Contagion (20 page)

     On the external exam the most obvious abnormality was the freshly sutured, two-inch-long appendectomy incision. But Jack quickly discovered more pathology. When he examined the corpse’s hands he found subtle evidence of early gangrene on the tips of the fingers. He found some even fainter evidence of the same process on the man’s earlobes.

     “Reminds me of Nodelman,” Vinnie said. “It’s just less, and he doesn’t have any on his pecker. Do you think it’s plague again?”

     “I don’t know,” Jack said. “Nodelman didn’t have an appendectomy.”

     Jack spent twenty minutes diligently searching the rest of the body for any signs of insect or animal bites. Since Lagenthorpe was a moderately dark-skinned African-American, this was more difficult than it had been with the considerably lighter-skinned Lopez.

     Although Jack’s diligence didn’t reward him with any bite marks, it did make it possible for him to appreciate another subtle abnormality. On Lagenthorpe’s palms and soles there was a faint rash. Jack pointed it out to Vinnie, but Vinnie said he couldn’t see it.

     “Tell me what I’m looking for,” Vinnie said.

     “Flat, pinkish blotches,” Jack said. “Here’s more on the underside of the wrist.”

     Jack held up Lagenthorpe’s right arm.

     “I’m sorry,” Vinnie said. “I don’t see it.”

     “No matter,” Jack said. He took several photographs even though he doubted the rash would show up. The flash often washed out such subtle findings.

     As Jack continued the external exam he found himself progressively mystified. The patient had come in with a presumed diagnosis of pneumonic plague, and externally he resembled a plague victim, as Vinnie had pointed out. Yet there were discrepancies. The record indicated he’d had a negative test for plague, which made Jack suspect tularemia.

     But tularemia seemed implausible because the patient’s sputum test had shown no free bacteria. To complicate things further, the patient had had severe enough abdominal symptoms to suggest appendicitis, which he proved not to have. And on top of that he had a rash on his palms and soles.

     At that point Jack had no idea what he was dealing with. As far as he was concerned, he doubted the case was either plague or tularemia. Starting the internal exam, he immediately came across strong presumptive evidence that substantiated his belief. The lymphatics were minimally involved.

     Slicing open the lung, Jack also detected a difference even on gross from what he’d expect to see in either plague or tularemia. To Jack’s eye Lagenthorpe’s lung resembled heart failure more than it did infection. There was plenty of fluid but little consolidation.

     Turning to the other internal organs, Jack found almost all of them involved in the pathological process. The heart seemed acutely enlarged, as were the liver, the spleen, and the kidneys. Even the intestines were engorged, as if they had stopped functioning.

     “Got something interesting?” a husky voice demanded.

     Jack had been so absorbed, he hadn’t noticed that Calvin had nudged Vinnie aside.

     “I believe I do,” Jack managed.

     “Another infectious case?” another gruff voice asked.

     Jack’s head swung around to his left. He’d recognized the voice immediately, but he had to confirm his suspicion. He was right. It was the chief!

     “It came in as a presumed plague,” Jack said. He was surprised to see Bingham; the chief rarely came into the pit unless it was a highly unusual case or one that had immediate political ramifications.

     “Your tone suggests you don’t think it is,” Bingham said. He leaned over the open body and glanced in at the swollen, glistening organs.

     “You are very perceptive, sir,” Jack said. He made a specific effort to keep his patented sarcasm from his voice. This was one time he meant the compliment.

     “What do you think you have?” Bingham asked. He poked the swollen spleen gingerly with his gloved hand. “This spleen looks huge.”

     “I haven’t the faintest idea,” Jack said.

     “Dr. Washington informed me this morning that you’d made an impressive diagnosis on a case of tularemia yesterday,” Bingham said.

     “A lucky guess,” Jack said.

     “Not according to Dr. Washington,” Bingham said. “I’d like to compliment you. Following on the heels of your astute and rapid diagnosis of the case of plague, I’m impressed. I’m also impressed you left it up to me to inform the proper authorities. Keep up the good work. You make me happy I didn’t fire you yesterday.”

     “Now that’s a backhanded compliment,” Jack said. He chuckled, and so did Bingham.

     Where’s the Martin case?” Bingham asked Calvin.

     Calvin pointed. “Table three, sir,” he said. “Dr. McGovern’s doing it. I’ll be over in a second.”

     Jack watched Bingham long enough to see Chet’s double take when he recognized the chief. Jack turned back to Calvin. “My feelings are hurt,” he said jokingly. “For a moment I thought the chief came all the way down here and suited up just to pay me a compliment.”

     “Dream on,” Calvin said. “You were an afterthought. He really came down about that gunshot wound Dr. McGovern is doing.”

     “Is it a problem case?” Jack asked.

     “Potentially,” Calvin said. “The police claim the victim was resisting arrest.”

     “That’s not so uncommon,” Jack said.

     “The problem is whether the bullets went in the front or the back,” Calvin said. “Also there were five of them. That’s a bit heavy-handed.”

     Jack nodded. He understood all too well and was glad he wasn’t doing the case.

     “The chief didn’t come down here to compliment you, but he did it just the same,” Calvin said. “He was impressed about the tularemia, and I have to admit I was too. That was a rapid and clever diagnosis. It’s worth ten bucks, But I’ll tell you something: I didn’t appreciate that little ruse you pulled in the chief’s office yesterday about our bet. You might have confused the chief for a moment, but you didn’t fool me.”

     “I assumed as much,” Jack said. “That’s why I changed the subject so quickly.”

     “I just wanted you to know,” Calvin said. Leaning over Lagenthorpe’s open corpse, he pushed on the spleen just as Bingham had done. “The chief was right,” he said. “This thing is swollen.”

     “So’s the heart and just about everything else,” Jack said.

     “What’s your guess?” Calvin asked.

     “This time I don’t even have a guess,” Jack admitted. “It’s another infectious disease, but I’m only willing to bet it’s not plague or tularemia. I’m really starting to question what they are doing over there at the General.”

     “Don’t get carried away,” Calvin said. “New York is a big city and the General is a big hospital. The way people move around today and with all the flights coming into Kennedy day in and day out, we can see any disease here, any time of the year.”

     “You’ve got a point,” Jack conceded.

     “Well, when you have an idea what it is, let me know,” Calvin said. “I want to win that twenty dollars back.”

     After Calvin left, Vinnie moved back into place. Jack took samples from all the organs and Vinnie saw to it that they were placed in preservative and properly labeled. After all the samples had been taken, they both sutured Lagenthorpe’s incision.

     Leaving Vinnie to take care of the body, Jack wandered over to Laurie’s table. He had her show him the cut surfaces of the lungs, liver, and spleen. The pathology mirrored that of Lopez and Hard. There were hundreds of incipient abscesses with granuloma formation.

     “Looks like another case of tularemia,” Laurie said.

     “I can’t argue with you,” Jack said. “But this issue of person-to-person spread being so rare bugs me. I don’t know how to explain it.”

     “Unless they all were exposed to the same source,” Laurie said.

     “Oh sure!” Jack exclaimed scornfully. “They all happened to go to the same spot in Connecticut and feed the same sick rabbit.”

     “I’m just suggesting the possibility,” Laurie complained.

     “I’m sorry,” Jack said. “You’re right. I shouldn’t jump on you. It’s just that these infectious disease cases are driving me bananas. I feel like I’m missing something important, and yet I have no idea what it could be.”

     “What about Lagenthorpe?” Laurie asked. “Do you think he had tularemia as well?”

     “No,” Jack said. He seems to have had something completely different, and I have no idea what.”

     “Maybe you are getting too emotionally involved,” Laurie suggested.

     “Could be,” Jack said. He was feeling a bit guilty about wishing the worst for AmeriCare regarding the first case. “I’ll try to calm down. Maybe I should go do more reading on infectious diseases.”

     “That’s the point, Laurie said. “Instead of stressing yourself out, you should treat these cases as an opportunity to learn. After all, that’s part of the fun of this job.”

     Jack tried vainly to peer through Laurie’s plastic face mask to get an idea of whether she was being serious or just mocking him. Unfortunately with all the reflections from the overhead lights, he couldn’t tell.

     Leaving Laurie, Jack stopped briefly at Chet’s table. Chet was not in a good mood.

     “Hell,” he said. “It’s going to take me all day to trace these bullet paths the way Bingham suggested. If he wants to be this particular, I wonder why he doesn’t do the case himself.

     “Yell if you need any help,” Jack said. “I’ll be happy to come down and lend a hand.”

     “I might do that,” Chet said.

     Jack disposed of his protective gear, changed into his street clothes, and made sure his ventilation charger was plugged in. Then he got the autopsy folders for Lopez and Lagenthorpe. From Hester’s folder he looked up her next of kin. A sister was listed whose address was the same as the deceased. Jack surmised they were roommates. He copied down the phone number.

     Next Jack sought out Vinnie, whom he found coming out of the walk-in cooler where he’d just deposited Lagenthorpe’s corpse.

     “Where are all the samples from our two cases?” Jack asked.

     “I got’em all under control,” Vinnie said.

     “I want to take them upstairs myself,” Jack said.

     “Are you sure?” Vinnie asked. Running up the samples to the various labs was always an excuse for a coffee break. “I’m positive,” Jack said.

     Once he was armed with all the samples plus the autopsy folders Jack set out for his office. But he made two detours. The first was to the microbiology lab, where he sought out Agnes Finn.

     “I was impressed with your diagnosis of tularemia,” Agnes said.

     “I’m getting a lot of compliments out of that one,” Jack said.

     “Got something for me today?” Agnes asked, eyeing Jack’s armful of samples.

     “I do, indeed,” Jack said. He found the appropriate sample from Lopez and put it on the corner of Agnes’s desk. “This is another probable tularemia. Another sample will come up from a case Laurie Montgomery is doing as we speak. I want them both tested for tularemia.”

     “The reference lab is very eager to follow up on the Hard case, so that won’t be difficult. I should have results back today. What else?”

     “Well, this one is a mystery,” Jack said. He put several samples from Lagenthorpe on Agnes’s desk. “I don’t have any idea what this patient had. All I know is that it’s not plague, and it’s not tularemia.”

     Jack went on to describe the Lagenthorpe case, giving Agnes all the positive findings. She was especially interested that no bacteria had been reported on the gram stain of the sputum.

     “Have you thought of virus?” Agnes asked.

     “As much as my limited infectious disease knowledge would allow,” Jack admitted. “Hantavirus crossed my mind, but there was not a lot of hemorrhage.”

     “I’ll start some viral screening with tissue cultures,” Agnes said.

     “I plan to do some reading and maybe I’ll have another idea,” Jack said.

     “I’ll be here,” Agnes assured him.

     Leaving microbiology, Jack went up to the fifth-floor histology lab.

     “Wake up, girls, we have a visitor,” one of the histology techs shouted.

     Laughter echoed around the room.

     Jack smiled. He always enjoyed visiting histology. The entire group of women who worked there always seemed to be in the best of moods. Jack was particularly fond of Maureen O’Conner, a busty redhead with a devilish twinkle in her eye. He was pleased when he saw her round the corner of the lab bench, wiping her hands on a towel. The front of her lab coat was stained a rainbow of colors.

     “Well now, Dr. Stapleton,” she said in her pleasant brogue. “What can we do for the likes of you?”

     “I need a favor,” Jack said.

     “A favor, he says,” Maureen repeated. “You hear that, girls? What should we ask in return?”

     More laughter erupted. It was common knowledge that Jack and Chet were the only two unmarried male doctors, and the histology women liked to tease them.

     Jack unloaded his armful of sample bottles, separating Lagenthorpe’s from Lopez’s.

     “I’d like to do frozen sections on Lagenthorpe,” he said. “Just a few slides from each organ. Of course, I want a set of the regular slides as well.”

     “What about stains?” Maureen asked.

     “Just the usual,” Jack said.

     “Are you looking for anything in particular?” Maureen inquired.

     “Some sort of microbe,” Jack said. “But that’s all I can tell you.”

     “We’ll give you a call,” Maureen said. “I’ll get right on it.”

     Back in his office, Jack went through his messages. There was nothing of interest. Clearing a space in front of himself, he set down Lopez’s and Lagenthorpe’s folders intending to dictate the autopsy findings and then call the next of kin. He even intended to call the next of kin of the case Laurie was doing. But instead his eye caught sight of his copy of Harrison’s textbook of medicine.

     Pulling out the book, Jack cracked it open to the section on infectious disease and began reading. There was a lot of material: almost five hundred pages. But he was able to scan quickly since much of it was information he’d committed to memory at some point in his professional career.