Death Benefit

39.

COLUMBIA UNIVERSITY MEDICAL CENTER NEW YORK CITY MARCH 25, 2011, 11:20 A.M.

George returned with the ice. Pia was sitting at her desk, writing furiously on yellow legal paper, trying to make sense of what had happened in the past forty-eight hours. George took some ice and wrapped it in a towel for Pia to hold to her face. The rest he put in her sink. He then sat on the bed and watched her write on page after page.

Pia tested her prodigious memory, trying to isolate fact from speculation. She worked backward from the undeniable fact that she’d been attacked and threatened in her own dorm room. That was obviously a criminal act-but what else of all the events of the past two days had constituted unlawful activity? While she worked on the what, she also worked on the who. She tried to piece together a cast of characters using the information she was certain about. There had been two men in her room-but who else was involved and how broad was the conspiracy she now knew existed?

After an hour, Pia stopped.

“This is getting me nowhere. It could be anyone. And there’s so much that’s happened, and I bet we don’t know the half of it.”

“What about trying to establish a timeline? Isn’t that what they do in those cop shows on TV? They use a whiteboard: ‘six forty-two P.M., suspect seen in O’Leary’s bar . . .’ ”

“But we don’t know who the suspects are unless we just include everyone. And we can’t really investigate anything. Say we think Springer was involved somehow. The only times we know what he was doing are when I was with him. I can’t pick up the phone and demand he answer any questions about his whereabouts at any other time.”

“This is why we should call the police,” George said. “They can investigate to their heart’s content and ask him anything they please.”

“Given that there’s a conspiracy, one of the things we don’t know is why.”

“Only, as you keep saying, Rothman was hated by half the human race. Of course that raises the question, why kill Yamamoto as well? He wasn’t unpopular, was he?”

“Not at all, people loved him. He was devoted to Rothman. They were like two peas in a pod, working together. If they weren’t working together in either the biosafety unit or the organ bath unit, Yamamoto was in Rothman’s office. They even ate together if they took time out for lunch, which wasn’t always the case. Yamamoto was the only one Rothman allowed to use his private coffee machine or drink the bottled mineral water from his private office fridge. They were like Siamese twins.”

“So there’s much more we don’t know than we do know, as far as what other people were thinking and what they were doing,” George said. “So what do we know, other than the fact that you were attacked last night and told to stop involving yourself in this?”

Pia turned back to her desk and picked up her pen and underscored a couple of lines on the page.

George looked at his watch. He was concerned about getting back over to the hospital but decided he was more worried about Pia. The resident to whom he’d been assigned for the day was rather laid-back, to say the least, and probably didn’t even realize George wasn’t around. Besides, George wanted to stay and humor Pia for a while. He was worried that she might have a concussion from the attack, and he wanted to make sure her mental status didn’t change. In addition, he reasoned, she couldn’t get into any more trouble while they were there in her room.

Suddenly Pia turned back around. “You know what we know the most about?”

George shrugged.

“We know the most about Rothman and Yamamoto’s illness even without the autopsy results and even without seeing their charts. I was in the lab when it presented, I saw them in the hospital, I talked to the doctor who was treating them, I examined Rothman myself, I diagnosed new symptoms, I spoke with the department head involved.”

“Good, yes,” George said. They had gone over all this before but under the circumstances, George was happy to do it again. Pia tore the sheets she had written on off her legal pad, crumpled them into a ball, and threw the ball in the general direction of the trash basket. She missed. Pia began writing again, more slowly this time.

“Okay,” she said while she worked. “We do have a timeline of the infection. The onset was extremely rapid. Rothman or Yamamoto pressed the panic button and there was a medical team in the lab almost at once. I saw them arrive. Rothman and Yamamoto knew what to look out for, so from the first symptom to the medical team arriving may have been only ten minutes, at the outside. Springer showed up, and he went into the lab. Then he stayed and talked to the staff while Rothman and Yamamoto were taken directly up to the infectious disease floor and put in isolation, and treatment was started. I’d say they were there in five or six minutes. And Springer told us it was classic typhoid fever-high temperature, delirium, and so on, so it was diagnosed immediately. No delays. They got antibiotics within an hour of the initial symptoms.”

Pia had the pad on her knee.

“So Rothman and Yamamoto got all the symptoms straight off. It apparently wasn’t the usual sequence where a patient gets one symptom initially and then another a few hours later. It happened like a bolt of lightning. As far as I know, that’s not the way typhoid fever develops. Then the patients got the more ominous rebound tenderness by that evening. It’s all so speeded up.”

“You said this was a particularly virulent strain,” George said.

“True. One of the zero-gravity strains. The alpha strain. But still.”

“And you also said that Rothman’s own sensitivity studies suggested that the strain should have been knocked out by the antibiotic he was given.”

“That’s right, the chloramphenicol and later the ceftriaxone.”

“So what are you saying? Are you suggesting that it can’t have been that strain of salmonella?”

“No, I’m not. The strain had to be involved since Koch’s postulates were satisfied.”

“Meaning that they managed to grow the culture from samples taken from the patient.”

“Or by using more modern DNA techniques, yes.”

“Pia,” George complained, “you’re confusing me. What’s the bottom line here? What are you trying to say?”

“I suggested to Springer that there might be a second bacteria involved, a bacteria or a virus that was actually more virulent than the salmonella typhi and that was resistant to the antibiotics. It could explain the shockingly fast clinical course Rothman and Yamamoto experienced.”

“What was Springer’s reaction to your suggestion?”

“He went bonkers on me,” Pia said with disgust. “That was the end of the interview because he went out and called in reinforcements, meaning the dean.”

Pia put down her pad and pen back on the desk.

“So you think there might have been two bacteria involved,” George said.

“Right at this moment that’s the only thing I can think of. The clinical course was just too fast, especially in the face of two antibiotics given within hours of initial symptoms and known to handle salmonella. I know it’s contrary to recognized diagnostic rules, the major one being that one should look for a single causative agent even with seemingly multiple symptoms. But it’s the only way I can explain what we’ve seen with Rothman and Yamamoto.”

She turned back to her desk and read from her notes.

“We have all the symptoms right here: fever, delirium, prostration, temperature elevation, sweating, low white cell count known to be associated with salmonella, all leading up to abdominal rebound tenderness. From intestinal perforation and finally death.”

George got up from the bed and headed into the bathroom. Pia was overwhelming him. He was amazed she remembered Koch’s postulates from second-year microbiology. He certainly didn’t. He put some of the ice that was melting in her sink into a fresh towel, rolled it up and brought it to her desk. He exchanged it for the first one he’d made. Pia was staring at the paper, her back to him.

“Here’s some more ice,” he said.

Pia swiveled around in her chair, and George winced when he saw her jaw at such close quarters.

“How’s it feel?”

“It’s not too bad. A bit better with the ice.”

Pia took the fresh towel and held it to her face. An image flashed into her mind: Rothman lying on his deathbed, sweating into his pillow, delirious . . . Suddenly she stared directly up into George’s eyes with a fierce intensity that made George look away.

“The hair loss!” Pia said slowly, with emphasis. “What about the hair loss?”