Critical (46 page)

Suddenly, Laurie's hand stopped twirling the horizontal mechanical stage control. She'd seen something unusual zip past the microscope's field. Since she was viewing at high-power, objects moved very quickly in and out of the field with very little rotation of the control. She slowly reversed direction with the control, and the strange object came into view.

Laurie was entranced. It appeared to be in the middle of what had been a bronchiole, probably close to what had been an alveolus, or the terminal sac in the bronchial tree where oxygen entered the blood and carbon dioxide came out. Laurie immediately questioned whether it had been there originally or was an artifact, inadvertently introduced or formed during the slide's preparation. It was about the size of the white cells Laurie had seen, which were the body's defensive cells, but there was no nucleus. It had absorbed almost none of the standard stain used by histology.

Most remarkable, it was a nearly round disk, symmetrical with a scalloped border, giving it a stellate appearance. Why she thought the symmetry was important was that most artifacts she'd seen didn't have such symmetry. Laurie looked at the object itself. The scalloped border comprised about one-fifth the diameter. The center of the object was opaque, with the mere hint of either nodularity or being mottled. One minute she'd see it, the next minute she wouldn't. She wished the object had taken the stain, because if it had, she would have known if what she was seeing was real or something she was conjuring up. Trying to keep her excitement in check, Laurie took out a grease pencil to mark the glass slide so that if the scope's mechanical stage were to accidentally move, she could find the object again. She did this by placing four dots in the cardinal directions. Satisfied, Laurie then shifted to low power. When she looked in again, the object was significantly smaller, and because it lacked staining, it tended to blend in to the chaotic surroundings.

Switching back to high power, she made sure the object, whatever it was, was still in the field. With that ascertained, she quickly went down to get Jack.

When Jack looked at the object, he said, "My gosh, how did one of my grandmother's butter cookies get into David Jeffries's lung?"

"Be serious," Laurie said. "What do you think it is?"

"I'm not fooling. It looks just like it came from one of my grandmother's cookie cutters. We called it a star, but obviously it has far too many rounded points."

"Do you think it is an artifact?"

"That would be my first guess, but it is surprisingly symmetrical. I suppose that's due to the dynamic tension between the hydrophilic and hydrophobic forces at the interface of the menisci."

"What the hell is that?"

"How should I know?" Jack said, still looking at the microscopic object. "I'm just running off at the mouth, speaking pseudo-scientific gibberish."

Laurie swatted Jack's shoulder playfully. "Here I thought you knew what you were talking about."

Jack looked up. "Sorry, I have no idea what it is. I don't even know if it is real or artifact."

"Nor do I," Laurie admitted.

"Have you found any others, or is this it?"

"So far that's it. Now that I found it, though, I'm eager to see if there are more."

"Do you have any idea what it could be?"

"I know what I think it looks like, but it can't be."

"Come on! Run it by me!"

"It looks like a diatom. Do you remember those from biology?"

"I can't say that I do."

"You must. They're a type of algae or phytoplankton with silicate cell walls."

"Give me a break," Jack said. "Now, how do you remember that?"

"They're so beautiful, kinda like snowflakes. I did sketches of them in high-school biology."

"Well, congratulations on your discovery. But if you're interested in my vote, I'd say I'd lean toward artifact rather than a pelagic diatom unless the university gave him a glass of Antarctic sea water as part of his terminal treatment."

"Very funny," Laurie said sarcastically. "Artifact or not, I'm going to look for more."

"Good luck! Say, I'm about to head out. Do you want to change your mind and come along?"

"Thank you but no thank you. I'm going to look at these slides for a while, then finish my matrix. Don't wait up for me. I know you're going to bed early."

"Good grief, Laurie. You're beating a dead horse."

"Maybe so, but I'm not sure I'm going to sleep that much tonight, one way or the other."

Jack bent down to give Laurie a hug, but she stood up and gave him a real one.

"See you later," Jack said, affectionately touching the end of Laurie's nose with his index finger.

"What's that for?" Laurie asked, reflexively backing away.

Jack shrugged. "Beats me. I just wanted to touch you because, I guess ..." Jack paused, acting suddenly self-conscious. "I guess I think you are terrific."

"Get out of here, you oaf," Laurie said, nudging him. Jack's clumsy sentiment threatened to break down Laurie's carefully constructed defenses. In truth, her own emotions were barely under the surface. On the one hand, she wanted to support him through his surgery, as she assumed he could use, as everyone could, but on the other hand, she didn't want to lose him and was furious that he was putting her in such a conflicted state.

Gathering up his crutches and giving Laurie a final smile, Jack left. Laurie stood for a moment, looking at the stacks representing her twenty-five MRSA cases. Quickly leaning out into the hall, she called down to Jack, "Remember to use that antibiotic soap tonight!"

"It's on my list," Jack yelled back without turning around.

Laurie ducked back into her office. She stood for a moment, recognizing that one of the struggles with having a real relationship with another was to allow the person to be themselves and make some decisions independently, with hopefully enlightened self-interest. What it boiled down to from Laurie's perspective, and the question of whether to have the surgery or not was a good example, was that a real lover had to recognize that there were two centers of the universe.

Pushing what she feared was sophomoric philosophizing out of her mind, Laurie sat back down at her desk. Her eyes flicked back and forth between her microscope and her matrix. Both beckoned. Although she thought the matrix the most promising in the long haul, the diatom-like apparent artifact was the most seductive.

Leaning forward, Laurie put her face to the eyepiece. What she wanted to do was scan the entire slide methodically to see if there were any more of the diatom-like objects.

ANGELO PULLED TO a stop at the same location he and Franco had been when they'd left their stakeout earlier. They were at the curb on First Avenue where it crossed 30th Street. The OCME was just off to the right. Traffic was rush-hour heavy.

Angelo put the van in park and used the emergency brake. "No Range Rover," he said, making a stab at justifying his behavior at noontime.

"Don't even go there," Franco said, making himself comfortable. He'd gotten a coffee and a hero at Johnny's, as had Angelo.

"Here come Richie and Freddie," Angelo said, looking in the rearview mirror and watching the white van pull up within a foot behind them.

Franco didn't answer. He was intent on surveying the area to make sure there were no apparent problems, such as parked police cars or loitering flatfoot patrolmen.

Angelo took a swig from his coffee, then unwrapped his sub. When he was finished, he glanced out the windshield and started.

"The boyfriend!" Angelo called out loud enough to make Franco slosh a dollop of coffee into his crotch. Angelo blindly reached for the small cast-iron bottle of ethylene and a plastic bag.

"Shit!" Franco yelled, straightening his back to lift his butt off the seat.

Angelo ditched the ethylene onto the floor and reached behind his seat for a roll of paper towels without taking his eyes off the OCME's front door.

Franco used a few towels to blot up the coffee from his seat, and a few more to wipe his pants. Only then did he look out the windshield. "Where's Montgomery?"

"I don't know," Angelo said dejectedly "Jesus. This woman is such a pain in the ass. Where the hell is she?"

They watched as Jack stood with his arm raised and crutches tucked into his armpits. He had advanced out into the street as far as he dared with the traffic zooming past him.

"This is probably better," Franco said. "Without the boyfriend interfering, the snatch will be far easier."

"You're probably right," Angelo said. "I just hope she didn't leave early."

"Relax!" Franco countered. "Don't be such a pessimist."

"WOULD YOU LIKE some more tea?" the waiter asked.

Adam shook his head. He was sitting in the Pierre's oval high-tea room jutting off the main corridor leading to the hotel's Fifth Avenue entrance. When he'd been a preteen, it had been his favorite room in the hotel, with its whimsical murals and, more important, with its afternoon selection of cookies and crumpets. As he turned the page of the Arts section of the
Times,
he felt his BlackBerry vibrate. Taking the mobile device out, he saw that he had an e-mail. Using the appropriate buttons, he opened it. It was short and simple: 63 West 106th.

After signing the check to his room, Adam went up to gather his things. He was encouraged. The timing seemed to be impeccable. Ten minutes later, he was climbing back into the Range Rover. Sensing that the mission would soon be over, he changed the selection on the CD changer from Bach back to Beethoven.

LAURIE LEANED WAY back in her chair, and it squeaked in protest. With the tips of her fingers, she rubbed her eyes. She'd been so intent on staring into the microscope's eyepiece that she'd seemingly failed to blink as often as she should have. Her eyes had a gritty feeling, but the massage was rapidly therapeutic, and after only five seconds of rubbing followed by a series of rapid blinks, she was fine.

Although Laurie still had no idea whatsoever what the scalloped, disc-shaped object was, she'd found two more on the slide. And since all three were mirror images of each other, she felt they could not be artifacts introduced when the slides had been prepared. They were definite objects that had been in David Jeffries's lung at the time of his death.

Laurie's excitement soared. She even allowed herself to fantasize that she'd discovered a new infectious agent that in conjunction with staph made for an exceptionally lethal combination. At that point, she dashed down to histology and confronted Maureen, who was about to lock up for the night. After pleading her cause, Laurie convinced the woman to locate filed pulmonary slides on a handful of the former MRSA cases. After thanking her effusively, Laurie dashed back to her office.

To her delight, she found more of the diatom-like objects, and she noticed that the amounts differed from case to case, with some cases having none. They were extremely rare and consistently unstained, which excused her colleagues from having not seen them. It was at that point that the matrix had provided its first payoff. Although the matrix had not been completed, it had provided a seeming corroboration of the pathogenicity of the discs. The shorter the period between the onset of the individual patient's symptoms and the time of death, the more diatom-like objects Laurie found. Although this discovery hadn't been akin to fulfilling Koch's postulate confirming a microorganism as the source of a particular disease, Laurie felt encouraged. Very encouraged.

With her eyes feeling as though they were back to normal, Laurie grabbed her Rolodex. Obviously, she had to try to identify the scalloped, microscopic objects. A few years earlier, Jack had had a similar situation about a liver cyst, and he'd taken the slide over to the NYU Medical Center and had it looked at by a giant in the field of pathology, Dr. Peter Malovar. Despite being in his nineties and a professor emeritus, he still maintained an office and a reputation of maintaining his encyclopedic mind. The man's life was his work, especially since his wife had died twenty years earlier.

With a shaking hand, Laurie punched the numbers of Malovar's extension into her phone, hoping that the rumors of the long hours the aged pathologist maintained were correct. She kept her fingers crossed as the phone rang once, then twice, and to her delight was picked up at the commencement of the third ring.

Dr. Malovar's voice had a slight but pleasing English accent, a grandfather-like calmness, and a surprising clarity for a nonagenarian. Laurie told her story in a rapid monologue, tripping over her words at times in her haste. When she finished, there was a pause. For a second, she'd feared that she'd been cut off.

"Well, this is an unexpected treat," Dr. Malovar said happily. "Offhand, I have no idea what this diatom-like object is but I would love to see it. It sounds perfectly intriguing."

"Would there be any chance of my bringing it over now?" Laurie questioned.

"I would be delighted," Dr. Malovar insisted.

"It's not too late? I mean, I don't want to keep you."

"Nonsense, Dr. Montgomery. I'm here until ten or eleven every evening. I'm at your disposal."

"Thank you. I'll be over shortly Is it difficult to find your office?"