Robin Cook - Critical

"Nonsense, Dr. Montgomery. I'm here until ten or eleven every evening. I'm at your disposal."

"Thank you. I'll be over shortly Is it difficult to find your office?"

Laurie was given explicit instructions before she hung up. She got her coat and hurried out to the elevator. As she boarded, her stomach growled as a visceral reminder that she'd skipped lunch. With Dr. Malovar having assured her he was not about to leave, she pressed the second-floor button. There wasn't much choice in the lunchroom's vending machines, but she trusted she could find something of caloric value, if nothing else.

The lunchroom was a favorite hangout for the support staff, especially during meal hours, and that evening was no exception. It was just after seven, and half of the three-to-eleven shift were present. With its stark concrete walls, the sound level in the room was almost painful for Laurie in contrast to her office's silence. As she stood in front of one of the vending machines, anxiously trying to decide which selection was the least bad for her, she heard her name over the din. Turning, she saw the smiling faces of Jeff Cooper and Pete Molimo. They were the evening shift Health and Hospital Corporation van drivers who went out to fetch the bodies. As with most of the rest of the staff, Laurie had become friendly with them over the years. Laurie and Jack, in contrast to their colleagues, were more apt to visit scenes during the evening and night hours, because they both felt such visits were exceedingly helpful.

The men were enjoying a break in their routine. They had finished their meals, as evidenced by the debris on their table. Except for rush-hour auto accidents, calls of deaths during mealtime were relatively rare and didn't pick up again until after nine. Both had their feet up on the opposing empty chairs at their four-top table.

"Haven't seen you much, Dr. Montgomery," Jeff said.

"Yeah, where've you been hiding?" Pete added.

Laurie smiled. "Either in my office or in the pit."

"You're a little late for going home, aren't you?" Pete asked. "Most of the other MEs are out of here before five."

"I've been working on a special project," Laurie said. "In fact, I'm not even going home now. I'm heading over to NYU Medical Center."

"How are you getting over there? I don't know what it's doing now, but it was sprinkling an hour or so ago."

"I'm walking," Laurie said. "It's too short for a cab ride."

"Why don't I run you over?" Pete offered. "We're just sitting here, and I'm tired of talking to this die-hard Boston fan."

"What if you get a call?" Laurie asked.

"What's the difference. I got a radio."

It took Laurie two seconds to make up her mind. "Are you ready to go now?"

"You bet," Pete said, gathering up his trash.

In a lot of ways, it was ludicrous to ride, because the medical center entrance was on the same block as the OCME, and when they backed out of the morgue's receiving dock onto 30th Street, it was not raining. In fact, there was a patch of pale blue-green sky off to the west and moving closer.

"This is rather silly," Laurie said, as Pete almost immediately turned into the curved driveway at the medical center's entrance several hundred feet down First Avenue. He managed to get up to only about twenty miles per hour. "I'm sorry to trouble you."

"No trouble at all," Pete assured her. "I was glad to get away from Jeff, the bum. He's so sure the Sox are going to beat the Yankees that he won't shut up about it."

Laurie hopped out of the van, thanked Pete, and used the microscope slide box she was carrying to wave as she hurried through the revolving door. The center was crowded with visitors, but Laurie quickly left them behind on her way to the academic portion of the institution. Using the elevator, she rose to the sixth floor. As she exited, she noticed that the corridor was as silent as the one outside her own office. Most all doors were closed, and she didn't pass a single person.

She found the renowned doctor in a small, windowless interior space that could have been a storeroom but which the aged man had decorated with all his diplomas, rewards, and honors, all protected in simple, glazed black frames. A very large freestanding bookcase filled with all his favorite pathology tomes, some with tooled leather bindings, dominated one wall. Most of the rest of the room was filled by a large mahogany desk piled high with reprints and legal pads covered with erratic cursive.

He stood up and extended a hand as Laurie entered. She was surprised how much he looked like Einstein, with a cumulus of white hair. His back was kyphotic, as if he were anatomically built to look into a microscope.

"I see you have brought the slides," he said, eagerly eyeing Laurie's slide box.

In anticipation of her arrival, he'd positioned his impressive microscope on a customized shelf that pulled out of the end of the desk. It was a teaching scope with double-binocular eyepieces. An impressive digital camera was mounted on top and shared the same view as the eyepieces.

"Should we?" he continued, motioning for Laurie to take the seat positioned on her side of the scope.

Laurie sat. She could see out of the corner of her eye how zealously he watched as she opened her tray and carefully extracted one of the slides marked with grease pencil. Respecting that the microscope was his, she handed him the slide. Eagerly, he placed it onto the mechanical stage and lined up the grease-pencil markings. After he'd lowered the low-power objective, he told her to use the mechanical stage control to find the object of interest.

Having become quite proficient at locating the objects despite their lack of staining, Laurie quickly located one. "I don't know if you can quite see it, but it's under the pointer now."

"I think I see it," Dr. Malovar said. He backed up the objective, changed to higher power, then refocused. "Ah, yes!" he said, as if experiencing visceral pleasure. "Most interesting! Are they all similar?"

"They are," Laurie said. "Strikingly so."

"Such symmetry such an elegant border. Have you observed them on end?"

"No, I haven't," Laurie admitted, "so I don't know if it is disc-shaped or spherical."

"I'd say disc-shaped. Have you noted the slight nodularity?"

"I have, but I didn't know if it was real."

"It's real, all right. Fascinating, as is the degree of necrosis of the lung tissue."

Laurie was dying for him to tell her what it was and questioned why he was teasing her by withholding the information.

"It is quite apparent they are in the bronchioles and not within the alveolar walls."

"I felt the same way," Laurie admitted.

"I can see why you said they looked like diatoms, but I wouldn't have thought of it myself."

Laurie was becoming impatient. Finally, she just asked, "What is it?"

"I have no idea," Dr. Malovar said.

Laurie was stunned. Particularly from the appreciative way he was describing the object, she thought for sure he knew what it was the very instant he'd seen it. Shock turned into dismay when she realized she could not charge home to Jack with new, decisive information. It also made her consider that maybe some of her colleagues had seen them, but dismissed them as being unimportant.

"Do you think that they had anything to do with the fulminant MRSA infections these people had?"

"I have no idea."

"Do you have any idea of how we might identify them?"

"For that, I do have an idea. I'd like to look at them under the scanning electron microscope, especially after slicing one open."

"Is that a lengthy procedure? Can we do it tonight?"

Dr. Malovar leaned back and laughed. "Your eagerness is commendable. No, we cannot do it tonight. There's some skill involved. We do have a talented person, but of course he is gone for the night. I can see if he can at least start tomorrow."