Jack slowed his walk while his mind churned. Susanne Hard had come down with symptoms after only being in the hospital for a day. Since the incubation period for plague was generally thought to be two days at a minimum, she would have been exposed prior to coming into the hospital. Jack went back to Janice’s office.

“One more question,” Jack called out to her. “Do you happen to know whether the Hard woman visited the hospital in the days prior to her admission?”

“Her husband said no,” Janice said. “I asked that question specifically. Apparently she hated the hospital and only came in at the very last minute.”

Jack nodded. “Thanks,” he said, even more preoccupied. He turned and started back toward the ID room. That information made the situation more baffling, requiring him to postulate that the outbreak had occurred almost simultaneously in two, maybe three locations. That wasn’t probable. The other possibility was that the incubation period was extremely short, less than twenty-four hours. That would mean Hard’s illness was a nosocomial infection, as he suspected Nodelman’s was as well as Mueller’s. The problem with that idea was that it would suggest a huge, overwhelming infecting dose, which also seemed unlikely. After all, how many sick rats could be in a ventilation duct all coughing at the same time?

In the ID room Jack wrestled the sports page of the Daily News away from a reluctant Vinnie and dragged him down to the pit to begin the day.

“How come you always start so early?” Vinnie complained. “You’re the only one. Don’t you have a life?”

Jack swatted him in the chest with Katherine Mueller’s folder. “Remember the saying ‘The early bird gets the worm’?”

“Oh, barf,” Vinnie said. He took the folder from Jack and opened it. “Is this the one we’re doing first?” he asked.

“Might as well move from the known to the unknown,” Jack said. “This one had a positive fluorescein antibody test to plague, so zip up tight in your moon suit.”

Fifteen minutes later Jack began the autopsy. He spent a good deal of time on the external exam, looking for any signs of insect bites. It wasn’t an easy job, since Katherine Mueller was an overweight forty-four-year-old with hundreds of moles, freckles, and other minor skin blemishes. Jack found nothing he was sure was a bite, although a few lesions looked mildly suspicious. To be on the safe side he photographed them.

“No gangrene on this body,” Vinnie commented.

“Nor purpura,” Jack said.

By the time Jack started on the internal exam, a number of the other staff had arrived in the autopsy room and half of the tables were in use. There were a few comments about Jack becoming the local plague expert, but Jack ignored them. He was too engrossed.

Mueller’s lungs appeared quite similar to Nodelman’s, with extensive lobar pneumonia, consolidation, and early stages of tissue death. The woman’s cervical lymphatics were also generally involved, as were the lymph nodes along the bronchial tree.

“This is just as bad or worse than Nodelman,” Jack said. “It’s frightening.”

“You don’t have to tell me,” Vinnie said. “These infectious cases are the kind that make me wish I’d gone into gardening.”

Jack was nearing the end of the internal exam when Calvin came through the door. There was no mistaking his huge silhouette. He was accompanied by another figure who was half his size. Calvin came directly to Jack’s table.

“Anything out of the ordinary?” Calvin asked, while peering into the pan of internal organs.

“Internally this case is a repeat of yesterday’s,” Jack said.

“Good,” Calvin said, straightening up. He then introduced Jack to his guest. It was Clint Abelard, the city epidemiologist.

Jack could make out the man’s prominent jaw, but because of the reflection off the plastic face mask, he couldn’t see the fellow’s squirrelly eyes. He wondered if he was still as cantankerous as he’d been the day before.

“According to Dr. Bingham you two have already met,” Calvin said.

“Indeed,” Jack said. The epidemiologist did not respond.

“Dr. Abelard is trying to discern the origin of this plague outbreak,” Calvin explained.

“Commendable,” Jack said.

“He’s come to us to see if we can add any significant information,” Calvin said. “Perhaps you could run through your positive findings.”

“My pleasure,” Jack said. He started with the external exam, indicating skin abnormalities he thought could have been insect bites. Then he showed all the gross internal pathology, concentrating on the lungs, lymphatics, liver, and spleen. Throughout the entire discourse, Clint Abelard stayed silent.

“There you have it,” Jack said as he finished. He put the liver back into the pan. “As you can see it’s a severe case, as was Nodelman’s, and it’s no wonder both patients died so quickly.”

“What about Hard?” Clint asked.

“She’s next,” Jack said.

“Mind if I watch?” Clint asked.

Jack shrugged. “That’s up to Dr. Washington,” he said.

“No problem,” Calvin said.

“If I may ask,” Jack said, “have you come up with a theory where this plague came from?”

“Not really,” Clint said gruffly. “Not yet.”

“Any ideas?” Jack asked, trying to keep sarcasm out of his voice. It seemed Clint was in no better humor than he had been the day before.

“We’re looking for plague in the area’s rodent population,” Clint said condescendingly.

“Splendid idea,” Jack said. “And just how are you doing that?”

Clint paused as if he didn’t want to divulge any state secrets.

“The CDC is helping,” he said finally. “They sent someone up here from their plague division. He’s in charge of the trapping and analysis.”

“Any luck so far?” Jack asked.

“Some of the rats caught last night were ill,” Clint said. “But none with plague.”

“What about the hospital?” Jack asked. He persisted despite Clint’s apparent reluctance to talk. “This woman we’ve just autopsied worked in central supply. Seems likely her illness was nosocomial like Nodelman’s. Do you think she got it from some primary source in and around the hospital, or do you think she got it from Nodelman?”

“We don’t know,” Clint admitted.

“If she got it from Nodelman,” Jack asked, “any ideas of a possible route of transmission?”

“We’ve checked the hospital’s ventilation and air-conditioning system carefully,” Clint said. “All the HEPA filters were in place and had been changed appropriately.”

“What about the lab situation?” Jack asked.

“What do you mean?” Clint said.

“Did you know that the chief tech in micro actually suggested plague to the director of the lab purely from his clinical impression, but the director talked him out of following up on it?”

“I didn’t know that,” Clint mumbled.

“If the chief tech had followed up on it he would have made the diagnosis and appropriate therapy could have been started,” Jack said. “Who knows; it could have saved a life. The problem is that the lab has been downsizing because of pressure from AmeriCare to save a few bucks, and they don’t have a microbiology supervisor position. It got eliminated.”

“I don’t know anything about all that,” Clint said. “Besides, the case of plague still would have occurred.”

“You’re right,” Jack said. “One way or the other you still have to come up with the origin. Unfortunately, you don’t know any more than you did yesterday.” Jack smiled inside his mask. He was getting a bit of perverse pleasure out of putting the epidemiologist on the spot.

“I wouldn’t go that far,” Clint muttered.

“Any sign of illness in the hospital staff?” Jack asked.

“There are several nurses who are febrile and who are quarantined,” Clint said. “As of yet there is no confirmation of them having plague, but it is suspected. They were directly exposed to Nodelman.”

“When will you be doing Hard?” Calvin asked.