Robin Cook - Contagion

“Uh oh,” Chet said. “Now what?”

“I’m going over to the Manhattan General,” Jack said. “I think I’ll make a site visit. This case is too important to leave up to the generals.”

Chet swung around in his chair as Jack went through the door.

“Of course, you know that Bingham doesn’t encourage us MEs doing site work,” Chet said. “You’ll be adding insult to injury.”

“I’ll take my chances,” Jack said. “Where I was trained it was considered necessary.”

“Bingham thinks it’s the job of the PAs,” Chet said. “He’s told us that time and again.”

“This case is too interesting for me to pass up,” Jack called from down the hall. “Hold down the fort. I won’t be long.”

It was overcast and threatening rain, but Jack didn’t mind. Regardless of the weather, the vigorous bike ride uptown to the Manhattan General was a pleasure after having stood all morning in the autopsy room imprisoned inside his moon suit.

Near the hospital’s front entrance Jack located a sturdy street sign to lock his mountain bike to. He even locked up his helmet and bomber jacket with a separate wire lock that also secured the seat.

Standing within the shadow of the hospital, Jack glanced up at its soaring facade. It had been an old, respected, university-affiliated, proprietary hospital in its previous life. AmeriCare had gobbled it up during the fiscally difficult times the government had unwittingly created in health care in the early 1990s. Although Jack knew revenge was far from a noble emotion, he savored the knowledge that he was about to hand AmeriCare a public relations bomb.

Inside Jack went to the information booth and asked about Dr. Carl Wainwright. He learned that the man was an AmeriCare internist whose office was in the attached professional building. The receptionist gave Jack careful directions.

Fifteen minutes later, Jack was in the man’s waiting room. After Jack flashed his medical examiner’s badge, which looked for all intents and purposes like a police badge, the receptionist wasted no time in letting Dr. Wainwright know he was there. Jack was immediately shown into the doctor’s private office, and within minutes the doctor himself appeared.

Dr. Carl Wainwright was prematurely white-haired and slightly stooped over. His face, however, was youthful with bright blue eyes. He shook hands with Jack and motioned for him to sit down.

“It’s not every day we’re visited by someone from the medical examiner’s office,” Dr. Wainwright said.

“I’d be concerned if it were,” Jack said.

Dr. Wainwright looked confused until he realized Jack was kidding. Dr. Wainwright tittered. “Right you are,” he said.

“I’ve come about your patient Donald Nodelman,” Jack said, getting right to the point. “We have a presumptive diagnosis of plague.”

Dr. Wainwright’s mouth dropped open. “That’s impossible,” he said when he’d recovered enough to speak.

Jack shrugged. “I guess it’s not,” he said. “Fluorescein antibody for plague is quite reliable. Of course, we haven’t yet grown it out.”

“My goodness,” Dr. Wainwright managed. He rubbed a nervous palm across his face. “What a shock.”

“It is surprising,” Jack agreed. “Especially since the patient had been in the hospital for five days before his symptoms started.”

“I’ve never heard of nosocomial plague,” Dr. Wainwright said.

“Nor have I,” Jack said. “But it was pneumonic plague, not bubonic, and as you know the incubation period is shorter for pneumonic, probably only two to three days.”

“I still can’t believe it,” Dr. Wainwright said. “Plague never entered my thoughts.”

“Anybody else sick with similar symptoms?” Jack asked.

“Not that I know of,” Dr. Wainwright said, “but you can rest assured that we will find out immediately.”

“I’m curious about this man’s lifestyle,” Jack said. “His wife denied any recent travel or visitors from areas endemic to plague. She also doubted he’d come in contact with wild animals. Is that your understanding as well?”

“The patient worked in the garment district,” Dr. Wainwright said. “He did bookkeeping. He never traveled. He wasn’t a hunter. I’d been seeing him frequently over the last month, trying to get his diabetes under control.”

“Where was he in the hospital?” Jack asked.

“On the medical ward on the seventh floor,” Dr. Wainwright said. “Room seven-oh-seven. I remember the number specifically.”

“Single room?” Jack asked.

“All our rooms are singles,” Dr. Wainwright said.

“That’s a help,” Jack said. “Can I see the room?”

“Of course,” Dr. Wainwright said. “But I think I should call Dr. Mary Zimmerman, who’s our infection-control officer. She’s got to know about this immediately.”

“By all means,” Jack said. “Meanwhile, would you mind if I went up to the seventh floor and looked around?”

“Please,” Dr. Wainwright said as he gestured toward the door. “I’ll call Dr. Zimmerman and we’ll meet you up there.” He reached for the phone.

Jack retraced his route back to the main hospital building. He took the elevator to the seventh floor, which he found was divided by the elevator lobby into two wings. The north wing housed internal medicine while the south wing was reserved for OB-GYN. Jack pushed through the doors that led into the internal-medicine division.

As soon as the swinging door closed behind Jack, he knew that word of the contagion had arrived. A nervous bustle was apparent, and all the personnel were wearing newly distributed masks. Obviously Wainwright had wasted no time.

No one paid Jack any attention as he wandered down to room 707. Pausing at the door, Jack watched as two masked orderlies wheeled out a masked and confused patient clutching her belongings who was apparently being transferred. As soon as they were gone, Jack walked in.

Seven-oh-seven was a nondescript hospital room of modern design; the interior of the old hospital had been renovated in the not-too-distant past. The metal furniture was typical hospital issue and included a bed, a bureau, a vinyl-covered chair, a night table, and a variable-height bed table. A TV hung from an arm attached to the ceiling.

The air-conditioning apparatus was beneath the window. Jack went over to it, lifted the top, and looked inside. A hot-water and a chill-water pipe poked up through the concrete floor and entered a thermostated fan unit that recirculated room air. Jack detected no holes large enough for any type of rodent much less a rat.

Stepping into the bathroom, Jack glanced around at the sink, toilet, and shower. The room was newly tiled. There was an air return in the ceiling. Bending down, he opened the cabinet below the sink; again there were no holes.

Hearing voices in the other room, Jack stepped back through the door. It was Dr. Wainwright clutching a mask to his face. He was accompanied by two women and a man, all of whom were wearing masks. The women were attired in the long, white professorial coats Jack associated with medical-school professors.

After handing Jack a mask, Dr. Wainwright made the introductions. The taller woman was Dr. Mary Zimmerman, the hospital’s infection-control officer and head of the like-named committee. Jack sensed she was a serious woman who felt defensive under the circumstances. As she was introduced, she informed him that she was a board-certified internist with subspecialty training in infectious disease.

Not knowing how to respond to this revelation, Jack complimented her.

“I did not have an opportunity to examine Mr. Nodelman,” she added.