Critical

21

"Hello, excuse me!" a voice called.

Laurie looked up from her work. One of the histology technicians was standing in the doorway, clutching a cardboard tray for microscope slides.

"Maureen asked me to run these down," the woman said. "She also asked me to apologize for not getting them to you sooner. Two people called in sick today."

"No problem," Laurie said. She reached over and took the tray. "Thanks for bringing them, and thank Maureen for getting them to me so quickly."

"Will do," the woman said amiably.

Clutching the tray, Laurie looked back at her cluttered desk. Working nonstop, she had filled in only approximately two-thirds of her matrix, although the process, as painstaking as it was, was speeding up, since she had become accustomed to where in the hospital records she'd find the specific information she wanted. She'd also added more categories as she'd gone on, which forced her to go back to cases she thought she'd finished. One thing was certain: With as many categories as she now had, constructing the matrix was significantly more work than she'd originally imagined.

Although Laurie enjoyed a certain compulsive contentment about her progress, it had to contend with a growing disappointment that her efforts were probably not going to provide any insight into the mystery. As she worked, she'd hoped that she'd see some unexpected commonality, but it wasn't happening. If a few cases were in the same OR, the next one would be in a different OR; if several patients were on the same floor, the next one would be on a different floor; and so on and so forth. Yet she had persisted and would continue to do so, since it was all she had.

Relishing a break from what was essentially tedious data entry, Laurie cleared a space on her desk for her microscope. Turning on the lamp, she slipped the first slide of David Jeffries's lung section into the stage clip, rotated the revolving nosepiece to the lowest objective, and lowered the objective close to but not touching the slide. Putting her eyes to the eyepiece, she used the coarse adjustment knobs to pull the objective back up from the slide until she got an image. Reflexively her hand went to the fine-adjustment knob and brought the image into sharp focus.

Laurie was again awed by the degree of damage wrought by the bacteria, many of which she could see as disc-like clusters in the microscope's two-dimensional field. The normal alveolar structure of the lung was being dissolved by the bacteria's flesh-eating toxins such that abscesses of varying sizes were being formed. As she moved around with the help of the mechanical stage, she could see capillary walls in various stages of sepsis, causing hemorrhages into the septic soup that filled the lungs. The amount of destruction of the lungs' normal architecture reminded her of images of a city following a carpet bombing or a trailer park directly ravaged by a category five hurricane.

For more than an hour Laurie went through the tray of slides one by one. Using a higher-power lens, Laurie was even more impressed with the bacteria's pathogenicity. Focusing in on fibrous tissue responsible for maintaining the lung's normal structural architecture, she could see that the tissue was coming apart like the skin of an onion. Covalent bonds were being broken and collagen itself was dissolving into its constituent molecules.

"Hey, sweetie," Jack said as he quietly breezed in. He was becoming progressively adept on his crutches. "How's your day going?"

Laurie looked up, her face paler than usual.

"What's up?" Jack questioned. His smile waned. "You look terrible."

Laurie took in a deep breath and let it out. The tissue destruction she had been viewing had had a visceral effect on her. The fact that it had occurred within hours in a previously healthy person couldn't help but underline how fragile human beings ultimately were. The idea of enjoying any sort of health seemed a miracle.

Jack put his hand on her shoulder. "Really, are you okay?"

Laurie nodded and took another breath. She tapped the barrel of her microscope. "I think you ought to take a look at this. Keep in mind it was a normal, healthy person just a few hours earlier."

Laurie pushed herself back from the desk to give Jack room.

Jack put his crutches aside and leaned down toward the eyepiece, but about halfway he hesitated, then regained full height.

"Wait a second," he said suspiciously. "Is this a setup? Am I being slyly seduced into looking at a slide of your MRSA case from yesterday?"

"Remind me never to try to slip something by you," Laurie said with a wan smile. Her blood pressure had quickly risen back to normal, returning color to her face and clearing the accompanying queasiness. She admitted it was a section of lung from David Jeffries.

Jack looked into the microscope, and, moving the mechanical stage, he took a quick tour of the section. "Wow," he said. "It's totally destroyed. I see hardly any normal architecture."

"Does it change your mind about elective surgery where you might find yourself dealing with such a pathogen?"

"Laurie!" Jack scolded.

"Okay," Laurie said, pretending to be nonchalant. "I just thought I'd ask."

"How were your cases today? You seemed to have been engrossed more than usual."

"They were fine, particularly from a teaching perspective, such that they took longer than I hoped. I wanted to get up here ASAP and work on my matrix." She patted the legal pad. "It's the only thing left that I have that has a snowball's chance in hell to convince you that you are specifically at risk for being exposed to MRSA during your scheduled surgery."

"And?" Jack asked, looking at Laurie askance.

"I haven't found anything yet," she admitted before looking at her watch. "But I still have about fifteen hours."

"Ye gods. And you call me bullheaded."

"You are bullheaded. I'm merely persistent, and, of course, I have the added benefit of being right."

Jack waved Laurie away and gathered his crutches. "I'm heading to my office to clean things up since I'll be gone for a few days." He emphasized the few days.

"How were your cases today?"

"Don't ask. Riva promised some good ones; instead she gave me two natural deaths and an accidental one, none of which were at all challenging. Lou's case was more interesting. The slug's caliber and the indentations from an apparent chain to keep her sunk suggested the same killer. The difference was she was raped."

"Tragic."

"Another testament to the inherent wickedness of man."

"I'm glad you said man. Now get out of here. I only have fifteen hours."

"What time do you want to leave this evening?"

"Actually, we should take separate cabs, unless you want to stay late. I want to finish this matrix."

"I'll come back here when I'm done in case you change your mind. I don't want to hang around, because I want to watch my buddies play basketball to remind me why I'm willing to go under the knife."

On that issue, Laurie had to hold her tongue. Instead, she said, "Is Chet still in your office, or has he left for the day?"

"I wouldn't know. I stopped in here first."

"Well, if he is, you should try to dampen his enthusiasm for his new lady friend."

"Oh? How come?"

"By coincidence, she's the CEO of the company that has built the three Angels specialty hospitals."

"Really?" Jack said, raising his eyebrows. "That is a coincidence. Why dampen his enthusiasm?"

"She's the one who all but ordered me out of the orthopedic hospital yesterday. I don't know about long-term, but right now I question her motivation."

"Not to worry," Jack said. "I'm sure Chet will have eyes for someone else tonight. A week from now, he won't even remember her name."

"I hope so, for his sake."

With Jack out of her office, Laurie went back to the microscope. Although she had made an effort to appear upbeat with Jack, she was again feeling despondent. She'd joked about the fifteen hours, but in reality, it was far too little time to solve a mystery that had been confounding people with Ph.D.s in epidemiology.

Suddenly, Laurie's hand stopped twirling the horizontal mechanical stage control. She'd seen something unusual zip past the microscope's field. Since she was viewing at high-power, objects moved very quickly in and out of the field with very little rotation of the control. She slowly reversed direction with the control, and the strange object came into view.

Laurie was entranced. It appeared to be in the middle of what had been a bronchiole, probably close to what had been an alveolus, or the terminal sac in the bronchial tree where oxygen entered the blood and carbon dioxide came out. Laurie immediately questioned whether it had been there originally or was an artifact, inadvertently introduced or formed during the slide's preparation. It was about the size of the white cells Laurie had seen, which were the body's defensive cells, but there was no nucleus. It had absorbed almost none of the standard stain used by histology.

Most remarkable, it was a nearly round disk, symmetrical with a scalloped border, giving it a stellate appearance. Why she thought the symmetry was important was that most artifacts she'd seen didn't have such symmetry. Laurie looked at the object itself. The scalloped border comprised about one-fifth the diameter. The center of the object was opaque, with the mere hint of either nodularity or being mottled. One minute she'd see it, the next minute she wouldn't. She wished the object had taken the stain, because if it had, she would have known if what she was seeing was real or something she was conjuring up. Trying to keep her excitement in check, Laurie took out a grease pencil to mark the glass slide so that if the scope's mechanical stage were to accidentally move, she could find the object again. She did this by placing four dots in the cardinal directions. Satisfied, Laurie then shifted to low power. When she looked in again, the object was significantly smaller, and because it lacked staining, it tended to blend in to the chaotic surroundings.

Switching back to high power, she made sure the object, whatever it was, was still in the field. With that ascertained, she quickly went down to get Jack.

When Jack looked at the object, he said, "My gosh, how did one of my grandmother's butter cookies get into David Jeffries's lung?"

"Be serious," Laurie said. "What do you think it is?"

"I'm not fooling. It looks just like it came from one of my grandmother's cookie cutters. We called it a star, but obviously it has far too many rounded points."

"Do you think it is an artifact?"

"That would be my first guess, but it is surprisingly symmetrical. I suppose that's due to the dynamic tension between the hydrophilic and hydrophobic forces at the interface of the menisci."

"What the hell is that?"

"How should I know?" Jack said, still looking at the microscopic object. "I'm just running off at the mouth, speaking pseudo-scientific gibberish."

Laurie swatted Jack's shoulder playfully. "Here I thought you knew what you were talking about."

Jack looked up. "Sorry, I have no idea what it is. I don't even know if it is real or artifact."

"Nor do I," Laurie admitted.

"Have you found any others, or is this it?"

"So far that's it. Now that I found it, though, I'm eager to see if there are more."

"Do you have any idea what it could be?"

"I know what I think it looks like, but it can't be."

"Come on! Run it by me!"

"It looks like a diatom. Do you remember those from biology?"

"I can't say that I do."

"You must. They're a type of algae or phytoplankton with silicate cell walls."

"Give me a break," Jack said. "Now, how do you remember that?"

"They're so beautiful, kinda like snowflakes. I did sketches of them in high-school biology."

"Well, congratulations on your discovery. But if you're interested in my vote, I'd say I'd lean toward artifact rather than a pelagic diatom unless the university gave him a glass of Antarctic sea water as part of his terminal treatment."

"Very funny," Laurie said sarcastically. "Artifact or not, I'm going to look for more."

"Good luck! Say, I'm about to head out. Do you want to change your mind and come along?"

"Thank you but no thank you. I'm going to look at these slides for a while, then finish my matrix. Don't wait up for me. I know you're going to bed early."

"Good grief, Laurie. You're beating a dead horse."

"Maybe so, but I'm not sure I'm going to sleep that much tonight, one way or the other."

Jack bent down to give Laurie a hug, but she stood up and gave him a real one.

"See you later," Jack said, affectionately touching the end of Laurie's nose with his index finger.

"What's that for?" Laurie asked, reflexively backing away.

Jack shrugged. "Beats me. I just wanted to touch you because, I guess…" Jack paused, acting suddenly self-conscious. "I guess I think you are terrific."

"Get out of here, you oaf," Laurie said, nudging him. Jack's clumsy sentiment threatened to break down Laurie's carefully constructed defenses. In truth, her own emotions were barely under the surface. On the one hand, she wanted to support him through his surgery, as she assumed he could use, as everyone could, but on the other hand, she didn't want to lose him and was furious that he was putting her in such a conflicted state.

Gathering up his crutches and giving Laurie a final smile, Jack left. Laurie stood for a moment, looking at the stacks representing her twenty-five MRSA cases. Quickly leaning out into the hall, she called down to Jack, "Remember to use that antibiotic soap tonight!"

"It's on my list," Jack yelled back without turning around.

Laurie ducked back into her office. She stood for a moment, recognizing that one of the struggles with having a real relationship with another was to allow the person to be themselves and make some decisions independently, with hopefully enlightened self-interest. What it boiled down to from Laurie's perspective, and the question of whether to have the surgery or not was a good example, was that a real lover had to recognize that there were two centers of the universe.

Pushing what she feared was sophomoric philosophizing out of her mind, Laurie sat back down at her desk. Her eyes flicked back and forth between her microscope and her matrix. Both beckoned. Although she thought the matrix the most promising in the long haul, the diatom-like apparent artifact was the most seductive.

Leaning forward, Laurie put her face to the eyepiece. What she wanted to do was scan the entire slide methodically to see if there were any more of the diatom-like objects.

ANGELO PULLED TO a stop at the same location he and Franco had been when they'd left their stakeout earlier. They were at the curb on First Avenue where it crossed 30th Street. The OCME was just off to the right. Traffic was rush-hour heavy.

Angelo put the van in park and used the emergency brake. "No Range Rover," he said, making a stab at justifying his behavior at noontime.

"Don't even go there," Franco said, making himself comfortable. He'd gotten a coffee and a hero at Johnny's, as had Angelo.

"Here come Richie and Freddie," Angelo said, looking in the rearview mirror and watching the white van pull up within a foot behind them.

Franco didn't answer. He was intent on surveying the area to make sure there were no apparent problems, such as parked police cars or loitering flatfoot patrolmen.

Angelo took a swig from his coffee, then unwrapped his sub. When he was finished, he glanced out the windshield and started.

"The boyfriend!" Angelo called out loud enough to make Franco slosh a dollop of coffee into his crotch. Angelo blindly reached for the small cast-iron bottle of ethylene and a plastic bag.

"Shit!" Franco yelled, straightening his back to lift his butt off the seat.

Angelo ditched the ethylene onto the floor and reached behind his seat for a roll of paper towels without taking his eyes off the OCME's front door.

Franco used a few towels to blot up the coffee from his seat, and a few more to wipe his pants. Only then did he look out the windshield. "Where's Montgomery?"

"I don't know," Angelo said dejectedly "Jesus. This woman is such a pain in the ass. Where the hell is she?"

They watched as Jack stood with his arm raised and crutches tucked into his armpits. He had advanced out into the street as far as he dared with the traffic zooming past him.

"This is probably better," Franco said. "Without the boyfriend interfering, the snatch will be far easier."

"You're probably right," Angelo said. "I just hope she didn't leave early."

"Relax!" Franco countered. "Don't be such a pessimist."

"WOULD YOU LIKE some more tea?" the waiter asked.

Adam shook his head. He was sitting in the Pierre's oval high-tea room jutting off the main corridor leading to the hotel's Fifth Avenue entrance. When he'd been a preteen, it had been his favorite room in the hotel, with its whimsical murals and, more important, with its afternoon selection of cookies and crumpets. As he turned the page of the Arts section of the Times, he felt his BlackBerry vibrate. Taking the mobile device out, he saw that he had an e-mail. Using the appropriate buttons, he opened it. It was short and simple: 63 West 106th.

After signing the check to his room, Adam went up to gather his things. He was encouraged. The timing seemed to be impeccable. Ten minutes later, he was climbing back into the Range Rover. Sensing that the mission would soon be over, he changed the selection on the CD changer from Bach back to Beethoven.

LAURIE LEANED WAY back in her chair, and it squeaked in protest. With the tips of her fingers, she rubbed her eyes. She'd been so intent on staring into the microscope's eyepiece that she'd seemingly failed to blink as often as she should have. Her eyes had a gritty feeling, but the massage was rapidly therapeutic, and after only five seconds of rubbing followed by a series of rapid blinks, she was fine.

Although Laurie still had no idea whatsoever what the scalloped, disc-shaped object was, she'd found two more on the slide. And since all three were mirror images of each other, she felt they could not be artifacts introduced when the slides had been prepared. They were definite objects that had been in David Jeffries's lung at the time of his death.

Laurie's excitement soared. She even allowed herself to fantasize that she'd discovered a new infectious agent that in conjunction with staph made for an exceptionally lethal combination. At that point, she dashed down to histology and confronted Maureen, who was about to lock up for the night. After pleading her cause, Laurie convinced the woman to locate filed pulmonary slides on a handful of the former MRSA cases. After thanking her effusively, Laurie dashed back to her office.

To her delight, she found more of the diatom-like objects, and she noticed that the amounts differed from case to case, with some cases having none. They were extremely rare and consistently unstained, which excused her colleagues from having not seen them. It was at that point that the matrix had provided its first payoff. Although the matrix had not been completed, it had provided a seeming corroboration of the pathogenicity of the discs. The shorter the period between the onset of the individual patient's symptoms and the time of death, the more diatom-like objects Laurie found. Although this discovery hadn't been akin to fulfilling Koch's postulate confirming a microorganism as the source of a particular disease, Laurie felt encouraged. Very encouraged.

With her eyes feeling as though they were back to normal, Laurie grabbed her Rolodex. Obviously, she had to try to identify the scalloped, microscopic objects. A few years earlier, Jack had had a similar situation about a liver cyst, and he'd taken the slide over to the NYU Medical Center and had it looked at by a giant in the field of pathology, Dr. Peter Malovar. Despite being in his nineties and a professor emeritus, he still maintained an office and a reputation of maintaining his encyclopedic mind. The man's life was his work, especially since his wife had died twenty years earlier.

With a shaking hand, Laurie punched the numbers of Malovar's extension into her phone, hoping that the rumors of the long hours the aged pathologist maintained were correct. She kept her fingers crossed as the phone rang once, then twice, and to her delight was picked up at the commencement of the third ring.

Dr. Malovar's voice had a slight but pleasing English accent, a grandfather-like calmness, and a surprising clarity for a nonagenarian. Laurie told her story in a rapid monologue, tripping over her words at times in her haste. When she finished, there was a pause. For a second, she'd feared that she'd been cut off.

"Well, this is an unexpected treat," Dr. Malovar said happily. "Offhand, I have no idea what this diatom-like object is but I would love to see it. It sounds perfectly intriguing."

"Would there be any chance of my bringing it over now?" Laurie questioned.

"I would be delighted," Dr. Malovar insisted.

"It's not too late? I mean, I don't want to keep you."

"Nonsense, Dr. Montgomery. I'm here until ten or eleven every evening. I'm at your disposal."

"Thank you. I'll be over shortly Is it difficult to find your office?"

Laurie was given explicit instructions before she hung up. She got her coat and hurried out to the elevator. As she boarded, her stomach growled as a visceral reminder that she'd skipped lunch. With Dr. Malovar having assured her he was not about to leave, she pressed the second-floor button. There wasn't much choice in the lunchroom's vending machines, but she trusted she could find something of caloric value, if nothing else.

The lunchroom was a favorite hangout for the support staff, especially during meal hours, and that evening was no exception. It was just after seven, and half of the three-to-eleven shift were present. With its stark concrete walls, the sound level in the room was almost painful for Laurie in contrast to her office's silence. As she stood in front of one of the vending machines, anxiously trying to decide which selection was the least bad for her, she heard her name over the din. Turning, she saw the smiling faces of Jeff Cooper and Pete Molimo. They were the evening shift Health and Hospital Corporation van drivers who went out to fetch the bodies. As with most of the rest of the staff, Laurie had become friendly with them over the years. Laurie and Jack, in contrast to their colleagues, were more apt to visit scenes during the evening and night hours, because they both felt such visits were exceedingly helpful.

The men were enjoying a break in their routine. They had finished their meals, as evidenced by the debris on their table. Except for rush-hour auto accidents, calls of deaths during mealtime were relatively rare and didn't pick up again until after nine. Both had their feet up on the opposing empty chairs at their four-top table.

"Haven't seen you much, Dr. Montgomery," Jeff said.

"Yeah, where've you been hiding?" Pete added.

Laurie smiled. "Either in my office or in the pit."

"You're a little late for going home, aren't you?" Pete asked. "Most of the other MEs are out of here before five."

"I've been working on a special project," Laurie said. "In fact, I'm not even going home now. I'm heading over to NYU Medical Center."

"How are you getting over there? I don't know what it's doing now, but it was sprinkling an hour or so ago."

"I'm walking," Laurie said. "It's too short for a cab ride."

"Why don't I run you over?" Pete offered. "We're just sitting here, and I'm tired of talking to this die-hard Boston fan."

"What if you get a call?" Laurie asked.

"What's the difference. I got a radio."

It took Laurie two seconds to make up her mind. "Are you ready to go now?"

"You bet," Pete said, gathering up his trash.

In a lot of ways, it was ludicrous to ride, because the medical center entrance was on the same block as the OCME, and when they backed out of the morgue's receiving dock onto 30th Street, it was not raining. In fact, there was a patch of pale blue-green sky off to the west and moving closer.

"This is rather silly," Laurie said, as Pete almost immediately turned into the curved driveway at the medical center's entrance several hundred feet down First Avenue. He managed to get up to only about twenty miles per hour. "I'm sorry to trouble you."

"No trouble at all," Pete assured her. "I was glad to get away from Jeff, the bum. He's so sure the Sox are going to beat the Yankees that he won't shut up about it."

Laurie hopped out of the van, thanked Pete, and used the microscope slide box she was carrying to wave as she hurried through the revolving door. The center was crowded with visitors, but Laurie quickly left them behind on her way to the academic portion of the institution. Using the elevator, she rose to the sixth floor. As she exited, she noticed that the corridor was as silent as the one outside her own office. Most all doors were closed, and she didn't pass a single person.

She found the renowned doctor in a small, windowless interior space that could have been a storeroom but which the aged man had decorated with all his diplomas, rewards, and honors, all protected in simple, glazed black frames. A very large freestanding bookcase filled with all his favorite pathology tomes, some with tooled leather bindings, dominated one wall. Most of the rest of the room was filled by a large mahogany desk piled high with reprints and legal pads covered with erratic cursive.

He stood up and extended a hand as Laurie entered. She was surprised how much he looked like Einstein, with a cumulus of white hair. His back was kyphotic, as if he were anatomically built to look into a microscope.

"I see you have brought the slides," he said, eagerly eyeing Laurie's slide box.

In anticipation of her arrival, he'd positioned his impressive microscope on a customized shelf that pulled out of the end of the desk. It was a teaching scope with double-binocular eyepieces. An impressive digital camera was mounted on top and shared the same view as the eyepieces.

"Should we?" he continued, motioning for Laurie to take the seat positioned on her side of the scope.

Laurie sat. She could see out of the corner of her eye how zealously he watched as she opened her tray and carefully extracted one of the slides marked with grease pencil. Respecting that the microscope was his, she handed him the slide. Eagerly, he placed it onto the mechanical stage and lined up the grease-pencil markings. After he'd lowered the low-power objective, he told her to use the mechanical stage control to find the object of interest.

Having become quite proficient at locating the objects despite their lack of staining, Laurie quickly located one. "I don't know if you can quite see it, but it's under the pointer now."

"I think I see it," Dr. Malovar said. He backed up the objective, changed to higher power, then refocused. "Ah, yes!" he said, as if experiencing visceral pleasure. "Most interesting! Are they all similar?"

"They are," Laurie said. "Strikingly so."

"Such symmetry such an elegant border. Have you observed them on end?"

"No, I haven't," Laurie admitted, "so I don't know if it is disc-shaped or spherical."

"I'd say disc-shaped. Have you noted the slight nodularity?"

"I have, but I didn't know if it was real."

"It's real, all right. Fascinating, as is the degree of necrosis of the lung tissue."

Laurie was dying for him to tell her what it was and questioned why he was teasing her by withholding the information.

"It is quite apparent they are in the bronchioles and not within the alveolar walls."

"I felt the same way," Laurie admitted.

"I can see why you said they looked like diatoms, but I wouldn't have thought of it myself."

Laurie was becoming impatient. Finally, she just asked, "What is it?"

"I have no idea," Dr. Malovar said.

Laurie was stunned. Particularly from the appreciative way he was describing the object, she thought for sure he knew what it was the very instant he'd seen it. Shock turned into dismay when she realized she could not charge home to Jack with new, decisive information. It also made her consider that maybe some of her colleagues had seen them, but dismissed them as being unimportant.

"Do you think that they had anything to do with the fulminant MRSA infections these people had?"

"I have no idea."

"Do you have any idea of how we might identify them?"

"For that, I do have an idea. I'd like to look at them under the scanning electron microscope, especially after slicing one open."

"Is that a lengthy procedure? Can we do it tonight?"

Dr. Malovar leaned back and laughed. "Your eagerness is commendable. No, we cannot do it tonight. There's some skill involved. We do have a talented person, but of course he is gone for the night. I can see if he can at least start tomorrow."

"How about a microbiologist?" Laurie suggested. "Should I show it to a microbiologist?"

"You could, but I'm not optimistic. I've had a bit of microbiology myself." He pointed to a Ph.D. diploma in microbiology.

Laurie was crestfallen.

"But I believe I do know who will be able to identify it at a glance."

Laurie's eyes brightened. Her emotional roller coaster was taking her up once again. "Who?" she asked eagerly.

"Our own Dr. Collin Wiley. My sense is that what we are seeing is a parasite, and Dr. Wiley is department head of parasitology."

"Can we get him to look at it tonight? Do you think he a still here?"

"He is not here. In fact, Dr. Wiley is in New Zealand for a parasitology meeting."

"Good Lord," Laurie murmured. The roller coaster was on its way down again. She visibly sagged in her seat.

"Don't look so forlorn, my dear," Dr. Malovar said, leaning to the side to gaze directly at Laurie with his glacial blue eyes. "We live in the information age. I will simply take a few high-definition digital photos tonight and e-mail them to Dr. Wiley, along with a description of the case. I know for a fact he has his laptop with him, since it has his lectures' Power Points. Could you give me your e-mail address?"

Laurie rummaged in her bag for one of her ME business cards. She handed it over.

"Perfect," Dr. Malovar said, putting it on the corner of his desk.

"When do you suppose I might get an answer?"

"That's totally up to Dr. Wiley. And remember, he's halfway around the world."

After discussing with Dr. Malovar the process of getting a sample of David Jeffries's lung to him, perhaps even the paraffin block used by histology, Laurie left the pathologist's office. As she rode down in the empty elevator, she made a decision. Although she was eager to finish her matrix, she decided to forgo it for the time being and go home. She thought there was a significant chance, maybe not huge but at least possible, that the discovery of the unknown objects might be enough in and of itself to make Jack see the risk issue her way.

Down at the hospital entrance, she was able to catch a taxi with relative ease.

AS SOON AS Adam had turned onto 106th Street, he had sensed his thoughts about the imminent end to the mission were probably unduly optimistic. Instead of being a quiet side street, it had been alive with all sorts of people and children enjoying the improving weather. Driving by Laurie Montgomery's house had added to his feeling, because directly across the street was a sizable and popular playground with an impressive array of mercury vapor lights capable of turning the entire area into day. But what had totally convinced him was when he'd stopped for a few moments to survey the area, he'd spotted Montgomery's injured spouse or boyfriend on the sidelines of an active neighborhood basketball game with more than fifty people either playing or watching. Seeing the man standing there leaning on his crutches strongly suggested to Adam that Laurie was probably already home as well.

But Adam had not been discouraged. Quite the contrary. He still thought the area a far better location than in front of the OCME for the hit. It just meant he'd have to wait for morning, when she would appear at her door on her way to work and either walk east to catch a cab on Central Park West or walk west and snag one on Columbus Avenue. Either way he'd have his opportunity to take her out. And considering Laurie had arrived at work that morning at seven-fifteen, he estimated that she'd left the house around six-forty-five. With that decided, Adam had vowed to be parked in front of Montgomery's house by six-fifteen at the latest the following day.

"Good evening, Mr. Bramford," the doorman said when Adam climbed from the Range Rover back at the Pierre. "Will you be needing your vehicle again this evening?"

"No, but I'd like it to be available at six a.m. sharp. Will that be a problem?"

"No problem whatsoever, Mr. Bramford. It will be waiting for you."

After collecting his things, particularly his tennis case, Adam hurried into the Pierre. He wanted to see if it wasn't too late for the concierge to get him a symphony ticket or a ticket for whatever else was happening that evening at Lincoln Center.

TO BET ANGELO'S attention about the hour, Franco made a production of looking at his watch by sticking out his left arm full length, pulling back his jacket sleeve, rebending his elbow, and rotating his wrist. Next to him, Angelo was staring straight ahead out through the windshield at the darkened scene. Had his eyes not been open with an occasional blink, Franco would have thought he was asleep. The vehicular traffic racing past them on First Avenue had slowed to a mere trickle. Had it not been for the streetlights, it would have been pitch dark. The sun had long since set, and no moon had arisen to take its place.

"It's not going to happen," Franco said at length. "At least not tonight. We can't sit here all night."

"The bitch!" Angelo murmured.

"I know it's frustrating. It's as if she were taunting us. I guess she went home early, just before we got here, or maybe she's working late. Either way, I think we should go. The troops behind us are getting antsy."

"I want to stay another fifteen minutes."

"Angelo! That's what you said a half-hour ago. It's time to move on. We'll come back tomorrow morning. You'll get your revenge soon enough."

"Ten minutes."

"No! We're going now! I wanted to leave a half-hour ago. I've already extended our sitting here longer than I feel comfortable with. I don't want someone noticing us and getting suspicious. Start the van and signal the guys in back!"

Angelo got the engine going and then turned the headlights on and off a few times.

"All right, we're out of here."

Reluctantly, Angelo pulled away from the curb. He drove slowly so that when they came abreast of the OCME, he could look through the front door into the building's interior.

"The place looks dead," Franco said. "How appropriate."

As they drove up First Avenue, Angelo broke the silence. "Maybe we'll have to check out the boyfriend's apartment if we can't get her here at the OCME."

"That's on the bottom of the list," Franco blurted with a shake of his head. He and Angelo had visited Jack's apartment ten years earlier, with disastrous results. "Those neighborhood gang friends of his are a menace to society, and they are always on alert for other gangs. We're going to stick with what we got. I mean, it's not like we've been sitting here for a week, you know what I'm saying."

Angelo nodded, but he wasn't happy. He felt like a kid promised a present but being forced to wait.

AS LAURIE CLIMBED out of the taxi in front of her house, she looked over at the lighted basketball court. It seemed like a particularly crowded evening, which always made the competition that much more fierce. As evidence, Laurie could hear that the cries of accomplishment and derision were more strident than usual. Standing on her tiptoes, Laurie scanned the spectators for Jack. As much as he enjoyed the game, she wouldn't have been surprised if she saw him, but she didn't.

A few minutes later, she found him soaking in the bathtub.

"You're early," he said. "With as much work as you looked like you had with your matrix, I didn't expect to see you until after ten at the earliest. Did you finish already?"

"No, I did not finish," Laurie admitted, as she stripped off her coat and tossed it out into the hallway. She shut the bathroom door to keep in the steamy heat. After putting down the toilet seat cover she sat and locked eyes with Jack.

"I'm soaking in antibiotic soap," Jack said, averting his gaze. Laurie's serious expression and the fact that she was willing to sit in the steamy bathroom gave him the uncomfortable feeling that she was in one of her talking moods and, considering the timing, there was only one subject. "I thought you'd like to know how responsible I'm being," he added.

"I didn't finish my matrix because I found more of those diatom-like objects."

"Really?" Jack said without a lot of enthusiasm.

"Really" Laurie repeated. She then went on to describe how she'd first found more in David Jeffries's slides, and then found them in most of the cases whose slides she was able to get.

"Were they in all cases whose slides you had?" Jack asked. Despite knowing where the discussion was going, Jack found himself interested. He'd convinced himself that the object he'd seen was an artifact of some sort.

"Not all but most. And most interesting is that I discovered with the help of my unseen matrix that the shorter the interval from the onset of symptoms until death, the greater the number of these particles were."

"So you just randomly counted the number on each slide."

"Exactly."

"Well, that's hardly scientific."

"I know," Laurie admitted. "It's just suggestive, but it was consistent, and therefore very supportive."

Jack ran a soapy hand through his hair. "This is all very interesting, but I'm not sure how to interpret it. I mean, neither one of us knows what it is."

"I didn't leave it at that. I called up Dr. Malovar, whom you had praised so highly about your liver cyst."

"How is he? He's a trip, isn't he? I admire the guy. I hope I'm still around at his age, much less still contributing."

"He's fine, but don't you want to know what he said?"

"Of course. What was his diagnosis?"

"He said he didn't know."

Jack gave a short laugh of amazement. "He didn't know at all? I'm shocked."

"He said he thought it was a parasite."

"That's more like it. Then did you get Dr. Wiley to look at it?

"Dr. Wiley unfortunately is in New Zealand at a parasitology conference."

"Well, then I guess we'll have to wait, because Wiley in his field is like Malovar in his."

"Dr. Malovar sent a digital photo, so I'm certain we'll hear when Dr. Wiley gets it."

"Of course, there's no accounting of when that may be."

"I'm afraid not."

"Okay, Laurie," Jack said, sitting up. "What's your real point here? Is this another attempt at getting me to cancel my surgery? If it is, out with it!"

"Of course it is," Laurie said with some heat. "How could it not be, I've found an unknown parasite associated with a rapidly fatal postoperative course. What seems to be happening is a synergism with MRSA, which I have agreed is in every hospital. But this unknown parasite is apparently in only three hospitals, one of which you are scheduled to enter and allow yourself to become a potential victim."

"Laurie, let me remind you that I'm going to have my operation with a surgeon who has not had one case of whatever this is, and he's been operating nonstop at the Angels Ortho Hospital. Well, that's not entirely true. He had to stop when they closed the ORs to fumigate them. But since then, he's been back with a full schedule day in, day out, with no problems whatsoever. Secondly, I do not have a parasitic disease. Maybe that's the basis of this outbreak: These people have visited the backwaters of the Amazon and picked up this parasite unbeknownst to anyone. Hey! I commend your work, and certainly keep at it. If it turns out that this unknown parasite is infectious and you've discovered some new illness, all the power to you. Hell, you might even win a Nobel Prize."

Laurie stood up abruptly. "Don't patronize me!"

"I'm not patronizing you," Jack contended. "I'm just trying to fend off your negativity and prepare myself for this operation tomorrow. You know how I feel about it. What I'd really like is some support on your side, not fearmongering."

Laurie felt a rush of emotion dominated, for the moment, by frustrated anger. Yanking open the bathroom door and slamming it behind her, she stalked down the hall to the darkened living room, where she threw herself onto the couch to brood. Jack had touched the sore spot of her ambivalence.

CARLO NOSED HIS Denali into one of the few parking places along the front of the strip mall. What that meant at nine-thirty on a Wednesday night was that the Venetian was doing a brisk business. Both Carlo and Brennan alighted. The weather had completely cleared up. Despite the garish light coming from a neon gondola on the roof, two stars could be faintly seen in the sky.

Brennan stretched with a few noisy grunts and groans as they walked down the sidewalk toward the restaurant's entrance and passed the open DVD rental store in the process. Brennan's whole body was stiff after sitting in the SUV since five o'clock.

Inside, they had to search the crowd for Louie. Carlo finally found him at a four-top table near the bar. "Wait here!" he said to Brennan and struck off, weaving in and out among the tables. Carlo thought it ironic that the restaurant was doing as well as it was, considering it was in reality a cover for the Vaccarro family's real work. Carlo attributed it to Louie's influence. Louie loved good food and red wine, as was suggested by his body's profile.

When Louie caught sight of Carlo, he excused himself from his buddies, heaved himself to his feet, and took Carlo off to the side. Despite the crowd, it was easy to talk, thanks to the assemblage of black-velvet paintings that crowded every wall and the acoustic ceiling tiles.

"What's up?" Louie asked. "You're early."

"They closed up shop," Carlo explained. "All four of them went back to the Neapolitan, parked the vans, and went inside. We waited a good hour and a half, and when none of them reappeared, we came here to let you know what was up."

"I'm listening."

"Well, nothing, actually. From the moment Arthur and Ted hooked up with Angelo and Franco mid-morning, they've been staking out the medical examiner's office. Except for the one-sided scuffle between Angelo and some unknown guy nothing's happened. They've just sat in their vans, and us in my Denali."

"Any idea why they sat in two vans?"

"No idea whatsoever."

"None of this makes sense," Louie complained. "It's one hell of an effort on their part, but why?"

Carlo shrugged. He had no idea, either, despite the fact that he and Brennan spent part of the afternoon batting around ideas.

"Yet because it doesn't make sense, my intuition tells me it's important," Louie said, and then paused for a minute. "I want you guys to keep up the surveillance, that's for certain. I want to know where Angelo and Franco are and what they are doing. And have Arthur and Ted start early, like at six. I think the reason they didn't hook up with them until the middle of the morning was they went out too late."

"I'll tell them. Anything else?"

"What about the tracking device."

"We got it, and we've got it on the boat. How it works, you'll have to ask Brennan."

"I don't care how it works. I just want to know when the boat goes out and where it goes, so tell Brennan to stay on top of it."