As soon as Laurie saw Jack enter, she stood and came around the weighty desk with her arms extended. They met halfway. For a long moment they hugged. Jack was impressed with the intensity she expressed. He hugged her back with equal force.
Finally, with a deep exhale, Laurie let her arms fall to her sides. “What an afternoon!” she said, and then added, “What a day! I can’t tell you how long I’ve been on the phone. You wouldn’t believe it.”
“I have an idea,” Jack told her. “This was my third attempt at a drop-in visit. Cheryl has turned me away twice.”
“I’m sorry,” Laurie said. “It couldn’t be helped. The City Council wants to cut the OCME budget by fifteen percent. Can you imagine?”
“I can,” Jack said. “I can hear various uninformed City Council members pontificating that they would rather spend money on the living than on the dead.”
“Luckily the mayor is on our side. I don’t know what I’d do if he wasn’t.” Laurie leaned her backside up against the desk and attempted to relax by folding her arms across her chest. “How has your day been? I’m jealous that you still get to do forensic pathology. I miss it more than I thought I would. Taking on a few handpicked teaching cases on Thursdays with the residents doesn’t compare.”
“It’s been a challenging day,” Jack conceded. “I did have an especially interesting case this afternoon, which is why I’m here.”
“I thought you came in just to give me moral support,” she teased.
“Well, that, too,” Jack said diplomatically. “But really, listen to this. A twenty- to thirty-year-old well-dressed and bejeweled woman was brought into Bellevue moribund and quickly pronounced dead on arrival. She’d boarded the R train someplace in Brooklyn in apparent good health, started having respiratory problems due to the pneumonia sherapidly developed, and had to be evacuated in dire straits by EMS when she got to Manhattan. Does that story ring any bells?”
“It certainly does,” Laurie said. “It sounds like the great flu pandemic of 1918.”
“That was my first thought as well,” Jack said. “We’ve all heard the stories of that scary time. That’s why I jumped on the case and posted it right away. My fear was that it could be the index case of a really bad seasonal flu strain, maybe as bad as or even worse than 1918.”
“Did you take precautions?” Laurie asked. She stared at Jack. Her face had paled at the dire implications of what Jack was saying.
“Most definitely,” Jack said. “I wasn’t going to take any chances. I had Vinnie set the case up in the decomposed room with the HEPA ventilation turned on.”
“Did you wear isolation suits?” Laurie questioned. She was well aware Jack was not a fan and had had a couple of run-ins with Dr. Bingham over not wearing them when Bingham thought they were called for. If anybody knew that Jack had a mind of his own, it was his wife.
“We did,” Jack assured her. “I have too much respect for influenza from sore experience.” Jack was referring to a flu outbreak that had been artificially spread nearly twenty years ago. He had almost singlehandedly aborted it, but not before contracting it himself.
“So what did you find? Did it look like influenza?”
“Yes and no,” Jack said. “The lungs did appear as if it could have been a primary influenza pneumonia, complicated by a cytokine storm. They were completely full of fluid and exudate.”
“I’ve never seen a cytokine storm,” Laurie said. She was getting increasingly concerned.
“Nor have I, to be honest,” Jack said. “I’ve just read about it and seen slides. Anyway, it seemed grossly consistent with the descriptions I’ve come across, but obviously we don’t have any slides yet. But there was a major surprise in the case. The patient had had a total heart transplant not more than three or four months ago.”
“Really?” Laurie frowned as she tried to fit this surprising new information into the picture she was forming of the case. It wasn’t easy. “So what was your conclusion?”
“I haven’t come to any conclusion,” Jack said. “Everything is pending, including multiple rapid respiratory virus screens. I literally ran the samples over to the Public Health Laboratory myself and gave them to a specific individual who is going to get back to me ASAP.”
“Good gravy,” Laurie said.
Jack smiled behind a concealing hand. He wasn’t a fan of foul language, as he’d let Carlos know that afternoon, but he certainly would have come up with a more appropriate expletive thangood gravy. In the face of such a potentially important case, with time of the essence, it was comically virtuous.
“There’s another complication,” Jack said. “We don’t have any identification yet. There was no phone or purse with the body. As for the body itself, we’re in luck. There were a number of tattoos, so if and when we get a loved one or a friend to call in, we can be sure of an identification, even over the phone. Making an identification and reconstructing her social connections will be critical if quarantining and/or prophylactic treatment is to be done. It could involve everyone on the subway car she was riding and their contacts. What I’m thinking is that maybe you should start putting all the major health entities on notice, possibly even including the NYC Emergency Management and the CDC.”
“But there is no diagnosis yet,” Laurie said. “When do you expect to hear from your contact at the Public Health Laboratory?”
“Within a few hours,” Jack said. He briefly thought about telling Laurie that the virologist coincidentally lived in their neighborhood and was interested in joining the local street basketball game. But remembering Laurie’s current feelings about his own playing, he decided against it. He didn’t want to prompt another lecture.
“Then we wait,” Laurie said firmly. “I don’t want to say anything toanyone until we have a confirmed diagnosis. I’d also like to have an ID. Which MLI is on the case?”
“Bart Arnold,” Jack said.
“Good. He’s got the experience to deal with something as potentially disruptive as this.”
“I think you should at least let the Commissioner of Health know,” Jack said. “Some of the preliminary plans they’ve drawn up for this kind of eventuality could be put in motion. If it is a new, particularly lethal strain of influenza, which it would have to be for her to develop a cytokine storm in the face of the immunosuppressant medication she undoubtedly was taking, time will be critical. Getting enough antivirals alone into the city might be a serious challenge in itself, so best to start immediately.”
