Contagion

27

NEW YORK CITY

The first thing Jack did when he woke up was to try calling Beth Holderness. When she’d still not answered he’d tried to be optimistic about her visiting a friend, but in the face of everything that had happened, the inability to get ahold of her was progressively more distressing.

Still without a bike, Jack was forced back into the subway for his commute. But he wasn’t alone. From the moment Jack had emerged from his tenement he’d been trailed by one of the younger members of the local gang. His name was Slam, in deference to his dunking ability with the basketball. Even though he was Jack’s height, he could outjump Jack by at least twelve inches.

Jack and Slam did not talk during the train ride. They sat opposite each other, and although Slam didn’t try to avoid eye contact, his expression never changed from one of total indifference. He was dressed like most of the younger African-Americans in the city, with oversized clothes. His sweatshirt was tentlike, and Jack preferred not to imagine what it concealed. Jack didn’t believe that Warren would have sent the young man out to protect Jack without some significant weaponry.

As Jack crossed First Avenue and mounted the steps in front of the medical examiner’s office, he glanced behind him. Slam had paused on the sidewalk, obviously confused as to what he should do. Jack hesitated as well. The unreasonable thought went through Jack’s mind of inviting the man in so that he could pass the time in the second-floor canteen, but that was clearly out of the question.

Jack shrugged. Although he appreciated Slam’s efforts on his behalf, it was Slam’s problem what he was going to do for the day.

Jack turned back to the building, steeling himself for the possibility of having to face one or more bodies in whose death he somehow felt complicit.

Gathering his courage, Jack pulled open the door and entered.

Even though he was scheduled for a “paper day” and no autopsies, Jack wanted to see what had come in during the night. Not only was he concerned about Reginald and the vagrants, he was also concerned about the possibility of more meningococcus cases.

Jack had the receptionist buzz him into the ID area. Walking into the scheduling room, Jack knew instantly that it was not going to be a normal day. Vinnie was not sitting in his usual location with his morning newspaper.

“Where’s Vinnie?” Jack asked George.

Without looking up, George told Jack that Vinnie was already in the pit with Bingham.

Jack’s pulse quickened. Given his guilt about the previous evening’s events, he had the irrational thought that Bingham could have been called in to do Reginald. At this stage of his career Bingham rarely did autopsies unless they were of particular interest or importance.

“What’s Bingham doing in this early?” Jack asked, trying to sound disinterested.

“It’s been a busy night,” George said. “There was another infectious death over at the General. Apparently it’s got the city all worked up. During the night the city epidemiologist called the Commissioner of Health, who called Bingham.”

“Another meningococcus?” Jack asked.

“Nope,” George said. “They think this one is a viral pneumonia.”

Jack nodded and felt a chill descend his spine. His immediate concern was hantavirus. He knew there had been a case on Long Island the previous year in the early spring. Hantavirus was a scary proposition, although it was still not an illness with much patient-to-patient spread.

Jack could see there were more than the usual number of folders on the desk in front of George. “Anything else interesting last night?” Jack asked. He shuffled through the folders looking for Reginald’s name.

“Hey,” George complained. “I got these things in order.” He looked up, then did a double take. “What the hell happened to you?”

Jack had forgotten how bad his face looked.

“I tripped when I was out jogging last night,” Jack said. Jack didn’t like to lie. What he said was true, but hardly the whole story.

“What did you fall into?” George asked. “A roll of barbed wire?”

“Any gunshot wounds last night?” Jack asked, to change the subject.

“You’d better believe it,” George said. “We got four. Too bad it’s a paper day for you. I’d give you one.”

“Which ones are they?” Jack asked. He glanced around the desk.

George tapped the top of one of his stacks of folders.

Jack reached over and picked up the first one. When he opened the cover, his heart sank. He had to reach out and steady himself against the desk. The name was Beth Holderness.

“Oh, God, no,” Jack murmured.

George’s head shot up again. “What’s the matter?” he asked. “Hey, you’re as white as a sheet. You okay?”

Jack sat in a nearby chair and put his head down between his legs. He felt dizzy.

“Is it someone you know?” George asked with concern.

Jack straightened up. The dizziness had passed. He took a deep breath and nodded. “She was an acquaintance,” he said. “But I’d spoken with her just yesterday.” Jack shook his head. “I can’t believe it.”

George reached over and took the folder from Jack’s hands. He opened it up. “Oh, yeah,” he said. “This is the lab tech from over at the General. Sad! She was only twenty-eight. Supposedly shot through the forehead for a TV and some cheap jewelry. What a waste.”

“What are the other gunshot wounds?” Jack asked. For the moment he remained seated.

George consulted his master sheet. “I’ve got a Hector Lopez, West Hundred and Sixtieth Street, a Mustafa Aboud, East Nineteenth Street, and Reginald Winthrope, Central Park.”

“Let me see Winthrope,” Jack said.

George handed Jack the folder.

Jack opened it up. He wasn’t looking for anything in particular, but his sense of involvement made him want to check the case. The strangest thing was that had it not been for Spit, Jack himself would have been represented there on George’s desk with his own folder. Jack shuddered. He handed Reginald’s folder back to George.

“Is Laurie here yet?” Jack asked.

“She came in just before you did,” George said. “She wanted some folders, but I told her that I’d not made out the schedule yet.”

“Where is she?” Jack asked.

“Up in her office, I guess,” George said. “I really don’t know.”

“Assign her the Holderness and the Winthrope cases,” Jack said. Jack stood up. He anticipated feeling dizzy again, but he didn’t.

“How come?” George asked.

“George, just do it,” Jack said.

“All right, don’t get mad,” George said.

“I’m sorry,” Jack said. “I’m not mad. Just preoccupied.”

Jack walked back through communications. He passed Janice’s office, where she was putting in her usual overtime. Jack didn’t bother her. He was too absorbed by his own thoughts. Beth Holderness’s death made him feel unhinged. Feeling guilty about his complicity in her losing her job was bad enough; the idea that she might have lost her life because of his actions was unthinkable.

Jack pressed the button for the elevator and waited. The attempt on his own life the night before had given more weight to his suspicions. Someone had tried to kill him after he refused to heed the warning. The very same night Beth Holderness had been murdered. Could it have been in the course of an unrelated robbery or could it have been because of Jack, and, if so, what did that mean about Martin Cheveau? Jack didn’t know. But what he did know was that he could not involve anyone else in this affair for fear of putting them in jeopardy. From that moment on, Jack knew he had to keep everything to himself.

As George had surmised, Laurie was in her office. While waiting for George to assign the day’s cases, she was using the time profitably, working on some of her uncompleted cases. She took one look at Jack and recoiled. Jack offered the same explanation he’d given George, but he could tell that Laurie wasn’t quite convinced.

“Did you hear that Bingham is down in the pit?” Jack asked, to move the conversation away from his previous night’s experiences.

“I did,” Laurie said. “I was shocked. I didn’t think there was anything that could get him here before eight, much less in the autopsy room.”

“Do you know anything about the case?” Jack asked.

“Just that it was atypical pneumonia,” Laurie said. “I spoke with Janice for a moment. She said they’d had preliminary confirmation it was influenza.”

“Uh-oh!” Jack said.

“I know what you’re thinking,” Laurie said, wagging her finger. “Influenza was one of the diseases you said you’d use if you were a terrorist type trying to start an epidemic. But before you go jumping off using this as confirmation of your theory, just remember that it is still influenza season.”

“Primary influenza pneumonia is not very common,” Jack said, trying to stay calm. The mention of the word “influenza” had his pulse racing again.

“We see it every year,” Laurie said.

“Maybe so,” Jack said. “But I tell you what. How about calling that internist friend of yours and asking if there are any more cases?”

“Right now?” Laurie asked. She glanced at her watch.

“It’s as good a time as any,” Jack said. “She’ll probably be making her rounds. She can use the computer terminal at one of the nurses’ stations.”

Laurie shrugged and picked up her phone. A few minutes later she had her friend on the line. She asked the question, then waited. While she waited she looked up at Jack. She was worried about him. His face was not only scratched up, it was now flushed.

“No cases,” Laurie repeated into the phone when her friend came back on the line. “Thanks, Sue. I appreciate it. Talk to you soon. Bye.”

Laurie hung up the phone. “Satisfied?” she said.

“For the moment,” Jack said. “Listen: I asked George to assign you two particular cases this morning. The names are Holderness and Winthrope.”

“Is there some specific reason?” Laurie asked. She could see that Jack was trembling.

“Do it as a favor,” Jack said.

“Of course,” Laurie said.

“One thing I’d like you to do is look for any hairs or fibers on the Holderness woman’s body,” Jack said. “And find out if homicide had a criminologist at the scene to do the same. If there are any hairs, see if there is a DNA match with Winthrope.”

Laurie didn’t say anything. When she found her voice, she asked: “You think that Winthrope killed Holderness?” Her voice reflected her disbelief.

Jack looked off and sighed. “There’s a chance,” he said.

“How would you know?” Laurie asked.

“Let’s call it a disturbing hunch,” Jack said. He would have liked to tell Laurie more, but with the new pact he had with himself, he didn’t. He wasn’t about to put anyone else at risk in any form or fashion.

“Now you really have my curiosity going,” Laurie said.

“I’d like to ask one more favor,” Jack said. “You told me that you had a relationship with a police detective who’s now a friend.”

“That’s true,” Laurie said.

“Do you think you could give him a call?” Jack said. “I’d like to talk with him sorta off the record.”

“You are scaring me,” Laurie said. “Are you in some kind of trouble?”

“Laurie,” Jack said. “Please don’t ask any questions. The less you know right now the better off you are. But I think I should talk to someone high up in law enforcement.”

“You want me to call him now?”

“Whenever is convenient,” Jack said.

Laurie blew out through pursed lips as she dialed Lou Soldano’s number. She’d not talked to him in a few weeks, and she felt it was a little awkward calling about a situation she knew so little about. But she was definitely worried about Jack and wanted to help.

When police headquarters answered and Laurie asked for Lou, she was told the detective wasn’t available. She left a message on his voice mail for him to call her.

“That’s the best I could do,” Laurie said as she hung up. “Knowing Lou, he’ll be back to me as soon as he can.”

“I appreciate it,” Jack said. He gave her shoulder a squeeze. He had the comforting sense she was a true friend.

Jack went back to his own office just in time to run into Chet. Chet took one look at Jack’s face and whistled.

“And what did the other guy look like?” Chet asked jokingly.

“I’m not in the mood,” Jack said. He took off his jacket and hung it over his chair.

“I hope this doesn’t have anything to do with those gang members who visited you Friday,” Chet said.

Jack gave the same explanation he’d given to the others.

Chet flashed a wry smile as he stowed his coat in his file cabinet. “Sure, you fell while jogging,” he said. “And I’m dating Julia Roberts. But, hey, you don’t have to tell me what happened; I’m just your friend.”

That was exactly the point, Jack mused. After checking to see if he had any phone messages, he started back out of the office.

“You missed a nice little dinner last night,” Chet said. “Terese came along. We talked about you. She’s a fan of yours, but she’s as concerned as I am about your monomania concerning these infectious cases.”

Jack didn’t even bother to answer. If Chet or Terese knew what had really happened last night, they’d be more than concerned.

Returning to the first floor, Jack looked into Janice’s office. Now he wanted to ask her about the influenza case that was being posted by Bingham, but she’d left. Jack descended to the morgue level and changed into his isolation gear.

He went into the autopsy room and walked up to the only table in operation. Bingham was on the patient’s right, Calvin on the left, and Vinnie at the head. They were almost done.

“Well, well,” Bingham said when Jack joined them. “Isn’t this convenient? Here’s our in-house infectious expert.”

“Perhaps the expert would like to tell us what this case is,” Calvin challenged.

“I’ve already heard,” Jack said. “Influenza.”

“Too bad,” Bingham said. “It would have been fun to see if you truly have the nose for this stuff. When it came in early this morning there was no diagnosis yet. The suspicion was some sort of viral hemorrhagic fever. It had everybody up in arms.”

“When did you learn it was influenza?” Jack asked.

“A couple of hours ago,” Bingham answered. “Just before we started. It’s a good case, though. You want to see the lungs?”

“I would,” Jack said.

Bingham reached into the pan and lifted out the lungs. He showed the cut surface to Jack.

“My God, the whole lung is involved!” Jack commented. He was impressed. In some areas there was frank hemorrhage.

“Even some myocarditis,” Bingham said. He put the lung back and lifted up the heart and displayed it for Jack. “When you can see the inflammation grossly like this, you know it’s extensive.”

“Looks like a virulent strain,” Jack said.

“You’d better believe it,” Bingham said. “This patient’s only twenty-nine years old, and his first symptoms occurred around six last night. He was dead at four A.M. It reminds me of a case I did back in my residency during the pandemic of fifty-seven and fifty-eight.”

Vinnie rolled his eyes. Bingham had a mind-numbing habit of comparing every case to one that he’d had in his long career.

“That case was also a primary influenza pneumonia,” Bingham continued. “Same appearance of the lung. When we looked at it histologically we were amazed at the degree of damage. It gave us a lot of respect for certain strains of influenza.”

“Seeing this case concerns me,” Jack said. “Especially in light of the other diseases that have been popping up.”

“Now, don’t head off into left field!” Bingham warned, remembering some of Jack’s comments the day before. “This isn’t out of the ordinary, like the plague case or even the tularemia. It’s flu season. Primary influenza pneumonia is a rare complication, but we see it. In fact we had a case just last month.”

Jack listened, but Bingham wasn’t making him feel any more comfortable. The patient in front of them had had a lethal infection with an agent that had the capability of spreading from patient to patient like wildfire. Jack’s only consolation was the call Laurie had made to her internist friend who’d said there were no other cases in the hospital.

“Mind if I take some washings?” Jack asked.

“Hell no!” Bingham said. “Be my guest. But be careful what you do with them.”

“Obviously,” Jack said.

Jack took the lungs over to one of the sinks, and with Vinnie’s help prepared some samples by washing out some of the small bronchioles with sterile saline. He then sterilized the outside of the containers with ether.

Jack was on his way out when Bingham asked him what he was going to do with the samples.

“Take them up to Agnes,” Jack said. “I’d like to know the subtype.”

Bingham shrugged and looked across at Calvin.

“Not a bad idea,” Calvin said.

Jack did exactly what he said he would. But he was disappointed when he presented the bottles to Agnes up on the third floor.

“We don’t have the capability of subtyping it,” she said.

“Who does?” Jack asked.

“The city or state reference lab,” Agnes said. “Or even over at the university lab. But the best place would be the CDC. They have a whole section devoted to influenza. If it were up to me, I’d send it there.”

Jack got some viral transport medium from Agnes and transferred the washings into it. Then he went up to his office. Sitting down, he placed a call to the CDC and was put through to the influenza unit. A pleasant-sounding woman answered, introducing herself as Nicole Marquette.

Jack explained what he wanted, and Nicole was accommodating. She said she’d be happy to see that the influenza was typed and subtyped.

“If I manage to get the sample to you today,” Jack said, “how long would it take for you to do the typing?”

“We can’t do this overnight,” Nicole said, “if that’s what you have in mind.”

“Why not?” Jack asked impatiently.

“Well, maybe we could,” Nicole corrected herself. “If there is a sufficient viral titer in your sample, meaning enough viral particles, I suppose it is possible. Do you know what the titer is?”

“I haven’t the faintest idea,” Jack said. “But the sample was taken directly from the lung of a patient who passed away from primary influenza pneumonia. The strain is obviously virulent, and I’m worried about a possible epidemic.”

“If it is a virulent strain, then the titer might be high,” Nicole said.

“I’ll find a way to get it to you today,” Jack promised. He then gave Nicole his telephone number both at the office and at home. He told her to call anytime she had any information.

“We’ll do the best we can,” Nicole said. “But I have to warn you, if the titer is too low it might be several weeks before I get back to you.”

“Weeks!” Jack complained. “Why?”

“Because we’ll have to grow the virus out,” Nicole explained. “We usually use ferrets, and it takes a good two weeks for an adequate antibody response which guarantees we’ll have a good harvest of virus. But once we have the virus in quantity, we can tell you a lot more than just its subtype. In fact, we can sequence its genome.”

“I’ll keep my fingers crossed that my samples have a high titer,” Jack said. “And one other question. What subtype would you think was the most virulent?”

“Whoa!” Nicole said. “That’s a hard question. There are a lot of factors involved, particularly host immunity. I’d have to say the most virulent would be an entirely new pathological strain, or one that hasn’t been around for a long time. I suppose the subtype that caused the pandemic of 1918 to 1919 that killed twenty-five million people worldwide might get the dubious honor of having been the most virulent.”

“What subtype was that?” Jack asked.

“No one knows for sure,” Nicole said. “The subtype doesn’t exist. It disappeared years ago, maybe right after the epidemic wore itself out. Some people think it was similar to the subtype that caused that swine-flu scare back in seventy-six.”

Jack thanked Nicole and again assured her he’d get the samples to her that day. After he hung up, he called Agnes back and asked her opinion on shipping. She told him the name of the courier service they used, but she said she didn’t know if they shipped interstate.

“Besides,” Agnes added, “it will cost a small fortune. I mean overnight is one thing, but you’re talking about the same day. Bingham will never authorize it.”

“I don’t care,” Jack said. “I’ll pay for it myself.”

Jack called the courier company. They were delighted with the request and put Jack through to one of the supervisors, Tony Liggio. When Jack explained what he wanted, Tony said no problem.

“Can you come to pick it up now?” Jack asked. He was encouraged.

“I’ll send someone right away,” Tony said.

“It will be ready,” Jack said.

Jack was about to hang up when he heard Tony add: “Aren’t you interested in the cost? I mean, this is not like taking something over to Queens. Also, there’s the question of how you plan to pay.”

“Credit card,” Jack said. “If that’s okay.”

“Sure, no problem, Doc,” Tony said. “It’s going to take me a little while to figure out the exact charge.”

“Just give me a ballpark figure,” Jack said.

“Somewhere between one and two thousand dollars,” Tony said.

Jack winced but didn’t complain. Instead, he merely gave Tony his credit card number. He’d envisioned the cost would be two or three hundred dollars, but then he hadn’t thought about the fact that someone might have to fly round-trip to Atlanta.

While Jack had been engaged in giving his credit card information, one of the secretaries from the front office had appeared at his door. She’d handed him an overnight Federal Express package and departed without saying a word. As Jack hung up from the courier service he saw that the parcel was from National Biologicals. It was the DNA probes he’d requested the day before.

Taking the probes and his viral samples, Jack went back down to Agnes. He told her about the arrangements he’d made with the courier service.

“I’m impressed,” Agnes said. “But I’m not going to ask how much it’s costing.”

“Don’t,” Jack advised. “How should I package the samples?”

“We’ll take over,” she said. She called in the department secretary and commissioned her to do it with appropriate biohazard containers and labels.

“Looks like you have something else for me,” she said, eyeing the vials containing the probes.

Jack explained what they were and what he wanted, namely to have the DNA lab use the probes to see if they reacted with the nucleoproteins of the cultures taken from any of the four recent infectious disease cases he’d been working on. What he didn’t tell her was why he wanted it done.

“All I need to know is whether it is positive or not,” Jack said. “It doesn’t have to be quantitative.”

“I’ll have to handle the rickettsia and the tularemia agent myself,” Agnes said. “I’m afraid to have any of the techs working with them.”

“I really appreciate all this,” Jack said.

“Well, it’s what we’re here for,” Agnes said agreeably.

After leaving the lab Jack went downstairs to the scheduling room and helped himself to some coffee. He’d been so frantic since he’d arrived that he’d not had much time to think. Now, as he stirred his coffee, he realized that neither of the homeless men that he’d inadvertently run into in his flight from Reginald had been brought in. That meant that they were either in some hospital or they were still out there in the park.

Carrying his coffee back upstairs, Jack sat down at his desk. With both Laurie and Chet in the autopsy room, he knew he could count on some peace and quiet.

Before he could enjoy his solitude, the phone interrupted. It was Terese.

“I’m mad at you,” she said without preamble.

“That’s wonderful,” Jack said with his usual sarcasm. “Now my day is complete.”

“I am angry,” Terese maintained, but her voice had softened considerably. “Colleen just hung up from talking with Chet. He told her you were beaten up again.”

“That was Chet’s personal interpretation,” Jack said. “The fact is, I wasn’t beaten up again.”

“You weren’t?”

“I explained to Chet that I’d fallen while jogging,” Jack said.

“But he told Colleen…”

“Terese,” Jack said sharply. “I wasn’t beaten up. Can we talk about something else?”

“Well, if you weren’t assaulted, why are you sounding so irritable?”

“It’s been a stressful morning,” Jack admitted.

“Care to talk about it?” she asked. “That’s what friends are for. I’ve certainly bent your ear about my problems.”

“There’s been another infectious death at the General,” Jack said. He would have liked to tell her what was really on his mind-his sense of guilt about Beth Holderness-but he dared not.

“That’s terrible!” Terese said. “What is wrong with that place? What is it this time?”

“Influenza,” Jack said. “A very virulent case. It’s the kind of illness I’ve been truly worried we’d see.”

“But the flu is around,” Terese said. “It’s flu season.”

“That’s what everybody says,” Jack admitted.

“But not you?”

“Put it this way,” Jack said. “I’m worried, especially if it is a unique strain. The deceased was a young patient, only twenty-nine. In the face of what else has been popping up over there at the General, I’m worried.”

“Are some of your colleagues worried as well?” Terese asked.

“At the moment, I’m on my own,” Jack admitted.

“I guess we’re lucky to have you,” Terese said. “I have to admire your dedication.”

“That’s kind of you to say,” Jack said. “Actually, I hope I’m wrong.”

“But you’re not going to give up, are you?”

“Not until I have some proof one way or the other,” Jack said. “But let’s talk about you. I hope you are doing better than I.”

“I appreciate your asking,” Terese said. “Thanks in no small part to you, I think we have the makings of a good ad campaign. Plus, I’ve managed to have the in-house presentation put off until Thursday, so we have another whole day of breathing room. At the moment things are looking reasonable, but in the advertising world that could change at any moment.”

“Well, good luck,” Jack said. He wanted to get off the phone.

“Maybe we could have a quick dinner tonight,” Terese suggested. “I’d really enjoy it. There’s a great little Italian restaurant just up the street on Madison.”

“It’s possible,” Jack said. “I’ll just have to see how the day progresses.”

“Come on, Jack,” Terese complained. “You have to eat. We both could use the relaxation, not to mention the companionship. I can hear the tension in your voice. I’m afraid I’m going to have to insist.”

“All right,” Jack said, relenting. “But it might have to be a short dinner.” He realized there was some truth to what Terese was saying, although at the moment it was hard for him to think as far ahead as dinnertime.

“Fantastic,” Terese said happily. “Call me later and we’ll decide on the time. If I’m not here, I’ll be home. Okay?”

“I’ll call you,” Jack promised.

After they exchanged good-byes, Jack hung up the phone. For a few minutes he stared at it. He knew that conventional wisdom held that talking about a problem was supposed to relieve anxiety. But at the moment, having talked about the case of influenza with Terese, he only felt more anxious. At least the viral sample was on its way to the CDC and the DNA lab was working with the probe from National Biologicals. Maybe soon he’d start to get some answers.