Jack’s concentration was inadvertently aided by Vinnie’s hangover. Preferring to nurse his headache, Vinnie remained silent, sparing Jack his usual quips and running commentary on sports trivia. Jack reveled in the thought-provoking silence.

Jack handled the internal exam the same way he’d handled those of the previous infectious cases. He was extraordinarily careful to avoid unnecessary movement of the organs to keep bacterial aerosolization to a minimum.

As the autopsy progressed, Jack’s overall impression was that Lopez’s case mirrored that of Susanne Hard, not Katherine Mueller. Hence, his preliminary diagnosis remained tularemia, not plague. This only highlighted his confusion of how two women from central supply had managed to catch these illnesses while other, more exposed hospital workers had avoided them.

When he finished with the internal exam and had taken the samples he wanted, he put aside a special sample of lung to take up to Agnes Finn. Once he had similar samples from Joy Hester and Donald Lagenthorpe, he planned to have them all sent immediately to the reference lab to be tested for tularemia.

By the time Jack and Vinnie had commenced stitching up Maria Lopez, they began to hear voices in the washroom and out in the hall.

“Here come the normal, civilized people,” Vinnie commented.

Jack didn’t respond.

Presently the door to the washroom opened. Two figures entered in their moon suits and ambled over to Jack’s table. It was Laurie and Chet.

“Are you guys finished already?” Chet said.

“It’s not my doing,” Vinnie said. “The mad biker has to start before the sun is up.”

“What do you think?” Laurie asked. “Plague or tularemia?”

“My guess is tularemia,” Jack said.

“That will be four cases if these other two are tularemia as well,” Laurie said.

“I know,” Jack said. “It’s weird. Person-to-person spread is supposed to be rare. It doesn’t make a lot of sense, but that seems par for the course with these recent cases.”

“How is tularemia spread?” Chet asked. “I’ve never seen a case.”

“It’s spread by ticks or direct contact with an infected animal, like a rabbit,” Jack said.

“I’ve got you scheduled for Lagenthorpe next,” Laurie told Jack. “I’m going to do Hester myself.”

“I’m happy to do Hester as well,” Jack said.

“No need,” Laurie said. “There aren’t that many autopsies today. A lot of last night’s deaths didn’t need to be posted. I can’t let you have all the fun.”

Bodies began arriving. They were being pushed into the autopsy room by other mortuary techs and lifted onto their designated tables. Laurie and Chet moved off to do their own cases.

Jack and Vinnie returned to their suturing. When they were finished, Jack helped Vinnie move the body onto a gurney. Then Jack asked how quickly Vinnie could have Lagenthorpe ready to go.

“What a slave driver,” Vinnie complained. “Aren’t we going to have coffee like everybody else?”

“I’d rather get it over with,” Jack said. “Then you can have coffee for the rest of the day.”

“Bull,” Vinnie said. “I’ll be reassigned back in here helping someone else.”

Still complaining, Vinnie pushed Maria Lopez out of the autopsy room. Jack wandered over to Laurie’s table. Laurie was engrossed in the external exam but straightened up when she caught sight of Jack.

“This poor woman was thirty-six,” Laurie said wistfully. “What a waste.”

“What have you found? Any insect bites or cat scratches?”

“Nothing except a shaving nick on her lower leg,” Laurie said. “But it’s not inflamed, so I’m convinced it’s incidental. There is something interesting. She has definite eye infections.”

Laurie carefully lifted the woman’s eyelids. Both eyes were deeply inflamed, although the corneas were clear.

“I can also feel enlarged preauricular lymph nodes,” Laurie said. She pointed to visible lumps in front of the patient’s ears.

“Interesting,” Jack commented. “That’s consistent with tularemia, but I didn’t see it on the other cases. Give a yell if you come across anything else unusual.”

Jack stepped over to Chet’s table. He was happily engrossed in a multiple gunshot wound case. At the moment he was busy photographing the entrance and exit wounds. When he saw Jack he handed the camera to Sal, who was helping him, and pulled Jack aside.

“How was your time last night?” Chet asked.

“This is hardly the best time to discuss it,” Jack said. Conversation in the moon suits was difficult at best.

“Oh, come on,” Chet said. “I had a blast with Colleen. After the China Club we went back to her pad on East Sixty-sixth.”

“I’m happy for you,” Jack said.

“What did you guys end up doing?” Chet asked.

“You wouldn’t believe me if I told you,” Jack said.

“Try me,” Chet challenged. He leaned closer to Jack.

“We went over to her office, and then we came over here to ours,” Jack said.

“You’re right,” Chet said. “I don’t believe you.”

“The truth is often difficult to accept,” Jack said.

Jack used Vinnie’s arrival with Lagenthorpe’s corpse as an excuse to return to his table. Jack pitched in to help set up the case because it was preferable to further grilling by Chet. Besides, it made it possible to start the case that much sooner.

On the external exam the most obvious abnormality was the freshly sutured, two-inch-long appendectomy incision. But Jack quickly discovered more pathology. When he examined the corpse’s hands he found subtle evidence of early gangrene on the tips of the fingers. He found some even fainter evidence of the same process on the man’s earlobes.

“Reminds me of Nodelman,” Vinnie said. “It’s just less, and he doesn’t have any on his pecker. Do you think it’s plague again?”

“I don’t know,” Jack said. “Nodelman didn’t have an appendectomy.”

Jack spent twenty minutes diligently searching the rest of the body for any signs of insect or animal bites. Since Lagenthorpe was a moderately dark-skinned African-American, this was more difficult than it had been with the considerably lighter-skinned Lopez.

Although Jack’s diligence didn’t reward him with any bite marks, it did make it possible for him to appreciate another subtle abnormality. On Lagenthorpe’s palms and soles there was a faint rash. Jack pointed it out to Vinnie, but Vinnie said he couldn’t see it.

“Tell me what I’m looking for,” Vinnie said.

“Flat, pinkish blotches,” Jack said. “Here’s more on the underside of the wrist.”

Jack held up Lagenthorpe’s right arm.

“I’m sorry,” Vinnie said. “I don’t see it.”

“No matter,” Jack said. He took several photographs even though he doubted the rash would show up. The flash often washed out such subtle findings.

As Jack continued the external exam he found himself progressively mystified. The patient had come in with a presumed diagnosis of pneumonic plague, and externally he resembled a plague victim, as Vinnie had pointed out. Yet there were discrepancies. The record indicated he’d had a negative test for plague, which made Jack suspect tularemia.

But tularemia seemed implausible because the patient’s sputum test had shown no free bacteria. To complicate things further, the patient had had severe enough abdominal symptoms to suggest appendicitis, which he proved not to have. And on top of that he had a rash on his palms and soles.

At that point Jack had no idea what he was dealing with. As far as he was concerned, he doubted the case was either plague or tularemia!

Starting the internal exam, he immediately came across strong presumptive evidence that substantiated his belief. The lymphatics were minimally involved.

Slicing open the lung, Jack also detected a difference even on gross from what he’d expect to see in either plague or tularemia. To Jack’s eye Lagenthorpe’s lung resembled heart failure more than it did infection. There was plenty of fluid but little consolidation.