Contagion (28 page)

     “Fits the pattern,” Jack said.

     “What pattern?” Laurie asked.

     “All the index cases from these recent outbreaks have had some sort of chronic illness,” Jack said.

     “A lot of people who are hospitalized have chronic illnesses,” Laurie said. “In fact, most of them. What does that have to do with anything?”

     “I’ll tell you what’s on his paranoid, sick mind,” Chet said. Chet had appeared at Laurie’s door. He stepped into the room and leaned against the second desk. “He’s got this thing about AmeriCare and wants to see conspiracy behind all this trouble.”

     “Is that true?” Laurie asked.

     “I think it’s less that I want to see conspiracy than it’s staring me in the face,” Jack said.

     “What do you mean by ‘conspiracy’?” Laurie asked.

     “He has this notion that these unusual illnesses are being spread deliberately,” Chet said. Chet summarized Jack’s theory that the culprit was either someone at AmeriCare trying to protect its bottom line or some crazy person with terrorist inclinations.

     Laurie looked questioningly at Jack. Jack shrugged.

     “There are a lot of unanswered questions,” Jack offered.

     “As there are in just about any outbreak,” Laurie said. “But really! This is all a bit far-fetched. I hope you didn’t mention this theory to the powers that be over at the General.”

     “Yeah, I did,” Jack said. “In fact I sort of asked the director of the lab if he was involved. He’s rather disgruntled with his budget. He immediately informed the infection-control officer. I imagine they’ve let the administration know.”

     Laurie let out a short, cynical laugh. “Oh, brother,” she said. “No wonder you’ve become persona non grata around there.”

     “You have to admit there’s been an awful lot of questionable nosocomial infection at the General,” Jack said.

     “I’m not even so sure about that,” Laurie said. “Both the tularemia patient and the patient with Rocky Mountain spotted fever developed their illnesses within forty-eight hours of admission. By definition, they are not nosocomial infections.”

     “Technically that’s true,” Jack admitted. “But...”

     “Besides, all these illnesses have been seen in New York,” Laurie said. “I’ve done some recent reading myself. There was a serious outbreak of Rocky Mountain spotted fever in eighty-seven.”

     “Thank you, Laurie,” Chet said. “I tried to tell Jack the same thing. Even Calvin has told him.”

     “What about the series of cases coming from central supply?” Jack asked Laurie. “And what about the rapidity with which the patients with Rocky Mountain spotted fever developed their illnesses? You were questioning that just this Saturday.”

     “Of course I’d question those things,” Laurie said. “They’re the type of questions that have to be asked in any epidemiological situation.”

     Jack sighed. “I’m sorry,” he said. “But I’m convinced something highly unusual is going on. All along I’ve been worried that we might see a real epidemic crop up. This outbreak of meningococcus may be it. If it peters out like the other outbreaks, I’ll be relieved, of course, in human terms.

     But it will only add to my suspicions. This pattern of multiple fulminant cases, then nothing, is highly unusual in itself.”

     “But this is the season for meningococcus,” Laurie said. “It’s not so unusual.”

     “Laurie’s right,” Chet said. “But regardless, my concern is that you’re going to get yourself into real trouble. You’re like a dog with a bone. Calm down! I don’t want to see you fired. At least reassure me you’re not going back to the General.”

     “I can’t say that,” Jack said. “Not with this new outbreak. This one doesn’t depend on some arthropods that aren’t around. This is an airborne problem, and as far as I’m concerned, it changes the rules.”

     “Just a moment,” Laurie said. “What about that warning you got from those thugs?”

     “Now what?” Chet questioned. “What thugs?”

     “Jack had a cozy visit from some charming members of a gang,” Laurie said. “It seems that at least one of the New York gangs is going into the extortion business.”

     “Somebody has to explain,” Chet said.

     Laurie told Chet what she knew of Jack’s beating.

     “And you’re still thinking of going over there?” Chet asked when she was through.

     “I’ll be careful,” Jack said. “Besides, I haven’t exactly decided to go yet.”

     Chet rolled his eyes to the ceiling. “I think I would have preferred you as a suburbanite ophthalmologist.”

     “What do you mean, ophthalmologist?” Laurie questioned.

     “Come on, you guys,” Jack said. He stood up. “Enough is enough. We’ve got work to do.”

     Jack, Laurie, and Chet did not emerge from the autopsy room until after one in the afternoon. Although George had questioned the need to post all the meningococcal cases, the triumvirate had insisted; George relented in the end. Doing some on their own and some together, they autopsied the initial patient, one orthopedic resident, two nurses, one orderly, two people who’d visited the patient, including the nine-year-old girl, and particularly important as far as Jack was concerned, one woman from central supply.

     After the marathon they all changed back to their street clothes and met up in the lunchroom. Relieved to be away from the mayhem and a bit overwhelmed by the findings, they didn’t talk at first. They merely got their selections from the vending machines and sat down at one of the free tables.

     “I haven’t done many meningococcal cases in the past,” Laurie said finally. “But these today were a lot more impressive than the ones I did do.”

     “You won’t see a more dramatic case of the Waterhouse-Friderichsen syndrome,” Chet said. “None of these people had a chance. The bacteria marched through them like a Mongol horde. The amount of internal hemorrhage was extraordinary. I tell you, it scares the pants off me.”

     “It was one time that I actually didn’t mind being in the moon suit,” Jack agreed. “I couldn’t get over the amount of gangrene on the extremities. It was even more than on the recent plague cases.”

     “What surprised me was how little meningitis was involved,” Laurie said. “Even the child had very little, and I would have thought at least she would have had extensive involvement.”

     “What puzzles me,” Jack said, “is the amount of pneumonitis. Obviously it is an airborne infection, but it usually invades the upper part of the respiratory tree, not the lungs.”

     “It can get there easily enough once it gets into the blood,” Chet said.

     “Obviously all these people had high levels coursing through their vascular systems.”

     “Have either of you heard if any more cases have come in today?” Jack asked.

     Chet and Laurie exchanged glances. Both shook their heads.

     Jack scraped back his chair and went to a wall phone. He called down to communications and posed the same question to one of the operators.

     The answer was no. Jack walked back to the table and reclaimed his seat.

     “Well, well,” he said. “Isn’t this curious. No new cases.”

     “I’d say it was good news,” Laurie said.

     “I’d second that,” Chet said.

     “Does either of you know any of the internists over at the General?” Jack asked.

     “I do,” Laurie said. “One of my classmates from medical school is over there.”

     “How about giving her a call and seeing if they have many meningococcal cases under treatment?” Jack asked.

     Laurie shrugged and went to use the same phone Jack had just used.

     “I don’t like that look in your eye,” Chet said.

     “I can’t help it,” Jack said. “Just like with the other outbreaks, little disturbing facts are beginning to appear. We’ve just autopsied some of the sickest meningococcal patients any of us has ever seen and then, boom!

     No more cases, as if a faucet had been turned off. It’s just what I was talking about earlier.”

     “Isn’t that characteristic of the disease?” Chet asked. “Peaks and valleys.”

     “Not this fast,” Jack said. Then he paused. “Wait a second,” he added. “I just thought of something else. We know who the first person was to die in this outbreak, but who was the last?”

     “I don’t know, but we’ve got all the folders,” Chet said.

     Laurie returned. “No meningococcal cases presently,” she said. “But the hospital doesn’t consider itself out of the woods. They’ve instituted a massive campaign of vaccination and chemoprophylaxis. Apparently the place is in an uproar.”

     Both Jack and Chet merely grunted at this news. They were preoccupied with going through the eight folders and jotting down notations on their napkins.

     “What on earth are you guys doing?” Laurie asked.

     “We’re trying to figure out who was the last to die,” Jack said.

     “What on earth for?” Laurie asked.

     “I’m not sure,” Jack said.

     “This is it,” Chet said. “It was Imogene Philbertson.”

     “Honest?” Jack questioned. “Let me see.”

     Chet turned around the partially filled-out death certificate that listed the time of death.

     “I’ll be damned,” Jack said.

     “Now what?” Laurie asked.

     “She was the one who worked in central supply,” Jack said.

     “Is that significant?” Laurie asked.

     Jack pondered for a few minutes, then shook his head. “I don’t know,” he said. “I’ll have to look back at the other outbreaks. As you know, each outbreak has included someone from central supply. I’ll see if it is a pattern I’d missed.”

     “You guys weren’t particularly impressed with my news that there are currently no more cases of meningococcal disease over at the General.”

     “I am,” Chet said. “Jack sees it as confirmation of his theories.”

     “I’m worried it is going to frustrate our hypothetical terrorist,” Jack said. “It’s also going to teach him an unfortunate lesson.”

     Both Laurie and Chet rolled their eyes to the ceiling and let out audible groans.

     “Come on, you guys,” Jack said. “Hear me out. Let’s just say for the sake of argument that I’m right about some weirdo spreading these microbes in hopes of starting an epidemic. At first he picks the scariest, most exotic diseases he can think of, but he doesn’t know that they won’t really spread patient to patient. They are spread by arthropods having access to an infected reservoir. But after a few flops he figures this out and turns to a disease that is spread airborne. But he picks meningococcus.

     The problem with meningococcus is that it really isn’t a patient-to-patient disease either: it’s a carrier disease that’s mainly spread by an immune individual walking around and giving it to others. So now our weirdo is really frustrated, but he truly knows what he needs. He needs a disease that is spread mainly patient-to-patient by aerosol.”

     “And what would you choose in this hypothetical scenario?” Chet asked superciliously.

     ‘”Let’s see,” Jack said. He pondered for a moment. “I’d use drug-resistant diphtheria, or maybe even drug-resistant pertussis. Those old standbys are making some devastating comebacks. Or you know what else would be perfect? Influenza! A pathological strain of influenza.”

     “What an imagination!” Chet commented.

     Laurie stood up. “I’ve got to get back to work,” she said. “This conversation is too hypothetical for me.” Chet did the same.

     “Hey, isn’t anybody going to comment?” Jack said.

     “You know how we feel,” Chet said. “This is just mental masturbation. It seems like the more you think and talk about this stuff the more you believe it. I mean, really, if it were one disease, okay, but now we’re up to four. Where would someone get these microbes? They are not the kind of thing you can go into your neighborhood dell and order. I’ll see you upstairs.

     Jack watched Laurie and Chet dispose of their trash and leave the lunchroom. He sat for a few moments and considered what Chet had said. Chet had a good point, one that Jack had not even considered. Where would someone get pathological bacteria? He really had no idea.

     Jack got up and stretched his legs. After discarding his tray and sandwich wrappings, he followed the others up to the fifth floor. By the time he got to the office, Chet was already engrossed and didn’t look up.

     Sitting down at his desk, Jack got all the folders together plus his notes and looked up the time of death of each of the women victims from central supply. To date, central supply had lost four people. Jack imagined that the department head would have to be actively recruiting to keep up with that type of attrition.

     Next Jack looked up the time of death of each of the other infectious cases. For the times of death of the few he’d not autopsied, he called down to Bart Arnold, the chief PA.

     When Jack had all the information it became immediately apparent that with each outbreak, it had been the woman from central supply to be the last to succumb. That suggested, but certainly didn’t prove, that in each instance those from central supply were the last to become infected.

     Jack asked himself what that meant, but couldn’t come up with an answer. Still, it was an extremely curious detail.

     “I have to go back to the General,” Jack said suddenly. He stood up.

     Chet didn’t even bother to look up. “Do what you have to do,” he said with resignation. “Not that my opinion counts.”

     Jack pulled on his bomber jacket. “Don’t take it personally,” he said. “I appreciate your concern, but I’ve got to go. I’ve got to look into this strange central supply connection. It could just be a coincidence, I agree, but it seems unlikely.”

     “What about Bingham and what about those gang members Laurie mentioned?” Chet asked. “You’re taking a lot of risk.”

     “Such is life,” Jack said. He gave Chet a tap on the shoulder on his way to the hallway. Jack had just reached the threshold when his phone rang. He debated whether to take the time to answer it. It was usually someone from one of the labs.