They sat silently watching the phone, as though it were a criminal whose nerves they were testing. Finally, it rang, and Broussard clapped his pudgy hand on the receiver. “Broussard.”
“It’s Teddy. No luck.”
With that hope snuffed, Broussard and Gatlin tried to calm their emotions and focus only on what had to be done next. “What about her friends?” Broussard asked. “Any names we should check out first?”
Teddy recited half a dozen women’s names and, at Gatlin’s prompting, added their places of employment for the two he knew.
Gatlin jotted the information in his little notebook and said, “What was she wearing when you last saw her?”
“White pants with pockets cut straight across the top instead of angled, a blue-and-white horizontally striped pull-over blouse with a boat neck, white sneakers, and a white cap with red capital letters on it—AMAE . . . P . . . MA, I think. It’s Russian, the name of the ship whose chief mate gave her the cap when we were on the docks. And the cap has a little gold anchor on it that I bought her.”
“Doesn’t sound like she was dressed for work,” Gatlin said.
“She was going to walk Lucky, then change. Andy, was Lucky there when you went to her house?”
“Yeah,” Broussard said. “Bubba’s got him. Don’t worry, we’ll find her.”
“But in what condition? How bad is this thing?”
“It can be very bad.”
“Lethal?”
“We know of one case where it was.”
“If she does have it, how long before she . . .”
The evidence suggested that after vomiting, Walter Baldwin had lived at most only forty-eight hours. Turning from his path of complete disclosure, Broussard said, “We’ve got time. I’ll let you know soon as we learn anything.”
He hung up and looked at Gatlin. “How do we handle this?”
“I’ll ask some people from Missing Persons to work on those files and the names Teddy gave us. But the fact her car is there suggests she’s somewhere within walking distance of her house. It could be she got sick and someone took her in.”
Broussard shook his head. “They might have taken her in for a little while, but once she started hemorrhagin’, they’d surely get her to a hospital.”
“We’ll check on that. But I also think we ought to canvass the immediate neighborhood . . . see if anybody knows anything. I’ll round up as many men as I can and send them door-to-door. I’ll need a picture of her.”
“You can probably get the one on her hospital ID from security.”
“Is it any good?”
“It’s actually not bad.”
“They must have screwed up somewhere.”
“What are our chances? We’ve probably got only fortyeight hours.”
Gatlin sucked his teeth. “No way to know. We’ll just have to get after it and see.”
“Anything I can do?”
“Think positive.”
When the door had shut behind Gatlin, Broussard’s thoughts turned to Natalie and he headed for the TB isolation ward.
Upon reaching the first floor, he was joined on the elevator by an old man in baggy clothes and a Dallas Cowboys cap. With the old fellow was a slim young woman in jeans and a red jersey pullover, a four-year-old boy on one hand, a similaraged girl on the other. Broussard guessed that they were here to visit the old man’s wife or the young woman’s husband. Either way, their lives had taken an unfortunate turn.
They were all forced to the back of the elevator by additional passengers—a couple of workmen with OTIS lettered above their pockets, a fellow with a clear plastic tube running from above the zipper on his jacket into his nose, a couple of nurses in purple scrubs, and an old woman oddly attired in a tailored blue suit and a red knit stocking hat. Whatever was in the black plastic garbage bag she carried was obviously heavy.
Broussard could name at least five serial killers whose careers would have been extremely short had the cops who pulled them over for minor traffic violations after their first kill looked in the garbage bag on the backseat. And more than once, a killer’s handiwork had come to the morgue in such a bag. He was, therefore, probably more curious than anyone else on the elevator about that bag. But his interest was fleeting and his thoughts quickly returned to Natalie and Kit.
The TB ward was part of the Pulmonary Unit. When he arrived, the unit was structured chaos—phones ringing, people in every variety of hospital garb spilling in every direction, wheeling patients down the hall, pulling charts from the lazy Susan on the big round table behind the counter separating the nurses’ station from the hall, sorting papers, checking reports on computers.
He stepped up to the counter, next to a balding, white-coated doctor he didn’t recognize, and looked down at the black girl working the phone. She punched a button, switching the phone to intercom. “Team two call the desk . . . team two . . .” Switching to another line, she said, “Ma’am, I have no idea where that doctor is.” And back to intercom: “Betty Jones, one-seven-nine-three . . . Betty Jones.”
A woman in a beige suit came to the counter; she was carrying two green-backed charts. She gave the doctor next to Broussard one of them, cautioning him that, “He’s not there. He’s gone down for a bronchoscopy.”
“Okay, thanks.”
She looked at Broussard. Her name tag said she was the unit coordinator.
“I’m Dr. Broussard, the medical examiner. You have one of my assistants up here—Natalie D’Souza. I was wonderin’ how she’s doin’.”
“I’ll get the head nurse and you can talk to her about it.” She picked up the phone and punched the intercom button. “Virginia Gardner, please come to the desk.”
Two minutes later, a surprisingly young woman, who appeared to enjoy food as much as Broussard, presented herself. “Virginia, this doctor is inquiring about Natalie D’Souza. I don’t seem to have her chart.”
“Dr. Seymour has it.” She looked at Broussard with brown eyes that had a slightly panicky look in them, and he suspected she’d only recently been given the responsibility of head nurse. “And you are Dr. . . .”
“Broussard. Natalie works for me. If Seymour is on the floor, I’d like to talk to him.”
“Certainly. He’s down here.” Watching to see that he was following, she moved off in the direction from which she’d come.
The isolation ward was at the end of the hall. When they reached Natalie’s room, there were two white-coated men conferring quietly in front of it. The one facing him and holding a chart was a slim, long-faced fellow wearing a thick brown Charlie Chaplin mustache and oversized pink-framed glasses: David Seymour.
“Dr. Seymour, this is Dr. Broussard. He’d like to talk to you about patient D’Souza.”
Seymour smiled and extended his hand. “Hello, Andy.”
As they exchanged a handshake, the other man turned, and Broussard saw that it was one of the few people in the city he’d cross the street to avoid.
“Andy, I think you know Mark Blackledge, chairman of Tropical Medicine at Tulane. . . .”
Blackledge nodded but offered no hand.
A broad shock of brown hair hung down almost to his eyebrows and on top his hair was quite disheveled, a look that could have been explained by the stiff breeze now drying the streets, except Broussard had never seen him groomed any better. He was not particularly heavy, but his face always showed a certain slackness, suggesting he’d recently dropped about thirty pounds. He had hard narrow eyes that reminded Broussard of the window slits in an armored car, and there were tight little bags under them. His pointed nose was thin like his lips, but his chin was round and fleshy. Under his unbuttoned lab coat, he was wearing a fuchsia sport shirt open at the neck, and no undershirt, so you could see chest hair. The total effect, especially when he gave that sly little grin now on his face, made you want to see if you still had your wallet.
They’d once been friends, and Broussard wasn’t sure what had happened to change that. However, h
e knew when it had happened. Back before there was such a thing as the impaired-physician program, Blackledge was an alcoholic, and it had gotten to the point where the dean at Tulane wanted to fire him. But Broussard had intervened, convincing the dean to give him a leave of absence instead to get his problem under control, which he did. Since then, he’d become such an effective teacher and scientist he’d been made department head.
The trouble began immediately upon his return from his leave. He started making snide remarks about practically anything Broussard said at the local medical society meetings and did the same thing at social gatherings, where they seemed inevitably to cross paths. Broussard would comment on the high quality of the offerings in the current opera season; Blackledge would say it was third-rate and wonder aloud if Broussard had a tin ear. Broussard would decry the destruction of the Louisiana coastal marshes by the oil industry; Blackledge would sneeringly call him a Greenpeace fanatic who cared more for birds than people. And there were always nasty remarks about Broussard’s weight. Once, when an ME trainee had mixed up some records and caused a minor but widely publicized problem for the police, Blackledge had written a scathing letter to the Times-Picayune, criticizing the ME’s office for shoddy procedures.
It was all quite inexplicable, and eventually Broussard had given up on him. Now they shared a mutual dislike of each other. But with all that, Broussard’s distress at seeing him had more to do with Blackledge’s medical specialty and what it would mean to Natalie than it did with his personality.
“Hello, Andy.” Blackledge looked him up and down, then turned to Seymour. “Wouldn’t you think a physician would know the dangers of carrying all that weight?”
Clearly, Seymour didn’t know what to say.
“Don’t worry yourself, David,” Broussard said. “Mark has decided to make a career out of boorish behavior.”
“Look,” Seymour said. “I don’t know what you two have going, but could we forget it for now and get our attention on what’s important here . . . the patient in that room?”
“Of course. You’re right,” Broussard said.
Blackledge said nothing.
“We haven’t had time to do much lab work, but I know her blood chemistry and her clotting cascade are shot to hell and we’re doing what we can to control that. I never thought I’d hope a patient had typhoid, but I’d rather she had that than most of the other possibilities. It’ll take awhile for the cultures to come back, but she doesn’t have a coated tongue or rose spots, so I think typhoid is out. I believe we can also rule out leptospirosis or an amoebic disease. Unfortunately, that leaves us with—”
“Viral hemorrhagic fevers,” Broussard said grimly. Because most of these diseases are unknown in this country, Broussard was not alone in never having seen such a patient in his training days and probably wouldn’t have seen one even had he chosen any other specialty than forensics. But he’d read enough to know that if Natalie had a viral hemorrhagic fever, she was in terrible trouble.
Seymour said, “That’s why I asked Mark in. Nobody in the country knows more about those things than he does.”
Broussard noticed that in response to Seymour’s compliment, Blackledge subtly struck a pose he thought might look good on a coin. Then he looked at Broussard. “Was anyone with her before she became obviously ill?” he asked.
“I was.”
“How’d she act? Did she say how she felt?”
Broussard related what had taken place in the morgue, including Natalie’s odd behavior before she began to feel sick and her nosebleed began. While Broussard talked, Seymour added that information to her chart. Because it was largely conjecture, Broussard did not mention his speculations about the apparent susceptibility of the cortex and the resistance of the limbic system to the causal agent.
“I don’t know exactly what she’s got,” Blackledge said. “But I’ve seen enough of these fevers to believe it’s almost certainly a tropical virus, most likely a slight variation on one we’ve already cataloged. Unfortunately, none of them has a cure. Depending on the virus, ribavirin sometimes ameliorates the seriousness if it’s given early in the disease, but when it’s advanced, as in that girl’s case in there, all you can do is deal with her physiological imbalances and hope she can fight it off. I understand she was infected from working on a cadaver in the morgue and that you now have two bodies that came in with it?”
“That’s right.”
“The girl’s fate is out of our hands. The people we can really help are the other inhabitants of this city. We’ve got to know what the virus is. If we knew that, we’d have some idea of the way it’s spread. And we’ve got to know soon.” He looked at Broussard. “Brief me on the other two victims.”
He listened carefully, then said, “Is there any information linking them with each other?”
“None.”
“It sounds like Baldwin may be our index case. It’s possible he infected the other one. Or they may both have become infected from a host that isn’t sick.”
“An animal?” Seymour said.
“Possibly.”
“The police have an address book listin’ all the calls Baldwin made before he got sick,” Broussard offered.
“That’s going to be important. I want that book.”
“Isn’t that somethin’ that should go to the state’s epidemiologists?”
“Those salaried little hepatitis chasers?” Blackledge sneered. “They’re not mentally equipped to deal with this.”
“Maybe they wouldn’t agree.”
“They already have. I’m the state’s consultant for tropical fevers.”
“Then I’ll make a call and get you the book.”
“Are you going to bring in the CDC?” Seymour asked.
Blackledge shot him a cold look. “Hell no. What do I need them for? I trained the people they’d send.” Then to Broussard: “You’ve got slides on the two cases?”
“Only on the John Doe. There hasn’t been time to process Baldwin’s tissues, but his organs were so deteriorated, they’re not likely to be of any use.”
“What sort of pathology did you see in the John Doe?”
“The most significant was early stages of disseminated intravascular coagulation.”
Blackledge’s lips curled down at the corners and he shook his head. “I doubt that. In most of these hemorrhagic fevers, DIC isn’t generally a feature.”
“It may not generally be a feature,” Broussard said. “But it was there.”
“I’d like to see the slides.”
Broussard hesitated, wavering between telling Blackledge that he knew DIC when he saw it or letting him take a look for himself. Finally, realizing how sweet it would be to hear him admit that DIC was present, he said, “You can see ’em.”
“Good.” He turned to Seymour. “I’ll need a blood sample from the patient in there, double-tubed, with the outside of both tubes thoroughly wiped with bleach.”
Seymour reached into the pocket of his lab coat. “Already done.”
Blackledge put the tube in his pocket and looked at Broussard. “Okay, let’s stop by your office and get those slides.”
“We’re not gonna get ’em. You’re lookin’ at ’em in my office and leavin’ ’em there.”
“Aren’t we territorial?” Blackledge said. “As you wish.”
Broussard looked at Seymour. “I’d like to see Natalie before we go.”
“She’s barely conscious,” Seymour said. “And she won’t know you’re there. So, for your own safety, why not just look through the glass in the inside door. Otherwise, you’ll need to gear up.”
“I don’t have time to waste,” Blackledge said testily. “I’ve got to get this sample to my lab.”
Broussard persisted. “Just a peek then.”
The TB ward consisted of a series of double rooms with negative pressure, where all the airflow was directed from the hall into a staging room, then into the patient’s room and out through a filtered exhaust.
“Oh Natalie . . .” He sighed. He felt so damned responsible for what had happened. Saddened, he turned and went back into the hall, where he said to Seymour, “Have you notified her family?”
“Her mother’s on the way.”
“The slides . . .” Blackledge sniped.
“I’m ready.”
The first word either of them spoke after leaving the Pulmonary Unit was when Blackledge saw Broussard’s office.
“My God, man, how do you find anything in this mess?” he said, gesturing to the piles of reprints and journals.
“I manage,” Broussard said. “The slides are over there on that tray.”
Blackledge went to the microscope, sat down, and picked up a slide, which he put on the stage of the scope.
Broussard pulled another rolling chair around to where he could watch Blackledge’s face while he examined the slide, but he saw no reaction.
Blackledge put that slide back on the tray and chose another.
Still no reaction.
He briefly studied three more slides, then stood up. “I’ve got to get this blood to the lab.”
His unwillingness to discuss what he’d seen through the scope was an unceremonious sort of victory, but it was enough.
“I can’t wait for that address book. You get it and I’ll call and tell you where to bring it.”
“I’ll get it,” Broussard said, “but don’t count on me takin’ it to you.”
Blackledge looked incredulous. “Are we having a peckorder snit? That’s one of your employees upstairs fighting for her life. As her superior, it was within your power to insist that anyone doing any dissection wear chain-metal gloves. Had you done that, she’d still be healthy. So I’d think you’d be more concerned with helping to get control of this disease than staking out turf.”
Louisiana Fever Page 10
