Pandemic

9

TUESDAY, 9:10 A.M.

With Vinnie’s help, Jack finished both the routine overdose cases in just a smidgen over an hour and a half. Carlos didn’t help, but he didn’t seriously hinder the process, either. As far as Jack was concerned, whether the new guy was going to work out was still up in the air. Jack still felt he had an attitude problem besides a foul mouth.

The only difference between the autopsies was that the second had some signs of head trauma, which Jack interpreted as most likely caused by terminal seizure activity. Both patients were male and in their early twenties. From a forensic point of view, both showed the usual and characteristic pulmonary edema. From his experience with some fifty similar autopsies, Jack guessed the culprit was most likely a combination of fentanyl and heroin, with the fentanyl coming from China. Whatever it was, John DeVries and his miraculous toxicology machines would have the last word. Jack felt a certain detachment from the tragedy the cases represented, even though the young men were otherwise perfectly healthy and in the prime of their lives. For all the MEs, including Jack, repetition bred a kind of stoic acceptance.

After finishing the second case, Jack checked his phone for messages. He’d half expected there would be a text or a voicemail from Bart. But it wasn’t to be. Jack changed back into his street clothes, as he had no intention of doing any more autopsies, no matter what came in through the door. He was now committed to making some sense of the subway death and somehow getting enough facts to get himself really involved. He had no idea what to make of the newest surprise that the patient had no immunosuppressant drugs in her system. In one sense it favored a rejection phenomenon, but that did not compute with there being absolutely no sign of inflammation in the heart. Consequently, Jack was back to favoring the infectious idea. With that in mind, he put in a call to Aretha Jefferson as he climbed the stairs to his office.

“Dr. Stapleton,” Aretha said brightly, the moment she picked up.

“Let’s skip the formality. Jack is fine. After last night we should be on a first-name basis!”

“Fair enough,” Aretha said. “Thank you again for introducing me to your friends and getting me into the game. It was really fun.”

“You impressed the lot of them,” Jack said. “Ultimately, you didn’t need my help in the slightest.” Aretha had proved herself to be personable as well as a gifted player. Jack was certain from then on she would be in high demand whenever she showed up at the playground.

“I disagree,” Aretha said. “From experience, I know something about the sociology of street basketball. Anyway, I’m sure you aren’t calling about last night’s game. You want to know what’s up with your samples, am I right?”

“If you don’t mind, I’d love it.”

“Here’s what I can say at this point. There is a suggestion of cytotoxicity with one of the inoculated tissue samples. It’s the one with human kidney cells. I used a variety of different tissue cultures, as viruses can be choosy. The reason I didn’t call you is that it’s not absolutely definitive. Not yet. But in my mind, it is mighty suggestive. I should know more by this afternoon. If it turns out to be true cytotoxicity, it would be considered a rapid reaction, meaning the virus has to be quite pathogenic or in a very high titer or both.”

“I wish you could just out-and-out tell me.” Jack was aware the comment sounded perilously close to a complaint.

“Sorry,” Aretha said. “Working with viruses is a tricky but fascinating business, which is why I ended up majoring in the field. People mistakenly think viruses are primitive, but they’re not. Not by a long shot. They have been evolving for millions upon millions of years.”

“I’m glad you’re a fan,” Jack said. “But for me, at the moment, I see them as the enemy. What I need to know is whether a virus killed this woman. And if it did, what kind of virus it is and whether it’s planning on killing a whole bunch more people.”

“I’m on your side,” Aretha said. “I’ll be checking these tissue cultures on a regular basis. As soon as I know something, I’ll call. If there is a virus, the next step will be to try to identify it. Let’s touch base this afternoon.”

“Much appreciated,” Jack said.

“Will you be playing tonight?”

“That I can’t say. Depends on what’s happening on the home front.”

“I hope your daughter is doing okay.”

“That remains to be seen,” Jack said noncommittally before ending the call.

Jack had reached his office with plans to work on his many outstanding cases, but the conversation with Aretha had reenergized him. Hearing that some cytopathic effects were potentially showing up in less than twenty-four hours in tissue cultures of human cells certainly increased the chances that a lethal virus was loose in the city. It might not be influenza, but influenza wasn’t the only bad guy in the viral hall of horrors.

Grabbing his leather jacket, as the weather was a bit cooler, Jack went back down to the basement level and got his Trek. Just as he had done the day before, he took the short ride down to 26th Street. When he arrived, he went directly up to the fifth floor.

“You look all charged up,” Bart Arnold said, the moment Jack appeared.

“I am,” Jack admitted. He mentioned the possible evidence a virus was involved with the subway death, even though all the rapid viral tests had been negative. “I also learned something else surprising, if not shocking. John DeVries in Toxicology ran a screen overnight for immunosuppressants. The woman had none on board. Zero!”

“How can that be if she recently had a heart transplant? I mean, you are sure she had a heart transplant, aren’t you?”

For a few beats Jack just stared at Bart, expecting the man to laugh. It seemed absurd for him to pose this question at all, let alone to one of New York’s most seasoned MEs. With some difficulty Jack suppressed the urge to make one of his cuttingly sarcastic responses. Without immediately responding, he got one of the stools on wheels from a neighboring desk, as he had on his last visit, and sat down.

“I’m going to assume that was a rhetorical question,” Jack said. “Let’s cut to the chase. Did Janice mention that I popped in here on my way in to work today? I was so sure it was an oversight that I hadn’t been called during the evening. Instead I learned there hadn’t been any calls about a missing, attractive, elegantly dressed woman. In particular, no calls from an apparent partner or wife named Helen.”

“Janice did tell me,” Bart said. “And she told me the time. You certainly were early.”

“What’s happened since I visited? Have there been any calls into Communications about the case that could lead to an identification?”

“I’m afraid not,” Bart said.

“That’s disappointing, to say the least. So what are you doing to solve this situation?” Jack couldn’t keep the touch of sarcasm from his tone. He knew they were doing nothing. “You said that no one gets concerned until at least eight hours or even twenty-four hours go by. Well, for your edification, we are rapidly closing in on the twenty-four-hour marker. We need an identification! Especially if it turns out to involve some sort of a lethal virus, containment is going to be the number one priority. To do containment, an ID is absolutely essential. Have you spoken with Sergeant Murphy or Hank Monroe?” Sergeant Murphy was a New York City police officer attached to the NYPD Missing Persons Squad of the Detective Bureau. Hank Monroe was the director of the relatively new Identification Department. Prior to the 9/11 catastrophe, there hadn’t been such a department; but after 9/11, when identification had been an operational nightmare, it was deemed essential.

“Not yet,” Bart admitted.

“How about with the DNA people? Have you spoken with them this morning? Any results yet?”

“No, I haven’t spoken with them. It is much too early for any results. Same with histology and serology.”

“Call up everybody potentially involved and light a fire under them!” Jack said. He stood. “Meanwhile, I’m going to go up and talk with Sergeant Murphy and Hank Monroe myself. Something needs to be done around here.”

Without waiting for a response, Jack headed over to the elevators. He knew he was being unfair, as ID was not officially in the purview of the MLI. But Jack felt this case was an exception. As far as he was concerned, the whole OCME team should have been on it as a priority right from the start.

Sergeant Murphy, or Murph, as he was known, had been assigned to the OCME seemingly for forever. He was past retirement age but seemed ageless, and no one pressed the issue. He loved his work, and everyone loved him. Previously he had the tiniest office in the entire organization, even smaller than the Toxicology director’s. It was located on the first floor in the old 520 First Avenue building, directly behind Communications, and had been designed to be a small storage closet. But like a lot of OCME staff, Sergeant Murphy had been moved to the new high-rise when it opened and had been given a real office with not only a window but one with a fantastic view. He shared the space with two other PD officers who were also members of the NYPD Missing Persons Squad. These other officers, in contrast to Murph, were rotated on a three-month schedule.

Since Jack had gotten to know Sergeant Murphy over the years and thought of him as a friend, he sought him out first. The red-faced, silver-haired Irishman was at his new, comparatively large desk, kibitzing with his two youthful officemates. As usual, he had a mug of coffee in his hand. When Jack walked in, his already smiling face lit up further. He introduced Jack to the younger men. All three were in uniform.

“I have to talk to you about a body that came in yesterday,” Jack said, wasting no time with small talk.

“Let me guess,” Murph interrupted. “You want to talk about the Bellevue case that originated from the Twenty-third Street subway station.”

“That’s the one,” Jack said, encouraged. “We have no ID, and making one could be extremely important. Unfortunately, Communications hasn’t gotten any calls about a missing, youthful, well-dressed woman, which is very strange. Do you have any information at all?”

“No ID,” Murph said. “The patrolman at the Bellevue emergency room copied me on his report sent to the Missing Persons Squad at One Police Plaza. It’s standard operating procedure in this kind of case that I get notified. My understanding is that there was no ID when the patient was taken off the R train at the Twenty-third Street subway station. I have the report someplace.” Sergeant Murphy opened a side drawer of his desk and began fumbling through a disorganized bunch of papers.

“Do you know if the Missing Persons Squad has made any headway on making an ID?” Jack asked.

“Not to my knowledge,” Murph said as he pulled a paper free, “or I would have heard.” He quickly read over the paper. “Okay, the case was assigned to a missing-persons case detective at the Thirteenth Precinct by the name of Pauli Cosenza. He’s the one in charge. He also copied me with his report. Do you want his telephone number?”

“Please!” Jack said. “Have you spoken with him?”

“Nope,” Murph said. “There would have been no reason. It’s much too early in the case. It’s not even been twenty-four hours.” Sergeant Murphy took out a Post-it Note, jotted down a number, and handed the note to Jack. “But I have spoken with him in the past. Between you and me, he’s not what I would call a ball of fire.”

Jack took the slip of paper and made sure he could recognize the numbers. Sergeant Murphy’s handwriting was notorious for illegibility. Jack tucked it into his wallet to be sure not to misplace it.

“You know what I find most amazing about this case,” Murph said, “is how similar it is to one that Dr. Montgomery had five or six years ago. That patient had no ID when the body was picked up from the Fifty-ninth Street IND subway platform. It, too, involved a relatively young, well-dressed victim that no one called about. Of course, that one turned out to be very different in that it was a homicide and the victim was a Japanese male. But do you remember the case I’m talking about, Dr. Stapleton?”

“I do,” Jack said. “You’re right. I’d forgotten about that.” Suddenly all the details flooded back into Jack’s consciousness. There were definite similarities. Most interesting of all, thinking about the case reminded Jack of how creative Laurie had been in her investigations, which he’d made fun of at the time, but which now gave him a few ideas he’d not thought about. With such thoughts in mind, he asked Sergeant Murphy if he would do him a favor.

“Of course, Doc,” Murph said. “Name it.”

“I’d like you to find out the name and phone number of the Transit Police Officer involved in having the patient picked up from the Twenty-third Street station. There had to be one involved to coordinate with the EMTs.”

“I’m sure there was,” Murph said. “Shouldn’t be a problem. I’ll put one of these young guys on it right away.”

Jack thanked Sergeant Murphy for Pauli Cosenza’s number and for reminding him about Laurie’s case, which he admitted might come in handy. After they assured each other that if one learned anything significant about the mystery woman’s ID they would let the other know, Jack left the PD Missing Persons office. His destination was the newly expanded Anthropology Department, which happened to be on the same floor. Prior to 9/11, OCME Anthropology had been a single individual. Now it was an entire team and part of the Identification Department that included forensic dentistry. Within minutes, Jack was in the director’s office, standing alongside a long Formica-topped table on which various groupings of human bones were laid out anatomically, each representing a different deceased human being.

“What can I do for you?” Hank Monroe said. He was a heavyset man sporting a long white coat, similar in silhouette to Bart Arnold but with a full head of hair. Also, his facial features were strikingly different. Whereas Bart’s were appropriately rounded, Hank’s were all full of sharp angles. It was as if the body and the face belonged to two different people. Jack had met the man on numerous occasions but didn’t know him well. They hadn’t worked many cases together and had offices in different buildings. The new OCME organization was not as collegial as the old was.

“Have you heard about the subway death case that came in yesterday?” Jack asked. When Hank said he had heard a bit from Rebecca Marshall but not much, Jack gave a rapid synopsis of the case, emphasizing the woman’s youth, expensive clothes, Cartier watch, diamond earrings, tattoos, and the startling fact she’d had a relatively recent heart transplant.

“This is not the kind of case we usually get involved in,” Hank said. He gestured toward the piles of bleached bones. “They’ve usually been dead for some time or are victims of mass disasters like 9/11.”

“I understand,” Jack said. “But we need an ID, and we need it now. I’m concerned it’s a contagion case and possibly an index case of a potential outbreak. If there is a chance to control it, the effort has to start immediately. I need all the help I can get. Strangely enough, I’m having an equally difficult time isolating what I believe is a virus.”

“Sorry to hear about your struggles,” Hank said. “But let me tell you this: It is almost unheard of for a case of this kind to go unreported by a family member, a friend, or a coworker. Invariably it happens within hours, especially in this day and age, with our mobile phones keeping us in constant touch with each other.”

“I’m well aware, but there has been nothing, and it is now approaching the twenty-four-hour limit.”

“That’s phenomenal,” Hank said. He pursed his lips and shook his head. “In this business we all know if someone doesn’t come forward within the first twenty-four-hour period, the chances of making an ID begin to fall precipitously. Not too many people know this fact, but it’s true, even in this era of DNA technology.”

“That doesn’t sound encouraging,” Jack said.

“It’s not,” Hank agreed. “But let’s think positively. Do you think the patient having had a heart transplant might be of assistance?”

“Certainly,” Jack said. “But how much, I don’t know. There are a number of centers here in the metropolitan area that do them, and there must be hundreds of cases done each year. On top of that, there’s no way to know whether she had her procedure here in the city or not.”

“Okay, I understand,” Hank said. “Here’s what I can do. I can get my department actively involved and see if we can help. Meanwhile, the DNA people will be doing their magic, which will allow us to tap into the FBI’s CODIS system and NamUs, the National Missing and Unidentified Persons System. The only other thing I can do is get in touch with my contacts at the NYPD Missing Persons Squad at One Police Plaza and try to goad them into action. Sometimes they need a bit of coaxing.”