Contagion

by Robin Cook

  Jack opened the printout. It was a copy of everything that had been sent from central supply to a patient by the name of Broderick Humphrey. The man’s diagnosis wasn’t mentioned, but his age was: forty-eight.

  The list was just as long as the lists he had for the infectious disease index cases. Like the other lists, it appeared to be random. It was not in alphabetical order, nor were similar products or equipment lumped together. Jack guessed the list was generated in the sequence the items were ordered. That idea was bolstered by the fact that all five lists started out identically, presumably because as each patient was admitted, he required standard, routine equipment.

  The random nature of the lists made them hard to compare. Jack’s interest was finding any ways that the control list differed from the others. After spending fifteen wasted minutes going back and forth among the lists, Jack decided to use the computer.

  The first thing he did was create separate files for each patient. Into each file he copied each list. Since he was hardly the world’s best typist, this activity took him a considerable amount of time.

  Several hours drifted by. In the middle of the transcription process Laurie again knocked on his door to say good night and to see if she could do anything for him. Jack was preoccupied, but he assured her that he was fine.

  When all the data were entered, Jack asked the computer to list the ways the infectious cases differed from the control case. What he got was disheartening: another long list! Looking at it, he realized the problem. In contrast to the control case, all five infectious cases had had sojourns in the intensive-care unit. In addition, all five infectious cases had died and the control hadn’t.

  For a few minutes Jack thought that his painstaking efforts had been for naught, but then he got another idea. Since he’d typed the lists into the computer in the same order they’d been originally, he asked the computer to make the comparison prior to the first product used in the ICU.

  As soon as Jack pushed his execute button the computer flashed its answer. The word “humidifier” appeared on the screen. Jack stared. Apparently the infectious cases had all used humidifiers from central supply; the control hadn’t. But was it a significant difference? From Jack’s childhood, he remembered his mother had put a humidifier in his room when he’d had the croup. He remembered the device as a small, boiling cauldron that sputtered and steamed at his bedside. So Jack could not imagine a humidifier having anything to do with spreading bacteria. At 212° Fahrenheit, it would boil bacteria.

  But then Jack remembered the newer type of humidifier: the ultrasonic, cold humidifier. That, he realized, could be a totally different story.

  Jack snatched up his phone and called the General. He asked to be put through to central supply. Mrs. Zarelli was off, so he asked to speak to the evening supervisor. Her name was Darlene Springborn. Jack explained who he was and then asked if central supply at the General handled the humidifiers.

  “Certainly do,” Darlene said. “Especially during the winter months.”

  “What kind does the hospital use?” Jack asked. “The steam type or the cold type?”

  “The cold type almost exclusively,” Darlene said.

  “When a humidifier comes back from a patient room what happens to it?” Jack asked.

  “We take care of it,” Darlene said.

  “Do you clean it?” Jack asked.

  “Certainly,” Darlene said. “Plus we run them for a while to be sure they still function normally. Then we empty them and scrub them out. Why?”

  “Are they always cleaned in the same location?” Jack asked.

  “They are,” Darlene said. “We keep them in a small storeroom that has its own sink. Has there been a problem with the humidifiers?”

  “I’m not sure,” Jack said. “But if so, I’ll let you or Mrs. Zarelli know.”

  “I’d appreciate it,” Darlene said.

  Jack disconnected but kept the phone in the crook of his shoulder while he got out Gloria Hernandez’s phone number. He punched in the digits and waited. A man answered who could speak only Spanish. After Jack struggled with a few broken phrases, the man told Jack to wait.

  A younger voice came on the line. Jack assumed it was Juan. He asked the boy if he could speak to his mother.

  “She’s very sick,” Juan said. “She’s coughing a lot and having trouble breathing.”

  “Did she call the hospital like I urged?” Jack asked.

  “No, she didn’t,” Juan said. “She said she didn’t want to bother anybody.”

  “I’m going to call an ambulance to come and get her,” Jack said without hesitation. “You tell her to hold on, okay?”

  “Okay,” Juan said.

  “Meanwhile, could you ask her one question,” Jack said. “Could you ask her if she cleaned any humidifiers last night? You know what humidifiers are, don’t you?”

  “Yeah, I know,” Juan said. “Just a minute.”

  Jack waited nervously, tapping his fingers on top of Kevin Carpenter’s chart. To add to his guilt, he thought he should have followed up on his suggestion for Gloria to call Zimmerman. Juan came back on the line.

  “She says thank you about the ambulance,” Juan said. “She was afraid to call herself because AmeriCare doesn’t pay unless a doctor says okay.”

  “What about the humidifiers?” Jack asked.

  “Yeah, she said she cleaned two or three. She couldn’t remember exactly.”

  After Jack hung up from talking to the Hernandez boy he called 911 and dispatched an ambulance to the Hernandez residence. He told the dispatcher to inform the EMTs that it was an infectious case and that they should at least wear masks. He also told her that the patient should go to the Manhattan General and no place else.

  With growing excitement, Jack placed a call to Kathy McBane. As late as it was, he didn’t expect to get her, but he was pleasantly surprised. She was still in her office. When Jack commented on the fact that she was still there after six, she said she’d probably be there for some time.

  “What’s going on?” Jack asked.

  “Plenty,” Kathy said. “Kim Spensor has been admitted into the intensive care unit with respiratory distress syndrome. George Haselton is also in the hospital and is worsening. I’m afraid your fears were well grounded.”

  Jack quickly added that Gloria Hernandez would be coming to the emergency room soon. He also recommended that the contacts of all these patients be immediately started on rimantadine.

  “I don’t know if Dr. Zimmerman will go for the rimantadine for contacts,” Kathy said. “But at least I’ve talked her into isolating these patients. We’ve set up a special ward.”

  “That might help,” Jack said. “It’s certainly worth a try. What about the microbiology tech?”

  “He’s on his way in at the moment,” Kathy said.

  “I hope by ambulance rather than public transportation,” Jack said.

  “That was my recommendation,” Kathy said. “But Dr. Zimmerman followed up on it. I honestly don’t know what the final decision was.”

  “That printout you sent over was helpful,” Jack said, finally getting around to why he’d called. “Remember when you told me about the General’s nebulizers getting contaminated in the intensive-care unit three months ago? I think there might have been a similar problem with the hospital’s humidifiers.”

  Jack told Kathy how he’d come to this conclusion, particularly about Gloria Hernandez having admitted to handling humidifiers the previous evening.

  “What should I do?” Kathy said with alarm.

  “At the moment I don’t want you to do anything,” Jack said.

  “But I should at least take the humidifiers out of service until their safety is assured,” Kathy said.

  “The problem is I don’t want you to become involved,” Jack said. “I’m afraid doing something like that might be dangerous.”

  “What are you talking about?” Kathy demanded angrily. “I am already involved.”

  “Don
’t get upset,” Jack said soothingly. “I apologize. I’m afraid I’m handling this badly.” Jack had not wanted to draw anyone else into the web of his suspicions for fear of their safety, yet at the moment he didn’t seem to have any choice. Kathy was right: the humidifiers had to be taken out of service.

  “Listen, Kathy,” Jack said. Then, as succinctly as possible, he explained his theory about the recent illnesses being intentionally spread. He also told her there was a possibility Beth Holderness had been killed because he’d asked her to search the microbiology lab for the offending agents.

  “That’s a rather extraordinary story,” Kathy said haltingly. Then she added: “It’s a little hard to swallow all at once.”

  “I’m not asking you necessarily to subscribe to it,” Jack said. “My only interest in telling you now is for your safety. Whatever you do or say to anyone, please keep what I have told you in mind. And for God’s sake, don’t mention my theory to anyone. Even if I’m right, I have no idea who’s behind it.”

  “Well,” Kathy said with a sigh. “I don’t know what to say.”

  “You don’t have to say anything,” Jack said. “But if you want to help, there is something you could do.”

  “Like what?” Kathy asked warily.

  “Get some bacterial culture medium and viral transport medium from the microbiology lab,” Jack said. “But don’t tell anyone why you want them. Then get someone from engineering to open the elbow drain below the sink in the storeroom where the humidifiers are kept. Put aliquots from the trap into the two mediums and take them to the city reference lab. Ask them to see if they can isolate any one of the five agents.”

  “You think some of the microorganisms would still be there?” Kathy asked.

  “It’s a possibility,” Jack said. “It’s a long shot, but I’m trying to find proof whatever way I can. At any rate, what I’m suggesting you do is not going to hurt anyone except possibly yourself if you are not careful.”

  “I’ll think about it,” Kathy said.

  “I’d do it myself except for the reception I invariably get over there,” Jack said. “I was able to get away with visiting your office, but trying to get bacterial samples out of a trap in central supply is another thing entirely.”

  “I’d have to agree with you there,” Kathy said.

  After he hung up, Jack wondered about Kathy’s reaction to his revelations. From the moment he’d voiced his suspicions she’d sounded subdued, almost wary. Jack shrugged. At the moment there wasn’t anything else he could say to convince her. All he could do was hope she’d heed his warnings.

  Jack had one more call to make, and as he dialed the longdistance number he superstitiously crossed the middle and index fingers of his left hand. He was calling Nicole Marquette at the CDC, and Jack was hoping for two things. First, he wanted to hear that the sample had arrived. Second, he wanted Nicole to say that the titer was high, meaning there were enough viral particles to test without having to wait to grow it out.

  As the call went through Jack glanced at his watch. It was nearing seven p.m. He scolded himself for not having called earlier, thinking he’d have to wait until morning to reach Nicole. But after dialing the extension for the influenza unit, he got Nicole immediately.

  “It arrived here fine,” Nicole said in response to his query. “And I have to give you credit for packing it so well. The refrigerant pack and the Styrofoam kept the sample well preserved.”

  “What about the titer?” Jack asked.

  “I was impressed with that too,” Nicole said. “Where was this sample from?”

  “Bronchiole washings,” Jack said.

  Nicole gave a short whistle. “With this concentration of virus it’s got to be one hell of a virulent strain. Either that, or a compromised host.”

  “It’s a virulent strain all right,” Jack said. “The victim was a young healthy male. Besides that, one of the nurses taking care of him is already in the ICU herself in acute respiratory distress. That’s in less than twenty-four hours after exposure.”

  “Wow! I’d better do this typing immediately. In fact, I’ll stay here tonight. Are there any more cases besides the nurse?”

  “Three others that I know about,” Jack said.

  “I’ll call in the morning,” Nicole said. Then she hung up.

  Jack was mildly taken aback by the precipitous end to the conversation, but he was pleased that Nicole was as motivated as she’d apparently become.

  Jack replaced the phone receiver, and as he did so, he noticed the tremble of his hand. He took a few deep breaths and tried to decide what to do. He was concerned about going home. He had no way of gauging Warren’s reaction to Slam’s death. He also wondered if yet another assassin would be sent after him.

  The unexpected ring of the telephone interrupted his thoughts. He reached for the phone but didn’t pick it up while he tried to think who it could be. As late as it was, he had to shake off some irrational thoughts, like the worry it might be the man who’d tried to kill him that afternoon.

  Finally, Jack picked up the phone. To his relief, it was Terese.

  “You promised you would call,” she said accusingly. “I hope you’re not going to tell me you forgot.”

  “I’ve been on the phone,” Jack said. “In fact, I just this second got off.”

  “Well, all right,” Terese said. “But I’ve been ready to eat for an hour. Why don’t you come to the restaurant directly from work?”

  “Oh, jeez, Terese,” Jack voiced. With everything that had happened he’d totally forgotten about their dinner plans.

  “Don’t tell me you are going to try to cop out,” Terese said.

  “I’ve had a wicked day,” Jack said.

  “So have I,” Terese countered. “You promised, and as I said this morning, you have to eat. Tell me, did you have lunch?”

  “No,” Jack said.

  “Well, there you go,” Terese said. “You can’t skip dinner as well as lunch. Come on! I’ll understand if you have to go back to work. I might myself.”

  Terese was making a lot of sense. He needed to eat something even if he wasn’t hungry, and he needed to relax. Besides, knowing Terese’s persistence he didn’t expect she’d take no for an answer, and Jack did not have the energy for an argument.

  “Are you thinking or what?” Terese asked impatiently. “Jack, please! I’ve been looking forward to seeing you all day. We can compare war stories and have a vote whose day was the worst.”

  Jack was weakening. Suddenly having dinner with Terese sounded wonderfully appealing. He was concerned about putting her at risk simply through proximity, but he doubted anyone was trailing him now. If they were, he could certainly shake them on the way to the restaurant.

  “What’s the name of the restaurant?” Jack asked finally.

  “Thank you,” Terese said. “I knew you’d come through. It’s called Positano. It’s just up the street from me on Madison. You’ll love it. It’s small and very relaxing. Very un-New-Yorkish.”

  “I’ll meet you there in a half hour,” Jack said.

  “Perfect,” Terese said. “I’m really looking forward to this. It’s been a stressful few days.”

  “I can attest to that,” Jack said.

  Jack locked up his office and went down to the first floor. He did not know how to ensure that no one followed him, but he thought that he should at least glance out the front to see if anyone suspicious was lurking there. As he passed through communications he noticed that Sergeant Murphy was still in his cubbyhole talking with someone Jack didn’t recognize.

  Jack and the sergeant exchanged waves. Jack wondered if there had been an unusual number of unidentified dead over the last several days. Murphy usually left at five like clockwork.

  Reaching the front door, Jack scanned the area outside. He immediately recognized the futility of what he was doing. Particularly with the homeless facility next door in the old Bellevue Hospital building, there were any number of people loitering who co
uld have qualified as suspicious.

  For a few moments Jack watched the activity on First Avenue. Rush hour was still in full swing with bumper-to-bumper traffic heading north. The buses were all filled to overflowing. All the cabs were occupied.

  Jack debated what to do. The idea of standing in the street, trying to catch a taxi, had no appeal whatsoever. He’d be too exposed. Someone might even attack him right there, especially if they had been willing to try to shoot him in a drugstore.

  A passing delivery van gave Jack an idea. Turning back into the building, he descended to the morgue floor and walked into the mortuary office. Marvin Fletcher, one of the evening mortuary techs, was having coffee and doughnuts.

  “Marvin, I have a favor to ask,” Jack said.

  “What’s that?” Marvin asked, washing down a mouthful with a gulp of his coffee.

  “I don’t want you to tell anyone about this,” Jack said. “It’s personal.”

  “Yeah?” Marvin questioned. His eyes opened wider than usual. He was interested.

  “I need a ride up to New York Hospital,” Jack said. “Could you take me in one of the mortuary vans?”

  “I’m not supposed to drive—” Marvin began.

  “There’s a good reason,” Jack said, interrupting Marvin. “I’m trying to duck a girlfriend, and I’m afraid she’s outside.

  I’m sure a good-looking guy like you has had similar problems.”

  Marvin laughed. “I suppose,” he said.

  “It will only take a second,” Jack said. “We shoot up First and cut over to York. You’ll be back here in a flash, and here’s a ten-spot for your trouble.” Jack laid a ten-dollar bill on the desk.

  Marvin eyed the bill and looked up at Jack. “When do you want to go?”

  “Right now,” Jack said.

  Jack climbed into the passengerside door of the van and then stepped back into the van’s cargo area. He held on to whatever handhold he could find while Marvin backed out onto Thirtieth Street. As they waited for the light at the corner of First Avenue, Jack made sure he stayed well out of sight.

  Despite the traffic they made good time to New York Hospital. Marvin dropped Jack off at the busy front entrance, and Jack immediately went inside. Within the lobby he stood off to the side for five minutes. When no one even vaguely suspicious entered, Jack headed for the emergency room.