“The point is that your training and your responsibility involve the dead, not the origin of disease.”
“Wrong again,” Jack said. “We deal with the dead so that they speak to the living. Our goal is to prevent death.”
“I don’t know how to make it much plainer to you,” Clint said with exasperation. “You told us a man died of plague. We appreciate that, and we didn’t interfere in your work. Now it is for me to figure out how he got it.”
“I’m just trying to help,” Jack said.
“Thank you, but if I need your help I’ll ask for it,” Clint said and strode off toward room 707.
Jack watched Clint’s figure recede, when a commotion behind him attracted his attention. Kelley had emerged from the utility room and was immediately besieged by the people he’d been speaking with earlier. Jack was impressed by how quickly his plastic smile returned and with what ease he sidestepped all questions. Within seconds, he was on his way down the hall toward the elevators and the safety of the administrative offices.
Dr. Zimmerman and Dr. Wainwright stepped out of the utility room deep in conversation. When Kathy McBane appeared, she was alone. Jack intercepted her.
“Sorry to have been the bearer of bad news,” Jack offered.
“Don’t be sorry,” Kathy said. “From my point of view, we owe you a vote of thanks.”
“Well, it’s an unfortunate problem,” Jack said.
“I’d guess it’s the worst since I’ve been on the Infection Control Committee,” she said. “I thought last year’s outbreak of hepatitis B was bad. I never dreamed we’d ever see plague.”
“What is the Manhattan General’s experience in regard to nosocomial infections?” Jack asked.
Kathy shrugged. “Pretty much the equivalent of any large tertiary-care hospital,” she said. “We’ve had our methicillin-resistant staph. Of course, that’s an ongoing problem. We even had klebsiella growing in a canister of surgical scrub soap a year ago. That resulted in a whole series of postoperative wound infections until it was discovered.”
“How about pneumonias?” Jack asked. “Like this case.”
“Oh, yeah, we’ve had our share of them too,” Kathy said with a sigh. “Mostly it’s been pseudomonas, but two years ago we had an outbreak of Legionella.”
“I hadn’t heard about that,” Jack said.
“It was kept quiet,” Kathy said. “Luckily no one died. Of course, I can’t say that about the problem we had just five months ago in the surgical intensive care. We lost three patients to enterobacterial pneumonia. We had to close the unit until it was discovered that some of our nebulizers had become contaminated.”
“Kathy!” a voice called out sharply.
Both Jack and Kathy abruptly turned to see that Dr. Zimmerman had come up behind them.
“That is confidential information,” Dr. Zimmerman lectured.
Kathy started to say something but then thought better of it.
“We have work to do, Kathy,” Dr. Zimmerman said. “Let’s go to my office.”
Suddenly abandoned, Jack debated what he should do. For a moment he considered going back to room 707, but after Clint’s tirade, he thought it best to leave the man alone. After all, Jack had intended to provoke Kelley, not Clint. Then he got an idea: It might be instructive to visit the lab. As defensively as Dr. Zimmerman had responded, Jack thought it was the lab that should have been chagrined. They were the ones who missed the diagnosis.
After inquiring about the location of the lab, Jack took the elevator down to the second floor. Flashing his medical examiner’s badge again produced immediate results. Dr. Martin Cheveau, the lab director, materialized and welcomed Jack into his office. He was a short fellow with a full head of dark hair and pencil-line mustache.
“Have you heard about the case of plague?” Jack asked once they were seated.
“No, where?” Martin questioned.
“Here at the Manhattan General,” Jack said. “Room seven-oh-seven. I posted the patient this morning.”
“Oh, no!” Martin moaned. He sighed loudly. “That doesn’t sound good for us. What was the name?”
“Donald Nodelman,” Jack said.
Martin swung around in his seat and accessed his computer. The screen flashed all Nodelman’s laboratory results for the duration of his admission. Martin scrolled through until he got to the microbiology section.
“I see we had a sputum gram stain showing weakly gram-negative bacilli,” Martin said. “There’s also a culture pending that was negative for growth at thirty-six hours. I guess that should have told us something, especially where I see pseudomonas was suspected. I mean, pseudomonas would have grown out without any trouble way before thirty-six hours.”
“It would have been helpful if Giemsa’s or Wayson’s stain had been used,” Jack said. “The diagnosis could have been made.”
“Exactly,” Martin said. He turned back to Jack. “This is terrible. I’m embarrassed. Unfortunately, it’s an example of the kind of thing that’s going to happen more and more often. Administration has been forcing us to cut costs and downsize even though our workload has gone up. It’s a deadly combination, as this case of plague proves. And it’s happening all over the country.”
“You’ve had to let people go?” Jack asked. He thought that the clinical lab was one place hospitals actually made money.
“About twenty percent,” Martin said. “Others we’ve had to demote. In microbiology we don’t have a supervisor any longer; if we had, he probably would have caught this case of plague. With the operating budget we’ve been allotted we can’t afford it. Our old supervisor got demoted to head tech. It’s discouraging. It used to be we strove for excellence in the lab. Now we strive for ‘adequate,’ whatever that means.”
“Does your computer say which tech did the gram stain?” Jack asked. “If nothing else, we could turn this episode into a teaching experience.”
“Good idea,” Martin said. He faced the computer and accessed data. The tech’s identity was in code. Suddenly he turned back to Jack.
“I just remembered something,” he said. “My head tech thought of plague in relation to a patient just yesterday and asked me what I thought. I’m afraid I discouraged him by telling him the chances were somewhere on the order of a billion to one.”
Jack perked up. “I wonder what made him think of plague?”
“I wonder too,” Martin said. Reaching over to his intercom system, he paged Richard Overstreet. While they waited for the man to arrive, Martin determined that Nancy Wiggens had signed out on the original gram stain. Martin paged her as well.
Richard Overstreet appeared within minutes. He was a boyish, athletic-looking individual with a shock of auburn hair that fell across his forehead. The hair had a habit of slipping over his eyes. Richard was ever pushing it back with his hand or throwing it back with a snap of his head. He wore a white jacket over surgical scrubs; his jacket pockets were crammed with test tubes, tourniquets, gauze pads, lab chits, and syringes.
Martin introduced Richard to Jack, then asked him about the short discussion they’d had about plague the day before.
Richard seemed embarrassed. “It was just my imagination getting the best of me,” he said with a laugh.
“But what made you think of it?” Martin asked.
Richard swept his hair from his face and for a moment left his hand on the top of his head while he thought. “Oh, I remember,” he said. “Nancy Wiggens had gone up to get a sputum culture and draw the man’s blood. She told me how sick he was and that he appeared to have some gangrene on the tips of his fingers. She said his fingers were black.” Richard shrugged. “It made me think of the black death.”
Jack was impressed.
“Did you follow up on it at all?” Martin asked.
“No,” Richard said. “Not after what you’d said about the probability. As behind as we are in the lab, I couldn’t take the time. All of us, including me, have been out drawing blood. Is there some kind of problem?” Richard asked.