Contagion

24

Jack walked rapidly toward the General. After the conversation with Terese he needed some fresh air. She had a way of agitating him. Not only was she emotionally confusing, but she was also right about the Black Kings. As much as Jack didn’t want to think about it, he was taking a chance defying their threat. The questions were: Whom had he irritated enough to send a gang to threaten him, and did the threat confirm his suspicions? Unfortunately there was no way to know. As he’d told Terese, he would have to be careful. The problem with that flippant answer, of course, was that he had no idea with whom he had to be careful. He assumed it would have to be Kelley, Zimmerman, Cheveau, or Abelard because those were the people he’d irritated. The trick was to avoid them all.

As Jack rounded the final corner, it was immediately apparent that things were abnormal at the hospital. Several wooden police sawhorses stood on the sidewalk, and two New York City uniformed policemen lounged on either side of the main door. Jack stopped to watch them for a moment, since they seemed to be spending more time talking with each other than anything else.

Feeling confused about their role, Jack went up to them and asked.

“We were supposed to discourage people from going into the hospital,” one officer said. “There was some kind of epidemic in there, but they think it’s under control.”

“We’re really here more for crowd control,” the other officer admitted. “They were expecting trouble earlier when they were toying with the idea of quarantining the facility, but things have settled down.”

“For that we can all be thankful,” Jack said. He started forward, but one of the officers restrained him.

“You sure you want to go in?” he asked.

“Afraid so,” Jack said.

The officer shrugged and let Jack pass.

The minute Jack entered through the door he was confronted by a uniformed hospital security officer wearing a surgical mask.

“I’m sorry,” the officer said. “No visitors today.”

Jack pulled out his medical examiner’s badge.

“Sorry, Doctor,” the officer said. He stepped aside.

Although calm outside, the inside of the hospital was still in a minor furor. The lobby was filled with people. What gave the scene a surrealistic aura was that everyone was wearing a mask.

With the sudden cessation of new meningococcal cases some twelve hours earlier, Jack was reasonably confident that a mask was superfluous. Yet he wanted one, not so much for protection as for disguise. He asked the security officer if they were available. He was directed to the unmanned information desk, where he found several boxes. Jack took one out and put it on.

Next he located the doctors’ coatroom. He entered when one of the staff doctors was exiting. Inside he took off his bomber jacket and searched for an appropriately sized long white coat. When he found one, he put it on, then returned to the lobby.

Jack’s destination was central supply. He felt that if he was to learn anything on this visit, it would be there. He got off the elevator on the third floor and was impressed with how much less patient traffic there was than there had been on his visit the previous Thursday. A glance through the glass portal on the OR suite doors told him why. Apparently the ORs had been temporarily shut down. With some knowledge of hospital cash flow, Jack surmised that AmeriCare must be having a financial stroke.

Jack pushed through the swinging doors into central supply. Even there the level of activity was a quarter of what it had been on his first visit. He only saw two women near the end of one of the long aisles between the floor-to-ceiling shelving. Like everyone else he’d seen so far, they were wearing masks. Obviously the hospital was taking this last outbreak particularly seriously.

Avoiding the aisle with the women, Jack set off for Gladys Zarelli’s office. She’d been receptive on his first visit, and she was the supervisor. Jack couldn’t think of a better person with whom to talk.

As he walked through the department, Jack eyed the myriad hospital supplies and equipment stacked on the shelves. Seeing such a profusion of items made him wonder if there had been anything unique sent from central supply to the index cases. It was an interesting thought, he reasoned, but he couldn’t imagine how it would matter. There was still the question of how the women in central supply could have come in contact with the patient and the infecting bacteria. As he’d been told, the employees rarely, if ever, even saw a patient.

Jack found Gladys in her office. She was on the phone, but when she saw him standing at her door, she motioned exuberantly for him to come in. Jack sat down on a straight-back chair opposite her narrow desk. With the size of the office, he could not help overhearing both sides of Gladys’s conversation. As he might have imagined, she was busy recruiting.

“Sorry to keep you waiting,” she said when she finished her call. Despite her problems she was as affable as the last time Jack had talked with her. “But I’m in desperate need of more help.”

Jack reintroduced himself, but Gladys said she’d recognized him despite the mask. So much for the disguise, Jack thought glumly.

“I’m sorry about what’s happened,” Jack said. “It must be difficult for you for all sorts of reasons.”

“It’s been terrible,” she admitted. “Just terrible. Who would have guessed? Four wonderful people!”

“It’s shocking,” Jack said. “Especially since it’s so unusual. As you said last time I was here, no one in this department had ever caught anything serious before.”

Gladys raised her uplifted hands. “What can you do?” she said. “It’s in God’s hands.”

“It might be in God’s hands,” Jack said. “But usually there is some way to explain this kind of contagion. Have you given it any thought at all?”

Gladys nodded vigorously. “I’ve thought about it until I was blue in the face,” she said. “I don’t have a clue. Even if I didn’t want to think about it, I’ve had to because everybody has been asking me the same question.”

“Really,” Jack said with a twinge of disappointment. He’d had the idea he was exploring virginal territory.

“Dr. Zimmerman was in here right after you on Thursday,” Gladys said. “She came with this cute little man who kept sticking his chin out as if his collar button were too tight.”

“That sounds like Dr. Clint Abelard,” Jack said, realizing he truly was strolling a beaten path.

“That was his name,” Gladys said. “He sure could ask a lot of questions. And they’ve been back each time someone else has gotten sick. That’s why we’re all wearing our masks. They even had Mr. Eversharp down here from engineering, thinking there might have been something messed up with our air-conditioning system, but apparently that’s fine.”

“So they haven’t come up with any explanation?” Jack said.

“Nope,” Gladys said. “Unless they haven’t told me. But I doubt that. It’s been like Grand Central in here. Used to be no one came. Some of these doctors, though, they’re a little strange.”

“How so?” Jack asked.

“Just weird,” Gladys said. “Like the doctor from the lab. He’s come down here plenty of times lately.”

“Is that Dr. Cheveau?” Jack asked.

“I think so,” Gladys said.

“In what way was he strange?” Jack asked.

“Just unfriendly,” Gladys said. She lowered her voice as if telling a secret. “I asked him if I could help him a couple of times, and he bites my head off. He says he just wants to be left alone. But, you know, this is my department. I’m responsible for all this inventory. I don’t like people wandering around, even doctors. I had to tell him.”

“Who else has been around?” Jack asked.

“A bunch of the bigwigs,” Gladys said. “Even Mr. Kelley. Usually I’d only see him at the Christmas party. Last couple of days he’s been down here three or four times, always with a bunch of people. Once with that little doctor.”

“Dr. Abelard?” Jack asked.

“That’s the one,” Gladys said. “I can never remember his name.”

“I hate to ask you the same questions as the others,” Jack said. “But did the women who died perform similar tasks? I mean, did they share some specific job?”

“Like I told you last time,” Gladys said, “we all pitch in.”

“None of them went up to the patients’ rooms who died of the same illnesses?” Jack asked.

“No, nothing like that,” Gladys said. “That was the first thing that Dr. Zimmerman checked.”

“Last time I was here you printed out a big list of all the stuff that you’d sent up to the seventh floor,” Jack said. “Could you make the same list for an individual patient?”

“That would be more difficult,” Gladys said. “The order usually comes from the floor, and then it is the floor that enters it into the patient’s data.”

“Is there any way you could come up with such a list?” Jack asked.

“I suppose,” Gladys said. “When we do inventory there is a way of double-checking through billing. I could tell billing I’m doing that kind of check even though we’re not officially doing inventory.”

“I’d appreciate it,” Jack said. He took out one of his cards. “You could either call me or just send it over.”

Gladys took the card and examined it. “I’ll do anything that might help,” she said.

“One other thing,” Jack said. “I’ve had my own run-in with Mr. Cheveau and even a few of the other people around here. I’d appreciate it if this was just between you and me.”

“Isn’t he weird!” Gladys said. “Sure, I won’t tell anybody.”

Easing out from in front of Gladys’s desk, Jack bid good-bye to the robust woman and exited central supply. He wasn’t in the best of moods. After beginning with high expectations, the only thing of note he’d been told was something he already knew: Martin Cheveau was irascible.

Jack pushed the down button at the bank of elevators while he pondered his next move. He had two choices: either he could just leave and minimize his risk, or he could make a careful visit to the lab. Ultimately, he decided in favor of the lab. Chet’s comment about the lack of availability of pathological bacteria carried the day, since it had raised a question Jack needed to answer.

When the elevator doors opened, Jack started to board, but then he hesitated. Standing directly in front of the crowded car was Charles Kelley. Jack recognized him instantly despite his mask.

Jack’s first impulse was to back away and let the elevator go. But such a move would have only drawn attention. Instead he put his head down, proceeded onto the elevator, and immediately turned to face the closing door. The administrator was standing right behind him. Jack half expected a tap on the shoulder.

Luckily, Kelley had not recognized him. The administrator was deep in conversation with a colleague about how much it was costing the hospital to transport the ER patients by ambulance and the clinic patients by bus to their nearest facility. Kelley’s agitation was palpable. He said their self-imposed semi-quarantine would have to end.

Kelley’s companion assured him that everything was being done that could be done, since the city and state regulatory people were all there making an evaluation.

When the doors opened on the second floor, Jack exited with great relief, especially when Kelley didn’t get off as well. With such a close call, Jack wondered if he was doing the right thing, but after a moment of indecision he elected to continue with a quick visit to the lab. After all, he was right there.

In contrast to the rest of the hospital, the lab was in full swing. The outer lobby area was thronged with hospital personnel, all of whom were masked.

Jack was confused as to why so many hospital employees were there but thankful because it was easy to blend in with the crowd. With his mask and white lab coat he fit in perfectly. Since Martin’s office was just off this main reception, Jack had worried that he’d be apt to run into him. Now he felt the chances were next to nil.

At the far end of the room was a series of cubicles used by the technicians to draw blood or obtain other samples from clinic patients. Near them the crowd concentrated. As Jack wormed his way past this area it dawned on him what was going on. The entire hospital staff was having throat cultures taken.

Jack was impressed. It was an appropriate response to the current outbreak. Since most meningococcal epidemics resulted from a carrier state, there was always a chance the carrier was a hospital employee. It had happened in the past.

A glance into the last cubicle made Jack do a double take. Despite a mask and even a surgical cap, Jack recognized Martin. He literally had his sleeves rolled up as he worked as a technician, swabbing throat after throat. Next to him on a tray the used swabs were piling up in an impressive pyramid. Obviously, everyone in the lab was pitching in.

Feeling even more confident, Jack slipped through the doors into the lab itself. No one paid him any attention. In sharp contrast to the comparative pandemonium in reception, the lab’s interior was a study in automated solitude. The only sounds were a muted chorus of mechanical clicks and low-pitched beeps. There were no technicians in sight.

Jack made a beeline for the microbiology section. His hope was to run across either the head tech, Richard, or the vivacious Beth Holderness. But when he arrived he found no one. The micro area appeared as deserted as the rest of the lab.

Jack approached the spot where Beth had been working on his last visit. There he found something encouraging. A Bunsen burner was aflame. Next to it was a tray of throat culture swabs and a large stack of fresh agar plates. On the floor stood a plastic trash barrel brimming with discarded culture tubes.

Sensing that Beth must be in the immediate area, Jack began to explore. The microbiology section was a room about thirty feet square divided by two rows of countertop. Jack walked down the center aisle. Along the back wall were several biosafety cabinets. Jack rounded the lab bench to his right and glanced into a small office. It had a desk and a file cabinet. On a bulletin board he could see some photos. Without going into the room, Jack recognized Richard, the head tech, in several of them.

Moving on, Jack came abreast of several polished aluminum insulated doors that looked like walk-in refrigerators. Glancing over to the opposite side of the room, he saw a regular door that he thought could lead into a storeroom. As he was about to head in that direction one of the insulated doors opened with a loud click that made him jump.

Beth Holderness emerged along with a waft of warm, moist air and nearly collided with Jack. “You scared me to death,” she said, pressing a hand to her chest.

“I’m not sure who scared whom more,” Jack said. He then reintroduced himself.

“Don’t worry, I remember you,” Beth said. “You caused quite a stir, and I don’t think you should be here.”

“Oh?” Jack questioned innocently.

“Dr. Cheveau is really mad at you,” Beth said.

“Is he now?” Jack said. “I’ve noticed he’s been rather grumpy.”

“He can be cranky,” Beth admitted. “But Richard said something about your accusing him of spreading the bacteria that we’ve been experiencing here at the General.”

“Actually, I didn’t accuse your boss of anything,” Jack said. “It was only an implication I made after he irritated me. I’d come over here just to have a conversation with him. I really wanted his opinion about the plausibility of all these relatively rare illnesses having appeared so close together and at this time of year. But for reasons unknown to me, he was in as inhospitable a mood as he’d been on my previous visit.”

“Well, I must admit I was surprised how he treated you the day we met,” Beth said. “Same with Mr. Kelley and Dr. Zimmerman. I just thought you were trying to help.”

Jack had to restrain himself from giving this lively young woman a hug. It seemed as if she were the only person on the planet who appreciated what he was doing.

“I was so sorry about your co-worker, Nancy Wiggens,” Jack said. “I imagine it’s been difficult for you all.”

Beth’s cheerful face clouded over to the point just shy of tears.

“Maybe I shouldn’t have said anything,” Jack said when he noticed her reaction.

“It’s all right,” Beth managed. “But it was a terrible shock. We all worry about such a thing, but hope it will never happen. She was such a warm person, although she could be a bit reckless.”

“How so?” Jack asked.

“She just wasn’t as careful as she should have been,” Beth said. “She took chances, like not using one of the hoods when it was indicated or not wearing her goggles when she was supposed to.”

Jack could understand that attitude.

“She didn’t even take the antibiotic Dr. Zimmerman prescribed for her after the plague case,” Beth said.

“How unfortunate,” Jack said. “That might have protected her against the Rocky Mountain spotted fever.”

“I know,” Beth said. “I wish that I had tried harder to convince her. I mean, I took it, and I don’t think I was exposed.”

“Did she happen to say she did anything different when she got samples from Lagenthorpe?” Jack asked.

“No, she didn’t,” Beth said. “That’s why we feel she was exposed down here in the lab when she processed the samples. Rickettsia are notoriously dangerous in the lab.”

Jack was about to respond when he noticed that Beth had begun to fidget and look over his shoulder. Jack glanced in the direction she was looking, but there was no one there.

“I really should be getting back to work,” Beth said. “And I shouldn’t be talking with you. Dr. Cheveau told us specifically.”

“Don’t you find that strange?” Jack said. “After all, I am a medical examiner in this city. Legally I have a right to investigate the deaths of the patients assigned to us.”

“I guess I do,” Beth admitted. “But what can I say? I just work here.” She stepped around Jack and went back to her workstation.

Jack followed her. “I don’t mean to be a pest,” he said. “But my intuition tells me something weird is going on here; that’s why I keep coming back. A number of people have been acting defensive, including your boss. Now there could be an explanation. AmeriCare and this hospital are a business, and these outbreaks have been tremendously disruptive economically. That’s reason enough for people to be acting strangely. But from my point of view it’s more than that.”

“So what do you want from me?” Beth asked. She’d taken her seat and gone back to transferring the throat cultures to the agar plates.

“I’d like to ask you to look around,” Jack said. “If pathological bacteria are being deliberately spread they have to come from somewhere, and the microbiology lab would be a good place to start looking. I mean, the equipment is here to store and handle the stuff. It’s not as if plague bacteria is something you’d find anywhere.”

“It wouldn’t be so strange to find it on occasion in any standard lab,” Beth said.

“Really?” Jack questioned. He’d assumed that outside of the CDC and maybe a few academic centers, plague bacteria would be a rarity.

“Intermittently labs have to get cultures of all different bacteria to test the efficacy of their reagents,” Beth said as she continued to work. “Antibodies, which are often the main ingredient in many modern reagents, can deteriorate, and if they do the tests would give false negatives.”

“Oh, of course,” Jack said. He felt stupid. He should have remembered all this. All laboratory tests had to be constantly checked.

“Where do you get something like plague bacteria?”

“From National Biologicals in Virginia,” Beth said.

“What’s the process for getting it?” Jack asked.

“Just call up and order it,” Beth said.

“Who can do that?” Jack asked.

“Anybody,” Beth said.

“You’re joking,” Jack said. Somehow he’d thought the security at a minimum would be comparable to that involved in getting a controlled drug like morphine.

“I’m not joking,” Beth said. “I’ve done it many times.”

“You don’t need some special permit?” Jack asked.

“I have to get the signature of the director of the lab on the purchase order,” Beth said. “But that’s just to guarantee that the hospital will pay for it.”

“So let me get this straight,” Jack said. “Anyone can call these people up and have plague sent to them?”

“As long as their credit is okay,” Beth said.

“How do the cultures come?” Jack said.

“Usually by mail,” Beth said. “But if you pay extra and need it faster you can get overnight service.”

Jack was appalled, but he tried to hide his reaction. He was embarrassed at his own naïveté. “Do you have this organization’s phone number?” he asked.

Beth pulled open a file drawer to her immediate right, leafed through some files, and pulled out a folder. Opening it up, she took out a sheet and indicated the letterhead.

Jack wrote the number down. Then he pointed to the phone. “Do you mind?” he asked.

Beth pushed the phone in his direction but glanced up at the clock as she did so.

“I’ll just be a second,” Jack said. He still couldn’t believe what he’d just been told.

Jack dialed the number. The phone was answered and a recording gave him the name of the company and asked him to make a selection. Jack pressed two for sales. Presently a charmingly friendly voice came on the line and asked if she could be of assistance.

“Yes,” Jack said. “This is Dr. Billy Rubin and I’d like to place an order.”

“Do you have an account with National Biologicals?” the woman asked.

“Not yet,” Jack said. “In fact, for this order I’d just like to use my American Express card.”

“I’m sorry, but we only accept Visa or MasterCard,” the woman said.

“No problem,” Jack said. “Visa will be fine.”

“Okay,” the woman said cheerfully. “Could I have your first order?”

“How about some meningococcus,” Jack said.

The woman laughed. “You’ll have to be more specific,” she said. “I need the serologic group, the serotype, and the subtype. We have hundreds of meningococcus subspecies.”

“Uh-oh!” Jack said, pretending to have been suddenly paged. “An emergency has just come up! I’m afraid I’ll have to call back.”

“No problem,” the woman said. “Call anytime. As you know, we’re here twenty-four hours a day to serve your culture needs.”

Jack hung up the phone. He was stunned.

“I have the feeling you didn’t believe me,” Beth said.

“I didn’t,” Jack admitted. “I didn’t realize the availability of these pathogens. But I’d still like you to look around here and see if these offending bugs might somehow be stashed here now. Could you do that?”

“I suppose,” Beth said without her usual enthusiasm.

“But I want you to be discreet,” Jack said. “And careful. I want this just between you and me.”

Jack took out one of his cards and wrote his home number on the back. He handed it to her. “You can call me anytime, day or night, if you find anything or if you get into any trouble because of me. Okay?”

Beth took the card, examined it briefly, and then stuck it into her lab coat pocket. “Okay,” she said.

“Would you mind if I asked for your number?” Jack said. “I might have some more questions myself. Obviously microbiology isn’t my forte.”

Beth thought for a moment, then relented. She got out a piece of paper and wrote her phone number down. She handed it to Jack, who put it into his wallet.

“I think you’d better go now,” she said.

“I’m on my way,” Jack said. “Thanks for your help.”

“You’re welcome,” Beth said. She was her old self again.

Preoccupied, Jack walked out of the microbiology section and headed across the main portion of the lab. He still couldn’t believe how easy it was to order pathological cultures.

About twenty feet from the double swinging doors that connected the lab to the reception area, Jack stopped dead in his tracks. Backing through the doors was a figure that looked alarmingly like Martin. The individual was carrying a tray loaded with prepared throat swabs ready for plating.

Jack felt like a criminal caught in the act. For a fraction of a second he contemplated fleeing or trying to hide. But there was no time. Besides, irritation at the absurdity of his fear of being recognized inspired him to stand his ground.

Martin held the door open for a second figure Jack recognized as Richard. He, too, was carrying a tray of throat swabs. It was Richard who saw Jack first.

Martin was a quick second. He recognized Jack immediately, despite the mask.

“Hi, folks,” Jack said.

“You…!” Martin cried.

“It is I,” Jack said cheerfully. He grabbed the end of his face mask with his thumb and forefinger and pulled it away from his face to give Martin an unobstructed look.

“You’ve been warned about sneaking around in here,” Martin snapped. “You’re trespassing.”

“Not so,” Jack said. He produced his medical examiner’s badge and pointed it toward Martin’s face. “Just making an official site visit. There’ve been a few more regrettable infectious deaths over here at the General. At least this time you were able to make the diagnosis on your own.”

“We’ll see whether this is a legitimate site visit,” Martin said. He heaved the tray of throat swabs onto the countertop and snatched up the nearest phone. He told the operator to put him through to Charles Kelley.

“Couldn’t we just discuss this like grown-ups?” Jack asked.

Martin ignored the question as he waited for Kelley.

“Out of curiosity, maybe you could just tell me why you were so accommodating on my first visit and so nasty on my next,” Jack said.

“In the interim Mr. Kelley informed me what your attitude had been on that first day,” Martin said. “And he told me he had learned that you were here without authorization.”

Jack was about to respond when it became clear that Kelley had come on the line. Martin informed the administrator that he’d again found Dr. Stapleton lurking in the lab.

While Martin listened to an apparent monologue from Kelley, Jack moved over and leaned casually against the nearest countertop. Richard, on the other hand, stood rooted in place, still supporting his tray of throat swabs.

Martin punctuated Kelley’s apparent tirade with a few strategically placed yeses and a final “Yes sir!” at the end of the conversation. As he hung up the phone he treated Jack to a supercilious smile.

“Mr. Kelley told me to inform you,” Martin said haughtily, “that he will be personally calling the mayor’s office, the Commissioner of Health, and your chief. He’ll be lodging a formal complaint concerning your harassment of this hospital while we’ve been making every effort to deal with a state of emergency. He also told me to inform you that our security will be up here in a few moments to escort you off the premises.”

“That’s terribly considerate of him,” Jack said. “But I really don’t need to be shown the way out. In fact, I was on my way when we happened to bump into each other. Good day, gentlemen.”