Critical (41 page)

“Of course. What was his diagnosis?”

“He said he didn't know.”

Jack gave a short laugh of amazement. “He didn't know at all? I'm shocked.”

“He said he thought it was a parasite.”

“That's more like it. Then did you get Dr. Wiley to look at it?”

“Dr. Wiley, unfortunately, is in New Zealand at a parasitology conference.”

“Well, then I guess we'll have to wait, because Wiley in his field is like Malovar in his.”

“Dr. Malovar sent a digital photo, so I'm certain we'll hear when Dr. Wiley gets it.”

“Of course, there's no accounting of when that may be.”

“I'm afraid not.”

“Okay, Laurie,” Jack said, sitting up. “What's your real point here? Is this another attempt at getting me to cancel my surgery? If it is, out with it!”

“Of course it is,” Laurie said with some heat. “How could it not be, I've found an unknown parasite associated with a rapidly fatal postoperative course. What seems to be happening is a synergism with MRSA, which I have agreed is in every hospital. But this unknown parasite is apparently in only three hospitals, one of which you are scheduled to enter and allow yourself to become a potential victim.”

“Laurie, let me remind you that I'm going to have my operation with a surgeon who has not had one case of whatever this is, and he's been operating nonstop at the Angels Ortho Hospital. Well, that's not entirely true. He had to stop when they closed the ORs to fumigate them. But since then, he's been back with a full schedule day in, day out, with no problems whatsoever. Secondly, I do not have a parasitic disease. Maybe that's the basis of this outbreak: These people have visited the backwaters of the Amazon and picked up this parasite unbeknownst to anyone. Hey! I commend your work, and certainly keep at it. If it turns out that this unknown parasite is infectious and you've discovered some new illness, all the power to you. Hell, you might even win a Nobel Prize.”

Laurie stood up abruptly. “Don't patronize me!”

“I'm not patronizing you,” Jack contended. “I'm just trying to fend off your negativity and prepare myself for this operation tomorrow. You know how I feel about it. What I'd really like is some support on your side, not fearmongering.”

Laurie felt a rush of emotion dominated, for the moment, by frustrated anger. Yanking open the bathroom door and slamming it behind her, she stalked down the hall to the darkened living room, where she threw herself onto the couch to brood. Jack had touched the sore spot of her ambivalence.

 

CARLO NOSED HIS
Denali into one of the few parking places along the front of the strip mall. What that meant at nine-thirty on a Wednesday night was that the Venetian was doing a brisk business. Both Carlo and Brennan alighted. The weather had completely cleared up. Despite the garish light coming from a neon gondola on the roof, two stars could be faintly seen in the sky.

Brennan stretched with a few noisy grunts and groans as they walked down the sidewalk toward the restaurant's entrance and passed the open DVD rental store in the process. Brennan's whole body was stiff after sitting in the SUV since five o'clock.

Inside, they had to search the crowd for Louie. Carlo finally found him at a four-top table near the bar. “Wait here!” he said to Brennan and struck off, weaving in and out among the tables. Carlo thought it ironic that the restaurant was doing as well as it was, considering it was in reality a cover for the Vaccarro family's real work. Carlo attributed it to Louie's influence. Louie loved good food and red wine, as was suggested by his body's profile.

When Louie caught sight of Carlo, he excused himself from his buddies, heaved himself to his feet, and took Carlo off to the side. Despite the crowd, it was easy to talk, thanks to the assemblage of black-velvet paintings that crowded every wall and the acoustic ceiling tiles.

“What's up?” Louie asked. “You're early.”

“They closed up shop,” Carlo explained. “All four of them went back to the Neapolitan, parked the vans, and went inside. We waited a good hour and a half, and when none of them reappeared, we came here to let you know what was up.”

“I'm listening.”

“Well, nothing, actually. From the moment Arthur and Ted hooked up with Angelo and Franco mid-morning, they've been staking out the medical examiner's office. Except for the one-sided scuffle between Angelo and some unknown guy nothing's happened. They've just sat in their vans, and us in my Denali.”

“Any idea why they sat in two vans?”

“No idea whatsoever.”

“None of this makes sense,” Louie complained. “It's one hell of an effort on their part, but why?”

Carlo shrugged. He had no idea, either, despite the fact that he and Brennan spent part of the afternoon batting around ideas.

“Yet because it doesn't make sense, my intuition tells me it's important,” Louie said, and then paused for a minute. “I want you guys to keep up the surveillance, that's for certain. I want to know where Angelo and Franco are and what they are doing. And have Arthur and Ted start early, like at six. I think the reason they didn't hook up with them until the middle of the morning was they went out too late.”

“I'll tell them. Anything else?”

“What about the tracking device.”

“We got it, and we've got it on the boat. How it works, you'll have to ask Brennan.”

“I don't care how it works. I just want to know when the boat goes out and where it goes, so tell Brennan to stay on top of it.”

T
rying not to wake Jack, Laurie rolled over and looked at the clock. She'd been awake for almost an hour, and she was now convinced that more sleep was not an option. She didn't know if it was depression, frustration, or dread, or a mixture of all three, but she couldn't stay in bed a moment longer. Her mind was constantly going over the same issues, with the same results.

Being as quiet as she could, she slipped from under the covers, gathered up the clothes she had set out for the day by feel, since the only light came from the clock face, and slowly inched toward the open bathroom door. Once she was in the bathroom, she leaned back into the bedroom to listen to the sound of Jack's breathing. It hadn't changed, which pleased her.

Waking up as early as she had and wanting something to occupy her overly busy mind, Laurie had suddenly thought of heading into work early. She thought she could at least finish her matrix, and whether it would have any effect on Jack's thinking was not the point. As the discussion the previous evening had proved, he was not about to be deterred, and besides, it was clearly too late. His surgery was only four hours and fifteen minutes away.

Laurie showered quickly and put on her usual small amount of makeup. As she did so, she thought about the evening before. It had gone badly at first, with both of them irritated at the other. But that had soon changed, and once again they'd agreed to disagree. Although Laurie said she didn't want to have anything to do with the operation itself, such as going with him to the hospital in the morning, she promised she'd be there in the afternoon to support him one hundred percent in his rehabilitation. He had been warned by Dr. Anderson that his mobility postsurgery would be restricted because he would be waking up with a device that would be constantly flexing and extending his knee, and that he would be attached to it for at least twenty-four hours.

Laurie dressed quickly. While she had a quick bite to eat in the kitchen, she wrote a note for Jack, telling him she'd gone to work early and why, and asked him to have Dr. Anderson call her at the OCME when the procedure was done. She signed the note by telling him she loved him and that she'd see him around noon.

Unsure of where to put the note to be certain he saw it, Laurie took some tape from the kitchen and returned to the bathroom, using the door from the hall. They had designed the bathroom with two doors, one from the bedroom and one from the hall, for exactly this kind of situation when one of them was up before the other. With a piece of tape, she adhered the note to the center of the mirror such that there was no way he could argue he'd not seen it.

Getting her coat, key, the tray of slides, and her bag, Laurie opened the hallway door and was about to close it behind her when she remembered her cell phone was charging at her bedside table. For a moment, she debated whether she wanted to risk waking Jack. Believing Jack should get as much sleep as possible and that she would not need her cell, since she would be spending the first half of the day at her OCME desk and the second half in Jack's hospital room, she decided to forgo its convenience.

Outside, it was still dark with only a hint of dawn in the eastern sky, and the street was completely deserted in both directions. Thinking it would have been wiser to have called a radio cab, Laurie hesitated on the front stoop. But not wanting to take the time now that she was already down, she ran toward Columbus Avenue. In her experience, it was a lot easier getting a taxi there than on Central Park West, and she was proved to be correct as one pulled to the curb the moment she extended her hand.

As the cab zipped downtown in the nearly empty streets, Laurie admitted to herself that April 5, 2007, was not going to be a day she would ever want to relive. The level of general anxiety she was experiencing was as high as she'd ever felt, evidenced by the abdominal distress she'd suffered after eating her skimpy breakfast, which was now being made worse by the jolting and rocking of the taxi. At one point she sensed she was about to vomit, but it passed. It was with definite relief that the taxi finally reached the OCME. Laurie directed the driver to the side of the building and down the ramp to the receiving dock. Still queasy, Laurie quickly paid the fare and climbed out.

She waited a half-minute or so to let a mild wave of dizziness dissipate, then mounted the stairs to the receiving dock. As she passed down the hall, she said hello to the night security man in his cubbyhole office. Surprised to see her, Mr. Novak jumped up from his desk, poked his head out, and called down to Laurie, who'd already reached the back elevator. “Good morning, Dr. Montgomery,” he called. “What brings you in so early?”

“Just a little extra work,” she lied. She waved as she boarded.

Laurie stopped again on the second floor, as she had the evening before. She bought herself a cup of vendor coffee. Strangely, coffee tended to calm her stomach. At least it had in the past.

Laurie turned on her office light, and after hanging up her coat, she surveyed her cluttered desk. Her microscope still occupied center stage. The piles of case files and hospital records looked daunting. Her matrix was balanced on the top of one of them.

After putting her scope to the side along with the trays of slides, Laurie sat down. She moved the matrix in front of her. Before beginning, she opened the lid of the coffee and took a tentative sip. A grimace followed by reflex. It wasn't because it was too hot, which was what she feared, but because it tasted horrid. If she hadn't known, she wouldn't have even suspected it was coffee. With the lid replaced, she put it aside, intending to go down to the ID room when she thought Vinnie would have the communal coffee made.

Laurie then took the next case file and hospital record and set to work. Not quite an hour later, the phone rang. As much as she'd been concentrating combined with the near-absolute silence of the deserted fifth floor, the phone's old-style raucous jangle totally startled her. She answered it in a panic before she'd even had a chance to guess who it might be. It was Jack.

“What time did you leave?” he asked.

“I'm not sure. It was three-fifteen when I got up.”

“Why didn't you wake me? I missed you when I awoke a few minutes ago.”

“I wanted you to get as much sleep as you could.”

“Are you exhausted?”

“I've been exhausted for days. Luckily, I didn't have any trouble getting to sleep.”

“I'm glad we talked again last night,” Jack said, “even if I wasn't when we began.”

“I'm glad, too.”

“Well, I had better jump into the shower with my antibiotic soap. I'm supposed to be over there at six-fifteen, and it's already twenty after five.”

“I forgot to ask: How long does this patella tendon graft take?”

“Dr. Anderson told me a little more than an hour.”

“I'm impressed. That's fast.”

“He does them so often, he's got it down to a science.”

“I'll see you around noon,” Laurie said.

“I love you.”

“I love you, too,” Laurie closed. She heard the click. It sounded so final. Slowly, she replaced the receiver.
What was the day going to bring?
she asked herself uneasily. She wished she'd hung up first, because she kept hearing the metaphoric disturbing finality of the click over and over in the depths of her brain.

Shaking off any morbid thoughts engendered by the phone, Laurie went back to her matrix, taking yet another case file and its accompanying hospital record from the slowly dwindling stack. To keep from thinking about anything other than the busywork of data entry, Laurie kept at her task compulsively, as if it were a life-or-death necessity. Close to seven, she had only two more to go when Riva arrived.

“What on earth are you doing here so early?”

“I couldn't sleep,” Laurie said. “I thought I might as well work.”

Riva looked over her shoulder at Laurie's nearly complete matrix. “Very impressive! Have you learned anything earth-shattering?”

“Hardly,” Laurie said. She thought for a moment about telling Riva about the unknown and possibly infectious agent she'd found microscopically, but then changed her mind. Riva would undoubtedly want to see it, and Laurie was intent on finishing her matrix.

“Are you still planning on a paper day today?” Riva questioned.

“Absolutely,” Laurie said. “I want to finish what I'm doing and then go over to see Jack. He's having his surgery today.”

“Oh, that's right,” Riva said. “I'd forgotten. I don't have Jack to schedule, either. I'd better get down there and see what's come in overnight.”

By seven-twenty-five, Laurie had finally made the last entry. She held the matrix up. It was quite extensive, with every known variable she had been able to conjure up to compare the cases.

Quickly she scanned the document, looking for gross, unexpected commonalities among the twenty-five cases that might suggest the how and the why the patients had gotten infected. But nothing seemed to jump out until she looked back at the column for date of surgery. Having always had a facility with mathematics and numbers in general, there seemed to be a pattern. Believing it was only some sort of coincidence, Laurie got out her daily calendar and translated the dates of her series into days of the week. To her surprise, there was a pattern in that all the eye or cosmetic cases were on Tuesday, the heart cases were on Wednesday or Friday, and the orthopedic cases were on Monday or Thursday. With her knowledge of statistics, Laurie immediately knew that twenty-five cases were not nearly enough to give any credence whatsoever to her finding, yet she found it curious.

Returning to the matrix and slowing down, she let her eyes pause at each entry in each of the categories, such as age, duration of the procedure, type of anesthesia, et cetera, but still nothing significant caught her attention. Coming to the end of the matrix, Laurie switched her gaze to the wall clock. It was seven-thirty exactly, and Jack's surgery was starting. Laurie could visualize the scalpel cut through the skin, and she winced at the thought. Looking back at her matrix, she felt sorry she had finished filling it in. The process itself had been effective in keeping her mind from thinking about what she preferred not to think about.

Suddenly, Laurie thought of something else she could do to avoid obsessing over what was happening to Jack. She thought of Dr. Collin Wylie in New Zealand and the possibility that he'd gotten the photomicrograph, and the possibility he'd had an opportunity to look at it, and if he had, whether he'd been able to recognize it and respond. There were a lot of ifs, but, undeterred, Laurie went to her e-mail. The main reason she'd not thought about doing so earlier was because the outgoing e-mail had been sent during the night, and she'd forgotten to factor in that New Zealand was on the opposite side of the world, meaning in Auckland it had been morning.

The moment after she'd clicked the appropriate icon and her e-mail opened, she saw it: [email protected] Eagerly, Laurie opened it.

As astonished as she was about what she was reading, Laurie had read the e-mail without blinking, and she had to make up for it by squeezing her eyes shut and then blinking several times in a row. She knew next to nothing about amoebas in general or acanthamoeba in particular. Leaning over, she pulled her Harrison's
Principles of Internal Medicine
from the shelf and rapidly looked up acanthamoeba. The reference was short, and merely part of a general article about infection with free-living amoeba. It talked about acanthamoeba causing an encephalitis, but nothing about pneumonia. It also mentioned that the CDC had a fluorescein-labeled antiserum available for definitive diagnosis, which Laurie thought might be helpful to confirm Dr. Wylie's impression.

Laurie replaced the textbook and scanned her shelf for a possible second source. Not seeing one, she repositioned herself at her monitor screen and Googled acanthamoeba. A large number of hits appeared in seconds. She chose a general one.

With a growing sense of urgency, Laurie scanned the first part of the article, which described the protozoa as one of the most common in soil and fresh water. It described some of its characteristics, including the fact that it was a free-living bacterivore but could on rare occasions cause infections in humans. The next paragraph elaborated this issue at length, and Laurie quickly skimmed it.