“Yeah, come on over,” Jack said. “No use going through this more than once.”
Laurie sent Sal to the sink to wash out the intestines on her case, then stepped over to table one.
“The first thing I want you to look at is the lymphatics I dissected in the throat,” Jack said. He had retracted the skin of the neck from the chin to the collarbone.
“No wonder autopsies take so long around here,” a voice boomed in the confined space.
All eyes turned toward Dr. Calvin Washington, the deputy chief. He was an intimidating six-foot-seven, two-hundred-and-fifty-pound African-American man who’d passed up a chance to play NFL football to go to medical school.
“What the hell is going on around here?” he demanded half in jest. “What do you people think this is, a holiday?”
“Just pooling resources,” Laurie said. “We’ve got an unknown infectious case that appears to be quite an aggressive microbe.”
“So I heard,” Calvin said. “I already got a call from the administrator over at the Manhattan General. He’s justly concerned. What’s the verdict?”
“A bit too soon to tell,” Jack said. “But we’ve got a lot of pathology here.”
Jack quickly summarized for Calvin what was known of the history and pointed out the positive findings on the external exam. Then he started back on the internal, indicating the spread of the disease along the lymphatics of the neck.
“Some of these nodes are necrotic,” Calvin said.
“Exactly,” Jack said. “In fact most of them are necrotic. The disease was spreading rapidly through the lymphatics, presumably from the throat and bronchial tree.”
“Airborne, then,” Calvin said.
“It would be my first guess,” Jack admitted. “Now look at the internal organs.”
Jack presented the lungs and opened the areas where he’d made slices.
“As you can see, this is pretty extensive lobar pneumonia,” Jack said. “There’s a lot of consolidation. But there is also some necrosis, and I believe early cavitation. If the patient had lived longer, I think we would be seeing some abscess formation.”
Calvin whistled. “Wow,” he said. “All this was happening in the face of massive IV antibiotics.”
“It’s worrisome,” Jack agreed. He carefully slid the lungs back into the pan. He didn’t want them sloshing around, potentially throwing infective particles into the air. Next he picked up the liver and gently separated its cut surface.
“Same process,” he announced, pointing with his fingers to areas of early abscess formation. “Just not as extensive as with the lungs.” Jack put the liver down and picked up the spleen. There were similar lesions throughout the organ. He made sure everyone saw them.
“So much for the gross,” Jack said as he carefully replaced the spleen in the pan. “We’ll have to see what the microscopic shows, but I actually think we’ll be relying on the lab to give us the definitive answer.”
“What’s your guess at this point?” Calvin asked.
Jack let out a short laugh. “A guess it would have to be,” he said. “I haven’t seen anything pathognomonic yet. But its fulminant character should tell us something.”
“What’s your differential diagnosis?” Calvin asked. “Come on, Wonderboy, let’s hear it.”
“Ummmm,” Jack said. “You’re kinda putting me on the spot. But okay, I’ll tell you what’s been going through my head. First, I don’t think it could be pseudomonas as suspected at the hospital. It’s too aggressive. It could have been something atypical like strep group A or even staph with toxic shock, but I kinda doubt it, especially with the gram stain suggesting it was a bacillus. So I’d have to say it is something like tularemia or plague.”
“Whoa!” Calvin exclaimed. “You’re coming up with some pretty arcane illnesses for what was apparently a hospital-based infection. Haven’t you heard the phrase about when you hear hoofbeats you should think of horses, not zebras?”
“I’m just telling you what’s going through my mind. It’s just a differential diagnosis. I’m trying to keep an open mind.”
“All right,” Calvin said soothingly. “Is that it?”
“No, that’s not it,” Jack said. “I’d also consider that the gram stain could have been wrong and that would let in not only strep and staph but meningococcemia as well. And I might as well throw in Rocky Mountain spotted fever and hantavirus. Hell, I could even throw in the viral hemorrhagic fevers like Ebola.”
“Now you’re getting out in the stratosphere,” Calvin said. “Let’s come back to reality. If I made you guess which one it is right now with what you know, what would you say?”
Jack clucked his tongue. He had the irritated feeling he was being put back in medical school, and that Calvin, like many of his medical-school professors, was trying to make him look bad.
“Plague,” Jack said to a stunned audience.
“Plague?” Calvin questioned with surprise bordering on disdain. “In March? In New York City? In a hospitalized patient? You got to be out of your mind.”
“Hey, you asked me for one diagnosis,” Jack said. “So I gave it to you. I wasn’t responding by probabilities, just pathology.”
“You weren’t considering the other epidemiological aspects?” Calvin asked with obvious condescension. He laughed. Then, talking more to the others than Jack, he said: “What the hell did they teach you out there in the Chicago boonies?”
“There are too many unknowns in this case for me to put a lot of weight on unsubstantiated information,” Jack said. “I didn’t visit the site. I don’t know anything about the deceased’s pets, travel, or contact with visitors. There are a lot of people coming and going in this city, even in and out of a hospital. And there are certainly more than enough rats around here to support the diagnosis.”
For a moment a heavy silence hung over the autopsy room. Neither Laurie nor Chet knew what to say. Jack’s tone made them both uncomfortable, especially knowing Calvin’s stormy temperament.
“A clever comment,” Calvin said finally. “You’re quite good at double entendre. I have to give you credit there. Perhaps that’s part of pathology training in the Midwest.”
Both Laurie and Chet laughed nervously.
“All right, smartass,” Calvin continued. “How much are you willing to put on your diagnosis of plague?”
“I didn’t know it was customary to gamble around here,” Jack said.
“No, it’s not common to gamble, but when you come up with a diagnosis of plague, I think it’s worthwhile to make a point of it. How about ten dollars?”
“I can afford ten dollars,” Jack said.
“Fine,” Calvin said. “With that settled, where’s Paul Plodgett and that gunshot wound from the World Trade Center?”
“He’s down on table six,” Laurie said.
Calvin lumbered away and for a moment the others watched him. Laurie broke the silence. “Why do you try to provoke him?” she asked Jack. “I don’t understand. You’re making it more difficult for yourself.”
“I can’t help it,” Jack said. “He provoked me!”
“Yeah, but he’s the deputy chief and it’s his prerogative,” Chet said. “Besides, you were pushing things with a diagnosis of plague. It certainly wouldn’t be on the top of my list.”
“Are you sure?” Jack asked. “Look at the black fingers and toes on this patient. Remember, it was called the black death back in the fourteenth century.”
“A lot of diseases can cause such thrombotic phenomena,” Chet said.
“True,” Jack said. “That’s why I almost said tularemia.”
“And why didn’t you?” Laurie asked. In her mind tularemia was equally improbable.
“I thought plague sounded better,” Jack said. “It’s more dramatic.”
“I never know when you are serious,” Laurie said.
“Hey, I feel the same way,” Jack said.
Laurie shook her head in frustration. At times it was hard t
o have a serious discussion with Jack. “Anyway,” she said, “are you finished with Nodelman? If you are, I’ve got another case for you.”
“I haven’t done the brain yet,” Jack said.
“Then get to it,” Laurie said. She walked back to table three to finish her own case.
2
WEDNESDAY, 9:45 A.M., MARCH 20, 1996
NEW YORK CITY
Terese Hagen stopped abruptly and looked at the closed door to the “cabin,” the name given to the main conference room. It was called the cabin because the interior was a reproduction of Taylor Heath’s Squam Lake house up in the wilds of New Hampshire. Taylor Heath was the CEO of the hot, up-and-coming advertising firm Willow and Heath, which was threatening to break into the rarefied ranks of the advertising big leagues.
After making sure she was not observed, Terese leaned toward the door and put her ear against it. She heard voices.
With her pulse quickening, Terese hurried down the hall to her own office. It never took long for her anxiety to soar. She’d only been in the office five minutes and already her heart was pounding. She didn’t like the idea of a meeting she didn’t know about being held in the cabin, the CEO’s habitual domain. In her position as the creative director of the firm, she felt she had to know everything that was going on.
The problem was that a lot was going on. Taylor Heath had shocked everybody with his previous month’s announcement that he planned to retire as CEO and was designating Brian Wilson, the current president, to succeed him. That left a big question mark about who would succeed Wilson. Terese was in the running. That was for sure. But so was Robert Barker, the firm’s executive director of accounts. And on top of that, there was always the worry that Taylor would pick someone from outside.
Terese pulled off her coat and stuffed it into the closet. Her secretary, Marsha Devons, was on the phone, so Terese dashed to her desk and scanned the surface for any telltale message; but there was nothing except a pile of unrelated phone messages.
“There’s a meeting in the cabin,” Marsha called from the other room after hanging up the phone. She appeared in the doorway. She was a petite woman with raven-black hair. Terese appreciated her because she was intelligent, efficient, and intuitive—all the qualities lacking in the year’s previous four secretaries. Terese was tough on her assistants, since she expected commitment and performance equivalent to her own.
“Why didn’t you call me at home?” Terese demanded.
“I did, but you’d already left,” Marsha said.
“Who’s at the meeting?” Terese barked.
“It was Mr. Heath’s secretary who called,” Marsha said. “She didn’t say who would be attending. Just that your presence was requested.”
“Was there any indication what the meeting is about?” Terese asked.
“No,” Marsha said simply.
“When did it start?”
“The call came through at nine,” Marsha said.
Terese snatched up her phone and punched in Colleen Anderson’s number. Colleen was Terese’s most trusted art director. She was currently heading up a team for the National Health Care account.
“You know anything about this meeting in the cabin?” Terese asked as soon as Colleen was on the line.
Colleen didn’t, only that it was going on.
“Damn!” Terese said as she hung up.
“Is there a problem?” Marsha asked solicitously.
“If Robert Barker has been in there all this time with Taylor, there’s a problem,” Terese said. “That prick never misses a beat to put me down.”
Terese snatched the phone again and redialed Colleen. “What’s the status on National Health? Do we have any comps or anything I can show right now?”
“I’m afraid not,” Colleen said. “We’ve been brainstorming, but we don’t have anything zippy like I know you want. I’m looking for a home run.”
“Well, goose your team,” Terese said. “I have a sneaking suspicion I’m most vulnerable with National Health.”
“No one’s been sleeping down here,” Colleen said. “I can assure you of that.”
Terese hung up without saying good-bye. Snatching up her purse, she ran down the hall to the ladies’ room and positioned herself in front of the mirror. She pushed her Medusa’s head of highlighted tight curls into a semblance of order, then reapplied some lipstick and a bit of blush.
Stepping back, she surveyed herself. Luckily she’d chosen to wear one of her favorite suits. It was dark blue wool gabardine and seriously severe, hugging her narrow frame like a second skin.
Satisfied with her appearance, Terese hustled to the cabin door. After a deep breath she grasped the knob, turned it, and entered.
“Ah, Miss Hagen,” Brian Wilson said, glancing at his watch. He was sitting at the head of a rough-hewn plank table that dominated the room. “I see you’re now indulging in banker’s hours.”
Brian was a short man with thinning hair. He vainly tried to camouflage his bald spot by combing his side hair over it. As per usual he was attired in a white shirt and tie, loosened at the neck, giving him the appearance of a harried newspaper publisher. To complete the journalistic look, his sleeves were rolled up above his elbows and a yellow Dixon pencil was tucked behind his right ear.
Despite the catty comment, Terese liked and respected Brian. He was an able administrator. He had a patented derogatory style, but he was equally demanding of himself.
“I was in the office last night until one A.M.,” Terese said. “I certainly would have been here for this meeting if someone had been kind enough to have let me know about it.”
“It was an impromptu meeting,” Taylor called out. He was standing near the window, in keeping with his laissez-faire management style. He preferred to hover above the group like an Olympian god, watching his demigods and mere mortals hammer out decisions.
Taylor and Brian were opposite in most ways. Where Brian was short, Taylor was tall. Where Brian was balding, Taylor had a dense halo of silver-gray hair. Where Brian appeared as the harried newspaper columnist always with his back against the wall, Taylor was the picture of sophisticated tranquillity and sartorial splendor. Yet no one doubted Taylor’s encyclopedic grasp of the business and his uncanny ability to maintain strategic goals in the face of daily tactical disaster and controversy.
Terese took a seat at the table directly across from her nemesis, Robert Barker. He was a tall, thin-faced man with narrow lips who seemed to take a cue from Taylor in regard to his dress. He was always attired nattily in dark silk suits and colorful silk ties. The ties were his trademark. Terese could not remember ever having seen the same tie twice.
Next to Robert was Helen Robinson, whose presence made Terese’s racing heart beat even a little faster. Helen worked under Robert as the account executive assigned specifically to National Health. She was a strikingly attractive twenty-five-year-old woman with long, chestnut-colored hair that cascaded to her shoulders, tanned skin even in March, and full, sensuous features. Between her intelligence and looks she was a formidable adversary.
Also sitting at the table was Phil Atkins, the chief financial officer, and Carlene Desalvo, the corporate director of account planning. Phil was an impeccably precise man with his perennial three-piece suit and wire-rimmed glasses. Carlene was a bright, full-figured woman who always dressed in white. Terese was mildly surprised to see both of them at the meeting.
“We’ve got a big problem with the National Health account,” Brian said. “That’s why this meeting was called.”
Terese’s mouth went dry. She glanced at Robert and detected a slight but infuriating smile. Terese wished to God she’d been there since the beginning of the meeting so she could have known everything that had been said.
Terese was aware of trouble with National Health. The company had called for an internal review a month ago, which meant that Willow and Heath had to come up with a new advertising campaign if they expected to keep the account. And everybody knew
they had to keep the account. It had mushroomed to somewhere around forty million annually and was still growing. Health-care advertising was in the ascendancy, and would hopefully fill the hole vacated by cigarettes.
Brian turned to Robert. “Perhaps you could fill Terese in on the latest developments,” he said.
“I defer to my able assistant, Helen,” Robert said, giving Terese one of his condescending smiles.
Helen moved forward in her seat. “As you know, National Health has had misgivings about its advertising campaign. Unfortunately their displeasure has increased. Just yesterday their figures came in for the last open subscriber period. The results weren’t good. Their loss of market share to AmeriCare in the New York metropolitan area has increased. After building the new hospital, this is a terrible blow.”
“And they blame our ad campaign for that?” Terese blurted out. “That’s absurd. They only made a twenty-five-point buy with our sixty-second commercial. That was not adequate. No way.”
“That may be your opinion,” Helen said evenly. “But I know it is not National Health’s.”
“I know you are fond of your ‘Health care for the modern era’ campaign, and it is a good tag line,” Robert said, “but the fact of the matter is that National Health has been losing market share from the campaign’s inception. These latest figures are just consistent with the previous trend.”
“The sixty-second spot has been nominated for a Clio,” Terese countered. “It’s a damn good commercial. It’s wonderfully creative. I’m proud of my team for having put it together.”
“And indeed you should be,” Brian interjected. “But it is Robert’s feeling that the client is not interested in our winning a Clio. And remember, as the Benton and Bowles agency held, ‘If it doesn’t sell, it isn’t creative.’”
“That’s equally absurd,” Terese snapped. “The campaign is solid. It’s just that the account people couldn’t get the client to buy adequate exposure. There should have been ‘flights’ on multiple local stations at a bare minimum.”
“With all due respect, they would have bought more time if they’d liked the commercial,” Robert said. “I don’t think they were ever sold on this idea of ‘them versus us,’ ancient medicine versus modern medicine. I mean it was humorous, but I don’t know if they were convinced the viewer truly associated the ancient methods with National Health Care’s competitors, particularly AmeriCare. My personal opinion is that it went over people’s heads.”