Robin Cook - Contagion

“I’ve got to get back to work,” Janice said. “If you need me to do anything just let me know.”

“I’m sorry,” Jack said. “I didn’t mean to have you stand here. Thanks for getting this to me.”

“No problem,” Janice said. She waved and headed back to the elevators.

“Is tularemia as bad as plague?” Terese asked.

“It’s hard to make comparisons,” Jack said. “But it’s bad, particularly the pneumonic form, which is highly contagious. If Susanne Hard were still here she could tell us exactly how bad it is.”

“Why are you so surprised?” Terese asked. “Is it as rare as plague?”

“Probably not,” Jack said. “It’s seen in a wider area in the U.S. than plague, particularly in southern states like Arkansas. But like plague it’s not seen much in the winter, at least not up here in the north. Here it’s a late-spring and summer problem, if it exists at all. It needs a vector, just like plague. Instead of the rat flea it’s usually spread by ticks and deerflies.”

“Any tick or deerfly?” Terese asked. Her parents had a cabin up in the Catskills where she liked to go in the summer. It was isolated and surrounded by forest and fields. There were plenty of ticks and deerflies.

“The reservoir for the bacteria is small mammals like rodents and especially rabbits,” Jack said. He started to elaborate but quickly stopped. He’d suddenly recalled that afternoon’s conversation with Susanne’s husband, Maurice. Jack remembered being told that Susanne liked to go to Connecticut, walk in the woods, and feed wild rabbits!

“Maybe it was the rabbits,” Jack mumbled.

“What are you talking about?” Terese asked.

Jack apologized for thinking out loud. Shaking himself out of a momentary daze, he motioned for Terese to follow him into his office and to take Chet’s chair. He described his phone conversation with Susanne’s husband and explained about the importance of wild rabbits in relation to tularemia.

“Sounds incriminating to me,” Terese said.

“The only problem is that her exposure to the Connecticut rabbits was almost two weeks ago,” Jack mused. He drummed his fingers on his telephone receiver. “That’s a long incubation period, especially for the pneumonic form. Of course, if she didn’t catch it in Connecticut, then she had to catch it here in the city, possibly at the General. Of course, nosocomial tularemia doesn’t make any more sense than nosocomial plague.”

“One way or the other the public has to know about this,” Terese said. She nodded toward his hand on the phone. “I hope you are calling the media as well as the hospital.”

“Neither,” Jack said. He glanced at his watch. It was still before midnight. He picked up the phone and dialed. “I’m calling my immediate boss. The politics of all this are his bailiwick.”

Calvin picked up on the first ring but mumbled as if he’d been asleep. Jack cheerfully identified himself.

“This better be important,” Calvin growled.

“It is to me,” Jack said. “I wanted you to be first to know you owe me another ten dollars.”

“Get outta here,” Calvin boomed. The grogginess had disappeared from his voice. “I hope to God this isn’t some kind of sick joke.”

“No joke,” Jack assured him. “The lab just reported it in tonight. The Manhattan General had a case of tularemia in addition to its two cases of plague. I’m as surprised as anyone.”

“The lab called you directly?” Calvin said.

“Nope,” Jack said. “One of the PAs just gave it to me.”

“Are you in the office?” Calvin asked.

“Sure am,” Jack said. “Working my fingers to the bone.”

“Tularemia?” Calvin questioned. “I’d better read up on it. I don’t think I’ve ever seen a case.”

“I read up on it just this afternoon,” Jack admitted.

“Make sure there are no leaks from our office,” Calvin said. “I won’t call Bingham tonight, because there’s nothing to be done at the moment. I’ll let him know first thing in the morning, and he can call the commissioner, and she can call the Board of Health.”

“Okay,” Jack said.

“So you are going to keep it a secret,” Terese said angrily as Jack hung up the receiver.

“It’s not my doing,” Jack said.

“Yeah, I know,” Terese said sarcastically. “It’s not your job.”

“I already got myself in trouble over the plague episode for calling the commissioner on my own,” Jack said. “I don’t see any benefit by doing it again. Word will be out in the morning through the proper channels.”

“What about people over at the General who are suspected of having plague?” Terese questioned. “They might have this new disease. I think you should let everyone know tonight.”

“That’s a good point,” Jack said. “But it doesn’t really matter. The treatment for tularemia is the same as the treatment for plague. We’ll wait until morning. Besides, it’s only a few hours away.”

“What if I alerted the press?” Terese asked.

“I’ll have to ask you not to do that,” Jack said. “You heard what my boss said. If it were investigated, the source would come back to me.”

“You don’t like advertising in medicine and I don’t like politics in medicine,” Terese said.

“Amen,” Jack said.

Despite having gone to bed much later than usual for the second night in a row, Jack was wide awake at five-thirty Friday morning. He began mulling over the irony of a case of tularemia appearing in the middle of a plague outbreak. It was a curious coincidence, especially since he’d made the diagnosis. It was a feat certainly worth the ten dollars and twenty-five cents that he stood to win from Calvin and Laurie.

With his mind churning, Jack recognized the futility of trying to go back to sleep. Consequently he got up, ate breakfast, and was on his bike before six. With less traffic than usual, he got to work in record time.

The first thing Jack did was to visit the ID room to look for Laurie and Vinnie. Both had yet to arrive. Passing back through communications, he knocked on Janice’s door. She appeared even more beleaguered than usual.

“What a night,” she said.

“Busy?” Jack asked.

“That’s an understatement,” she said. “Especially with these added infectious cases. What’s going on over there at the General?”

“How many today?” Jack asked.

“Three,” Janice said. “And not one of them tested positive for plague even though that’s their presumed diagnosis. Also, all three were fulminant cases. The people all died within twelve or so hours after their first symptoms. It’s very scary.”

“All of these recent infectious cases have been fulminant,” Jack commented.

“Do you think these three new ones are tularemia?” Janice asked.

“There’s a good chance,” Jack said. “Especially if they tested negative for plague as you say. You didn’t mention Susanne’s diagnosis to anyone, did you?”

“I had to bite my tongue, but I didn’t,” Janice said. “I’d learned in the past by sore experience that my role is to gather information, not give it out.”

“I had to learn the same lesson,” Jack said. “Are you finished with these three folders?”

“They’re all yours,” Janice said.

Jack carried the folders back to the ID room. Since Vinnie had not arrived Jack made the coffee in the communal pot. Mug in hand, he sat down and began going through the material.

Almost immediately he stumbled onto something curious. The first case was a forty-two-year-old woman by the name of Maria Lopez. What was surprising was that she worked in central supply of the Manhattan General Hospital! Not only that, but she had worked on the same shift as Katherine Mueller!