Robin Cook - Contagion

Leaving Laurie, Jack stopped briefly at Chet’s table. Chet was not in a good mood.

“Hell,” he said. “It’s going to take me all day to trace these bullet paths the way Bingham suggested. If he wants to be this particular, I wonder why he doesn’t do the case himself.”

“Yell if you need any help,” Jack said. “I’ll be happy to come down and lend a hand.”

“I might do that,” Chet said.

Jack disposed of his protective gear, changed into his street clothes, and made sure his ventilation charger was plugged in. Then he got the autopsy folders for Lopez and Lagenthorpe. From Hester’s folder he looked up her next of kin. A sister was listed whose address was the same as the deceased. Jack surmised they were roommates. He copied down the phone number.

Next Jack sought out Vinnie, whom he found coming out of the walk-in cooler where he’d just deposited Lagenthorpe’s corpse.

“Where are all the samples from our two cases?” Jack asked.

“I got ’em all under control,” Vinnie said.

“I want to take them upstairs myself,” Jack said.

“Are you sure?” Vinnie asked. Running up the samples to the various labs was always an excuse for a coffee break.

“I’m positive,” Jack said.

Once he was armed with all the samples plus the autopsy folders Jack set out for his office. But he made two detours. The first was to the microbiology lab, where he sought out Agnes Finn.

“I was impressed with your diagnosis of tularemia,” Agnes said.

“I’m getting a lot of compliments out of that one,” Jack said.

“Got something for me today?” Agnes asked, eyeing Jack’s armful of samples.

“I do, indeed,” Jack said. He found the appropriate sample from Lopez and put it on the corner of Agnes’s desk. “This is another probable tularemia. Another sample will come up from a case Laurie Montgomery is doing as we speak. I want them both tested for tularemia.”

“The reference lab is very eager to follow up on the Hard case, so that won’t be difficult. I should have results back today. What else?”

“Well, this one is a mystery,” Jack said. He put several samples from Lagenthorpe on Agnes’s desk. “I don’t have any idea what this patient had. All I know is that it’s not plague, and it’s not tularemia.”

Jack went on to describe the Lagenthorpe case, giving Agnes all the positive findings. She was especially interested that no bacteria had been reported on the gram stain of the sputum.

“Have you thought of virus?” Agnes asked.

“As much as my limited infectious disease knowledge would allow,” Jack admitted. “Hantavirus crossed my mind, but there was not a lot of hemorrhage.”

“I’ll start some viral screening with tissue cultures,” Agnes said.

“I plan to do some reading and maybe I’ll have another idea,” Jack said.

“I’ll be here,” Agnes assured him.

Leaving microbiology, Jack went up to the fifth-floor histology lab.

“Wake up, girls, we have a visitor,” one of the histology techs shouted. Laughter echoed around the room.

Jack smiled. He always enjoyed visiting histology. The entire group of women who worked there always seemed to be in the best of moods. Jack was particularly fond of Maureen O’Conner, a busty redhead with a devilish twinkle in her eye. He was pleased when he saw her round the corner of the lab bench, wiping her hands on a towel. The front of her lab coat was stained a rainbow of colors.

“Well now, Dr. Stapleton,” she said in her pleasant brogue. “What can we do for the likes of you?”

“I need a favor,” Jack said.

“A favor, he says,” Maureen repeated. “You hear that, girls? What should we ask in return?”

More laughter erupted. It was common knowledge that Jack and Chet were the only two unmarried male doctors, and the histology women liked to tease them.

Jack unloaded his armful of sample bottles, separating Lagenthorpe’s from Lopez’s.

“I’d like to do frozen sections on Lagenthorpe,” he said. “Just a few slides from each organ. Of course, I want a set of the regular slides as well.”

“What about stains?” Maureen asked.

“Just the usual,” Jack said.

“Are you looking for anything in particular?” Maureen inquired.

“Some sort of microbe,” Jack said. “But that’s all I can tell you.”

“We’ll give you a call,” Maureen said. “I’ll get right on it.”

Back in his office, Jack went through his messages. There was nothing of interest. Clearing a space in front of himself, he set down Lopez’s and Lagenthorpe’s folders intending to dictate the autopsy findings and then call the next of kin. He even intended to call the next of kin of the case Laurie was doing. But instead his eye caught sight of his copy of Harrison’s textbook of medicine.

Pulling out the book, Jack cracked it open to the section on infectious disease and began reading. There was a lot of material: almost five hundred pages. But he was able to scan quickly since much of it was information he’d committed to memory at some point in his professional career.

Jack had gotten to the chapters on specific bacterial infections when Maureen called. She said that the frozen section slides were ready. Jack immediately walked down to the lab to retrieve them. He carried them back to his office and moved his microscope to the center of the desk.

The slides were organized by organ. Jack looked at the sections of the lung first. What impressed him most was the amount of swelling of the lung tissue and the fact that he saw no bacteria.

Looking at the heart sections, he could immediately see why the heart had appeared swollen. There was a massive amount of inflammation, and the spaces between the heart muscle cells were filled with fluid.

Switching to a higher power of magnification, Jack immediately appreciated the primary pathology. The cells lining the blood vessels that coursed through the heart were severely damaged. As a result, many of these blood vessels had become occluded with blood clots, causing multiple tiny heart attacks!

With a shot of adrenaline coursing through his own circulation from the excitement of discovery, Jack quickly switched back to the section of lung. Using the same high power he saw identical pathology in the walls of the tiny blood vessels, a finding he hadn’t noticed on his first examination.

Jack exchanged the lung section with one from the spleen. Adjusting the focus, he saw the same pathology. Obviously it was a significant finding, one that immediately suggested a possible diagnosis.

Jack pushed back from his desk and made a quick trip back to the micro lab and sought out Agnes. He found her at one of the lab’s many incubators.

“Hold up on the tissue cultures on Lagenthorpe,” he said breathlessly. “I got some new information you’re going to love.”

Agnes regarded him curiously through her thick glasses.

“It’s an endothelial disease,” Jack said excitedly. “The patient had an acute infectious disease without bacteria seen or cultured. That should have given it away. He also had the faintest beginnings of a rash that included his palms and soles. Plus he’d been suspected of having appendicitis. Guess why?”

“Muscle tenderness,” Agnes said.

“Exactly,” Jack said. “So what does that make you think of?”

“Rickettsia,” Agnes said.

“Bingo,” Jack said, and he punched the air for emphasis. “Good old Rocky Mountain spotted fever. Now, can you confirm it?”

“It’s as difficult as tularemia,” Agnes said. “We’ll have to send it out again. There is a direct immunofluorescent technique, but we don’t have the reagent. But I know the city reference lab has it, because there’d been an outbreak of Rocky Mountain spotted fever in the Bronx in eighty-seven.”