Contagion

by Robin Cook

  “I don’t think the time sequences are correct,” Jack said. “Nor are the clinical courses consistent with—”

  “Hold on,” Bingham interrupted. “Let me remind you that Dr. Abelard is an epidemiologist. He’s got a Ph.D. as well as an M.D. His whole job is to figure out the where and the why of disease.”

  “I don’t doubt his credentials,” Jack said. “Just his conclusions. He didn’t impress me from the start.”

  “You certainly are opinionated,” Bingham said.

  “I might have ruffled feathers on past visits to the General,” Jack admitted, “but this time all I did was talk to the supervisor of central supply and one of the microbiology techs.”

  “From the calls I got you were deliberately hampering their efforts to deal with the meningococcal outbreak,” Bingham said.

  “God is my witness,” Jack said, holding up his hand. “All I did was talk to Ms. Zarelli and Ms. Holderness, who happen to be two pleasant, cooperative people.”

  “You do have a way of rubbing people the wrong way,” Bingham said. “I suppose you know that.”

  “Usually, I only have that effect on those I intend to provoke,” Jack said.

  “I get the feeling I’m one of those people,” Bingham snapped.

  “Quite the contrary,” Jack said. “Irritating you is entirely unintentional.”

  “I wouldn’t have known,” Bingham said.

  “In speaking with Ms. Holderness, the lab tech, I did uncover an interesting fact,” Jack said. “I learned that just about anyone with reasonable credit can call up and order pathological bacteria. The company doesn’t do any background check.”

  “You don’t need a license or a permit?” Bingham asked.

  “Apparently not,” Jack said.

  “I suppose I’d never thought about it,” Bingham said.

  “Nor had I,” Jack said. “Needless to say, thought provoking.”

  “Indeed,” Bingham said. He appeared to ponder this for a moment as his rheumy eyes glazed over. But then they quickly cleared.

  “Seems to me you’ve managed to get this conversation off track,” he said, regaining his gruff posture. “The issue here is what to do with you.”

  “You could always send me on vacation to the Caribbean,” Jack suggested. “It’s nice down there this time of year.”

  “Enough of your impertinent humor,” Bingham snapped. “I’m trying to be serious with you.”

  “I’ll try to control myself,” Jack said. “My problem is that during the last five years of my life cynicism has led to reflex sarcasm.”

  “I’m not going to fire you,” Bingham announced. “But I’ve got to warn you again, you’ve come very close. In fact, when I hung up the phone from the mayor’s office, I was going to let you go. I’ve changed my mind for now. But there is one thing that we have to be clear on: You are to stay away from the General. Do we have an understanding?”

  “I think it’s finally getting through,” Jack said.

  “If you need more information, send the PAs,” Bingham said. “For chrissake, that’s what they’re here for.”

  “I’ll try to remember that,” Jack said.

  “All right, get out of here,” Bingham said with a sweep of his hand.

  With relief Jack stood up and left Bingham’s office. He went straight up to his own. When he arrived he found Chet talking with George Fontworth. Jack squeezed by the two of them and draped his coat over the back of his chair.

  “Well?” Chet asked.

  “Well what?” Jack asked back.

  “The daily question,” Chet said. “Are you still employed here?”

  “Very funny,” Jack said. He was perplexed by the stack of four large manila envelopes at the center of his desk. He picked one up. It was about two inches thick. There were no markings on the exterior. Opening the latch, he slid out the contents. It was a copy of Susanne Hard’s hospital chart.

  “You’ve seen Bingham?” Chet asked.

  “I just came from there,” Jack said. “He was sweet. He wanted to commend me on my diagnoses of tularemia and Rocky Mountain spotted fever.”

  “Bull!” Chet exclaimed.

  “Honest,” Jack said with a chuckle. “Of course, he also bawled me out for going over to the General.” While Jack was talking, he took the contents out of all the manila envelopes. He now had copies of the hospital charts of the index cases of each outbreak.

  “Was your visit worth it?” Chet asked.

  “What do you mean, ‘worth it’?” Jack asked.

  “Did you learn enough to justify stirring up the pot once more?” Chet said. “We heard you got everyone over there angry again.”

  “Not a lot of secrets around here,” Jack commented. “But I did learn something that I didn’t know.” Jack explained to Chet and George about the ease of ordering pathological bacteria.

  “I knew that,” George said. “I worked in a micro lab during summers while I was in college. I remember the supervisor ordering a cholera culture. When it came in I picked it up and held it. It gave me a thrill.”

  Jack glanced at George. “A thrill?” he questioned. “You’re weirder than I thought.”

  “Seriously,” George said. “I know other people who had the same reaction. Comprehending how much pain, suffering, and death the little buggers had caused and could cause was both scary and stimulating at the same time, and holding it in my hand just blew me away.”

  “I guess my idea of a thrill and yours are a bit different,” Jack said. He went back to the charts and organized them chronologically so that Nodelman was on top.

  “I hope the mere availability of pathological bacteria doesn’t encourage your paranoid thinking,” Chet said. “I mean, that’s hardly proof of your theory.”

  “Umm hmm,” Jack murmured. He was already beginning to go over the charts. He planned to read through them rapidly to see if anything jumped out at him. Then he would go back over them in detail. What he was looking for was any way the cases could have been related that would suggest they were not random occurrences.

  Chet and George went back to their conversation when it was apparent Jack was preoccupied. Fifteen minutes later George got up and left. As soon as he did Chet went to the door and closed it.

  “Colleen called me a little while ago,” he said.

  “I’m happy for you,” Jack said, still trying to concentrate on the charts.

  “She told me what had happened over there at the agency,” Chet said. “I think it stinks. I can’t imagine one part of the same company undermining another. It doesn’t make sense.”

  Jack looked up from his reading. “It’s the business mentality,” he said. “Lust for power is the major motivator.”

  Chet sat down. “Colleen also told me that you gave Terese a terrific idea for a new campaign.”

  “Don’t remind me,” Jack said. He redirected his attention to the charts. “I really don’t want to be a part of it. I don’t know why she asked me. She knows how I feel about medical advertising.”

  “Colleen also said that you and Terese are hitting it off,” Chet said.

  “Really now?” Jack said.

  “She said that you two had gotten each other to open up. I think that is terrific for both of you.”

  “Did she give any specifics?” Jack asked.

  “I didn’t get the sense she had any specifics,” Chet said.

  “Thank God,” Jack said without looking up.

  When Jack answered Chet’s next few questions with mere grunts, it dawned on Chet that Jack was again engrossed in his reading. Chet gave up trying to have a conversation and turned his attention to his own work.

  By five-thirty Chet was ready to call it a day. He got up and stretched noisily, hoping that Jack would respond. Jack didn’t. In fact, Jack had not moved for the last hour or so except to turn pages and jot down more notes.

  Chet got his coat from the top drawer of his file cabinet and cleared his throat several times. Still Jack did
not respond. Finally Chet resorted to speech.

  “Hey, old sport,” Chet called out. “How long are you going to work on that stuff?”

  “Until I’m done,” Jack said without looking up.

  “I’m meeting Colleen for a quick bite,” Chet said. “We’re meeting at six. Are you interested? Maybe Terese could join us. Apparently they are planning to work most of the night.”

  “I’m sticking here,” Jack said. “Enjoy yourselves. Say hello for me.”

  Chet shrugged, pulled on his coat, and left.

  Jack had been through the charts twice. So far the only genuine similarity among the four cases was the fact that their infectious disease symptoms had started after they had been admitted for other complaints. But as Laurie had pointed out, by definition, only Nodelman was a nosocomial case. In the other three situations the symptoms had come on within forty-eight hours of admission.

  The only other possible similarity was the one that Jack had already considered: namely that all four patients were people who’d been hospitalized frequently and hence were economically undesirable in a capitated system. But other than that, Jack found nothing.

  The ages ranged from twenty-eight to sixty-three. Two had been on the medical ward, one in OB-GYN, and one in orthopedics. There were no medications common to them all. Two were on “keep open” IVs. Socially they ranged from lower- to upper-middle class, and there was no indication that any of the four knew any of the others. There was one female and three males. Even their blood types differed.

  Jack tossed his pen onto his desk and leaned back in his chair to stare at the ceiling. He didn’t know what he expected from the charts, but so far he hadn’t learned anything.

  “Knock, knock,” a voice called.

  Jack turned to see Laurie standing in the doorway.

  “I see you made it back from your foray to the General,” she said.

  “I don’t think I was in any danger until I got back here,” Jack said.

  “I know what you mean,” Laurie said. “Rumor had it that Bingham was fit to be tied.”

  “He wasn’t happy, but we managed to work it out,” Jack said.

  “Are you worried about the threat from the people who beat you up?” Laurie asked.

  “I suppose,” Jack said. “I haven’t thought too much about it. I’m sure I’ll feel differently when I get to my apartment.”

  “You’re welcome to come over to mine,” Laurie said. “I have a sad couch in my living room that pulls out into a decent bed.”

  “You’re kind to offer,” Jack said. “But I have to go home sometime. I’ll be careful.”

  “Did you learn anything to explain the central supply connection?” Laurie asked.

  “I wish,” Jack said. “Not only didn’t I learn anything, but I found out that a number of people, including the city epidemiologist and the hospital infection-control officer, have been in there beating the bushes for clues. I had the mistaken notion it was a novel idea.”

  “Are you still thinking of the conspiracy slant?” Laurie asked.

  “In some form or fashion,” Jack admitted. “Unfortunately, it seems to be a lonely stance.”

  Laurie wished him good luck. He thanked her, and she left. A minute later she was back.

  “I’m planning on getting a bite on the way home,” Laurie said. “Are you interested?”

  “Thanks, but I’ve started on these charts, and I want to keep at it while the material is fresh in my mind.”

  “I understand. Good night.”

  “Good night, Laurie,” Jack said.

  No sooner had Jack opened Nodelman’s chart for the third time than the phone rang. It was Terese.

  “Colleen is about to leave to meet up with Chet,” Terese said. “Can I talk you into coming out for a quick dinner? We could all eat together.”

  Jack was amazed. For five years he’d been avoiding social attachments of any kind. Now suddenly two intelligent, attractive women were both asking him to dine with them on the same night.

  “I appreciate the offer,” Jack said. He then told Terese the same thing he’d told Laurie about the charts he was working on.

  “I keep hoping you’ll give up on that crusade,” Terese said. “It hardly seems worth the risks, since you’ve already been beaten up and threatened with the loss of your job.”

  “If I can prove someone is behind this affair it will certainly be worth the risks,” Jack said. “My fear is that there might be a real epidemic.”

  “Chet seems to think you’re acting foolishly,” Terese persisted.

  “He’s entitled to his opinion,” Jack said.

  “Please be careful when you go home,” Terese intoned.

  “I will,” Jack said. He was getting weary of everyone’s solicitude. The danger of going home that evening was something he’d considered as early as that morning.

  “We’ll be working most of the night,” she added. “If you need to call, call me at work.”

  “Okay,” Jack said. “Good luck.”

  “Good luck to you,” Terese said. “And thanks for this ‘no waiting’ idea. Everyone loves it so far. I’m very grateful. ‘Bye!”

  Jack went back to Nodelman’s chart as soon as he put the phone down. He was attempting to get through the reams of nurses’ notes. But after five minutes of reading the same paragraph over and over, he acknowledged he wasn’t concentrating. His mind kept mulling over the irony of both Laurie and Terese asking him to dine with them. Thinking about the two women led to pondering again the similarities and differences in their personalities, and once he started thinking about personality, Beth Holderness popped into his mind. As soon as he thought about Beth, he began musing about the ease of ordering bacteria.

  Jack closed Nodelman’s chart and drummed his fingers on his desk. He began to wonder. If someone had obtained a culture of a pathological bacteria from National Biologicals and then intentionally spread it to people, could National Biologicals tell it had been their bacteria?

  The idea intrigued him. With the advances in DNA technology he thought it was scientifically possible for National Biologicals to tag their cultures, and for reasons of both liability and economic protection, he thought it was a reasonable thing to do. The question then became whether they did it or not.

  Jack searched for the phone number. Once he found it, he put through a second call to the organization.

  Early that afternoon on Jack’s first call he’d pressed “two” for sales. This time he pressed “three” for “support.” After being forced to listen to a rock music station for a few minutes, Jack heard a youthful-sounding male voice give his name, Igor Krasnyansky, and ask how he could be of assistance.

  Jack introduced himself properly on this occasion and inquired if he could pose a theoretical question.

  “Of course,” Igor said with a slight Slavic accent. “I will try to answer.”

  “If I had a culture of bacteria,” Jack began, “is there any way that I could determine that it had originally come from your company even if it had gone through several passages in vivo?”

  “That’s an easy one,” Igor said. “We phage-type all our cultures. So, sure, you could tell it came from National Biologicals.”

  “What’s the identification process?” Jack asked.

  “We have a fluorescein-labeled DNA probe,” Igor said. “It’s very simple.”

  “If I wanted to make such an identification, would I have to send the sample to you?” Jack asked.

  “Either that or I could send you some of the probe,” Igor said.

  Jack was pleased. He gave his address and asked for the probe to be shipped via overnight express. He said he wanted it as soon as possible.

  Hanging up the phone, Jack felt pleased with himself. He thought he’d come up with something that might lend considerable weight to his theory of intentional spread if any of the patients’ bacteria tested positive.

  Jack looked down at the charts and considered giving up on them for t
he time being. After all, if the opposite turned out to be the case, and none of the bacteria was from National Biologicals, perhaps he would have to rethink the whole affair.

  Jack scraped back his chair and stood up. He’d had enough for one day. Pulling on his jacket, he prepared to head home. Suddenly the idea of some vigorous exercise had a strong appeal.

  26

  MONDAY, 6:00 P.M., MARCH 25, 1996

  Beth Holderness had stayed late to get all the throat cultures of the hospital employees planted. The evening crew had come in at the usual time, but at that moment they were down in the cafeteria having their dinner. Even Richard had disappeared, although Beth wasn’t sure if he’d left for the day or not.

  Since the micro section of the lab was deserted except for her, Beth thought that if she were to do any clandestine searching, this was as good a time as any. Sliding off her stool, she walked over to the door to the main part of the lab. She didn’t see a soul, which encouraged her further.

  Turning back to microbiology, Beth headed over to the insulated doors. She wasn’t sure she should be doing what she was doing, but having said she would, she felt some obligation. She was confused about Dr. Jack Stapleton, but she was even more confused about her own boss, Dr. Martin Cheveau. He’d always been temperamental, but lately that moodiness had reached ridiculous proportions.

  That afternoon he’d stormed in after Dr. Stapleton had left, demanding to know what she had told the medical examiner. Beth had tried to say that she’d told him nothing of consequence and had tried to get him to leave, but Dr. Cheveau wouldn’t listen. He even threatened to fire Beth for willfully disobeying him. His ranting had brought her close to tears.

  After he’d left Beth had thought about Dr. Stapleton’s comment that people at the hospital, including her boss, had been acting defensively. Considering Dr. Cheveau’s behavior, she’d thought Dr. Stapleton might be right. It made her even more willing to follow up on Dr. Stapleton’s request.

  Beth stood in front of the two insulated doors. The one on the left was the walk-in freezer, the other the walk-in incubator. She debated which one to search first. Since she’d been in and out of the incubator all day with the throat cultures, she decided to tackle that first. After all, there was only a small area in the incubator where the contents were unfamiliar to her.