“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 Lodgett 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 to have a serious discussion with Jack. “Anyway,” she said, “are you finished with Nodelman? If you are, I’ve got another case for you.”