Робин Кук - Pandemic

“My gosh!” Bart said, getting to his feet when he caught sight of Jack approaching. As an old-school employee, he had more respect for the professional staff than some of his younger colleagues did. “I didn’t mean for you to have to come over here, Dr. Stapleton. I was just hoping for a call.”

“No problem,” Jack said. “Please sit.” Jack snagged a stool on wheels, pulled it over, and sat across from Bart. “Whatcha got? Dr. Hernandez said you were concerned about a possible contagious case.”

“That’s right,” Bart said. “My intuition is telling me this is no ordinary case. The call came in not too long ago. Let me tell you what I learned. The patient was on the R train from Brooklyn and the engineer let MTA operations know about a sick passenger. The EMTs who picked her up from the Twenty-third Street station knew she was in extremis, so they had to move quickly and couldn’t get much history. But it seems that the victim, who’s a twenty- to thirtysomething woman, had been fine while on the train, which of course makes sense. She wouldn’t have gotten on the train if she felt really crappy, especially getting all dolled up the way she was. Whatever befell her came on like gangbusters, with apparent breathing difficulty, making her turn a bit blue, although it wasn’t anything she choked on. My guess is an overwhelming case of pneumonia, because when they tried to ventilate her, they couldn’t. The only thing I noticed when I looked at her was some froth in the corners of her mouth, around the endotracheal tube.”

“Could it have been some sort of overdose?” Jack asked.

“I truly don’t think so,” Bart said. “In my considerable experience, this is not the way an overdose presents itself. I think it’s a case of sudden and overwhelming viral or bacterial pneumonia. This woman was on the move and very well dressed. She could have been on her way to lunch at the Ritz, the way she was decked out.”

“You know what this is reminding me of?” Jack asked, sitting up straighter.

“A scary-ass illness,” Bart said. “Something like Ebola.”

“Actually, I was thinking of something more pedestrian but ultimately even scarier,” Jack said, allowing the first hints of excitement to trickle into his voice. He didn’t want to get his hopes up, but suddenly this was all sounding to him like something the “doctor might order” to take his mind off Emma, autism, and his mother-in-law’s invasion. “Back in the disastrous flu pandemic of 1918 that killed upward of one hundred million people, there were stories of asymptomatic people getting on the subway in Brooklyn and being dead from viral pneumonia by the time they got to Manhattan. Whether such stories were apocryphal or not no one knows for sure, but I think they were true because of the virulence of that particular flu strain. What is believed now is that they died from their own immune systems going wild in what is called a cytokine storm.”

“I’ve heard the same stories,” Bart said. “It’s why I jumped on this when the call came in.”

“Did you advise the Bellevue people to do anything with the body for safety concerns?” Jack asked.

“I certainly did,” Bart said. “I advised them to put the corpse in a body bag and treat the outside with hypochlorite and to do the same thing to the ER room. I even called the EMT station and told them to follow suit with the ambulance, but they had already done it.”

“Good call,” Jack said. “I would have advised the same thing. Where do you think the body is now?”

“It should already be in the cooler at 520. I sent one of our vans right away. If it’s not there yet, it will be shortly. Bellevue was eager to have it out of the emergency room, for obvious reasons.”

Jack stood up quickly. The stool he’d been sitting on scooted off to collide noisily with a nearby desk. Jack grimaced and apologized to the surprised occupant. Jack was eager to get cracking. Being in a position as a medical examiner to possibly head off an influenza pandemic had a huge, mind-numbing appeal. Last year’s flu had been bad. This year’s could be catastrophic if this sudden death turned out to be the index case.

“Thanks for cluing me in,” Jack said. “This could be really important.”

“I thought as much,” Bart said. “Let me know what you find out. I’ll be interested to learn.”

“I’ll keep you posted,” Jack promised.

“Oh, there is one problem I didn’t mention.” Bart rose from his own seat. “There’s no identification. My guess is that when she collapsed, whatever she was carrying, be it a purse or a phone or both, was taken.”

“You said she was well dressed,” Jack said. “Getting an ID shouldn’t be much of a hurdle. Someone will undoubtedly miss her sooner rather than later and call Missing Persons when she doesn’t show up where she lives or works.”

“That would be my guess,” Bart agreed.

“ID is going to be important if it is a contagious case, as we suspect,” Jack said. “Social history and contacts might turn out to be crucial.”

“I know. I’ll check back with the ER just to make sure they didn’t misplace a purse or a phone. It wouldn’t be the first time. If I find out anything, I’ll let you know.”

Jack flashed Bart a thumbs-up before making a beeline for the elevators. He hit the down button repeatedly in the vain hope of encouraging an elevator to come more quickly. His heart was racing. Coming across an index case for a possible influenza pandemic was heady stuff. Best of all, it might keep him busy and occupied for a week.

MONDAY, 12:20 P.M.

Jack dialed his mobile phone before he was even out of the 421 elevator, but he waited until the doors opened and he got a decent signal before he put the call through. He wanted to talk to Vinnie ASAP. Vinnie’s irritated voice came on the line after two rings. Over the years, Vinnie had gotten wise to Jack’s demanding nature, as Jack performed far more autopsies than any of the other doctors, by a long shot. When Vinnie saw it was Jack calling, it usually meant yet another trip back to the pit, no matter the time of day. If it was after three P.M., he avoided answering at all.

“A case should have come in recently,” Jack began, unable to keep the excitement from his tone.

“Aren’t we lucky,” Vinnie said. He’d also acquired a strong predilection for serious sarcasm from Jack. “Should I clap or cheer?”

“I’d like you to take your sorry ass into the cooler and let me know if it’s there yet,” Jack said. “It will be in a body bag and labeled JANE DOE or something similar. I’ll hold on.”

Jack arrived at his bike and waited. He smiled at the guard in the tiny booth that overlooked the entire loading area. The guard glanced at him askance, as if he’d never seen a doctor in a white coat using a bike in the city, even though with Bellevue and NYU Hospital in the immediate area there were doctors galore.

Maybe Jack’s impatience stemmed from his exhilaration after meeting with Bart, but it seemed to take Vinnie an age to accomplish such an easy task. Finally, he came back on the line.

“It’s here, zipped up tight. Don’t tell me you are thinking of us doing it today. It’s after twelve, and we’ve already done three cases. Why not spread the wealth?”

“This one has the makings of being an interesting case,” Jack said. “We might even become heroes. Who knows? It is a potentially contagious problem involving a woman who died on the subway.”

“Shit! Double whammy,” Vinnie complained. “You know how I hate contagion cases. Can’t you find another sap to torture? Why me?”

“I wouldn’t want to deny you the pleasure, and we are a team, my friend,” Jack said. It was true, to an extent. They had worked so often together that they often anticipated each other’s actions. “I want to do the case in the decomposed room, for safety’s sake.” The decomposed room was a separate, relatively small autopsy room usually reserved for decomposing corpses, to limit the smell of putrefaction. It had its own self-contained ventilation system with high-efficiency particulate filters and odor absorbers.