Robin Cook - Contagion

Reading on in the report, Jack silently complimented Janice Jaeger’s work. After the conversation he’d had with her the day before by phone, she added information about travel, pets, and visitors. In the case of Mueller it was all negative.

“Where’s the suspected plague?” Jack asked Laurie.

Laurie pushed a second folder toward him.

Jack opened the second file and was immediately surprised. The victim neither worked at the Manhattan General nor had obvious contact with Nodelman. Her name was Susanne Hard. Like Nodelman, she’d been a patient in the General, but not on the same ward as Nodelman. Hard had been on the OB-GYN ward after giving birth! Jack was mystified.

Reading further, Jack learned that Hard had been in the hospital for twenty-four hours when she’d experienced sudden high fever, myalgia, headache, overwhelming malaise, and progressive cough. These symptoms had come on about eighteen hours after undergoing a cesarean section during which she delivered a healthy child. Eight hours after the symptoms appeared, the patient was dead.

Out of curiosity Jack looked up Hard’s address, remembering that Nodelman had lived in the Bronx. But Hard had not lived in the Bronx. She had lived in Manhattan on Sutton Place South, hardly a ghetto neighborhood.

Reading on, Jack learned that Hard had not traveled since she’d become pregnant. As far as pets were concerned, she owned an elderly but healthy poodle. Concerning visitors, she had entertained a business associate of her husband’s from India three weeks previously who was described as being healthy and well.

“Is Janice Jaeger still here this morning?” Jack asked Laurie.

“She was about fifteen minutes ago when I passed her office,” Laurie said.

Jack found Janice where she’d been the previous morning.

“You are a dedicated civil servant,” Jack called out from the threshold.

Janice looked up from her work. Her eyes were red from fatigue. “Too many people dying lately. I’m swamped. But tell me: Did I ask the right questions on the infectious cases last night?”

“Absolutely,” Jack said. “I was impressed. But I do have a couple more.”

“Shoot,” Janice said.

“Where’s the OB-GYN ward in relation to the medical ward?”

“They’re right next to each other,” Janice said. “Both are on the seventh floor.”

“No kidding,” Jack said.

“Is that significant?” Janice asked.

“I haven’t the slightest idea,” Jack admitted. “Do patients from the OB ward mix with those on the medical ward?”

“You got me there,” Janice admitted. “I don’t know, but I wouldn’t imagine so.”

“Nor would I,” Jack said. But if they didn’t, then how did Susanne Hard manage to get sick? Something seemed screwy about this plague outbreak. Facetiously he wondered if a bunch of infected rats could be living in the ventilation system on the seventh floor.

“Any other questions?” Janice asked. “I want to get out of here, and I have this last report to finish.”

“One more,” Jack said. “You indicated that Katherine Mueller was employed by the General but you didn’t say for what department. Do you know if she worked for nursing or for the lab?”

Janice leafed through her night’s notes and came up with the sheet on which she’d recorded Mueller’s information. She quickly glanced through it and then looked back up at Jack. “Neither,” she said. “She worked in central supply.”

“Oh, come on!” Jack said. He sounded disappointed.

“I’m sorry,” Janice said. “That’s what I was told.”

“I’m not blaming you,” Jack said with a wave of his hand. “It’s just that I’d like there to be some sort of logic to all this. How would a woman in central supply get into contact with a sick patient on the seventh floor? Where’s central supply?”

“I believe it’s on the same floor with the operating rooms,” Janice said. “That would be the third floor.”

“Okay, thanks,” Jack said. “Now get out of here and get some sleep.”

“I intend to,” Janice said.

Jack wandered back toward the ID room, thinking that nothing seemed to be making much sense. Usually the course of a contagious illness could be easily plotted sequentially through a family or a community. There was the index case, and the subsequent cases extended from it by contact, either directly or through a vector like an insect. There wasn’t a lot of mystery. That wasn’t the case so far with this plague outbreak. The only unifying factor was that they all involved the Manhattan General.

Jack absently waved to Sergeant Murphy, who’d apparently just arrived in his cubbyhole office off the communications room. The ebullient Irish policeman waved back with great enthusiasm.

Jack slowed his walk while his mind churned. Susanne Hard had come down with symptoms after only being in the hospital for a day. Since the incubation period for plague was generally thought to be two days at a minimum, she would have been exposed prior to coming into the hospital. Jack went back to Janice’s office.

“One more question,” Jack called out to her. “Do you happen to know whether the Hard woman visited the hospital in the days prior to her admission?”

“Her husband said no,” Janice said. “I asked that question specifically. Apparently she hated the hospital and only came in at the very last minute.”

Jack nodded. “Thanks,” he said, even more preoccupied. He turned and started back toward the ID room. That information made the situation more baffling, requiring him to postulate that the outbreak had occurred almost simultaneously in two, maybe three locations. That wasn’t probable. The other possibility was that the incubation period was extremely short, less than twenty-four hours. That would mean Hard’s illness was a nosocomial infection, as he suspected Nodelman’s was as well as Mueller’s. The problem with that idea was that it would suggest a huge, overwhelming infecting dose, which also seemed unlikely. After all, how many sick rats could be in a ventilation duct all coughing at the same time?

In the ID room Jack wrestled the sports page of the Daily News away from a reluctant Vinnie and dragged him down to the pit to begin the day.

“How come you always start so early?” Vinnie complained. “You’re the only one. Don’t you have a life?”

Jack swatted him in the chest with Katherine Mueller’s folder. “Remember the saying ‘The early bird gets the worm’?”

“Oh, barf,” Vinnie said. He took the folder from Jack and opened it. “Is this the one we’re doing first?” he asked.

“Might as well move from the known to the unknown,” Jack said. “This one had a positive fluorescein antibody test to plague, so zip up tight in your moon suit.”

Fifteen minutes later Jack began the autopsy. He spent a good deal of time on the external exam, looking for any signs of insect bites. It wasn’t an easy job, since Katherine Mueller was an overweight forty-four-year-old with hundreds of moles, freckles, and other minor skin blemishes. Jack found nothing he was sure was a bite, although a few lesions looked mildly suspicious. To be on the safe side he photographed them.

“No gangrene on this body,” Vinnie commented.

“Nor purpura,” Jack said.

By the time Jack started on the internal exam, a number of the other staff had arrived in the autopsy room and half of the tables were in use. There were a few comments about Jack becoming the local plague expert, but Jack ignored them. He was too engrossed.

Mueller’s lungs appeared quite similar to Nodelman’s, with extensive lobar pneumonia, consolidation, and early stages of tissue death. The woman’s cervical lymphatics were also generally involved, as were the lymph nodes along the bronchial tree.