by Robin Cook
“I’m calling because you asked me to,” Laurie said. “Otherwise I wouldn’t call this early on a Sunday morning.”
“It’s not early for me,” Jack said.
“But it was late when you went home,” Laurie said.
“It wasn’t that late,” Jack said. “Besides, no matter what time I go to bed I always wake up early.”
“Anyway, you wanted me to let you know if there were any infectious deaths from the General last night,” Laurie said. “There weren’t. Janice even told me before she left that there wasn’t even anyone ill with Rocky Mountain spotted fever in the hospital. That’s good news, isn’t it?”
“Very good news,” Jack agreed.
“My parents were quite impressed with you last night,” Laurie added. “I hope you enjoyed yourself.”
“It was a delightful evening,” Jack said. “Frankly I’m embarrassed I stayed so long. Thank you for inviting me and thank your parents. They couldn’t have been more hospitable.”
“We’ll have to do it again sometime,” Laurie said.
“Absolutely,” Jack said.
After they had said good-byes, Jack hung up the phone and tried to go back to reading. But he was momentarily distracted by thoughts of the previous evening. He had enjoyed himself. In fact he’d enjoyed himself much more than he could have imagined, and that confused him. He’d purposefully kept to himself for five years, and now without warning he found himself enjoying the company of two very different women.
What he liked about Laurie was how easy she was to be with. Terese, on the other hand, could be overbearing even while she was being warmly caring. Terese was more intimidating than Laurie, but she was also challenging in a way that was more consistent with Jack’s reckless lifestyle. But now that he’d had the opportunity to see Laurie interact with her parents, he appreciated her open, warm personality all the more. He imagined having a pompous cardiovascular surgeon for a father couldn’t have been easy.
Laurie had tried to engage Jack in personal conversation after the older generation had retired, but Jack had resisted, as was his habit. Yet he’d been tempted. Having opened up a little with Terese the night before, it had surprised him how good it felt to talk with someone caring. But Jack had fallen back on his usual stratagem of turning the conversation back to Laurie, and he’d learned some unexpected things.
Most surprising was that she was unattached. Jack had just assumed someone as desirable and sensitive as Laurie would have been involved with someone, but Laurie insisted she didn’t even date much. She’d explained that she’d had a relationship with a police detective for a time, but it hadn’t worked out.
Eventually Jack got back to his journal. He read until hunger drove him to a neighborhood deli. On his way home from lunch he saw that a group of guys was already beginning to appear on the basketball court. Eager for more physical activity, Jack dashed home, changed, and joined them.
Jack played for several hours. Unfortunately his shot wasn’t as smooth or accurate as on the previous day. Warren teased him unmercifully, especially when he guarded Jack during several of the games. Warren was making up for the ignominy of the previous day’s defeats.
At three o’clock after another loss, which meant Jack would be sitting out for at least three games, maybe more, he gave up and returned to his apartment. After a shower he sat down to try to read again, but found himself thinking about Terese.
Concerned about being rejected a second time, Jack had not planned on calling her. But by four he relented; after all, she had asked him to call. More important, he truly wanted to talk with her. Having partially opened up to her, he felt curiously disturbed not to have told her the whole story. He felt he owed her more.
Even more anxious than he had been the evening before, Jack dialed the number.
This time Terese was much more receptive. In fact, she was ebullient.
“We made great progress last night,” she announced proudly. “Tomorrow we’re going to knock the socks off the president and the CEO. Thanks to you this idea of hospital cleanliness and low infection rate is a great hook. We’re even having some fun with your sterilization idea.”
Finally Jack got around to asking her if she’d like to get together for some coffee. He reminded her it had been her suggestion.
“I’d love it,” Terese said without hesitation. “When?”
“How about right now?” Jack said.
“Fine by me,” Terese said.
They met at a small French-style café on Madison Avenue between Sixty-first and Sixty-second conveniently close to the Willow and Heath building. Jack got there ahead of Terese and took a table in the window and ordered an espresso.
Terese arrived soon after. She waved through the window, and after entering, she forced Jack into a repeat of the cheek-pressing routine. She was vibrant. She ordered a decaf cappuccino from the attentive waiter.
As soon as they were alone, she leaned across the table and grasped Jack’s hand. “How are you?” she asked. She looked directly into his eyes and then at his jawline. “Your pupils are equal, and you look okay. I thought you’d be black and blue.”
“I’m better than I would have expected,” Jack admitted.
Terese then launched into an excited monologue about her upcoming review and how wonderfully everything was falling into place. She explained what a “ripomatic” was and how they had managed to put one together with tape sequences from their previous National Health campaign. She said it was terrific and gave a good impression of the Do-No-Harm Hippocrates idea.
Jack let her carry on until she’d exhausted the subject. After taking a few gulps of her cappuccino, she asked him what he’d been doing.
“I’ve been thinking a lot about the conversation we had Friday night,” he said. “It’s been bothering me.”
“How so?” Terese asked.
“We were being open with each other, but I wasn’t completely forthright,” Jack said. “I’m not accustomed to talking about my problems. The truth is: I didn’t tell you the whole story.”
Terese put her coffee cup down and studied Jack’s face. His dark blue eyes were intense. His face was stubbled; he’d obviously not shaved that day. She thought that under different circumstances Jack could appear intimidating, maybe even scary.
“My wife wasn’t the only person who died,” Jack said haltingly. “I lost my two daughters as well. It was a commuter plane crash.”
Terese swallowed with difficulty. She’d felt a welling of emotion clog her throat. Jack’s story was hardly what she’d expected.
“The problem is, I’ve always felt so damn responsible,” he continued. “If it hadn’t been for me they wouldn’t have been on that plane.”
Terese felt an intense stab of empathy. After a few moments she said: “I wasn’t entirely forthright either. I told you I’d lost my child. What I didn’t say is that it was an unborn child, and at the same time I lost the child, I lost my ability to have any more. To add insult to injury, the man I’d married deserted me.”
For a few emotionally choked minutes neither Jack nor Terese spoke. Finally, Jack broke the silence: “It sounds like we’re trying to outdo each other with our personal tragedies,” he said, managing a smile.
“Just like a couple of depressives,” Terese agreed. “My therapist would love this.”
“Of course, what I’ve told you is for your ears only,” Jack said.
“Don’t be silly,” Terese assured him. “Same goes for you. I haven’t told my story to anyone but my therapist.”
“I haven’t told anybody,” Jack said. “Not even a therapist.”
Feeling a sense of relief from having both bared their innermost secrets, Jack and Terese went on to talk about happier things. Terese, who’d grown up in the city, was shocked to hear how little of the area Jack had visited since he’d been there. She talked about taking him to the Cloisters when spring had truly arrived.
“You’ll love it,” she promised.
> “I’ll look forward to it,” Jack said.
23
MONDAY, 7:30 A.M., MARCH 25, 1996
Jack was irritated at himself. He’d had time to buy a new bike on Saturday, but he’d failed to do so. Consequently, he had to use the subway again to commute to work, although he’d considered jogging. The problem with jogging was that he’d have to have a change of clothes in his office. To give him the option in the future he brought some to work in a small shoulder bag.
Coming in from First Avenue, Jack again entered the medical examiner’s facility through the front entrance. As he passed through the glass door, he was impressed with the number of families waiting in the outer reception area. It was highly unusual for so many people to be there that early. Something must be up, he surmised.
Jack had himself buzzed in. He walked into the scheduling room and saw George Fontworth sitting at the desk Laurie had occupied each morning the previous week.
Jack was sorry Laurie’s week as supervisor was over. George had rotated to the position. He was a short, moderately overweight doctor of whom Jack had a low opinion. He was perfunctory and often missed important findings.
Ignoring George, Jack headed over to Vinnie and pushed down the edge of his newspaper.
“Why are there so many people out in the ID area?” Jack asked.
“Because there’s a minor disaster over at the General,” George said, answering for Vinnie. Vinnie treated Jack to a jaunty but disdainful expression and went back to his paper.
“What kind of disaster?” Jack asked.
George patted the top of a stack of folders. “A whole bunch of meningococcal deaths,” he said. “Could be an epidemic in the making. We’ve got eight so far.”
Jack rushed over to George’s desk and snapped up a folder at random. He opened it and shuffled through its contents until he came to the investigative report. Scanning it quickly, he learned that the patient’s name was Robert Caruso, and that he had been a nurse on the orthopedic floor at the General.
Jack tossed the folder back onto the desk and literally ran through communications to the offices of the PAs. He was relieved to see Janice was still there, putting in overtime as usual.
She looked terrible. The dark circles under her eyes were so distinct, she resembled a battered woman. She put her pen down and leaned back. She shook her head. “I might have to get another job,” she said. “I can’t keep this up. Thank God I have tomorrow and the next day off.”
“What happened?” Jack asked.
“It started on the shift before mine,” Janice said. “The first case was called in around six-thirty. Apparently the patient had died about six p.m.”
“An orthopedic patient?” Jack asked.
“How’d you know?”
“I just saw a folder from an orthopedic nurse,” Jack said.
“Oh, yeah, that was Mr. Caruso,” Janice said with a yawn. She excused herself before continuing. “Anyway, I started getting called shortly after I arrived at eleven. Since then it’s been nonstop. I’ve been back and forth all night. In fact, I just got back here twenty minutes ago. I tell you, this is worse than the the other outbreaks. One of the patients is a nine-year-old girl. What a tragedy.”
“Was she related to the first case?” Jack asked.
“She was a niece,” Janice said.
“Had she been in to visit her uncle?” Jack asked.
“Around noon yesterday,” Janice said. “You don’t think that could have contributed to her death, do you? I mean, that was only about twelve hours before her death.”
“Under certain circumstances meningococcus has a frightful capacity to kill, and kill incredibly swiftly,” Jack said. “In fact, it can kill in just a few hours.”
“Well, the hospital is in a panic.”
“I can imagine,” Jack said. “What was the name of the first case?”
“Carlo Pacini,” Janice said. “But that’s about all I know. He came in on the shift before mine. Steve Mariott handled it.”
“Could I ask a favor?” Jack asked.
“That depends,” Janice said. “I’m awfully tired.”
“Just leave word for Bart that I want you PAs to get all the charts of the index case in each of these outbreaks. Let’s see, that’s Nodelman with the plague, Hard with tularemia, Lagenthorpe with Rocky Mountain spotted fever, and Pacini with meningococcus. Do you think that will be a problem?”
“Not at all,” Janice said. “They are all active ME cases.”
Jack stood up and gave Janice a pat on the back. “Maybe you should go over to the clinic on your way home,” he said. “Some chemoprophylaxis might not be a bad idea.”
Janice’s eyes widened. “You think that is necessary?”
“Better safe than sorry,” Jack said. “Anyway, discuss it with one of the infectious disease gurus. They know better than I. There’s even a tetravalent vaccine, but that takes a few days to kick in.”
Jack dashed back to the ID room and asked George for Carlo Pacini’s folder.
“It’s not here,” George said. “Laurie came in early, and when she heard about what was going on, she requested the case. She’s got the folder.”
“Where is she?” Jack asked.
“Up in her office,” Vinnie responded from behind his paper.
Jack hustled up to Laurie’s office. Contrary to the way Jack worked, she liked to go over each folder in her office before doing the autopsy.
“Pretty frightening, I’d say,” Laurie said as soon as she saw Jack.
“It’s terrifying,” Jack said. He grabbed Laurie’s officemate’s chair, pulled it over to Laurie’s desk, and sat down. “This is just what I’ve been worrying about. This could be a real epidemic. What have you learned about this index case?”
“Not much,” Laurie admitted. “He’d been admitted Saturday evening with a fractured hip. Apparently he’d had a brittle bone problem; he’d had a whole string of fractures over the last few years.”
“Fits the pattern,” Jack said.
“What pattern?” Laurie asked.
“All the index cases from these recent outbreaks have had some sort of chronic illness,” Jack said.
“A lot of people who are hospitalized have chronic illnesses,” Laurie said. “In fact, most of them. What does that have to do with anything?”
“I’ll tell you what’s on his paranoid, sick mind,” Chet said. Chet had appeared at Laurie’s door. He stepped into the room and leaned against the second desk. “He’s got this thing about AmeriCare and wants to see conspiracy behind all this trouble.”
“Is that true?” Laurie asked.
“I think it’s less that I want to see conspiracy than it’s staring me in the face,” Jack said.
“What do you mean by ‘conspiracy’?” Laurie asked.
“He has this notion that these unusual illnesses are being spread deliberately,” Chet said. Chet summarized Jack’s theory that the culprit was either someone at AmeriCare trying to protect its bottom line or some crazy person with terrorist inclinations.
Laurie looked questioningly at Jack. Jack shrugged.
“There are a lot of unanswered questions,” Jack offered.
“As there are in just about any outbreak,” Laurie said. “But really! This is all a bit far-fetched. I hope you didn’t mention this theory to the powers that be over at the General.”
“Yeah, I did,” Jack said. “In fact I sort of asked the director of the lab if he was involved. He’s rather disgruntled with his budget. He immediately informed the infection-control officer. I imagine they’ve let the administration know.”
Laurie let out a short, cynical laugh. “Oh, brother,” she said. “No wonder you’ve become persona non grata around there.”
“You have to admit there’s been an awful lot of questionable nosocomial infection at the General,” Jack said.
“I’m not even so sure about that,” Laurie said. “Both the tularemic patient and the patient with Rocky Mountain spotte
d fever developed their illnesses within forty-eight hours of admission. By definition, they are not nosocomial infections.”
“Technically that’s true,” Jack admitted. “But…”
“Besides, all these illnesses have been seen in New York,” Laurie said. “I’ve done some recent reading myself. There was a serious outbreak of Rocky Mountain spotted fever in eighty-seven.”
“Thank you, Laurie,” Chet said. “I tried to tell Jack the same thing. Even Calvin has told him.”
“What about the series of cases coming from central supply?” Jack asked Laurie. “And what about the rapidity with which the patients with Rocky Mountain spotted fever developed their illnesses? You were questioning that just this Saturday.”
“Of course I’d question those things,” Laurie said. “They’re the type of questions that have to be asked in any epidemiological situation.”
Jack sighed. “I’m sorry,” he said. “But I’m convinced something highly unusual is going on. All along I’ve been worried that we might see a real epidemic crop up. This outbreak of meningococcus may be it. If it peters out like the other outbreaks. I’ll be relieved, of course, in human terms. But it will only add to my suspicions. This pattern of multiple fulminant cases, then nothing, is highly unusual in itself.”
“But this is the season for meningococcus,” Laurie said. “It’s not so unusual.”
“Laurie’s right,” Chet said. “But regardless, my concern is that you’re going to get yourself into real trouble. You’re like a dog with a bone. Calm down! I don’t want to see you fired. At least reassure me you’re not going back to the General.”
“I can’t say that,” Jack said. “Not with this new outbreak. This one doesn’t depend on some arthropods that aren’t around. This is an airborne problem, and as far as I’m concerned, it changes the rules.”
“Just a moment,” Laurie said. “What about that warning you got from those thugs?”
“Now what?” Chet questioned. “What thugs?”
“Jack had a cozy visit from some charming members of a gang,” Laurie said. “It seems that at least one of the New York gangs is going into the extortion business.”
