“I need a favor,” Jack said.
“A favor, he says,” Maureen repeated. “You hear that, girls? What should we ask in return?”
More laughter erupted. It was common knowledge that Jack and Chet were the only two unmarried male doctors, and the histology women liked to tease them.
Jack unloaded his armful of sample bottles, separating Lagenthorpe’s from Lopez’s.
“I’d like to do frozen sections on Lagenthorpe,” he said. “Just a few slides from each organ. Of course, I want a set of the regular slides as well.”
“What about stains?” Maureen asked.
“Just the usual,” Jack said.
“Are you looking for anything in particular?” Maureen inquired.
“Some sort of microbe,” Jack said. “But that’s all I can tell you.”
“We’ll give you a call,” Maureen said. “I’ll get right on it.”
Back in his office, Jack went through his messages. There was nothing of interest. Clearing a space in front of himself, he set down Lopez’s and Lagenthorpe’s folders intending to dictate the autopsy findings and then call the next of kin. He even intended to call the next of kin of the case Laurie was doing. But instead his eye caught sight of his copy of Harrison’s textbook of medicine.
Pulling out the book, Jack cracked it open to the section on infectious disease and began reading. There was a lot of material: almost five hundred pages. But he was able to scan quickly since much of it was information he’d committed to memory at some point in his professional career.
Jack had gotten to the chapters on specific bacterial infections when Maureen called. She said that the frozen section slides were ready. Jack immediately walked down to the lab to retrieve them. He carried them back to his office and moved his microscope to the center of the desk.
The slides were organized by organ. Jack looked at the sections of the lung first. What impressed him most was the amount of swelling of the lung tissue and the fact that he saw no bacteria.
Looking at the heart sections, he could immediately see why the heart had appeared swollen. There was a massive amount of inflammation, and the spaces between the heart muscle cells were filled with fluid.
Switching to a higher power of magnification, Jack immediately appreciated the primary pathology. The cells lining the blood vessels that coursed through the heart were severely damaged. As a result, many of these blood vessels had become occluded with blood clots, causing multiple tiny heart attacks!
With a shot of adrenaline coursing through his own circulation from the excitement of discovery, Jack quickly switched back to the section of lung. Using the same high power he saw identical pathology in the walls of the tiny blood vessels, a finding he hadn’t noticed on his first examination.
Jack exchanged the lung section with one from the spleen. Adjusting the focus, he saw the same pathology. Obviously it was a significant finding, one that immediately suggested a possible diagnosis.
Jack pushed back from his desk and made a quick trip back to the micro lab and sought out Agnes. He found her at one of the lab’s many incubators.
“Hold up on the tissue cultures on Lagenthorpe,” he said breathlessly. “I got some new information you’re going to love.”
Agnes regarded him curiously through her thick glasses.
“It’s an endothelial disease,” Jack said excitedly. “The patient had an acute infectious disease without bacteria seen or cultured. That should have given it away. He also had the faintest beginnings of a rash that included his palms and soles. Plus he’d been suspected of having appendicitis. Guess why?”
“Muscle tenderness, Agnes said.”
“Exactly,” Jack said. “So what does that make you think of?”
Rickettsia, Agnes said.
“Bingo,” Jack said, and he punched the air for emphasis. “Good old Rocky Mountain spotted fever. Now, can you confirm it?”
“It’s as difficult as tularemia,” Agnes said. “We’ll have to send it out again. There is a direct immunofluorescent technique, but we don’t have the reagent. But I know the city reference lab has it, because there’d been an outbreak of Rocky Mountain spotted fever in the Bronx in eighty-seven.”
“Get it over there right away,” Jack said. “Tell them we want a reading as soon as they can get it to us.”