Robin Cook - Contagion

Jack closed his eyes and tried to think of how two people from central supply could possibly have come down with two different fatal infectious diseases. As far as he was concerned, it could not be a coincidence. He was convinced their illnesses had to be work-related. The question was how?

In his mind’s eye, Jack revisited central supply. He could picture the shelving and the aisles, even the outfits the employees wore. But nothing came to mind as a way for the employees to come in contact with contagious bacteria. Central supply had nothing to do with the disposal of hospital waste or even soiled linen, and as the supervisor had mentioned, workers there had little or no contact with patients.

Jack read the rest of Janice’s investigative report. As she’d done with the cases since Nodelman, she included information about pets, travel, and visitors. For Maria Lopez, none of the three seemed a factor.

Jack opened the second folder. The patient’s name was Joy Hester. In this case Jack felt there was little mystery. She’d been an OB-GYN nurse and had had significant exposure to Susanne Hard just prior to and after the onset of Susanne’s symptoms. The only thing that bothered Jack was recalling that he’d read that person-to-person transmission of tularemia rarely occurred.

The third case was Donald Lagenthorpe, a thirty-eight-year-old petroleum engineer who’d been admitted to the hospital the previous morning. He’d come in through the ER with a refractory bout of asthma. He’d been treated with IV steroids and bronchodilators as well as humidified air and bed rest. According to Janice’s notes, he’d shown steady improvement and had even been campaigning to be released, when he’d had the sudden onset of a severe frontal headache.

The headache had started in the late afternoon and was followed by shaking chills and fever. There was also an increase in cough and exacerbation of his asthmatic symptoms despite the continued treatment. At that point he was diagnosed to have pneumonia, which was confirmed by X ray. Curiously enough, however, a gram stain of his sputum was negative for bacteria.

Myalgia also had become prominent. Sudden abdominal pain and deep tenderness had suggested a possible appendicitis. At seven-thirty in the evening Lagenthorpe had undergone an appendectomy, but the appendix proved to be normal. After the surgery his situation became progressively grave with apparent multisystem failure. His blood pressure dropped and became unresponsive to treatment. Urine output became negligible.

Reading on in Janice’s report, Jack learned that the patient had visited isolated oil rigs in Texas the previous week and had literally been tramping around in desert conditions. Jack also learned that Mr. Lagenthorpe’s girlfriend had recently obtained a pet Burmese cat. But he’d not been exposed to any visitors from exotic places.

“Wow! You’re here early!” Laurie Montgomery exclaimed.

Jack was shocked out of his concentration in time to see Laurie sweep into the ID room and drape her coat over the desk she used for her early-morning duties. It was the last day of her current rotation as supervisor in charge of determining which of the previous night’s cases should be autopsied and who would do them. It was a thankless task that none of the board-certified doctors enjoyed.

“I’ve got some bad news for you,” Jack said.

Laurie paused on her way into communications; a shadow passed over her usually bright, honey-complected face.

Jack laughed. “Hey, relax,” he said. “It’s not that bad. It’s just that you owe me a quarter.”

“Are you serious?” she asked. “The Hard case was tularemia?”

“The lab reported a positive fluorescein antibody last night,” Jack said. “I think it’s a firm diagnosis.”

“It’s a good thing I didn’t bet any more than a quarter,” Laurie said. “You are amassing some impressive statistics in the infectious arena. What’s your secret?”

“Beginner’s luck,” Jack said. “By the way, I have three of last night’s cases here. They’re all infectious and all from the General. I’d like to do at least two of them.”

“I can’t think of any reason why not,” Laurie said. “But let me run over to communications and get the rest.”

The moment Laurie left, Vinnie made his appearance. His face was a pasty color and his heavily lidded eyes were red. From Jack’s perspective he appeared as if he belonged in one of the coolers downstairs.

“You look like death warmed over,” Jack said.

“Hangover,” Vinnie remarked. “I went to a buddy’s bachelor party. We all got whacked.”

Vinnie tossed his newspaper on a desk and went over to the cupboard where the coffee was stored.

“In case you haven’t noticed,” Jack said, “the coffee is already made.”

Vinnie had to stare at the coffee machine with its full pot for several beats until his tired mind comprehended that his current efforts were superfluous.

“How about starting on this instead?” Jack said. He pushed the Maria Lopez folder over to Vinnie. “Might as well get set up. Remember, the early bird…”

“Hold the clichés,” Vinnie said. He took the folder and let it fall open in his hands. “Frankly, I’m not in the mood for any of your sappy sayings. What bugs me is that you can’t come in here when everybody else does.”

“Laurie’s here,” Jack reminded him.

“Yeah, but this is her week for scheduling. You don’t have any excuse.” He briefly read portions of the folder. “Wonderful! Another infectious case! My favorite! I should have stayed in bed.”

“I’ll be down in a few minutes,” Jack said.

Vinnie irritably snapped up his newspaper and headed downstairs.

Laurie reappeared with an armful of folders and dumped them on her desk. “My, my, but we do have a lot of work to do today,” she said.

“I’ve already sent Vinnie down to get prepared for one of these infectious cases,” Jack said. “I hope I’m not overstepping my authority. I know you haven’t looked at them yet, but all of them are suspected plague but tested negative. At a minimum I think we have to make a diagnosis.”

“No question,” Laurie said. “But I should still go downstairs and do my external. Come on, I’ll do it right away, and you can get started.” She grabbed the master list of all the previous night’s deaths.

“What’s the story on this first case you want to do?” Laurie asked as they walked.

Jack gave her a quick synopsis of what he knew about Maria Lopez. He emphasized the coincidence of her being employed in central supply at the General. He reminded her that the plague victim from the day before had also worked in that department. They boarded the elevator.

“That’s kinda strange, isn’t it?” Laurie asked.

“It is to me,” Jack agreed.

“Do you think it’s significant?” Laurie asked. The elevator bumped to a stop, and they got off.

“My intuition tells me it is,” Jack said. “That’s why I’m eager to do the post. For the life of me, I can’t figure out what the association could be.”

As they passed the mortuary office Laurie beckoned to Sal. He caught up to them, and she handed him her master list. “Let’s see the Lopez body first,” she said.

Sal took the list, referred to his own, then stopped at compartment 67, opened the door, and slid out the tray.

Maria Lopez, like her late co-worker, Katherine Mueller, was an overweight female. Her hair was stringy and dyed a peculiar reddish orange. Several IVs were still in place. One was taped to the right side of her neck, the other to her left arm.

“A fairly young woman,” Laurie commented.

Jack nodded. “She was only forty-two.”

Laurie held Maria Lopez’s full-body X ray up to the ceiling light. Its only abnormality was patchy infiltration in her lungs.