Pandemic

by Robin Cook

  “Because not everyone has access to it, including me,” Aretha said. “To use it, I had to put in a formal application, which I did yesterday. Today I learned I got permission.”

  “I still don’t understand,” Jack said.

  “I can use the MPS machine to determine the unknown virus,” Aretha explained. “In the past characterizing a new, unknown virus has been a laborious process. The MPS machine will do billions of short-segment DNA reads, which I can then run through BLAST.”

  “It’s like you’re speaking to me in a foreign language,” Jack complained. “What the hell is BLAST?”

  “Oh, sorry.” Aretha laughed good-naturedly. “I forgot you went to school in the previous century. BLAST stands for Basic Local Alignment Search Tool. It’s a bioinformatics software method for analyzing the billions of short segments of DNA produced by the MPS. It can search through an enormous database of known viral genomes for matches. That means that within days I could be able to identify our unknown virus. Without the MPS and BLAST, it could take literally weeks, even months.”

  “Okay!” Jack said. “Wow! Now I get it. Sounds great. Obviously, the sooner we have a virus nailed down, the better.”

  “That I am aware,” Aretha said. “As a backup I sent off a couple samples to Connie Moran, who heads up the viral pathogen discovery team at the CDC.”

  “Uh-oh,” Jack said. He made a face, as if he were suddenly pained. He explained: “My boss, the chief medical examiner, specifically ordered me not to involve the CDC at this stage of this case.” He didn’t mention his boss was also his wife.

  “Why not?” Aretha asked. She was surprised. “This is right up the CDC’s alley. They have a whole Department of Viral Diseases as well as a Respiratory Virus branch. This is what they do, and they are better at it than I.”

  “My boss is afraid of causing a disruptive and costly panic here in NYC until we have a firm diagnosis. And there is reason for her position. There’s been so much worry and preparation and even agency-wide exercises for a new, deadly flu pandemic here in the city that she is afraid the response that was generated could not be controlled if it was a false alarm. So far, she has been correct. There hasn’t been another case. Anyway, she has chosen not to let the Department of Health know about this case. Consequently, she doesn’t want the CDC prematurely contacting the media or, worse yet, sending an army of CDC epidemiological investigators up here.”

  “Okay,” Aretha said. “I understand. Well, I didn’t provide any details. All I said was it was an unknown virus. Nothing else. I didn’t even say the patient died.”

  “Good,” Jack said. “That sounds innocuous enough. Hey, I think we are going to be on the same team tonight.”

  “Great,” Aretha said, and she high-fived Jack.

  Jack said he’d give her a yell when they were ready for her and headed back to the basketball court. His timing was near perfect. As Jack reached the court the final basket was made by Warren’s team to win the game. Turning around, he yelled for Aretha to come over to the court on the double. She waved back to indicate she had heard.

  As the disappointed losers slunk off the court, Jack, Flash, Ron, and David walked on. They were eager to take a few practice shots. But before he took any shots, Jack approached Warren and took him aside.

  “I need to ask a favor, my friend,” Jack said, talking quietly. “I’d like to borrow your wheels tomorrow. I need to drive out to Dover, New Jersey.”

  “Why Dover?” Warren questioned. Perspiration glistened on the well-defined muscles of his Greek-statue-like body, which always made Jack feel decidedly inadequate. “There’s nothing out there but a bunch of little lakes and green mountains. Well, not really mountains. More like green hills.”

  “It’s a complicated story. I want to visit a hospital, a pharmaceutical company, and a farm, which are all connected to a young woman I autopsied. She died yesterday morning on the subway with a flu-like illness.”

  “You’re too much, Doc,” Warren said. “You always have some weird shit happening. Sure! You can use my Escalade. It’s on the south side of 106th Street, down near Columbus Ave. You’ll need to gas it up. The thing is a thirsty mother.”

  17

  WEDNESDAY, 6:05 A.M.

  It seemed strange to Jack to be driving to work. Actually, it seemed strange to be driving at all. Ever since coming to NYC to accept an associate medical examiner position at the OCME fifteen or so years ago, he could count on his hands the number of times he’d driven a motor vehicle. Back in Champaign, Illinois, when he’d been a practicing ophthalmologist, using a car was second nature, as he drove every day to and from his office and to and from the hospital. His Range Rover had been like an appendage. But when he arrived in New York he’d seen a car as a handicap and had adopted the bicycle. He wished more people would follow his lead. As far as he was concerned, the Dutch and the Danish urban dwellers had the right idea.

  Despite a fine misty rain falling, Jack missed his morning ride and felt a bit claustrophobic confined inside a metal box, even a large metal box like the black Escalade he was driving. The car was a relatively new model, but the actual year Jack had no idea. Nor did he care. It was going to carry him out to Dover, New Jersey, that morning, and that was all that mattered.

  Progress was slow, especially driving across town after using one of the traverses through Central Park. As he waited at most every traffic light in Midtown, Jack felt sorry for all the drivers, himself included. They all looked and acted angry, each trying to nose the others out of the way to gain an advantage measured in feet. It was an aggravating, dog-eat-dog world blanketed in exhaust fumes.

  Like he did the day before, Jack felt a little guilty about rising early and sneaking out of the house, but not guilty enough not to have done it. After exhausting himself last night on the basketball court, he’d returned to the apartment, showered, and then tried to be social with Laurie’s parents. But it hadn’t worked. To keep the conversation neutral, Jack had tried to talk about his day and the trials and tribulations of making an identification on the subway death. Thinking Sheldon and Dorothy and Laurie, too, might find it interesting, Jack recounted his visit to the tattoo parlor. As an added piece of information, he described learning that the puzzle tattoo had been adopted by the autism awareness movement.

  The mere reference to Emma’s diagnosis forced the issue back into the open, and Sheldon’s presence did little to ameliorate the controversies and emotional toll. Not only did the MMR issue resurface, to Jack’s intense chagrin, but so did Laurie’s failure to take maternity leave soon enough to prevent the developing embryo from having to deal with formaldehyde and other preservatives and chemicals. Sheldon even brought up his lifelong disappointment in Laurie’s choice of forensic pathology over thoracic surgery, which stimulated a comment from Dorothy that Laurie’s choice had been an embarrassment for her with her fellow fund-raising friends. From Jack’s perspective, the evening had turned into a disaster, and getting away that morning before facing anyone was an act of self-preservation.

  Arriving in the area of the OCME, Jack drove directly to the 421 high-rise. There was little to no parking around 520 where his office was located, but plenty near 421. Next to 421 was a large open lot, which was to be the future home of the new morgue building. It was also the place that huge balloon tents would be raised if and when a 1918 influenza-like pandemic broke out. These tents were part of the elaborate emergency plans that had been drawn up to deal with such a disaster and would house additional autopsy space. Also, currently parked in this area were a fleet of large refrigerator trailers for body storage that would be delivered to all the metropolitan hospitals in a severe flu pandemic. They, too, were part of the extensive preparation and training the city had been doing in anticipation of a deadly pandemic. Jack was one of the people who knew that as many as five hundred deaths a day could be expected in such a circumstance, which was why the
subway death scared him as much as it did.

  Pulling into the lot through a gate in a temporary chain-link fence, he parked the Escalade. To avoid any problems, he left a note on the dash with his name and mobile number. He didn’t expect any problems. He knew a lot of people in both 421 and 520 who took advantage of parking there.

  Initially, Jack had every intention of hiking directly to 520, but since he was already in the shadow of 421, he thought he’d stop in and ask Janice Jaeger if she knew anything at all about Dover Valley Hospital. Janice had been the night-shift MLI for many, many years, and Jack had always been impressed with the range of her experience with local hospitals, even a few in New Jersey. It seemed that she had talked with all of them or visited them in the course of her investigative work. He found her at her desk, reading The New York Times. Once again, it had been a quiet night for her.

  “What on earth are you doing here this early two days in a row?” Janice asked playfully when she looked up and saw Jack approach.

  “You wouldn’t want to know, trust me,” Jack said. He then went on to ask her about the Dover Valley Hospital in New Jersey.

  “That’s a hospital I’ve never had any dealings with,” Janice said. “Sorry. But I do know a little about the Morristown Medical Center, which is only about ten miles away. That whole area is familiar, if you want some general information. My parents had a home on Lake Hopatcong before they went to Florida. Hopatcong is just a bit beyond Dover.”

  “It’s Dover Valley that I’m interested in,” Jack said. “Thanks anyway.”

  “I hear you finally got an ID on that subway case,” Janice said. “It is certainly strange it took so long.”

  “We didn’t get an ID,” Jack corrected. “So far all we’ve got is a name. That’s the reason I’m interested in Dover Valley Hospital. I’m hoping to get a full informational ID from them.”

  “That’s not what I heard,” Janice said. “I heard people came in last night, IDed the body, and took it with them.”

  “What?” Jack practically yelled. “I hadn’t heard that. Why wasn’t I called? I thought there was a standing order for me to be called if that happened.”

  “When I came on duty I’d heard that order had been rescinded by Bart Arnold. Did you tell him you had a name?”

  “I did,” Jack said. “But only a name, as I said.”

  “Well, speak of the devil,” Janice said. “Here comes Bart now.”

  Jack turned in time to see Bart come through the glass door leading out to the elevator lobby. With his extra weight mostly around his middle section, he moved with a particular rolling gait. As he approached his desk, he pulled off his hat from his mostly bald head and peeled his jacket off his shoulders. “You are in way too early, Dr. Stapleton,” he called out. He dumped an armload of manila envelopes on his desk, then joined the others. “How was the night, Janice?”

  “All quiet on the western front,” Janice joked.

  “Janice just told me that people came in, identified Carol Stewart, and then left with the body,” Jack said challengingly. “Why wasn’t I called?”

  “You already had the name,” Bart said defensively. “Consequently, I didn’t think you’d want to be disturbed at home, so I told the MLIs not to have you called.”

  “But the name of the deceased was all I had,” Jack complained.

  “Well, now you have it all,” Bart said. “I’m sure it’s all in the computer. Pull it up, Janice! Let’s show the gentleman.”

  A moment later, Janice had all the information on her monitor screen. Jack and Bart looked over her shoulder and read the details. The identification was made by Agnes Mitchel, whose own form of identification was a New Jersey driver’s license. Her Denville, New Jersey, address was duly listed and her association with the deceased was described as neighbor and family friend, not next of kin, suggesting Carol Stewart was originally from that part of New Jersey. Also listed was Carol Stewart’s current address in Sunset Park, Brooklyn, along with her Social Security number.

  “Looks like just about everything you need,” Bart said, straightening up. “And it’s curious that this sudden identification and information gathering all happened just after you managed to get the name from Manhattan General Hospital. My guess would be that somebody from MGH called someone out in New Jersey about Carol’s death, probably somebody at the Dover Valley Hospital.”

  “I’m sure you are right,” Jack said. “God! This case never stops surprising me. And I’m shocked that the body was released with no next of kin involved.”

  “I can explain that,” Bart said. “It was a bit out of the ordinary. I know because the forensic pathology resident who was covering last night called me about releasing the body, since the mortuary techs had asked him. There was no next of kin, but there was a representative from the Higgins Funeral Home in Dover who had accompanied Agnes Mitchel. This individual was in possession of two necessary important documents. First, he had an undertaker’s license here in New York, as required, as well as one in New Jersey. And second, he had a legal release already signed by Carol Stewart’s executor. Since the autopsy was done and there was no formal hold on the body, I said it could be released. Should I have not done that?”

  “If they had a signed legal release from the executor of the estate, there wasn’t much that could be done,” Jack said. “They own the body once the autopsy has been completed. My concern is the potential infectious nature of the remains. Was the funeral director notified of that possibility when the body was handed over?”

  “That I don’t know,” Bart said. “You’ll have to ask the evening mortuary techs. But they are all sharp guys, so I imagine they brought up the possible contagion issue. Was the body in a sealed body bag?”

  “Yes,” Jack said.

  “Well, there you go,” Bart said. “That speaks for itself.”

  “For a thirtyish woman to have a standing executor of her estate is rather unique,” Jack said. “But I suppose when you are facing a heart transplant, you are forced to think of such things.”

  “I imagine so,” Bart said.

  “When such a release is used, is it usually recorded?” Jack asked. As a busy medical examiner, the legal details didn’t concern him. He let the legal people worry about such things.

  “Of course.” Bart bent over Janice’s keyboard, tapped a few keys, and a moment later a legal release form appeared on the screen.

  Not entirely sure why he wanted to read the document other than pure curiosity, Jack leaned forward and struggled with the tiny print. It was the usual lawyerly gobbledygook that bored him to tears, until the very end. It was then that he did a double take when he read the name of the executor at the very bottom of the page, because it was yet another major surprise. The executor of Carol’s estate was none other than Wei Zhao. “I don’t believe it,” he blurted out. “What a damn coincidence. This guy seems to be all over the place.”

  “What guy?” Bart asked. He began to skim the release, clearly worrying that the night before there might have been some legal aberration.

  “The executor,” Jack said. He pointed at the name. “That’s bizarre. Wei Zhao is a wealthy Chinese businessman who must be a local celebrity out there in northern New Jersey. He’s the owner of a pharmaceutical company that’s the area’s largest employer. And he’s quite a philanthropist. His company owns the Dover Valley Hospital, and MGH’s heart center here in New York is named after him.”

  “Sounds very noble-minded,” Bart said.

  “We’ll see,” Jack said. “Why would this guy be this woman’s executor? That doesn’t make much sense to me. I tell you, this is by far the weirdest case I’ve ever been involved with as a medical examiner. I truly don’t know what I’m going to find when I go out there.”

  “Are you still going to do a site visit? Even after we have all the identification information.”

  “I w
ouldn’t miss it,” Jack said. “There are too many oddities and unanswered questions.”

  “It doesn’t bother you that you have no jurisdiction in New Jersey?”

  “Details,” Jack said flippantly. “Someone has to read the fine print on my ME badge to know it’s from New York. I’m not going to lie.”

  “What about the address in Sunset Park, Brooklyn? Do you want me to send someone out there to check it out?”

  “Hold off on that,” Jack said. “Let’s wait until we get a diagnosis of what killed her. Visiting the woman’s apartment might require barrier precautions if some lethal virus is involved. Obviously, she lives alone. Otherwise, someone would have declared her missing.”

  “That’s a good point,” Bart said. “I’ll wait for you to give us a green light.”

  Ten minutes later Jack was on his way, walking up to 520. If it had been a quiet night for Janice, chances were it had been a quiet night for the OCME in general. That was the usual pattern, even though it hadn’t been the case the night before. Nonetheless, Jack was reasonably confident he’d be able to get a paper day to exempt him from any autopsies.

  18

  WEDNESDAY, 7:40 A.M.

  Emerging from the depths of the Lincoln Tunnel that runs under the Hudson River between Manhattan and New Jersey, Jack had to smile while thinking of New Jersey’s nickname: the Garden State. The traffic was nightmarish, with trucks and buses, and there was hardly a tree, a shrub, or even a blade of grass in sight. It was all concrete or macadam and as densely built up as New York, just not as high.

  Jack had been to the state perhaps a dozen times and thought of it as quintessentially suburban, with lots of single-family houses separated by green lawns. But those forays had always been over the George Washington Bridge. Where he was now, racing west on a sunken highway, it seemed decidedly dystopian. Yet the farther he drove, the more pleasant it became. He even began to progressively see trees clothed in autumnal splendor, as well as a few homes with white picket fences. After twenty minutes of rather frantic driving, it was apparent he was heading for the countryside.