Hello, excuse me!” a voice called.
Laurie looked up from her work. One of the histology technicians was standing in the doorway, clutching a cardboard tray for microscope slides.
“Maureen asked me to run these down,” the woman said. “She also asked me to apologize for not getting them to you sooner. Two people called in sick today.”
“No problem,” Laurie said. She reached over and took the tray. “Thanks for bringing them, and thank Maureen for getting them to me so quickly.”
“Will do,” the woman said amiably.
Clutching the tray, Laurie looked back at her cluttered desk. Working nonstop, she had filled in only approximately two-thirds of her matrix, although the process, as painstaking as it was, was speeding up, since she had become accustomed to where in the hospital records she’d find the specific information she wanted. She’d also added more categories as she’d gone on, which forced her to go back to cases she thought she’d finished. One thing was certain: With as many categories as she now had, constructing the matrix was significantly more work than she’d originally imagined.
Although Laurie enjoyed a certain compulsive contentment about her progress, it had to contend with a growing disappointment that her efforts were probably not going to provide any insight into the mystery. As she worked, she’d hoped that she’d see some unexpected commonality, but it wasn’t happening. If a few cases were in the same OR, the next one would be in a different OR; if several patients were on the same floor, the next one would be on a different floor; and so on and so forth. Yet she had persisted and would continue to do so, since it was all she had.
Relishing a break from what was essentially tedious data entry, Laurie cleared a space on her desk for her microscope. Turning on the lamp, she slipped the first slide of David Jeffries’s lung section into the stage clip, rotated the revolving nosepiece to the lowest objective, and lowered the objective close to but not touching the slide. Putting her eyes to the eyepiece, she used the coarse adjustment knobs to pull the objective back up from the slide until she got an image. Reflexively, her hand went to the fine-adjustment knob and brought the image into sharp focus.
Laurie was again awed by the degree of damage wrought by the bacteria, many of which she could see as disclike clusters in the microscope’s two-dimensional field. The normal alveolar structure of the lung was being dissolved by the bacteria’s flesh-eating toxins such that abscesses of varying sizes were being formed. As she moved around with the help of the mechanical stage, she could see capillary walls in various stages of sepsis, causing hemorrhages into the septic soup that filled the lungs. The amount of destruction of the lungs’ normal architecture reminded her of images of a city following a carpet bombing or a trailer park directly ravaged by a category five hurricane.
For more than an hour Laurie went through the tray of slides one by one. Using a higher-power lens, Laurie was even more impressed with the bacteria’s pathogenicity. Focusing in on fibrous tissue responsible for maintaining the lung’s normal structural architecture, she could see that the tissue was coming apart like the skin of an onion. Covalent bonds were being broken and collagen itself was dissolving into its constituent molecules.
“Hey, sweetie,” Jack said as he quietly breezed in. He was becoming progressively adept on his crutches. “How’s your day going?”
Laurie looked up, her face paler than usual.
“What’s up?” Jack questioned. His smile waned. “You look terrible.”
Laurie took in a deep breath and let it out. The tissue destruction she had been viewing had had a visceral effect on her. The fact that it had occurred within hours in a previously healthy person couldn’t help but underline how fragile human beings ultimately were. The idea of enjoying any sort of health seemed a miracle.
Jack put his hand on her shoulder. “Really, are you okay?”
Laurie nodded and took another breath. She tapped the barrel of her microscope. “I think you ought to take a look at this. Keep in mind it was a normal, healthy person just a few hours earlier.”
Laurie pushed herself back from the desk to give Jack room.
Jack put his crutches aside and leaned down toward the eyepiece, but about halfway he hesitated, then regained full height.
“Wait a second,” he said suspiciously. “Is this a setup? Am I being slyly seduced into looking at a slide of your MRSA case from yesterday?”
“Remind me never to try to slip something by you,” Laurie said with a wan smile. Her blood pressure had quickly risen back to normal, returning color to her face and clearing the accompanying queasiness. She admitted it was a section of lung from David Jeffries.
Jack looked into the microscope, and, moving the mechanical stage, he took a quick tour of the section. “Wow,” he said. “It’s totally destroyed. I see hardly any normal architecture.”
“Does it change your mind about elective surgery where you might find yourself dealing with such a pathogen?”
“Laurie!” Jack scolded.
“Okay,” Laurie said, pretending to be nonchalant. “I just thought I’d ask.”
“How were your cases today? You seemed to have been engrossed more than usual.”
“They were fine, particularly from a teaching perspective, such that they took longer than I hoped. I wanted to get up here ASAP and work on my matrix.” She patted the legal pad. “It’s the only thing left that I have that has a snowball’s chance in hell to convince you that you are specifically at risk for being exposed to MRSA during your scheduled surgery.”
“And?” Jack asked, looking at Laurie askance.
“I haven’t found anything yet,” she admitted before looking at her watch. “But I still have about fifteen hours.”
“Ye gods. And you call me bullheaded.”
“You are bullheaded. I’m merely persistent, and, of course, I have the added benefit of being right.”
Jack waved Laurie away and gathered his crutches. “I’m heading to my office to clean things up since I’ll be gone for a few days.” He emphasized the few days.
“How were your cases today?”
“Don’t ask. Riva promised some good ones; instead she gave me two natural deaths and an accidental one, none of which were at all challenging. Lou’s case was more interesting. The slug’s caliber and the indentations from an apparent chain to keep her sunk suggested the same killer. The difference was she was raped.”
“Tragic.”
“Another testament to the inherent wickedness of man.”
“I’m glad you said man. Now get out of here. I only have fifteen hours.”
“What time do you want to leave this evening?”
“Actually, we should take separate cabs, unless you want to stay late. I want to finish this matrix.”
“I’ll come back here when I’m done in case you change your mind. I don’t want to hang around, because I want to watch my buddies play basketball to remind me why I’m willing to go under the knife.”
On that issue, Laurie had to hold her tongue. Instead, she said, “Is Chet still in your office, or has he left for the day?”
“I wouldn’t know. I stopped in here first.”
“Well, if he is, you should try to dampen his enthusiasm for his new lady friend.”
“Oh? How come?”
“By coincidence, she’s the CEO of the company that has built the three Angels specialty hospitals.”
“Really?” Jack said, raising his eyebrows. “That is a coincidence. Why dampen his enthusiasm?”
“She’s the one who all but ordered me out of the orthopedic hospital yesterday. I don’t know about long-term, but right now I question her motivation.”
“Not to worry,” Jack said. “I’m sure Chet will have eyes for someone else tonight. A week from now, he won’t even remember her name.”
“I hope so, for his sake.”
With Jack out of her office, Laurie went back to the microscope. Although she had made an effort to appear upbeat
with Jack, she was again feeling despondent. She’d joked about the fifteen hours, but in reality, it was far too little time to solve a mystery that had been confounding people with Ph.D.s in epidemiology.
Suddenly, Laurie’s hand stopped twirling the horizontal mechanical stage control. She’d seen something unusual zip past the microscope’s field. Since she was viewing at high-power, objects moved very quickly in and out of the field with very little rotation of the control. She slowly reversed direction with the control, and the strange object came into view.
Laurie was entranced. It appeared to be in the middle of what had been a bronchiole, probably close to what had been an alveolus, or the terminal sac in the bronchial tree where oxygen entered the blood and carbon dioxide came out. Laurie immediately questioned whether it had been there originally or was an artifact, inadvertently introduced or formed during the slide’s preparation. It was about the size of the white cells Laurie had seen, which were the body’s defensive cells, but there was no nucleus. It had absorbed almost none of the standard stain used by histology.
Most remarkable, it was a nearly round disk, symmetrical with a scalloped border, giving it a stellate appearance. Why she thought the symmetry was important was that most artifacts she’d seen didn’t have such symmetry. Laurie looked at the object itself. The scalloped border comprised about one-fifth the diameter. The center of the object was opaque, with the mere hint of either nodularity or being mottled. One minute she’d see it, the next minute she wouldn’t. She wished the object had taken the stain, because if it had, she would have known if what she was seeing was real or something she was conjuring up. Trying to keep her excitement in check, Laurie took out a grease pencil to mark the glass slide so that if the scope’s mechanical stage were to accidentally move, she could find the object again. She did this by placing four dots in the cardinal directions. Satisfied, Laurie then shifted to low power. When she looked in again, the object was significantly smaller, and because it lacked staining, it tended to blend in to the chaotic surroundings.
Switching back to high power, she made sure the object, whatever it was, was still in the field. With that ascertained, she quickly went down to get Jack.
When Jack looked at the object, he said, “My gosh, how did one of my grandmother’s butter cookies get into David Jeffries’s lung?”
“Be serious,” Laurie said. “What do you think it is?”
“I’m not fooling. It looks just like it came from one of my grandmother’s cookie cutters. We called it a star, but obviously it has far too many rounded points.”
“Do you think it is an artifact?”
“That would be my first guess, but it is surprisingly symmetrical. I suppose that’s due to the dynamic tension between the hydrophilic and hydrophobic forces at the interface of the menisci.”
“What the hell is that?”
“How should I know?” Jack said, still looking at the microscopic object. “I’m just running off at the mouth, speaking pseudo-scientific gibberish.”
Laurie swatted Jack’s shoulder playfully. “Here I thought you knew what you were talking about.”
Jack looked up. “Sorry, I have no idea what it is. I don’t even know if it is real or artifact.”
“Nor do I,” Laurie admitted.
“Have you found any others, or is this it?”
“So far that’s it. Now that I found it, though, I’m eager to see if there are more.”
“Do you have any idea what it could be?”
“I know what I think it looks like, but it can’t be.”
“Come on! Run it by me!”
“It looks like a diatom. Do you remember those from biology?”
“I can’t say that I do.”
“You must. They’re a type of algae or phytoplankton with silicate cell walls.”
“Give me a break,” Jack said. “Now, how do you remember that?”
“They’re so beautiful, kinda like snowflakes. I did sketches of them in high-school biology.”
“Well, congratulations on your discovery. But if you’re interested in my vote, I’d say I’d lean toward artifact rather than a pelagic diatom unless the university gave him a glass of Antarctic sea water as part of his terminal treatment.”
“Very funny,” Laurie said sarcastically. “Artifact or not, I’m going to look for more.”
“Good luck! Say, I’m about to head out. Do you want to change your mind and come along?”
“Thank you but no thank you. I’m going to look at these slides for a while, then finish my matrix. Don’t wait up for me. I know you’re going to bed early.”
“Good grief, Laurie. You’re beating a dead horse.”
“Maybe so, but I’m not sure I’m going to sleep that much tonight, one way or the other.”
Jack bent down to give Laurie a hug, but she stood up and gave him a real one.
“See you later,” Jack said, affectionately touching the end of Laurie’s nose with his index finger.
“What’s that for?” Laurie asked, reflexively backing away.
Jack shrugged. “Beats me. I just wanted to touch you because, I guess…” Jack paused, acting suddenly self-conscious. “I guess I think you are terrific.”
“Get out of here, you oaf,” Laurie said, nudging him. Jack’s clumsy sentiment threatened to break down Laurie’s carefully constructed defenses. In truth, her own emotions were barely under the surface. On the one hand, she wanted to support him through his surgery, as she assumed he could use, as everyone could, but on the other hand, she didn’t want to lose him and was furious that he was putting her in such a conflicted state.
Gathering up his crutches and giving Laurie a final smile, Jack left. Laurie stood for a moment, looking at the stacks representing her twenty-five MRSA cases. Quickly leaning out into the hall, she called down to Jack, “Remember to use that antibiotic soap tonight!”
“It’s on my list,” Jack yelled back without turning around.
Laurie ducked back into her office. She stood for a moment, recognizing that one of the struggles with having a real relationship with another was to allow the person to be themselves and make some decisions independently, with hopefully enlightened self-interest. What it boiled down to from Laurie’s perspective, and the question of whether to have the surgery or not was a good example, was that a real lover had to recognize that there were two centers of the universe.
Pushing what she feared was sophomoric philosophizing out of her mind, Laurie sat back down at her desk. Her eyes flicked back and forth between her microscope and her matrix. Both beckoned. Although she thought the matrix the most promising in the long haul, the diatomlike apparent artifact was the most seductive.
Leaning forward, Laurie put her face to the eyepiece. What she wanted to do was scan the entire slide methodically to see if there were any more of the diatomlike objects.
ANGELO PULLED TO a stop at the same location he and Franco had been when they’d left their stakeout earlier. They were at the curb on First Avenue where it crossed 30th Street. The OCME was just off to the right. Traffic was rush-hour heavy.
Angelo put the van in park and used the emergency brake. “No Range Rover,” he said, making a stab at justifying his behavior at noontime.
“Don’t even go there,” Franco said, making himself comfortable. He’d gotten a coffee and a hero at Johnny’s, as had Angelo.
“Here come Richie and Freddie,” Angelo said, looking in the rearview mirror and watching the white van pull up within a foot behind them.
Franco didn’t answer. He was intent on surveying the area to make sure there were no apparent problems, such as parked police cars or loitering flatfoot patrolmen.
Angelo took a swig from his coffee, then unwrapped his sub. When he was finished, he glanced out the windshield and started.
“The boyfriend!” Angelo called out loud enough to make Franco slosh a dollop of coffee into his crotch. Angelo blindly reached for the small cast-iron bottle of ethylene and a pl
astic bag.
“Shit!” Franco yelled, straightening his back to lift his butt off the seat.
Angelo ditched the ethylene onto the floor and reached behind his seat for a roll of paper towels without taking his eyes off the OCME’s front door.
Franco used a few towels to blot up the coffee from his seat, and a few more to wipe his pants. Only then did he look out the windshield. “Where’s Montgomery?”
“I don’t know,” Angelo said dejectedly. “Jesus. This woman is such a pain in the ass. Where the hell is she?”
They watched as Jack stood with his arm raised and crutches tucked into his armpits. He had advanced out into the street as far as he dared with the traffic zooming past him.
“This is probably better,” Franco said. “Without the boyfriend interfering, the snatch will be far easier.”
“You’re probably right,” Angelo said. “I just hope she didn’t leave early.”
“Relax!” Franco countered. “Don’t be such a pessimist.”
“WOULD YOU LIKE some more tea?” the waiter asked.
Adam shook his head. He was sitting in the Pierre’s oval high-tea room jutting off the main corridor leading to the hotel’s Fifth Avenue entrance. When he’d been a preteen, it had been his favorite room in the hotel, with its whimsical murals and, more important, with its afternoon selection of cookies and crumpets. As he turned the page of the Arts section of the Times, he felt his BlackBerry vibrate. Taking the mobile device out, he saw that he had an e-mail. Using the appropriate buttons, he opened it. It was short and simple: 63 West 106th.
After signing the check to his room, Adam went up to gather his things. He was encouraged. The timing seemed to be impeccable. Ten minutes later, he was climbing back into the Range Rover. Sensing that the mission would soon be over, he changed the selection on the CD changer from Bach back to Beethoven.
LAURIE LEANED WAY back in her chair, and it squeaked in protest. With the tips of her fingers, she rubbed her eyes. She’d been so intent on staring into the microscope’s eyepiece that she’d seemingly failed to blink as often as she should have. Her eyes had a gritty feeling, but the massage was rapidly therapeutic, and after only five seconds of rubbing followed by a series of rapid blinks, she was fine.