Contagion

18

Jack had been on the phone for over an hour, calling the next of kin of that day’s three infectious disease cases. He’d talked with Laurie before calling Joy Hester’s sister and roommate. Jack didn’t want Laurie to think he was trying to take over her case, but she assured him she didn’t mind.

Unfortunately Jack did not learn anything positive. All he was able to do was to confirm a series of negatives, such as that none of the patients had had contact with wild animals in general or wild rabbits in particular. Only Donald Lagenthorpe had had contact with a pet, and that was his girlfriend’s newly acquired cat, which was alive and well.

Hanging up at the end of the final call, Jack slouched down in his chair and stared moodily at the blank wall. The adrenaline rush he’d felt earlier with the tentative diagnosis of Rocky Mountain spotted fever had given way to frustration. He seemed to be making no headway.

The phone startled Jack and pulled him out of his gloom. The caller identified himself as Dr. Gary Eckhart, a microbiologist at the city reference lab.

“Are you Dr. Stapleton?”

“Yes, I am,” Jack said.

“I’m reporting a positive reaction for Rickettsia rickettsii,” Dr. Eckhart said. “Your patient had Rocky Mountain spotted fever. Will you be reporting this to the Board of Health or do you want me to do it?”

“You do it,” Jack said. “I’m not even sure I’d know whom to call.”

“Consider it done,” Dr. Eckhart said. He hung up.

Jack slowly replaced the receiver. That his diagnosis had been confirmed was as much of a shock as it had been when his diagnoses of the plague and tularemia had been confirmed. These developments were incredible. Within three days he’d seen three relatively rare infectious diseases.

Only in New York, he thought. In his mind’s eye he saw all those planes Calvin had made reference to arriving at Kennedy Airport from all over the world.

But Jack’s shock began to metamorphose to disbelief. Even with all the planes and all the people arriving from exotic locales carrying all manner of vermin, bugs, and microbes, it seemed too much of a coincidence to see back-to-back cases of plague, tularemia, and now Rocky Mountain spotted fever. Jack’s analytical mind tried to imagine what the probability of such an occurrence would be.

“I’d say about zero,” he said out loud.

Suddenly Jack pushed back from his desk and stormed out of his office. His disbelief was now changing to something akin to anger. Jack was sure something weird was going on, and for the moment he was taking it personally. Believing that something had to be done, he headed downstairs and presented himself to Mrs. Sanford. He demanded to talk with the chief.

“I’m afraid Dr. Bingham is over at City Hall meeting with the mayor and the chief of police,” Mrs. Sanford said.

“Oh, hell!” Jack exclaimed. “Is he moving in over there or what?”

“There’s a lot of controversy surrounding that gunshot case this morning,” Mrs. Sanford said warily.

“When will he be back?” Jack demanded. Bingham’s being unavailable was adding to his frustration.

“I just don’t know,” Mrs. Sanford said. “But I’ll be sure to tell him you want to speak with him.”

“What about Dr. Washington?”

“He’s at the same meeting,” Mrs. Sanford said.

“Oh, great!”

“Is there something I can help you with?” Mrs. Sanford asked.

Jack thought for a moment. “How about a piece of paper,” he said. “I think I’ll leave a note.”

Mrs. Sanford handed him a sheet of typing paper. In block letters Jack wrote: LAGENTHORPE HAD ROCKY MOUNTAIN SPOTTED FEVER. Then he drew a half dozen large question marks and exclamation points. Beneath that he wrote: THE CITY BOARD OF HEALTH HAS BEEN NOTIFIED BY THE CITY MICROBIOLOGICAL REFERENCE LAB.

Jack handed the sheet to Mrs. Sanford, who promised that she’d personally see to it that Dr. Bingham got it as soon as he came in. Then she asked Jack where he’d be if the chief wanted to speak with him.

“Depends on when he gets back,” Jack said. “I plan to be out of the office for a while. Of course, he might hear about me before he hears from me.”

Mrs. Sanford regarded him quizzically, but Jack didn’t elaborate.

Jack returned to his office and grabbed his jacket. Then he descended to the morgue and unlocked his bike. Bingham’s exhortations notwithstanding, Jack was on his way to the Manhattan General Hospital. For two days he’d had the suspicion that something unusual was going on over there; now he was sure of it.

After a quick ride, Jack locked his bike to the same sign he’d used on his previous visits and entered the hospital. With visiting hours just beginning, the lobby was jammed with people, particularly around the information booth.

Jack wormed his way through the crowd and climbed the stairs to the second floor. He went directly to the lab and waited in line to speak with the receptionist. This time he asked to see the director, even though his impulse was to march right in.

Martin Cheveau made Jack wait for a half hour before seeing him. Jack tried to use the time to calm himself. He recognized that over the last four or five years he’d become less than tactful in the best of circumstances; when he was upset, as he was now, he could be abrasive.

A laboratory tech eventually came out and informed Jack that Dr. Martin Cheveau would see him now.

“Thanks for seeing me so promptly,” Jack said as he entered the office. Despite his best intentions he couldn’t avoid a touch of sarcasm.

“I’m a busy man,” Martin said, not bothering to stand up.

“I can well imagine,” Jack said. “With the string of rare infectious diseases emanating from this hospital on a daily basis, I’d think you’d be putting in overtime.”

“Dr. Stapleton,” Martin said in a controlled voice. “I have to tell you that I find your attitude distinctly disagreeable.”

“I find yours confusing,” Jack said. “On my first visit you were the picture of hospitality. On my second visit, you were just the opposite.”

“Unfortunately I don’t have time for this conversation,” Martin said. “Is there something in particular you wanted to say to me?”

“Obviously,” Jack said. “I didn’t come over here just for abuse. I wanted to ask your professional opinion about how you think three rare, arthropod-borne diseases have mysteriously occurred in this hospital. I’ve been cultivating my own opinion, but as the director of the lab I’m curious about yours.”

“What do you mean three diseases?” Martin asked.

“I just got confirmation that a patient named Lagenthorpe who expired here in the General last night had Rocky Mountain spotted fever.”

“I don’t believe you,” Martin said.

Jack eyed the man and tried to decide if he was a good actor or truly surprised.

“Well then, let me ask you a question,” Jack said. “What would I accomplish by coming over here and telling you something that wasn’t true? Do you think of me as some sort of health-care provocateur?”

Martin didn’t answer. Instead he picked up the phone and paged Dr. Mary Zimmerman.

“Calling in reinforcements?” Jack asked. “Why can’t you and I have a talk?”

“I’m not sure you are capable of normal conversation,” Martin said.

“Good technique,” Jack commented. “When defense doesn’t work, switch to offense. The problem is, strategies won’t change the facts. Rickettsias are extremely dangerous in the laboratory. Maybe we should make sure whoever handled Lagenthorpe’s specimens did so with proper precautions.”

Martin pressed his intercom button and paged his chief microbiology tech, Richard Overstreet.

“Another thing I’d like to discuss,” Jack said. “On my first visit here you told me how discouraging it was to run your lab with the budgets foisted on you by AmeriCare. On a scale of one to ten, how disgruntled are you?”

“What are you implying?” Martin demanded ominously.

“At the moment I’m not implying anything,” Jack said. “I’m just asking.”

The phone rang and Martin picked it up. It was Dr. Mary Zimmerman. Martin asked her if she could come down to the lab since something important had just come up.

“The problem as I see it is that the probability of these three illnesses popping up as they have is close to zero,” Jack said. “How would you explain it?”

“I don’t have to listen to this,” Martin snarled.

“But I think you have to consider it,” Jack said.

Richard Overstreet appeared in the doorway dressed as he’d been before, in a white lab coat over surgical scrubs. He appeared harried.

“What is it, Chief?” he asked. He nodded a greeting to Jack, who returned the gesture.

“I’ve just learned a patient by the name of Lagenthorpe expired from Rocky Mountain spotted fever,” Martin said gruffly. “Find out who got the samples and who processed them.”

Richard stood for a moment, obviously shocked by the news. “That means we had rickettsia in the lab,” he said.

“I’m afraid so,” Martin said. “Get right back to me.” Richard vanished and Martin turned back to Jack. “Now that you have brought us this happy news, perhaps you could do us the favor and leave.”

“I’d prefer to hear your opinion as to the origin of these diseases,” Jack said.

Martin’s face flushed, but before he could respond Dr. Mary Zimmerman appeared at his door.

“What can I do for you, Martin?” she asked. She started to tell him that she’d just been paged to the ER when she caught sight of Jack. Her eyes narrowed. She was obviously no happier than Martin to see Jack.

“Howdy, Doctor,” Jack said cheerfully.

“I was assured we would not see you again,” Dr. Zimmerman said.

“You can never believe everything you hear,” Jack said.

Just then Richard returned, clearly distraught. “It was Nancy Wiggens,” he blurted out. “She’s the one who got the sample and processed it herself. She called in sick this morning.”

Dr. Zimmerman consulted a note she held in her hand. “Wiggens is one of the patients I’ve just been called to see in the ER,” she said. “Apparently she’s suffering from some sort of fulminant infection.”

“Oh, no!” Richard said.

“What’s going on here?” Dr. Zimmerman demanded.

“Dr. Stapleton just brought news that a patient of ours died from Rocky Mountain spotted fever,” Martin said. “Nancy was exposed.”

“Not here in the lab,” Richard said. “I’ve been a bear about safety. Ever since the plague case I have insisted all infectious material be handled in the biosafety III cabinet. If she were exposed it had to be from the patient.”

“That’s not likely,” Jack said. “The only other possibility is that the hospital is lousy with ticks.”

“Dr. Stapleton, your comments are tasteless and inappropriate,” Dr. Zimmerman said.

“They are a lot worse than that,” Martin said. “Just before you got here, Dr. Zimmerman, he slanderously suggested that I had something to do with the spread of these latest illnesses.”

“That’s not true,” Jack corrected. “I was merely implying that the idea of deliberate spread has to be considered when the probability of them occurring by chance is so negligible. It only makes sense. What’s wrong with you people?”

“I think such thoughts are the product of a paranoid mind,” Dr. Zimmerman said. “And frankly I don’t have time for this nonsense. I’ve got to get to the ER. In addition to Miss Wiggens, there are two other employees with the same severe symptoms. Good-bye, Dr. Stapleton!”

“Just a minute,” Jack said. “Let me guess what areas these two other stricken employees work in. Could they be from nursing and central supply?”

Dr. Zimmerman, who was already several steps away from Martin’s door, paused and looked back at Jack. “How did you know that?” she asked.

“I’m beginning to see a pattern,” Jack said. “I can’t explain it, but it’s there. I mean, the nurse is regrettable but understandable. But someone from central supply?”

“Listen, Dr. Stapleton,” Dr. Zimmerman said. “Perhaps we’re in your debt for once again having alerted us to a dangerous disease. But we will take over from here, and we certainly don’t need any of your paranoid delusions. Good day, Dr. Stapleton.”

“Hold on a minute,” Martin called out to Dr. Zimmerman. “I’ll come with you to the ER. If this is rickettsial disease I want to be sure all samples are handled safely.”

Martin grabbed his long white lab coat from a hook behind the door and ran after Dr. Zimmerman.

Jack shook his head in disbelief. Every visit he’d made to the General had been strange, and this one was no exception. On previous occasions he’d been chased out. This time he’d been all but deserted.

“Do you really think these illnesses could have been spread deliberately?” Richard asked.

Jack shrugged. “To tell you the truth, I don’t know what to think. But there certainly has been some defensive behavior, particularly on the part of those two who just left. Tell me, is Dr. Cheveau generally mercurial? He seemed to turn on me rather suddenly.”

“He’s always been a gentleman with me,” Richard said.

Jack got to his feet. “It must be me, then,” he said. “And I suppose our relations won’t improve after today. Such is life. Anyway, I’d better be going. I sure hope Nancy is okay.”

“You and me both,” Richard said.

Jack wandered out of the lab debating what to do next. He thought about either going to the emergency room to see about the three sick patients or heading up to central supply for another visit. He decided on the emergency room. Even though Dr. Zimmerman and Dr. Cheveau had headed down there, Jack thought the chance of another run-in was remote, given the size of the ER and the constant activity there.

As soon as he arrived he detected a general panic. Charles Kelley was anxiously conferring with several other administrators. Then Clint Abelard came dashing through the main ambulance entry only to disappear down the central corridor.

Jack went over to one of the nurses who was busy behind the main counter. He introduced himself and asked if the hubbub was about the three sick hospital staff.

“It most certainly is,” she said. “They’re trying to decide how best to isolate them.”

“Any diagnosis?” Jack asked.

“I just heard they suspect Rocky Mountain spotted fever,” the nurse said.

“Pretty scary,” Jack said.

“Very,” the nurse said. “One of the patients is a nurse.”

Out of the corner of his eye Jack saw Kelley approaching. Jack quickly faced away. Kelley came to the desk and asked the nurse for the phone.

Jack left the bustling ER. He thought about going up to central supply, but decided against it. Having come close to another confrontation with Charles Kelley, he thought it best to head back to the office. Although he hadn’t accomplished anything, at least he was leaving on his own volition.

“Uh-oh! Where have you been?” Chet asked as Jack came into their office.

“Over at the General,” Jack admitted. He started organizing the clutter on his desk.

“At least you must have behaved yourself; there haven’t been any frantic calls from the front office.”

“I was a good boy,” Jack said. “Well, reasonably good. The place is in an uproar. They have another outbreak. This one is Rocky Mountain spotted fever. Can you believe it?”

“That’s incredible,” Chet said.

“That’s my feeling exactly,” Jack said. He went on to tell Chet how he’d implied to the head of the lab that outbreaks of three rare, infectious, arthropod-borne diseases in as many days couldn’t occur naturally.

“I bet that went over well,” Chet said.

“Oh, he was indignant,” Jack said. “But then he got preoccupied with some fresh cases and forgot about me.”

“I’m surprised you weren’t thrown out again,” Chet said. “Why do you do this to yourself?”

“Because I’m convinced that there’s ‘something rotten in the state of Denmark,’ ” Jack said. “But enough about me. How did your case go?”

Chet gave a short, scornful laugh. “And to think I used to like gunshot cases,” he said. “This one is kicking up a storm. Three of the five bullets entered through the back.”

“That’s going to give the police department a headache,” Jack said.

“And me too,” Chet said. “Oh, by the way, I got a call from Colleen. She wants you and me to come by their studio when we leave work tonight. Listen to this: They want our opinion about some ads. What do you say?”

“You go,” Jack said. “I’ve got to get some of these cases of mine signed out. I’m so far behind it’s scaring me.”

“But they want both of us,” Chet said. “Colleen specifically said that. In fact, she said they particularly wanted you there because you had helped already. Come on, it will be fun. They are going to show us a bunch of sketches outlining some potential TV commercials.”

“Is that really your idea of fun?” Jack asked.

“Okay,” Chet admitted. “I’ve an ulterior motive. I’m enjoying spending time with Colleen. But they want both of us. Help me out.”

“All right,” Jack said. “But for the life of me I don’t understand why you think you need me.”