Critical

by Robin Cook

  Although Laurie still had no idea whatsoever what the scalloped, disc-shaped object was, she’d found two more on the slide. And since all three were mirror images of each other, she felt they could not be artifacts introduced when the slides had been prepared. They were definite objects that had been in David Jeffries’s lung at the time of his death.

  Laurie’s excitement soared. She even allowed herself to fantasize that she’d discovered a new infectious agent that in conjunction with staph made for an exceptionally lethal combination. At that point, she dashed down to histology and confronted Maureen, who was about to lock up for the night. After pleading her cause, Laurie convinced the woman to locate filed pulmonary slides on a handful of the former MRSA cases. After thanking her effusively, Laurie dashed back to her office.

  To her delight, she found more of the diatomlike objects, and she noticed that the amounts differed from case to case, with some cases having none. They were extremely rare and consistently unstained, which excused her colleagues from having not seen them. It was at that point that the matrix had provided its first payoff. Although the matrix had not been completed, it had provided a seeming corroboration of the pathogenicity of the discs. The shorter the period between the onset of the individual patient’s symptoms and the time of death, the more diatomlike objects Laurie found. Although this discovery hadn’t been akin to fulfilling Koch’s postulate confirming a microorganism as the source of a particular disease, Laurie felt encouraged. Very encouraged.

  With her eyes feeling as though they were back to normal, Laurie grabbed her Rolodex. Obviously, she had to try to identify the scalloped, microscopic objects. A few years earlier, Jack had had a similar situation about a liver cyst, and he’d taken the slide over to the NYU Medical Center and had it looked at by a giant in the field of pathology, Dr. Peter Malovar. Despite being in his nineties and a professor emeritus, he still maintained an office and a reputation of maintaining his encyclopedic mind. The man’s life was his work, especially since his wife had died twenty years earlier.

  With a shaking hand, Laurie punched the numbers of Malovar’s extension into her phone, hoping that the rumors of the long hours the aged pathologist maintained were correct. She kept her fingers crossed as the phone rang once, then twice, and to her delight was picked up at the commencement of the third ring.

  Dr. Malovar’s voice had a slight but pleasing English accent, a grandfatherlike calmness, and a surprising clarity for a nonagenarian. Laurie told her story in a rapid monologue, tripping over her words at times in her haste. When she finished, there was a pause. For a second, she’d feared that she’d been cut off.

  “Well, this is an unexpected treat,” Dr. Malovar said happily. “Offhand, I have no idea what this diatomlike object is but I would love to see it. It sounds perfectly intriguing.”

  “Would there be any chance of my bringing it over now?” Laurie questioned.

  “I would be delighted,” Dr. Malovar insisted.

  “It’s not too late? I mean, I don’t want to keep you.”

  “Nonsense, Dr. Montgomery. I’m here until ten or eleven every evening. I’m at your disposal.”

  “Thank you. I’ll be over shortly. Is it difficult to find your office?”

  Laurie was given explicit instructions before she hung up. She got her coat and hurried out to the elevator. As she boarded, her stomach growled as a visceral reminder that she’d skipped lunch. With Dr. Malovar having assured her he was not about to leave, she pressed the second-floor button. There wasn’t much choice in the lunchroom’s vending machines, but she trusted she could find something of caloric value, if nothing else.

  The lunchroom was a favorite hangout for the support staff, especially during meal hours, and that evening was no exception. It was just after seven, and half of the three-to-eleven shift were present. With its stark concrete walls, the sound level in the room was almost painful for Laurie in contrast to her office’s silence. As she stood in front of one of the vending machines, anxiously trying to decide which selection was the least bad for her, she heard her name over the din. Turning, she saw the smiling faces of Jeff Cooper and Pete Molimo. They were the evening shift Health and Hospital Corporation van drivers who went out to fetch the bodies. As with most of the rest of the staff, Laurie had become friendly with them over the years. Laurie and Jack, in contrast to their colleagues, were more apt to visit scenes during the evening and night hours, because they both felt such visits were exceedingly helpful.

  The men were enjoying a break in their routine. They had finished their meals, as evidenced by the debris on their table. Except for rush-hour auto accidents, calls of deaths during mealtime were relatively rare and didn’t pick up again until after nine. Both had their feet up on the opposing empty chairs at their four-top table.

  “Haven’t seen you much, Dr. Montgomery,” Jeff said.

  “Yeah, where’ve you been hiding?” Pete added.

  Laurie smiled. “Either in my office or in the pit.”

  “You’re a little late for going home, aren’t you?” Pete asked. “Most of the other MEs are out of here before five.”

  “I’ve been working on a special project,” Laurie said. “In fact, I’m not even going home now. I’m heading over to NYU Medical Center.”

  “How are you getting over there? I don’t know what it’s doing now, but it was sprinkling an hour or so ago.”

  “I’m walking,” Laurie said. “It’s too short for a cab ride.”

  “Why don’t I run you over?” Pete offered. “We’re just sitting here, and I’m tired of talking to this die-hard Boston fan.”

  “What if you get a call?” Laurie asked.

  “What’s the difference. I got a radio.”

  It took Laurie two seconds to make up her mind. “Are you ready to go now?”

  “You bet,” Pete said, gathering up his trash.

  In a lot of ways, it was ludicrous to ride, because the medical center entrance was on the same block as the OCME, and when they backed out of the morgue’s receiving dock onto 30th Street, it was not raining. In fact, there was a patch of pale blue-green sky off to the west and moving closer.

  “This is rather silly,” Laurie said, as Pete almost immediately turned into the curved driveway at the medical center’s entrance several hundred feet down First Avenue. He managed to get up to only about twenty miles per hour. “I’m sorry to trouble you.”

  “No trouble at all,” Pete assured her. “I was glad to get away from Jeff, the bum. He’s so sure the Sox are going to beat the Yankees that he won’t shut up about it.”

  Laurie hopped out of the van, thanked Pete, and used the microscope slide box she was carrying to wave as she hurried through the revolving door. The center was crowded with visitors, but Laurie quickly left them behind on her way to the academic portion of the institution. Using the elevator, she rose to the sixth floor. As she exited, she noticed that the corridor was as silent as the one outside her own office. Most all doors were closed, and she didn’t pass a single person.

  She found the renowned doctor in a small, windowless interior space that could have been a storeroom but which the aged man had decorated with all his diplomas, rewards, and honors, all protected in simple, glazed black frames. A very large freestanding bookcase filled with all his favorite pathology tomes, some with tooled leather bindings, dominated one wall. Most of the rest of the room was filled by a large mahogany desk piled high with reprints and legal pads covered with erratic cursive.

  He stood up and extended a hand as Laurie entered. She was surprised how much he looked like Einstein, with a cumulus of white hair. His back was kyphotic, as if he were anatomically built to look into a microscope.

  “I see you have brought the slides,” he said, eagerly eyeing Laurie’s slide box.

  In anticipation of her arrival, he’d positioned his impressive microscope on a customized shelf that pulled out of the end of the desk. It was a teaching scope with double-binocular eyepieces. An impr
essive digital camera was mounted on top and shared the same view as the eyepieces.

  “Should we?” he continued, motioning for Laurie to take the seat positioned on her side of the scope.

  Laurie sat. She could see out of the corner of her eye how zealously he watched as she opened her tray and carefully extracted one of the slides marked with grease pencil. Respecting that the microscope was his, she handed him the slide. Eagerly, he placed it onto the mechanical stage and lined up the grease-pencil markings. After he’d lowered the low-power objective, he told her to use the mechanical stage control to find the object of interest.

  Having become quite proficient at locating the objects despite their lack of staining, Laurie quickly located one. “I don’t know if you can quite see it, but it’s under the pointer now.”

  “I think I see it,” Dr. Malovar said. He backed up the objective, changed to higher power, then refocused. “Ah, yes!” he said, as if experiencing visceral pleasure. “Most interesting! Are they all similar?”

  “They are,” Laurie said. “Strikingly so.”

  “Such symmetry, such an elegant border. Have you observed them on end?”

  “No, I haven’t,” Laurie admitted, “so I don’t know if it is disc-shaped or spherical.”

  “I’d say disc-shaped. Have you noted the slight nodularity?”

  “I have, but I didn’t know if it was real.”

  “It’s real, all right. Fascinating, as is the degree of necrosis of the lung tissue.”

  Laurie was dying for him to tell her what it was and questioned why he was teasing her by withholding the information.

  “It is quite apparent they are in the bronchioles and not within the alveolar walls.”

  “I felt the same way,” Laurie admitted.

  “I can see why you said they looked like diatoms, but I wouldn’t have thought of it myself.”

  Laurie was becoming impatient. Finally, she just asked, “What is it?”

  “I have no idea,” Dr. Malovar said.

  Laurie was stunned. Particularly from the appreciative way he was describing the object, she thought for sure he knew what it was the very instant he’d seen it. Shock turned into dismay when she realized she could not charge home to Jack with new, decisive information. It also made her consider that maybe some of her colleagues had seen them, but dismissed them as being unimportant.

  “Do you think that they had anything to do with the fulminant MRSA infections these people had?”

  “I have no idea.”

  “Do you have any idea of how we might identify them?”

  “For that, I do have an idea. I’d like to look at them under the scanning electron microscope, especially after slicing one open.”

  “Is that a lengthy procedure? Can we do it tonight?”

  Dr. Malovar leaned back and laughed. “Your eagerness is commendable. No, we cannot do it tonight. There’s some skill involved. We do have a talented person, but of course he is gone for the night. I can see if he can at least start tomorrow.”

  “How about a microbiologist?” Laurie suggested. “Should I show it to a microbiologist?”

  “You could, but I’m not optimistic. I’ve had a bit of microbiology myself.” He pointed to a Ph.D. diploma in microbiology.

  Laurie was crestfallen.

  “But I believe I do know who will be able to identify it at a glance.”

  Laurie’s eyes brightened. Her emotional roller coaster was taking her up once again. “Who?” she asked eagerly.

  “Our own Dr. Collin Wiley. My sense is that what we are seeing is a parasite, and Dr. Wiley is department head of parasitology.”

  “Can we get him to look at it tonight? Do you think he is still here?”

  “He is not here. In fact, Dr. Wiley is in New Zealand for a parasitology meeting.”

  “Good Lord,” Laurie murmured. The roller coaster was on its way down again. She visibly sagged in her seat.

  “Don’t look so forlorn, my dear,” Dr. Malovar said, leaning to the side to gaze directly at Laurie with his glacial blue eyes. “We live in the information age. I will simply take a few high-definition digital photos tonight and e-mail them to Dr. Wiley, along with a description of the case. I know for a fact he has his laptop with him, since it has his lectures’ PowerPoints. Could you give me your e-mail address?”

  Laurie rummaged in her bag for one of her ME business cards. She handed it over.

  “Perfect,” Dr. Malovar said, putting it on the corner of his desk.

  “When do you suppose I might get an answer?”

  “That’s totally up to Dr. Wiley. And remember, he’s halfway around the world.”

  After discussing with Dr. Malovar the process of getting a sample of David Jeffries’s lung to him, perhaps even the paraffin block used by histology, Laurie left the pathologist’s office. As she rode down in the empty elevator, she made a decision. Although she was eager to finish her matrix, she decided to forgo it for the time being and go home. She thought there was a significant chance, maybe not huge but at least possible, that the discovery of the unknown objects might be enough in and of itself to make Jack see the risk issue her way.

  Down at the hospital entrance, she was able to catch a taxi with relative ease.

  AS SOON AS Adam had turned onto 106th Street, he had sensed his thoughts about the imminent end to the mission were probably unduly optimistic. Instead of being a quiet side street, it had been alive with all sorts of people and children enjoying the improving weather. Driving by Laurie Montgomery’s house had added to his feeling, because directly across the street was a sizable and popular playground with an impressive array of mercury vapor lights capable of turning the entire area into day. But what had totally convinced him was when he’d stopped for a few moments to survey the area, he’d spotted Montgomery’s injured spouse or boyfriend on the sidelines of an active neighborhood basketball game with more than fifty people either playing or watching. Seeing the man standing there leaning on his crutches strongly suggested to Adam that Laurie was probably already home as well.

  But Adam had not been discouraged. Quite the contrary. He still thought the area a far better location than in front of the OCME for the hit. It just meant he’d have to wait for morning, when she would appear at her door on her way to work and either walk east to catch a cab on Central Park West or walk west and snag one on Columbus Avenue. Either way, he’d have his opportunity to take her out. And considering Laurie had arrived at work that morning at seven-fifteen, he estimated that she’d left the house around six-forty-five. With that decided, Adam had vowed to be parked in front of Montgomery’s house by six-fifteen at the latest the following day.

  “Good evening, Mr. Bramford,” the doorman said when Adam climbed from the Range Rover back at the Pierre. “Will you be needing your vehicle again this evening?”

  “No, but I’d like it to be available at six a.m. sharp. Will that be a problem?”

  “No problem whatsoever, Mr. Bramford. It will be waiting for you.”

  After collecting his things, particularly his tennis case, Adam hurried into the Pierre. He wanted to see if it wasn’t too late for the concierge to get him a symphony ticket or a ticket for whatever else was happening that evening at Lincoln Center.

  TO GET ANGELO’S attention about the hour, Franco made a production of looking at his watch by sticking out his left arm full length, pulling back his jacket sleeve, rebending his elbow, and rotating his wrist. Next to him, Angelo was staring straight ahead out through the windshield at the darkened scene. Had his eyes not been open with an occasional blink, Franco would have thought he was asleep. The vehicular traffic racing past them on First Avenue had slowed to a mere trickle. Had it not been for the streetlights, it would have been pitch dark. The sun had long since set, and no moon had arisen to take its place.

  “It’s not going to happen,” Franco said at length. “At least not tonight. We can’t sit here all night.”

  “The bitch!” Angelo murmu
red.

  “I know it’s frustrating. It’s as if she were taunting us. I guess she went home early, just before we got here, or maybe she’s working late. Either way, I think we should go. The troops behind us are getting antsy.”

  “I want to stay another fifteen minutes.”

  “Angelo! That’s what you said a half-hour ago. It’s time to move on. We’ll come back tomorrow morning. You’ll get your revenge soon enough.”

  “Ten minutes.”

  “No! We’re going now! I wanted to leave a half-hour ago. I’ve already extended our sitting here longer than I feel comfortable with. I don’t want someone noticing us and getting suspicious. Start the van and signal the guys in back!”

  Angelo got the engine going and then turned the headlights on and off a few times.

  “All right, we’re out of here.”

  Reluctantly, Angelo pulled away from the curb. He drove slowly so that when they came abreast of the OCME, he could look through the front door into the building’s interior.

  “The place looks dead,” Franco said. “How appropriate.”

  As they drove up First Avenue, Angelo broke the silence. “Maybe we’ll have to check out the boyfriend’s apartment if we can’t get her here at the OCME.”

  “That’s on the bottom of the list,” Franco blurted with a shake of his head. He and Angelo had visited Jack’s apartment ten years earlier, with disastrous results. “Those neighborhood gang friends of his are a menace to society, and they are always on alert for other gangs. We’re going to stick with what we got. I mean, it’s not like we’ve been sitting here for a week, you know what I’m saying.”

  Angelo nodded, but he wasn’t happy. He felt like a kid promised a present but being forced to wait.

  AS LAURIE CLIMBED out of the taxi in front of her house, she looked over at the lighted basketball court. It seemed like a particularly crowded evening, which always made the competition that much more fierce. As evidence, Laurie could hear that the cries of accomplishment and derision were more strident than usual. Standing on her tiptoes, Laurie scanned the spectators for Jack. As much as he enjoyed the game, she wouldn’t have been surprised if she saw him, but she didn’t.