Robin Cook - Contagion

Calvin whistled. “Wow,” he said. “All this was happening in the face of massive IV antibiotics.”

“It’s worrisome,” Jack agreed. He carefully slid the lungs back into the pan. He didn’t want them sloshing around, potentially throwing infective particles into the air. Next he picked up the liver and gently separated its cut surface.

“Same process,” he announced, pointing with his fingers to areas of early abscess formation. “Just not as extensive as with the lungs.” Jack put the liver down and picked up the spleen. There were similar lesions throughout the organ. He made sure everyone saw them.

“So much for the gross,” Jack said as he carefully replaced the spleen in the pan. “We’ll have to see what the microscopic shows, but I actually think we’ll be relying on the lab to give us the definitive answer.”

“What’s your guess at this point?” Calvin asked.

Jack let out a short laugh. “A guess it would have to be,” he said. “I haven’t seen anything pathognomonic yet. But its fulminant character should tell us something.”

“What’s your differential diagnosis?” Calvin asked. “Come on, Wonderboy, let’s hear it.”

“Ummmm,” Jack said. “You’re kinda putting me on the spot. But okay, I’ll tell you what’s been going through my head. First, I don’t think it could be pseudomonas as suspected at the hospital. It’s too aggressive. It could have been something atypical like strep group A or even staph with toxic shock, but I kinda doubt it, especially with the gram stain suggesting it was a bacillus. So I’d have to say it is something like tularemia or plague.”

“Whoa!” Calvin exclaimed. “You’re coming up with some pretty arcane illnesses for what was apparently a hospital-based infection. Haven’t you heard the phrase about when you hear hoofbeats you should think of horses, not zebras?”

“I’m just telling you what’s going through my mind. It’s just a differential diagnosis. I’m trying to keep an open mind.”

“All right,” Calvin said soothingly. “Is that it?”

“No, that’s not it,” Jack said. “I’d also consider that the gram stain could have been wrong and that would let in not only strep and staph but meningococcemia as well. And I might as well throw in Rocky Mountain spotted fever and hantavirus. Hell, I could even throw in the viral hemorrhagic fevers like Ebola.”

“Now you’re getting out in the stratosphere,” Calvin said. “Let’s come back to reality. If I made you guess which one it is right now with what you know, what would you say?”

Jack clucked his tongue. He had the irritated feeling he was being put back in medical school, and that Calvin, like many of his medical-school professors, was trying to make him look bad.

“Plague,” Jack said to a stunned audience.

“Plague?” Calvin questioned with surprise bordering on disdain. “In March? In New York City? In a hospitalized patient? You got to be out of your mind.”

“Hey, you asked me for one diagnosis,” Jack said. “So I gave it to you. I wasn’t responding by probabilities, just pathology.”

“You weren’t considering the other epidemiological aspects?” Calvin asked with obvious condescension. He laughed. Then, talking more to the others than Jack, he said: “What the hell did they teach you out there in the Chicago boonies?”

“There are too many unknowns in this case for me to put a lot of weight on unsubstantiated information,” Jack said. “I didn’t visit the site. I don’t know anything about the deceased’s pets, travel, or contact with visitors. There are a lot of people coming and going in this city, even in and out of a hospital. And there are certainly more than enough rats around here to support the diagnosis.”

For a moment a heavy silence hung over the autopsy room. Neither Laurie nor Chet knew what to say. Jack’s tone made them both uncomfortable, especially knowing Calvin’s stormy temperament.

“A clever comment,” Calvin said finally. “You’re quite good at double entendre. I have to give you credit there. Perhaps that’s part of pathology training in the Midwest.”

Both Laurie and Chet laughed nervously.

“All right, smartass,” Calvin continued. “How much are you willing to put on your diagnosis of plague?”

“I didn’t know it was customary to gamble around here,” Jack said.

“No, it’s not common to gamble, but when you come up with a diagnosis of plague, I think it’s worthwhile to make a point of it. How about ten dollars?”

“I can afford ten dollars,” Jack said.

“Fine,” Calvin said. “With that settled, where’s Paul Plodgett and that gunshot wound from the World Trade Center?”

“He’s down on table six,” Laurie said.

Calvin lumbered away and for a moment the others watched him. Laurie broke the silence. “Why do you try to provoke him?” she asked Jack. “I don’t understand. You’re making it more difficult for yourself.”

“I can’t help it,” Jack said. “He provoked me!”

“Yeah, but he’s the deputy chief and it’s his prerogative,” Chet said. “Besides, you were pushing things with a diagnosis of plague. It certainly wouldn’t be on the top of my list.”

“Are you sure?” Jack asked. “Look at the black fingers and toes on this patient. Remember, it was called the black death back in the fourteenth century.”

“A lot of diseases can cause such thrombotic phenomena,” Chet said.

“True,” Jack said. “That’s why I almost said tularemia.”

“And why didn’t you?” Laurie asked. In her mind tularemia was equally improbable.

“I thought plague sounded better,” Jack said. “It’s more dramatic.”

“I never know when you are serious,” Laurie said.

“Hey, I feel the same way,” Jack said.

Laurie shook her head in frustration. At times it was hard to have a serious discussion with Jack. “Anyway,” she said, “are you finished with Nodelman? If you are, I’ve got another case for you.”

“I haven’t done the brain yet,” Jack said.

“Then get to it,” Laurie said. She walked back to table three to finish her own case.

NEW YORK CITY

Terese Hagen stopped abruptly and looked at the closed door to the “cabin,” the name given to the main conference room. It was called the cabin because the interior was a reproduction of Taylor Heath’s Squam Lake house up in the wilds of New Hampshire. Taylor Heath was the CEO of the hot, up-and-coming advertising firm Willow and Heath, which was threatening to break into the rarefied ranks of the advertising big leagues.

After making sure she was not observed, Terese leaned toward the door and put her ear against it. She heard voices.

With her pulse quickening, Terese hurried down the hall to her own office. It never took long for her anxiety to soar. She’d only been in the office five minutes and already her heart was pounding. She didn’t like the idea of a meeting she didn’t know about being held in the cabin, the CEO’s habitual domain. In her position as the creative director of the firm, she felt she had to know everything that was going on.

The problem was that a lot was going on. Taylor Heath had shocked everybody with his previous month’s announcement that he planned to retire as CEO and was designating Brian Wilson, the current president, to succeed him. That left a big question mark about who would succeed Wilson. Terese was in the running. That was for sure. But so was Robert Barker, the firm’s executive director of accounts. And on top of that, there was always the worry that Taylor would pick someone from outside.

Terese pulled off her coat and stuffed it into the closet. Her secretary, Marsha Devons, was on the phone, so Terese dashed to her desk and scanned the surface for any telltale message; but there was nothing except a pile of unrelated phone messages.