Robin Cook - Contagion

“When a humidifier comes back from a patient room what happens to it?” Jack asked.

“We take care of it,” Darlene said.

“Do you clean it?” Jack asked.

“Certainly,” Darlene said. “Plus we run them for a while to be sure they still function normally. Then we empty them and scrub them out. Why?”

“Are they always cleaned in the same location?” Jack asked.

“They are,” Darlene said. “We keep them in a small storeroom that has its own sink. Has there been a problem with the humidifiers?”

“I’m not sure,” Jack said. “But if so, I’ll let you or Mrs. Zarelli know.”

“I’d appreciate it,” Darlene said.

Jack disconnected but kept the phone in the crook of his shoulder while he got out Gloria Hernandez’s phone number. He punched in the digits and waited. A man answered who could speak only Spanish. After Jack struggled with a few broken phrases, the man told Jack to wait.

A younger voice came on the line. Jack assumed it was Juan. He asked the boy if he could speak to his mother.

“She’s very sick,” Juan said. “She’s coughing a lot and having trouble breathing.”

“Did she call the hospital like I urged?” Jack asked.

“No, she didn’t,” Juan said. “She said she didn’t want to bother anybody.”

“I’m going to call an ambulance to come and get her,” Jack said without hesitation. “You tell her to hold on, okay?”

“Okay,” Juan said.

“Meanwhile, could you ask her one question,” Jack said. “Could you ask her if she cleaned any humidifiers last night? You know what humidifiers are, don’t you?”

“Yeah, I know,” Juan said. “Just a minute.”

Jack waited nervously, tapping his fingers on top of Kevin Carpenter’s chart. To add to his guilt, he thought he should have followed up on his suggestion for Gloria to call Zimmerman. Juan came back on the line.

“She says thank you about the ambulance,” Juan said. “She was afraid to call herself because AmeriCare doesn’t pay unless a doctor says okay.”

“What about the humidifiers?” Jack asked.

“Yeah, she said she cleaned two or three. She couldn’t remember exactly.”

After Jack hung up from talking to the Hernandez boy he called 911 and dispatched an ambulance to the Hernandez residence. He told the dispatcher to inform the EMTs that it was an infectious case and that they should at least wear masks. He also told her that the patient should go to the Manhattan General and no place else.

With growing excitement, Jack placed a call to Kathy McBane. As late as it was, he didn’t expect to get her, but he was pleasantly surprised. She was still in her office. When Jack commented on the fact that she was still there after six, she said she’d probably be there for some time.

“What’s going on?” Jack asked.

“Plenty,” Kathy said. “Kim Spensor has been admitted into the intensive care unit with respiratory distress syndrome. George Haselton is also in the hospital and is worsening. I’m afraid your fears were well grounded.”

Jack quickly added that Gloria Hernandez would be coming to the emergency room soon. He also recommended that the contacts of all these patients be immediately started on rimantadine.

“I don’t know if Dr. Zimmerman will go for the rimantadine for contacts,” Kathy said. “But at least I’ve talked her into isolating these patients. We’ve set up a special ward.”

“That might help,” Jack said. “It’s certainly worth a try. What about the microbiology tech?”

“He’s on his way in at the moment,” Kathy said.

“I hope by ambulance rather than public transportation,” Jack said.

“That was my recommendation,” Kathy said. “But Dr. Zimmerman followed up on it. I honestly don’t know what the final decision was.”

“That printout you sent over was helpful,” Jack said, finally getting around to why he’d called. “Remember when you told me about the General’s nebulizers getting contaminated in the intensive-care unit three months ago? I think there might have been a similar problem with the hospital’s humidifiers.”

Jack told Kathy how he’d come to this conclusion, particularly about Gloria Hernandez having admitted to handling humidifiers the previous evening.

“What should I do?” Kathy said with alarm.

“At the moment I don’t want you to do anything,” Jack said.

“But I should at least take the humidifiers out of service until their safety is assured,” Kathy said.

“The problem is I don’t want you to become involved,” Jack said. “I’m afraid doing something like that might be dangerous.”

“What are you talking about?” Kathy demanded angrily. “I am already involved.”

“Don’t get upset,” Jack said soothingly. “I apologize. I’m afraid I’m handling this badly.” Jack had not wanted to draw anyone else into the web of his suspicions for fear of their safety, yet at the moment he didn’t seem to have any choice. Kathy was right: the humidifiers had to be taken out of service.

“Listen, Kathy,” Jack said. Then, as succinctly as possible, he explained his theory about the recent illnesses being intentionally spread. He also told her there was a possibility Beth Holderness had been killed because he’d asked her to search the microbiology lab for the offending agents.

“That’s a rather extraordinary story,” Kathy said haltingly. Then she added: “It’s a little hard to swallow all at once.”

“I’m not asking you necessarily to subscribe to it,” Jack said. “My only interest in telling you now is for your safety. Whatever you do or say to anyone, please keep what I have told you in mind. And for God’s sake, don’t mention my theory to anyone. Even if I’m right, I have no idea who’s behind it.”

“Well,” Kathy said with a sigh. “I don’t know what to say.”

“You don’t have to say anything,” Jack said. “But if you want to help, there is something you could do.”

“Like what?” Kathy asked warily.

“Get some bacterial culture medium and viral transport medium from the microbiology lab,” Jack said. “But don’t tell anyone why you want them. Then get someone from engineering to open the elbow drain below the sink in the storeroom where the humidifiers are kept. Put aliquots from the trap into the two mediums and take them to the city reference lab. Ask them to see if they can isolate any one of the five agents.”

“You think some of the microorganisms would still be there?” Kathy asked.

“It’s a possibility,” Jack said. “It’s a long shot, but I’m trying to find proof whatever way I can. At any rate, what I’m suggesting you do is not going to hurt anyone except possibly yourself if you are not careful.”

“I’ll think about it,” Kathy said.

“I’d do it myself except for the reception I invariably get over there,” Jack said. “I was able to get away with visiting your office, but trying to get bacterial samples out of a trap in central supply is another thing entirely.”

“I’d have to agree with you there,” Kathy said.

After he hung up, Jack wondered about Kathy’s reaction to his revelations. From the moment he’d voiced his suspicions she’d sounded subdued, almost wary. Jack shrugged. At the moment there wasn’t anything else he could say to convince her. All he could do was hope she’d heed his warnings.

Jack had one more call to make, and as he dialed the long-distance number he superstitiously crossed the middle and index fingers of his left hand. He was calling Nicole Marquette at the CDC, and Jack was hoping for two things. First, he wanted to hear that the sample had arrived. Second, he wanted Nicole to say that the titer was high, meaning there were enough viral particles to test without having to wait to grow it out.