“Does that mean you haven’t known him for very long?” Jack asked.
“I just met him last night,” Darlene said. “It was in my favorite Lower East Side bar. I had seen him before in that particular bar on several occasions.”
“Were you introduced, or did you just start chatting?” Jack asked.
“He looked depressed and was nursing a drink by himself,” Darlene said. “I went up to him and asked him what was wrong. He said someone he knew had died.”
“He didn’t say who had died or what they had died of?”
“No, and I didn’t ask,” Darlene said. “He didn’t seem to want to talk about it. We talked mostly about music. We were both into music. Aftera few beers we ended up going back to my apartment to listen to some jazz.”
Bad idea,Jack thought but didn’t say.
“But tell me,” Darlene continued. “What did John die of? No one would tell me at the emergency room. I asked several people. They just put me off.”
“We’re not sure,” Jack said. “That’s what we are trying to find out. How did his illness start?”
“What do you mean?”
“I’m assuming he was acting as if he was healthy when you met,” Jack said.
Darlene gave a short, disparaging laugh. “I’ll say. Very healthy.”
“What I am asking is what were his first symptoms? A headache, or sore throat, or a cough?” Jack said, ignoring Darlene’s last comment and its implications.
“A chill,” Darlene said. “All of a sudden he was shivering for no reason.”
“I see,” Jack said. He considered that significant, as John had described Helen’s episode as having started in the same way. Intuitively, Jack imagined the chill most likely heralded an acute viremia with virus particles suddenly bursting out into the bloodstream, and the idea brought a kind of revelation. For that to happen, the viruses had to be somehow isolated or locked away, and as far as he knew, there was only one way for that to happen. The virus had to be inside cells in a kind of dormant state.
All at once Jack thought he understood why Aretha had had so much trouble making a diagnosis. It wasn’t a typical virus such as those that produced a cold, hemorrhagic fever, or even influenza. They were most likely dealing with an unknown retrovirus like HIV, which took two years to identify. And the moment the idea occurred to him, he wondered why he hadn’t thought of it earlier. It explained why some people saw it with electron microscopy and others didn’t.
“And the next thing I know is he was having trouble breathing,”Darlene continued. “It got worse fast. Then he started turning blue, so I called nine-one-one. It was terrible.”
“Excuse me,” a voice called.
Jack turned and looked up into the face of one of the night-shift ID clerks, who was standing to the side and behind him. She was holding a number of recently printed photos. “If Ms. Aaronson would like to do the identification, we are ready,” she said.
“May I see,” Jack asked.
“Of course, Dr. Stapleton,” the clerk said. She handed the entire stack to Jack.
Jack needed to look at only the top photo and immediately recognized that it was without doubt the John Carver he had spoken with the day before. For a moment Jack felt a tug on his heartstrings. He could remember the man asking if he had to worry about catching what had killed Helen and Carol. Jack hadn’t known what to say, and now the man was dead. Whatever specific virus it was, Jack could now say with reasonable certitude that it was definitely contagious but with low infectivity and most likely spread by body fluids, similar to HIV. But what made it particularly worrisome was its ability to be far more rapidly fatal. HIV killed by gradually weakening the immune system, whereas this new, unknown disease apparently killed by suddenly unleashing the immune system in a totally uncontrolled fashion.
At that moment there was no doubt in Jack’s mind that NYC was dealing with at least an outbreak of a new disease. Whether it would prove contagious enough to become an epidemic and then a pandemic, he had no way of knowing. Suddenly, he was no longer engaged in an undertaking merely as a way to deal with his daughter’s affliction, but rather one that had a potentially grave public-health impact. For Jack it was a case that clearly demonstrated both the power and importance of forensic pathology, and it certainly justified his switch to the field.
But his work was far from being done. There was still one more major question he needed answered. Of the three victims, who was theindex case? Who contracted this unknown disease and then spread it to the others? Carol was his guess, because she was first, but the order of the deaths might or might not be indicative of who got it first, as the illness apparently had a long latent period between contracting the virus and the appearance of the first symptoms. All at once he was pleased the CDC epidemic intelligence team was en route. Epidemiology was their bailiwick, and his crusade had morphed into an epidemiological mystery. One of the biggest questions was whether the disease had anything to do with Carol’s heart transplant.
“Would you like to come back to my office, Ms. Aaronson?” the clerk asked, interrupting Jack’s rapid musings. “We need to get your information and signature.”
“Okay,” Darlene said. “But I’d like to ask Dr. Stapleton a question, if I may.”
“Of course,” Jack said. He’d gotten to his feet. He was now eager to leave. He wanted to see if John’s affliction was the same as Carol’s and Helen’s, just to be sure.
“Should I be worried about what has happened to John?” she questioned. “I mean... you know... I spent time with him.”
For a moment Jack was unable to speak, as his mind raced in circles in an attempt to come up with an appropriate answer. The question was essentially the same as the one John had asked him yesterday, and Jack felt he’d failed the man. Yet he truly didn’t know what to say. There was no way to make a diagnosis of an unknown disease, nor was there any treatment. Clearly Darlene was at risk, especially if she’d been intimate with John, and Jack was probably correct about the illness spreading by body fluids, but there was no way to assay the risk or do anything about it.
“Well?” Darlene asked. She went back to chewing her cuticles. She had hoped for reassurance. Jack’s silence was doing the opposite.
