Robin Cook

The following is an exclusive excerpt from Pandemic, by godfather of the medical thriller, Robin Cook, whose 1977 work Coma, helped popularize the genre. In the following passage, unusual symptoms point to a possible contagion that may be deliberate in both its effects and its quick spread, setting up this terrifying and timely thriller about the dangers of biological warfare.

MONDAY, 11:45 a.m.

“I’m up on the second floor in the formal dining room, Dr. Hernandez,” Jack said into the phone. “I’m here with a group of visiting nuns. Come on up!” He was using the speakerphone while he adjusted the ringtone to a more normal setting.

Lou chuckled. That kind of impious exaggeration sounded more like the irreverent Jack Stapleton he knew and loved. Maybe Jack wasn’t as bad off as he’d been suggesting.

A minute later a youthful-looking woman approached who reminded Lou of Laurie, with the care she obviously expended on her general appearance. She was wearing a fresh, highly starched white doctor’s coat, which was the opposite of the rumpled and soiled ones the veteran MEs generally wore. Beneath it was a bright red dress that, in Lou’s estimation, wouldn’t have been out of place at a cocktail party. Her features, coloring, and tightly gathered hair suggested a Hispanic genealogy.

Jack performed the introductions, describing Lou as a dear old friend of both his and Laurie’s. Then Jack explained that Jennifer was the granddaughter of the woman who’d been Laurie’s nanny from when Laurie was pint-size all the way up to her teenage years.

“Jennifer even came to the OCME under Laurie’s tutelage and spent a week here as a high school student,” Jack said. “I was told she was quite a pistol back then and needed some direction, which Laurie supplied.”

“I’m afraid I was on the wild side,” Jennifer agreed. “My poor grandmother Maria, who raised me, didn’t know what to do with me and turned to Laurie in desperation. But my coming here ended up being a life-changing experience. It got me so interested in academics and forensics that I went to medical school and did the whole nine yards. And here I am.”

“And there’s even more to the story,” Jack said. “It was because of Jennifer that Laurie and I ended up taking that trip to India about ten years ago. So she has expanded our lives as well.”

“I remember that trip,” Lou said. “It was about medical tourism.”

“That it was,” Jennifer agreed. “Unfortunately for my grandmother.”

“It was a disaster for Maria,” Jack said in agreement. “So, Jennifer. What’s up? How come you’re looking for me?”

“A problematic case is on its way in to the OCME from the Bellevue emergency room.”

“I got a call from Bart Arnold, the MLI supervisor,” Jennifer said. “A problematic case is on its way in to the OCME from the Bellevue emergency room. He’d heard about the call-in and was concerned enough to head over there himself. He called me from the ER to say that he thinks it might be a contagious case, and he specifically asked me to ask if you would get involved. He told me something I didn’t know. You are known around here as the ‘contagion guru.’ ”

“What the hell does that mean?” Lou asked. He visibly cringed. He was a world-class germaphobe, and anything to do with pestilence gave him the creeps.

“During my first year here at the OCME I made a couple surprisingly accurate diagnostic calls on a number of fatal contagious cases that were being artificially spread.”

“You mean someone was doing it on purpose?” Lou questioned. “Like bioterrorism?”

“You got it,” Jack said. “But we nipped it in the bud. It could have been bad.”

“Bart wants to know if you’ll give him a call,” Jennifer told him. “Sounds like my kind of case,” Jack said. “I’ll do better than call him.

I’ll run down to 421 and see him in person.” 421 was how everyone at the OCME referred to the new high-rise building on 26th Street. The old building that still housed the morgue and the medical examiners was referred to as 520, its First Avenue address.

“Then I’ll let him know you’re coming,” Jennifer said. She nodded to Jack, told Lou it had been a pleasure to meet him, and then left.

“Doctors are getting younger and prettier all the time,” Lou said once she’d gone. “Makes me feel like an old fart. But be that as it may, I’m outta here. Thanks for the morning entertainment, and let me know the final dispensation on the three cases we did ASAP.”

“It goes without saying.” Jack stood. “Come on. I’ll walk you to your car on my way down to 421.”

After closing the door to Lou’s unmarked Chevy Impala, Jack waved him goodbye as the car backed up from the OCME unloading dock  and pulled out onto 30th Street. Besides the OCME vans, Lou’s car was the only vehicle permitted to park there, and to ensure it wasn’t towed away, Lou always made certain to leave his laminated NYPD detective card in full view on the dash.

The moment Lou’s car disappeared, Jack returned to 520’s interior to retrieve his bike, which he’d parked near the autopsy room. Even though it was only four blocks south to the 421 high-rise, he couldn’t pass up the opportunity for even a short burst of speed and a bit of fresh air. Unfortunately, it wasn’t really fresh air, since the OCME was situated on the East Side of Manhattan and therefore constantly bathed in the considerable car, truck, and bus fumes carried along on the island’s prevailing westerlies. Hopping on the bike, Jack pedaled east and then south along the edge of Franklin Delano Roosevelt Drive with his not-so-clean doctor’s coat flapping in the wind. Despite the cool temperature, he was wearing only blue scrubs underneath. The trip was over practically before it had started. Jack carried his bike in through the building’s loading bay, parked it next to a security booth, and took the elevators up to the fifth floor.

The fifth floor was the busiest in the entire building. Not only did it house the medical-legal investigative team, but Communications as well, where all calls came in to the OCME day and night. It was also the arrival area, where all specimens came into the building for analysis from the autopsy room and from off campus. That included everything from run- of-the-mill histology, bones, and teeth to the most sophisticated DNA tests. The only samples that didn’t come into the fifth floor of 421 were toxicology specimens, since Toxicology was the only major department of the OCME besides the morgue itself that had yet to move from the 520 building.

The MLI Department occupied the area immediately beyond the glass doors defining the elevator lobby. It was an open office, comprising rows of desks with their backs pushed up against one another. Bart Arnold’s desk was in a central location, so he had a bird’s-eye view of his team.

Bart had been with the OCME since way before Jack’s arrival, back when the department had been a shadow of its current self, with a mere handful of employees. In those days the investigators were called physician assistants and sat in tiny individual shoulder-height cubicles behind the telephone operators’ switchboard. Now the department was large enough to field its own softball team at the spring picnic.

Bart himself was a heavyset man with just a handful of curly grayish hair that extended from just a little over each ear in a ring around the back of his head. He was an intelligent, quick-witted individual with a remarkably calm personality. He needed his patience. His team was quite variegated in temperament, age, and gender, and the MLI role had to be maintained 24/7, holidays notwithstanding. Like Jack, he was wearing a white coat a little worse for wear over scrubs. As a hands-on super- visor, Bart was known to make frequent trips out of the office to investigate troublesome deaths, particularly at local hospitals. He was known in his field and had been influential in getting forensic pathology to adapt therapeutic complication as the new term for hospital deaths. This was the label used when the death was unexpected, as with a patient undergoing a normally safe procedure. It had replaced the more vague accidental death.

“My gosh!” Bart said, getting to his feet when he caught sight of Jack approaching. As an old-school employee, he had more respect for the professional staff than some of his younger colleagues did. “I didn’t mean for you to have to come over here, Dr. Stapleton. I was just hoping for a call.”

“No problem,” Jack said. “Please sit.” Jack snagged a stool on wheels, pulled it over, and sat across from Bart. “Whatcha got? Dr. Hernandez said you were concerned about a possible contagious case.”

“Whatcha got? Dr. Hernandez said you were concerned about a possible contagious case.”

“That’s right,” Bart said. “My intuition is telling me this is no ordinary case. The call came in not too long ago. Let me tell you what I learned. The patient was on the R train from Brooklyn and the engineer let MTA operations know about a sick passenger. The EMTs who picked her up from the Twenty-third Street station knew she was in extremis,  so they had to move quickly and couldn’t get much history. But it seems that the victim, who’s a twenty- to thirtysomething woman, had been fine while on the train, which of course makes sense. She wouldn’t have gotten on the train if she felt really crappy, especially getting all dolled up the way she was. Whatever befell her came on like gangbusters, with apparent breathing difficulty, making her turn a bit blue, although it wasn’t anything she choked on. My guess is an overwhelming case of pneumonia, because when they tried to ventilate her, they couldn’t. The only thing I noticed when I looked at her was some froth in the corners of her mouth, around the endotracheal tube.”

“Could it have been some sort of overdose?” Jack asked.

“I truly don’t think so,” Bart said. “In my considerable experience, this is not the way an overdose presents itself. I think it’s a case of sudden and overwhelming viral or bacterial pneumonia. This woman was on the move and very well dressed. She could have been on her way to lunch at the Ritz, the way she was decked out.”

“You know what this is reminding me of?” Jack asked, sitting up straighter.

“A scary-ass illness,” Bart said. “Something like Ebola.”

“Actually, I was thinking of something more pedestrian but ultimately even scarier,” Jack said, allowing the first hints of excitement to trickle into his voice. He didn’t want to get his hopes up, but suddenly this was all sounding to him like something the “doctor might order” to take his mind off Emma, autism, and his mother-in-law’s invasion. “Back in the disastrous flu pandemic of 1918 that killed upward of one hundred million people, there were stories of asymptomatic people getting on the subway in Brooklyn and being dead from viral pneumonia by the time they got to Manhattan. Whether such stories were apocryphal or not no one knows for sure, but I think they were true because of the virulence of that particular flu strain. What is believed now is that they died from their own immune systems going wild in what is called a cytokine storm.”

“I’ve heard the same stories,” Bart said. “It’s why I jumped on this when the call came in.”

“Did you advise the Bellevue people to do anything with the body for safety concerns?” Jack asked.

“I certainly did,” Bart said. “I advised them to put the corpse in a body bag and treat the outside with hypochlorite and to do the same thing to the ER room. I even called the EMT station and told them to follow suit with the ambulance, but they had already done it.”

“Good call,” Jack said. “I would have advised the same thing. Where do you think the body is now?”

“It should already be in the cooler at 520. I sent one of our vans right away. If it’s not there yet, it will be shortly. Bellevue was eager to have it out of the emergency room, for obvious reasons.”

Jack stood up quickly. The stool he’d been sitting on scooted off to collide noisily with a nearby desk. Jack grimaced and apologized to the surprised occupant. Jack was eager to get cracking. Being in a position as a medical examiner to possibly head off an influenza pandemic had a huge, mind-numbing appeal. Last year’s flu had been bad. This year’s could be catastrophic if this sudden death turned out to be the index case. “Thanks for cluing me in,” Jack said. “This could be really important.”

“I thought as much,” Bart said. “Let me know what you find out. I’ll be interested to learn.”

“I’ll keep you posted,” Jack promised.

“Oh, there is one problem I didn’t mention.” Bart rose from his own seat. “There’s no identification. My guess is that when she collapsed, whatever she was carrying, be it a purse or a phone or both, was taken.” “You said she was well dressed,” Jack said. “Getting an ID shouldn’t be much of a hurdle. Someone will undoubtedly miss her sooner rather than later and call Missing Persons when she doesn’t show up where she lives or works.”

“That would be my guess,” Bart agreed.

“ID is going to be important if it is a contagious case, as we suspect,” Jack said. “Social history and contacts might turn out to be crucial.”

“I know. I’ll check back with the ER just to make sure they didn’t misplace a purse or a phone. It wouldn’t be the first time. If I find out anything, I’ll let you know.”

Jack flashed Bart a thumbs-up before making a beeline for the elevators. He hit the down button repeatedly in the vain hope of encouraging an elevator to come more quickly. His heart was racing. Coming across an index case for a possible influenza pandemic was heady stuff. Best of all, it might keep him busy and occupied for a week.


From PANDEMIC by Robin Cook, published by G. P. Putnam’s Sons, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2018 by Robin Cook.

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