Robin Cook - Contagion

“Even some myocarditis,” Bingham said. He put the lung back and lifted up the heart and displayed it for Jack. “When you can see the inflammation grossly like this, you know it’s extensive.”

“Looks like a virulent strain,” Jack said.

“You’d better believe it,” Bingham said. “This patient’s only twenty-nine years old, and his first symptoms occurred around six last night. He was dead at four A.M. It reminds me of a case I did back in my residency during the pandemic of fifty-seven and fifty-eight.”

Vinnie rolled his eyes. Bingham had a mind-numbing habit of comparing every case to one that he’d had in his long career.

“That case was also a primary influenza pneumonia,” Bingham continued. “Same appearance of the lung. When we looked at it histologically we were amazed at the degree of damage. It gave us a lot of respect for certain strains of influenza.”

“Seeing this case concerns me,” Jack said. “Especially in light of the other diseases that have been popping up.”

“Now, don’t head off into left field!” Bingham warned, remembering some of Jack’s comments the day before. “This isn’t out of the ordinary, like the plague case or even the tularemia. It’s flu season. Primary influenza pneumonia is a rare complication, but we see it. In fact we had a case just last month.”

Jack listened, but Bingham wasn’t making him feel any more comfortable. The patient in front of them had had a lethal infection with an agent that had the capability of spreading from patient to patient like wildfire. Jack’s only consolation was the call Laurie had made to her internist friend who’d said there were no other cases in the hospital.

“Mind if I take some washings?” Jack asked.

“Hell no!” Bingham said. “Be my guest. But be careful what you do with them.”

“Obviously,” Jack said.

Jack took the lungs over to one of the sinks, and with Vinnie’s help prepared some samples by washing out some of the small bronchioles with sterile saline. He then sterilized the outside of the containers with ether.

Jack was on his way out when Bingham asked him what he was going to do with the samples.

“Take them up to Agnes,” Jack said. “I’d like to know the subtype.”

Bingham shrugged and looked across at Calvin.

“Not a bad idea,” Calvin said.

Jack did exactly what he said he would. But he was disappointed when he presented the bottles to Agnes up on the third floor.

“We don’t have the capability of subtyping it,” she said.

“Who does?” Jack asked.

“The city or state reference lab,” Agnes said. “Or even over at the university lab. But the best place would be the CDC. They have a whole section devoted to influenza. If it were up to me, I’d send it there.”

Jack got some viral transport medium from Agnes and transferred the washings into it. Then he went up to his office. Sitting down, he placed a call to the CDC and was put through to the influenza unit. A pleasant-sounding woman answered, introducing herself as Nicole Marquette.

Jack explained what he wanted, and Nicole was accommodating. She said she’d be happy to see that the influenza was typed and subtyped.

“If I manage to get the sample to you today,” Jack said, “how long would it take for you to do the typing?”

“We can’t do this overnight,” Nicole said, “if that’s what you have in mind.”

“Why not?” Jack asked impatiently.

“Well, maybe we could,” Nicole corrected herself. “If there is a sufficient viral titer in your sample, meaning enough viral particles, I suppose it is possible. Do you know what the titer is?”

“I haven’t the faintest idea,” Jack said. “But the sample was taken directly from the lung of a patient who passed away from primary influenza pneumonia. The strain is obviously virulent, and I’m worried about a possible epidemic.”

“If it is a virulent strain, then the titer might be high,” Nicole said.

“I’ll find a way to get it to you today,” Jack promised. He then gave Nicole his telephone number both at the office and at home. He told her to call anytime she had any information.

“We’ll do the best we can,” Nicole said. “But I have to warn you, if the titer is too low it might be several weeks before I get back to you.”

“Weeks!” Jack complained. “Why?”

“Because we’ll have to grow the virus out,” Nicole explained. “We usually use ferrets, and it takes a good two weeks for an adequate antibody response which guarantees we’ll have a good harvest of virus. But once we have the virus in quantity, we can tell you a lot more than just its subtype. In fact, we can sequence its genome.”

“I’ll keep my fingers crossed that my samples have a high titer,” Jack said. “And one other question. What subtype would you think was the most virulent?”

“Whoa!” Nicole said. “That’s a hard question. There are a lot of factors involved, particularly host immunity. I’d have to say the most virulent would be an entirely new pathological strain, or one that hasn’t been around for a long time. I suppose the subtype that caused the pandemic of 1918 to 1919 that killed twenty-five million people worldwide might get the dubious honor of having been the most virulent.”

“What subtype was that?” Jack asked.

“No one knows for sure,” Nicole said. “The subtype doesn’t exist. It disappeared years ago, maybe right after the epidemic wore itself out. Some people think it was similar to the subtype that caused that swine-flu scare back in seventy-six.”

Jack thanked Nicole and again assured her he’d get the samples to her that day. After he hung up, he called Agnes back and asked her opinion on shipping. She told him the name of the courier service they used, but she said she didn’t know if they shipped interstate.

“Besides,” Agnes added, “it will cost a small fortune. I mean overnight is one thing, but you’re talking about the same day. Bingham will never authorize it.”

“I don’t care,” Jack said. “I’ll pay for it myself.”

Jack called the courier company. They were delighted with the request and put Jack through to one of the supervisors, Tony Liggio. When Jack explained what he wanted, Tony said no problem.

“Can you come to pick it up now?” Jack asked. He was encouraged.

“I’ll send someone right away,” Tony said.

“It will be ready,” Jack said.

Jack was about to hang up when he heard Tony add: “Aren’t you interested in the cost? I mean, this is not like taking something over to Queens. Also, there’s the question of how you plan to pay.”

“Credit card,” Jack said. “If that’s okay.”

“Sure, no problem, Doc,” Tony said. “It’s going to take me a little while to figure out the exact charge.”

“Just give me a ballpark figure,” Jack said.

“Somewhere between one and two thousand dollars,” Tony said.

Jack winced but didn’t complain. Instead, he merely gave Tony his credit card number. He’d envisioned the cost would be two or three hundred dollars, but then he hadn’t thought about the fact that someone might have to fly round-trip to Atlanta.

While Jack had been engaged in giving his credit card information, one of the secretaries from the front office had appeared at his door. She’d handed him an overnight Federal Express package and departed without saying a word. As Jack hung up from the courier service he saw that the parcel was from National Biologicals. It was the DNA probes he’d requested the day before.

Taking the probes and his viral samples, Jack went back down to Agnes. He told her about the arrangements he’d made with the courier service.

“I’m impressed,” Agnes said. “But I’m not going to ask how much it’s costing.”