Robin Cook - Contagion

“This is just as bad or worse than Nodelman,” Jack said. “It’s frightening.”

“You don’t have to tell me,” Vinnie said. “These infectious cases are the kind that make me wish I’d gone into gardening.”

Jack was nearing the end of the internal exam when Calvin came through the door. There was no mistaking his huge silhouette. He was accompanied by another figure who was half his size. Calvin came directly to Jack’s table.

“Anything out of the ordinary?” Calvin asked, while peering into the pan of internal organs.

“Internally this case is a repeat of yesterday’s,” Jack said.

“Good,” Calvin said, straightening up. He then introduced Jack to his guest. It was Clint Abelard, the city epidemiologist.

Jack could make out the man’s prominent jaw, but because of the reflection off the plastic face mask, he couldn’t see the fellow’s squirrelly eyes. He wondered if he was still as cantankerous as he’d been the day before.

“According to Dr. Bingham you two have already met,” Calvin said.

“Indeed,” Jack said. The epidemiologist did not respond.

“Dr. Abelard is trying to discern the origin of this plague outbreak,” Calvin explained.

“Commendable,” Jack said.

“He’s come to us to see if we can add any significant information,” Calvin said. “Perhaps you could run through your positive findings.”

“My pleasure,” Jack said. He started with the external exam, indicating skin abnormalities he thought could have been insect bites. Then he showed all the gross internal pathology, concentrating on the lungs, lymphatics, liver, and spleen. Throughout the entire discourse, Clint Abelard stayed silent.

“There you have it,” Jack said as he finished. He put the liver back into the pan. “As you can see it’s a severe case, as was Nodelman’s, and it’s no wonder both patients died so quickly.”

“What about Hard?” Clint asked.

“She’s next,” Jack said.

“Mind if I watch?” Clint asked.

Jack shrugged. “That’s up to Dr. Washington,” he said.

“No problem,” Calvin said.

“If I may ask,” Jack said, “have you come up with a theory where this plague came from?”

“Not really,” Clint said gruffly. “Not yet.”

“Any ideas?” Jack asked, trying to keep sarcasm out of his voice. It seemed Clint was in no better humor than he had been the day before.

“We’re looking for plague in the area’s rodent population,” Clint said condescendingly.

“Splendid idea,” Jack said. “And just how are you doing that?”

Clint paused as if he didn’t want to divulge any state secrets.

“The CDC is helping,” he said finally. “They sent someone up here from their plague division. He’s in charge of the trapping and analysis.”

“Any luck so far?” Jack asked.

“Some of the rats caught last night were ill,” Clint said. “But none with plague.”

“What about the hospital?” Jack asked. He persisted despite Clint’s apparent reluctance to talk. “This woman we’ve just autopsied worked in central supply. Seems likely her illness was nosocomial like Nodelman’s. Do you think she got it from some primary source in and around the hospital, or do you think she got it from Nodelman?”

“We don’t know,” Clint admitted.

“If she got it from Nodelman,” Jack asked, “any ideas of a possible route of transmission?”

“We’ve checked the hospital’s ventilation and air-conditioning system carefully,” Clint said. “All the HEPA filters were in place and had been changed appropriately.”

“What about the lab situation?” Jack asked.

“What do you mean?” Clint said.

“Did you know that the chief tech in micro actually suggested plague to the director of the lab purely from his clinical impression, but the director talked him out of following up on it?”

“I didn’t know that,” Clint mumbled.

“If the chief tech had followed up on it he would have made the diagnosis and appropriate therapy could have been started,” Jack said. “Who knows; it could have saved a life. The problem is that the lab has been downsizing because of pressure from AmeriCare to save a few bucks, and they don’t have a microbiology supervisor position. It got eliminated.”

“I don’t know anything about all that,” Clint said. “Besides, the case of plague still would have occurred.”

“You’re right,” Jack said. “One way or the other you still have to come up with the origin. Unfortunately, you don’t know any more than you did yesterday.” Jack smiled inside his mask. He was getting a bit of perverse pleasure out of putting the epidemiologist on the spot.

“I wouldn’t go that far,” Clint muttered.

“Any sign of illness in the hospital staff?” Jack asked.

“There are several nurses who are febrile and who are quarantined,” Clint said. “As of yet there is no confirmation of them having plague, but it is suspected. They were directly exposed to Nodelman.”

“When will you be doing Hard?” Calvin asked.

“In about twenty minutes,” Jack said. “As soon as Vinnie gets things turned around.”

“I’m going around to check on some other cases,” Calvin said to Clint. “You want to stay here with Dr. Stapleton or do you want to come with me?”

“I think I’ll go with you, if you don’t mind,” Clint said.

“By the way, Jack,” Calvin said before leaving. “There’s a bevy of media people upstairs crawling all over the outer office like bloodhounds. I don’t want you giving any unauthorized press conferences. Any information coming from the ME’s office comes from Mrs. Donnatello and her PR assistant.”

“I wouldn’t dream of talking to the press,” Jack assured him.

Calvin wandered to the next table. Clint stayed at his heels.

“It didn’t sound as if that guy wanted to talk with you,” Vinnie said to Jack when Calvin and Clint were far enough away. “Not that I can blame him.”

“That little mouse has been spleeny since I first met him,” Jack said. “I don’t know what his problem is. He’s kinda a weird duck, if you ask me.”

“Now there’s the pot calling the kettle black,” Vinnie said.

NEW YORK CITY

“Mr. Lagenthorpe, can you hear me?” Dr. Doyle called to his patient. Donald Lagenthorpe was a thirty-eight-year-old African-American oil engineer who had a chronic problem with asthma. That morning, just after three A.M., he’d awakened with progressive difficulty breathing. His prescribed home remedies had not interrupted the attack, and he’d come into the emergency room of the Manhattan General at four. Dr. Doyle had been called at quarter to five after the usual emergency medications had had no effect.

Donald’s eyes blinked open. He hadn’t been sleeping, just trying to rest. The ordeal had been exhausting and frightening. The feeling of not being able to catch his breath was torture, and this episode had been the worst he’d ever experienced.

“How are you doing?” Dr. Doyle inquired. “I know what you have been through. You must be very tired.” Dr. Doyle was one of those rare physicians who were able to empathize with all his patients with a depth of understanding suggesting he suffered from all the same conditions.

Donald nodded his head, indicating that he was okay. He was breathing through a face mask that made conversation difficult.

“I want you to stay in the hospital for a few days,” Dr. Doyle said. “This was a difficult attack to break.”

Donald nodded again. No one had to tell him that.

“I want to keep you on the IV steroids for a little while longer,” Dr. Doyle explained.