Robin Cook - Contagion

Donald lifted the face mask off his face. “Couldn’t I get the steroids at home?” he suggested. As thankful as he was about the hospital’s having been there in his hour of need, he much preferred the idea of going home now that his breathing had returned to normal. At home he knew he could at least get some work done. As was always the case, this asthma attack had come at a particularly inconvenient time. He was supposed to go back to Texas the following week for more fieldwork.

“I know you don’t want to be in the hospital,” Dr. Doyle said. “I’d feel the same way. But I think it is best under the circumstances. We’ll get you out just as soon as possible. Not only do I want to continue giving you IV steroids, but I want you breathing humidified, clean, nonirritating air. I also want to follow your peak expiratory flow rate carefully. As I explained to you earlier, it is still not completely back to normal.”

“How many days do you estimate I’ll have to be in here?” Donald asked.

“I’m sure it will only be a couple,” Dr. Doyle said.

“I’ve got to go back to Texas,” Donald explained.

“Oh?” Dr. Doyle said. “When were you there last?”

“Just last week,” Donald said.

“Hmm,” Dr. Doyle said while he thought. “Were you exposed to anything abnormal while you were there?”

“Just Tex-Mex cuisine,” Donald said, managing a smile.

“You haven’t gotten any new pets or anything like that, have you?” Dr. Doyle asked. One of the difficulties of managing someone with chronic asthma was determining the factors responsible for triggering attacks. Frequently it was allergenic.

“My girlfriend got a new cat,” Donald said. “It has made me itch a bit the last few times I’ve been over there.”

“When was the last time?” Dr. Doyle asked.

“Last night,” Donald admitted. “But I was home just a little after eleven, and I felt fine. I didn’t have any trouble falling asleep.”

“We’ll have to look into it,” Dr. Doyle said. “Meanwhile I want you in the hospital. What do you say?”

“You’re the doctor,” Donald said reluctantly.

“Thank you,” Dr. Doyle said.

“For chrissake!” Jack murmured under his breath as he was about to start the autopsy on Susanne Hard. Clint Abelard was hovering behind him like a gnat, constantly switching his weight from one leg to the other.

“Clint, why don’t you step around the table and stand on the other side,” Jack suggested. “You’ll be able to see much better.”

Clint took the suggestion and stood with his arms behind his back opposite from Jack.

“Now don’t move,” Jack mumbled to himself. Jack didn’t like Clint hanging around, but he had no choice.

“It’s sad when you see a young woman like this,” Clint said suddenly.

Jack looked up. He hadn’t expected such a comment from Clint. It seemed too human. He had struck Jack as an unfeeling, moody bureaucrat.

“How old is she?” Clint asked.

“Twenty-eight,” Vinnie said from the head of the table.

“From the looks of her spine she didn’t have an easy life,” Clint said.

“She had several major back surgeries,” Jack said.

“It’s a double tragedy since she’d just given birth,” Clint said. “Now the child is motherless.”

“It was her second child,” Vinnie said.

“I suppose I shouldn’t forget her husband,” Clint said. “It must be upsetting to lose your spouse.”

A knifelike stab of emotion went down Jack’s spine. He had to fight to keep from reaching across the table and yanking Clint off his feet. Abruptly he left the table and exited to the washroom. He heard Vinnie call after him, but he ignored him. Instead Jack leaned on the edge of the sink and tried to calm himself. He knew that getting angry with Clint was an unreasonable reaction; it was nothing but pure, unadulterated transference. But understanding the origin did not lessen the irritation. It always irked Jack when he heard such clichés from people who truly had no idea.

“Is there a problem?” Vinnie asked. He’d stuck his head through the door.

“I’ll be there in a second,” Jack said.

Vinnie let the door close.

As long as he was there, Jack washed and regloved his hands. When he was finished he returned to the table.

“Let’s get this show on the road,” he said.

“I’ve looked the body over,” Clint said. “I don’t see anything that looks like an insect bite, do you?”

Jack had to restrain himself from subjecting Clint to a lecture like the one Clint had given to him. Instead, he merely proceeded with his external exam. Only after he’d finished did he speak.

“No gangrene, no purpura, and no insect bites as far as I can see,” Jack said. “But by just looking at her I can see some of her cervical lymph nodes are swollen.”

Jack pointed out the finding to Clint, who then nodded in agreement.

“That’s certainly consistent with plague,” Clint said.

Jack didn’t answer. Instead he took a scalpel from Vinnie and quickly made the typical Y-shaped autopsy incision. The bold cruelty of the move jolted Clint. He took a step back.

Jack worked quickly but with great care. He knew that the less the internal organs were disturbed, the less chance that any of the infecting microbes would be aerosolized.

When Jack had the organs out, he turned his attention first to the lungs. Calvin had drifted over at this point and towered behind Jack as he made his initial cuts into the obviously diseased organ. Jack spread open the lung like a butterfly.

“Lots of bronchopneumonia and early tissue necrosis,” Calvin said. “Looks pretty similar to Nodelman.”

“I don’t know,” Jack said. “Seems to me there is an equal amount of pathology but less consolidation. And look at these nodal areas. They almost look like early granulomas with caseation.”

Clint listened to this pathological jargon with little interest or comprehension. He remembered the terms from medical school, but had long since forgotten their meaning. “Does it look like plague?” he asked.

“Consistent,” Calvin said. “Let’s look at the liver and the spleen.”

Jack carefully pulled these organs from the pan and sliced into them. As he’d done with the lung, he spread open their cut surfaces so everyone could see. Even Laurie had stepped over from her table.

“Lots of necrosis,” Jack said. “Certainly just as virulent a case as with Nodelman or with the case I did earlier.”

“Looks like plague to me,” Calvin said.

“But why was the fluorescein antibody negative?” Jack said. “That’s telling me something, especially combined with the lung appearance.”

“What’s with the lungs?” Laurie asked.

Jack moved the liver and the spleen aside and showed Laurie the cut surface of the lung. He explained what he thought of the pathology.

“I see what you mean now that you mention it,” Laurie said. “It is different from Nodelman. His lungs definitely had more consolidation. This looks more like some sort of horribly aggressive TB.”

“Whoa!” Calvin said. “This isn’t TB. No way.”

“I don’t think Laurie was suggesting it was,” Jack said.

“I wasn’t,” Laurie agreed. “I was just using TB as a way of describing these infected areas.”

“I think it is plague,” Calvin said. “I mean, I wouldn’t if we hadn’t just had a case from the same hospital yesterday. Chances are it is plague regardless of what their lab said.”

“I don’t think it is,” Jack said. “But let’s see what our lab says.”

“How about double or nothing with that ten dollars,” Calvin said. “Are you that sure?”