“Was she related to the first case?” Jack asked.
“She was a niece,” Janice said.
“Had she been in to visit her uncle?” Jack asked.
“Around noon yesterday,” Janice said. “You don’t think that could have contributed to her death, do you? I mean, that was only about twelve hours before her death.”
“Under certain circumstances meningococcus has a frightful capacity to kill, and kill incredibly swiftly,” Jack said. “In fact, it can kill in just a few hours.”
“Well, the hospital is in a panic.”
“I can imagine, Jack said. “What was the name of the first case?”
“Carlo Pacini,” Janice said. “But that’s about all I know. He came in on the shift before mine. Steve Mariott handled it.”
“Could I ask a favor?” Jack asked.
“That depends,” Janice said. “I’m awfully tired.”
“Just leave word for Bart that I want you PAs to get all the charts of the index case in each of these outbreaks. Let’s see, that’s Nodelman with the plague, Hard with tularemia, Lagenthorpe with Rocky Mountain spotted fever, and Pacini with meningococcus. Do you think that will be a problem?”
“Not at all,” Janice said. “They are all active ME cases.”
Jack stood up and gave Janice a pat on the back. “Maybe you should go over to the clinic on your way home,” he said. “Some chemoprophylaxis might not be a bad idea.”
Janice’s eyes widened. “You think that is necessary?”
“Better safe than sorry,” Jack said. “Anyway, discuss it with one of the infectious disease gurus. They know better than I. There’s even a tetravalent vaccine, but that takes a few days to kick in.”
Jack dashed back to the ID room and asked George for Carlo Pacini’s folder.
“It’s not here,” George said. “Laurie came in early, and when she heard about what was going on, she requested the case. She’s got the folder.”
“Where is she?” Jack asked.
“Up in her office,” Vinnie responded from behind his paper.
Jack hustled up to Laurie’s office. Contrary to the way Jack worked, she liked to go over each folder in her office before doing the autopsy.
“Pretty frightening, I’d say,” Laurie said as soon as she saw Jack.
“It’s terrifying,” Jack said. He grabbed Laurie’s officemate’s chair, pulled it over to Laurie’s desk, and sat down. “This is just what I’ve been worrying about. This could be a real epidemic. What have you learned about this index case?”
“Not much,” Laurie admitted. “He’d been admitted Saturday evening with a fractured hip. Apparently he’d had a brittle bone problem; he’d had a whole string of fractures over the last few years.”
“Fits the pattern,” Jack said.
“What pattern?” Laurie asked.
“All the index cases from these recent outbreaks have had some sort of chronic illness,” Jack said.
“A lot of people who are hospitalized have chronic illnesses,” Laurie said. “In fact, most of them. What does that have to do with anything?”
“I’ll tell you what’s on his paranoid, sick mind,” Chet said. Chet had appeared at Laurie’s door. He stepped into the room and leaned against the second desk. “He’s got this thing about AmeriCare and wants to see conspiracy behind all this trouble.”
“Is that true?” Laurie asked.
“I think it’s less that I want to see conspiracy than it’s staring me in the face,” Jack said.
“What do you mean by ‘conspiracy’?” Laurie asked.
“He has this notion that these unusual illnesses are being spread deliberately,” Chet said. Chet summarized Jack’s theory that the culprit was either someone at AmeriCare trying to protect its bottom line or some crazy person with terrorist inclinations.
Laurie looked questioningly at Jack. Jack shrugged.
“There are a lot of unanswered questions,” Jack offered.
“As there are in just about any outbreak,” Laurie said. “But really! This is all a bit far-fetched. I hope you didn’t mention this theory to the powers that be over at the General.”
“Yeah, I did,” Jack said. “In fact I sort of asked the director of the lab if he was involved. He’s rather disgruntled with his budget. He immediately informed the infection-control officer. I imagine they’ve let the administration know.”
Laurie let out a short, cynical laugh. “Oh, brother,” she said. “No wonder you’ve become persona non grata around there.”