Hirose Nakano,” Nicole said. “He, in turn, called the director of the CDC. He’s been on the phone with everyone from the Surgeon General on down. We’re mobilizing to fight a war here. We need a vaccine, and we need it fast. This is the swine-flu scare of seventy-six all over again.”

  “Is there anything I can do?” Jack asked even though he already knew the answer.

  “Not at this time,” Nicole said. “We owe you a debt of gratitude for alerting us to the problem as soon as you did. I told as much to the director. I wouldn’t be surprised if he gave you a call himself.”

  “So the hospital has been notified?” Jack asked.

  “Most definitely,” Nicole said. “A CDC team will be coming up there today to assist in any way it can, including helping the local epidemiologist. Needless to say, we’d love to find out where this virus came from. One of the mysteries of influenza is where the dormant reservoirs are. Birds, particularly ducks, and pigs are suspected, but no one knows for sure. It’s astonishing, to say the least, that a strain that hasn’t been seen for some seventy-five years comes back to haunt us.”

  A few minutes later, Jack hung up the phone. He was stunned, yet also relieved to a degree. At least his warnings of a possible epidemic had been heeded, and the proper authorities mobilized. If an epidemic was to be averted, the only people who could make that happen were now involved.

  But there was still the question of where these infectious agents had come from. Jack certainly did not think it was a natural source like another animal or a bird for the influenza. He thought it was either a person or an organization, and now he could concentrate on that issue.

  Before Jack did anything else, he called Terese. He found her at home. She was extremely relieved to hear his voice. “What happened to you?” she asked. “I’ve been worried sick.”

  “I stayed the night in a hotel,” Jack said.

  “Why didn’t you call like you said you would?” Terese asked. “I’ve called your apartment a dozen times.”

  “I’m sorry,” Jack said. “I should have called. But by the time I left the police headquarters and found a hotel, I wasn’t feeling much like talking to anyone. I can’t tell you how stressful the last twenty-four hours have been. I’m afraid I’m not myself.”

  “I suppose I understand,” Terese said. “After that horrid incident last night I’m amazed you are functioning at all today. Didn’t you consider just staying home? I think that’s what I would have done.”

  “I’m too caught up in everything that is happening,” Jack said.

  “That’s just what I was afraid of,” Terese said. “Jack, listen to me. You’ve been beat up and now almost killed. Isn’t it time to let other people take over, and you get back to your normal job?”

  “It’s already happening to an extent,” Jack said. “Officials from the Centers for Disease Control are on their way up here in force to contain this influenza outbreak. All I have to do is make it through today.”

  “What is that supposed to mean?” Terese asked.

  “If I don’t solve this mystery of mine by tonight I’m giving up on it,” Jack said. “I had to promise as much to the police.”

  “That’s music to my ears,” Terese said, “When can I see you? I have some exciting news to tell.”

  “After last night I would have thought you’d consider me dangerous to be around,” Jack said.

  “I’m assuming that once you stop this crusade of yours people will leave you alone.”

  “I’ll have to call you,” Jack said. “I’m not sure how the day is going to play out.”

  “You’d promised to call last night and didn’t,” Terese said. “How can I trust you?”

  “You’ll just have to give me another chance,” Jack said. “And now I have to get to work.”

  “Aren’t you going to ask me about my exciting news?” Terese asked.

  “I thought you’d tell me if you wanted to,” Jack said.

  “National Health canceled the internal review,” Terese said.

  “Is that good?” Jack asked.

  “Absolutely,” Terese said. “The reason they canceled it is because they are so sure they’ll like our ‘no waiting’ campaign that I leaked yesterday.
So instead of having to throw the presentation together haphazardly we have a month to do it properly.”

  “That’s wonderful,” Jack said. “I’m pleased for you.”

  “And that’s not all,” Terese said. “Taylor Heath called me in to congratulate me. He also told me he’d learned what Robert Barker had tried to do, so Barker is out and I’m in. Taylor all but assured me I’ll be the next president of Willow and Heath.”

  “That calls for a celebration,” Jack said.

  “Exactly,” Terese said. “A good way to do it would be to have lunch today at the Four Seasons.”

  “You certainly are persistent,” Jack said.

  “As a career woman I have to be,” Terese said.

  “I can’t have lunch, but maybe dinner,” Jack said. “That is, unless I’m in jail.”

  “Now what does that mean?” Terese asked.

  “It would take too long to explain,” Jack said. “I’ll call you later. Bye, Terese.” Jack hung up before Terese could get in another word. As tenacious as she was, Jack had the feeling she’d keep him on the phone until she got her way.

  Jack was about to head up to the DNA lab when Laurie appeared in his doorway.

  “I can’t tell you how glad I am to see you,” Laurie said.

  “And I have you to thank for my being here,” Jack said. “A few days ago I might have thought of you as having interfered. But not now. I appreciate whatever you said to Lieutenant Soldano, because it saved my life.”

  “He called me last night and told me what happened,” Laurie said. “I tried to call you at your apartment a number of times.”

  “You and everyone else,” Jack said. “To tell you the truth, I was scared to go home.”

  “Lou also told me he thought you were taking a lot of risks with these gangs involved,” Laurie said. “Personally, I think you should call off whatever you are doing.”

  “Well, you are siding with the majority if it is any consolation,” Jack said. “And I’m sure my mother would agree if you were to call her in South Bend, Indiana, and ask her opinion.”

  “I don’t understand how you can be flippant in light of everything that has happened,” Laurie said. “Besides, Lou wanted me to make sure you understand that he can’t protect you with twenty-four-hour security. He doesn’t have the manpower. You’re on your own.”

  “At least I’ll be working with someone I’ve spent a lot of time with,” Jack said.

  “You are impossible!” Laurie said. “When you don’t want to talk about something you hide behind your clever repartee. I think you should tell everything to Lou. Tell him about your terrorist idea and turn it over to him. Let him investigate it. He’s good at it. It’s his job.”

  “That might be,” Jack said. “But this is a unique circumstance in a lot of ways. I think it requires knowledge that Lou doesn’t have. Besides, I sense it might do a world of good for my self-confidence to follow this thing through. Whether it’s obvious or not, my ego has taken a beating over the last five years.”

  “You are a mystery man,” Laurie said. “Also stubborn, and I don’t know enough about you to know when you are joking and when you are serious. Just promise to be more careful than you’ve been the last few days.”

  “I’ll make you a deal,” Jack said. “I’ll promise if you agree to take rimantadine.”

  “I did notice there were more influenza deaths downstairs,” Laurie said. “You think it warrants rimantadine?”

  “Absolutely,” Jack said. “The CDC is taking this outbreak very seriously, and you should as well. In fact, they think it might be the same strain that caused the disastrous influenza outbreak in 1918. I’ve started rimantadine myself.”

  “How could it be the same strain?” Laurie asked. “That strain doesn’t exist.”

  “Influenza has a way of hiding out,” Jack said. “It’s one of the things that has the CDC so interested.”

  “Well, if that were the case, it sure shoots holes in your terrorist theory,” Laurie said. “There’s no way for someone to deliberately spread something that doesn’t exist outside of some unknown natural reservoir.”

  Jack stared at Laurie for a minute. She was right, and he wondered why he hadn’t thought of it.

  “I don’t mean to rain on your parade,” Laurie said.

  “That’s okay,” Jack said, preoccupied. He was busy wondering if the influenza episode could be a natural phenomenon, while the other outbreaks were intentional. The problem with that line of thinking was that it violated a cardinal rule in medical diagnostics: single explanations are sought even for seemingly disparate events.

  “Nevertheless, the influenza threat is obviously real,” Laurie said. “So I’ll take the drug, but to make sure you hold up your side of the bargain, I want you to keep in touch with me. I noticed that Calvin took you off autopsy, so if you leave the office you have to call me at regular intervals.”

  “Maybe you’ve been talking to my mother after all,” Jack said. “Sounds remarkably like the orders she gave me during my first week at college.”

  “Take it or leave it,” Laurie said.

  “I’ll take it,” Jack said.

  After Laurie left, Jack headed to the DNA lab to seek out Ted Lynch. Jack was glad to get out of his office. Despite the good intentions involved he was tiring of people giving him advice and he was afraid Chet would soon be arriving. Undoubtedly he’d voice the same concerns just expressed by Laurie.

  As Jack mounted the stairs he thought more about Laurie’s point concerning the influenza’s source. He couldn’t believe he’d not thought of it himself, and it undermined his confidence. It also underlined how much he was depending on a positive result with the probe National Biologicals had sent. If they were all negative he’d have scant hope of proving his theory. All he’d have left would be the improbable cultures he’d hoped Kathy McBane had obtained from the sink trap in central supply.

  The moment Ted Lynch caught sight of Jack approaching, he pretended to hide behind his lab bench.

  “Shucks, you found me,” Ted joked when Jack came around the end of the counter. “I was hoping not to see you until the afternoon.”

  “It’s your unlucky day,” Jack said. “I’m not even on autopsy, so I’ve decided to camp out here in your lab. I don’t suppose you’ve had a chance to run my probes…”

  “Actually, I stayed late last night and even came in early to prepare the nucleoproteins. I’m ready to run the probes now. If you give me an hour or so, I should have some results.”

  “Did you get all four cultures?” Jack asked.

  “Sure did,” Ted said. “Agnes was on the ball as usual.”

  “I’ll be back,” Jack said.

  With some time to kill, Jack went down to the morgue and changed into his moon suit before entering the autopsy room.

  The morning routine was well under way. Six of the eight tables were in various stages of the autopsy procedure. Jack walked down the row until he recognized one of the cases. It was Gloria Hernandez. For a moment he looked at her pale face and tried to comprehend the reality of death. Having just spoken with her in her apartment the day before, it seemed an inconceivable transition.

  The autopsy was being done by Riva Mehta, Laurie’s officemate. She was a petite woman of Indian extraction who had to stand on a stool to do the procedure. At that moment she was just entering the chest.

  Jack stayed and watched. When the lungs were removed he asked to see the cut surface. It was identical to Kevin Carpenter’s from the day before, complete with pinpoint hemorrhages. There was no doubt it was a primary influenza pneumonia.

  Moving on, Jack found Chet, who was busy with the nurse, George Haselton. Jack was surprised; it was Chet’s usual modus operandi to stop into the office before doing his day’s autopsies. When Chet saw it was Jack, he seemed annoyed.

  “How come you didn’t answer your phone last night?” Chet demanded.

  “It was too long a reach,” Jack said. “I wasn’t there.
”

  “Colleen called to tell me what happened,” Chet said. “I think this whole thing has gone far enough.”

  “Chet, instead of talking, how about showing me the lung,” Jack said.

  Chet showed Jack the lung. It was identical to Gloria Hernandez’s and Kevin Carpenter’s. When Chet started to talk again, Jack merely moved on.

  Jack stayed in the autopsy room until he’d seen the gross on all the influenza cases. There were no surprises. Everyone was impressed by the pathogenicity of the virus.

  Changing back into his street clothes, Jack went directly up to the DNA lab. This time Ted acted glad to see him.

  “I’m not sure what you wanted me to find,” Ted said. “But you are batting five hundred. Two of the four were positive.”

  “Just two?” Jack asked. He’d prepared himself for either all positive or all negative. Like everything else associated with these outbreaks, he was surprised.

  “If you want I can go back and fudge the results,” Ted joked. “How many do you want to be positive?”

  “I thought I was the jokester around here,” Jack said.

  “Do these results screw up some theory of yours?” Ted asked.

  “I’m not sure yet,” Jack said. “Which two were positive?”

  “The plague and the tularemia,” Ted said.

  Jack walked back to his office while he pondered this new information. By the time he was sitting down he’d decided that it didn’t make any difference how many of the cultures were positive. That fact that any of them were positive supported his theory. Unless an individual was a laboratory worker it would be hard to come in contact with an artificially propagated culture of a bacteria.

  Pulling his phone over closer to himself, Jack put in a call to National Biologicals. He asked to speak with Igor Krasnyansky,since the man had already been accommodating enough to send the probes.