Robin Cook - Contagion

“An orthopedic patient?” Jack asked.

“How’d you know?”

“I just saw a folder from an orthopedic nurse,” Jack said.

“Oh, yeah, that was Mr. Caruso,” Janice said with a yawn. She excused herself before continuing. “Anyway, I started getting called shortly after I arrived at eleven. Since then it’s been nonstop. I’ve been back and forth all night. In fact, I just got back here twenty minutes ago. I tell you, this is worse than the the other outbreaks. One of the patients is a nine-year-old girl. What a tragedy.”

“Was she related to the first case?” Jack asked.

“She was a niece,” Janice said.

“Had she been in to visit her uncle?” Jack asked.

“Around noon yesterday,” Janice said. “You don’t think that could have contributed to her death, do you? I mean, that was only about twelve hours before her death.”

“Under certain circumstances meningococcus has a frightful capacity to kill, and kill incredibly swiftly,” Jack said. “In fact, it can kill in just a few hours.”

“Well, the hospital is in a panic.”

“I can imagine,” Jack said. “What was the name of the first case?”

“Carlo Pacini,” Janice said. “But that’s about all I know. He came in on the shift before mine. Steve Mariott handled it.”

“Could I ask a favor?” Jack asked.

“That depends,” Janice said. “I’m awfully tired.”

“Just leave word for Bart that I want you PAs to get all the charts of the index case in each of these outbreaks. Let’s see, that’s Nodelman with the plague, Hard with tularemia, Lagenthorpe with Rocky Mountain spotted fever, and Pacini with meningococcus. Do you think that will be a problem?”

“Not at all,” Janice said. “They are all active ME cases.”

Jack stood up and gave Janice a pat on the back. “Maybe you should go over to the clinic on your way home,” he said. “Some chemoprophylaxis might not be a bad idea.”

Janice’s eyes widened. “You think that is necessary?”

“Better safe than sorry,” Jack said. “Anyway, discuss it with one of the infectious disease gurus. They know better than I. There’s even a tetravalent vaccine, but that takes a few days to kick in.”

Jack dashed back to the ID room and asked George for Carlo Pacini’s folder.

“It’s not here,” George said. “Laurie came in early, and when she heard about what was going on, she requested the case. She’s got the folder.”

“Where is she?” Jack asked.

“Up in her office,” Vinnie responded from behind his paper.

Jack hustled up to Laurie’s office. Contrary to the way Jack worked, she liked to go over each folder in her office before doing the autopsy.

“Pretty frightening, I’d say,” Laurie said as soon as she saw Jack.

“It’s terrifying,” Jack said. He grabbed Laurie’s officemate’s chair, pulled it over to Laurie’s desk, and sat down. “This is just what I’ve been worrying about. This could be a real epidemic. What have you learned about this index case?”

“Not much,” Laurie admitted. “He’d been admitted Saturday evening with a fractured hip. Apparently he’d had a brittle bone problem; he’d had a whole string of fractures over the last few years.”

“Fits the pattern,” Jack said.

“What pattern?” Laurie asked.

“All the index cases from these recent outbreaks have had some sort of chronic illness,” Jack said.

“A lot of people who are hospitalized have chronic illnesses,” Laurie said. “In fact, most of them. What does that have to do with anything?”

“I’ll tell you what’s on his paranoid, sick mind,” Chet said. Chet had appeared at Laurie’s door. He stepped into the room and leaned against the second desk. “He’s got this thing about AmeriCare and wants to see conspiracy behind all this trouble.”

“Is that true?” Laurie asked.

“I think it’s less that I want to see conspiracy than it’s staring me in the face,” Jack said.

“What do you mean by ‘conspiracy’?” Laurie asked.

“He has this notion that these unusual illnesses are being spread deliberately,” Chet said. Chet summarized Jack’s theory that the culprit was either someone at AmeriCare trying to protect its bottom line or some crazy person with terrorist inclinations.

Laurie looked questioningly at Jack. Jack shrugged.

“There are a lot of unanswered questions,” Jack offered.

“As there are in just about any outbreak,” Laurie said. “But really! This is all a bit far-fetched. I hope you didn’t mention this theory to the powers that be over at the General.”

“Yeah, I did,” Jack said. “In fact I sort of asked the director of the lab if he was involved. He’s rather disgruntled with his budget. He immediately informed the infection-control officer. I imagine they’ve let the administration know.”

Laurie let out a short, cynical laugh. “Oh, brother,” she said. “No wonder you’ve become persona non grata around there.”

“You have to admit there’s been an awful lot of questionable nosocomial infection at the General,” Jack said.

“I’m not even so sure about that,” Laurie said. “Both the tularemic patient and the patient with Rocky Mountain spotted fever developed their illnesses within forty-eight hours of admission. By definition, they are not nosocomial infections.”

“Technically that’s true,” Jack admitted. “But…”

“Besides, all these illnesses have been seen in New York,” Laurie said. “I’ve done some recent reading myself. There was a serious outbreak of Rocky Mountain spotted fever in eighty-seven.”

“Thank you, Laurie,” Chet said. “I tried to tell Jack the same thing. Even Calvin has told him.”

“What about the series of cases coming from central supply?” Jack asked Laurie. “And what about the rapidity with which the patients with Rocky Mountain spotted fever developed their illnesses? You were questioning that just this Saturday.”

“Of course I’d question those things,” Laurie said. “They’re the type of questions that have to be asked in any epidemiological situation.”

Jack sighed. “I’m sorry,” he said. “But I’m convinced something highly unusual is going on. All along I’ve been worried that we might see a real epidemic crop up. This outbreak of meningococcus may be it. If it peters out like the other outbreaks, I’ll be relieved, of course, in human terms. But it will only add to my suspicions. This pattern of multiple fulminant cases, then nothing, is highly unusual in itself.”

“But this is the season for meningococcus,” Laurie said. “It’s not so unusual.”

“Laurie’s right,” Chet said. “But regardless, my concern is that you’re going to get yourself into real trouble. You’re like a dog with a bone. Calm down! I don’t want to see you fired. At least reassure me you’re not going back to the General.”

“I can’t say that,” Jack said. “Not with this new outbreak. This one doesn’t depend on some arthropods that aren’t around. This is an airborne problem, and as far as I’m concerned, it changes the rules.”

“Just a moment,” Laurie said. “What about that warning you got from those thugs?”

“Now what?” Chet questioned. “What thugs?”

“Jack had a cozy visit from some charming members of a gang,” Laurie said. “It seems that at least one of the New York gangs is going into the extortion business.”

“Somebody has to explain,” Chet said.

Laurie told Chet what she knew of Jack’s beating.

“And you’re still thinking of going over there?” Chet asked when she was through.

“I’ll be careful,” Jack said. “Besides, I haven’t exactly decided to go yet.”