"You mean like the cytokine storm they are seeing with people dying from H5N1 bird flu?" Laurie asked. The thought went through her mind that she would have to suggest to Jack that he might need to adjust the opinion he had of Besserman. He was embarrassing her by how much more he knew about MRSA than she.
"Exactly," Arnold said.
"I'm afraid I'm going to have to do some serious reading about all this," Laurie admitted. "Thanks for all the information. How is it that you are such an expert?"
Arnold laughed. "You're giving me too much credit. But a month or so ago, Kevin and I got interested in the issue because of several cases we each had. We kinda challenged each other to learn about it. It's a good example of the genetic versatility of bacteria and how quickly they can evolve."
Laurie struggled to rein in her mind, which was bouncing from one topic to another. She looked down at the turgid, nearly solid slice of lung she was holding. She knew pathological bacteria were making a comeback, but what she was facing in terms of pathogenicity seemed beyond the pale.
"So the cases you mentioned earlier were necrotizing pneumonia?" she asked. "Just like this case appears to be."
"That would be my guess, but I'd be even more certain if I looked at the microscope section of your case. I'd be glad to take a peek."
Laurie nodded. "And Kevin's cases were the same as yours?"
"Very much so."
"Were his nosocomial also?"
"Of course. They were nosocomial but also involved the community-acquired strain, the same as mine."
"Why didn't you bring this up at Thursday conference?"
"Well, frankly, it was not that many cases, and everyone is aware of the burgeoning problem of staph, particularly antibiotic-resistant staph."
"Were the involved hospitals fairly evenly distributed around the city?"
"No, they were all here in midtown Manhattan. I mean, there could have been cases in Queens or Brooklyn, since they would be sent to their respective borough morgues."
"What hospitals here in Manhattan?"
"I can't remember the exact breakdown from individual institutions, but all six came from three specialty hospitals: Angels Heart Hospital, Angels Cosmetic Surgery and Eye Hospital, and Angels Orthopedic Hospital."
Laurie stiffened. It was as if Arnold had slapped her. "None from Manhattan General or University or any of the other big city hospitals?"
"Nope. Does that surprise you?"
"Yes and no," Laurie said, taken aback by such a coincidence. There were a lot of hospitals in New York City. It begged the question: Why just three?
"Did you contact the hospitals, or look into the situation at all? I mean, why just those three hospitals?"
"Kevin and I thought it coincidental, so yes, we looked into it to a degree. I also asked for Cheryl Myers's help as well. I called the Angels Orthopedic Hospital and spoke to a very nice woman whose name escapes me at the moment. I'd gotten the name from the hospital administrator. The individual I spoke with chaired the interdepartmental infection-control committee."
"Was she helpful?"
"Absolutely. She said the hospital was well aware of the problem and had hired an infection-control professional, or at least the company that owned the hospital did. So I called this individual whose name I can't forget was Dr. Cynthia Sarpoulus."
"Was she helpful?"
"Well, I suppose, at least to an extent."
"What do you mean?"
"She wasn't terribly cooperative, although I suppose she was stressed and defensive under the circumstances. My assumption was that her employer, Angels Healthcare, which is the name of the company, had put the burden on her. Anyway, she essentially told me to butt out, and that the situation was well under control, thank you very much. You know the attitude, I'm sure. To her credit, it sounded to me that she was on top of the problem. Against management's objections, according to her, she had insisted all the ORs in all three hospitals be closed, which also according to her had everybody on her back. She then had all the ORs fumigated by an alcohol-based agent, which is what is recommended. She'd also instigated a rigorous hand-washing regimen. On top of that, she'd had the entire staff tested as potential carriers, and those who tested positive treated. I have to say I was impressed. They surely weren't sitting around, wringing their hands."
"Thanks for the information. Sorry to take so much of your time," Laurie said.
"My pleasure," Arnold said.
"Would you mind if I came up to your office later and got the names of the cases you've mentioned?"
"Not at all! I might still have a couple of the case files. You can also borrow the notes I made about CA-MRSA if you'd like. And you can talk with Kevin. Back when we were working on this, I think he also called over to one of the involved hospitals, but I don't remember if he told me what he learned."
After Arnold had stepped back to his table, Laurie looked over at Marvin, who had patiently waited through the whole conversation. "That was incredible," she said.
"What, that he's sweet on you?"
"No, silly! What he said. He's not sweet on me!"
"That's not the chatter around the morgue. It's generally accepted both Southgate and Besserman would throw themselves in front of a subway train for you."
"Nonsense," Laurie said, although hearing she was even remotely the source of gossip made her uneasy. She never liked being the center of attention, which was why she had such trouble talking in front of a group.
By the time Laurie had finished with Jeffries, she'd found far more pathology than she had expected. Every organ was grossly involved with obvious destructive infection or at least inflammatory swelling. Within the heart, she found beginning infectious vegetations on the valves. In the liver, there were incipient abscesses, as well as in the brain and kidneys, suggesting the victim had had a massive bacteremia. There were even ulcers in the gut, attesting to the ease with which the bacteria spread.
"How long to the next case?" Laurie asked, as she and Marvin finished suturing the giant autopsy incision encompassing both David Jeffries's chest and abdomen.
"As little time or as much time as you'd like," Marvin said. "If you want a coffee break, I'll stretch it out."
"Actually, if you don't mind, I'll call you when I want to do it. Among other things, I want to see if Cheryl Myers is here and catch her before she goes out on a case."
"Then I'll take my time," Marvin said. "Give me a call when you want to start."
"Make sure you leave a note for whoever releases Jeffries's body to inform the funeral home that a serious infection is involved and precautions should be taken."
On her way out of the autopsy room, Laurie briefly stopped at Jack's table.
"Ah! The doomsayer!" Jacked quipped at recognizing her. "Forsooth, Vinnie! Take heed! She's surely here to terrify us with the grisly horrors of her nosocomial surgical-site infection case."