Critical (20 page)
"Freddie, my friend," Lou called out.
Freddie stopped and turned as Lou came up to him. As soon as he recognized Lou, his face blanched. Nervously, he looked around, especially over to the nearby restaurant door.
"Gosh!" Lou effused. "How long has it been, Freddie, old boy?" The last time Lou had seen Freddie, he was a scrawny kid who artificially held his arms out from his body as if he were muscle-bound. Now he was a man: well, sort of.
"Holy shit, Lieutenant! What the hell are you doing here?"
"Just having a sub across the street for old time's sake. I used to go there when I was in high school, and then I see you pull up. What a coincidence."
"Nice to see you," Freddie said quickly. "But I gotta go."
"Not so fast," Lou said. He wrapped a restraining hand around Freddie's upper arm while Lou's other hand was holding on to his holstered gun. Lou knew these people were nasty and unpredictable.
"You could get me killed if I'm seen with you!" Freddie blurted.
"I could have you killed with a single phone call, my friend. I just want to talk to you for two minutes. My car is across the street in Johnny's parking lot. Let's hightail it over there, and we can talk out of sight."
Freddie looked around Lou over toward Johnny's, as if he didn't believe Lou, and then back at the Neapolitan's door.
"The longer you put this off, the more chance you're taking," Lou said. He gave Freddie's arm a tug in the direction of Lou's Caprice.
It didn't take long for Freddie to realize that he didn't have a choice. He nodded and quickly crossed the street. Lou followed Freddie all the way to the front passenger-side door. Freddie opened it quickly but took one look at the tiny meatballs, tomato slices, and onion rings fanned out on the seat and said, "I'm not sitting in that mess!"
Lou glanced around Freddie to see what he was referring to. "I can understand your reluctance," Lou said. He closed the door and opened the back. He motioned to Freddie to enter, then climbed in after him.
"Make this fast," Freddie commanded, as if he had a say in the matter.
"I'll try," Lou said, ignoring Freddie's bravado. "First up, who's the current local capo for the Vaccarros? I've been out of the loop."
"His name is Louie Barbera, but he's only a temp, because Paulie Cerino's supposedly getting out on parole."
"Really?" Lou commented. He'd not heard the rumor about Cerino.
"What the hell are you bothering me for with that kind of question?" Freddie grumbled. "You could learn that from any number of people."
"How do Vinnie and Louie get along?"
Freddie merely laughed.
"Is it that bad?" Lou asked.
"Vinnie made hay right after Paulie got sent up, especially with drugs. The Vaccarros want their old territory back."
"What about the Asians, Hispanics, and Russians?"
"They are getting to be a pain in the ass for everyone."
"All three groups."
"Mainly the Asians bringing in drugs from the East rather than South America."
"It was rumored there was an apparent hit last night," Lou said, finally getting around to the point. "Do you know anything about it?" He purposefully didn't want to give any of the details.
Freddie's eyes flicked over toward the restaurant door in a nervous fashion, which for Lou was a giveaway. From his years of experience, he guessed skinny Freddie knew something.
"I don't know anything about no hit," Freddie said unconvincingly.
"Come on! Don't make me threaten, and don't make me call Vinnie for old times' sake."
"Okay, I know there was a hit last night, but that's all I know about it."
"Please! Don't drag this out."
"I don't know who it was, honest. All I know, it was some guy who was going to rat."
"What was the victim going to rat about and to whom?"
"Who knows?"
"Are you pulling my chain here or what?"
"Honest, I'm telling you all I know, which is close to zilch. Vinnie's upset about something, but I have no clue. He doesn't talk about such things, except to Franco Ponti."
Lou eyed the hopeless kid-turned-man. In one sense, he felt sorry for him, because Lou was sure he was going to end up in a Dumpster some night. He'd been playing two ends against the middle but wasn't intelligent enough to carry it off over the long haul. In another sense, Lou was angry with him because like all these other misfits, the shithead was abetting a tiny group of people who made all Italian Americans look bad.
"All right," Lou said after a pause. "I want you to find out who this guy was who got whacked. I don't want a war breaking out between the Lucia and Vaccarro factions, which is what I'm worrying about."
"There's no way for me to find out any such thing. Vinnie is tight-mouthed. If I asked him anything, he'd know something was screwy."
"Don't ask him, ask Franco."
"That would be worse than asking Vinnie. You know the guy's crazy."
"Figure out a way," Lou said. He reached across Freddie and opened the door.
7
APRIL 3, 2007 2:20 P.M.
Laurie's eyes were glazed over as she stared blankly out of the taxi's side window as it raced northward on Second Avenue. She was totally preoccupied with her MRSA series, which had started out as a possible way of convincing Jack to postpone his knee surgery but which had morphed into something else entirely. She still intended to use the issue with Jack, but now she sensed there was a wider significance, and the possibility electrified her. Her conception of the role of the medical examiner was to speak for the dead to help the living. Suddenly, she saw her current series as a means to do just that. If she could figure out why these MRSA deaths were occurring in such a cluster, she could presumably save potential victims.
Thinking in such a vein had a disheartening aspect. Why hadn't the OCME picked up on the problem sooner? Laurie pondered the question for a moment before guessing the reason: a low index of suspicion, which Laurie assumed would have influenced her, too, concerning David Jeffries, had the personal aspect not intervened.
Laurie knew that as many as ten percent of all patients entering the hospital come away with a hospital-acquired infection, meaning about two million patients a year, resulting in nearly ninety thousand deaths in the United States alone. Of these infections, about thirty-five percent were staph, many of which were MRSA. In short, the problem was just too common to cause much of a stir, especially with bacteria on the rise.
A sudden crash jolted Laurie from her reflections. Had she not had her seat belt on, her head would have hit the ceiling.
"Sorry!" the cabbie said, glancing at Laurie in his rearview mirror to see if she was okay. "Potholes from the winter."
Laurie nodded. She appreciated the apology, as unexpected as it was, but not the driving style.
"Maybe you could slow down," she suggested.
"Time is money," the turbaned driver answered.
Knowing the futility of trying to influence the taxi driver's mind-set, Laurie went back to her musing. She was on her way to the Angels Orthopedic Hospital, which was sited on Fifth Avenue on the Upper East Side, and surprisingly enough, approximately directly across Central Park from where she and Jack lived. Over the previous two hours she'd been frantically busy, and, despite a mild fear for her life in the cab, she appreciated the forced respite and time to organize her thoughts that the ride offered. She'd finally been able to meet with Arnold Besserman and Kevin Southgate, and had gotten the names of their six cases and four of the six case files and hospital records. Arnold had even given her the personal monograph he'd written on MRSA, which Laurie had quickly read.
Laurie now knew more about the bacterium than she'd ever known, even more than she had just before taking her forensic pathology boards, for which she had crammed in her old collegiate style, with all sorts of esoteric facts, including some about MRSA and other staph organisms. As Agnes had said, staphylococcus aureus was an extraordinary and versatile pathogen.
With the accession numbers of Arnold's and Kevin's cases plus those of George Fontworth, Laurie had relayed them all to Agnes Finn. Laurie wanted Agnes to retrieve their frozen samples for culture and subtyping just as she was already doing with Laurie's case that morning and Riva's cases. Laurie thought it was important to see how closely they all matched.
Laurie had then made some important phone calls with the numbers Cheryl had gotten for her. First, she called Loraine Newman at the Angels Orthopedic Hospital. Laurie found her as accommodating as both Arnold and Cheryl had described. The woman graciously agreed to a meeting that very afternoon at two-thirty.
Next, Laurie had called a woman at the CDC by the name of Dr. Silvia Salerno, who was associated with the CDC's national library of MRSA strains that had been formed to identify genetic patterns in the subtype, in hopes of influencing prevention and control strategies. In addition, she was part of the CDC's Web-based National Healthcare Safety Network and had been the person to whom Riva had been referred. It was she who had had Riva's isolates subtyped.
"If I am not mistaken, they were a community-acquired MRSA, or what we call CA-MRSA," Silvia had said when Laurie had asked if she remembered the cases. "Let me look it up. Okay, here it is. CA-MRSA, USA four hundred, MWtwo, SCCmecIV, PVL. Now I remember it very clearly. That is a particularly virulent organism, maybe one of the most virulent we've seen, particularly with the PVL toxin."
"Do you recall Dr. Mehta mentioning that her two cases came from two separate hospitals?"
"I don't. I assumed it was the same institution."
"It was definitely two hospitals. Does that surprise you?"
"It suggests the two individuals knew each other or they each knew a third person."
"Meaning you believe these were not nosocomial infection?"
"Technically, for an infection to be considered nosocomial, the patient has to have been in the hospital for more than forty-eight hours."
"But that's only a technical definition. I mean, the patients could have gotten them from the hospital."
"Of course. The definition is more for statistical reasons than scientific, but getting such an infection within twenty-four hours of admission would suggest to me that they were part of the patient's own flora."
Laurie described her series, all of whose victims had died of MRSA within twenty-four hours and, of those whose subtyping was available, had died of community-acquired MRSA, which Silvia said backed up her contention that the bacteria were most likely brought in by the patients. Regardless, Silvia had specifically said she was interested in the cases and had been surprised not to have heard of the cluster. Offering to help in any way she could, she took Laurie's direct-dial office number, and promised to get back to her after she'd asked around to see if anybody at the CDC had heard about the outbreak. She'd also promised to have a second look at Riva's samples to determine if they were the exact same strain or merely close.
Finally Laurie had called the Joint Commission on Accreditation of Healthcare Organizations. Cheryl had not been able to get her a specific person to talk with, and after Laurie had been switched around numerous times, each time being given the name of someone else who could supposedly help her, she had given up, defeated for the moment by the bureaucratic mind-set.
Arriving at her destination, the taxi pulled up to the curb and stopped, and Laurie handed over the fare and the tip. As she climbed from the cab, she looked up at an impressive, modern highrise of green-tinted glass held in place by vertical ribs of green granite. The name, Angels Orthopedic Hospital, was inscribed into a pediment-shaped marble lintel over the front doors. A liveried doorman stood on the sidewalk. A sloping driveway led to a receiving dock, a service entrance, and a multistory parking garage in the rear.
The interior was even more impressive. It was more like walking into a Ritz-Carlton than a hospital, exactly as Jack described that morning. The floor was a mixture of hardwood and marble, and the information booth looked like a concierge desk, with two uniformed men sitting side by side in suits and ties. But what caught Laurie's eye more than the decor was the lack of people. There was no hustle and bustle like a normal hospital. Other than the two men at the information booth, there were only two people in the large lounge area sitting opposite each other on opposing, elegantly upholstered couches.
Laurie went up to the information booth and received the full attention of both gentlemen. She asked for Loraine Newman, mentioning her name and that she had an appointment.
"Certainly, ma'am," one of the men said. He picked up the phone, and after a brief conversation directed Laurie to a pair of interior doors to the left of the bank of elevators. "Miss Newman is waiting for you in administration."
Laurie followed the directions and pushed through the designated doors. The administration area was more utilitarian than the lounge area but still sumptuous compared to any hospital Laurie had ever been in. It was a wide, long room with glass-enclosed offices on either side, each fronted by individual secretarial desks. Most all the desks were occupied, but it didn't appear that much work was being done. Only a few of the secretaries were typing into their monitors, while most were chatting in subdued tones.
