Contagion

12

“For chrissake!” Jack murmured under his breath as he was about to start the autopsy on Susanne Hard. Clint Abelard was hovering behind him like a gnat, constantly switching his weight from one leg to the other.

“Clint, why don’t you step around the table and stand on the other side,” Jack suggested. “You’ll be able to see much better.”

Clint took the suggestion and stood with his arms behind his back opposite from Jack.

“Now don’t move,” Jack mumbled to himself. Jack didn’t like Clint hanging around, but he had no choice.

“It’s sad when you see a young woman like this,” Clint said suddenly.

Jack looked up. He hadn’t expected such a comment from Clint. It seemed too human. He had struck Jack as an unfeeling, moody bureaucrat.

“How old is she?” Clint asked.

“Twenty-eight,” Vinnie said from the head of the table.

“From the looks of her spine she didn’t have an easy life,” Clint said.

“She had several major back surgeries,” Jack said.

“It’s a double tragedy since she’d just given birth,” Clint said. “Now the child is motherless.”

“It was her second child,” Vinnie said.

“I suppose I shouldn’t forget her husband,” Clint said. “It must be upsetting to lose your spouse.”

A knifelike stab of emotion went down Jack’s spine. He had to fight to keep from reaching across the table and yanking Clint off his feet. Abruptly he left the table and exited to the washroom. He heard Vinnie call after him, but he ignored him. Instead Jack leaned on the edge of the sink and tried to calm himself. He knew that getting angry with Clint was an unreasonable reaction; it was nothing but pure, unadulterated transference. But understanding the origin did not lessen the irritation. It always irked Jack when he heard such clichés from people who truly had no idea.

“Is there a problem?” Vinnie asked. He’d stuck his head through the door.

“I’ll be there in a second,” Jack said.

Vinnie let the door close.

As long as he was there, Jack washed and regloved his hands. When he was finished he returned to the table.

“Let’s get this show on the road,” he said.

“I’ve looked the body over,” Clint said. “I don’t see anything that looks like an insect bite, do you?”

Jack had to restrain himself from subjecting Clint to a lecture like the one Clint had given to him. Instead, he merely proceeded with his external exam. Only after he’d finished did he speak.

“No gangrene, no purpura, and no insect bites as far as I can see,” Jack said. “But by just looking at her I can see some of her cervical lymph nodes are swollen.”

Jack pointed out the finding to Clint, who then nodded in agreement.

“That’s certainly consistent with plague,” Clint said.

Jack didn’t answer. Instead he took a scalpel from Vinnie and quickly made the typical Y-shaped autopsy incision. The bold cruelty of the move jolted Clint. He took a step back.

Jack worked quickly but with great care. He knew that the less the internal organs were disturbed, the less chance that any of the infecting microbes would be aerosolized.

When Jack had the organs out, he turned his attention first to the lungs. Calvin had drifted over at this point and towered behind Jack as he made his initial cuts into the obviously diseased organ. Jack spread open the lung like a butterfly.

“Lots of bronchopneumonia and early tissue necrosis,” Calvin said. “Looks pretty similar to Nodelman.”

“I don’t know,” Jack said. “Seems to me there is an equal amount of pathology but less consolidation. And look at these nodal areas. They almost look like early granulomas with caseation.”

Clint listened to this pathological jargon with little interest or comprehension. He remembered the terms from medical school, but had long since forgotten their meaning. “Does it look like plague?” he asked.

“Consistent,” Calvin said. “Let’s look at the liver and the spleen.”

Jack carefully pulled these organs from the pan and sliced into them. As he’d done with the lung, he spread open their cut surfaces so everyone could see. Even Laurie had stepped over from her table.

“Lots of necrosis,” Jack said. “Certainly just as virulent a case as with Nodelman or with the case I did earlier.”

“Looks like plague to me,” Calvin said.

“But why was the fluorescein antibody negative?” Jack said. “That’s telling me something, especially combined with the lung appearance.”

“What’s with the lungs?” Laurie asked.

Jack moved the liver and the spleen aside and showed Laurie the cut surface of the lung. He explained what he thought of the pathology.

“I see what you mean now that you mention it,” Laurie said. “It is different from Nodelman. His lungs definitely had more consolidation. This looks more like some sort of horribly aggressive TB.”

“Whoa!” Calvin said. “This isn’t TB. No way.”

“I don’t think Laurie was suggesting it was,” Jack said.

“I wasn’t,” Laurie agreed. “I was just using TB as a way of describing these infected areas.”

“I think it is plague,” Calvin said. “I mean, I wouldn’t if we hadn’t just had a case from the same hospital yesterday. Chances are it is plague regardless of what their lab said.”

“I don’t think it is,” Jack said. “But let’s see what our lab says.”

“How about double or nothing with that ten dollars,” Calvin said. “Are you that sure?”

“No, but I’ll take you up on it. I know how much the money means to you.”

“Are we finished here?” Clint asked. “If so, I think I’ll be going.”

“I’m essentially finished,” Jack said. “I’ll do a little more on the lymphatics, and then I’ll be obtaining samples for the microscopic. You won’t be missing anything if you take off now.”

“I’ll head out with you,” Calvin said.

Calvin and Clint disappeared through the door to the washroom.

“If you don’t think this case is plague, what do you think it is?” Laurie asked, looking back at the woman’s corpse.

“I’m embarrassed to tell you,” Jack said.

“Come on,” Laurie urged. “I won’t tell anybody.”

Jack looked at Vinnie. Vinnie held up his hands. “My lips are sealed.”

“Well, I’d have to fall back on my original differential I had for Nodelman,” Jack said. “To narrow it down more than that, I have to again go out on thin ice. If it isn’t plague, the nearest infectious disease both pathologically and clinically is tularemia.”

Laurie laughed. “Tularemia in a twenty-eight-year-old postpartum female in Manhattan?” she questioned. “That would be pretty rare, although not as rare as your diagnosis yesterday of plague. After all, she could have a hobby of rabbit hunting on weekends.”

“I know it’s not very probable,” Jack said. “Once again I’m relying totally on the pathology and the fact that the test for plague was negative.”

“I’d be willing to bet a quarter,” Laurie said.

“Such a spender!” Jack joked. “Fine! We’ll bet a quarter.”

Laurie returned to her own case. Jack and Vinnie turned their attention back to Susanne Hard. While Vinnie did his tasks, Jack finished the lymphatic dissection he wanted to do, then took the tissue samples he felt appropriate for microscopic study. When the samples were all in the proper preservatives and appropriately labeled, he helped Vinnie suture the corpse.

Leaving the autopsy room, Jack properly dealt with his isolation equipment. After plugging in his rechargeable ventilator battery, he took the elevator up to the third floor to see Agnes Finn. He found her sitting in front of a stack of petri dishes examining bacterial cultures.

“I’ve just finished another infectious case that’s suspected plague,” he told her. “All the samples will be coming up shortly. But there is a problem. The lab over at the Manhattan General claims the patient tested negative. Of course, I want to repeat that, but at the same time I want you to rule out tularemia, and I want it done as quickly as possible.”

“That’s not easy,” she said. “Handling Francisella tularen- sis is hazardous. It’s very contagious to laboratory workers if it gets into the air. There is a fluorescein antibody stain for tularemia, but we don’t have it.”

“How do you make the diagnosis, then?” Jack asked.

“We have to send any samples out,” she said. “Because of the risk of handling the bacteria the reagents are generally kept only at reference labs where the personnel are accustomed to dealing with the microbe. There is such a lab here in the city.”

“Can you send it right away?” Jack asked.

“We’ll messenger it over as soon as it gets here,” she said. “If I call and put a rush on it, we’ll have a preliminary result in less than twenty-four hours.”

“Perfect,” Jack said. “I’ll be waiting. I’ve got ten dollars and twenty-five cents riding on the outcome.”

Agnes gave Jack a look. He considered explaining, but feared he’d sound even more foolish. Instead he fled upstairs to his office.