“Got something for me today?” Agnes asked, eyeing Jack’s armful of samples.

“I do, indeed,” Jack said. He found the appropriate sample from Lopez and put it on the corner of Agnes’s desk. “This is another probable tularemia. Another sample will come up from a case Laurie Montgomery is doing as we speak. I want them both tested for tularemia.”

“The reference lab is very eager to follow up on the Hard case, so that won’t be difficult. I should have results back today. What else?”

“Well, this one is a mystery,” Jack said. He put several samples from Lagenthorpe on Agnes’s desk. “I don’t have any idea what this patient had. All I know is that it’s not plague, and it’s not tularemia.”

Jack went on to describe the Lagenthorpe case, giving Agnes all the positive findings. She was especially interested that no bacteria had been reported on the gram stain of the sputum.

“Have you thought of virus?” Agnes asked.

“As much as my limited infectious disease knowledge would allow,” Jack admitted. “Hantavirus crossed my mind, but there was not a lot of hemorrhage.”

“I’ll start some viral screening with tissue cultures,” Agnes said.

“I plan to do some reading and maybe I’ll have another idea,” Jack said.

“I’ll be here,” Agnes assured him.

Leaving microbiology, Jack went up to the fifth-floor histology lab.

“Wake up, girls, we have a visitor,” one of the histology techs shouted. Laughter echoed around the room.

Jack smiled. He always enjoyed visiting histology. The entire group of women who worked there always seemed to be in the best of moods. Jack was particularly fond of Maureen O’Conner, a busty redhead with a devilish twinkle in her eye. He was pleased when he saw her round the corner of the lab bench, wiping her hands on a towel. The front of her lab coat was stained a rainbow of colors.

“Well now, Dr. Stapleton,” she said in her pleasant brogue. “What can we do for the likes of you?”

“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.”

“Will do,” Agnes said.

“You’re a doll,” Jack said.

He started for the door. Before he got there Agnes called out to him: “I appreciate you letting me know about this as soon as you did,” she said. “Rickettsias are extremely dangerous for us lab workers. In an aerosol form it is highly contagious. It’s as bad or worse than tularemia.”

“Needless to say, be careful,” Jack told her.

Helen Robinson brushed her hair with quick strokes. She was excited. Having just hung up the phone with her main contact at National Health’s home office, she wanted to get in to see Robert Barker as soon as possible. She knew he was going to love what she had to tell him.

Stepping back from the mirror, Helen surveyed herself from both the right and the left. Satisfied, she closed the closet door and headed out of her office.

Her usual method of contacting Robert was merely to drop in on him. But she thought the information she now had justified a more formal approach; she’d asked one of the secretaries to call ahead. The secretary had reported back that Robert was available at that very moment, not that Helen was surprised.

Helen had been cultivating Robert for the last year. She started when it became apparent to her that Robert could ascend to the presidency. Sensing the man had a salacious streak, she’d deliberately fanned the fires of his imagination. It was easy, although she knew she treaded a fine line. She wanted to encourage him, but not to the point where she would have to openly deny him. In reality, she found him physically unpleasant at best.