Authors: Robin Cook
After inquiring about the location of the lab, Jack took the elevator down to the second floor.
Flashing his medical examiner's badge again produced immediate results. Dr. Martin Cheveau, the lab director, materialized and welcomed Jack into his office. He was a short fellow with a full head of dark hair and pencil-line mustache.
“Have you heard about the case of plague?” Jack asked once they were seated.
“No, where?” Martin questioned.
“Here at the Manhattan General,” Jack said. “Room seven-oh-seven. I posted the patient this morning.”
“Oh, no!” Martin moaned. He sighed loudly. “That doesn't sound good for us. What was the name?”
“Donald Nodelman,” Jack said.
Martin swung around in his seat and accessed his computer. The screen flashed all Nodelman's laboratory results for the duration of his admission. Martin scrolled through until he got to the microbiology section.
“I see we had a sputum gram stain showing weakly gram-negative bacilli,” Martin said. “There's also a culture pending that was negative for growth at thirty-six hours. I guess that should have told us something, especially where I see pseudomonas was suspected. I mean, pseudomonas would have grown out without any trouble way before thirty-six hours.”
“It would have been helpful if Giemsa's or Wayson's stain had been used,” Jack said. “The diagnosis could have been made.”
“Exactly,” Martin said. He turned back to Jack. “This is terrible. I'm embarrassed. Unfortunately, it's an example of the kind of thing that's going to happen more and more often. Administration has been forcing us to cut costs and downsize even though our workload has gone up. It's a deadly combination, as this case of plague proves. And it's happening all over the country.”
“You've had to let people go?” Jack asked. He thought that the clinical lab was one place hospitals actually made money.
“About twenty percent,” Martin said. “Others we've had to demote. In microbiology we don't have a supervisor any longer; if we had, he probably would have caught this case of plague. With the operating budget we've been allotted we can't afford it. Our old supervisor got demoted to head tech. It's discouraging. It used to be we strove for excellence in the lab. Now we strive for 'adequate,' whatever that means.”
“Does your computer say which tech did the gram stain?” Jack asked. “If nothing else, we could turn this episode into a teaching experience.”
“Good idea,” Martin said. He faced the computer and accessed data. The tech's identity was in code. Suddenly he turned back to Jack.
“I just remembered something,” he said. “My head tech thought of plague in relation to a patient just yesterday and asked me what I thought. I'm afraid I discouraged him by telling him the chances were somewhere on the order of a billion to one.”
Jack perked up. “I wonder what made him think of plague?”
“I wonder too,” Martin said. Reaching over to his intercom system, he paged Richard Overstreet. While they waited for the man to arrive, Martin determined that Nancy Wiggens had signed out on the original gram stain. Martin paged her as well.
Richard Overstreet appeared within minutes. He was a boyish, athletic-looking individual with a shock of auburn hair that fell across his forehead. The hair had a habit of slipping over his eyes. Richard was ever pushing it back with his hand or throwing it back with a snap of his head. He wore a white jacket over surgical scrubs; his jacket pockets were crammed with test tubes, tourniquets, gauze pads, lab chits, and syringes.
Martin introduced Richard to Jack, then asked him about the short discussion they'd had about plague the day before.
Richard seemed embarrassed. “It was just my imagination getting the best of me,” he said with a laugh.
“But what made you think of it?” Martin asked.
Richard swept his hair from his face and for a moment left his hand on the top of his head while he thought. “Oh, I remember,” he said. “Nancy Wiggens had gone up to get a sputum culture and draw the man's blood. She told me how sick he was and that he appeared to have some gangrene on the tips of his fingers. She said his fingers were black.” Richard shrugged. “It made me think of the black death.”
Jack was impressed.
“Did you follow up on it at all?” Martin asked.
“No,” Richard said. “Not after what you'd said about the probability. As behind as we are in the lab, I couldn't take the time. All of us, including me, have been out drawing blood. Is there some kind of problem?” Richard asked.
“A big problem,” Martin said. “The man did have plague. Not only that, but he's already dead.”
Richard literally staggered. “My God!” he exclaimed.
“I hope you encourage safety with your techs,” Jack said.
“Absolutely,” Richard said, regaining his composure. “We have biosafety cabinets, both type two and three. I try to encourage my techs to use one or the other, especially with obviously serious infectious cases. Personally I like the type three, but some people find using the thick rubber gloves too clumsy.”
At that moment Nancy Wiggens appeared. She was a shy woman who appeared more like a teenager than a college graduate. She could barely look Jack in the eye as they were introduced. She wore her dark hair parted down the middle of her head, and like that of her immediate boss, Richard, it constantly fell across her eyes.
Martin explained to her what had happened. She was as shocked as Richard had been. Martin assured her she was not being blamed but that they should all try to learn from the experience.
“What should I do about my exposure?” she questioned. “I was the one who got the specimen as well as the one who processed it.”
“You'll probably be taking tetracycline by mouth or streptomycin IM,” Jack said. “The hospital infection-control officer is working on that at the moment.”
“Uh oh!” Martin voiced under his breath but loud enough for the others to hear. “Here comes our fearless leader and the chief of the medical staff, and both look unhappy.”
Kelley swept into the room like an irate general after a military defeat. He towered over Martin with his hands on his hips and his reddened face thrust forward. “Dr. Cheveau,” he began with a scornful tone. “Dr. Arnold here tells me you should have made this diagnosis before...”
Kelley stopped mid-sentence. Although he was content to ignore the two microbiology techs, Jack was a different story.
“What in God's name are you doing down here?” he demanded.
“Just helping out,” Jack replied.
“Aren't you overstepping your mandate?” he suggested venomously.
“We like to be thorough in our investigations,” Jack said.
“I think you have more than exhausted your official capacity,” Kelley snapped. “I want you out of here. After all, this is a private institution.”
Jack got to his feet, vainly trying to look the towering Kelley in the eye. “If AmeriCare thinks it can do without me, I think I'll run along.”
Kelley's face turned purple. He started to say something else but changed his mind. Instead he merely pointed toward the door.
Jack smiled and waved to the others before taking his leave. He was pleased with his visit. As far as he was concerned, it couldn't have gone better.
6
WEDNESDAY, 4:05 P.M., MARCH 20, 1996
Susanne Hard was looking through the small, round window of the door to the elevator lobby with rapt attention. The end of the corridor was as far as she was allowed to go on her ambulation. She'd been walking with little steps while supporting her freshly sutured abdomen. As unpleasant as the exercise was, she knew from experience that the sooner she mobilized herself, the sooner she'd be in a position to demand release.
What had caught her attention out in the elevator lobby was the disturbing amount of traffic coming in and out of the medical ward as well as the nervous demeanor of the staff. Susanne's sixth sense told her that something was wrong, especially with most of the people wearing masks.
Before she could put a finger on the cause of the apparent stir, a literal chill passed through her like an icy arctic wind. Turning around, she expected to feel a draft. There wasn't any. Then the chill returned, causing her to tense and shiver until it had passed. Susanne looked down at her hands. They had turned bone white.
Increasingly anxious, Susanne started back to her room. Such a chill could not be a good sign. As an experienced patient she knew there was always the fear of a wound infection.
By the time she entered her room she had a headache behind her eyes. As she climbed back into bed, the headache spread over the top of her head. It wasn't like any headache she'd ever had before. It felt as if someone were pushing an awl into the depths of her brain.
For a few panicky moments Susanne lay perfectly still, hoping that whatever had seemed wrong was now all right. But instead a new symptom developed: the muscles of her legs began to ache. Within minutes she found herself writhing in the bed, vainly trying to find a position that afforded relief.
Close on the heels of the leg pain came an overall malaise that settled over her like a stifling blanket. It was so enervating that she could barely reach across her chest for the nurse's call button.
She pressed it and let her arm fall limply back to the bed.
By the time the nurse came into the room, Susanne had developed a cough that chafed her already irritated throat. “I feel sick,” Susanne croaked. “How so?” the nurse questioned.
Susanne shook her head. It was even hard to talk. She felt so terrible she didn't know where to begin.
“I have a headache,” she managed.
“I believe you have a standing order of pain medication,” the nurse said. “I'll get it for you.”
“I need my doctor,” Susanne whispered. Her throat felt as bad as when she'd first awakened from the anesthesia.
“I think we should try the pain medicine before we call your doctor,” the nurse said.
“I feel cold,” Susanne said. “Terribly cold.”
The nurse put a practiced band on Susanne's forehead, then pulled it back in alarm. Susanne was burning up. The nurse took the thermometer from its container on the bedside table and stuck it into Susanne's mouth. While she waited for the thermometer to equilibrate, she wrapped a blood-pressure cuff around Susanne's arm. The blood pressure was low.
She then took the thermometer out of Susanne's mouth. When she saw what the reading was, she let out a little gasp of surprise. It was 106 Fahrenheit.
“Do I have a fever?” Susanne questioned.
“A little one,” the nurse said. “But everything is going to be fine. I'll go and give your doctor a call.”
Susanne nodded. A tear came to the corner of her eye. She didn't want this kind of complication. She wanted to go home.
7
WEDNESDAY, 4:35 P.M., MARCH 20, 1996
“Do you honestly think that Robert Barker deliberately sabotaged our ad campaign?” Colleen asked Terese as they descended the stairs. They were on their way to the studio where Colleen wanted to show Terese what the creative team had put together for a new National Health campaign.
“There's not a doubt in my mind,” Terese said. “Of course, he didn't do it himself. He had Helen do it by talking National Health out of buying adequate exposure time.”
“But he'd be shooting himself in the foot. If we lose the National Health account and we can't restructure, then his employee participation units are worth the same as ours: zilch.”
“Screw his employee participation units,” Terese said. “He wants the presidency, and he'll do anything to get it.”
“God, bureaucratic infighting disgusts me,” Colleen said. “Are you sure you want the presidency?”
Terese stopped dead on the stairs and looked at Colleen as if she'd just blasphemed. “I can't believe you said that.”
“But you've complained yourself that the more administrative duties you have, the less time you can spend on creativity.”
“If Barker gets the presidency he'll screw up the whole company,” Terese said indignantly.
“We'll start kowtowing to clients, and there goes creativity and quality in one fell swoop. Besides, I want to be president. It's been my goal for five years. This is my chance, and if I don't get it now, I'll never get it.”
“I don't know why you're not happy with what you've already accomplished,” Colleen said.
“You're only thirty-one and you're already creative director. You should be content and do what you are good at: doing great ads.”
“Oh, come on!” Terese said. “You know we advertising people are never satisfied. Even if I make president I'll probably start eyeing CEO.”
“I think you should cool it,” Colleen said. “You're going to burn out before you're thirty-five.”
“I'll cool it when I'm president,” Terese said.
“Yeah, sure!” Colleen said.
Once in the studio Colleen directed her friend into the small separate room that was affectionately called the “arena.” This was where pitches were rehearsed. The name came from the arenas of ancient Rome where Christians were thrown to the lions. At Willow and Heath the Christians were the low-level creatives.
“You got a film?” Terese questioned. In the front of the room a screen had been pulled down over the chalkboards. At best she thought she'd be looking at sketchy storyboards.
“We threw together a 'ripomatic,'” Colleen explained. A ripomatic was a roughly spliced together amalgam of previously shot video that had been “stolen” from other projects to give a sense of a commercial. Terese was encouraged. She'd not expected video.
“Now, I'm warning you, this is all very preliminary,” Colleen added.
“Save the disclaimers,” Terese said. “Run what you have.”
Colleen waved to one of her underlings. The lights dimmed and the video started. It ran for a hundred seconds. It depicted a darling four-year-old girl with a broken doll. Terese recognized the footage immediately. It was part of a spot they'd done the year before for a national toy chain to promote the company's generous return policy. Colleen had cleverly made it appear as if the child were bringing the doll to the new National Health hospital. The tag line was “We cure anything anytime.”