Critical

22

Trying not to wake Jack, Laurie rolled over and looked at the clock. She'd been awake for almost an hour, and she was now convinced that more sleep was not an option. She didn't know if it was depression, frustration, or dread, or a mixture of all three, but she couldn't stay in bed a moment longer. Her mind was constantly going over the same issues, with the same results.

Being as quiet as she could, she slipped from under the covers, gathered up the clothes she had set out for the day by feel, since the only light came from the clock face, and slowly inched toward the open bathroom door. Once she was in the bathroom, she leaned back into the bedroom to listen to the sound of Jack's breathing. It hadn't changed, which pleased her.

Waking up as early as she had and wanting something to occupy her overly busy mind, Laurie had suddenly thought of heading into work early. She thought she could at least finish her matrix, and whether it would have any effect on Jack's thinking was not the point. As the discussion the previous evening had proved, he was not about to be deterred, and besides, it was clearly too late. His surgery was only four hours and fifteen minutes away.

Laurie showered quickly and put on her usual small amount of makeup. As she did so, she thought about the evening before. It had gone badly at first, with both of them irritated at the other. But that had soon changed, and once again they'd agreed to disagree. Although Laurie said she didn't want to have anything to do with the operation itself, such as going with him to the hospital in the morning, she promised she'd be there in the afternoon to support him one hundred percent in his rehabilitation. He had been warned by Dr. Anderson that his mobility postsurgery would be restricted because he would be waking up with a device that would be constantly flexing and extending his knee, and that he would be attached to it for at least twenty-four hours.

Laurie dressed quickly While she had a quick bite to eat in the kitchen, she wrote a note for Jack, telling him she'd gone to work early and why, and asked him to have Dr. Anderson call her at the OCME when the procedure was done. She signed the note by telling him she loved him and that she'd see him around noon.

Unsure of where to put the note to be certain he saw it, Laurie took some tape from the kitchen and returned to the bathroom, using the door from the hall. They had designed the bathroom with two doors, one from the bedroom and one from the hall, for exactly this kind of situation when one of them was up before the other. With a piece of tape, she adhered the note to the center of the mirror such that there was no way he could argue he'd not seen it.

Getting her coat, key, the tray of slides, and her bag, Laurie opened the hallway door and was about to close it behind her when she remembered her cell phone was charging at her bedside table. For a moment, she debated whether she wanted to risk waking Jack. Believing Jack should get as much sleep as possible and that she would not need her cell, since she would be spending the first half of the day at her OCME desk and the second half in Jack's hospital room, she decided to forgo its convenience.

Outside, it was still dark with only a hint of dawn in the eastern sky, and the street was completely deserted in both directions. Thinking it would have been wiser to have called a radio cab, Laurie hesitated on the front stoop. But not wanting to take the time now that she was already down, she ran toward Columbus Avenue. In her experience, it was a lot easier getting a taxi there than on Central Park West, and she was proved to be correct as one pulled to the curb the moment she extended her hand.

As the cab zipped downtown in the nearly empty streets, Laurie admitted to herself that April 5, 2007, was not going to be a day she would ever want to relive. The level of general anxiety she was experiencing was as high as she'd ever felt, evidenced by the abdominal distress she'd suffered after eating her skimpy breakfast, which was now being made worse by the jolting and rocking of the taxi. At one point she sensed she was about to vomit, but it passed. It was with definite relief that the taxi finally reached the OCME. Laurie directed the driver to the side of the building and down the ramp to the receiving dock. Still queasy, Laurie quickly paid the fare and climbed out.

She waited a half-minute or so to let a mild wave of dizziness dissipate, then mounted the stairs to the receiving dock. As she passed down the hall, she said hello to the night security man in his cubbyhole office. Surprised to see her, Mr. Novak jumped up from his desk, poked his head out, and called down to Laurie, who'd already reached the back elevator. "Good morning, Dr. Montgomery," he called. "What brings you in so early?"

"Just a little extra work," she lied. She waved as she boarded.

Laurie stopped again on the second floor, as she had the evening before. She bought herself a cup of vendor coffee. Strangely, coffee tended to calm her stomach. At least it had in the past.

Laurie turned on her office light, and after hanging up her coat, she surveyed her cluttered desk. Her microscope still occupied center stage. The piles of case files and hospital records looked daunting. Her matrix was balanced on the top of one of them.

After putting her scope to the side along with the trays of slides, Laurie sat down. She moved the matrix in front of her. Before beginning, she opened the lid of the coffee and took a tentative sip. A grimace followed by reflex. It wasn't because it was too hot, which was what she feared, but because it tasted horrid. If she hadn't known, she wouldn't have even suspected it was coffee. With the lid replaced, she put it aside, intending to go down to the ID room when she thought Vinnie would have the communal coffee made.

Laurie then took the next case file and hospital record and set to work. Not quite an hour later, the phone rang. As much as she'd been concentrating combined with the near-absolute silence of the deserted fifth floor, the phone's old-style raucous jangle totally startled her. She answered it in a panic before she'd even had a chance to guess who it might be. It was Jack.

"What time did you leave?" he asked.

"I'm not sure. It was three-fifteen when I got up."

"Why didn't you wake me? I missed you when I awoke a few minutes ago."

"I wanted you to get as much sleep as you could."

"Are you exhausted?"

"I've been exhausted for days. Luckily, I didn't have any trouble getting to sleep."

"I'm glad we talked again last night," Jack said, "even if I wasn't when we began."

"I'm glad, too."

"Well, I had better jump into the shower with my antibiotic soap. I'm supposed to be over there at six-fifteen, and it's already twenty after five."

"I forgot to ask: How long does this patella tendon graft take?"

"Dr. Anderson told me a little more than an hour."

"I'm impressed. That's fast."

"He does them so often, he's got it down to a science."

"I'll see you around noon," Laurie said.

"I love you."

"I love you, too," Laurie closed. She heard the click. It sounded so final. Slowly, she replaced the receiver. What was the day going to bring? she asked herself uneasily. She wished she'd hung up first, because she kept hearing the metaphoric disturbing finality of the click over and over in the depths of her brain.

Shaking off any morbid thoughts engendered by the phone, Laurie went back to her matrix, taking yet another case file and its accompanying hospital record from the slowly dwindling stack. To keep from thinking about anything other than the busywork of data entry, Laurie kept at her task compulsively, as if it were a life-or-death necessity. Close to seven, she had only two more to go when Riva arrived.

"What on earth are you doing here so early?"

"I couldn't sleep," Laurie said. "I thought I might as well work."

Riva looked over her shoulder at Laurie's nearly complete matrix. "Very impressive! Have you learned anything earth-shattering?"

"Hardly" Laurie said. She thought for a moment about telling Riva about the unknown and possibly infectious agent she'd found microscopically but then changed her mind. Riva would undoubtedly want to see it, and Laurie was intent on finishing her matrix.

"Are you still planning on a paper day today?" Riva questioned.

"Absolutely," Laurie said. "I want to finish what I'm doing and then go over to see Jack. He's having his surgery today."

"Oh, that's right," Riva said. "I'd forgotten. I don't have Jack to schedule, either. I'd better get down there and see what's come in overnight."

By seven-twenty-five, Laurie had finally made the last entry. She held the matrix up. It was quite extensive, with every known variable she had been able to conjure up to compare the cases.

Quickly she scanned the document, looking for gross, unexpected commonalities among the twenty-five cases that might suggest the how and the why the patients had gotten infected. But nothing seemed to jump out until she looked back at the column for date of surgery. Having always had a facility with mathematics and numbers in general, there seemed to be a pattern. Believing it was only some sort of coincidence, Laurie got out her daily calendar and translated the dates of her series into days of the week. To her surprise, there was a pattern in that all the eye or cosmetic cases were on Tuesday, the heart cases were on Wednesday or Friday, and the orthopedic cases were on Monday or Thursday. With her knowledge of statistics, Laurie immediately knew that twenty-five cases were not nearly enough to give any credence whatsoever to her finding, yet she found it curious.

Returning to the matrix and slowing down, she let her eyes pause at each entry in each of the categories, such as age, duration of the procedure, type of anesthesia, et cetera, but still nothing significant caught her attention. Coming to the end of the matrix, Laurie switched her gaze to the wall clock. It was seven-thirty exactly, and Jack's surgery was starting. Laurie could visualize the scalpel cut through the skin, and she winced at the thought. Looking back at her matrix, she felt sorry she had finished filling it in. The process itself had been effective in keeping her mind from thinking about what she preferred not to think about.

Suddenly, Laurie thought of something else she could do to avoid obsessing over what was happening to Jack. She thought of Dr. Collin Wylie in New Zealand and the possibility that he'd gotten the photomicrograph, and the possibility he'd had an opportunity to look at it, and if he had, whether he'd been able to recognize it and respond. There were a lot of ifs, but, undeterred, Laurie went to her e-mail. The main reason she'd not thought about doing so earlier was because the outgoing e-mail had been sent during the night, and she'd forgotten to factor in that New Zealand was on the opposite side of the world, meaning in Auckland it had been morning.

The moment after she'd clicked the appropriate icon and her e-mail opened, she saw it: C_Wylie@NYU.EDU. Eagerly, Laurie opened it.

Dr. Montgomery: Greetings from Down Under I received the photomicrographs from Peter, and I have already duly chastised him for not recognizing an acanthamoeba polyphaga cyst, although I gave him some slack because of the location. I have never seen one in the lung. If you want to see it better, use an iodine stain. As for the evanescent nodularity Peter mentioned, I can only assume that it represents encasement of more of the same MRSA as is seen free in the microscopic field. It has been recently demonstrated in Bath, England, that MRSA can invade and multiply within acanthamoeba, similar to legionella, the cause of Legionnaire's disease. Since acanthamoeba normally eat bacteria, it is interesting to wonder how the MRSA and legionella have developed antiamoebic resistance, if you will, and how molecularly similar the process is to their antibiotic resistance. I will be back in the city on Monday. If I can be of any additional assistance please do not hesitate to contact me.

ALL THE BEST, COLLIN WYLIE

As astonished as she was about what she was reading, Laurie had read the e-mail without blinking, and she had to make up for it by squeezing her eyes shut and then blinking several times in a row. She knew next to nothing about amoebas in general or acanthamoeba in particular. Leaning over, she pulled her Harrison's Principles of Internal Medicine from the shelf and rapidly looked up acanthamoeba. The reference was short, and merely part of a general article about infection with free-living amoeba. It talked about acanthamoeba causing an encephalitis, but nothing about pneumonia. It also mentioned that the CDC had a fluorescein-labeled antiserum available for definitive diagnosis, which Laurie thought might be helpful to confirm Dr. Wylie's impression.

Laurie replaced the textbook and scanned her shelf for a possible second source. Not seeing one, she repositioned herself at her monitor screen and Googled acanthamoeba. A large number of hits appeared in seconds. She chose a general one.

With a growing sense of urgency, Laurie scanned the first part of the article, which described the protozoa as one of the most common in soil and fresh water. It described some of its characteristics, including the fact that it was a free-living bacterivore but could on rare occasions cause infections in humans. The next paragraph elaborated this issue at length, and Laurie quickly skimmed it.

It was at that point that Laurie's eyes encountered the caption of the next paragraph: Acanthamoeba and MRSA! With a surge of adrenaline coursing through her body, Laurie read an elaboration of what Dr. Wylie had mentioned, namely, that MRSA had recently been shown to be able to infect acanthamoeba. But in addition to what he'd cited, the article stated that the MRSA that emerged from the amoeba was frequently more virulent. And then, experiencing a reaction akin to a bolt of electricity passing through her, Laurie read that acanthamoeba cysts infected with MRSA can act as a mode of airborne dispersal for MRSA!

Laurie rocked back in her chair and stared blankly at her monitor screen. She was stunned. She'd been confident that MRSA could not be aerosolized, but now she was aware it could be, so all potential scenarios concerning how the MRSA was spread were back on the table, particularly the idea that the Angels hospitals HVAC systems could be involved.

With some difficulty, Laurie tried to calm herself. She had to think, and with her pulse racing and ideas flying around inside her brain, it was difficult. She took a few deep breaths, and after doing so, she remembered another reason she'd dismissed airborne spread as a serious possibility: The patients never breathed room air after being inducted. It was always bottled air or cleaned and piped-in air.

Laurie thought about this stumbling point. It seemed so definitive, or was it? With a mounting fear that her concerns were legitimate, she snapped her phone off the hook. Even though a quarter to eight might have been the worst time to call an anesthesiologist, as all the seven-thirty cases were being inducted, Laurie called over to the Manhattan General Hospital. She'd worked on a case with the MGH's chief of anesthesia, Dr. Ronald Havermeyer, and he'd been extraordinarily helpful. Laurie was sure he, of all people, could reassure her about patients never breathing OR air and would be happy to do so. Additionally, his being chief meant that he was in a supervisory role and might be available.

Nervously tapping her fingers on her desktop, Laurie willed the connection to go through as quickly as possible.

"Dr. Havermeyer," a voice finally said.

Laurie quickly explained who she was and without explaining why, asked her question.

"It's true," Dr. Havermeyer said. "The patient never breathes room air after induction until they get to the PACU, and even there they are often maintained on piped-in sources."

"Thank you," Laurie said.

"Not at all. I'm glad I could help."

Laurie was about to hang up when Dr. Havermeyer asked why she wanted to know.

Quickly, Laurie sketched out her concern – namely, whether bacteria in the HVAC system could be responsible for postoperative nosocomial pneumonia.

"Are you talking about an extended period of breathing ambient air, or just three or four breaths over fifteen or twenty seconds?"

Laurie felt her throat go dry as she intuitively sensed she was about to hear something she did not want to hear.

"Because if it's the latter, there usually is a time," Dr. Havermeyer said. "When the surgeon gives the word and it's time to wake the patient up, or at least terminate the anesthesia, the anesthetist frequently flushes the system with pure oxygen in order to get a faster turnover time for the OR. During the flush, the patient might take two, three, or even four breaths. So it's possible." Laurie thanked the doctor and hung up.

Suddenly, her fears coalesced. MRSA could spread airborne if encysted with acanthamoeba, and patients having general anesthesia did, even if for only a few seconds, breathe ambient OR air. Laurie snapped up the paper on which she'd written the days of the week her cases had occurred. Her memory told her that orthopedic cases were on Monday and Thursday, and it was unfortunately true. It was also unfortunately true that it was Thursday that very day, the day Jack had to have his surgery.

With growing desperation, Laurie grabbed one of her cases' hospital charts. Frantically, she searched for the anesthesia record to check the time anesthesia commenced. Anesthesia time was one variable she'd not included in her matrix. To her horror, it was seven-thirty-five a.m. Literally tossing the record to the side, Laurie grabbed another: seven-thirty-one a.m. Swearing under her breath, Laurie grabbed yet another: seven-thirty-four a.m.

"Damn!" Laurie shouted. She got another: seven-thirty a.m.

With four cases out of twenty-five enough for Laurie to fear for the worst in relation to Jack, she ran from her office and beat the elevator down button in hopes of hurrying its arrival. She checked her watch as she waited. It was just after eight. Jack's procedure was supposed to take a little more than an hour, so she might make it if she got a taxi immediately. Luckily, First Avenue was a good place to get a cab in the morning because of the hospitals and other services in the area. What Laurie had decided was that she wanted to be in the Angels Orthopedic Hospital's engineering spaces above the OR as soon as possible to make absolutely certain no one else did.

AS MUCH AS Angelo thought he was depressed the previous evening, he now felt worse. They'd been waiting for almost two hours after arriving at six-fifteen, and still no Laurie Montgomery. Since she and her boyfriend had arrived the previous morning from 30th Street, he'd positioned the van so as to be able to see as far up the street as possible. Every time he'd see a taxi approach, his heart would speed up in anticipation, only to be disappointed again and again.

"I don't think she's coming to work today," Angelo growled. "Kinda looks that way," Franco said while licking his finger to turn the page of his newspaper. "As if you give a shit!"

Franco lowered his paper and glared over at Angelo, who'd turned to look back up 30th Street. He felt like lashing out at his partner in crime but didn't. It wasn't worth the effort. Instead, he started to go back to the paper when he caught sight of a figure bursting out from the OCME and descending the front steps as if being chased.

"It's her!" Franco yelled.

Angelo's head spun around. He started to demand where when he caught sight of Laurie. She was standing at the curb, holding open a taxi door so a passenger could disembark.

"Holy shit!" Angelo yelled. He reached behind his seat for the ethylene, but Franco grabbed his arm.

"There's no time," Franco asserted. "We've got to follow her. Start the damn car!"

They watched while Laurie's hand anxiously waved for the obese woman passenger to hurry. Laurie even resorted to giving the woman one of her hands and attempting to help by pulling, as if the woman were stuck. As soon as the woman was barely out of the way, Laurie threw herself into the cab and pulled the door shut. A moment later, the cab was off with a screech of rubber.

"My God!" Angelo said. "The guy must be a NASCAR nut."

"Don't lose them," Franco cried, as he blindly reached for parts of the vehicle that could keep him from being thrown from his seat.

Angelo didn't need to be reminded about not losing Laurie, and he had the accelerator to the floor. The aged van responded admirably, and it shot forward with its own screech of complaint from its tires.

Briefly, Angelo glanced in the rearview mirror to see if Richie was on the ball. He was, and was not too far behind.

"Do you think she stayed the night in the morgue?" Angelo questioned, as he wove in and out of the traffic.

Franco didn't answer. He was too busy holding on and looking out for police cruisers. Luckily, he saw none. Soon Laurie's taxi and Angelo's van had to stop for a traffic light, and Franco had an opportunity to put on his seat belt.

WHEN LAURIE HAD finally managed to get into the taxi, she had hurriedly told the driver the name of the hospital, the address, and that she was a doctor. As a plea for speed, she'd said she was on a life-and-death emergency. The cab driver, who was a young individual, had taken the request to heart, and Laurie was pleased how quickly he took them up First Avenue. Although he'd not run any red lights as far as Laurie could tell, some of them had been debatably close and had required him to accelerate through the amber.

Unfortunately, going across town was different, and Laurie's feet began a nervous tap as they were forced to wait for a taxi to unload ahead of them at the corner of Park Avenue. Not only did the stop increase her anxiety of being too late, it also gave her a chance to add to her fears. If it were true that all the cases involved the seven-thirty OR time slot, then it was understandable why Wendell Anderson had never had an MRSA case; he didn't start his surgery until significantly later by choice, at least not before doing so, as a favor to Jack.

Laurie gritted her teeth. If she hadn't been so anxious, she could have gotten angry at Jack all over again about his headstrong insistence on having his surgery that day.

As they neared the destination, having just turned down Fifth Avenue, Laurie got out more than enough money and poked it through the Plexiglas divider. She had the door open before the cab came to a complete stop, and she was out on the pavement in a flash, slamming the taxi door behind her. She ran toward the entrance but then slowed as she neared the liveried doorman for fear of making him suspicious and delaying her. Seemingly unperturbed by Laurie's dash from the taxi, the man touched the brim of his hat as a kind of welcoming salute before giving the revolving door a push for her benefit.

Once inside, Laurie continued to force herself to walk at a nearly normal gait. She was conscious of her reception on Tuesday and did not want to call attention to herself, especially since there was a uniformed security man standing off to the side of the lobby.

Laurie reached the elevators and pushed the call button. Looking up to the floor indicator, she could see that one car was nearing the lobby.

Out of the corner of her eye, to her chagrin, Laurie glimpsed the security man push off the wall and walk in her direction. Self-consciously, she looked the other way. She could sense his presence at her side but slightly behind.

The elevator arrived. With relief Laurie boarded and in the process pushed the fourth-floor button. For a beat she faced into the car, fearing the man was about to accost her, but he didn't. Yet when she turned to face the elevator doors, he boarded and their eyes briefly met. They were the only two people in the elevator as the doors closed.

Laurie quickly shifted her gaze up to the cab's floor indicator above the doors and held her breath. Expecting to be questioned at any moment, the doors closed, the elevator rose but then immediately stopped.

To her surprise and relief, the security man exited on the second floor, apparently having pressed the button when Laurie had been purposefully keeping her eyes on the floor indicator. When the doors re-closed, Laurie breathed a sigh of relief.

The elevator then rose up to the fourth floor. As the doors opened, Laurie dashed out and ran headlong down the aseptically white corridor. Coming up to the engine room door, she hesitated, praying she was wrong and that her suspicions and fears were a product of an overly active imagination. Looking at her watch, she saw it was eight-forty; the timing would be correct.

Grasping the doorknob and with a bit of effort, Laurie pushed into the engineering room and was immediately enveloped in the throaty, deep hum of the machinery in the heavily insulated, high-ceilinged room.

The heavy door made a loud mechanical click that caught the attention of a surgically masked, hooded, and gowned figure who straightened up from where he had been otherwise hidden among the ducting. In one hand he held a wrench, hardly a surgical instrument, in the other a stoppered Erlenmeyer flask.

In took only a second for Laurie to believe her worst fears were confirmed. Shouting "No!" at the top of her lungs, she raced toward the man, who took a few steps back as if he were going to flee but then changed his mind and stood his ground. Laurie ran into him at full speed with her hands clawing at his mask and ripping it away. Instantly, she recognized who it was. It was Walter Osgood.

The unexpected contact forced Walter to stagger back. As he desperately tried to grasp something to keep him on his feet, he dropped both the wrench and the flask. The wrench clattered safely to the floor but the flask smashed into a dozen shards. The contained white powder was ignominiously dumped onto the floor.

Laurie screamed like a banshee and pounded Walter, who tried to protect himself by raising his crossed arms and briefly allowing Laurie to hit against them. She even got an arm through to his face, striking it as hard as she could, which jolted him out of his inaction. With a surge of defensive anger, he balled his hand into a fist and swung it wide in a roundhouse blow, catching Laurie above the ear. Laurie went down hard. Still, she shook herself and then tried to get up but felt her head yanked painfully to the side. Walter had roughly grabbed a handful of her hair and was dragging her. With Walter twice her size and weight, it was difficult for Laurie to resist, but she reached up and hit and then scratched his forearms. Walter's reaction was to strike her again, almost as hard, with his left hand.

She tried to break the hold he had on her hair as he pulled her over to a door. Opening it with his left hand, he dragged her inside. She tried to kick his legs, but he released the grip he had on her hair and hit her again on the side of her head with his fist. As she flopped back supine, he dashed back out through the door. Although dizzy, Laurie regained her feet and lunged for the doorknob only to feel and hear it make a loud mechanical click. She was locked in.

Walter gingerly touched the side of his face. Pulling his fingers away, he saw a small amount of blood. Quickly, he retrieved his N95 mask and secured it to his face, despite the fact that one of its ties had been snapped apart when Laurie had torn it off. Next, he ran to a large, deep sink, where he found a towel. Wetting it, he rushed back to the smashed flask and, being careful not to cause even the slightest air disturbance, laid the wet towel over the white powder.

Ignoring Laurie's muffled yells as she pounded on the storeroom's door, Walter pulled out his cell phone. He was pleased there was a signal. Quickly, he dialed the emergency number in Washington. Once again, it had to ring a number of times. As he waited, he winced at the new crashing sounds coming from the storeroom. Laurie was apparently throwing large metal containers against the door, which was more worrisome than her previous yelling or pounding against the door with her fists. Walter was concerned someone might hear the commotion, despite the extensive sound insulation with which the room had been equipped. There was no doubt in Walter's mind that Dr. Montgomery had to be removed, and she had to be removed quickly.

Finally, the phone was answered. Walter had no patience with the heretofore cloak-and-dagger routine. When the man started to ask whether Walter was on a cell phone, Walter yelled that he didn't have time for such intrigue. "I've got Dr. Laurie Montgomery locked in a storeroom in the OR HVAC room," he yelled. "Should I let you listen to her yelling and screaming and pounding on the walls? This whole mess is over if she's not dealt with. Do you understand what I'm saying? Whoever your best negotiator, as you called him, is, he's doing a hell of a lousy job. She burst in here and ruined my sample, so today's attempt isn't going to happen. I warned you about this two days ago."

"You say Miss Montgomery is locked in a closet?"

"I said a storeroom," Walter yelled.

"What floor?"

"Fourth floor. It's left down the corridor from the elevator. The door plaque says Engineering."

"Don't let anyone in!"

Walter laughed sarcastically "You don't understand. If one of the engineers needs to come up here for any reason, I couldn't stop them. How often they do come, I have no idea."

"I'll have someone there momentarily."

This time it was Walter who hung up first. For a moment he just stood there, furious at what he had been dragged into and everything that was happening, all because the company's health insurance wouldn't pay for his boy's lymphoma treatment.

Another crash brought Walter abruptly back to the present. He walked over to the storeroom door, pounded it himself, and told Laurie to shut up and that he'd let her out when she'd calmed down.

"Let me out now," Laurie yelled back.

"I've called security. They are on their way" Walter yelled, but his comment only resulted in another horrendous crash from within the storeroom. Giving up, he set his mind to clean up the airborne infection powder.

ADAM WAS PARKED on the playground side of the street just opposite Laurie Montgomery's house. He'd gotten there slightly earlier than he'd planned to give himself an extra cushion of time, but something had obviously gone awry. Although a few people had exited the building, neither Laurie nor her boyfriend had shown their faces.

Just when Adam was about to admit he'd have to return in the morning, his phone buzzed against his leg. It was one of his handlers in Washington.

"Where are you?" the man demanded.

"One hundred sixth Street on the Upper West Side."

"Get over to the Angels Orthopedic Hospital. The target is locked in a closet in a fourth-floor engineering space. An operative of ours is there. His name is Walter Osgood. Miss Montgomery must be extracted ASAP and then dealt with accordingly It should be a challenge, but we trust you are up to it."

Adam quickly hung up and started his vehicle. He then switched on the Beethoven and turned up the volume.

IN THE DARKNESS, Laurie was becoming desperate. She'd always been somewhat claustrophobic, and being locked in the way she was had awakened her childhood fears. The only sliver of light was found beneath the stout door, and she'd been unable to locate a light switch. After the first few minutes of pounding on the door and yelling in hopes of being heard by someone other than Walter Osgood, she'd groped about in the utter blackness. The storeroom was about ten by twenty feet, with shelving on both sides. It was in the very back that she'd found the sizable metal containers whose tops were secured like paint cans. She had no idea what they contained and thought they may well have been paint. By rolling one forward, she'd used it to heave repeatedly against the door. It had had no perceivable effect despite its weight, and she had to be careful in the darkness that it didn't bounce off the door and injure her.

For a moment, she did nothing except try to listen. It had been some time since she'd heard Walter moving about in the outer room. Unable to hear anything and finding that standing in the darkness was more harrowing than trying to avoid hitting herself with the multi-gallon container, she went back to heaving it at the door. On her second try, she heard a deeper sound as the can struck the door and a softer one when it hit the floor. Laurie guessed that the top had come off and the contents spilled.

Bending down, Laurie gingerly patted the floor as she moved her hand forward. There was no smell of paint, so Laurie assumed it had to be something else. All at once, she encountered a fine powder with her fingers. Slowly, she moved her fingers toward her face, warily sniffing the closer she came. It wasn't until her fingers were close to her face that she smelled anything, and even then she wasn't sure what it was. She guessed it was a type of cleaning product.

Laurie righted the container. It still contained about half of its contents. She pushed it to the side so as not to stumble on it. Then she was about to get another one when she heard sounds coming from out in the other room. It sounded as if it were a door closing.

Hoping it was someone other than Walter, Laurie began rattling the doorknob with one hand and pounding on the door with the other, all the while yelling "Help" over and over. Within the confines of the storeroom, her yells were almost painfully loud, but she imagined they weren't so in the other room. Everything was so insulated.

Laurie stopped her clamor. No one had come to her rescue. She heard muttering voices. Obviously, someone had joined Walter and hadn't rushed to her aid. It wasn't hard for her to imagine that whoever it was was in league with Walter, probably coming to get her out of the hospital. Panicking, Laurie tried to think of what she could do. She'd not even been able to defend herself from one man, much less two. Suddenly, she thought of the fine powder. It certainly wouldn't hold them off for long, but may be enough to get a step on them. Maybe she could get out into the corridor, where yelling and screaming could bring someone… anyone.

Moving up to the door, Laurie felt around for the open container. Reaching in with her two hands, she scooped up as much of the powder as she could. Then, stepping forward, she pressed herself against the wall on the side of the door that opened. It was none too soon, as the door was suddenly unlocked and thrown completely ajar. For a second nothing happened, and then a head cautiously came in along with what could have been a gun. Laurie threw the powder into the face, then rolled around into the doorway and pushed the man backward.

Without waiting for an instant, Laurie took off running. She saw Walter grab the man who had his free hand slapped over his eyes.

The ruse had caught both unawares and had been more effective than Laurie had even hoped. The problem was that she'd not been able to run toward the door to the corridor but rather toward the far door that Laurie had been told led to a second HVAC room. More important for her at the moment was that she'd also been told it too had an exit leading to a back stairway.

Although the powder had provided Laurie with the opportunity to run, it was not caustic enough to hold Adam down for long. Laurie had just managed to get through the adjoining door when Adam got his sight more or less back to normal, and he was able to pursue, although he was still coughing to a degree.

When Adam dashed into the second HVAC room, he had to come to a full stop. For a second, he did not see Laurie. Rapidly, his eyes scanned the high-ceilinged room with its tangle of ducting. He didn't see Laurie, but he did see the room's second door settling into its jamb.

There were large service elevators, but Laurie ignored them. Going through yet another door that Laurie sensed was locked in the other direction, she plunged down the stairs, which had two runs per floor. Originally, she was going to run back into the hospital on the OR floor below and make a large ruckus, but she had to ditch that idea with the fear of the door being locked from the stairwell side. Instead, Laurie continued down. Behind her, she heard Adam burst out through the door on the fourth floor.

Reaching the ground floor, Laurie exited out to the deserted receiving dock. To her right was the parking garage, to the left the ramp leading up to Fifth Avenue. Without a second's hesitation, Laurie ran to the left. At least she was confident the avenue would be filled with moving traffic.

Halfway up the ramp and despite her heavy breathing, she heard behind her the exit door bang open against the side of the building. At this point of full-fledged, headlong sprinting, her muscles were complaining in agony and each breath gave her a searing sensation in her chest.

Laurie got to the street. To her left almost a half a block away was the liveried doorman. At the moment, the sidewalk was devoid of activity. The street was a different story. As she'd expected, it was all but clotted with traffic moving at a slow pace. For lack of any other alternative, Laurie ran directly out into the middle of the one-way multi-laned avenue, causing several cars to brake precipitously before drivers angrily drove on. With both hands waving, Laurie tried to get a car, a taxi, a bus, anything to stop. When she saw Adam sprinting in the middle of the street, she started to run north against the traffic while still waving her hands and pleading for someone to stop.

"IT'S HER, for chrissake!" Angelo yelled the moment he'd seen Laurie appear, dashing from the hospital's parking ramp. He was out of the van in an instant. He and Richie had parked their respective vans just south of the ramp entrance at the north end of the hospital. Since the traffic went north to south, they'd decided it was the best place to be when Laurie came out the front entrance, which was what they had expected.

Franco leaped out of his side of the blue van while Richie and Freddie jumped from the white one. All four men were running up the sidewalk on the park side of Fifth Avenue, with Angelo slightly in the lead. Suddenly, Angelo stopped, as did the others. All saw Adam race out into the street in pursuit of Laurie, at whom he was yelling to stop. They all saw that he was carrying something wrapped in a towel.

Because Laurie was not moving ahead exclusively but rather trying to get cars to stop by slapping their hoods, Adam rapidly closed the narrow gap between them.

Laurie turned to look at him. Although she'd thought upstairs in the HVAC room that he was a stranger, now she thought she recognized him as the bill collector at the OCME. But before she could say anything and before he said anything, he slowly raised the cone-shaped towel he was carrying such that Laurie could see a black cylinder just concealed in its tip.

The sound of the gun was muffled, and Laurie reflexively winced and closed her eyes. Strangely, nothing happened. She reopened her eyes. At her feet lay Adam, still clutching his pistol, which had partially come out from behind its towel. Laurie was shocked into momentary immobility, staring down at her attacker, who was on his stomach, slightly twitching. But Laurie's trance didn't last long. A moment later, she was set on by four men, one of whom was yelling "Police" and showing several motorists who'd finally stopped his police badge. Two other cars had actually pulled to the side of the road, and the drivers were climbing out.

Laurie was relieved as she allowed herself to be rapidly escorted to the park-side sidewalk. It was there that her relief dissolved in a totally new whirl of fear. One of the men was Angelo Facciolo, an old nemesis of hers going back fifteen years. She tried to slow the rapid progress being made as the four men hustled her toward the vans. "Excuse me," she called out, still wanting to believe the men had saved her. "Let's stop! I'm fine."

She was ignored. No one spoke. Suddenly, she tried desperately to break from their collective grasp but to no avail. She found herself being hoisted up into the air with her feet only lightly touching the pavement. It was at that point that Laurie belatedly tried to verbally protest, but even that was of limited value as a hand snaked from behind and was clasped over her mouth.

Reaching the vans, the sliding door of the white one was thrown open, and Laurie was pulled inside as if devoured. She tried to struggle, but the four men crushed her under them, making it hard for her to breathe. She felt her legs being bound with duct tape, then her arms. She still tried to struggle, and she screamed when the hand over her mouth had been removed. But her shouting didn't persist for long, as she was gagged with an oily rag held in by several turns of the duct tape.