Pandemic

32

THURSDAY, 6:56 A.M.

As Jack headed for the ID room, where all the OCME medical examiners started their day, he continued to fume about Laurie having the nerve to ask him if he had talked with the Daily News. Yet the more he thought about it, the more he could understand her position, if it was indeed true that the Commissioner of Health had gotten involved. Honestly, he didn’t know if that part was true. Nevertheless, his comment that he needed to find some work to do to keep his mind occupied definitely was. That meant going through the cases that had come in overnight and finding a case to autopsy. He remembered Janice saying there had been a homicide. That might be interesting, as Lou Soldano would be involved on some level.

To avoid the reception area in case any of the press had managed to get in, Jack used the back route. Because she had been called earlier, Dr. Jennifer Hernandez was already at the desk, where the folders were stacked up of the cases that had come in overnight. Jack was also pleased to find Vinnie had made it in and was busy making coffee in the common coffeepot, which most people thought was possibly his most important responsibility.

“Have you heard that the pandemic influenza emergency has been called off?” Jack asked.

“I have,” Jennifer said. “Thank goodness. The idea really terrified me.”

“It is still a disaster par excellence,” Jack said. “It is going to take days for the city to recover.”

“True, but nothing like a real pandemic,” Jennifer said.

“We could still have one with these subway deaths,” Jack said. “There still isn’t a specific diagnosis of the virus involved. At least it wouldn’t be a pandemic spread by aerosol, meaning it wouldn’t spread as rapidly.”

“It still could be bad,” Jennifer said. “Ebola and Marburg don’t spread by aerosol, either.”

“Good point,” Jack said. “But with only two cases in three days, we certainly aren’t dealing with the likes of Ebola.” Then he called over to Vinnie: “Did you leave your car in the 421 lot?”

“I did. And I left the keys with security in 421.”

“Did either of you guys have any trouble getting into the building with all the reporters outside?”

Both Jennifer and Vinnie said no simultaneously.

“We came in the back way,” Jennifer added.

“Smart move,” Jack said. “Vinnie, any sign of our friend Carlos?”

Vinnie laughed sardonically. “No. Nor do I expect to see him.”

“I’d like to slap him around a bit if he was the source of the Daily News article,” Jack said, and meant it.

“You’d have to wait in line,” Vinnie said.

“Are you looking for a case to tackle?” Jennifer asked. She had already gotten to know Jack and his work habits fairly well.

Jack was about to answer in the affirmative and inquire about the homicide when he felt his mobile ring in his pocket. He motioned for Jennifer to hold on as he pulled out the phone. It was the night-shift MLI, Janice Jaeger.

“Dr. Stapleton, I’m glad I got you,” Janice said. “Right after Dr. Montgomery phoned me this morning, I got a call on another case that was clinically similar to the two subway deaths but also slightly different. I assumed it was the first of many until I learned the pandemic influenza emergency had been canceled. Anyway, I know you asked to be notified when and if there were any more, so that’s what I’m doing.”

Jack moved a few steps away so he wouldn’t bother Jennifer. “How do you mean ‘clinically similar’?”

“It involved the rapid onset of respiratory distress in an otherwise healthy individual that very quickly resulted in death.”

“And how was it different?” Jack asked.

“Well, first of all, it wasn’t on a subway,” Janice said. “It happened in someone’s apartment. And second of all, it was a male in his late twenties, not a female.”

“Was the case handled at the Bellevue ER?” Jack asked.

“Yes, and it was treated as potentially contagious, just like the other two,” Janice said. “It is already in the morgue cooler in a sealed body bag.”

“How about the identification situation?”

“Not a problem,” Janice said. “The victim was accompanied by a friend, and I spoke with her at length. She’s there at 520 as we speak, ready to make a formal identification as soon as photos are available. I thought you might like to talk with her.”

“I would indeed,” Jack said. “One more question: Was a transplant involved?”

“Not that I am aware of,” Janice said. “Should I have asked?”

“No, we’ll find out soon enough,” Jack said. “Thanks for letting me know.”

“You’re welcome,” Janice said. “I would have called sooner, but we really did think it was the beginning of a dreaded surge. We’re so relieved we’re not going to be overwhelmed.”

“That we’re not going to be overwhelmed with deaths is the good side,” Jack said. “The bad side is that it is going to take the city days to recover.” He disconnected, then stepped back over to Jennifer. “Is there a file on the case I was just talking with Janice about? A male with rapid onset respiratory distress, out of Bellevue?”

“There is.” Jennifer handed the file to Jack. Jack opened it and read the name. He was shocked. It was John Carver. Could it possibly be the John Carver he’d interviewed yesterday after the man had made the identification of Helen VanDam? Jack thought it was possible, if not probable. After all, the John Carver he’d talked with had reputedly been intimate with both subway death victims.

“Vinnie!” Jack called.

“I’m right here,” Vinnie said. “You don’t have to yell.”

Surprised to find Vinnie standing right behind him, Jack slapped him with the Carver file. “Let’s get a jump on the day.”

“It’s only a quarter past seven,” Vinnie whined. “I haven’t finished my coffee or read the sports page. Have a heart!”

“This is another case just like the subway deaths,” Jack said with mounting excitement. He needed something to take his mind off the morning’s disaster, and this new case was perfect. “We’ll do it in the same fashion we did the other two, meaning full moon suits in the decomposed room.”

“If it is like the other two, I wouldn’t be willing to do it any other way,” Vinnie said. He could tell by Jack’s tone that there was no way he was going to be talked out of getting right to work.

“Have one of the other skilled mortuary techs help you with weighing and X-raying,” Jack said. “Then both of you suit up and take some photos for ID purposes and do the fingerprinting. When that’s done, prepare for the autopsy. I should be down there by then. I’m going to go talk with the individual who came in to do the identification. It could be important. I’m starting to get a sense of the viral culprit we’re dealing with.”

Without waiting for Vinnie’s inevitable further complaints about not having had enough coffee or gotten to check out the morning newspaper, Jack headed out to the family ID room. He passed the cubicles used by the identification clerks and walked into the room where he’d spoken with John Carver the day before. Sitting on the same blue couch was a woman Jack thought looked cut from a similar mold. She was about the same age, maybe a little younger, but also slender, well groomed, with blond-streaked hair and form-fitting contemporary clothes, and was rather attractive in a clean, well-scrubbed fashion.

Jack carried over one of the wooden chairs from the round table and sat down. He introduced himself and learned that the woman’s name was Darlene Aaronson, originally from Orlando, Florida. She had a slight southern accent and appeared nervous, like a caged wild bird, crossing and uncrossing her legs and alternately chewing on her cuticles.

“I’d like to ask you a few questions about John Carver,” Jack began. “I imagine this has been a difficult episode for you, and I hope talking about it isn’t too upsetting. I’ve been told you are prepared to formally identify Mr. Carver when photos are available.”

“Photos? Oh, thank goodness,” Darlene said. She appeared to relax a degree. “I was afraid I’d have to look at the body, like they do in the movies.”

“We use photos almost exclusively,” Jack said. “Can you tell me if this was the John Carver who grew up in Seattle?”

“I suppose,” Darlene said. “He did mention he’d gone to high school in Seattle, so I guess he grew up there.”

“Does that mean you haven’t known him for very long?” Jack asked.

“I just met him last night,” Darlene said. “It was in my favorite Lower East Side bar. I had seen him before in that particular bar on several occasions.”

“Were you introduced, or did you just start chatting?” Jack asked.

“He looked depressed and was nursing a drink by himself,” Darlene said. “I went up to him and asked him what was wrong. He said someone he knew had died.”

“He didn’t say who had died or what they had died of?”

“No, and I didn’t ask,” Darlene said. “He didn’t seem to want to talk about it. We talked mostly about music. We were both into music. After a few beers we ended up going back to my apartment to listen to some jazz.”

Bad idea, Jack thought but didn’t say.

“But tell me,” Darlene continued. “What did John die of? No one would tell me at the emergency room. I asked several people. They just put me off.”

“We’re not sure,” Jack said. “That’s what we are trying to find out. How did his illness start?”

“What do you mean?”

“I’m assuming he was acting as if he was healthy when you met,” Jack said.

Darlene gave a short, disparaging laugh. “I’ll say. Very healthy.”

“What I am asking is what were his first symptoms? A headache, or sore throat, or a cough?” Jack said, ignoring Darlene’s last comment and its implications.

“A chill,” Darlene said. “All of a sudden he was shivering for no reason.”

“I see,” Jack said. He considered that significant, as John had described Helen’s episode as having started in the same way. Intuitively, Jack imagined the chill most likely heralded an acute viremia with virus particles suddenly bursting out into the bloodstream, and the idea brought a kind of revelation. For that to happen, the viruses had to be somehow isolated or locked away, and as far as he knew, there was only one way for that to happen. The virus had to be inside cells in a kind of dormant state.

All at once Jack thought he understood why Aretha had had so much trouble making a diagnosis. It wasn’t a typical virus such as those that produced a cold, hemorrhagic fever, or even influenza. They were most likely dealing with an unknown retrovirus like HIV, which took two years to identify. And the moment the idea occurred to him, he wondered why he hadn’t thought of it earlier. It explained why some people saw it with electron microscopy and others didn’t.

“And the next thing I know is he was having trouble breathing,” Darlene continued. “It got worse fast. Then he started turning blue, so I called nine-one-one. It was terrible.”

“Excuse me,” a voice called.

Jack turned and looked up into the face of one of the night-shift ID clerks, who was standing to the side and behind him. She was holding a number of recently printed photos. “If Ms. Aaronson would like to do the identification, we are ready,” she said.

“May I see,” Jack asked.

“Of course, Dr. Stapleton,” the clerk said. She handed the entire stack to Jack.

Jack needed to look at only the top photo and immediately recognized that it was without doubt the John Carver he had spoken with the day before. For a moment Jack felt a tug on his heartstrings. He could remember the man asking if he had to worry about catching what had killed Helen and Carol. Jack hadn’t known what to say, and now the man was dead. Whatever specific virus it was, Jack could now say with reasonable certitude that it was definitely contagious but with low infectivity and most likely spread by body fluids, similar to HIV. But what made it particularly worrisome was its ability to be far more rapidly fatal. HIV killed by gradually weakening the immune system, whereas this new, unknown disease apparently killed by suddenly unleashing the immune system in a totally uncontrolled fashion.

At that moment there was no doubt in Jack’s mind that NYC was dealing with at least an outbreak of a new disease. Whether it would prove contagious enough to become an epidemic and then a pandemic, he had no way of knowing. Suddenly, he was no longer engaged in an undertaking merely as a way to deal with his daughter’s affliction, but rather one that had a potentially grave public-health impact. For Jack it was a case that clearly demonstrated both the power and importance of forensic pathology, and it certainly justified his switch to the field.

But his work was far from being done. There was still one more major question he needed answered. Of the three victims, who was the index case? Who contracted this unknown disease and then spread it to the others? Carol was his guess, because she was first, but the order of the deaths might or might not be indicative of who got it first, as the illness apparently had a long latent period between contracting the virus and the appearance of the first symptoms. All at once he was pleased the CDC epidemic intelligence team was en route. Epidemiology was their bailiwick, and his crusade had morphed into an epidemiological mystery. One of the biggest questions was whether the disease had anything to do with Carol’s heart transplant.

“Would you like to come back to my office, Ms. Aaronson?” the clerk asked, interrupting Jack’s rapid musings. “We need to get your information and signature.”

“Okay,” Darlene said. “But I’d like to ask Dr. Stapleton a question, if I may.”

“Of course,” Jack said. He’d gotten to his feet. He was now eager to leave. He wanted to see if John’s affliction was the same as Carol’s and Helen’s, just to be sure.

“Should I be worried about what has happened to John?” she questioned. “I mean... you know... I spent time with him.”

For a moment Jack was unable to speak, as his mind raced in circles in an attempt to come up with an appropriate answer. The question was essentially the same as the one John had asked him yesterday, and Jack felt he’d failed the man. Yet he truly didn’t know what to say. There was no way to make a diagnosis of an unknown disease, nor was there any treatment. Clearly Darlene was at risk, especially if she’d been intimate with John, and Jack was probably correct about the illness spreading by body fluids, but there was no way to assay the risk or do anything about it.

“Well?” Darlene asked. She went back to chewing her cuticles. She had hoped for reassurance. Jack’s silence was doing the opposite.

“To be totally honest, I don’t know,” Jack said, ultimately deciding truth was better than deception. “At this point, I’m concerned we might be witnessing the beginning of a new disease that potentially spreads by body fluids. You might have been exposed, but there is no way to know. Perhaps you should take that into consideration and avoid having intimate contact with anyone else for the time being. As soon as we know more we will be in touch with you. I can promise you that, since we’ll have your contact information from the identification process. That’s all I can say.” It was essentially what he had told John, which didn’t help the man. Yet on the spur of the moment he couldn’t think of anything else.