Contagion – Cook, Robin

Contagion

     Robin Cook

      

      

     June 12, 1991, dawned a near-perfect, late-spring day as the sun’s rays touched the eastern shores of the North American continent. Most of the United States, Canada, and Mexico expected clear, sunny skies.

     The only meteorological blips were a band of potential thunderstorms that was expected to extend from the plains into the Tennessee Valley and some showers that were forecasted to move in from the Bering Strait over the Seward Peninsula in Alaska. In almost every way this June twelfth was like every other June twelfth, with one curious phenomenon.

     Three incidents occurred that were totally unrelated, yet were to cause a tragic intersection of the lives of three of the people involved.

      

      

     11:36 A.M.

     DEADHORSE, ALASKA

     “Hey! Dick! Over here,” shouted Ron Halverton. He waved frantically to get his former roommate’s attention. He didn’t dare leave his Jeep in the brief chaos at the tiny airport. The morning 737 from Anchorage had just landed and the security people were strict about unattended vehicles in the loading area. Buses and vans were waiting for the tourists and the returning oil company personnel.

     Hearing his name and recognizing Ron, Dick waved back and then began threading his way through the milling crowd.

     Ron watched Dick as he approached. Ron hadn’t seen him since they’d graduated from college the year before, but Dick appeared just as he always did: the picture of normality with his Ralph Lauren shirt and windbreaker jacket, Guess jeans, and a small knapsack slung over his shoulder.

     Yet Ron knew the real Dick: the ambitious, aspiring microbiologist who would think nothing of flying all the way from Atlanta to Alaska with the hope of finding a new microbe. Here was a guy who loved bacteria and viruses. He collected the stuff the way other people collected baseball cards. Ron smiled and shook his head as he recalled that Dick had even had petri dishes of microbes in their shared refrigerator at the University of Colorado.

     When Ron had met Dick during their freshman year, it had taken a bit of time to get used to him. Although he was an indubitably faithful friend, Dick had some peculiar and unpredictable quirks. On the one hand he was a fierce competitor in intramural sports and surely the guy you wanted with you if you mistakenly wandered into the wrong part of town, yet on the other hand he’d been unable to sacrifice a frog in first-year biology lab.

     Ron found himself chuckling as he remembered another surprising and embarrassing moment involving Dick. It was during their sophomore year when a whole group had piled into a car for a weekend ski trip. Dick was driving and accidentally ran over a rabbit. His response had been to break down in tears. No one had known what to say. As a result some people began to talk behind Dick’s back, especially when it became common knowledge that he would pick up cockroaches at the fraternity house and deposit them outside instead of squishing them and flushing them down the toilet as everybody else did.

     As Dick came alongside the Jeep, he tossed his bag into the backseat before grasping Ron’s outstretched hand. They greeted each other enthusiastically.

     “I can’t believe this,” Ron said. “I mean, you’re here! In the Arctic.”

     “Hey, I wouldn’t have missed this for the world,” Dick said. “I’m really psyched. How far is the Eskimo site from here?”

     Ron looked nervously over his shoulder. He recognized several of the security people. Turning back to Dick, he lowered his voice. “Cool it,” he murmured. “I told you people are really sensitive about this.”

     “Oh, come on,” Dick scoffed. “You can’t be serious.”

     “I’m dead serious,” Ron said. “I could get fired for leaking this to you. No fooling around. I mean, we got to do this hush-hush or we don’t do it at all. You’re to tell no one, ever! You promised!”

     “All right, all right,” Dick said with a short, appeasing laugh. “You’re right. I promised. I just didn’t think it was such a big deal.”

     “It’s a very big deal,” Ron said firmly. He was beginning to think he’d made a mistake inviting Dick to visit, despite how much fun it was to see him.

     “You’re the boss,” Dick said. He gave his friend a jab on the shoulder. “My lips are sealed forever. Now chill out and relax.” He swung himself into the Jeep. “But let’s just buzz out there straight-away and check out this discovery.”

     “You don’t want to see where I live first?” Ron asked.

     “I have a feeling I’ll be seeing that more than I care to,” he said with a laugh.

     “I suppose it’s not a bad time while everybody is preoccupied with the Anchorage flight and screwing around with the tourists.” He reached forward and started the engine.

     They drove out of the airport and headed northeast on the only road. It was gravel. To talk they had to shout over the sound of the engine.

     “It’s about eight miles to Prudhoe Bay,” Ron said, “but we’ll be turning off to the west in another mile or so. Remember, if anybody stops us, I’m just taking you to the new oilfield.”

     Dick nodded. He couldn’t believe his friend was so uptight about this thing. Looking around at the flat, marshy monotonous tundra and the overcast gunmetal gray sky, he wondered if the place was getting to Ron. He guessed life was not easy on the alluvial plain of Alaska’s north slope. To lighten the mood he said: “Weather’s not bad. What’s the temperature?”

     “You’re lucky,” Ron said. “There was some sun earlier, so it’s in the low fifties. This is as warm as it gets up here. Enjoy it while it lasts. It’ll probably flurry later today. It usually does. The perpetual joke is whether it’s the last snow of last winter or the first snow of next winter.”

     Dick smiled and nodded but couldn’t help but think that if the people up there considered that funny, they were in sad shape.

     A few minutes later Ron turned left onto a smaller, newer road, heading northwest.

     “How did you happen to find this abandoned igloo?” Dick asked.

     “It wasn’t an igloo,” Ron said. “It was a house made out of peat blocks reinforced with whalebone. Igloos were only made as temporary shelters, like when people went out hunting on the ice. The Inupiat Eskimos lived in peat huts.”

     “I stand corrected,” Dick said. “So how’d you come across it?”

     “Totally by accident,” Ron said. “We found it when we were bulldozing for this road. We broke through the entrance tunnel.”

     “Is everything still in it?” Dick asked. “I worried about that flying up here. I mean, I don’t want this to be a wasted trip.”

     “Have no fear,” Ron said. “Nothing’s been touched. That I can assure you.”

     “Maybe there are more dwellings in the general area,” Dick suggested. “Who knows? It could be a village.”

     Ron shrugged. “Maybe so. But no one wants to find out. If anybody from the state got wind of this they’d stop construction on our feeder pipeline to the new field. That would be one huge disaster, because we have to have the feeder line functional before winter, and winter starts in August around here.”

     Ron began to slow down as he scanned the side of the road. Eventually he pulled to a stop abreast of a small cairn. Putting a hand on Dick’s arm to keep him in his scat, he turned to look back down the road. When he was convinced that no one was coming, he climbed from the Jeep and motioned for Dick to do the same.

     Reaching back into the Jeep, he pulled out two old and soiled and work gloves. He handed a set to Dick. “You’ll need these,” he explained. “We’ll be down below the permafrost.” Then he reached back into the Jeep for a heavy-duty flashlight.

     “All right,” Ron added nervously. “We can’t be here long. I don’t want anybody coming along the road and wondering what the hell is going on.”

     Dick followed Ron as he headed north away from the road. A cloud of mosquitoes mystically materialized and attacked them mercilessly. Looking ahead, Dick could see a fog bank about a half mile away and guessed it marked the coast of the Arctic Ocean. In all other directions there was no relief from the monotony of the fiat, windswept, featureless tundra that extended to the horizon. Overhead seabirds circled and cried raucously.

     A dozen steps from the road, Ron stopped. After one last glance for approaching vehicles, he bent down and grabbed the edge of a sheet of plywood that had been painted to match the variegated colors of the surrounding tundra. He pulled the wood aside to reveal a hole four feet deep.

     In the north wall of the hole was the entrance to a small tunnel.

     “It looks as if the hut was buried by ice,” Dick said.

     Ron nodded. “We think that pack ice was blown up from the beach during one of the ferocious winter storms.”

     “A natural tomb,” Dick said.

     “Are you sure you want to do this?” Ron asked.

     “Don’t be silly,” Dick said while he donned the parka and pulled on the gloves. “I’ve come thousands of miles. Let’s go.”

     Ron climbed into the hole and then bent down on all fours. Lowering himself, he entered the tunnel. Dick followed at his heels.

     As Dick crawled, he could see very little save for the eerie silhouette of Ron ahead of him. As he moved away from the entrance, the darkness closed in around him like a heavy, frigid blanket. In the failing light he noticed his breath crystallizing. He thanked God that he wasn’t claustrophobic.

     After about six feet the walls of the tunnel fell away. The floor also slanted downward, giving them an additional foot of headroom. There were about three and a half feet of clearance. Ron moved to the side and Dick crawled up next to him.

     “It’s colder than a witch’s tit down here,” Dick said.

     Ron’s flashlight beam played into the corners to illuminate short vertical struts of beluga rib bones.

     “The ice snapped those whalebones like they were toothpicks,” Ron said.

     “Where are the inhabitants?” Dick asked.

     Ron directed his flashlight beam ahead to a large, triangular piece of ice that had punched through the ceiling of the hut. “On the other side of that,” he said. He handed the flashlight to Dick.

     Dick took the flashlight and started crawling forward. As much as he didn’t want to admit it, he was beginning to feel uncomfortable. “You’re sure this place is safe?” he questioned.

     “I’m not sure of anything,” Ron said. “Just that it’s been like this for seventy-five years or so.”

     It was a tight squeeze around the block of dirty ice in the center. When Dick was halfway around he shone the light into the space beyond.

     Dick caught his breath while a little gasp issued from his mouth. Although he thought he’d been prepared, the image within the flashlight beam was more ghoulish than he’d expected. Staring back at him was the pale visage of a frozen, bearded Caucasian male dressed in furs. He was sitting upright. His eyes were open and ice blue, and they stared back at Dick defiantly. Around his mouth and nose was frozen pink froth. “You see all three?” Ron called from the darkness.

     Dick allowed the light to play around the room. The second body was supine, with its lower half completely encased in ice. The third body was positioned in a manner similar to the first, propped up against a wall in a half-sitting position. Both were Eskimos with characteristic features, dark hair, and dark eyes. Both also had frozen pink froth around their mouths and noses.

     Dick shuddered through a sudden wave of nausea. He hadn’t expected such a reaction, but it passed quickly.

     “You see the newspaper?” Ron called.

     “Not yet,” Dick said as he trained his light on the floor. He saw all sorts of debris frozen together, including bird feathers and animal bones. “It’s near the bearded guy,” Ron called.

     Dick shone the light at the frozen Caucasian’s feet. He saw the Anchorage paper immediately.

     The headlines were about the war in Europe. Even from where he was he could see the date: April 17, 1918.

     Dick wriggled back into the antechamber. His initial horror had passed. Now he was excited. “I think you were right,” he said. “It looks like all three died of pneumonia, and the date is right on.”

     “I knew you’d find it interesting,” Ron said.

     “It’s more than interesting,” Dick said. “It could be the chance of a lifetime. I’m going to need a saw.”

     The blood drained from Ron’s face. “A saw,” he repeated with dismay. “You’ve got to be joking.”

     “You think I’d pass up this chance?” Dick questioned. “Not on your life. I need some lung tissue.”

     “Jesus H. Christ!” Ron murmured. “You’d better promise again not to say anything about this ever!”

     “I promised already,” Dick said with exasperation. “If I find what I think I’m going to find, it will be for my own collection. Don’t worry. Nobody’s going to know.”

     Ron shook his head. “Sometimes I think you’re one weird dude.”

     “Let’s get the saw,” Dick said. He handed the flashlight to Ron and started for the entrance.

      

      

     6:40 P.M.

     O’HARE AIRPORT, CHICAGO

     Marilyn Stapleton looked at her husband of twelve years and felt torn. She knew that the convulsive changes that had racked their family had impacted most on John, yet she still had to think about the children. She glanced at the two girls who were sitting in the departure lounge and nervously looking in her direction, sensing that their life as they knew it was in the balance. John wanted them to move to Chicago where he was starting a new residency in pathology.

     Marilyn redirected her gaze to her husband’s pleading face. He’d changed over the last several years. The confident, reserved man she had married was now bitter and insecure. He had shed twenty-five pounds, and his once ruddy, full cheeks had hollowed, giving him a lean, haggard look consistent with his new personality.

     Marilyn shook her head. It was hard to recall that just two years previously they had been the picture of the successful suburban family with his flourishing ophthalmology practice and her tenured position in English literature at the University of Illinois.

     But then the huge health-care conglomerate AmeriCare had appeared on the horizon, sweeping through Champaign, Illinois, as well as numerous other towns, gobbling up practices and hospitals with bewildering speed. John had tried to hold out but ultimately lost his patient base. It was either surrender or flee, and John chose to flee. At first he’d looked for another ophthalmology position, but when it became clear there were too many ophthalmologists and that he’d be forced to work for AmeriCare or a similar organization, he’d made the decision to retrain in another medical specialty.

     “I think you would enjoy living in Chicago,” John said pleadingly. “And I miss you all terribly.”

     Marilyn sighed. “We miss you, too,” she said. “But that’s not the point. If I give up my job the girls would have to go to an inner-city public school. There’s no way we could afford private school with your resident’s salary.”

     The public-address system crackled to life and announced that all passengers holding tickets for Champaign had to be on board. It was last call. “We’ve got to go,” Marilyn said. “We’ll miss the flight.”

     John nodded and brushed away a tear. “I know,” he said. “But you will think about it?”

     “Of course I’ll think about it,” Marilyn snapped. Then she caught herself. She sighed again. She didn’t mean to sound angry. “It’s all I’m thinking about.” she added softly.

     Marilyn lifted her arms and embraced her husband. He hugged her back with ferocity.

     “Careful,” she wheezed. “You’ll snap one of my ribs.”

     “I love you,” John said in a muffled voice. He’d buried his face in the crook of her neck.

     After echoing his sentiments, Marilyn broke away and gathered Lydia and Tamara. She gave the boarding passes to the ticket agent and herded the girls down the ramp. As she walked she glanced at John through the glass partition. As they turned into the jetway she gave a wave. It was to be her last.

     “Are we going to have to move?” Lydia whined. She was ten and in the fifth grade.

     “I’m not moving,” Tamara said. She was eleven and strong-willed. “I’ll move in with Connie. She said I could stay with her.”

     “And I’m sure she discussed that with her mother,” Marilyn said sarcastically. She was fighting back tears she didn’t want the girls to see.

     Marilyn allowed her daughters to precede her onto the small prop plane. She directed the girls to their assigned seats and then had to settle an argument about who was going to sit alone. The seating was two by two.

     Marilyn answered her daughters’ impassioned entreaties about what the near future would bring with vague generalities. In truth, she didn’t know what was best for the family.

     The plane’s engines started with a roar that made further conversation difficult. As the plane left the terminal and taxied out toward the runway, she put her nose to the window. She wondered how she would have the strength to make a decision.

     A bolt of lightning to the southwest jolted Marilyn from her musing. It was an uncomfortable reminder of her disdain for commuter flights. She did not have the same confidence in small planes as she did in regular jets. Unconsciously she cinched her seat belt tighter and again checked her daughters’.

     During the takeoff Marilyn gripped the armrests with a force that suggested she thought her effort helped the plane get aloft. It wasn’t until the ground had significantly receded that she realized she’d been holding her breath.

     “How long is Daddy going to live in Chicago?” Lydia called across the aisle.

     “Five years,” Marilyn answered. “Until he finishes his training.”

     “I told you,” Lydia yelled to Tamara. “We’ll be old by then.”

     A sudden bump made Marilyn reestablish her death grip on her armrests. She glanced around the cabin.

     The fact that no one was panicking gave her some solace. Looking out the window, she saw that they were entirely enveloped in clouds. A flash of lightning eerily lit up the sky.

     As they flew south the turbulence increased, as did the frequency of the lightning. A terse announcement by the pilot that they would try to find smoother air at a different altitude did little to assuage Marilyn’s rising fears. She wanted the flight to be over.

     The first sign of real disaster was a strange light that filled the plane, followed instantly by a tremendous bump and vibration. Several of the passengers let out half-suppressed screams that made Marilyn’s blood run cold. Instinctively she reached over and pulled Tamara closer to her.

     The vibration increased in intensity as the plane began an agonizing roll to the right. At the same time the sound of the engines changed from a roar to an earsplitting whine. Sensing that she was being pressed into her seat and feeling disoriented in space, Marilyn looked out the window.

     At first she didn’t see anything but clouds. But then she looked ahead and her heart leaped into her throat.

     The earth was rushing up at them at breakneck speed! They were flying straight down…

      

      

     10:40 P.M.

     MANHATTAN GENERAL HOSPITAL NEW YORK CITY

     Terese Hagen tried to swallow, but it was difficult; her mouth was bone dry. A few minutes later her eyes blinked open, and for a moment she was disoriented. When she realized she was in a surgical recovery room it all came back to her in a flash.

     The problem had started without warning that evening just before she and Matthew were about to go out to dinner. There had been no pain. The first thing she was aware of was wetness, particularly on the inside of her thigh. Going into the bathroom, she was dismayed to find that she was bleeding. And it wasn’t just spotting.

     It was active hemorrhaging. Since she was five months pregnant, she was afraid it spelled trouble.

     Events had unfolded rapidly from that point. She’d been able to reach her physician, Dr. Carol Glanz, who offered to meet her at the Manhattan General’s emergency room. Once there, Terese’s suspicions had been confirmed and surgery scheduled. The doctor had said that it appeared as if the embryo had implanted in one of her tubes instead of the uterus—an ectopic pregnancy.

     Within minutes of her regaining consciousness, one of the recovery-room nurses was at her side, reassuring her that everything was fine.

     “What about my baby?” Terese asked. She could feel a bulky dressing over her disturbingly flat abdomen.

     “Your doctor knows more about that than I do,” the nurse said. “I’ll let her know you are awake. I know she wants to talk with you.”

     Before the nurse left, Terese complained about her dry throat. The nurse gave her some ice chips, and the cool fluid was a godsend.

     Terese closed her eyes. She guessed that she dozed off, because the next thing she knew was that Dr. Carol Glanz was calling her name.

     “How do you feel?” Dr. Glanz asked.

     Terese assured her she was fine thanks to the ice chips. She then asked about her baby.

     Dr. Glanz took a deep breath and reached out and put her hand on Terese’s shoulder. “I’m afraid I have double bad news,” she said. Terese could feel herself tense.

     “It was ectopic,” Dr. Glanz said, falling back on doctor jargon to make a difficult job a bit easier. “We had to terminate the pregnancy and, of course, the child was not viable.”

     Terese nodded, ostensibly without emotion. She had expected as much and had tried to prepare herself. What she wasn’t prepared for was what Dr. Glanz said next.

     “Unfortunately the operation wasn’t easy. There were some complications, which was why you were bleeding so profusely when you came into the emergency room. We had to sacrifice your uterus. We had to do a hysterectomy.”

     At first Terese’s brain was unable to comprehend what she’d been told. She nodded and looked expectantly at the doctor as if she anticipated more information.

     “I’m sure this is very upsetting for you,” Dr. Glanz said. “I want you to understand that everything was done that could have been done to avoid this unfortunate outcome.”

     Sudden comprehension of what she’d been told jolted Terese. Her silent voice broke free from its bounds and she cried: “No!”

     Dr. Glanz squeezed her shoulder in sympathy. “Since this was to be your first child, I know what this means to you,” she said. “I’m terribly sorry.”

     Terese groaned. It was such crushing news that for the moment she was beyond tears. She was numb. All her life she had assumed she would have children. It had been part of her identity. The idea that it was impossible was too difficult to grasp.

     “What about my husband?” Terese managed. “Has he been told?”

     “He has,” Dr. Glanz said. “I spoke to him as soon as I’d finished the case. He’s downstairs in your room, where I’m sure you’ll be going momentarily.”

     There was more conversation with Dr. Glanz, but Terese remembered little of it. The combined realization that she’d lost her child and would never be able to have another was devastating.

     A quarter hour later an orderly arrived to wheel her to her room. The trip went quickly; she was oblivious to her surroundings. Her mind was in turmoil; she needed reassurance and support.

     When she reached her room, Matthew was on his cellular phone. As a stockbroker, it was his constant companion.

     The floor nurses expertly transferred Terese to her bed and hung her IV on a pole behind her head. After making sure all was in order and encouraging her to call if she needed anything, they left.

     Terese looked over at Matthew, who had averted his gaze as he finished his call. She was concerned about his reaction to this catastrophe. They had been married for only three months.

     With a definitive click Matthew flipped his phone closed and slipped it into his jacket pocket.

     He turned to Terese and stared at her for a moment. His tie was loosened and his shirt collar unbuttoned.

     She tried to read his expression but couldn’t. He was chewing the inside of his cheek.

     “How are you?” he asked finally with little emotion.

     “As well as can be expected,” Terese managed. She desperately wanted him to come to her and hold her, but he kept his distance.

     “This is a curious state of affairs,” he said.

     “I’m not sure I know what you mean,” Terese said.

     “Simply that the main reason we got married has just evaporated,” Matthew said. “I’d say your planning has gone awry.”

     Terese’s mouth slowly dropped open. Stunned, she had to struggle to find her voice. “I don’t like your implication,” she said. “I didn’t get pregnant on purpose.”

     “Well, you have your reality and I have mine,” Matthew said. “The problem is: What are we going to do about it?”

     Terese closed her eyes. She couldn’t respond. It had been as if Matthew had plunged a knife into her heart.

     She knew from that moment that she didn’t love him. In fact she hated him…

     1

    

     WEDNESDAY, 7:15 A.M., MARCH 20, 1996

     NEW YORK CITY

     “Excuse me,” Jack Stapleton said with false civility to the darkly complected Pakistani cabdriver. “Would you care to step out of your car so we can discuss this matter fully?”

     Jack was referring to the fact that the cabdriver had cut him off at the intersection of Forty-sixth Street and Second Avenue. In retaliation Jack had kicked the cab’s driver-side door when they had both stopped at a red light at Forty-fourth Street. Jack was on his Cannondale mountain bike that he used to commute to work.

     This morning’s confrontation was not unusual. Jack’s daily route included a hair-raising slalom down Second Avenue from Fifty-ninth Street to Thirtieth Street at breakneck speed. There were frequent close calls with trucks and taxicabs and the inevitable arguments. Anyone else would have found the trip nerve-racking. Jack loved it. As he explained to his colleagues, it got his blood circulating.

     Choosing to ignore Jack until the light turned green, the Pakistani cabdriver then cursed him soundly before speeding off.

     “And to you too!” Jack yelled back. He accelerated standing up until he reached a speed equal to the traffic. Then he settled onto the seat while his legs pumped furiously.

     Eventually he caught up with the offending cabdriver, but Jack ignored him. In fact, he whisked past him, squeezing between the taxi and a delivery van.

     At Thirtieth Street Jack turned east, crossed First Avenue, and abruptly turned into the loading bay of the Office of the Chief Medical Examiner for the City of New York. Jack had been working there for five months, having been offered a position as an associate medical examiner after finishing his pathology residency and a year’s fellowship in forensics.

     Jack wheeled his bike past the security office and waved at the uniformed guard. Turning left, he passed the mortuary office and entered the morgue itself. Turning left again, he passed a bank of the refrigerated compartments used to store bodies prior to autopsy. In a corner where simple pine coffins were stored for unclaimed bodies heading for Hart Island, Jack parked his bike and secured it with several Kryptonite locks.

     The elevator took Jack up to the first floor. It was well before eight in the morning and few of the daytime employees had arrived. Even Sergeant Murphy wasn’t in the office assigned to the police.

     Passing through the communications room, Jack entered the ID area. He said hello to Vinnie Amendola, who returned the greeting without looking up from his newspaper. Vinnie was one of the mortuary techs who worked with Jack frequently.

     Jack also said hello to Laurie Montgomery, one of the board-certified forensic pathologists. It was her turn in the rotation to be in charge of assigning the cases that had come in during the night. She’d been at the Office of the Chief Medical Examiner for four and a half years. Like Jack, she was usually one of the first to arrive in the morning.

     “I see you made t into the office once again without having to come in feet first,” Laurie said teasingly. She was referring to Jack’s dangerous bike ride. “Coming in feet first” was office vernacular for arriving dead.

     “Only one brush with a taxi,” Jack said. “I’m accustomed to three or four. It was like a ride in the country this morning.”

     “I’m sure,” Laurie said without belief. “Personally I think you are foolhardy to ride your bike in this city. I’ve autopsied several of those daredevil bicycle messengers. Every time I see one in traffic I wonder when I’ll be seeing him in the pit.” The “pit” was office vernacular for the autopsy room.

     Jack helped himself to coffee, then wandered over to the desk where Laurie was working.

     “Anything particularly interesting?” Jack asked, looking over her shoulder.

     “The usual gunshot wounds,” Laurie said. “Also a drug overdose.”

     “Ugh,” Jack said.

     “You don’t like overdoses?”

     “Nah,” Jack said. “They’re all the same. I like surprises and a challenge.”

     “I had a few overdoses that fit into that category during my first year,” Laurie said.

     “How so?”

     “It’s a long story,” Laurie said evasively. Then she pointed to one of the names on her list. “Here’s a case you might find interesting: Donald Nodelman. The diagnosis is unknown infectious disease.”

     “That would certainly be better than an overdose,” Jack said.

     “Not in my book,” Laurie said. “But it’s yours if you want it. Personally I don’t care for infectious disease cases, never have and never will. When I did the external exam earlier, it gave me the creeps. Whatever it was, it was an aggressive bug. He’s got extensive subcutaneous bleeding.”

     “Unknowns can be a challenge,” Jack said. He picked up the Folder. “I’ll be glad to do the case. Did he die at home or in an institution?”

     “He was in a hospital,” Laurie said. “He was brought in From the Manhattan General. But infectious disease wasn’t his admitting diagnosis. He’d been admitted for diabetes.”

     “It’s my recollection that the Manhattan General is an AmeriCare hospital,” Jack said. “Is that true?”

     “I think so,” Laurie said. “Why do you ask?”

     “Because it might make this case personally rewarding,” Jack said. “Maybe I’ll be lucky enough for the diagnosis to be something like Legionaries’ disease. I couldn’t think of anything more enjoyable than giving AmeriCare heartburn. I’d love to see that corporation squirm.”

     “Why’s that?” Laurie asked.

     “It’s a long story,” Jack said with an impish smile. “One of these days we should have a drink and you can tell me about your overdoses and I’ll tell you about me and AmeriCare.”

     Laurie didn’t know if Jack’s invitation was sincere or not. She didn’t know much about Jack Stapleton beyond his work at the medical examiner’s office; her understanding was that no one else did either. Jack was a superb forensic pathologist, despite the fact that he’d only recently finished his training. But he didn’t socialize much, and he was never very personally revealing in his small talk. All Laurie knew was that he was forty-one, unmarried, entertainingly flippant, and came from the Midwest.

     “I’ll let you know what I find,” Jack said as he headed toward the communications room.

     “Jack, excuse me,” Laurie called out.

     Jack stopped and turned around.

     “Would you mind I gave you a bit of advice,” she said hesitantly. She was speaking impulsively. It wasn’t like her, but she appreciated Jack and hoped that he would be working there for some time.

     Jack’s impish smile returned. He stepped back to the desk. “By all means,” he said.

     “I’m probably speaking out of turn,” Laurie said.

     “Quite the contrary,” Jack said. “I honor your opinion. What’s on your mind?”

     “Just that you and Calvin Washington have been at odds,” Laurie said. “I know it’s just a clash of personalities, but Calvin has had a long-standing relationship with the Manhattan General, as AmeriCare does with the mayor’s office. I think you should be careful.”

     “Being careful hasn’t been one of my strong points for five years,” Jack said. “I have utmost respect for the deputy chief. Our only disagreement is that he believes rules to be carved in stone while I see them as guidelines. As for AmeriCare, I don’t care for their goals or methods.”

     “Well, it’s not my business,” Laurie said. “But Calvin keeps saying he doesn’t see you as a team player.”

     “He’s got a point there,” Jack said. “The problem is that I’ve developed an aversion to mediocrity. I’m honored to work with most people around here, especially you. However, there are a few whom I can’t deal with, and I don’t hide it. It’s as simple as that.”

     “I’ll take that as a compliment,” Laurie said.

     “It was meant as one,” Jack said.

     “Well, let me know what you find on Nodelman,” Laurie said. “Then I’ll have at least one more case for you to do.”

     “My pleasure,” Jack said. He turned and headed for the communications room. As he walked past Vinnie, he snatched away his paper.

     “Come on, Vinnie,” Jack said. “We’re going to get a jump on the day.”

     Vinnie complained but followed. While trying to retrieve his paper he collided with Jack, who had abruptly stopped outside of Janice Jaeger’s office. Janice was one of the forensic investigators, frequently referred to as PAs or physician’s assistants. Her tour of duty was the graveyard shift, from eleven to seven. Jack was surprised to find her still in her office. A petite woman with dark hair and dark eyes, she was obviously tired.

     “What are you still doing here?” Jack asked.

     “I’ve got one more report to finish.”

     Jack held up the folder in his hand. “Did you or Curt handle Nodelman?”

     “I did,” Janice said. “Is there a problem?”

     “Not that I know about yet,” Jack said with a chuckle. He knew Janice to be extremely conscientious, which made her ideal for teasing. “Was it your impression the cause of death was a nosocomial infection?”

     “What the hell is a ‘nosocomial infection’?” Vinnie asked.

     “It’s an infection acquired in a hospital,” Jack explained.

     “It certainly seems so,” Janice said. “The man had been in the hospital five days for his diabetes before developing symptoms of an infectious disease. Once he got them, he died within thirty-six hours.”

     Jack whistled in respect. “Whatever the bug was, it certainly was virulent.”

     “That’s what worried the doctors I spoke with,” Janice said.

     “Any laboratory results from microbiology?” Jack questioned.

     “Nothing has grown out,” Janice said. “Blood cultures were negative as of four o’clock this morning. The terminal event was acute respiratory distress syndrome, or ARDS, but sputum cultures have been negative as well. The only positive thing was the gram stain of the sputum. That showed gram-negative bacilli. That made people think of pseudomonas, but it hasn’t been confirmed.”

     “Any question of the patient being immunologically compromised?” Jack asked. “Did he have AIDS or had he been treated with anti-metabolites?”

     “Not that I could ascertain,” Janice said. “The only problem he had listed was diabetes and some of the usual sequelae. Anyway, it’s all in the investigative report if you’d care to read it.”

     “Hey, why read when I can get it from the horse’s mouth?” Jack said with a laugh. He thanked Janice and headed for the elevator.

     “I hope you are planning to wear your moon suit,” Vinnie said. The moon suit, the completely enclosed, impervious outfit complete with a clear plastic face mask, was designed for maximum protection. Air was forced into the suit by a fan worn at the small of the back, pulling air through a filter before circulating it within the headpiece. That provided enough ventilation to breathe but guaranteed sauna-like temperatures inside. Jack detested the setup.

     As far as Jack was concerned the moon suit was bulky, restrictive, uncomfortable, hot, and unnecessary. He’d not worn one throughout his training. The problem was that the New York chief, Dr. Harold Bingham, had decreed that the suits be used. Calvin, the deputy chief, was intent on enforcing it. Jack had endured several confrontations as a result.

     “This might be the first time the suit is indicated, Jack said, to Vinnie’s relief. “Until we know what we are dealing with we have to take all precautions. After all, it could be something like Ebola virus.”

     Vinnie stopped in his tracks. “You really think it’s possible?” he asked, his eyes opened wide.

     “Not a chance,” Jack said. He slapped him on the back. “Just kidding.”

     “Thank God,” Vinnie said. They started walking again.

     “But maybe plague.”

     Vinnie stopped again. “That would be just as bad,” he said.

     Jack shrugged his shoulders. “All in a day’s work,” he said. “Come on, let’s get it over with.”

     They changed into scrubs, and then while Vinnie put on his moon suit and went into the autopsy room, Jack went through the contents of Nodelman’s folder. It had a case work sheet, a partially completed death certificate, an inventory of medical-legal case records, two sheets for autopsy notes, a telephone notice of death as received that night by communications, a completed identification sheet, Janice’s investigative report, a sheet for the autopsy report, and a lab slip for HIV antibody analysis.

     Despite having spoken with Janice, Jack read her report carefully as he always did. When he was finished he went into the room next to the pine coffins and put on his moon suit. He took his ventilation unit from where it had been charging and hooked himself up. Then he set out for the autopsy room on the other side of the morgue.

     Jack cursed the suit as he walked past most of the 126 refrigerated compartments for bodies. Being encased in the contraption put him in a bad mood, and he eyed his surroundings with a jaundiced eye. The morgue had been state of the art at one time, but it was now in need of repair and upgrading. With its aged, blue tile walls and stained cement floor it looked like a set for an old horror movie.

     There was an entrance to the autopsy room directly from the hallway, but that wasn’t used any longer except to bring bodies in and out. Instead Jack entered through a small anteroom with a washbasin.

     By the time Jack entered the autopsy room Vinnie had Nodelman’s body on one of the eight tables and had assembled all the necessary equipment and paraphernalia necessary to do the case. Jack positioned himself on the patient’s right, Vinnie on the left.

     “He doesn’t look so good,” Jack said. “I don’t think he’s going to make it to the prom.” It was hard to talk in the moon suit, and he was already perspiring.

     Vinnie, who never quite knew how to react to Jack’s irreverent comments, didn’t respond even though the corpse did look terrible.

     “This is gangrene on his fingers,” Jack said. He lifted one of the hands and examined the almost-black fingertips closely. Then he pointed to the man’s shriveled genitals. “That’s gangrene on the end of his penis. Ouch! That must have hurt. Can you imagine?”

     Vinnie held his tongue.

     Jack carefully examined every inch of the man’s exterior. For Vinnie’s benefit he pointed out the extensive subcutaneous hemorrhages on the man’s abdomen and legs. He told him it was called purpura. Then Jack mentioned there were no obvious insect bites. “That’s important,” he added. “A lot of serious diseases are transmitted by arthropods.”

     “Arthropods?” Vinnie questioned. He never knew when Jack was joking.

     “Insects,” Jack said. “Crustaceans aren’t much of a problem as disease vectors.”

     Vinnie nodded appreciatively, although he didn’t know any more than he had when he’d asked his question. He made a mental note to try to remember to look up the meaning of “arthropods” when he had an opportunity.

     “What are the chances whatever killed this man is contagious?” Vinnie asked.

     “Excellent, I’m afraid,” Jack said. “Excellent.”

     The door to the hallway opened and Sal D’Ambrosio, another mortuary tech, wheeled in another body. Totally absorbed in the external exam of Mr. Nodelman, Jack did not look up. He was already beginning to form a differential diagnosis.

     A half hour later six of the eight tables were occupied by corpses awaiting autopsies. One by one the other medical examiners on duty that day began to arrive. Laurie was the first, and she came over to Jack’s table. “Any ideas yet?” she asked.

     “Lots of ideas but nothing definitive,” Jack said. “But I can assure you this is one virulent organism. I was teasing Vinnie earlier about its being Ebola. There’s a lot of disseminated intravascular coagulation.”

     “My God!” Laurie exclaimed. “Are you serious?”

     “No, not really,” Jack said. “But from what I’ve seen so far it’s still possible, just not probable. Of course I’ve never seen a case of Ebola, so that should tell you something.”

     “Do you think we ought to isolate this case?” Laurie asked nervously.

     “I can’t see any reason to,” Jack said. “Besides, I’ve already started, and I’ll be careful to avoid throwing any of the organs around the room. But I’ll tell you what we should do: alert the lab to be mighty careful with the specimens until we have a diagnosis.”

     “Maybe I’d better ask Bingham’s opinion,” Laurie said.

     “Oh, that would be helpful,” Jack said sarcastically. “Then we’ll have the blind leading the blind.”

     “Don’t be disrespectful,” Laurie said. “He is the chief.”

     “I don’t care if he’s the Pope,” Jack said. “I think I should just get it done, the sooner the better. If Bingham or even Calvin gets involved it will drag on all morning.”

     “All right,” Laurie said. “Maybe you’re right. But let me see any abnormality. I’ll be on table three.”

     Laurie left to do her own case. Jack took a scalpel from Vinnie and was about to make the incision when he noticed that Vinnie had moved away.

     “Where are you going to watch this from, Queens?” Jack asked. “You’re supposed to be helping.”

     “I’m a little nervous,” Vinnie admitted.

     “Oh, come on, man,” Jack said. “You’ve been at more autopsies than I have. Get your Italian ass over here. We’ve got work to do.”

     Jack worked quickly but smoothly. He handled the internal organs gently and was meticulously careful about the use of instruments when either his or Vinnie’s hands were in the field.

     “Whatcha got?” Chet McGovern asked, looking over Jack’s shoulder. Chet was also an associate medical examiner, having been hired in the same month as Jack. Of all the colleagues he’d become the closest to Jack, since they shared both a common office and the social circumstance of being single males. But Chet had never been married and at thirty-six, he was five years Jack’s junior.

     “Something interesting,” Jack said. “The mystery disease of the week. And it’s a humdinger. This poor bastard didn’t have a chance.”

     “Any ideas?” Chet asked. His trained eye took in the gangrene and the hemorrhages under the skin.

     “I got a lot of ideas,” Jack said. “But let me show you the internal. I’d appreciate your opinion.”

     “Is there something I should see?” Laurie called from table three. She’d noticed Jack conversing with Chet.

     “Yeah, come on over,” Jack said. “No use going through this more than once.”

     Laurie sent Sal to the sink to wash out the intestines on her case, then stepped over to table one.

     “The first thing I want you to look at is the lymphatics I dissected in the throat,” Jack said. He had retracted the skin of the neck from the chin to the collarbone.

     “No wonder autopsies take so long around here,” a voice boomed in the confined space.

     All eyes turned toward Dr. Calvin Washington, the deputy chief. He was an intimidating six-foot-seven, two-hundred-and-fifty-pound African-American man who’d passed up a chance to play NFL football to go to medical school.

     “What the hell is going on around here?” he demanded half in jest. “What do you people think this is, a holiday?”

     “Just pooling resources,” Laurie said. “We’ve got an unknown infectious case that appears to be quite an aggressive microbe.”

     “So I heard,” Calvin said. “I already got a call from the administrator over at the Manhattan General. He’s justly concerned. What’s the verdict?”

     “A bit too soon to tell,” Jack said. “But we’ve got a lot of pathology here.”

     Jack quickly summarized for Calvin what was known of the history and pointed out the positive findings on the external exam. Then he started back on the internal, indicating the spread of the disease along the lymphatics of the neck.

     “Some of these nodes are necrotic,” Calvin said.

     “Exactly,” Jack said. “In fact most of them are necrotic. The disease was spreading rapidly through the lymphatics, presumably from the throat and bronchial tree.”

     “Airborne, then,” Calvin said.

     “It would be my first guess,” Jack admitted. “Now look at the internal organs.”

     Jack presented the lungs and opened the areas where he’d made slices. “As you can see, this is pretty extensive lobar pneumonia,” Jack said. “There’s a lot of consolidation. But there is also some necrosis, and I believe early cavitation. If the patient had lived longer, I think we would be seeing some abscess formation.”

     Calvin whistled. “Wow,” he said. “All this was happening in the face of massive IV antibiotics.”

     “It’s worrisome,” Jack agreed. He carefully slid the lungs back into the pan. He didn’t want them sloshing around, potentially throwing infective particles into the air. Next he picked up the liver and gently separated its cut surface.

     “Same process,” he announced, pointing with his fingers to areas of early abscess formation. “Just not as extensive as with the lungs.” Jack put the liver down and picked up the spleen. There were similar lesions throughout the organ. He made sure everyone saw them. “So much for the gross,” Jack said as he carefully replaced the spleen in the pan. “We’ll have to see what the microscopic shows, but I actually think we’ll be relying on the lab to give us the definitive answer.”

     “What’s your guess at this point?” Calvin asked.

     Jack let out a short laugh. “A guess it would have to be,” he said. “I haven’t seen anything pathognomonic yet. But its fulminant character should tell us something.”

     “What’s your differential diagnosis?” Calvin asked. “Come on, Wonderboy, let’s hear it.”

     “Ummmm,” Jack said. “You’re kinda putting me on the spot. But okay, I’ll tell you what’s been going through my head. First, I don’t think it could be pseudomonas as suspected at the hospital. It’s too aggressive. It could have been something atypical like strep group A or even staph with toxic shock, but I kinda doubt it, especially with the gram stain suggesting it was a bacillus. So I’d have to say it is something like tularemia or plague.”

     “Whoa!” Calvin exclaimed. “You’re coming up with some pretty arcane illnesses for what was apparently a hospital-based infection. Haven’t you heard the phrase about when you hear hoofbeats you should think of horses, not zebras?”

     “I’m just telling you what’s going through my mind. It’s just a differential diagnosis. I’m trying to keep an open mind.”

     “All right,” Calvin said soothingly. “Is that it?”

     “No, that’s not it,” Jack said. “I’d also consider that the gram stain could have been wrong and that would let in not only strep and staph but meningococcemia as well. And I might as well throw in Rocky Mountain spotted fever and hantavirus. Hell, I could even throw in the viral hemorrhagic fevers like Ebola.”

     “Now you’re getting out in the stratosphere,” Calvin said. “Let’s come back to reality. If I made you guess which one it is right now with what you know, what would you say?”

     Jack clucked his tongue. He had the irritated feeling he was being put back in medical school, and that Calvin, like many of his medical-school professors, was trying to make him look bad.

     “Plague,” Jack said to a stunned audience.

     “Plague?” Calvin questioned with surprise bordering on disdain. “In March? In New York City? In a hospitalized patient? You got to be out of your mind.”

     “Hey, you asked me for one diagnosis,” Jack said. “So I gave it to you. I wasn’t responding by probabilities, just pathology.”

     “You weren’t considering the other epidemiological aspects?” Calvin asked with obvious condescension. He laughed. Then, talking more to the others than Jack, he said: “What the hell did they teach you out there in the Chicago boonies?”

     “There are too many unknowns in this case for me to put a lot of weight on unsubstantiated information,” Jack said. “I didn’t visit the site. I don’t know anything about the deceased’s pets, travel, or contact with visitors. There are a lot of people coming and going in this city, even in and out of a hospital. And there are certainly more than enough rats around here to support the diagnosis.”

     For a moment a heavy silence hung over the autopsy room. Neither Laurie nor Chet knew what to say. Jack’s tone made them both uncomfortable, especially knowing Calvin’s stormy temperament.

     “A clever comment,” Calvin said finally. “You’re quite good at double entendre. I have to give you credit there. Perhaps that’s part of pathology training in the Midwest.”

     Both Laurie and Chet laughed nervously.

     “All right, smartass,” Calvin continued. “How much are you willing to put on your diagnosis of plague?”

     “I didn’t know it was customary to gamble around here,” Jack said.

     “No, it’s not common to gamble, but when you come up with a diagnosis of plague, I think it’s worthwhile to make a point of it. How about ten dollars?”

     “I can afford ten dollars,” Jack said.

     “Fine,” Calvin said. “With that settled, where’s Paul Lodgett and that gunshot wound from the World Trade Center?”

     “He’s down on table six,” Laurie said.

     Calvin lumbered away and for a moment the others watched him. Laurie broke the silence.

     “Why do you try to provoke him?” she asked Jack. “I don’t understand. You’re making it more difficult for yourself.”

     “I can’t help it,” Jack said. “He provoked me!”

     “Yeah, but he’s the deputy chief and it’s his prerogative,” Chet said. “Besides, you were pushing things with a diagnosis of plague. It certainly wouldn’t be on the top of my list.”

     “Are you sure?” Jack asked. “Look at the black fingers and toes on this patient. Remember, it was called the black death back in the fourteenth century.”

     “A lot of diseases can cause such thrombotic phenomena,” Chet said.

     “True,” Jack said. “That’s why I almost said tularemia.”

     “And why didn’t you?” Laurie asked. In her mind tularemia was equally improbable.

     “I thought plague sounded better,” Jack said. “It’s more dramatic.”

     “I never know when you are serious,” Laurie said.

     “Hey, I feel the same way,” Jack said.

     Laurie shook her head in frustration. At times it was hard to have a serious discussion with Jack. “Anyway,” she said, “are you finished with Nodelman? If you are, I’ve got another case for you.”

     “I haven’t done the brain yet,” Jack said.

     “Then get to it,” Laurie said. She walked back to table three to finish her own case.

     2

    

     WEDNESDAY, 9:45 A.M., MARCH 20, 1996

     NEW YORK CITY

     Terese Hagen stopped abruptly and looked at the closed door to the “cabin,” the name given to the main conference room. It was called the cabin because the interior was a reproduction of Taylor Heath’s Square Lake house up in the wilds of New Hampshire. Taylor Heath was the CEO of the hot, up-and-coming advertising firm Willow and Heath, which was threatening to break into the rarefied ranks of the advertising big leagues.

     After making sure she was not observed, Terese leaned toward the door and put her ear against it. She heard voices.

     With her pulse quickening, Terese hurried down the hall to her own office. It never took long for her anxiety to soar. She’d only been in the office five minutes and already her heart was pounding. She didn’t like the idea of a meeting she didn’t know about being held in the cabin, the CEO’s habitual domain. In her position as the creative director of the firm, she felt she had to know everything that was going on.

     The problem was that a lot was going on. Taylor Heath had shocked everybody with his previous month’s announcement that he planned to retire as CEO and was designating Brian Wilson, the current president, to succeed him. That left a big question mark about who would succeed Wilson. Terese was in the running. That was for sure. But so was Robert Barker, the firm’s executive director of accounts.

     And on top of that, there was always the worry that Taylor would pick someone from outside.

     Terese pulled off her coat and stuffed it into the closet. Her secretary, Marsha Devons, was on the phone, so Terese dashed to her desk and scanned the surface for any telltale message; but there was nothing except a pile of unrelated phone messages.

     “There’s a meeting in the cabin,” Marsha called from the other room after hanging up the phone. She appeared in the doorway. She was a petite woman with raven-black hair. Terese appreciated her because she was intelligent, efficient, and intuitive—all the qualities lacking in the year’s previous four secretaries. Terese was tough on her assistants, since she expected commitment and performance equivalent to her own.

     “Why didn’t you call me at home?” Terese demanded.

     “I did, but you’d already left,” Marsha said.

     “Who’s at the meeting?” Terese barked.

     “It was Mr. Heath’s secretary who called,” Marsha said. “She didn’t say who would be attending. Just that your presence was requested.”

     “Was there any indication what the meeting is about?” Terese asked.

     “No,” Marsha said simply.

     “When did it start?”

     “The call came through at nine,” Marsha said.

     Terese snatched up her phone and punched in Colleen Anderson’s number. Colleen was Terese’s most trusted art director. She was currently heading up a team for the National Health Care account.

     “You know anything about this meeting in the cabin?” Terese asked as soon as Colleen was on the line.

     Colleen didn’t, only that it was going on.

     “Damn!” Terese said as she hung up.

     “Is there a problem?” Marsha asked solicitously.

     “If Robert Barker has been in there all this time with Taylor, there’s a problem,” Terese said. “That prick never misses a beat to put me down.” Terese snatched the phone again and redialed Colleen. “What’s the status on National Health? Do we have any comps or anything I can show right now?”

     “I’m afraid not,” Colleen said. “We’ve been brainstorming, but we don’t have anything zippy like I know you want. I’m looking for a home run.”

     “Well, goose your team,” Terese said. “I have a sneaking suspicion I’m most vulnerable with National Health.”

     “No one’s been sleeping down here,” Colleen said. “I can assure you of that.”

     Terese hung up without saying good-bye. Snatching up her purse, she ran down the hall to the ladies’ room and positioned herself in front of the mirror. She pushed her Medusa’s head of highlighted tight curls into a semblance of order, then reapplied some lipstick and a bit of blush.

     Stepping back, she surveyed herself. Luckily she’d chosen to wear one of her favorite suits. It was dark blue wool gabardine and seriously severe, hugging her narrow frame like a second skin.

     Satisfied with her appearance, Terese hustled to the cabin door. After a deep breath she grasped the knob, turned it, and entered.

     “Ah, Miss Hagen,” Brian Wilson said, glancing at his watch. He was sitting at the head of a rough-hewn plank table that dominated the room. “I see you’re now indulging in banker’s hours.”

     Brian was a short man with thinning hair. He vainly tried to camouflage his bald spot by combing his side hair over it. As per usual he was attired in a white shirt and tie, loosened at the neck, giving him the appearance of a harried newspaper publisher. To complete the journalistic look, his sleeves were rolled up above his elbows and a yellow Dixon pencil was tucked behind his right ear.

     Despite the catty comment, Terese liked and respected Brian. He was an able administrator. He had a patented derogatory style, but he was equally demanding of himself.

     “I was in the office last night until one A.M.,” Terese said. “I certainly would have been here for this meeting if someone had been kind enough to have let me know about it.”

     “It was an impromptu meeting,” Taylor called out. He was standing near the window, in keeping with his laissez-faire management style. He preferred to hover above the group like an Olympian god, watching his demigods and mere mortals hammer out decisions.

     Taylor and Brian were opposite in most ways. Where Brian was short, Taylor was tall. Where Brian was balding, Taylor had a dense halo of silver-gray hair. Where Brian appeared as the harried newspaper columnist always with his back against the wall, Taylor was the picture of sophisticated tranquility and sartorial splendor. Yet no one doubted Taylor’s encyclopedic grasp of the business and his uncanny ability to maintain strategic goals in the face of daily tactical disaster and controversy.

     Terese took a seat at the table directly across from her nemesis, Robert Barker. He was a tall, thin-faced man with narrow lips who seemed to take a cue from Taylor in regard to his dress. He was always attired nattily in dark silk suits and colorful silk ties. The ties were his trademark. Terese could not remember ever having seen the same tie twice.

     Next to Robert was Helen Robinson, whose presence made Terese’s racing heart beat even a little faster. Helen worked under Robert as the account executive assigned specifically to National Health. She was a strikingly attractive twenty-five-year-old woman with long, chestnut-colored hair that cascaded to her shoulders, tanned skin even in March, and full, sensuous features. Between her intelligence and looks she was a formidable adversary.

     Also sitting at the table was Phil Atkins, the chief financial officer, and Carlene Desalvo, the corporate director of account planning. Phil was an impeccably precise man with his perennial three-piece suit and wire-rimmed glasses. Carlene was a bright, full-figured woman who always dressed in white. Terese was mildly surprised to see both of them at the meeting.

     “We’ve got a big problem with the National Health account,” Brian said. “That’s why this meeting was called.”

     Terese’s mouth went dry. She glanced at Robert and detected a slight but infuriating smile. Terese wished to God she’d been there since the beginning of the meeting so she could have known everything that had been said.

     Terese was aware of trouble with National Health. The company had called for an internal review a month ago, which meant that Willow and Heath had to come up with a new advertising campaign if they expected to keep the account. And everybody knew they had to keep the account. It had mushroomed to somewhere around forty million annually and was still growing. Health-care advertising was in the ascendancy, and would hopefully fill the hole vacated by cigarettes.

     Brian turned to Robert. “Perhaps you could fill Terese in on the latest developments,” he said.

     “I defer to my able assistant, Helen,” Robert said, giving Terese one of his condescending smiles.

     Helen moved forward in her seat. “As you know, National Health has had misgivings about its advertising campaign. Unfortunately their displeasure has increased. Just yesterday their figures came in for the last open subscriber period. The results weren’t good. Their loss of market share to AmeriCare in the New York metropolitan area has increased. After building the new hospital, this is a terrible blow.”

     “And they blame our ad campaign for that?” Terese blurted out. “That’s absurd. They only made a twenty-five-point buy with our sixty-second commercial. That was not adequate. No way.”

     “That may be your opinion,” Helen said evenly. “But I know it is not National Health’s.”

     “I know you are fond of your ‘Health care for the modern era’ campaign, and it is a good tag line,” Robert said, “but the fact of the matter is that National Health has been losing market share from the campaign’s inception. These latest figures are just consistent with the previous trend.”

     “The sixty-second spot has been nominated for a Clio,” Terese countered. “It’s a damn good commercial. It’s wonderfully creative. I’m proud of my team for having put it together.”

     “And indeed you should be,” Brian interjected. “But it is Robert’s feeling that the client is not interested in our winning a Clio. And remember, as the Benton and Bowles agency held, ‘If it doesn’t sell, it isn’t creative.

     “That’s equally absurd,” Terese snapped. “The campaign is solid. It’s just that the account people couldn’t get the client to buy adequate exposure. There should have been ‘flights’ on multiple local stations at a bare minimum.”

     “With all due respect, they would have bought more time if they’d liked the commercial,” Robert said. “I don’t think they were ever sold on this idea of ‘them versus us,’ ancient medicine versus modern medicine. I mean it was humorous, but I don’t know if they were convinced the viewer truly associated the ancient methods with National Health Care’s competitors, particularly AmeriCare. My personal opinion is that it went over people’s heads.”

     “Your real point is that National Health Care has a very specific type of advertising it wants,” Brian said. “Tell Terese what you told me just before she came in here.”

     “It’s simple,” Robert said, making an open gesture with his hands. “They want either ‘talking heads’ discussing actual patient experiences, or a celebrity spokesperson. They couldn’t care less whether their ad wins a Clio or any of the other awards. They want results. They want market share, and I want to give it to them.”

     “Am I hearing that Willow and Heath wants to turn its back on its successes and become a mere vendor shop?” Terese asked. “We’re on the edge of becoming one of the big-league firms. And how did we get here? We got here by doing quality advertising. We’ve carried on in the Doyle-Dane-Bernback tradition. If we start letting clients dictate that we turn out slop, we’re doomed.”

     “What I’m hearing is the usual conflict between the account executive and the creative,” Taylor said, interrupting the increasingly heated discussion. “Robert, you think Terese is this self-indulgent child who is bent on alienating the client. Terese, you think Robert is this shortsighted pragmatist who wants to throw out the baby with the bathwater. The trouble is you are both right and both wrong at the same time. You have to use each other as a team. Stop arguing and deal with the problem at hand.”

     For a moment everyone was quiet. Zeus had spoken and everyone knew he was on target as usual.

     “All right,” Brian said finally. “Here’s our reality. National Health is a vital client to our long-term stability. Thirty-odd days ago it asked for an internal review, which we expected in a couple of months. They now have told us they want it next week.”

     “Next week!” Terese all but shouted. “My God.” It took months to put together a new campaign and pitch it.

     “I know that will put the creatives under a lot of pressure,” Brian said. “But the reality is National Health is the boss. The problem is that after our pitch, if they are not satisfied, they’ll set up an outside review. The account will then be up for grabs, and I don’t have to remind you that these health-care giants are going to be the advertising cash cows of the next decade. All the agencies are interested.”

     “As chief financial officer I think I should make it clear what the loss of the National Health account would do to our bottom line,” Phil Atkins said. “We’ll have to put off the restructuring because we won’t have the funds to buy back our junk bonds.”

     “Obviously it is in all our best interests that we not lose the account,” Brian said.

     “I don’t know if it is possible to put together a pitch for next week,” Terese said.

     “You have anything you can show us at the moment?” Brian asked. Terese shook her head.

     “You must have something,” Robert said. “I assume you have a team working on it.” The smile had returned to the corners of his mouth.

     “Of course we have a team on National Health,” Terese said. “But we haven’t had any ‘big ideas’ to date. Obviously we thought we had several more months.”

     “Perhaps you might assign some additional personnel,” Brian said. “But I’ll leave that up to your judgment.” Then to the rest of the group he said: “For now we’ll adjourn this meeting until we have something from Creative to look at.” He stood up. Everybody else did the same.

     Dazed, Terese stumbled out of the cabin and descended to the agency’s main studio on the floor below.

     Willow and Heath had reversed a trend that began during the seventies and eighties when New York advertising firms had experienced a diaspora to varying chic sections of the city like TriBeCa and Chelsea. The agency returned to the old stamping ground of Madison Avenue, taking over several floors of a modest-sized building.

     Terese found Colleen at her drawing board. “What’s the scoop?” Colleen asked. “You look pale.”

     “Trouble!” Terese exclaimed.

     Colleen had been Terese’s first hire. She was her most reliable art director. They got along fatuously both professionally and socially. Colleen was a milky-white-skinned strawberry blonde with a smattering of pale freckles over an upturned nose. Her eyes were a deep blue, a much stronger hue than Terese’s. She favored oversized sweatshirts that somehow seemed to accentuate rather than hide her enviable figure.

     “Let me guess,” Colleen said. “Has National Health pushed up the deadline for the review?”

     “How’d you know?”

     “Intuition,” Colleen said. “When you said ‘trouble,’ that’s the worst thing I could think of.”

     “The Robert-and-Helen sideshow brought in information that National Health has lost more market share to AmeriCare despite our campaign.”

     “Damn!” Colleen said. “It’s a good campaign and a great sixty-second commercial.”

     “You know it and I know it,” Terese said. “Problem is that it wasn’t shown enough. I have an uncomfortable suspicion that Helen undermined us and talked them out of the two-hundred- to three-hundred-point TV commercial buy they had initially intended to make. That would have been saturation. I know it would have worked.”

     “I thought you told me you had pulled out the stops to guarantee National Health’s market share would go up,” Colleen said.

     “I did,” Terese said. “I’ve done everything I could think of and then some. I mean, it’s my best sixty-second spot. You told me yourself.”

     Terese rubbed her forehead. She was getting a headache. She could still feel her pulse clanging away at her temples.

     “You might as well tell me the bad news,” Colleen said. She put down her drawing pencil and swung around to face Terese. “What’s the new time frame?”

     “National Health wants us to pitch a new campaign next week.”

     “Good Lord!” Colleen said.

     “What do we have so far?” Terese asked.

     “Not a lot.”

     “You must have some tissues or some preliminary executions,” Terese said. “I know I haven’t been giving you any attention lately since we’ve had deadlines with three other clients. But you have had a team working on this for almost a month.”

     “We’ve been having strategy session after strategy session,” Colleen said. “A lot of brainstorming, but no big idea. Nothing’s jumped out and grabbed us. I mean, I have a sense of what you are looking for.”

     “Well, I want to see what you have,” Terese said. “I don’t care how sketchy or preliminary. I want to see what the team has been doing. I want to see it today.”

     “All right,” Colleen said without enthusiasm. “I’ll get everybody together.”

     3

    

     WEDNESDAY, 11:15 A.M., MARCH 20, 1996

     Susanne Hard had never liked hospitals.

     A scoliotic back had kept her in and out of them as a child. Hospitals made her nervous. She hated the sense that she was not in control and that she was surrounded by the sick and the dying.

     Susanne was a firm believer in the adage “If something can go wrong, it will go wrong.” She felt this way particularly in relation to hospitals. Indeed, on her last admission, she’d been carted off to urology to face some frightful procedure before she’d finally been able to convince a reluctant technician to read the name on her wristband. They’d had the wrong patient.

     On her present admission Susanne wasn’t sick. The previous night her labor had started with her second child. In addition to her back problem, her pelvis was distorted, making a normal vaginal delivery impossible. As with her first child, she had to have a cesarean section.

     Since she’d just undergone abdominal surgery, her doctor insisted that she stay at least a few days. No amount of cajoling on Susanne’s part had been successful in convincing the doctor otherwise.

     Susanne tried to relax by wondering what kind of child she’d just birthed. Would he be like his brother, Allen, who had been a wonderful baby? Allen had slept through the night almost from day one. He’d been a delight, and now that he was three and already exerting independence, Susanne was looking forward to a new baby. She thought of herself as a natural mother.

     With a start, Susanne awoke. She’d surprised herself by nodding off. What had awakened her was a white-clad figure fiddling with the IV bottles that hung from a pole at the head of her bed.

     “What are you doing?” Susanne asked. She felt paranoid about anybody doing anything she didn’t know about.

     “Sorry to have awakened you, Mrs. Hard,” a nurse said. “I was just hanging up a new bottle of fluid. Yours is just about out.”

     Susanne glanced at the IV snaking into the back of her hand. As an experienced hospital patient, she suggested that it was time for the IV to come out.

     “Maybe I should check on that,” the nurse said. She then waltzed out of the room.

     Tilting her head back, Susanne looked at the IV bottle to see what it was. It was upside down, so she couldn’t read the label.

     She started to turn over, but a sharp pain reminded her of her recently sutured incision. She decided to stay on her back.

     Gingerly she took a deep breath. She didn’t feel any discomfort until right at the end of inspiration.

     Closing her eyes, Susanne tried again to calm down. She knew that she still had a significant amount of drugs “on board” from the anesthesia, so sleep should be easy. The trouble was, she didn’t know if she wanted to be asleep with so many people coming in and out of her room.

     A very soft clank of plastic hitting plastic drifted out of the background noise of the hospital and caught Susanne’s attention. Her eyes blinked open. She saw an orderly off to the side by the bureau.

     “Excuse me,” Susanne called.

     The man turned around. He was a handsome fellow in a white coat over scrubs. From where he was standing, Susanne could not read his name tag. He appeared surprised to be addressed.

     “I hope I didn’t disturb you, ma’am,” the young man said.

     “Everybody is disturbing me,” Susanne said without malice. “It’s like Grand Central Station in here.”

     “I’m terribly sorry,” the man said. “I can always return later if it would be more convenient.”

     “What are you doing?” Susanne asked.

     “Just filling your humidifier,” the man said.

     “What do I have a humidifier for?” Susanne said. “I didn’t have one after my last cesarean.”

     “The anesthesiologists frequently order them this time of year,” the man said. “Right after surgery, patients’ throats are often irritated from the endotracheal tube. It’s usually helpful to use a humidifier for the first day or even the first few hours. In what month did you have your last cesarean?”

     “May,” Susanne said.

     “That’s probably the reason you didn’t have one then,” the man said. “Would you like me to return?”

     “Do what you have to do,” Susanne said.

     No sooner had the man left than the original nurse returned. “You were right,” she said. “The orders were to pull the IV as soon as the bottle was through.”

     Susanne merely nodded. She felt like asking the nurse if missing orders was something she did on a regular basis. Susanne sighed. She wanted out of there.

     After the nurse had removed the IV, Susanne managed to calm herself enough to fall back asleep. But it didn’t last long. Someone was nudging her arm.

     Susanne opened her eyes and looked into the face of another smiling nurse. In the foreground and between them was a five-cc syringe.

     “I’ve got something for you,” the nurse said as if Susanne were a toddler and the syringe candy.

     “What is it?” Susanne demanded. She instructively pulled away.

     “It’s the pain shot you requested,” the nurse said. “So roll over and I’ll give it to you.”

     “I didn’t request a pain shot,” Susanne said.

     “But of course you did,” the nurse said.

     “But I didn’t,” Susanne said.

     The nurse’s expression changed to exasperation like a cloud passing over the sun. “Well then, it’s doctor’s orders. You are supposed to have a pain shot every six hours.”

     “But I don’t have much pain,” Susanne said. “Only when I move or breathe deeply.”

     “There you are,” the nurse said. “You have to breathe deeply, otherwise you’ll get pneumonia. Come on now, be a good girl.”

     Susanne thought for a moment. On the one hand she felt like being contrary. On the other hand she wanted to be taken care of and there was nothing inherently wrong with a pain shot. It might even make her sleep better.

     “Okay,” Susanne said.

     Gritting her teeth, she managed to roll to the side as the nurse bared her bottom.

     4

    

     WEDNESDAY, 2:05 P.M., MARCH 20, 1996

     “You know, Laurie’s right,” Chet McGovern said.

     Chet and Jack were sitting in the narrow office they shared on the fifth floor of the medical examiner’s building. They both had their feet up on their respective gray metal desks. They’d finished their autopsies for the day, eaten lunch, and were now supposedly doing their paperwork.

     “Of course she’s right,” Jack agreed.

     “But if you know that, why do you provoke Calvin? It’s not rational. You’re not doing yourself any favors. It’s going to affect your promotion up through the system.”

     “I don’t want to rise up in the system,” Jack said.

     “Come again?” Chet asked. In the grand scheme of medicine, the concept of not wanting to get ahead was heresy.

     Jack let his feet fall off the desk and thump onto the floor. He stood up, stretched, and yawned loudly. Jack was a stocky, six-foot man accustomed to serious physical activity. He found that standing at the autopsy table and sitting at a desk tended to cause his muscles to cramp, particularly his quadriceps.

     “I’m happy being a low man on the totem pole,” Jack said, cracking his knuckles.

     “You don’t want to become board certified?” Chet asked with surprise.

     “Ah, of course I want to be board certified,” Jack said. “But that’s not the same issue. As far as I’m concerned, becoming board certified is a personal thing. What I don’t care about is having supervisory responsibility. I just want to do forensic pathology. To hell with bureaucracy and red tape.”

     “Jesus,” Chet-remarked, letting his own feet fall to the floor. “Every time I think I get to know you a little, you throw me a curveball. I mean, we’ve been sharing this office for almost five months. You’re still a mystery. I don’t even know where the hell you live.”

     “I didn’t know you cared,” Jack teased.

     “Come on,” Chet said. “You know what I mean.”

     “I live on the Upper West Side,” Jack said. “It’s no secret.”

     “In the seventies?” Chet asked.

     “A bit higher,” Jack said.

     “Eighties?”

     “Higher.”

     “You’re not going to tell me higher than the nineties, are you?” Chet asked.

     “A tad,” Jack said. “I live on a Hundred and Sixth Street.”

     “Good grief,” Chet exclaimed. “You’re living in Harlem.”

     Jack shrugged. He sat down at his desk and pulled out one of his unfinished files. “What’s in a name?” he said.

     “Why in the world live in Harlem?” Chet asked. “Of all the neat places to live in and around the city, why live there? It can’t be a nice neighborhood. Besides, it must be dangerous.”

     “I don’t see it that way,” Jack said. “Plus there are a lot of playgrounds in the area and a particularly good one right next door. I’m kind of a pickup basketball nut.”

     “Now I know you are crazy,” Chet said. “Those playgrounds and those pickup games are controlled by neighborhood gangs. That’s like having a death wish. I’m afraid we might see you in here on one of the slabs even without the mountain bike heroics.”

     “I haven’t had any trouble,” Jack said. “After all, I paid for new back-boards and lights and I buy the balls. The neighborhood gang is actually quite appreciative and even solicitous.”

     Chet eyed his officemate with a touch of awe. He tried to imagine what Jack would look like out running around on a Harlem neighborhood blacktop. He imagined Jack would certainly stand out racially with his light brown hair cut in a peculiar Julius Caesar-like shag. Chet wondered if any of the other players had any idea about Jack, like the fact that he was a doctor. But then Chet acknowledged that he didn’t know much more.

     “What did you do before you went to medical school?” Chet asked.

     “I went to college,” Jack said. “Like most people who went to medical school. Don’t tell me you didn’t go to college.”

     “Of course I went to college,” Chet said. “Calvin is right: you are a smartass. You know what I mean. If you just finished a pathology residency, what did you do in the interim?” Chet had wanted to ask the question for months, but there had never been an opportune moment.

     “I became an ophthalmologist,” Jack said. “I even had a practice out in Champaign, Illinois. I was a conventional, conservative suburbanite.”

     “Yeah, sure, just like I was a Buddhist monk.” Chet laughed. “I mean I suppose I can see you as an ophthalmologist. After all, I was an emergency-room physician for a few years until I saw the light. But you conservative? No way.”

     “I was,” Jack insisted. “And my name was John, not Jack. Of course, you wouldn’t have recognized me. I was heavier. I also had longer hair, and I parted it along the right side of my head the way I did in high school. And as far as dress was concerned, I favored glen-plaid suits.”

     “What happened,” Chet asked. Chet glanced at Jack’s black jeans, blue sports shirt, and dark blue knitted tie.

     A knock on the doorjamb caught both Jack’s and Chet’s attention. They turned to see Agnes Finn, head of the micro lab, standing in the doorway. She was a small, serious woman with thick glasses and stringy hair.

     “We just got something a little surprising,” she said to Jack. She was clutching a sheet of paper in her hand. She hesitated on the threshold. Her dour expression didn’t change.

     “Are you going to make us guess or what?” Jack asked. His curiosity had been titillated, since Agnes did not make it a point to deliver lab results.

     Agnes pushed her glasses higher onto her nose and handed Jack the paper. “It’s the fluorescein antibody screen you requested on Nodelman.”

     “My word,” Jack said after glancing at the page. He handed it to Chet.

     Chet looked at the paper and then leaped to his feet. “Holy crap!” he exclaimed. “Nodelman had the goddamn plague!”

     “Obviously we were taken aback by the result,” Agnes said in her usual monotone. “Is there anything else you want us to do?”

     Jack pinched his lower lip while he thought. “Let’s try to culture some of the incipient abscesses,” he said. “And let’s try some of the usual stains. What’s recommended for plague?”

     “Giemsa’s or Wayson’s,” Agnes said. “They usually make it possible to see the typical bipolar ‘safety pin’ morphology.”

     “Okay, let’s do that,” Jack said. “Of course, the most important thing is to grow the bug. Until we do that, the case is only presumptive plague.”

     “I understand,” Agnes said. She started from the room. “I guess I don’t have to warn you to be careful,” Jack said.

     “No need,” Agnes assured him. “We have a class-three hood, and I intend to use it.”

     “This is incredible,” Chet said when they were alone. “How the hell did you know?”

     “I didn’t,” Jack said. “Calvin forced me to make a diagnosis. To tell the truth, I thought I was being facetious. Of course, the signs were all consistent, but I still didn’t imagine I had a snowball’s chance in hell of being right. But now that I am, it’s no laughing matter. The only positive aspect is that I win that ten dollars from Calvin.”

     “He’s going to hate you for that,” Chet said.

     “That’s the least of my worries,” Jack said. “I’m stunned. A case of pneumonic plague in March in New York City, supposedly contracted in a hospital! Of course, that can’t be true unless the Manhattan General is supporting a horde of infected rats and their fleas. Nodelman had to have had contact with some sort of infected animal. It’s my guess he was traveling recently.” Jack snatched up the phone.

     “Who are you calling?” Chet asked.

     “Bingham, of course,” Jack said as he punched the numbers. “There can’t be any delay. This is a hot potato I want out of my hands.”

     Mrs. Sanford picked up the extension but informed Chet that Dr. Bingham was at City Hall and would be all day. He had left specific instructions he was not to be bothered since he’d be closeted with the mayor.

     “So much for our chief,” Jack said. Without putting down the receiver, he dialed Calvin’s number. He didn’t have any better luck. Calvin’s secretary told him that Calvin had had to leave for the day. There was an illness in the family.

     Jack hung up the phone and drummed his fingers on the surface of the desk.

     “No luck?” Chet asked.

     “The entire general staff is indisposed,” Jack said. “We grunts are on our own.” Jack suddenly pushed back his chair, got up, and started out of the office.

     Chet bounded out of his own chair and followed. “Where are you going?” he asked. He had to run to catch up with Jack.

     “Down to talk to Bart Arnold,” Jack said. He got to the elevator and hit the Down button. “I need more information. Somebody has to figure out where this plague came from or this city’s in for some trouble.”

     “Hadn’t you better wait for Bingham?” Chet asked. ‘”That look in your eye disturbs me.”

     “I didn’t know I was so transparent,” Jack said with a laugh. “I guess this incident has caught my interest. It’s got me excited.”

     The elevator door opened and Jack got on. Chet held the door from closing. “Jack, do me a favor and be careful. I like sharing the office with you. Don’t ruffle too many feathers.”

     “Me?” Jack questioned innocently. “I’m Mister Diplomacy.”

     “And I’m Muammar el Qaddafi,” Chet said. He let the elevator door slide closed.

     Jack hummed a perky tune while the elevator descended. He was definitely keyed up, and he was enjoying himself. He smiled when he remembered telling Laurie that he’d hoped Nodelman turned out to have something with serious institutional consequences like Legionnaires’ disease so he could give AmeriCare some heartburn. Plague was ten times better. And on top of sticking it to AmeriCare, he’d have the pleasure of collecting his ten bucks from Calvin.

     Jack exited on the first floor and went directly to Bart Arnold’s office. Bart was the chief of the PAs, or physician’s assistants. Jack was pleased to catch him at his desk.

     “We’ve got a presumptive diagnosis of plague. I’ve got to talk with Janice Jaeger right away,” Jack said.

     “She’ll be sleeping,” Bart said. “Can’t it wait?”

     “No,” Jack said.

     “Bingham or Calvin know about this?” Bart asked.

     “Both are out, and I don’t know when they’ll be back,” Jack said. Bart hesitated a moment, then opened up the side drawer of his desk. After looking up Janice’s number, he made the call. When she was on the line, he apologized for having awakened her and explained that Dr. Stapleton needed to speak with her. He handed the phone to Jack.

     Jack apologized as well and then told her about the results on Nodelman. Any sign of sleepiness in Janice’s voice disappeared instantly. “What can I do to help?” she asked.

     “Did you find any reference to travel in any of the hospital records?” Jack asked.

     “Not that I recall,” Janice said.

     “Any reference to contact with pets or wild animals?” Jack asked.

     “Negative,” Janice said. “But I can go back there tonight. Those questions were never specifically asked.”

     Jack thanked her and told her that he’d be looking into it himself. He handed the phone back to Bart and hurried back to his own office. Chet looked up as Jack dashed in. “Learn anything?” he asked. “Not a thing,” Jack said happily. He pulled out Nodelman’s folder and rapidly shuffled through the pages until he found the completed identification sheet.

     On it were phone numbers for the next of kin. With his index finger marking Nodelman’s wife’s number, Jack made the call. It was an exchange in the Bronx.

     Mrs. Nodelman answered on the second ring.

     “I’m Dr. Stapleton,” Jack said. “I’m a medical examiner for the City of New York.”

     At that point Jack had to explain the role of a medical examiner, because even the archaic term “coroner” didn’t register with Mrs. Nodelman.

     “I’d like to ask you a few questions,” Jack said once Mrs. Nodelman understood who he was.

     “It was so sudden,” Mrs. Nodelman said. She had started to cry. “He had diabetes, that’s true. But he wasn’t supposed to die.”

     “I’m very sorry for your loss,” Jack said. “But did your late husband do any recent traveling?”

     “He went to New Jersey a week or so ago,” Mrs. Nodelman said. Jack could hear her blow her nose.

     “I was thinking of travel to more distant destinations,” Jack said. “Like to the Southwest or maybe India.”

     “Just to Manhattan every day,” Mrs. Nodelman said.

     “How about a visitor from some exotic locale?” Jack asked.

     “Donald’s aunt visited in December,” Mrs. Nodelman said.

     “And where is she from?”

     “Queens,” Mrs. Nodelman said.

     “Queens,” Jack repeated. “That’s not quite what I had in mind. How about contact with any wild animals? Like rabbits.”

     “No,” Mrs. Nodelman said. “Donald hated rabbits.”

     “How about pets?” Jack asked.

     “We have a cat,” Mrs. Nodelman said.

     “Is the cat sick?” Jack asked. “Or has the cat brought home any rodents?”

     “The cat is fine,” Mrs. Nodelman said. “She’s a house cat and never goes outside.”

     “How about rats?” Jack asked. “Do you see many rats around your house? Have you seen any dead ones lately?”

     “We don’t have any rats,” Mrs. Nodelman said indignantly. “We live in a nice, clean apartment.”

     Jack tried to think of something else to ask, but for the moment nothing came to mind. “Mrs. Nodelman,” he said, “you’ve been most kind. The reason I’m asking you these questions is because we have reason to believe that your husband died of a serious infectious disease. We think he died of plague.”

     There was a brief silence.

     “You mean bubonic plague like they had in Europe long ago?” Mrs. Nodelman asked.

     “Sort of,” Jack said. “Plague comes in two clinical forms, bubonic and pneumonic. Your husband seems to have had the pneumonic form, which happens to be the more contagious. I would advise you to go to your doctor and inform him of your potential exposure. I’m sure he’ll want you to take some precautionary antibiotics. I would also advise you to take your pet to your vet and tell him the same thing.”

     “Is this serious?” Mrs. Nodelman asked.

     “It’s very serious,” Jack said. He then gave her his phone number in case she had any questions later. He also asked her to call him if the vet found anything suspicious with the cat.

     Jack hung up the phone and turned to Chet. “The mystery is deepening,” he said. Then he added cheerfully: “AmeriCare is going to have some severe indigestion over this.”

     “There’s that facial expression again that scares me,” Chet said. Jack laughed, got up, and started out of the room. “Where are you going now?” Chet asked nervously.

     “To tell Laurie Montgomery what’s going on,” Jack said. “She’s supposed to be our supervisor for today. She has to be apprised.” A few minutes later Jack returned.

     “What’d she say?” Chet asked.

     “She was as stunned as we were,” Jack said. He grabbed the phone directory before taking his seat. He flipped open the pages to the city listings.

     “Did she want you to do anything in particular?” Chet asked.

     “No,” Jack said. “She told me to tread water until Bingham is informed. In fact she tried to call our illustrious chief, but he’s still incommunicado with the mayor.” Jack picked up the phone and dialed.

     “Who are you calling now?” Chet asked.

     “The Commissioner of Health, Patricia Markham,” Jack said. “I ain’t waiting.”

     “Good grief!” Chet exclaimed, rolling his eyes. “Hadn’t you better let Bingham do that? You’ll be calling his boss behind his back.”

     Jack didn’t respond. He was busy giving his name to the commissioner’s secretary. When she told him to hold on, he covered the mouthpiece with his hand and whispered to Chet: “Surprise, surprise, she’s in!”

     “I guarantee Bingham is not going to like this,” Chet whispered back. Jack held up his hand to silence Chet. “Hello, Commissioner,” Jack said into the phone. “Howya doing. This is Jack Stapleton here, from over at the ME’s office.”

     Chet winced at Jack’s breezy informality.

     “Sorry to spoil your day,” Jack continued, “but I felt I had to call. Dr. Bingham and Dr. Washington are momentarily unavailable and a situation has developed that I believe you should know about. We’ve just made a presumptive diagnosis of plague in a patient from Manhattan General Hospital.”

     “Good Lord!” Dr. Markham exclaimed loud enough for Chet to hear. “That’s frightening, but only one case, I trust.”

     “So far,” Jack said.

     “All right, I’ll alert the City Board of Health,” Dr. Markham said. “They’ll take over and contact the CDC. Thanks for the warning. What was your name again?”

     “Stapleton,” Jack said. “Jack Stapleton.”

     Jack hung up with a self-satisfied smile on his lips. “Maybe you should sell short your AmeriCare stock,” he told Chet. “The commissioner sounds concerned.”

     “Maybe you’d better brush off your résumé,” Chet said. “Bingham is going to be pissed.”

     Jack whistled while he leafed through Nodelman’s file until he came up with the investigative report. Once he had located the name of the attending physician, Dr. Carl Wainwright, he wrote it down. Then he got up and put on his leather bomber jacket.

     “Uh oh,” Chet said. “Now what?”

     “I’m going over to the Manhattan General,” Jack said. “I think I’ll make a site visit. This case is too important to leave up to the generals.” Chet swung around in his chair as Jack went through the door.

     “Of course, you know that Bingham doesn’t encourage us MEs doing site work,” Chet said. “You’ll be adding insult to injury.”

     “I’ll take my chances,” Jack said. “Where I was trained it was considered necessary.”

     “Bingham thinks it’s the job of the PAs,” Chet said. “He’s told us that time and again.”

     “This case is too interesting for me to pass up,” Jack called from down the hall. “Hold down the fort. I won’t be long.”

     5

    

     WEDNESDAY, 3:10 P.M., MARCH 20, 1996

     It was overcast and threatening rain, but Jack didn’t mind. Regardless of the weather, the vigorous bike ride uptown to the Manhattan General was a pleasure after having stood all morning in the autopsy room imprisoned inside his moon suit.

     Near the hospital’s front entrance Jack located a sturdy street sign to lock his mountain bike to. He even locked up his helmet and bomber jacket with a separate wire lock that also secured the seat.

     Standing within the shadow of the hospital, Jack glanced up at its soaring facade. It had been an old, respected, university-affiliated, proprietary hospital in its previous life. AmeriCare had gobbled it up during the fiscally difficult times the government had unwittingly created in health care in the early 1990s. Although Jack knew revenge was far from a noble emotion, he savored the knowledge that he was about to hand AmeriCare a public relations bomb.

     Inside Jack went to the information booth and asked about Dr. Carl Wainwright. He learned that the man was an AmeriCare internist whose office was in the attached professional building. The receptionist gave Jack careful directions.

     Fifteen minutes later, Jack was in the man’s waiting room. After Jack flashed his medical examiner’s badge, which looked for all intents and purposes like a police badge, the receptionist wasted no time in letting Dr. Wainwright know he was there. Jack was immediately shown into the doctor’s private office, and within minutes the doctor himself appeared.

     Dr. Carl Wainwright was prematurely white-haired and slightly stooped over. His face, however, was youthful with bright blue eyes. He shook hands with Jack and motioned for him to sit down.

     “It’s not every day we’re visited by someone from the medical examiner’s office,” Dr. Wainwright said.

     “I’d be concerned if it were,” Jack said.

     Dr. Wainwright looked confused until he realized Jack was kidding. Dr. Wainwright tittered. “Right you are,” he said.

     “I’ve come about your patient Donald Nodelman,” Jack said, getting right to the point. “We have a presumptive diagnosis of plague.”

     Dr. Wainwright’s mouth dropped open. “That’s impossible,” he said when he’d recovered enough to speak.

     Jack shrugged. “I guess it’s not,” he said. “Fluorescein antibody for plague is quite reliable. Of course, we haven’t yet grown it out.”

     “My goodness,” Dr. Wainwright managed. He rubbed a nervous palm across his face. “What a shock.”

     “It is surprising,” Jack agreed. “Especially since the patient had been in the hospital for five days before his symptoms started.”

     “I’ve never heard of nosocomial plague,” Dr. Wainwright said.

     “Nor have I,” Jack said. “But it was pneumonic plague, not bubonic, and as you know the incubation period is shorter for pneumonic, probably only two to three days.”

     “I still can’t believe it,” Dr. Wainwright said. “Plague never entered my thoughts.”

     “Anybody else sick with similar symptoms?” Jack asked.

     “Not that I know of,” Dr. Wainwright said, “but you can rest assured that we will find out immediately.”

     “I’m curious about this man’s lifestyle,” Jack said. “His wife denied any recent travel or visitors from areas endemic to plague. She also doubted he’d come in contact with wild animals. Is that your understanding as well?”

     “The patient worked in the garment district,” Dr. Wainwright said. “He did bookkeeping. He never traveled. He wasn’t a hunter. I’d been seeing him frequently over the last month, trying to get his diabetes under control.”

     “Where was he in the hospital?” Jack asked.

     “On the medical ward on the seventh floor,” Dr. Wainwright said. “Room seven-oh-seven. I remember the number specifically.”

     “Single room?” Jack asked.

     “All our rooms are singles,” Dr. Wainwright said.

     “That’s a help,” Jack said. “Can I see the room?”

     “Of course,” Dr. Wainwright said. “But I think I should call Dr. Mary Zimmerman, who’s our infection-control officer. She’s got to know about this immediately.”

     “By all means,” Jack said. “Meanwhile, would you mind if I went up to the seventh floor and looked around?”

     “Please,” Dr. Wainwright said as he gestured toward the door. “I’ll call Dr. Zimmerman and we’ll meet you up there.” He reached for the phone.

     Jack retraced his route back to the main hospital building. He took the elevator to the seventh floor, which he found was divided by the elevator lobby into two wings. The north wing housed internal medicine while the south wing was reserved for OB-GYN. Jack pushed through the doors that led into the internal-medicine division.

     As soon as the swinging door closed behind Jack, he knew that word of the contagion had arrived. A nervous bustle was apparent, and all the personnel were wearing newly distributed masks. Obviously Wainwright had wasted no time.

     No one paid Jack any attention as he wandered down to room 707. Pausing at the door, Jack watched as two masked orderlies wheeled out a masked and confused patient clutching her belongings who was apparently being transferred. As soon as they were gone, Jack walked in.

     Seven-oh-seven was a nondescript hospital room of modern design; the interior of the old hospital had been renovated in the not-too-distant past. The metal furniture was typical hospital issue and included a bed, a bureau, a vinyl-covered chair, a night table, and a variable-height bed table. A TV hung from an arm attached to the ceiling.

     The air-conditioning apparatus was beneath the window. Jack went over to it, lifted the top, and looked inside. A hot-water and a chill-water pipe poked up through the concrete floor and entered a thermostated fan unit that recirculated room air. Jack detected no holes large enough for any type of rodent much less a rat.

     Stepping into the bathroom, Jack glanced around at the sink, toilet, and shower. The room was newly tiled. There was an air return in the ceiling. Bending down, he opened the cabinet below the sink; again there were no holes.

     Hearing voices in the other room, Jack stepped back through the door. It was Dr. Wainwright clutching a mask to his face. He was accompanied by two women and a man, all of whom were wearing masks. The women were attired in the long, white professorial coats Jack associated with medical-school professors.

     After handing Jack a mask, Dr. Wainwright made the introductions. The taller woman was Dr. Mary Zimmerman, the hospital’s infection-control officer and head of the like-named committee.

     Jack sensed she was a serious woman who felt defensive under the circumstances. As she was introduced, she informed him that she was a board-certified internist with subspecialty training in infectious disease.

     Not knowing how to respond to this revelation, Jack complimented her.

     “I did not have an opportunity to examine Mr. Nodelman,” she added.

     “I’m certain you would have made the diagnosis instantly had you done so,” Jack said, consciously trying to keep sarcasm out of his voice.

     “No doubt,” she said.

     The second woman was Kathy McBane, and Jack was happy to turn his attention to her, especially since Ms. McBane had a warmer demeanor than her committee chairwoman. He learned she was an RN supervisor and a member of the Infection Control Committee. It was usual for such a committee to have representatives from most if not all the hospital departments.

     The man was George Eversharp. He was dressed in a heavy cotton twill blue uniform. As Jack suspected, he was the supervisor of the department of engineering and was also a member of the Infection Control Committee.

     “We certainly are indebted to Dr. Stapleton for his rapid diagnosis,” Dr. Wainwright said, trying to lighten the atmosphere.

     “Just a lucky guess,” Jack said.

     “We’ve already begun to react,” Dr. Zimmerman said in a deadpan voice. “I’ve ordered a list to be drawn up of possible contacts to start chemoprophylaxis.”

     “I think that is wise,” Jack said.

     “And as we speak, the clinical computer is searching our current patient database for symptom complexes suggestive of plague,” she continued.

     “Commendable,” Jack said.

     “Meanwhile we have to discover the origin of the current case,” she said.

     “You and I are thinking along the same lines,” Jack said.

     “I’d advise you to wear your mask,” she added.

     “Okay,” Jack said agreeably. He held it up to his face.

     Dr. Zimmerman turned to Mr. Eversharp. “Please continue with what you were saying about the air flow.”

     Jack listened as the engineer explained that the ventilation system in the hospital was designed so that there was a flow from the hall into each room and then its bathroom. The air was then filtered. He also explained that there were a few rooms where the air flow could be reversed for patients with compromised immune systems.

     “Is this one of those rooms?” Dr. Zimmerman asked.