“If it makes you feel better, by all means,” Kathy said. “Come and sit down.”

Jack took one of the seats facing the desk. It was a small office with barely enough room for a desk, two facing chairs, and a file cabinet. The walls had a series of diplomas and licenses attesting to Kathy’s impressive credentials. The decoration was spartan but comfortable. There were family photos on the desk.

Kathy herself appeared as Jack remembered her: friendly and open. She had a round face with small, delicate features. Her smile came easily.

“I’m very concerned about this recent case of primary influenza pneumonia,” Jack said, losing no time. “What’s been the reaction of the Infection Control Committee?”

“We’ve not met yet,” Kathy said. “After all, the patient just passed away last night.”

“Have you spoken about it with any of the other members?” Jack asked.

“No,” Kathy admitted. “Why are you so concerned? We’ve seen a lot of influenza this season. Frankly, this case hasn’t bothered me anywhere near the way the others did, particularly the meningococcus.”

“It bothers me because of a pattern,” Jack said. “It presented as a fulminant form of a pneumonia just like the other, rarer diseases. The difference is that with influenza the infectivity is higher. It doesn’t need a vector. It spreads person to person.”

“I understand that,” Kathy said. “But as I’ve pointed out we’ve been seeing influenza all winter long.”

“Primary influenza pneumonia?” Jack questioned.

“Well, no,” Kathy admitted.

“This morning I had someone check to see if there were any other similar cases currently in the hospital,” Jack said. “There weren’t. Do you know if there are now?”

“Not that I am aware of,” Kathy said.

“Could you check?” Jack asked.

Kathy turned to her terminal and punched in a query. The answer flashed back in an instant. There were no cases of influenza pneumonia.

“All right,” Jack said. “Let’s try something else. The patient’s name was Kevin Carpenter. Where was his room in the hospital?”

“He was on the orthopedic floor,” Kathy said.

“His symptoms started at six P.M.,” Jack said. “Let’s see if any of the orthopedic nurses on the evening shift are sick.”

Kathy hesitated for a moment, then turned back to her computer terminal. It took her several minutes to get the list and the phone numbers.

“You want me to call them now?” Kathy asked. “They’re due in for their shift in just a couple of hours.”

“If you don’t mind,” Jack said.

Kathy started making the calls. On her second call, to a Ms. Kim Spensor, she discovered that the woman was ill. In fact, she’d just been preparing to call in sick. She admitted to severe flu symptoms with a temperature of almost 104°.

“Would you mind if I talked with her?” Jack asked.

Kathy asked Kim if she’d be willing to speak to a doctor who was in her office. Kim apparently agreed, because Kathy handed the phone to Jack.

Jack introduced himself, but not as a medical examiner. He commiserated with her about her illness, and then inquired about her symptoms.

“It started abruptly,” Kim said. “One minute I was fine; the next minute I had a terrible headache and a shaking chill. Also, my muscles are aching, particularly my lower back. I’ve had the flu before, but this is the worst I’ve ever felt.”

“Any cough?” Jack asked.

“A little,” Kim said. “And it’s been getting worse.”

“How about substernal pain?” Jack asked. “Behind your breastbone when you breathe in?”

“Yes,” Kim said. “Does that mean anything in particular?”

“Did you have much contact with a patient by the name of Carpenter?” Jack asked.

“I did,” Kim said. “And so did the LPN, George Haselton. Mr. Carpenter was a demanding patient once he started complaining of headache and chills. You don’t think my contact with him could be the cause of my symptoms, do you? I mean, the incubation period for the flu is more than twenty-four hours.”

“I’m not an infectious disease specialist,” Jack said. “I truly don’t know. But I’d recommend you take some rimantadine.”

“How is Mr. Carpenter?” Kim asked.

“If you give me the name of your local pharmacy I’ll call you in a prescription,” Jack said, purposefully ignoring Kim’s question. Obviously his fulminant course started after Kim’s shift had departed.

As soon as he could, Jack terminated the conversation. He handed the phone back to Kathy. “I don’t like this,” Jack said. “It’s just what I was afraid of.”

“Aren’t you being an alarmist?” Kathy questioned. “I’d guess two to three percent of the hospital personnel are out with the flu currently.”

“Let’s call George Haselton,” Jack said.

George Haselton turned out to be even sicker than Kim; he’d already called in sick to the floor supervisor. Jack didn’t talk to him. He simply listened to Kathy’s side of the conversation.

Kathy hung up slowly. “Now you’re starting to get me worried,” she admitted.

They called the rest of the evening shift for the orthopedic floor, including the ward secretary. No one else was ill.

“Let’s try another department,” Jack said. “Someone from the lab must have been in to see Carpenter. How can we check?”

“I’ll call Ginny Whalen in personnel,” Kathy said, picking up the phone again.

A half hour later they had the full picture. Four people had symptoms of a bad case of the flu. Besides the two nurses, one of the evening microbiology techs had abruptly experienced sore throat, headache, shaking chill, muscle pain, cough, and substernal discomfort. His contact with Kevin Carpenter had occurred about ten o’clock in the evening, when he’d visited the patient to obtain a sputum culture.

The final person from the evening shift who was similarly ill was Gloria Hernandez. To Kathy’s surprise but not Jack’s, she worked in central supply and had had no contact with Kevin Carpenter.

“She can’t be related to the others,” Kathy said.

“I wouldn’t be too sure,” Jack said. He then reminded her that someone from central supply had perished with each of the other recent infectious cases. “I’m surprised this hasn’t been a topic of debate with the Infection Control Committee. I know for a fact that both Dr. Zimmerman and Dr. Abelard are aware of the connection, because they have been to central supply to talk to the supervisor, Mrs. Zarelli.”

“We haven’t had a formal committee meeting since all this started,” Kathy said. “We meet on the first Monday of each month.”

“Then Dr. Zimmerman is not keeping you informed,” Jack said.

“It wouldn’t be the first time,” Kathy said. “We’ve never been on the best of terms.”

“Speaking of Mrs. Zarelli,” Jack said. “She’d promised me printouts of everything central supply had sent to each of the index cases. Could we see if she has them and, if so, have her bring them down?”

Having absorbed some of Jack’s anxiety about the influenza, Kathy was eager to help. After talking briefly to Mrs. Zarelli and ascertaining that the printouts were available, Kathy had one of the administrative secretaries run up to get them.

“Let me have Gloria Hernandez’s phone number,” Jack said. “In fact, give me her address as well. This central supply connection is a mystery that for the life of me, I can’t understand. It can’t be coincidence and could be key to understanding what is going on.”

Kathy got the information from the computer, wrote it down, and handed it to Jack.

“What do you think we should do here at the hospital?” she asked.

Jack sighed. “I don’t know,” he admitted. “I guess you’ll have to discuss that with friendly Dr. Zimmerman. She’s the local expert. In general, quarantine is not very effective for influenza since it spreads so quickly. But if this is some special strain, perhaps it would be worth a try. I think I’d get those hospital personnel who are sick in here and isolate them: worst case, it’s an inconvenience; best case, it could help avert a disaster.”