“I haven’t told anybody,” Jack said. “Not even a therapist.”

Feeling a sense of relief from having both bared their innermost secrets, Jack and Terese went on to talk about happier things. Terese, who’d grown up in the city, was shocked to hear how little of the area Jack had visited since he’d been there. She talked about taking him to the Cloisters when spring had truly arrived.

“You’ll love it,” she promised.

“I’ll look forward to it,” Jack said.

Jack was irritated at himself. He’d had time to buy a new bike on Saturday, but he’d failed to do so. Consequently, he had to use the subway again to commute to work, although he’d considered jogging. The problem with jogging was that he’d have to have a change of clothes in his office. To give him the option in the future he brought some to work in a small shoulder bag.

Coming in from First Avenue, Jack again entered the medical examiner’s facility through the front entrance. As he passed through the glass door, he was impressed with the number of families waiting in the outer reception area. It was highly unusual for so many people to be there that early. Something must be up, he surmised.

Jack had himself buzzed in. He walked into the scheduling room and saw George Fontworth sitting at the desk Laurie had occupied each morning the previous week.

Jack was sorry Laurie’s week as supervisor was over. George had rotated to the position. He was a short, moderately overweight doctor of whom Jack had a low opinion. He was perfunctory and often missed important findings.

Ignoring George, Jack headed over to Vinnie and pushed down the edge of his newspaper.

“Why are there so many people out in the ID area?” Jack asked.

“Because there’s a minor disaster over at the General,” George said, answering for Vinnie. Vinnie treated Jack to a jaunty but disdainful expression and went back to his paper.

“What kind of disaster?” Jack asked.

George patted the top of a stack of folders. “A whole bunch of meningococcal deaths,” he said. “Could be an epidemic in the making. We’ve got eight so far.”

Jack rushed over to George’s desk and snapped up a folder at random. He opened it and shuffled through its contents until he came to the investigative report. Scanning it quickly, he learned that the patient’s name was Robert Caruso, and that he had been a nurse on the orthopedic floor at the General.

Jack tossed the folder back onto the desk and literally ran through communications to the offices of the PAs. He was relieved to see Janice was still there, putting in overtime as usual.

She looked terrible. The dark circles under her eyes were so distinct, she resembled a battered woman. She put her pen down and leaned back. She shook her head. “I might have to get another job,” she said. “I can’t keep this up. Thank God I have tomorrow and the next day off.”

“What happened?” Jack asked.

“It started on the shift before mine,” Janice said. “The first case was called in around six-thirty. Apparently the patient had died about six P.M.”

“An orthopedic patient?” Jack asked.

“How’d you know?”

“I just saw a folder from an orthopedic nurse,” Jack said.

“Oh, yeah, that was Mr. Caruso,” Janice said with a yawn. She excused herself before continuing. “Anyway, I started getting called shortly after I arrived at eleven. Since then it’s been nonstop. I’ve been back and forth all night. In fact, I just got back here twenty minutes ago. I tell you, this is worse than the the other outbreaks. One of the patients is a nine-year-old girl. What a tragedy.”

“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.”