“Could it have been sudden organ rejection that killed her?” Vinnie asked as he straightened up to let Carlos look. Vinnie had recalled a case that he and Jack had handled where the patient had had a massive and sudden rejection of a liver transplant.
“That’s a good question,” Jack said. This line of thought was one of the reasons he liked working with Vinnie. Despite Vinnie’s frequent grousing about working too hard, he occasionally contributed somethingsignificant to the conversation. Jack hadn’t yet thought of a rejection process being involved. With that in mind, Jack carefully examined the heart. When he was done, he shook his head. “It’s certainly not rejection of the heart. There’s no sign of inflammation whatsoever in the organ, nor in the pericardium.”
Vinnie explained to Carlos that the pericardium was the tissue that covered the heart.
“The pathology is all in the lungs,” Jack said. He then showed the two men the cut surface of the interior of the lungs. “The lungs are completely full of fluid and exudate. I’m back to the influenza idea.”
“It looks like she fucking drowned,” Carlos said.
Jack gritted his teeth. He was old-school in respect to foul language. He knew that the younger generation thought of it totally differently, but that didn’t mean he would stand for it in a professional setting. “Listen, Carlos,” Jack snapped. He took an intimidating step in Carlos’s direction. “Tone the language down when you are around me. You get what I’m saying?”
“Sorry,” Carlos said. He backed up and rolled his eyes for Vinnie’s benefit.
Jack let it go.
“How would influenza kill so fast?” Vinnie asked, to defuse the situation. He was well aware of Jack’s sensitivities. “This patient might have gone from the first symptom to death within an hour. How could that happen?”
“Another good question,” Jack said. “Back in 1918 they had absolutely no idea. What we now know is that it’s a process called cytokine storm. It’s when the body’s immune system senses the virus antigens and then goes berserk, releasing a bevy of extraordinarily damaging hormonelike proteins.”
“What are you saying?” Vinnie questioned. “Are you talking about a kind of cellular hari-kari?”
“That’s a colorful way to put it,” Jack said. “But yes. It’s the person’sown immune system that suddenly cranks out these cytokines that irreversibly damage the lungs. The virus just sets it all in motion, so to speak.”
“Holy f—” Vinnie started to say but caught himself.
“I want samples of the lung fluid for culture,” Jack said, pretending he hadn’t heard. There was a definite urgency in his voice. “And I want samples from the main bronchi. Then I want all the usual samples. Let’s get this show on the road!”
“Now you’re talking,” Vinnie said. Since Vinnie’s employment responsibilities had him coming in before seven to smooth the transition from the night crew to the day shift, he was supposed to leave at three. Too often Jack kept him busy well beyond then. And Jack’s sudden ardor hinted that this was going to be one of those days.
4
MONDAY, 2:55 P.M.
Because of the possible contagious nature of the case, when the autopsy was complete Jack stayed around to be sure everything was handled according to protocol, including decontaminating the outside of the body bag, all the specimen samples, the jewelry containers, and the outsides of the moon suits. He thought it was too much responsibility to leave with Vinnie, especially with Vinnie having to deal with the newbie, Carlos, meaning Vinnie was figuratively working with one hand tied behind his back.
Since Jack was again considering the serious possibility of a new influenza strain, he returned to the front office. He still thought it best to clue Laurie in to the situation so that she could begin to formulate a plan for how to alert the appropriate city agencies if Jack’s worst fears were substantiated. But Jack was thwarted on this second attempt just as he had been on his first. As soon as he appeared, Cheryl informed him that Laurie was still on the same conference call.
“It’s about the budget,” Cheryl explained in a forced whisper.
Jack couldn’t help but feel sorry for Laurie. He was impressed she was finding the patience and the stamina to stay on the phone, as heknew he’d find it impossible. Jack had trouble remaining on phone calls for anything over a few minutes. Apparently, Laurie had been on for hours.
After again telling Cheryl he’d be back, Jack decided to see that the specimens he’d taken during the autopsy got delivered to their appropriate laboratory destinations. The toxicology samples were easy, since it just required him taking them up to the sixth floor. All the other samples were a bit more difficult, since the other laboratories had been moved to the new building. To get them there required using the OCME van drivers when they weren’t out picking up bodies. To make it even more complicated, microbiology testing wasn’t done at the 421 OCME high-rise, but rather in a large building directly across First Avenue called the Public Health Laboratory, which was a separate city agency.
Since Jack wanted answers ASAP, particularly as to whether a dangerous respiratory virus was involved, he decided to do the deliveries himself. In order to have a specific destination, meaning a real person, for the virus cultures, he used his mobile phone to call the Virology Department of the Public Health Laboratory. After speaking with several secretaries, he finally managed to get through to one of the virologists. Her name was Dr. Aretha Jefferson.
“I’m one of the medical examiners,” Jack explained, after introducing himself.
“I’ve heard of you,” Aretha said, to Jack’s surprise. And then, to his further surprise, she added, “I understand you play basketball at the playground on West 106th Street. Are you that Jack Stapleton?”
“I am,” Jack said. “I didn’t know I was quite so famous. How did you hear about me?”
“I live on the Upper West Side,” Aretha explained. “I played basketball at UConn as an undergrad and kept it up through grad school. I have been looking for a game since I took this job in the city. I was planning on trying to get in touch with you to ask if there was any chance of my coming by your playground some evening.”
“It’s not my playground,” Jack said. New York never ceased to amaze him. It was a huge city, yet in some ways it felt like a small town.
“That’s not what I heard,” Aretha said with a laugh. “Anyway, I’d like to meet you and your friends, in hopes of getting into a game or two.”
“I’d be happy to meet you,” Jack said. “And maybe we can exchange favors. The reason I’m calling is that I have some lung and bronchial specimens, as well as serum and cerebrospinal fluid from an autopsy I just did, that I need to be tested. The woman died of a respiratory problem. I’m concerned about a possibly virulent influenza and would like to run a rapid screen test as well as a more detailed analysis ASAP. Can you help me?”
