“This is the fourth case that I have seen,” Jack said. “They are all exactly the same, which in my mind points to an infectious origin. If I had to guess, I’d say Carol Stewart is the index case, and she gave it to the others with whom she’d been intimate. For a number of reasons, I am thinking it is a retrovirus. Since she had just had a heart transplant and had never had any pulmonary problems, it is a reasonable guess she got it from the donor, who was carrying this unknown retrovirus that spreads via body fluids, like HIV.”
“That’s all very fanciful,” Stephen said in the same tone of voice. “I have to give you credit for being creative. But you haven’t told me what doesn’t make sense.”
“Margaret,” Jack said. “I’ve been told that she knew Carol but wouldn’t have been likely to share body fluids. That means that Margaret would have had to get it from her donor heart just like Carol, and unless this unknown retrovirus that’s never been seen was widespread, which it can’t be, the chances of that happening are infinitely small.”
“I can see where that is a problem,” Stephen said.
“How good a match was the donor heart that Margaret got?” Jack asked.
For a beat neither Stephen nor Ted responded. Finally, Ted spoke up. “It was an okay match, otherwise we wouldn’t have done it.”
“Where did it come from?” Jack asked. “Was it a local donation or from someplace far away?”
“That I’d have to look up,” Ted said. “I don’t remember offhand.”
“Was Margaret on high doses of immunosuppressants, unlike Carol?” Jack asked.
“No,” Ted said. “Just the normal amount.”
“From the looks of the heart here, there seems to be no inflammation whatsoever. I don’t have a lot of experience posting heart transplant recipients, but isn’t there usually some rejection phenomena going on that’s kept under control?”
“UNOS tries to make the best possible match to keep that at a minimum,” Ted replied.
“Sorry to interrupt,” Stephen said. “I want to thank you, Dr. Stapleton. This autopsy has been very enlightening, but I do have a transplant case starting in just a few minutes. If you’ll excuse me.” Without waiting for a response, he headed for the exit leading to the room to remove his protective gear. Wordlessly Dr. Han Lin followed.
“And I have a clinic full of patients to see,” Ted said. “I also want to thank you for coming and helping us, Dr. Stapleton. You’ve provided us with important information. I hope we see you again real soon.” Then he headed for the same exit Stephen had used and disappeared.
Jack, still holding the long-bladed knife he’d used on the lungs, felt suddenly abandoned. The exit of the three doctors had been so sudden and unexpected that he’d scarcely had time to react. It also seemed to contradict their previous warm hospitality. It was as if they had gotten what they wanted and that was it. They clearly hadn’t been concerned with giving Jack an opportunity to ask any of his myriad questions. Now, as he looked across the room at Harvey, who had busied himself by supervising the removal of the skull cap to facilitate finishing the autopsy, Jack wondered if he might be able to provide any answers. Yet as Jack watched the man struggle with his current task, he wasn’t optimistic. In comparison to Stephen and Ted, Harvey seemed like a dunce. Plus, Jackwas wary of the man after hearing him place a call to Wei Zhao as soon as Jack had left his office yesterday afternoon. Whatever hanky-panky might be going on at the Dover Valley Hospital, he feared Harvey was probably involved. Whether that was true of Stephen and Ted, he had no idea.
“See any pathology in the brain?” Jack asked, as he returned to the autopsy table.
“None so far,” Harvey said. “I hope you don’t mind that I had the techs push ahead.”
“Not in the slightest,” Jack said, making up his mind that Harvey wasn’t a good bet as a source. “In fact, I think I’m done here and would like to ask you to please finish up. I have a number of important questions for the doctors that I didn’t get a chance to ask, and I’d like to catch them before they leave the morgue.”
“But you’re not done here,” Harvey said with a whine.
“I beg to differ,” Jack said. “All you have to do is check the brain and prepare some specimens for microscopic sections. That’s not asking a lot with your capable hands. I’ve certainly accomplished what Dr. Friedlander and Dr. Markham had in mind for me, and I assume this is a Morris County case.”
“No, it was signed out to the Dover Valley Hospital,” Harvey corrected. “And if you want to get paid, I want you to stay here and finish.”
“I think I’ll argue that point with the bursar instead of with you,” Jack said, immediately taking offense. He’d suspected Harvey of being lazy and a laggard, but this seemed beyond the pale, as it would take him only ten minutes or so. He’d even given the man a questionably deserved compliment.
“Suit yourself,” Harvey said morosely.
37
THURSDAY, 12:27 P.M.
Knowing he was only in marginal control of his emotions after what the day had already wrought, Jack made an effort to keep himself on an even keel despite Harvey Lauder. Moving quickly, he pushed through the door into the side room, hoping at least to catch Ted. Unfortunately, he wasn’t there. The room was designed to facilitate decontamination if the case had needed biosafety 3 protection. It was also where the latex gloves, the shoe covers, and the impervious gown were left for disposal and the face shield was left to be cleaned. Jack accomplished this on the run and then exited into the hallway. Picking up his pace, he power-walked down to the men’s locker room. Going through the door, he practically bumped into Ted, who was already on his way out. Ted was dressed as he had been the day before, in a white shirt, conservative Ivy League tie, and a long, highly starched white coat.
“I beg your pardon,” Jack said.
“Not at all,” Ted said. “Wow! You already finished the autopsy? You are very efficient, I must say.”
“I left the rest for Harvey,” Jack said. “It was mostly done. I have some questions for you, if you don’t mind.”
“I’m afraid I do mind,” Ted said. He pushed by Jack and opened the door to the hallway. “As I said in the autopsy room, I have a clinic full of patients that I ignored to observe the autopsy on Margaret. Thank you again for your help, but I really have to go.”
