“You’ve turned the kid’s brain into roadkill!”
“I’m sorry, I’m doing my best.” She sliced through the deep brain structures. Again, the tissue almost melted under the knife. Inside the girl’s midbrain and pons medulla, she found what she was looking for: small weeping hemorrhages. These secondary weeping bleeds were areas of bloody discoloration, the result of tearing and crushing of the brain structures as the brain squeezed down upon them.
Ben Kly carried a glass jar over to the table. It was full of formalin. Using her knife as a paddle, she scraped and scooped the pulpy brain off the cutting board while Kly held the jar under it. The brain coddle plopped and splashed into the liquid, and floated in distorted fragments.
“Something destroyed the girl’s central nervous system,” she said.
The Chief
“SO HOW DID IT GO?” Lex Nathanson asked, half an hour later. Austen had found him in the death-reporting area, reviewing some new cases.
“It was bad,” she said. She had changed out of her scrubs and back into her street clothes, but she noticed—in a vague kind of way—that she smelled like Kate Moran. That would last for hours, unless she took a shower, and she did not have time for a shower.
They went into Nathanson’s office, and he slid open a drawer of his desk and took a cigar from a box and put it in his mouth, and then rummaged around for something. “Where in the hell is my cutter?” He held up a second cigar. “You want one?” he said.
Austen grinned. “No, thanks.”
“Yeah? You’re sure? These are twenty-buck cigars. If this vice of mine bothers you, please say so, okay?”
“It’s not a problem.”
He had found his cutter, and he notched the end of the cigar. He struck a wooden match, and, not holding the cigar in his mouth, but in his fingers, he toasted the end, rolling it gently in the match flame until the end of the cigar turned gray. “I’m afraid I am not an example to young people. Not only are these cigars a vice, but I have too much yellow abdominal fat. When they autopsy me—and I will insist on it—they will find a rat’s nest of problems, I’m sure. It is true that pathologists do not always learn from the lifestyle disasters they see on the autopsy table.” He drew on the cigar. A soft and mellow tobacco smoke infused the room. “Anyway, Winston Churchill smoked approximately sixty thousand cigars during his lifetime, and he lived to be ninety-one. Tell me what you found.”
Austen described the findings: blood blistering in the external openings of the body, including the mouth, nasopharynx, and eyelids. Golden streaky damage to the kidneys. Fatal brain swelling.
Nathanson looked at her quizzically. “Go on. Tell me about the C.N.S.” The central nervous system.
“The destruction was massive.”
“How so?” he asked.
“The brain was devastated.” She tried to summarize it. “The brain was puffed and swollen and had lost its physical integrity. It almost literally collapsed when I sectioned it. It had a shiny, glassy, reflective coloration that I’ve never seen before. The brain had turned into a kind of—how can I describe it?—like some kind of glassy pudding. She had a severe nosebleed, and she bit her tongue and mouth and lips very severely. She also showed signs of a common cold—streaming mucus exudate from the sinuses. There were golden pupillary rings in the irises of the eyes, with flamelike offshoots. It made the pupils look as if they were on fire. The total effect was—well—frightening. It made me think of a virus infection involving the central nervous system and possibly the tissues of the mouth and eyes and other openings of the body.”
“We don’t have the capability to test for a virus here.”
“You don’t have a lab for that?”
“No. We send biosamples over to the city health department’s lab. They test for bacteria. They don’t test for viruses.”
“We can do it,” Austen said. “May I send some samples down to C.D.C.?”
“Sure. Give them to Walt with my regards.” He gave her a sharp look. “How are you getting along with Glenn?”
Austen took a moment to reply, and she framed her answer carefully. “He’s straightforward in his views.”
“Boy—you’re quite a diplomat.” Nathanson drew on his cigar. “Glenn’s being a pain in the neck. If he gets to be too much of a pain, let me know and I’ll kick his ass for you. But I imagine you can handle yourself, Dr. Austen.”
She nodded and said nothing.
He went on, “Glenn’s having a bad time in his personal life. His wife recently left him. She took the children with her. He had been having an affair with a younger woman. But Glenn is a colleague and a valued member of my staff.”
“Of course.”
“Do you want to continue with this investigation?”
“Yes, I do.”
“Really, I don’t want to impose on you. I could turn this over to the health department.”
“You’re not imposing on me, Dr. Nathanson.”
He smiled broadly. “All right, enough of this ‘my dear Alphonse.’ Whaddaya need?”
“Well—I’d like to look at all your recent case files.”
“Sure. What else?”
“I’ll need a telephone. Also a map of New York City.”
There was a pause while he smoked his cigar. “That’s all you need?”
“Epi work is pretty simple,” she said. She looked out the window of his office. There wasn’t much to see, only the brick wall of the next building, but she observed that it had begun to rain. “I forgot to bring a raincoat.”
“I’ll get you one of our slickers. And you’ll need an office, won’t you?”
“I guess so.”
THEY GAVE HER a tiny office, almost a closet, on the third floor. Someone brought her a bright yellow rain slicker. Across the back in black letters it said, “OFFICE OF CHIEF MEDICAL EXAMINER.” It was a disaster raincoat, meant for protecting workers from blood and body fluid splashed around a disaster site, as well as from rain. It smelled of sweat.
The room was the office of a staff pathologist, a woman who was away on maternity leave. The office’s one window looked out on the blank wall of a parking garage some feet away. It was a nicer room than her digs in the C.D.C., anyway. She wondered why epidemiologists inhabited the world’s worst offices. She taped a map of New York City to the wall. With a pencil she marked an X on the map: at the location of the Mater School on Seventy-ninth Street, where Kate Moran had died. She marked another X on Times Square, where Harmonica Man had collapsed. The marks showed the location of death. They did not show where the victims had been exposed. If indeed they had been exposed to anything. If this was an outbreak of an infectious disease or a rash of poisoning, Harmonica Man was the first identified case. He was therefore what was known as the index case. Kate Moran, who died less than a week later, was the second case. There was no obvious connection between the two cases. It was not necessary for Austen to know what had killed them in order for her to begin an investigation. As Dr. John Snow knew, epidemiology can proceed without any knowledge of the nature of the disease-causing agent.
Deeper
KATE MORAN’S TISSUES were being processed in the O.C.M.E. histology lab, and they would not be ready for viewing for about a day. In the meantime, Harmonica Man’s tissues could be examined, and Austen called for samples, giving the case number to a technician. “Those slides have been checked out by Dr. Dudley,” he said. So she went down to Glenn Dudley’s office on the third floor and found Dudley sitting at a small table, staring into the eyepieces of a doubleheaded microscope. This is a microscope with two sets of binocular eyepieces, so that two people can look at a specimen at the same time.
“What do you want?” Dudley said without looking up.
“I wanted to take a look at the tissues of the first case.”
He grunted and kept staring into his microscope.
Austen sat down across from Dudley, facing him, and looked into the other set of binocular eyepieces. She saw a field of
brain cells. It was a thin slice of Harmonica Man’s brain tissue.
“It’s from the underside of the temporal lobe,” Dudley said. “The area of the hippocampus. It seems damaged.”
She let her gaze relax. She wandered through fields of cells. She saw threadlike neurons, which are the nerve cells that send signals in the brain. She saw other types of brain cells, and she saw white matter, which is a fatty substance in the brain. She came to a damaged area, where she began finding red blood cells. “I think I’m getting into a bleeding spot.”
“Nothing else? Okay, I’m zooming.”
The scene jumped. The cells were magnified more strongly. “Look at these cells,” he said. “Zooming again.” The scene jumped forward. They were on a voyage, running deep into the brain of Harmonica Man.
There was something wrong with the cells. A neuron, a nerve cell, is a long thread with branches. Somewhere in the middle of the thread there is a bulge. Inside the bulge there is a dot. The dot is the cell’s nucleus, where the cell’s genetic material is stored, its DNA. The nucleus of a cell looks like the yolk of a fried egg. It contains the chromosomes, which are pods of coiled protein that hold the cell’s DNA intact. Austen did not like the way these brain-cell nuclei looked.
“The cell nuclei are abnormal,” she said. “Would you zoom again, please?”
The scene jumped. The nuclei were bigger.
“That’s the highest magnification,” Dudley said.
It was hard to know what you were looking at. Life at the cellular level is complicated. There seemed to be structure in the cell nuclei—structure that didn’t belong there. Then she saw something. It was something she had never seen before, not even in a textbook. There were objects sitting in the cell nucleus. Things. Maybe this was something normal. Maybe the stain in the cells had brought out some feature that was explainable. It was hard to tell.
“What is this, Dr. Dudley?”
He grunted. He didn’t have any answers either.
The objects in the nucleus were shiny, glittery, angular crystals. They had a mathematical shape. They were bulging with many facets, like angular soccer balls. They were far too large to be virus particles. Virus particles are invisible in a regular microscope.
The light broke apart in the crystals and seemed to shimmer.
“This is like nothing I’ve ever seen before, Dr. Dudley,” Austen said.
“It’s weird,” Dudley replied, sounding unsure of himself. “This must be some kind of chemical compound. There’s some new drug hitting the street.”
“Maybe these crystals are lumps of virus in a crystallized form,” Austen said.
“Lumps! Lumps of virus. Don’t be an idiot,” he snapped. And he continued to stare into the microscope in silence.
Union Square
A COOL AND GENTLE April rain was passing over New York City. Alice Austen stared out the window of her office at the O.C.M.E., watching water run down the blank wall. Then she put on the yellow disaster raincoat, shouldered her knapsack, and took a taxi to Union Square.
A television van from Fox Channel 5 was double-parked on the street in front of the Morans’ building. A young woman reporter spotted Austen’s yellow raincoat as she rang the buzzer. “You’re from the medical examiner’s office? What happened to Kate Moran? Was she poisoned? Was it a murder? Can you tell us anything?” Behind her trailed a video man.
“I’m sorry, but you’ll have to talk to the chief medical examiner,” Austen said. The buzzer sounded, and she slipped inside.
The girl’s parents, Jim and Eunice Moran, sat holding each other’s hands on a couch in the living room. They seemed devastated. A large black-and-white photograph in a steel frame—a portrait of Eunice Moran by Robert Mapplethorpe—leaned against the wall across from the couch. In the photograph Mrs. Moran was wearing a soft white wool turtleneck sweater, and she looked thoughtful and elegant. In real life she was haggard, her eyes red from crying.
The housekeeper, an older Irish woman, retired to the kitchen, her footsteps padding on the oak floor. Austen heard sounds of her weeping.
Austen knew that people who are in the throes of grief can have unpredictable reactions to an epidemiologist asking questions, and she very gently identified herself as a doctor with the Centers for Disease Control in Atlanta, working with the city medical examiner’s office. When Kate’s parents understood that Austen had been dispatched to New York to investigate the death of their daughter, they spoke freely with her. The conversation was difficult, because at times Jim and Eunice Moran lost their ability to speak. Kate had been an only child. The parents’ life stretched ahead of them into a future that was more empty than they could have imagined.
They knew there had been an autopsy—in a case of sudden unexpected death an autopsy is required by law, and they had been notified. Austen chose not to tell them that she had performed the autopsy. “Your daughter’s body was released to the funeral home an hour ago,” she said. “However, because of the risk of possible infection, the city has ordered a cremation. The funeral home was instructed to take universal biohazard precautions. I called them myself and spoke with them, and they know how to do that.”
“What do you mean, biohazard precautions?” Eunice Moran said. Her voice sounded like breaking glass.
“I’m sorry. Your daughter may have had a contagious disease.”
“What kind of disease?” Mr. Moran asked.
“We don’t know. We don’t even know if it was contagious. What I’m here to do right now—I know it’s hard—is, I need to ask you some questions about what your daughter did and where she went during the past days and perhaps weeks, while your memory is fresh. We want to try to find out if she was exposed to something.”
Mrs. Moran held her husband tighter. Finally she said, “We’ll try to help you.” She nodded at a chair. “Please sit down.”
Austen sat on the edge of the chair. “Can you think of anything Kate did lately that might have exposed her to something infective or toxic? Did she travel in a foreign country recently?”
“No,” Mrs. Moran said.
“Was she receiving chemotherapy for cancer?”
“Kate? No!”
“Was she taking any strong or potentially toxic medications?”
“No,” Mrs. Moran said.
“Did she receive any vaccinations recently?”
“No.”
“Did she eat any shellfish or unusual foods? Visit any unusual places?”
“Not that I can think of,” Mrs. Moran said.
There was silence.
“Had she been outdoors in the woods, hiking or camping, where she could have been bitten by a tick?”
“No.”
“Did Kate have a boyfriend?”
They weren’t sure. They said that Kate had been going out with someone her age, a boy named Ter Salmonson.
Austen wrote the name down in her green epi notebook and got his phone number from Mrs. Moran.
“She broke up with Ter, I think,” Kate’s mother said.
Austen asked if they could carefully review Kate’s movements over the past two weeks. The parents were vague. Kate’s life had been quiet. She had friends, but she wasn’t a heavy socializer. She was a fan of rock music, and her parents had forbidden her to go to certain music clubs, but there had been no real trouble over that.
“There’s another question. This is hard for me to ask. Do you know if Kate used drugs?”
“Absolutely not,” Mr. Moran said.
“She didn’t smoke pot or anything?”
“I don’t know—I don’t think so, no,” Eunice Moran said.
Kate took the subway to school every day. She would come home late in the afternoon. She’d go into her room, listen to music, talk with friends on the telephone, do her homework, have supper, do more homework, sometimes surf the Web and send e-mail, go to bed.
“I’ve been very busy with my work,” Jim Moran said. “We haven’t done much as a family together lately.” r />
“Did she go anywhere recently?”
“The only thing I can think of is her art project for Mr. Talides, her teacher.” Mrs. Moran answered. “It’s a construction thing or something, and Kate was going around buying her boxes and things—when?” She turned to her husband.
“I don’t know,” Mr. Moran said.
“Last weekend, I think. She was buying things in SoHo and on Broadway and at the Sixth Avenue flea market, I guess. Mr. Talides was—” Mrs. Moran’s voice cracked. “I can’t stop thinking—I’m sorry—he tried to save her.”
“Do you know, did he attempt C.P.R.?”
“He had forgotten what to do, that’s—that’s what he told me when he called. He was very upset.”
Austen made a note to herself to interview the art teacher right away. He might have been exposed. On the other hand, she was beginning to get an uncomfortable feeling that this could turn out to be a wild-goose chase, that she had been pushed into some kind of hopeless problem by Walt Mellis. An unsolved outbreak. One of those blips that never gets explained.
The telephone rang. The housekeeper, whose name was Nanette, answered. It was a priest calling about the funeral arrangements. Austen could hear Nanette saying, “There won’t be a wake, Father, no, no, the health authorities have forbidden…”
“Do you mind if I look around the house just a little?”
The parents didn’t answer.
“Sometimes looking can be helpful. Also, would you mind if I took some photographs?” She removed her electronic camera from her knapsack. “May I look in the kitchen, and in Kate’s bedroom?”
They nodded, somewhat reluctantly.
She went into the kitchen first. Nanette hurried out as soon as Austen entered, almost hiding her face from her. It was a pleasant kitchen, with gray stone counters and a huge stove. She opened the refrigerator.
Austen did not think this was a food-borne illness, but she could not be sure, and there was, too, the issue of whether Kate had consumed a poison. She moved a few things around in the refrigerator. She photographed as much of the food as she could. Milk, some fish in paper. She opened the paper. It was salmon; it smelled fresh. Red-tipped lettuce. A bottle of French white wine, half finished. She sniffed at the wine. It seemed okay.