Pandemic

by Robin Cook

  The scenery was not the only thing that changed as Jack headed westward, away from the urban sprawl. His level of anxiety ratcheted down several notches, making him realize how tense he had been. He thanked his lucky stars for the subway death case having been dumped into his lap and wondered how he would have been coping had it not come his way. With Sheldon Montgomery now joining his wife in camping out in the apartment, Jack felt his living situation had gone from bad to worse, making it almost impossible for him to deal with the angst and guilt associated with Emma’s circumstance. For Jack, who had a surgeon’s mind-set, he felt totally frustrated that there was nothing he could do or fix about her disorder.

  As a method of emotional defense, Jack consciously turned his mind away from his domestic problems and concentrated on the case at hand. First and foremost, he still didn’t have a cause of death. He had a strong hunch plus probable laboratory confirmation it was a virus, but at almost forty-eight hours after the autopsy he didn’t have a specific organism. He’d had cases of unknown viruses in the past, but all had been at least identified by this time. Second, the patient had had a heart transplant with a heart that matched her own DNA at the twenty CODIS loci. For that to happen by chance, it would have been somewhere around one in seventy trillion, meaning it could happen only if the donor was an identical twin. Yet had that been the case, Jack was sure it would have been all over the media. Third was the weird circumstance of a youthful, well-kept, and well-dressed woman who suddenly died and yet was not missed by friends or family and even now seemed devoid of kin. Fourth involved the strange circumstance of the victim having been operated on at one hospital with expenses paid by another. And last, how was it that the executor of the woman’s estate, whatever it comprised, was a philanthropic billionaire Chinese businessman?

  With some contemporary music playing in the background on the Escalade’s radio, Jack mulled over all these unique issues and wondered how many of them he might be able to explain after his visit that day. He knew he wasn’t going to learn anything about the virus. That was dependent on Aretha’s efforts, perhaps with the help of the CDC. As for the others, he thought there was a chance he’d learn something, but he really didn’t have a specific plan about how to go about doing so. Vaguely he thought he would just go to the Dover Valley Hospital and start asking questions. But before he did that, he wanted to stop by the Higgins Funeral Home to be a hundred percent sure they had gotten the message about the potential contagious nature of the remains.

  Before he had set out, Jack had used Google Maps to locate the funeral home, as well as the hospital and GeneRx. It was a good move. Although the funeral home was in Dover itself, the hospital and the pharmaceutical company were situated a distance away in the direction of a federal property called Picatinny Arsenal. The site was north of Interstate 80, which Jack had used for about two-thirds of the drive from Manhattan. As he neared Dover, which was to the south, he exited the freeway and proceeded on side roads. He now could see what Warren meant about the area looking green. With the overcast sky and misty rain still falling, it reminded him of photos of Ireland.

  The closer Jack got to his destination, the more revved up he became. His active intuition was again sending alarms that something about this strange case hinted that chicanery or worse was afoot, yet he had no idea whatsoever what it might involve. At the same time, he made himself a promise that he would make a Herculean effort at being as diplomatic as possible, meaning he would try to keep his reflexive sarcasm and self-righteousness to a minimum. The last thing he wanted was for complaints to get back to Laurie and make her job more difficult. There was also the issue Bart had raised that Jack had no official jurisdiction whatsoever in New Jersey, which could have legal repercussions.

  Dover turned out to be a pleasant, modest rural town, with the tallest brick buildings only three or four stories tall. Google Maps had pegged the population at a bit more than eighteen thousand, and for Jack, coming directly from New York City, it appeared even smaller than that. Higgins Funeral Home was close to the center of town, and it was housed in a white, wood-framed Victorian building similar to a number of the funeral homes Jack had been forced to visit over the years. For Jack, the experience was like living a cliché, including the decorum and appearance of the funeral director, Robert Higgins III. Gaunt and pale and dressed in a dark three-piece suit, he was perfectly cast.

  Jack introduced himself without bothering to flash his NYC official badge and came right to the point. “I believe you have the body of Carol Stewart here in your facility, which was picked up last evening from the New York Chief Medical Examiner’s Office.”

  “That’s not correct,” Robert said. He spoke slowly and precisely, his tone hushed, even though there were no visitors in evidence.

  “What is not correct?” Jack asked. He tensed, wondering if he was in for another major surprise.

  “The body was picked up by my younger brother,” Robert agreed. “But it is not here.”

  “Has it already been cremated?” Jack asked. He couldn’t think of any other reason the body wouldn’t have been there.

  “It has not,” Robert said. “A second autopsy was formally requested by the executor of the estate. Early this morning the body was picked up by one of the Morris County medical examiners, who also has a small private office here in Dover.”

  “Is there no next of kin involved?” Jack asked.

  “None,” Robert said. “We have been dealing only with the executor.”

  “Interesting.” That had become his stock phrase over the last couple days, adopted from Aretha. The request for a second autopsy by Wei Zhao was a surprise for Jack, although not nearly in the same category as the other surprises he’d been experiencing about the case. But this had a personal aspect, as it was a minor professional slap in the face, since there had been no attempt to contact him about the findings of the first autopsy. Jack felt strongly that a second autopsy was a total waste of time and resources.

  “His name is Dr. Harvey Lauder,” Robert offered. “And his office is only a few blocks away. Would you care for the address?”

  “That would be helpful,” Jack said. While Robert wrote down the address on the back of one of his business cards, Jack added: “The reason I stopped in here was to make sure you were told that the case may involve an unknown infectious virus and precautions need to be taken until it is ruled out.”

  “We understood that,” Robert said. “And we communicated it to Dr. Lauder as well. We did not remove the body from the sealed body bag while it was in our possession in our cooler. When the body comes back we will treat it with the utmost care, whether it is to be cremated or embalmed, depending on the dispensation decided upon by the executor.”

  “That would be the prudent course,” Jack said, unconsciously mimicking the funeral director’s stilted language.

  Once outside, Jack used Google Maps on this phone to locate the private office of the forensic pathologist. When he saw how close it was, he walked. It felt good to stretch his legs.

  “I’m sorry, but Dr. Lauder is not here,” an assistant-cum-secretary said. “He’s at the Dover Valley Hospital for a case.”

  Jack left his card with his mobile number and asked if Dr. Lauder might give him a call. He thought there was a chance he might see the pathologist at the hospital, which was Jack’s next destination, but in case he didn’t, Jack wanted to find out exactly what was found at the second autopsy. He was also interested to learn why it was ordered.

  Leaving Dover, Jack drove north, going under Interstate 80. Soon he was in even more rural environs. Now he understood even better Warren’s laconic description of the area as “a bunch of little lakes and green hills.” Especially in the direction of Picatinny Arsenal to the north, Jack was amazed at the extent of the virgin temperate forest, all in a blaze of color despite the cloud cover and lack of direct sunlight. It didn’t seem possible to him that such an envi
ronment existed within a forty-minute drive of the concrete canyons of New York City.

  Coming within sight of the Dover Valley Hospital and its neighboring GeneRx building, Jack could see that the photos he’d viewed online did not do it justice. Both buildings were larger and more impressively modern, with their sheathing of travertine marble and gold-tinted glass, as well as more carefully constructed than the pictures suggested. What had not been apparent also was the degree of physical security around GeneRx. Although it was partially concealed with elaborate plantings, a high razor-wire-topped fence faced the building and disappeared off into the forest on either side. Also partly hidden with evergreen trees was a manned gatehouse guarding the entrance drive.

  The approach to the hospital was altogether different. Instead of the rather forbidding look surrounding GeneRx, it was inviting, with lawns, contoured shrubbery, and carefully attended flowerbeds bursting with mums and other fall flowers. What was not evident at either building was many people. As Jack parked and walked to the hospital entrance, only one other family emerged from the hospital and headed to their car. No ambulances came rushing with their sirens blazing, bound for the emergency room drop-off. The entire complex had a serene, futuristic atmosphere.

  But inside the building it was different. As soon as Jack entered he felt immediately at home, as if he was back in Champaign, Illinois, in his former life, arriving at a more modern version of the hospital where he did his eye surgery. In contrast to the parking lot, there were plenty of people, and they were all in the usual outfits seen in a community hospital, including pink-smocked volunteer ladies manning an information booth. There was even a busy coffee shop and a sundries store.

  Jack approached the information booth, deciding on a strategy on the spur of the moment. He had considered asking for Dr. Lauder, the fellow forensic pathologist, but decided he preferred to talk directly with someone who was part of the hospital organization and not a temporary hired hand. He ended up asking for the medical director of the Zhao Heart Center, with the idea of going for the jugular.

  “That would be Dr. Theodore Markham,” the volunteer said in response to his question. She motioned for Jack to pick up one of the red phones on the information booth’s countertop. A moment later, Jack was talking to the man’s secretary. When Jack asked for the doctor, the secretary asked who she could say was calling. Jack gave his full name and his official position in hopes that curiosity might get him a few minutes with the clinic director. The woman politely asked him to hold the line, promising she would be right back.

  As Jack waited, he marveled at how much more civil people could be in contrast to how they were all too often in the city. But it turned out the secretary had been lying. She didn’t come right back on the line as she’d promised. Instead, it was Dr. Theodore Markham himself.

  “Is this really Dr. Jack Stapleton of the NYC OCME?” the doctor asked, as if he hadn’t believed his secretary. His tone suggested true surprise, even glee.

  “The one and only,” Jack said, trying to tamp down his urge for sarcasm. He did not expect to be greeted with open arms after showing up uninvited at an institution that was possibly doing something not entirely kosher at best and immoral and illegal at worst.

  “But this is an internal line,” the medical director said.

  “It is indeed,” Jack responded. “I’m here at the information booth of your hospital.”

  “Well, isn’t that terrific! I’ll be right down.”

  Jack replaced the receiver with a sense of surprise. He’d been mildly concerned about how he’d be received, yet it seemed the man was truly delighted that Jack had unexpectedly dropped by. And this impression was confirmed when the doctor appeared. Although Jack had never met the man, he knew who he was the moment he got off the elevator. Of course, it helped that he waved as he rapidly approached, almost at a jog. He was of small to moderate stature and clean-shaven, sported a full head of dark, curly hair, and was smartly dressed with a crisp white shirt and fashionable tie. Most noticeable to Jack was that he moved with great energy, as though he’d had ten cups of coffee, such that his long white unbuttoned coat billowed behind him as if he were heading into a wind.

  “Welcome!” the doctor said, enthusiastically pumping Jack’s hand. “To what do we owe this pleasant surprise? Please call me Ted.”

  “I just had a few questions about a case,” Jack said, nonplussed at his reception. In his role as the final arbiter of patient care or the lack thereof, Jack was accustomed to defensive posturing by physicians. Secretly he wondered what the man would say if Jack admitted that a large part of why he was there was the need for an engrossing diversion from emotionally problematic domestic issues.

  “Well, we will do our best to answer them,” Ted said. “Please, come up to my office.” He gestured over his shoulder back toward the elevators.

  “Sure,” Jack said, following his exuberant host.

  “It’s quite a facility, isn’t it?” Ted said as they boarded the elevator. He hit the button for the second floor of the four-story building.

  “It’s surprising,” Jack said. “It’s not what I think of when I think of a community hospital.”

  Ted laughed with genuine amusement. “It is actually unbelievable. This fabulous architectural wonder of a building is not even half of it. The medical equipment we have is astounding. And everything is essentially brand-new. Believe me, this place is going to be on the map big-time.”

  “How so?” Jack asked as the elevator door opened.

  “Heart transplants, for one,” Ted said. “That’s going to be the main draw, although other organs will also be done. And our IVF clinic could rival the heart program. And gene therapy. And personalized cancer treatments. There are so many exciting things going on. I tell you, the sky is the limit. The secret is that we get to work directly with the hundreds of bioscientists across the lawn at GeneRx. That means we have a direct link from laboratory bench to hospital bedside. None of the usual town/gown divide. You’ve heard of the gene-editing marvel of CRISPR/CAS9, haven’t you?”

  “To a degree,” Jack said as they walked down the hallway of a clinic that rivaled the Zhao Heart Center at MGH, which Jack had visited the day before.

  “This little hospital stands to be the first out of the gate with the marvels CRISPR/CAS9 is going to bring to clinical medicine,” Ted explained. He gestured for Jack to precede him into his attractive corner office. “GeneRx specializes in biologicals, meaning protein-based drugs made by living systems. In their case, it’s mostly goats, sheep, pigs, and even chickens, and a few other animals, too.”

  Once inside and gazing out the window, Jack had a better view of the biopharmaceutical building, including the Farm behind it. The farm portion wasn’t visible from the public road or from the hospital parking lot.

  “Please, make yourself at home,” Ted said, gesturing toward a group of Herman Miller chairs at a round table. “Can I get you anything?” he asked graciously. “Coffee, tea, water, or even a Coke if you’d like.”

  “A coffee would be nice,” Jack said. While Ted went to ask his secretary to get the coffee, Jack looked around at Ted’s many framed diplomas from big-name institutions, including the American Boards of Internal Medicine and Cardiology. Jack couldn’t help but be impressed. Ted was an extremely well-trained academic cardiologist. Jack knew the type. They selflessly dedicated their lives to medicine as a true calling.

  “I have a confession to make,” Ted said when he returned and took one of the seats. “I took the liberty of calling our chief cardiac surgeon, Dr. Stephen Friedlander, right after you called me to say you were downstairs. I knew he’d want to come by to say hello and have an opportunity to thank you. We are all indebted to your efforts at identifying poor Carol Stewart.”

  “How exactly did you find out?” Jack asked.

  “We got a call from Dr. Chris Barton right after you left MGH yeste
rday. He told us of your visit to the Zhao Heart Center and explained all the effort you had expended and what you had managed to accomplish, thanks to a tattoo. Of course, we were crushed to learn of her untimely death. She was a courageous woman who had struggled with cardiomyopathy for several years. She was well-known around here, truly admired, and liked. It was a real loss for all of us. But we needed to know because we need to find out why it happened, so it doesn’t happen in the future. You did us a great service. Thank you so much.”

  “It’s part of my job,” Jack said.

  “That may be true, but from Chris Barton’s perspective you went way beyond what he would have expected,” Ted said. “Anyway, thank you. So, what are your questions? I’ll be happy to try to answer them, unless they involve details of surgical technique.”

  Jack had so many questions he didn’t know what to ask first. At the same time, he wanted to try to be as tactful as possible and not squander his unexpectedly hospitable reception, which he was afraid might happen if he ventured too hastily into sensitive areas. Since one of the issues that both intrigued and bedeviled him the most was the apparent DNA match between Carol and the donor heart, he tried to think of the subtlest way to broach it. What popped into his mind on the spot was getting into a discussion about the motorcycle victim, as it would have had to have been an identical twin. Why such an extraordinary fact would have been kept a secret totally mystified Jack, but there had to have been a reason. Yet before he could put a guileful question together, the secretary returned with the coffee.

  “Would you like cream or sugar?” Ted asked. He was solicitously holding both.

  “Both, please,” Jack said. Then as soon as the secretary had departed, and the cream and sugar had been stirred into his cup, which gave him a few extra moments to think, he said, “Dr. Barton told me about the coincidence of the fatal motorcycle accident happening on the same day that Carol Stewart’s heart situation became critical. Was the victim related to Carol? Dr. Barton had told me it was a good match.”