Contagion

15

Terese and Colleen climbed out of the cab on Second Avenue between Eighty-ninth and Eighty-eighth streets a few doors away from Elaine’s and walked to the restaurant. They couldn’t get out right in front because of several limos inconveniently double-parked.

“How do I look?” Colleen asked as they paused under the canvas awning. She’d pulled off her coat for Terese’s inspection.

“Too good,” Terese said, and she meant it. Colleen had discarded her signature sweatshirt and jeans for a simple black dress that revealed her ample bust to perfection. Terese felt dowdy by comparison. She still had on her tailored suit that she’d worn to work that day, not having found time to go home to change.

“I don’t know why I’m so nervous,” Colleen admitted.

“Relax,” Terese said. “With that dress Dr. McGovern doesn’t stand a chance.”

Colleen gave their names to the maître d’ who immediately indicated recognition. He motioned for the women to follow him. He started to the rear.

It was an obstacle course of sorts to weave among the densely packed tables and scurrying waiters. Terese had the sensation of being in a fishbowl. Everyone, male and female alike, gave them the once-over as they passed.

The men were at a tiny table squeezed into the far corner. They got to their feet as the women approached. Chet held out Colleen’s chair. Jack did the same for Terese. The women draped their coats over the backs of the chairs before sitting down.

“You men must know the owner to have gotten such a great table,” Terese said.

Chet, who misinterpreted Terese’s remark as a compliment, bragged he’d been introduced to Elaine a year previously. He explained she was the woman seated at the cash register at the end of the bar.

“They tried to seat us up in the front,” Jack said. “But we declined. We thought you women wouldn’t like the draft from the door.”

“How thoughtful,” Terese said. “Besides, this is so much more intimate.”

“You think so?” Chet questioned. His face visibly brightened. They were, in reality, packed in like proverbial sardines.

“How could you question her?” Jack asked Chet. “She’s so sincere.”

“All right, enough!” Chet said good-naturedly. “I might be dense, but eventually I catch on.”

They ordered wine and appetizers from the waiter who’d immediately appeared after the women had arrived. Colleen and Chet fell into easy conversation. Terese and Jack continued to be teasingly sarcastic with each other, but eventually the wine blunted their witticisms. By the time the main course was served, they were conversing congenially.

“What’s the inside scoop on the plague situation?” Terese asked.

“There were two more deaths at the General,” Jack said. “Plus a couple of febrile nurses are being treated.”

“That was in the morning news,” Terese said. “Anything new?”

“Only one of the deaths was actually plague,” Jack said. “The other resembled plague clinically, but I personally don’t think it was.”

Terese stopped a forkful of pasta midway to her mouth. “No?” she questioned. “If it wasn’t plague, what was it?”

Jack shrugged. “I wish I knew,” he said. “I’m hoping the lab can tell me.”

“The Manhattan General must be in an uproar,” Terese said. “I’m glad I’m not a patient there now. Being in the hospital is scary enough under the best of circumstances. With the worry of diseases like plague around, it must be terrible.”

“The administration is definitely agitated,” Jack said. “And for good reason. If it turns out the plague originated there, it will be the first modern episode of nosocomial plague. That’s hardly an accolade as far as the hospital is concerned.”

“This concept of nosocomial infections is new to me,” Terese said. “I’d never thought much about it before you and Chet talked about this current plague problem last night. Do all hospitals have such problems?”

“Absolutely,” Jack said. “It’s not common knowledge, but usually five to ten percent of hospitalized patients fall victim to infections contracted while they are in the hospital.”

“My God!” Terese said. “I had no idea it was such a widespread phenomenon.”

“It’s all over,” Chet agreed. “Every hospital has it, from the academic ivory tower to the smallest community hospital. What makes it so bad is that the hospital is the worst place to get an infection because many of the bugs hanging out there are resistant to antibiotics.”

“Oh, great!” Terese said cynically. After she thought for a moment she asked, “Do hospitals differ significantly in their infection rates?”

“For sure,” Chet said.

“Are these rates known?” Terese said.

“Yes and no,” Chet said. “Hospitals are required by the Joint Commission of Accreditation to keep records of their infection rates, but the rates aren’t released to the public.”

“That’s a travesty!” Terese said with a surreptitious wink at Colleen.

“If the rates go over a certain amount the hospital loses its accreditation,” Chet said. “So all is not lost.”

“But it’s hardly fair to the public,” Terese said. “By not having access to those rates people can’t make their own decisions about which hospitals to patronize.”

Chet opened his hands palms up like a supplicant priest. “That’s politics,” he said.

“I think it’s awful,” Terese said.

“Life’s not fair,” Jack said.

After dessert and coffee Chet and Colleen began campaigning to go someplace where there was dancing, like the China Club. Both Terese and Jack were disinclined. Chet and Colleen tried their best to change their minds, but they soon gave up.

“You guys go,” Terese said.

“Are you sure?” Colleen asked.

“We wouldn’t want to hold you back,” Jack said.

Colleen looked at Chet.

“Let’s go for it,” Chet said.

Outside the restaurant Chet and Colleen happily piled into a cab. Jack and Terese waved as they drove off.

“I hope they enjoy themselves,” Terese said. “I couldn’t have thought of anything worse. Sitting in a smoke-filled nightclub assaulted by music loud enough to damage my ears is not my idea of pleasure.”

“At least we’ve finally found something we can agree on,” Jack said.

Terese laughed. She was beginning to appreciate Jack’s sense of humor. It wasn’t too dissimilar from her own.

For a moment of self-conscious indecision they stood at the curbside, each looking in a different direction. Second Avenue was alive with revelers despite a nippy temperature in the high thirties. The air was clear and the sky cloudless.

“I think the weatherman forgot it was the first day of spring,” Terese said. She jammed her hands into her coat pockets and hunched up her shoulders.

“We could walk around the corner to that bar where we were last night,” Jack suggested.

“We could,” Terese said. “But I have a better idea. My agency is over on Madison. It’s not too far away. How about a quick visit?”

“You’re inviting me to your office despite knowing how I feel about advertising?” Jack asked.

“I thought it was only medical advertising you were against,” Terese said.

“The truth is I’m not particularly fond of advertising in general,” Jack said. “Last night Chet jumped in before I had a chance to say it.”

“But you’re not opposed to it per se?” Terese questioned.

“Just the medical kind,” Jack said. “For the reasons I gave.”

“Then how about a quick visit? We do a lot more than just medical advertising. You might find it enlightening.”

Jack tried to read the woman behind the soft, pale blue eyes and sensuous mouth. He was confused because the vulnerability they suggested wasn’t in sync with the no-nonsense, goal-oriented, driven woman he suspected she was.

Terese met his stare head-on and smiled back coquettishly. “Be adventuresome!” she challenged.

“Why do I have the feeling you have an ulterior motive?” Jack asked.

“Probably because I do,” Terese freely admitted. “I’d like your advice on a new ad campaign. I wasn’t going to admit you’d been a stimulus for a new idea, but tonight during dinner I changed my mind about telling you.”

“I don’t know whether to feel used or complimented,” Jack said. “How did I happen to give you an idea for an ad?”

“All this talk about plague at the Manhattan General Hospital,” Terese said. “It made me think seriously about the issue of nosocomial infection.”

Jack considered this statement for a moment. Then he asked, “And why did you change your mind about telling me and asking my advice?”

“Because it suddenly dawned on me that you might actually approve of the campaign,” Terese said. “You told me the reason you were against advertising in medicine was because it didn’t address issues of quality. Well, ads concerning nosocomial infections certainly would.”

“I suppose,” Jack said.

“Oh, come on,” Terese said. “Of course it would. If a hospital was proud of its record, why not let the public know?”

“All right,” Jack said. “I give up. Let’s see this office of yours.”

Having made the decision to go, there was the problem of Jack’s bike. At that moment it was locked to a nearby No Parking sign. After a short discussion they decided to leave the bike and go together in a cab. Jack would rescue the bike later on his way home.

With little traffic and a wildly fast and reckless Russian-émigré taxi driver, they arrived at Willow and Heath’s building in minutes. Jack staggered out of the rear of the taxi.

“God!” he said. “People accuse me of taking a risk riding my bike in this city. It’s nothing like riding with that maniac.”

As if to underline Jack’s statement, the cab shot away from the curb and disappeared up Madison Avenue with its tires screeching.

At ten-thirty the office building was locked up tight. Terese used her night key, and they entered. Their heels echoed noisily in the lonely marble hallway. Even the whine of the elevator seemed loud in the stillness.

“Are you here often after hours?” Jack asked.

Terese laughed cynically. “All the time,” she said. “I practically live here.”

They rode up in silence. When the doors opened Jack was shocked to find the floor brightly illuminated and bustling with activity as if it were midday. Toiling figures bent over many of the innumerable drawing boards.

“What do you have, two shifts?” Jack asked.

Terese laughed again. “Of course not,” she said. “These people have been here since early this morning. Advertising is a competitive world. If you want to make it, you have to put in your time. We have several reviews coming up.”

Terese excused herself and walked over to a woman at a nearby drawing table. While they conversed, Jack’s eyes roamed the expansive space. He was surprised there were so few partitions. There was only a handful of separate rooms, which shared a common wall with the bank of elevators.

“Alice is going to bring in some material,” Terese said when she rejoined Jack. “Why don’t we go into Colleen’s office.”

Terese led him into one of the rooms and turned on the lights. It was tiny, windowless, and claustrophobic when compared to the vast undivided space. It was also cluttered with papers, books, magazines, and videotapes. There were several easels set up with thick pads of drawing paper.

“I’m sure Colleen won’t mind if I clear away a little area on her desk,” Terese said as she moved aside stacks of orange-colored tracing paper. Gathering up an armload of books, she set them on the floor. No sooner had she finished than Alice Gerber, another of Terese’s associates, appeared.

After making introductions, Terese had Alice run through a number of the potential commercial ideas they’d comped up that day.

Jack found himself interested more in the process than the content. He’d never stopped to think about how TV commercials were made, and he came to appreciate the creativity involved and the amount of work.

It took Alice a quarter hour to present what she’d brought in. When she was finished, she gathered up the tissues and looked at Terese for further instructions. Terese thanked her and sent her back to her drawing board.

“So there you have it,” Terese said to Jack. “Those’re some of the ideas stemming from this nosocomial infection issue. What do you think?”

“I’m impressed with how hard you work on this sort of thing,” Jack said.

“I’m more interested in your reaction to the content,” Terese said. “What do you think of the idea of Hippocrates coming into the hospital to award it the ‘do no harm’ medal?”

Jack shrugged. “I don’t flatter myself to think I have the ability to intelligently critique a commercial.”

“Oh, give me a break,” Terese said, rolling her eyes to the ceiling. “I just want your opinion as a human being. This isn’t an intellectual quiz. What would you think if you saw this commercial on the TV, say when you were watching the Super Bowl?”

“I’d think it was cute,” Jack admitted.

“Would it make you think the National Health hospital might be a good place to go, since its nosocomial infection rates were low?”

“I suppose,” Jack said.

“All right,” Terese said, trying to keep herself calm. “Maybe you have some other ideas. What else could we do?”

Jack pondered for a few minutes. “You could do something about Oliver Wendell Holmes and Joseph Lister.”

“Wasn’t Holmes a poet?” Terese asked.

“He was also a doctor,” Jack said. “He and Lister probably did more for getting doctors to wash their hands when going from patient to patient than anybody. Well, Semmelweis helped too. Anyway, handwashing was probably the most important lesson that needed to be learned to prevent hospital-based infections.”

“Hmm,” Terese said. “That sounds interesting. Personally, I love period pieces. Let me tell Alice to get someone to research it.”

Jack followed Terese out of Colleen’s office and watched her talk with Alice. It only took her a few minutes.

“Okay,” Terese said, rejoining Jack. “She’ll start the ball rolling. Let’s get out of here.”

In the elevator Terese had another suggestion. “Why don’t we take a run over to your office,” she said. “It’s only fair now that you have seen mine.”

“You don’t want to see it,” Jack said. “Trust me.”

“Try me.”

“It’s the truth,” Jack said. “It’s not a pretty place.”

“I think it would be interesting,” Terese persisted. “I’ve only seen a morgue in the movies. Who knows, maybe it will give me some ideas. Besides, seeing where you work might help me understand you a little more.”

“I’m not sure I want to be understood,” Jack said.

The elevator stopped and the doors opened. They walked outside. They paused at the curb.

“What do you say? I can’t imagine it would take too long, and it’s not terribly late.”

“You are a persistent sort,” Jack commented. “Tell me: Do you always get your way?”

“Usually,” Terese admitted. Then she laughed. “But I prefer to think of myself as tenacious.”

“All right,” Jack said finally. “But don’t say I didn’t warn you.”

They caught a taxi. After Jack gave the destination the driver looped around and headed south on Park Avenue.

“You give me the impression of being a loner,” Terese said.

“You’re very perspicacious,” Jack said.

“You don’t have to be so caustic,” Terese said.

“For once I wasn’t,” Jack said.

The lambent reflections of the streetlights played over their faces as they regarded each other in the half-light of the taxi.

“It’s difficult for a woman to know how to feel around you,” Terese said.

“I could say the same,” Jack said.

“Have you ever been married?” Terese said. “That is, if you don’t mind me asking.”

“Yes, I was married,” Jack said.

“But it didn’t work out?” Terese said leadingly.

“There was a problem,” Jack admitted. “But I don’t really care to talk about it. How about you? Were you ever married?”

“Yes, I was,” Terese said. She sighed and looked out her window. “But I don’t like talking about it either.”

“Now we have two things we agree on,” Jack said. “We both feel the same about nightclubs and talking about our former marriages.”

Jack had given directions to be dropped off at the Thirtieth Street entrance of the medical examiner’s office. He was glad to see that both mortuary vans were gone. He thought their absence was a sign that there wouldn’t be any fresh corpses lying around on gurneys. Although Terese had insisted on the visit, he was afraid of offending her sensibilities unnecessarily.

Terese said nothing as Jack led her past the banks of refrigerated compartments. It wasn’t until she saw all the simple pine coffins that she spoke. She asked why they were there.

“They’re for the unclaimed and unidentified dead,” Jack said. “They are buried at city expense.”

“Does that happen often?” Terese asked.

“All the time,” Jack said.

Jack took her back to the area of the autopsy room. He opened the door to the washroom. Terese leaned in but didn’t enter. The autopsy room was visible through a windowed door. The stainless-steel dissecting tables glistened ominously in the half-light.

“I expected this place to be more modern,” she said. She was hugging herself to keep from touching anything.

“At one time it was,” Jack said. “It was supposed to have been renovated, but it didn’t happen. Unfortunately the city is always in some kind of budgetary crisis, and few politicians balk at pulling money away from here. Adequate funding for normal operating expenses is hard to come by, much less money to update the facility. On the other hand we do have a new, state-of-the-art DNA lab.”

“Where’s your office?” Terese asked.

“Up on the fifth floor,” Jack said.

“Can I see it?” she asked.

“Why not?” Jack said. “We’ve come this far.”

They walked back past the mortuary office and waited for the elevator.

“This place is a little hard to take, isn’t it?” Jack said.

“It has its gruesome side,” Terese admitted.

“We who work here often forget the effect it has on laypeople,” Jack said, though he was impressed with the degree of equanimity Terese had demonstrated.

The elevator arrived and they got on. Jack pressed the fifth floor, and they started up.

“How did you ever decide on this kind of career?” Terese asked. “Did you know back in medical school?”

“Heavens, no,” Jack said. “I wanted something clean, technically demanding, emotionally fulfilling, and lucrative. I became an ophthalmologist.”

“What happened?” Terese asked.

“My practice got taken over by AmeriCare,” Jack said. “Since I didn’t want to work for them or any similar corporation, I retrained. It’s the buzzword these days for superfluous medical specialists.”

“Was it difficult?” Terese asked.

Jack didn’t answer immediately. The elevator arrived on the fifth floor and the doors opened.

“It was very difficult,” Jack said as he started down the hall. “Mostly because it was so lonely.”

Terese hazarded a glance in Jack’s direction. She’d not expected him to be the type to complain of loneliness. She’d assumed he was a loner by choice. While she was looking, Jack furtively wiped the corner of an eye with his knuckle. Could there have been a tear? Terese was mystified.

“Here we are,” Jack announced. He opened his office door with his key and flipped on the light.

The interior was worse than Terese had expected. It was tiny and narrow. The furniture was gray metal and old, and the walls were in need of paint. There was a single, filthy window positioned high on the wall.

“Two desks?” Terese questioned.

“Chet and I share this space,” Jack explained.

“Which desk is yours?”

“The messy one,” Jack said. “This plague episode has put me further behind than ususal. I’m generally behind because I’m rather compulsive about my reports.”

“Dr. Stapleton!” a voice called out.

It was Janice Jaeger, the PA investigator.

“Security told me you were here when I just came through the receiving bay,” she said after being introduced to Terese. “I’ve been trying to reach you at home.”

“What’s the problem?” Jack asked.

“The reference lab called this evening,” Janice said. “They ran the fluorescein antibody on Susanne Hard’s lung tissue as you requested. It was positive for tularemia.”

“Are you kidding?” Jack took the paper from Janice and stared at it with disbelief.

“What’s tularemia?” Terese asked.

“It’s another infectious disease,” Jack said. “It’s similar in some ways to plague.”

“Where was this patient?” Terese asked, although she suspected the answer.

“Also at the General,” Jack said. He shook his head. “I truly can’t believe it. This is extraordinary!”

“I’ve got to get back to work,” Janice said. “If you need me to do anything just let me know.”

“I’m sorry,” Jack said. “I didn’t mean to have you stand here. Thanks for getting this to me.”

“No problem,” Janice said. She waved and headed back to the elevators.

“Is tularemia as bad as plague?” Terese asked.

“It’s hard to make comparisons,” Jack said. “But it’s bad, particularly the pneumonic form, which is highly contagious. If Susanne Hard were still here she could tell us exactly how bad it is.”

“Why are you so surprised?” Terese asked. “Is it as rare as plague?”

“Probably not,” Jack said. “It’s seen in a wider area in the U.S. than plague, particularly in southern states like Arkansas. But like plague it’s not seen much in the winter, at least not up here in the north. Here it’s a late-spring and summer problem, if it exists at all. It needs a vector, just like plague. Instead of the rat flea it’s usually spread by ticks and deerflies.”

“Any tick or deerfly?” Terese asked. Her parents had a cabin up in the Catskills where she liked to go in the summer. It was isolated and surrounded by forest and fields. There were plenty of ticks and deerflies.

“The reservoir for the bacteria is small mammals like rodents and especially rabbits,” Jack said. He started to elaborate but quickly stopped. He’d suddenly recalled that afternoon’s conversation with Susanne’s husband, Maurice. Jack remembered being told that Susanne liked to go to Connecticut, walk in the woods, and feed wild rabbits!

“Maybe it was the rabbits,” Jack mumbled.

“What are you talking about?” Terese asked.

Jack apologized for thinking out loud. Shaking himself out of a momentary daze, he motioned for Terese to follow him into his office and to take Chet’s chair. He described his phone conversation with Susanne’s husband and explained about the importance of wild rabbits in relation to tularemia.

“Sounds incriminating to me,” Terese said.

“The only problem is that her exposure to the Connecticut rabbits was almost two weeks ago,” Jack mused. He drummed his fingers on his telephone receiver. “That’s a long incubation period, especially for the pneumonic form. Of course, if she didn’t catch it in Connecticut, then she had to catch it here in the city, possibly at the General. Of course, nosocomial tularemia doesn’t make any more sense than nosocomial plague.”

“One way or the other the public has to know about this,” Terese said. She nodded toward his hand on the phone. “I hope you are calling the media as well as the hospital.”

“Neither,” Jack said. He glanced at his watch. It was still before midnight. He picked up the phone and dialed. “I’m calling my immediate boss. The politics of all this are his bailiwick.”

Calvin picked up on the first ring but mumbled as if he’d been asleep. Jack cheerfully identified himself.

“This better be important,” Calvin growled.

“It is to me,” Jack said. “I wanted you to be first to know you owe me another ten dollars.”

“Get outta here,” Calvin boomed. The grogginess had disappeared from his voice. “I hope to God this isn’t some kind of sick joke.”

“No joke,” Jack assured him. “The lab just reported it in tonight. The Manhattan General had a case of tularemia in addition to its two cases of plague. I’m as surprised as anyone.”

“The lab called you directly?” Calvin said.

“Nope,” Jack said. “One of the PAs just gave it to me.”

“Are you in the office?” Calvin asked.

“Sure am,” Jack said. “Working my fingers to the bone.”

“Tularemia?” Calvin questioned. “I’d better read up on it. I don’t think I’ve ever seen a case.”

“I read up on it just this afternoon,” Jack admitted.

“Make sure there are no leaks from our office,” Calvin said. “I won’t call Bingham tonight, because there’s nothing to be done at the moment. I’ll let him know first thing in the morning, and he can call the commissioner, and she can call the Board of Health.”

“Okay,” Jack said.

“So you are going to keep it a secret,” Terese said angrily as Jack hung up the receiver.

“It’s not my doing,” Jack said.

“Yeah, I know,” Terese said sarcastically. “It’s not your job.”

“I already got myself in trouble over the plague episode for calling the commissioner on my own,” Jack said. “I don’t see any benefit by doing it again. Word will be out in the morning through the proper channels.”

“What about people over at the General who are suspected of having plague?” Terese questioned. “They might have this new disease. I think you should let everyone know tonight.”

“That’s a good point,” Jack said. “But it doesn’t really matter. The treatment for tularemia is the same as the treatment for plague. We’ll wait until morning. Besides, it’s only a few hours away.”

“What if I alerted the press?” Terese asked.

“I’ll have to ask you not to do that,” Jack said. “You heard what my boss said. If it were investigated, the source would come back to me.”

“You don’t like advertising in medicine and I don’t like politics in medicine,” Terese said.

“Amen,” Jack said.