“Are you kidding?” Jack took the paper from Janice and stared at it with disbelief.
“What’s tularemia?” Terese asked.
“It’s another infectious disease,” Jack said. “It’s similar in some ways to plague.”
“Where was this patient?” Terese asked, although she suspected the answer.
“Also at the General,” Jack said. He shook his head. “I truly can’t believe it. This is extraordinary!”
“I’ve got to get back to work,” Janice said. “If you need me to do anything just let me know.”
“I’m sorry,” Jack said. “I didn’t mean to have you stand here. Thanks for getting this to me.”
“No problem,” Janice said. She waved and headed back to the elevators.”
Is tularemia as bad as plague?” Terese asked.
“It’s hard to make comparisons,” Jack said. “But it’s bad, particularly the pneumonic form, which is highly contagious. If Susanne Hard were still here she could tell us exactly how bad it is.”
“Why are you so surprised?” Terese asked. “Is it as rare as plague?”
“Probably not,” Jack said. “It’s seen in a wider area in the U.S. than plague, particularly in southern states like Arkansas. But like plague it’s not seen much in the winter, at least not up here in the north. Here it’s a late-spring and summer problem, if it exists at all. It needs a vector, just like plague. Instead of the rat flea it’s usually spread by ticks and deer-flies.”
“Any tick or deerfly?” Terese asked. Her parents had a cabin up in the Catskills where she liked to go in the summer. It was isolated and surrounded by forest and fields. There were plenty of ticks and deerflies.
“The reservoir for the bacteria is small mammals like rodents and especially rabbits,” Jack said. He started to elaborate but quickly stopped.
He’d suddenly recalled that afternoon’s conversation with Susanne’s husband, Maurice. Jack remembered being told that Susanne liked to go to Connecticut, walk in the woods, and feed wild rabbits!
“Maybe it was the rabbits,” Jack mumbled.
“What are you talking about?” Terese asked.
Jack apologized for thinking out loud. Shaking himself out of a momentary daze, he motioned for Terese to follow him into his office and to take Chet’s chair. He described his phone conversation with Susanne’s husband and explained about the importance of wild rabbits in relation to tularemia.
“Sounds incriminating to me,” Terese said.
“The only problem is that her exposure to the Connecticut rabbits was almost two weeks ago,” Jack mused. He drummed his fingers on his telephone receiver. “That’s a long incubation period, especially for the pneumonic form. Of course, if she didn’t catch it in Connecticut, then she had to catch it here in the city, possibly at the General. Of course, nosocomial tularemia doesn’t make any more sense than nosocomial plague.”
“One way or the other the public has to know about this,” Terese said. She nodded toward his hand on the phone. “I hope you are calling the media as well as the hospital.”
“Neither,” Jack said. He glanced at his watch. It was still before midnight. He picked up the phone and dialed. “I’m calling my immediate boss. The politics of all this are his bailiwick.”
Calvin picked up on the first ring but mumbled as if he’d been asleep. Jack cheerfully identified himself.
“This better be important,” Calvin growled.
“It is to me,” Jack said. “I wanted you to be first to know you owe me another ten dollars.”
“Get outta here,” Calvin boomed. The grogginess had disappeared from his voice. “I hope to God this isn’t some kind of sick joke.”
“No joke,” Jack assured him. “The lab just reported it in tonight. The Manhattan General had a case of tularemia in addition to its two cases of plague. I’m as surprised as anyone.”
“The lab called you directly?” Calvin said.
“Nope,” Jack said. “One of the PAs just gave it to me.”
“Are you in the office?” Calvin asked.
“Sure am,” Jack said. “Working my fingers to the bone.”
“Tularemia?” Calvin questioned. “I’d better read up on it. I don’t think I’ve ever seen a case.”
“I read up on it just this afternoon,” Jack admitted.
“Make sure there are no leaks from our office,” Calvin said. “I won’t call Bingham tonight, because there’s nothing to be done at the moment. I’ll let him know first thing in the morning, and he can call the commissioner, and she can call the Board of Health.”