Death Rounds
by
Peter Clement

KILLING GROUND

Throughout the community, panic and paranoia spread as wildly as the
outbreak itself, and the entire University Hospital staff is
quarantined. Yet the mastermind who created this deadly superresistant
strain may be someone they know, someone locked within the barricades.
Now the sociopath has threatened to infect fifty more people. And that
will be only the beginning. . . .

DEATH ROUNDS

No one captures the complex workings of an urban hospital like former ER
physician Dr. Peter Clement. His new medical thriller ranges from the
realm of microbiology to raw, human rage--in a plot so chillingly
authentic it could be happening right now. . . .


DEATH ROUNDS

By Peter Clement Published by Fawcett Books:

LETHAL PRACTICE

DEATH ROUNDS

Books published by The Ballantine Publishing Group are available at
quantity discounts on bulk purchases for premium, educational,
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18007333000.
DEATH

ROUNDS

Peter Clement

FAWCETTGOLD MEDAL NEW YORK
This book is dedicated to Vyta, Scan, and James, whose love makes all
things possible.

A special thanks to my longtime friend and colleague in ER, Dr. Brian
Connolly, for his support and advice. And a special thanks to my
agent, Denise Marcil, for her generous help with this book that went
far beyond what any writer could hope for.

Sale of this book without a front cover may be unauthorized. If this
book is coverless, it may have been reported to the publisher as
"unsold or destroyed" and neither the author nor the publisher may have
received payment for it.

A Fawcett Gold Medal Book Published by The Ballantine Publishing Group
Copyright 1999 by Baskerville Enterprises, Ltd.

All rights reserved under International and Pan-American Copyright
Conventions. Published in the United States by The Ballantine
Publishing Group, a division of Random House, Inc." New York, and
simultaneously in Canada by Random House of Canada Limited, Toronto.

Fawcett Gold Medal and colophon are trademarks of Random House, Inc.

www. random house.com/BB/

Library of Congress Catalog Card Number: 9896764

ISBN 0449004503

Manufactured in the United States of America

First Edition: March 1999

10 987654321
PART ONE

Incubation
Chapter 1

10.00 a.m." Tuesday, October 21

She looked dead. Her flesh was molded purple and white from not enough
oxygen and loss of circulation. But as I stepped up to the stretcher
where she was lying, I could hear her breathing--gurgling noises, each
ending with a whimper--and I could see the muscles between her ribs
suck in and out as she struggled for air. Her skin felt warm despite
its ghastly appearance and had a sour acrid smell, the aroma of sweat
saturated with lactic acid. Brown fingertips betrayed years of
smoking. At the touch of my hands she half opened her eyes and stared
about her with quick darting movements. Her pupils were wide with
terror, dilated by the flood of adrenaline that goes with dying, and
her gray hair splayed out wild and tangled over the pillow.

The worst was when those black eyes glared at me. Even in her agony,
gasping and unable to move or speak, her expression seemed to say. You
sent me home.

I smothered a rising wave of alarm and guilt as I placed two fingers at
the right side of her neck.

"Pressure?" I asked, trying to sound in control. I could barely
palpate a pulse in her carotid artery.

"Eighty over zip. Doctor," replied the nurse who was at the patient's
head. She was applying a translucent green oxygen mask and attaching
the tube to a hissing wall outlet "I just took it. And the pulse is
one-twenty and irregular." She'd already wired the woman to a cardiac
monitor. The erratic beeping accompanying the rapid squiggle on the
screen above me was far from reassuring.

"I think it's atrial fib," she added, as she watched me study the
tracing. She was right.

When I didn't reply, she asked, "Aren't you going to cardio vert it?"

Her tone made it clear she thought I should try to shock the heart back
into a normal rhythm. I shook my head.

"It may be the result of the shock and not the cause." I forced myself
to concentrate to keep thinking this through.

Two other nurses trying to start IVs in the woman's arms crouched at
opposite sides of the table. Bags of saline had been suspended in
readiness from overhead poles.

"Got it," announced Susanne Roberts at my elbow. She was the head
nurse and, like me, a twenty-year veteran of these desperate struggles.
Without waiting for instructions, she reached up and adjusted the valve
in the clear tubing that dangled from one of the bags of fluid. She
then stepped around the foot of the bed and came to the aid of her much
younger colleague, who'djust muttered, "Damn!"

The nurse at the head of the table reached past me to clip an oxygen
monitor to the tip of one of the patient's fingers. Yet another
machine began beeping behind me. "02 sat's only eighty percent," she
commented grimly, meaning the blood oxygen level was dangerously low.

"The first person free," I said, "get me a twelve-lead cardiogram, and
I want a portable chest stat. Get someone else in here to draw bloods
and catheterize her."

"Routine bloods are drawn and gone. Dr. Garnet," Susanne informed me
as she started the second IV, "and X ray's been called."

Then she nudged her flustered helper and quipped, "Even if he is chief
of ER, I hope he knows enough to want blood cultures because I ordered
them as well."

This time I barely managed a curt nod as I quickly slipped my
stethoscope into my ears and listened to the woman's heart sounds.

Susanne gave me a puzzled little glance.

Normally I welcomed her sassy wisecracks and joined in the fun.

It was how we kept the rookies relaxed.

I moved the stethoscope to the lower right side of the woman's chest.
Barely any air moved in her lungs. What little flow there was wheezed
and crackled as it passed through--what? Fluid? Pus?

Both? A listen on the left revealed more of the same. She was in warm
shock, probably caused by sepsis--an overwhelming infection spread into
the blood stream--with pneumonia being the most likely primary source.
Yet I continued to check elsewhere. Stepping around the tangle ofECG
wires Susanne was hooking up, I palpated the abdomen and examined the
lower extremities. Nothing. But when I moved back up to the patient's
head and flexed her neck, checking for stiffness and evidence of
meningitis, her eyes still followed me and I had to endure that stare
again. Look at what you 'we done to me!

I shuddered but kept myself focused on treating her.

"Okay, everyone, this is an infectious case, septic shock, probably
from overwhelming pneumonia of some kind, and isolation is in force."

We were already wearing masks and gloves as a general precaution.

Isolation meant donning surgical gowns for additional protection
against bodily fluids and discarding all this protective gear in a bin
at the door whenever we left the room. Such measures were intended to
protect us and the other patients in the rest of the hospital.
Hopefully.

The circus I was about to create wasn't conducive to the confinement of
deadly microbes.

People were running in, fumbling with back ties on their half-done-up
masks and gowns.

I kept giving orders.

"Keep the TVs open, raise her legs, but give me vitals every few
minutes. We don't want to overload her. And get me an inhalation
therapist fast. We need to intubate this lady and help her breathe
now!"

But my words sounded hollow. When I turned to speak specifically to
Susanne, I found it hard to look her in the eye.

"When whoever you called to take blood cultures gets down here, have
him culture and Gram-stain everything else as well--sputum, urine, CSF,
even stool--and repeat the blood cultures again in thirty minutes if we
get that far." While talking, I was already struggling into a green OR
gown I'd gotten from one of the racks where we kept gear for dirty
cases.

"Get one of our residents to do the LP," I added, praying that no one
would see through my phony show of calm.

The lab tech arrived with a basket of tubes and swabs.

I stepped to the top of the bed behind the woman's head and nipped off
her oxygen mask. She'd started to cough, and yellow foam was seeping
out between her lips. Mercifully her eyes were now closed.

"Get whoever's on call for I.C.U and ID," I said over the rising
voices. I grabbed a rigid suction catheter from the wall beside me and
opened the valve that activated it.

"And tell ID if they don't get here fast, we'll choose their
antibiotics for them." Infectious disease consultants, by definition,
never liked our choice of treatment, even when we got it right. Today
I knew I needed their help.

I put my gloved fingers into the pus streaked with blood flowing from
her mouth and scissored open her teeth. Through the thin latex I could
feel the debris was thick and warm. How could I have allowed her to
get like this? Whatever I thought of her, she was one of our own. With
the recriminations, I broke into a sweat.

"Let me culture that gunk before you suction it out," ordered the lab
tech who'd just finished drawing off the bloods. He pushed by me, took
a sterile cup and gingerly scooped up a glob of the stuff as it rolled
out the corner of her mouth. He'd mount a dab of this sample on a
glass slide and color it with violet and iodine solutions, the
ingredients of a Gram stain. In twenty minutes he'd have it under a
microscope and know what was killing her. He then plunged several long
Q-Tips into the pool of secretions welling up at the back of her
throat. Her whole body bucked as she gagged and choked while he poked
about. Small yellow droplets flew onto the front of my glasses. When
he withdrew, thick strands of the purulent sputum dripped from the ends
of the swabs. These specimens would be plated onto various types of
agar in which the organism would be grown to determine what
antibiotics, if any, it was sensitive to.

"That'll do it," he said, sliding the cultures back in their containers
of charcoal growth medium and sticking labels on them.

I stuck the catheter into the woman's mouth. The unsightly debris
vanished noisily up the tubing. She still bucked at the stimulation,
but less than before. I focused my thoughts enough to verify there was
no evidence of tonsillitis or discoloration of her mucous membranes to
suggest a toxic shock syndrome. But would she tolerate intubation
without sedation? My hesitancy disgusted me.

"I've got it. Earl," said a familiar voice at my side, and Dr.

Michael Popovitch reached across me, a laryngoscope in one hand, an
orange endotracheal tube in the other. Even if he hadn't spoken, the
pepper-and-salt beard sticking out from the corners of his mask and the
unmistakable pear-shaped physique under his surgical gown made him
instantly recognizable. He was both director of teaching and my
associate chief in ER, but more important, he was also my friend.

"Thanks, Michael," I said, moving out of the way.

He slipped the curved steel blade of the scope alongside her tongue,
opened her airway to illuminate her vocal cords, and slid the tip of
the curved rubber device into the woman's trachea. She immediately
heaved and blew out some more of the yellow slime that was clogging her
bronchi, then fell quiet. As he started ventilating her, the
inhalation therapist ran up and took over. Michael stepped back, then
led me by the arm away from the table to where we wouldn't be
overheard.

"Earl, what the hell's the story with this lady? And are you okay?

Christ, you're pale, you're sweating--" He suddenly looked horrified.

"Oh my God! You haven't got chest pain have you?"

I took a breath.

"The story with this lady, Michael, is that her name is Phyllis
Sanders, she's in her fifties, and she's an OH nurse at University
Hospital. Eighteen hours ago she presented here with a slight cough,
minimal fever, and a touch of diarrhea. I assured her she only had the
flu and sent her home."

The rest of the resuscitation raced on around me. Residents eager to
do procedures rushed into the room grabbing needle sets and ripping
open packets for central lines. Michael hastily reined them in and
orchestrated their frenzy into specific tasks. The beeping sounds from
the monitors and the shouted orders for blood gases and LP trays seemed
distant.

She needed antibiotics. But I couldn't organize all her symptoms and
signs to point to a likely organism and make the choice clear. All
that pus suggested a gram-positive coccal infection, probably
pneumococcal, but other parts of the pattern didn't fit, nagged at me,
hinted at something unlikely and atypical. Or was I just trying to let
myself off the hook... make it seem more complicated than it was to
justify my screw up?

A sudden stench in the room told me someone had gotten a stool sample.
Even though her source of infection was obviously in her lungs, the
emergence of drug-resistant infections in many U.S. hospitals made
screening her feces for VRE, vancomycin-resistant enterococcus,
mandatory and routine.

I wasn't waiting for ID.

"Hang up two grams ofceftriaxone in one IV, and one gram oferythromycin
in the other," I told Susanne as I saw her get off the phone. I'd
cover a mix of possibilities for now.

"I.C.U is ready for her as soon as you can get her up," she reported as
she wrote out my order and handed it to one of the orderlies she'd
stationed at the door to act as runners.

We got Phyllis Sanders's pressure to rise a bit, started the
antibiotics, and snapped a portable chest X ray before whipping her off
to I.C.U, where they would put her on a respirator. We even managed to
slow down her heart with a bit of intravenous digoxin. The X ray
confirmed my diagnosis of pneumonia--her entire right lung and part of
the left were whited out by the infection--but by then the woman had
drifted off into a coma. Her blood results, when I finally got them,
were a disaster of falling white counts, rising liver enzymes, and
increasing renal failure.

Michael had tried to be supportive when he'd gotten over his initial
surprise at my declaration, assuring me he was certain I'd acted
reasonably, but his reassurance hadn't helped. Even when he looked at
my notes on her chart from the previous day's visit and said he
couldn't see how he'd have acted any differently, I replied, "Given
what happened, I should have kept her."

"On what grounds?" he challenged.

"A little bit of temperature?

Look at the resident's workup. For once we can be thankful about their
habit of ordering too many tests. Apart from a slightly elevated white
count and a sodium of one-thirty-three, everything else was normal,
including the physical exam. Christ, the guy even ordered a chest X
ray, which frankly I wouldn't have done. From his note, apparently
there wasn't much on that either."

"A bit of COPD from smoking, and a minimal horizontal line in the lower
right lung we thought was either old scar tissue or atelectasis," I
interjected, precising the report from memory. We were huddled in a
quiet corner of the nurses' station, a large central room with huge
windows looking out on the rest of the department I kept watching over
Michael's shoulder for ambulances in triage or new patients in the
surrounding bed areas, but for the moment the city of Buffalo had given
us a breather and ER was quiet. Our residents seemed to be handling
whatever few cases the nurses had brought in.

"Obviously that little mark was the start of infection and was a lot
more significant than we thought," I added, sounding pathetically
morose even to myself.

"Bullshit!" Michael said, loud enough for anyone in the station to
hear. A young medical student looked up from her computer screen, but
no one else paid him any mind. He immediately lowered his voice, but
not his intensity.

"If a radiologist says that film suggests anything more than what you
called it, he's a liar. No one could predict that little mark was
brewing into what she had today, certainly not without a previous film
to compare it to--which, by the way, makes me wonder why she came here
to St. Paul's instead of the staff health service at University
Hospital."

"She was on vacation, St. Paul's was closer to her home, and she said
she didn't like everybody at work knowing her business anyway," I
answered, only giving part of the reason, In fact she had phoned in
ahead of time and found out I was on call.

"I work with his wife," she'd announced at triage, putting everyone on
the defensive.

She'd increased the level of discomfort even further by proclaiming,
"And my son's the chief technician for the labs at her hospital." By
the time she'd done the same routine with the resident who'd initially
assessed her--browbeating him into ordering more tests than he might
normally have asked for--anyone who went near the woman resented her. I
only learned all this from the clerks and nurses after I'd sent her
home. But I'd already taken my own dislike to Phyllis Sanders.

"I know Janet. Dr. Garnet," had been her greeting when I'd appeared
at her bedside to review her case with the resident.

Dr. Janet Graceton is my wife, an obstetrician at University
Hospital.

I met people all the time who announced they knew her, had had their
children delivered by her, thought the world of her, but this had been
different. I felt I'd had my chain yanked.

"I've heard so much about you as well," she'd continued in a high whiny
voice. Sitting up in her hospital gown, her arms crossed in front
other chest, her gray hair pulled tightly back into a bun, she'd seemed
rigid, held in. She'd forced a smile, but it had looked like a
reproach as her forehead frowned while her lips turned up. All the
while her eyes seemed to say Are you going to disappoint me too ?

I'd resented her immediately and had been particularly repulsed by her
attempt to use her acquaintance with Janet to manipulate me.

When she'd told me her son's position and then added, "He's worked with
your wife too, you know," I'd barely kept the irritation out of my
voice. Go do your wheedling for special treatment in someone else's
ER, I'd been thinking while explaining she'd nothing much wrong with
her.

"How long did you say she'd been sick?" Michael asked, snapping me
back from my thoughts.

"Only a day," I answered, trying to keep my words steady and not sound
defensive.

"She'd had a slight headache when she woke up that morning, then the
temperature and diarrhea."

"It doesn't sound like much to bring a nurse in toER I wonder if she
chose Saint Paul's over her own staff health service because they had
her number there and knew she was a malingerer?"

"Maybe," I answered, not admitting that was exactly what I'd suspected
as I'd firmly insisted she could go home.

"Obviously she wasn't malingering this time."

Michael gave me a smile and clapped his hand warmly on my shoulder.

"You made a solid call. Earl, given what was there. Hey!

After all your years in the pit, you of all people should know you
can't beat yourself up over every disease that turns nasty." He
finished signing off his part of today's resuscitation, handed
Sanders's chart back to me, and added, "When this case is reviewed,
everyone will agree with me." He then strode briskly out of the
station and over to where a new ambulance case had been rushed into
triage.

He'd meant to support me, but the mention of a case review un leashed
once more the sense of dread I'd been trying to control. All
unexpected return visits trigger investigations to identify possible
slipups. I'd instigated the mandatory checks myself when I'd first
become chief over eight years ago. But not all physicians at St.

Paul's Hospital had appreciated my setting up an arena where their
errors were dissected and laid bare for critical scrutiny. Whenever I
had a case on the schedule, more than a few of these doctors turned up
hungry to settle old scores. This time they might have a point. As I
signed off my own notes, my memory of yesterday's encounter kept
playing over and over. Had my resentment at the woman made me miss
something?
Chapter 2

I spent the next five minutes trying to make sense of a rambling
history given by an earnest medical student about an old man who seemed
to hurt everywhere. I ended up suggesting he discuss the patient with
Michael.

"Dr. Garnet," called the ER clerk from her work area on the other side
of the station.

"It's bacteriology on line three, about Mrs.

Sanders."

I grabbed the desktop telephone beside me and punched the third
button.

"Garnet here."

"Dr. Garnet," said the technician, his voice obviously excited, "it's
staph. Clusters and clusters of gram-positive cocci on the Gram stain
other sputum."

"You're sure?" I questioned, surprised.

"It's not just strands of pneumo cocci heaped together?"

While both these organisms are gram-positive cocci, that is, when
treated with Gram stain reagents they stain blue and appear round under
a microscope, pneumococcal bacteria line up in strands and pairs
whereas staphylococci tend to occur in clumps and to resemble bunches
of grapes. I'd been expecting pneumo cocci

"It's out of a textbook," he replied, "like a goddamned vineyard.

I'm keeping the slides for our teaching file. All the other cultures
are being plated out now."

He was as excited as a kid with a new toy. Staph pneumonia was
unusual, and bacteremia from staph pneumonia was outright rare. In all
his enthusiasm he seemed to have overlooked that he'd just given Mrs.
Sanders a one-in-three chance of dying.

"Do you know if it's a hospital- or community-acquired infection?"

he asked eagerly.

It was a good question despite the macabre exuberance.
Hospital-acquired staphylococcus was apt to be resistant to the
antibiotics we'd given her. One strain in particular, called MRSA, or
methicillin-resistant staphylococcus aureus, responded only to
vancomycin.

"She's a nurse at University Hospital," I replied.

"I suppose we'll have to assume resistance until we get your culture
and sensitivity results."

"Thanks for the great case. Doc!" he said before hanging up.

I was left shaking my head.

I called I.C.U and informed the charge nurse about the Gram stain
result. She told me ID still hadn't seen Sanders, so I ordered
vancomycin--just in case' Do we stop the erythromycin?" she asked, not
unreasonably. If the pneumonia was caused by staph, erythromycin
wouldn't add anything to the treatment already in place, except an
increased chance of side effects.

But I hesitated.

"Dr. Garnet?" asked the nurse, after a few seconds of silence.

Something still didn't fit. I couldn't pin it down, but one thing I'd
learned not to ignore in ER was an uneasy feeling that I was missing
something.

"No," I answered slowly, "leave it until ID sees her, and have them
call me here when they do. They'll probably change all my orders
anyway. By the way, has anyone talked to the family yet?"

"There's no answer at the woman's home. Her chart from yesterday says
she's widowed--Sanders's her maiden name--but the next of kin is her
son, a Harold Miller, with the same phone number.

Did he send her in?"

"No, according to the ambulance sheet a neighbor found her this morning
and dialed 911." I hesitated before giving my next suggestion.

But it had to be done.

"Her son's in charge of lab technicians at University Hospital. You
might try for him there. Tell him he can reach me in ER."

After I hung up, I glanced around the department, confirming that
Michael and the residents still had things under control. I stepped
over to a set of corner shelves where we kept reference texts. While
most of the residents used the computer to access material on any given
topic in emergency medicine, I still preferred the written page.

As chief of the department, I could assure we had both.

Despite the Gram stain result identifying staphylococcus, there were
simply too many features of this case that seemed unusual. I pulled
the middle volume of a medical text published by Scientific American--a
large three-ring-binder format that was updated monthly--and found the
section on pulmonic infections.

Looking at the differential diagnosis of pneumonias in a systematic
outline relaxed me. The bits and pieces of various syndromes suggested
by Sanders's symptoms suddenly seemed to settle into an organized
pattern. The thickness of her sputum and the presence of blood was
indeed consistent with the more common pneumococcal infection that I'd
been expecting to find, but pus was also a hallmark of how staph
infections released toxins that destroyed tissue and so created
abscesses. The bloody sputum could have been the result of non cardiac
pulmonary edema--a condition in which shock and sepsis break down the
membranes lining the tiny air sacs through which oxygen normally passes
into the blood. The result is a leaky-lung syndrome in which these
same little sacs are flooded with blood-tinged serum.

The article reiterated that staph organisms were carried in the
nostrils of up to fifty percent of hospital personnel, a well known
statistic, and that this was the most common nosocomial, or
hospital-acquired, source of this infection with elderly or
immunocompromised patients. In the update, however, was a new
statistic. The incidence of serious drug-resistant organisms in U.S.
hospitals, namely, MRSA or VRE, was now up to forty percent.

This creepy piece of data made my skin crawl. I immediately felt the
urge to wash my hands.

But the next chapter, while reassuring about my personal safety,
reinforced my suspicion there was something strange about Sanders's
being infected at all. Healthy adults only developed pneumonia from
staphylococcus after some event, like an influenza infection, made the
lung susceptible. The expected pattern was a flu like illness for at
least five days and then the classic symptoms of life-threatening
pneumonia we'd seen in Sanders today. The one-day prodrome she'd
presented with yesterday wasn't part of the picture.

Peering at the small print through the bottom part of my glasses, I
suddenly realized the yellow droplets from Sanders's sputum were still
dried on the lenses.

"Shit!" I exclaimed. The same medical student who'd overheard
Michael's profanity gave me a disapproving look.

"Sorry," I muttered, and rushed out of the nurses' station.
Illogically, I held my breath while running to a utility room. There I
whipped on a pair of gloves, dropped my glasses into the deep sink
where mops were cleaned, and emptied half a container of concentrated
cleaner on them. My eyes were red with the fumes by the time I
finished rinsing them off. On returning to the nurses' station, I
smelled like a recently scrubbed toilet.

"Phew!" said Michael, who was standing over the open book I'd
abandoned on the counter. The section on pneumonias must have caught
his eye.

"What are you using for aftershave?" he kidded, but his laugh sounded
a little nervous.

"Smart-ass!" I stepped by him to put away whati'dbeen reading.

"Hold it," he cautioned, and pointed to a section I hadn't looked at
yet.

There, in a succinct paragraph, was exactly the prodrome I'd been
looking for.

The pneumonia is preceded by a one day history of myalgia, malaise, and
a slight headache after an incubation period of 2 to 10 days.
Gastrointestinal complaints, especially diarrhea, may be present, and
orthostatic dizziness has been reported. The cough is initially
nonproductive.

I looked up to the title of this section. It was Legionnaires'
disease.

Little Gary Rossit, the chief of our infectious disease department, was
the biggest son of a bitch in the hospital. Whenever he could use his
considerable knowledge about communicable illnesses to humiliate his
fellow physicians, he did so with relish. Perhaps it was his way of
paying back the rest of the world for being taller than he was. I
always suspected he simply enjoyed being mean. That his considerable
skills also helped desperately ill patients get better was why most of
us put up with him.

"Look, Earl, just because you booted the case yesterday, don't think
over diagnosing the same symptoms today and ordering every antibiotic
you can think of is going to let you off the hook."

I felt my face flush with anger. We were outside the isolation cubicle
in I.C.U, a well-lit glassed-in room located against a back wall of the
department. He'd just finished pulling off his cap and other
protective wear after seeing Mrs. Sanders, and his wavy black hair was
sticking up in tufts. I had to resist grabbing one of them and lifting
him off the floor by it.

"I've ordered the lab to test for Legionella," I told him, gritting my
teeth to help me keep my temper. Special culture and staining
techniques that could take up to three days were required to isolate
the hard-to-detect organism. Even then, none of the tests was
one-hundred-percent sensitive.

"Where's your reference to justify even thinking of those tests," he
asked belligerently.

"There's no literature on Legionnaires' preceding staph pneumonia."

"Show me literature on staph pneumonia and bacteremia after a
twenty-four-hour prodrome in an otherwise healthy adult," I shot back
at him.

We glared at each other for a few seconds. The resident in charge of
I.C.U who'd been listening from a few feet away started to fidget Then
Rossit shrugged.

"No wonder we're way over budget," he muttered as he walked over to a
large desk near the central nurses' station where he began writing his
consultation note. Behind him were dozens of monitors and screens
arranged on a wide curved console--a flashing array of fluorescent
tracings, blinking numbers, and squiggled readouts. Every now and then
an alarm bell would softly sound and get the attention of a nurse.
Sometimes she'd readjust the monitor. Other times she and her
colleagues would rush into one of the many curtained cubicles that
lined the room and perform some procedure on a patient, out of sight.
Occasionally there would be a cry or moan, but I.C.U was generally a
quiet place where conversations were hushed and pain was monitored,
measured, and medicated until it was endured without a whimper.
Somewhere on the blinking wall of screens in front of me were the
numbers that documented Mrs. Sanders's agony.

The resident hesitantly approached and asked, "Dr. Garnet, what do we
do if he discontinues the erythromycin?"

Erythromycin was the treatment of choice for Legionella.

"Ignore him," I answered none too quietly.

"He's only a consultant giving an opinion."

I watched the little man flinch, sign off his brief entry with a
flourish of his pen, then rise and start back toward me. He was
shaking his head and trying to smile, but it was his turn to look
flushed.

"At this stage. Garnet, I think she's SOL, whatever we do. Our next
discussion about her will probably be at Death Rounds, when we'll have
the benefit of an autopsy and not have to endure some cock-and-bull
scenario cooked up by you to assuage your own guilt.

And by the way, chum, you did miss something yesterday that justified
keeping her." He abruptly wheeled about and walked swiftly toward the
exit. As he hit the metal disk that activated the sliding doors, he
glanced back at me. His bristly mustache, stocky body, and short legs
usually reminded me of a video game character, but there was nothing
comic in the triumphant glare he gave me before he stalked from the
room.

Looking embarrassed, the resident was tugging at her stethoscope.

"Excuse me. Dr. Garnet, but I have to round on the other patients,"
she said nervously, then rushed off to one of the cubicles.

I exhaled, trying to release the knot that was quickly tightening in my
stomach again, and forced myself to go over to the desk where Rossit
had left the chart. Cursing the little man's hostility, I quickly
reviewed the notes from yesterday's visit, yet couldn't find what he'd
inferred--and what I'd been dreading--that I'd missed something basic.
I was about to dismiss the accusation as a cheap shot when my eye fell
on a circled passage in the nurse's notes.

2 p.m. Patient discharged home by Dr. Garnet. Reported feeling dizzy
on standing but complaint passed when sitting. Patient taken to front
door in a wheelchair and helped into a taxi.

Orthostatic dizziness--the nurse should have recognized it was
significant and taken the woman's pressure standing. We would probably
have picked up a drop and known she was becoming unstable.

At the very least we would have started her on an IV to rehydrate her
and observed her vital signs. We would have had her here when she
decompensated, and earlier administration of antibiotics would
definitely have increased her chances of survival.

Sanders herself must have known the dizziness was of concern.

Had she protested, insisting that someone should take her pressure
again, but only increased the antagonism other nurse? Had she been
ignored and hustled out the door in a wheelchair?

In any ER, the attitude of the chief sets the tone. Kidding and
teasing aside, I knew my staff usually took their lead from me. Even
though we'd all found Sanders tiresome, it was up to me to make sure my
own attitude and dislike of the woman hadn't implicitly signaled that
the patient was a crock and that her complaints weren't to be taken
seriously.

Rossit was right. I'd missed a key sign oforthostatic hypotension that
was clearly there to be found. Worse, I'd probably assured no one else
would find it either.

I literally fled from I.C.U.
Chapter 5

Seeing patients was going to be difficult. As I headed down the
stairwell from the third floor, I thought of signing out to Michael
until I felt more collected, but the idea of sitting around and
dwelling on things unnerved me even more.

When I arrived in ER I took Susanne to a quiet corner and explained
what I'd learned. The expression on her face quickly registered the
same anxiety I was feeling.

She groaned.

"Oh no. Who was the nurse?"

In my confusion upstairs I hadn't bothered to notice.

"Sorry, but if you go over the chart, her note is now plenty obvious.

Rossit was kind enough to circle it."

"You're kidding!"

"You know how he is. Nailing the mistakes of others is a blood sport
to him, and I'm afraid he can't wait to wipe the floor with me over
this one. The trouble is, in his eagerness to have my hide, he's
likely to smear everyone else in the department who went near
Sanders."

"Chiefs make for especially good hunting, do they?" she asked harshly,
obviously angered by the prospect of Rossit's legendary trouble making
hitting so close to home.

"Christ, the man's a menace.

He makes everyone in the hospital want to cover up mistakes "instead of
learning from them."

I gave a little laugh.

"That's exactly what some physicians think about my mandatory reviews
of unexpected return visits."

I must have sounded as miserable as I felt.

Her eyes widened in surprise.

"Earl Garnet!" she exclaimed.

"How can you even think of yourself in the same category as a louse
like him. You're fair in those reviews, and everyone knows it, even, I
suspect, the ones who resent having to look at their own errors. You
help physicians be better doctors. Earl. Rossit doesn't care about
that. He's vicious, pure and simple, and everybody knows that, too!"

Susanne hardly ever called me Earl, except when we happened to meet at
a social function outside the department. At work, even after all
these years, she insisted the chain of command be evident and clear to
all our staff. The practice was one of the many fundamentals she
adhered to that ensured we ran a tightER Realizing the damage Rossit
could cause had obviously rattled her.

Still, I appreciated the spontaneous outburst of support.

"Thanks Susanne," I said, trying to sound a lot less worried than I
was, but her frown deepened.

"Are you sure you want to work? It's not that busy, and you could do
the light cases."

"Sanders had been a light case," I muttered without thinking.

Susanne started, then slowly nodded.

"Yeah," she said quietly.

"I

know what you mean."

In ER, the so-called little cases were the sleepers--the ones that
occasionally hid something rare but lethal. For most competent
physicians, the sicker the patient, the more straightforward the
treatment The already dead--a cardiac arrest--were the most routine
cases of all.

"The shape I'm in right now, Susanne, I'm probably safest in res us I
left her standing there with a doubtful look on her face as I headed
toward the triage desk to find the sick est patient we had.

For the next twenty minutes, a bad asthmatic in severe respiratory
distress kept me busy enough to push away any thoughts of Sanders and
Rossit, but when I got to more routine cases, those thoughts, always
present at the back of my mind, came to the fore. Each time I began
listening to a person's complaint and attempted to seem empathetic, I
felt like a fraud. I kept imagining Sanders's eyes. Remembering her
expression. Are you going to disappoint me too?

Then her son phoned.
I'd been sewing up the lip of a five-year-old girl who'd been dancing
on a slippery staircase in her stocking feet.

"Dr. Garnet," the clerk had summoned, poking her head in the door of
our minor surgery room.

"There's a Mr. Harold Miller from University Hospital on line three
inquiring about the Sanders woman."

"I'll be right there," I said, tensing.

I finished my suture and got to a phone.

"Mr. Miller, it's Dr. Earl Garnet. No doubt you're calling about
your mother?" I kept swallowing, but my mouth was dry.

"Dr. Garnet! I was in the medical library at the university, and our
lab secretary reached me only a few minutes ago. A nurse from your
I.C.U called and said you'd admitted Mother with a diagnosis of
pneumonia and septic shock?" His speech was fast and clipped. He
sounded tense, but I couldn't tell if he was also angry.

"I'm afraid she's very ill, Mr. Miller. I'm glad you're on your way,"
I said as evenly as I could. I hated having these conversations on the
phone, especially this one. Without seeing the face of the person I
was talking to, I couldn't fully judge the impact of my words. I
wasn't going to lie, but I didn't want to let something slip out that
would hand my head to his lawyer, either.

"But Dr. Garnet, what happened? I talked with her around ten last
night. She said that she saw you yesterday afternoon and you told her
everything was okay, that it was just the flu."

"You saw her last night? And she was all right?" I'd assumed she must
have deteriorated from the time she left ER. If she was still
apparently not too sick after ten, she must have gone septic in less
than twelve hours.

"No, I didn't see her," he answered.

"I phoned her at home from the hospital. I was on call for the night
She sounded like you said, like she had the flu."

Then wham, the kind of virulence we shouldn't see in an otherwise
healthy woman in her fifties. I suddenly felt more compelled to
explain that riddle than to try to avoid being sued. Perhaps I'd do
both.

"Mr. Miller, I apologize for questioning you on the phone about this,
but your mother's infection puzzles me. It's not typical, and perhaps
you can help us find the answers. Do you want to meet me in I.C.U?"

"Sure, but what do you mean 'not typical'?"

"The prodrome was unusually quick."

"What did the Gram stain show she has? Come on. Dr. Garnet, what are
you not telling me?"

Damn! I'd really wanted to do this face-to-face, but I didn't want to
cut him off. He was sounding increasingly alarmed.

"I'm afraid the Gram stain of her sputum showed staphylococcus," I said
as calmly as I could.

"Staph!" he exclaimed, incredulous.

"My mother has a staph pneumonia?"

I listened to him breathing a few seconds as he presumably digested the
odds against his mother's survival. As a chief technician, he'd
certainly have enough medical knowledge to know how grave her prognosis
was.

"Look, Mr. Miller, come over, and let's talk here " "Do you think it
was hospital acquired? You know she'd been on vacation for five days."
His voice was becoming much more agitated, but he seemed determined to
continue on the phone.

"Don't leave me hanging," he ordered.

I had to reply.

"Yes, I was worded that it was a hospital-acquired organism," I began,
"and that she might have MRSA, so I covered her with vancomycin." Let
him satisfy his immediate need for answers I decided. It might help
him prepare for seeing his mother so ill.

"Even with her being on vacation," I continued, "she could have been
carrying dormant organisms from the hospital in her upper respiratory
tract, as you're no doubt aware. Have you had any recent problems with
staphylococcus infections at University Hospital?"

"Not lately, but we have had MRSA in the past. I know because I'm on
the infection control board, along with your wife, Janet."

I cringed at his innocent use of Janet's name. It was like an
unwitting rebuke, and I prayed he'd never know how I'd resented his
mother for making the same reference yesterday.
"Your mother said she was in good health until the morning of her first
visit here. As far as you know, was that accurate?"

"Yes. She hadn't anything wrong with her that I knew of, apart from
her smoking."

"Might she have minimized a five-day flu like illness? Ignored the
symptoms? Not mentioned them to you?"

I heard a gentle chuckle.

"Dr. Garnet, my mother never minimized anything." His voice relaxed a
little; it was lower, less strained. Perhaps having a clinical
discussion, even over the phone, was helping him get over his initial
shock.

So I continued with my questions. To be honest, I found myself
especially wanting to know the details of what had happened to her
after I'd sent her home. That her son had talked to her so many hours
after I'd discharged her and she still wasn't very sick somehow made me
feel less guilty.

"Last night, did she complain to you about dizziness?"

"Not really. She said she felt a bit unsteady. But I assumed it was
the usual lightheadedness that went with the flu. Why?"

Careful now, I thought before answering, still not wanting to hang
myself legally.

"Her prodrome, and this may be off the wall, well, it suggested another
not so common but very bad infection."

"What are you talking about?" His voice rose sharply.

Damn! I was upsetting him again, I thought, as I tried once more to
calm him.

"Mr. Miller, please, it's all supposition right now.

Come over, and we can talk further, right after you see your mother."

"What rare and very bad infection?" he demanded, his anger now clearly
evident.

Great choice of words, Garnet, I cursed to myself.

"Mr. Miller, I repeat, I have no proof, and ID thinks I'm nuts even
bringing it up--" "Answer me!" he snapped.
"It reminded me of Legionnaires' disease," I finally admitted.

"Oh Jesus!" he said, and hung up on what sounded like a sob.

I'd retreated to my office, a cubby hole located in a back corridor
away from ER. My secretary, Carole Lament, had phoned in sick for the
day, so thankfully I was alone.

I sat at my desk without the lights on and wondered what else I could
do wrong. A small window in the outside wall was too grimy to see
through, but it let in a little gray illumination. The effect was
positively cheery compared to my mood.

I'd botched Sanders's first visit. My attempt to comfort her son was
worse man a disaster. Instead of reassuring him as I'd hoped, I'd
frightened him even more with my questions and talk of Legionnaires'
disease. Why hadn't I just kept my goddamned mouth shut?

Because I was increasingly impatient to know everything about this
infection that had tricked me.

Maybe Rossit was right. My guilt was making me overcompensate and
screwing up my judgment I'd better warn I.C.U that Mr. Miller was on
his way over, nicely primed, I thought, reaching for my phone. Stewart
Deloram, their chief, would have to deal with him personally. If there
was any hope of settling him down, Stewart could do it. I'd learned
firsthand when I'd once been a patient of his how supportive he could
be. Perhaps, despite the mess I'd made of things. Miller could still
trust the I.C.U staff enough to help him cope with what lay ahead for
his mother.

"Dr. Deloram is in the main auditorium attending an administrative
meeting," his secretary announced.

"Shit!"

"I beg your pardon!"

"Sorry. I just remembered where I'm suppose to be. I'll find him
there."

I ran out the door and headed for the huge reception hall. The meeting
I'd forgotten in my preoccupation with Sanders was a doozy. The boards
of St. Paul's Hospital and University Hospital had decided it would
save money if they completely amalgamated the administration of the two
institutions. The gathering I was rushing to was a combined assembly
of all chiefs to begin the process of naming a common chairperson for
each clinical department. It was the political equivalent of sudden
death. For weeks now administrators and department heads at every
level had been squaring off and vying to keep their turf. There'd be
winners and losers, and needless to say, the struggle for ascendancy
was sometimes outright nasty.

I had mixed feelings about it all. The losers would remain department
directors in their own hospital under the authority of an absentee
chairperson. In my case, if I lost out to my counterpart at University
Hospital, I'd still be in charge of ERat St. Paul's and there'd be a
whole lot fewer meetings. But without the mantle of being chief, I'd
have no way of protecting emergency services from loopy policies
adopted in other parts of the hospital. In a time of cut backs, I'd
had my fill of them.

I hurried through a double set of doors and entered a noisy group of
about a hundred people. They were standing, talking animatedly, and
balancing paper plates of cocktail wieners and glasses of variously
colored juices the luncheon fare of austerity. Our home crowd was
still decked out in their lab coats; the visitors wore suits.

Obviously the formal part of the assembly was over.

I immediately started looking for Deloram. A few of my acquaintances
razzed me for being late and joked that I'd already lost my job, but
they didn't seem very merry. I also greeted a few friends of Janet's
whom I'd met at various University Hospital functions, but I didn't
stop to talk. I found Deloram at the edge of the crowd near the stage,
conversing earnestly with Scan Carrington, the chief of surgery.
Whereas Deloram was medium sized, dark haired, and meticulously
groomed, Sean was tall with permanently tousled red hair and a bushy
mustache a sort of Yosemite Sam in a white coat "Earl!" he greeted me
enthusiastically.

"What say we settle this nonsense like the old gladiator movies. Pair
us off right here, using wienie toothpicks "We who are about to die'
and all that stuff."

In spite of my problem, I couldn't help but grin. The man always tried
to keep us laughing.

"Sorry, Sean, but I need Stewart here for an emergency," I announced
stepping up and gently taking Deloram by the arm to steer him toward a
nearby doorway.

"Of course," said Sean, turning away.

"I was just going back to the food table."

"What's up?" Deloram asked as soon as we were out of earshot I hastily
explained all about Sanders, and my bungled attempt to talk to her
son.
"You'd better hurry," I concluded.

"It won't take him long to get here."

"I'll handle him," he said curtly, handing me his unfinished plate of
wieners and some kind of green juice.

"Try not to worry," he called over his shoulder as he rushed out the
door.

I was left eyeing the remains of his lunch, wondering if I should eat
something. The increasing tightness in my stomach said no, and I
dumped everything in a nearby bin.

I did rejoin Sean at the food table, where he was busily loading up
with brownies. Other people were starting to leave, and thankfully
Rossit was nowhere to be seen.

"They should take those out of your pay," I teased, pretending to grab
at Sean's plate.

"What pay," he mumbled, his mouth full.

"Seriously, what happened here today?"

He swallowed a few times.

"No specific appointments yet. But Hurst made it pretty clear he
intended to give up the chair of some services in order to keep
anesthesia and internal medicine chaired by St. Paul's."

"Terrific!" I groaned, not surprised. Paul Hurst was a former surgeon
and now our VP medical and acting CEO. He pretty well ran the hospital
the way he liked. The two chiefs of the departments in question were
wimps he could easily control. Sean and I, however, challenged him
whenever we felt he was out of line and were right enough times that he
couldn't fire us.

"Obviously he's found a new way to cut us down to size," I added.

"Oh, what makes you think that?" replied Sean, pointing to draw my
attention to the center of the room. There was Hurst, tall,
gray-haired, and pale as always, laughing heartily with Arnold Pinter,
the diminutive chief of internal medicine. Arnold usually slouched,
and from a distance he reminded me of a field mouse on the lookout for
hawks, except today. He was grinning broadly and looking as happy as
I'd ever seen him.

The two men suddenly caught sight of Sean and me watching them. As if
to underline my suspicions, they immediately stopped smiling, turned,
and walked away with their heads huddled together.

"Maybe they're afraid we can read lips," Sean commented.

We made small talk after that, but I sensed he was worried. For all
his clowning around, I knew that he loved being a surgeon, and that
being chief of surgery was his passion.

Minutes later the page came booming over the PA.

"Dr. Garnet! Call I.C.U immediately! Dr. Garnet! Call I.C.U!"

It was loud enough to momentarily hush the room, but conversations
started up again as I ran for a wall phone. In my rush I dropped the
receiver while punching in the familiar numbers. It was Deloram who
picked up.

"Earl?" he asked, obviously expecting my call. I could hear shouting
in the background.

"What the--" "He beat me here. Earl, and what's worse, the nurses had
shown him the chart, as a professional courtesy. The note Rossit had
circled practically jumped out at him, and he's livid. Worse, he wants
to transfer his mother out of here and back to University Hospital. The
trip's out of the question--she's too unstable--but I can't talk sense
to the man."

Christ, I thought. Then I saw a familiar head towering above all the
others in the room.

"Stewart, there's someone here Miller will listen to. Cam hasn't left
yet. Tell Miller he'll be up in a minute!" I ordered, hanging up
without waiting for his reply.

I made my way through the thinning crowd toward me blond-haired, slim
man I'd spotted. In his mid-thirties and dressed in a navy blue sports
jacket, tan pants, and a light blue shirt open at the collar, he
resembled more a movie star than what he was--chief of the Department
of Infectious Diseases and director of laboratory services at
University Hospital. In any group he was a head taller than the rest
and had to continually lean down to hear what others were saying. That
he spent a lot of time surrounded by physicians and residents was a
tribute to his brilliance. And unlike Rossit, he was every bit a
gentleman.

I'd met him several times with Janet and had even been lucky enough to
be seated near him at several of her hospital dinner parties.

His funny stories were legendary. More pertinent was that he was
Miller's ultimate supervisor.

Having no time for niceties, I pushed through the circle of people
around him.

"Excuse me. Cam," I interrupted, drawing irritated stares from the
people I jostled. Cam himself smiled and said, "Hi, Earl. How come
your lovely wife isn't here? We could make her chief of everything and
solve--" "I'm sorry. Cam. We've got a big problem in I.C.U with one
of the nurses from your hospital. It's an ID case, and we need your
help fast."

His smiling face immediately became serious.

"Of course," he replied.

"Excuse me, everyone; it's back to reality." There were appreciative
chuckles from his audience as he strode away with me and we headed
toward the door. I almost had to run to keep up. I talked as we
went.

"Her name is Phyllis Sanders, and of course you know her son, Harold
Miller."

"Harold? Certainly I know him. We just named him our director of
laboratory technicians. He's very conscientious. His mother works in
OH doesn't she?"

"That's right. She's in her fifties, smokes, but otherwise has no
major risk factors. I saw her yesterday in ER and sent her home with
what seemed like a mild, one-day history of the flu. She'd been on
vacation and lived nearby, so she came to us instead of going to your
staff health service. Unfortunately, she was returned to us by
ambulance this morning in septic shock due to pneumonia."

We swung through the doors to the stairwell and started up. He took
the steps two at a time. He showed no reaction to what I'd just told
him.

"The Gram stain showed staph," I puffed, "but the short prodrome
bothered me." We swung around the first landing and continued toward
the second.

"It reminded me of something else. ID here thinks I'm crazy, but..." I
had to stop speaking for a few seconds to catch my breath while we
continued to run. Cam was half a staircase ahead of me.

"It made me think of Legionella," I said, far too loudly.

He stopped in midstride.

"Pardon?" he said, turning to look down at me as I caught up to him.

"I know it's foolish. Cam, but when you see the labs and review her
initial symptoms..." I trailed oft.

I'd expected him to be bemused, skeptical even, though not as rude as
Rossit had been. Instead, he was staring at me as if he'd seen
Banquo's ghost.

"Cam, are you all right?" I asked, dismayed at the shaken expression
on his face.

"It's not foolish at all. Earl," he said finally.

"If you're right, and frankly I hope you're not, then she'd be the
third perfectly healthy nurse from our hospital in the last six months
to have contracted Legionella."
Chapter 4

It was my turn to feel astonished.

"But that--that's impossible," I stammered after getting over my
initial shock.

"It's against the odds. And Janet's said nothing about Legionella's
being a problem at your hospital. Besides, we'd all have known
about--" "That's what's so bizarre. Earl," he interrupted, turning and
continuing up the stairs.

"We don't have a problem with Legionella. We checked everywhere, for
each case, and there was no source we could find. Neither nurse had
been involved in treating patients with Legionella, no other staff
members had the disease, and no pools of the organism could be found in
water distribution sites throughout the building. Believe me, we
looked, especially after the second case. We had to conclude they
weren't nosocomial infections."

He stopped at the third floor landing and held the door for me. He
obviously knew where our I.C.U was.

"The really creepy thing is the timing," he added.

"Those two nurses also developed their symptoms shortly after going on
vacation."

"What?" I exclaimed, stopping.

"Go on. You're kidding me."

"I'm afraid not. The first became ill five days after leaving work,
the second within seven days of the start of her holiday." He gestured
we should continue walking.

"Did they vacation together?" I asked, starting along the corridor.

"No such luck. There were snide jokes about shared hot tubs, but in
fact they didn't even know each other. One worked in I.C.U; the other
was an OR nurse. Nothing in common whatsoever, and they were away at
different times. The second case spooked us so much we even had an ID
team check out her home and where she vacationed, but again, there was
nothing. That's why I hope you're wrong. It's going to shake up a lot
of people at our hospital, including me, if this is a third case."

He pressed the metal disk outside the sliding doors.

I 26

"Did they recover?" I asked.

"One died. The I.C.U nurse not only survived but is back on the job,"
he answered, lowering his voice as we stepped into our own I.C.U.

It was quiet. Deloram was leaning against a desk in the nursing
station, his arms folded. Beside him stood a young man dressed in a
green isolation gown who I presumed was Harold Miller. He had closely
cropped blond hair and, though of medium height, broad shoulders and a
compact muscular physique that was evident even with the loose
clothing. He immediately looked up as we entered.

Beside him was little Gary Rossit.

I felt my stomach turn. Rossit looked furious to see Cam on his
turf.

"Harold," said Cam, quickly striding up and putting his hands on the
man's shoulders.

"I happened to be here and heard about your mother. I just wanted to
drop by and offer my support."

Miller mumbled, "Thank you."

Rossit seemed about to protest.

Cam gestured to him, "I've always said Dr. Rossit here is one of the
best ID experts in Buffalo. I'd trust him to care for me or a member
of my family anytime." He glanced around and found a place to sit
down.

"What do you think of this case, Gary?" he asked.

Rossit's ego was as big as his mean streak. Praise from the likes of
Cam stopped him cold.

"Why, I, well..."

"Let's take a look at the chart," suggested Cam as he pulled up an
other chair and invited Rossit to sit beside him.

Deloram grinned and winked at me from behind Rossit's back.

Miller stood very still watching the unlikely Mutt and Jeff pair of
infectious disease specialists huddle over his mother's records and
talk quietly together.

I didn't know if I should say something to the man or leave him be. I
wasn't even sure if he'd read my identity badge and knew who I was.
While I hesitated about what to do, he slowly turned and looked up at
his mother in her isolation cubicle at the far end of the room. Its
interior was more brightly lit than the rest of the unit. He watched
her lying there, a tube in every orifice, wired to total life support,
and said quietly but very coldly, "It reminds me of a glass coffin. Dr.
Garnet, right out of the Snow White story she used to read to me when
I was a kid. Dr. Rossit says you put her there. I really don't want
to talk to you. Just get the hell away from me."

"You can't do that, Michael!"

"Can't I? With two other nurses contracting Legionella in the last six
months!" he said incredulously.

We were alone in my office where I'd taken him so we could talk in
private. Michael had handled ER alone without a problem while I'd been
running around about Miller. What he wasn't coping with very well was
Cam's revelation.

"I accredited that hospital a month ago," he continued.

"There was no mention of Legionella in the minutes of the Infection
Control Committee then. If those sons of bitches think they can cover
up..."

I let him rant. His tirade wasn't bothering anybody, and I was still
trying to shake off what had happened in I.C.U. Miller's cold anger
wasn't a surprise, nor was Rossit's quick attempt to stir him up, but
both were unnerving. Rossit must have heard them paging me and--like a
shark catching the scent of blood--rushed over to see if it was about
Sanders.

"Why shouldn't I check them out?" Michael demanded, grabbing my full
attention.

"Because they'd say it was an abuse of your powers as a hospital ac
creditor for the state of New York," I answered. Accreditors were the
medical equivalent of tax auditors. They checked out hospitals to
assure they complied with the clinical and academic standards necessary
for public safety. Only the most credible physicians were chosen to
render these judgments, and Michael Popovitch was chosen more often
than most. By convention, they always assessed hospitals other than
their own to protect themselves from retaliation by their colleagues
and administration should they issue a particularly critical report.

"Nonsense!" he scoffed.

"I worked on the Sanders case. Nosocomial infection is suspected.
She's a nurse at University Hospital.

Doesn't that give me cause to alert them to a possible problem? I'll
call Cam tonight. If he's as forthright with me as he was with you,
I'll offer to look at the charts of those other two cases. I'll tell
him that at this stage it could be kept informal. Believe me, with the
jockeying for primacy going on between the two hospitals because of the
amalgamation, he'll jump at the chance to settle this privately. The
last thing University Hospital wants right now is a public review of a
Legionella scare."

"I don't know, Michael--" "A follow-up visit's in order here. Earl,
and if your tests for Le 9 gionella are positive, then University
Hospital is going to get hit with a full official visit from our team.
Who knows if they're as clean as they think? One teaching hospital I
visited that claimed it had never had Legionella had missed the
diagnosis in fourteen percent of its nosocomial infections. We found
the organism in two- thirds of the hospital's water supply
sites--drinking water, shower water, whirlpool bath water--" "Cam
assured me they'd checked all that," I interrupted.

"Hey, Earl. He's the best, but he's under the same kind of pressures
to cut costs and cover up bad news that we are. Besides, the
organism's even harder to find in water than it is in sputum, and the
tests are costly. Bottom line. Earl, there's something really screwy
going on over there, and it could be dangerous for anybody in the
place, patients or staff."

I knew he was using me as a sounding board, to test just how defensible
his twisting of the rules was going to be. But instead of continuing
to try to dissuade him, I found myself wanting him to go, to find out
what I'd been up against in the Sanders case after all. And I found
myself thinking of Janet.

"Yeah, I suppose you're right," I answered.

I drove home in the rain around 6:00.1 wanted Janet to be there. I
wanted to hold our baby son, Brendan. I wanted sanctuary.

What I got at the back door was our fifty-pound poodle, Mufiy.

As she leaped and wiggled for attention, I managed to get by her and
into the kitchen. The house seemed quiet A note on the kitchen table
from Amy Hollis, our live-in nanny, informed me that she'd gone to bed
early, that Brendan had been fed, bathed, and put in his crib, and that
Janet had phoned to say she'd be at a meeting until 10:00.

The only one thrilled to have me to herself was Muffy. I hooked up her
leash and took her outside. She normally loved walks, but she hated
rain. We were back in no time.

After drying her paws and giving her a biscuit, I headed upstairs to
the baby's room. Though it wasn't completely dark outside, I turned on
the night-light when I reached the side of his crib. He was lying on
his back, his Hide fists up by his head. I never tired of watching
him, even in his sleep.

Unable to resist, I reached down and picked him up. He was still so
small and weightless that I held him easily in one arm as I pulled a
rocking chair over near his bedroom window. He gave a few little
grunts, moved his fists around, and found his thumb. Three halfhearted
sucks, and he was back to sleep. I sat with him listening to the rain
until the last gray light of evening had turned to night.

Then I put him back in his crib, had a bowl of soup, and climbed into
bed to wait for Janet.

We had started making love in our sleep, unconsciously moving against
each other, becoming aroused, until I awoke already in her, both of us
thrusting and straining to climax.

"God, where did that come from?" whispered Janet afterward, rolling
over to lie against me.

I was flopped on my back, still trying to get my breath. It wasn't the
first time we'd made love since Brendan was born, but it had felt like
it. The fierceness had surprised me.

"We gotta have sex more often," I said.

"That was incredible."

Janet gave a throaty chuckle.

"Three a.m. feedings and a live-in nanny make that kind of hard. But
pent-up lust is nice."

"I didn't even hear you get home."

"You're the perfect obstetrician's spouse. Earl. You can sleep
through anything."

"Do you think we woke anybody?" I asked, listening for sounds from the
baby's room. There were none.

"Do you think we made him a brother?" asked Janet, nestling her head
against my chest.

"Janet!"

"Hey, you didn't exactly give me much warning, you know. I may deliver
babies, but I can't change the rules of nature, especially that one
about how they're made." She raised her head and looked at me, resting
on her elbow and cupping her chin on her hand. In the moonlight from
our bedroom window, I saw her smile.

"You aren't ready for the next one? What's so hard on you about having
another baby, apart from having a little fun with me?"

"I thought you might want to wait a little bit."

"Really! I may be your tall sexy blond, but I'm also forty-one, and
it's family time if you really want all those other little Garnets we
talked about."

I grinned.

"No argument from me there, ma'am. Just let me know when and where you
next need my services, and I'll be ready."

She giggled, then lay down and snuggled up at my side.

"Can you fifty-year-olds do it more than once a week?" she asked
slyly.

"Forty-eight, smart-ass."

"And a half," she corrected sleepily, laying her thigh over my groin.

"Do you think Amy will hear us?" I whispered, feeling encouraged.

"Earl, I think she knows we do it."

"I love you, Janet," I declared, suddenly clinging to her, trying to
keep away thoughts of the hospital. Damn it! I thought, don't rob us
of this.

"You just want my smart ass," she murmured into my ear while sliding on
top of me and straddling my hips.

Brendan started to cry.

Three a.m.

I groaned.

"Oh no."

I did the night feedings.

Twenty minutes later I was sitting in our darkened living room holding
Brendan and listening to him smack up the remains of his bottle. Even
by the streetlight I could see his brilliant blue eyes as he kicked and
punched with his pudgy little limbs, then grabbed the rubber nipple and
noisily finished gorging himself. I settled back on the couch,
refusing to be distracted by my worries, and tried to enjoy the
spectacle. His funny small fingers were practically holding the
plastic container.

"I gave birth to him; you can feed him," had been Janet's decree on the
division of labor. Her real worry was being called away from him all
the time for deliveries.

"Besides," she'd added, "don't guys your age have to get up at night
anyway?"

Nearly six months old, Brendan was sleeping through most of the time,
but occasionally, he got an urge for the good old days. And I didn't
mind, not even with tonight's interruption.

The phone rang, and I snapped up the receiver. If it was for me, I
didn't want Janet wakened needlessly.

"Dr. Garnet here."

"Oh, Dr. Garnet, it's the case room at University Hospital. I'm sorry
to bother you, but we need Dr. Graceton."

"No problem. I'll get her for you."

But already Janet had picked up the bedside extension.

"It's okay, Earl. I've got it."

I hung up, then sat watching Brendan suck at the dregs of his feed.

I was putting him over my shoulder to burp him when Janet descended the
stairs in her OR greens, obviously having been called in for a
delivery. Even in that shapeless garb, she was a terrific-looking
woman. She finished hooking up her hair into a ponytail with an
elastic band, then walked over to take Brendan from me.

"I've got twenty minutes. Why don't you make us some coffee?"

Brendan replied with a loud burp and spewed out some formula onto
Janet's shoulder.

"That's okay, my little angel," she said.

"This outfit will see a lot worse before the night's out."

On my way to the kitchen, I had to step over a large, dark mound in the
hallway that gave a low growl. Muffy had gone into a sulk when Brendan
arrived and moved out of our bedroom into the downstairs hallway to
sleep. Tripping over her was now part of the nighttime feeding
routine.

Five minutes later Brendan was asleep on the couch between Janet and
me. It was 3:40. Muffy had deigned to come and lie at our feet but
wouldn't look at the baby.

"Longest mope I ever saw," said Janet, reaching down to ruffle the
drooping ears.

"Are you going to be back for breakfast?" I asked, hoping for a chance
to talk.

"No, I'll stay at the hospital. I've got a lot to do today."

I felt a twinge of disappointment but wasn't going to say anything.

Janet looked straight at me.

"Cam told me what happened with Phyllis Sanders, Earl. The meeting
tonight was an emergency session of his Infection Control Committee.
My, you certainly set the cat among the pigeons. Even your buddy
Michael Popovitch showed up later, as an observer. He got Cam on his
cellular halfway through our session--calling about Sanders--and got
himself invited over. The trouble is, none of us came up with
anything."

I looked at her, astounded.

"Why did he act so quickly?"

"He had to. Whether Sanders has staph pneumonia with an unheard of
prodrome, or the equally unlikely combination of Legionella and staph,
the nosocomial implications have to be looked at. Besides, he's really
spooked, like the rest of us, by the mystery of why and how the nurses
got sick only after they left on vacation.

Two cases might be a troubling coincidence, but he couldn't sit on a
third."

I didn't know what to add.

"Did he tell you about Rossit?" I asked, after a few seconds.

"He mentioned it, privately, and told me not to worry. But I'd like
you to tell me what happened."

I must have talked for five minutes. The whole time Janet cradled
Brendan and stroked Muffy's ears. Even my admission of how I'd
resented Sanders didn't change her expression. She simply listened and
let me unburden myself. I felt knots I didn't know I had let go in my
stomach.

When I finished, she kept staring out the window. I waited for her to
say something, but she remained silent.

"Janet?" I asked, starting to feel uneasy.

"They were all bitches," she said in a faraway voice.

"Janet!" I protested, not believing what I'd heard.

She turned to me, suddenly becoming animated.

"You're right, Earl. It's a terrible thing to say, even to think, and
that's why no one has seen what those three nurses have in common."

"C'mon Janet, you can't call--" "Earl, Phyllis Sanders has always made
people resent her. Doctors and nurses at University Hospital have been
resenting her for years without your giving them permission to do
it."

"Janet!" I protested again but smiled in spite of myself.

"She's exactly like the other two nurses in that regard. I know,
because time and time again my patients have complained to me about all
three of them."

I listened without another word. I had no idea where she was going
with this.

"You know the kind of nurse who makes a patient feel humiliated for
needing help, who seems to resent their demands, particularly the
emotional demands put on them by those in their care. I'm not talking
about the occasional loss of patience; we all have those. I mean
systematic cruelty in little ways--delaying giving a bed pan, holding
back pain medication, leaving someone on a toilet too long, accusing
someone who's afraid or in pain of 'being a baby."" I winced. I'd had
to reprimand some of my own staff for such behavior, and they weren't
all confined to nursing.

"Sanders had some nerve invoking my name," Janet continued.

"I've forbidden her to go anywhere near my patients in the delivery
room. The second timers insist on it."

"So what are you suggesting?" I asked, feeling uneasy again.

"I'm suggesting that they're women who make people angry."

I sat there stunned.

"My God!" was all I could reply at first. What she was implying
couldn't be.

"You think that someone is deliberately infecting them?"

She sighed and gave Muffy's ears an extra rub. Brendan smacked his
lips, and Janet smiled down at him.

"It's crazy, I know. But, well, maybe I had those kind of crazy
thoughts for area son

If there was one thing I knew about Janet, she always had area son for
everything.

She looked up from watching the baby.

"Did you ever hear rumors about the Phantom of University Hospital?"
she asked, her smile for Brendan quickly fading.

"The what?" I said, not believing I had heard her correctly.

"Come on; give me a break."

She flushed.

"Hey! Don't laugh. It was serious at the time."

"Janet, what the hell are you talking about?" I still thought she was
kidding.

She sighed again and stared out the window.

"A few years ago there were some incidents that were brought to the
attention of the ID committee. They were lime things, but the staff
was worded. People would suddenly have unexplained but explosive
vomiting and think something had been slipped into their food or
coffee, but nothing was found. Another time an orderly came down with
a brief bout of bradycardia, dizziness, asthma, and diarrhea. He was
sure he'd been poisoned but couldn't prove it. There were other
occurrences, all brief, all nonspecific, and thank God, nothing serious
or fatal."

"Were they poisoned?"

Before answering she put Brendan over her shoulder and let him nestle
there.

"We were only responsible for checking that it wasn't something
nosocomial, but as far as I know, the events were never explained by
anyone else either."

"Hence, the story of a Phantom," I surmised.

"You got it. People started joking to each other to be good or the
Phantom would get them."

"Wait a minute. You're not saying these victims were like your
nurses."

"Let's just say there wasn't a lot of sympathy for them."

"Did they ever suspect anyone in particular?"

"I'm afraid not."

"Is it still going on?"

Janet looked up from adjusting Brendan's blanket.

"After what's happened in the last six months," she answered, "that may
have be come a very scary question."

Then the phone rang. Janet grabbed the receiver and answered, "I'm on
my way," without waiting for the caller to speak. She handed me
Brendan and was gone.
Chapter 3

Most ER doctors learn to sleep when and where they can. Normally I
would have grabbed another hour and a half before heading back to St.
Paul's. But after what Janet told me, I knew my sleep was finished for
the night. I returned Brendan to his crib, poured myself a second cup
of coffee, and stared out the living room window. Over the tops of the
nearby roofs and trees I saw a flash of lightning in the distance. I
counted about ten seconds before I heard a low roll of thunder.

I kept trying to dismiss Janet's suspicions. There was no way I could
conceive of by which Legionella could be transmitted to an individual
and be made specifically to infect him or her while sparing others.
That the victim could also be kept unaware of the attack seemed even
more impossible, if they had been unaware. The OR nurse had died. I
had no idea if she'd been able to answer any questions before her
death. Certainly Phyllis Sanders was in no condition to talk, whether
or not she turned out to have Legionella as well as staph. The
likelihood of her impending death went through me like a pain.

I assumed Cam had questioned the I.C.U nurse who had survived.

Yet, if Janet was the first to consider the infections were
deliberately inflicted, then Cam hadn't known the right questions to
ask. What would be that nurse's response now if she were prompted to
consider the infection as an attack?

She'd think we were loony was my instant reply, because whatever
unsavory personality trait the three nurses had shared, the possibility
they were all victims of a resurrected phantom stopped cold at the same
unsolved puzzle I'd started with--how could each of them have been
infected?

I got a third cup of coffee and mulled this over. Maybe it couldn't be
done. Maybe Janet was wrong, and the three women being nurses who were
obnoxious was a fluke. To be honest, if anyone besides Janet had tried
to suggest such a wild idea as a murderer being behind the Legionella
mystery, I'd have laughed in his face. Yet there I was, unable to toss
off the idea and not at all comfortable with the logic that it could
not be done simply because I couldn't figure out a way to infect three
women. Janet's instincts were too often proven right.

She possessed a rare gift--a brilliant intellect combined with plain
common sense--that made her judgments sound and her insights something
I'd learned to listen to or ignore at my peril. In University
Hospital, where her quick mind and clinical accuracy were legendary,
she was regarded as a treasure and was especially known for her ability
to look at the same symptoms and signs her colleagues had seen and to
think what no one else had thought.
They were all women who made people angry. The words kept rolling
through my thoughts like the ever-increasing thunder overhead, and were
joined by another idea. If she were right and the Legionella cases
were somehow part of a macabre vendetta being carried out at her
hospital, then asking questions about those cases could be dangerous.
Should I warn Michael?

By the time the rain began to pelt against the glass panes in front of
me, my stomach was churning on enough caffeine for the entire day.

Dawn was little more than a gray smudge in the east when I started out
for St. Paul's at 6:15. The downpour was deafening on my car roof. It
had soaked Muffy in the moments she'd taken to do her business in the
lane, but she'd enjoyed the extra toweling I'd given her drying her
off. When we'd finished, she'd playfully pranced about my feet, then
had pawed at a rubber ring that was her favorite toy, inviting me to
throw it. I'd bought her off instead with a dog biscuit, but as she'd
watched me go upstairs to check on Brenclan before I left, the sudden
droop in her ears and sad-eyed stare from her brown eyes had left no
doubts about what she'd thought of the deal. The object of her
jealousy had still been sleeping off his early morning feed. He'd not
even stirred when I'd gently stroked his head. Before leaving, I'd
given a gentle tap on the door of the nanny's third-floor bedroom to
warn her she was back in charge.

As I drove, the deluge increased and the wipers worked more like
paddles trying to keep the windshield clear of water. By the time I
reached the entrance to the expressway for downtown Buffalo, I found
myself leaning forward straining to see the other cars ahead of me. We
were all poking along at low speed, and the sign on the visor reminded
me I was likely to be killed by the air bag if I had a collision while
driving hunched up in my current position.

I pulled over and called St. Paul's on my car phone. As I was waiting
on the line, the battering from the rain suddenly became so noisy that
I could barely hear when someone finally answered, "ER, Mrs.

Cooper speaking."

"Mrs. Cooper, it's Dr. Garnet," I shouted over the din.

"I'm on my way, but for the moment I'm stuck in the storm; it's too
hard to see so I pulled over. How are things there?"

"We just got an MVA that should have done what you did," she answered
in a faraway voice.

"Apart from that it's quiet, but if the storm keeps up, we're liable to
get a lot more of the same." MVA referred to a victim of a motor
vehicle accident. Through the window I could make out a few cars that
were on the side of the road like myself.

The rest formed a line of red taillights crawling up the expressway
ramp, but overhead most of the vehicles already on the highway sped
past in a swirl of blinding spray, giving credence to her grim
prediction.

"Who's on?" I asked, wondering if we had enough veterans lined up to
handle the possible carnage.

"Dr. Kradic's in with the MVA now. We're not sure who's taking over
for days. It was suppose to be Dr. Popovitch, but he left a message
that he'd signed out his shifts to a number of the other doctors until
the end of the week. Apparently he's doing some kind of emergency
audit at University Hospital. Your secretary's supposed to give us the
revised schedule this morning."

"Shit," I muttered. I'd wanted to see Michael before he started poking
around over there. I'd decided to warn him about Janet's suspicions.

"Pardon, Dr. Garnet. I didn't hear what you said."

"It's nothing, Mrs. Cooper, just me thinking out loud. Tell Susanne
I'll be in as soon as I can."

I rang off and quickly dialed Michael's home number.

"Don't you two know the rest of the world sleeps now and then?"

yawned his wife. Donna. She was a fun lady, about five years older
than Michael, and had good-naturedly put up with my phone calls at
atrocious hours for over a decade. She was also twenty weeks pregnant
and a patient of Janet's.

"You think I'm a sleep disturber?" I answered.

"Just wait until your own little bundle of joy arrives. My
interruptions will seem like the good old days."

"Michael's already left. Earl," she answered with a chuckle.

"He's headed to University Hospital but said he wouldn't be at any one
extension once he got there. He told me to page him if I needed
him."

"Thanks, Donna," I said.

"How are you doing?"

"Janet says great. But it will be a relief to get the amnio over
with."

Donna was referring to a scheduled amniocentesis--the withdrawal of
amniotic fluid from her uterus through a long needle--routinely done on
pregnant women who were thirty-five or older. The fetal cells floating
in the fluid would be examined for chromosome defects--particularly 21
trisomy, or Down's syndrome. I remembered Janet's and my own worry
waiting for the results. The incidence wasn't common, but at one in
two hundred, it wasn't so rare as not to cause concern.

"I know what waiting for that can be like," I commiserated, unable to
change the odds for her. They were obviously on her mind.

"You men," she snorted.

"It's us who get the needle, not you guys."

I laughed, appreciating her way with troubles--beating them back with
wisecracks--and added, "Now you sound like Janet."

"Thanks. I'll take that as a compliment. Say hi to her for me." She
hung up.

Gusts of wind were buffeting the car as I called locating at University
Hospital.

"Hello, Dr. Garnet," the operator said.

"Shall I find Janet for you?"

"No, I actually need one of my own guys who's doing an audit there--Dr.
Michael Popovitch."

"At this hour?" she queried.

I glanced at my watch and saw it was only 6:35. "He may not have
arrived yet, but would you try him anyway?" I asked. The rain
peppering the sides of my car made it clear I wasn't going anywhere for
the moment.

She was back on the line in less than a minute.

"Security at the front desk has him signed in, but he's not answering.
Do you know where he is? He may not be hearing the page."

There were a number of possibilities where he might start--labs, staff
health, the medical records department--but at this hour there wouldn't
be any secretaries or clerks around to help him. He may have chosen
instead to log onto the hospital computer at a charting station in one
of the many doctors' lounges, taking advantage of the early hour before
the system got too busy.

"No," I answered, "he could be anywhere. Would you mind trying again
later?" I gave her my cellular number.

Visibility was still lousy, and the drumming sound of the rain was
unrelenting. Should I drop by UH and try to find him? I wanted to get
to St. Paul's as soon as possible. I wasn't scheduled to see patients
this morning, but my job as chief meant I was the ultimate
backup--twenty-four hours a day. While all our physicians were
competent to manage patients, not everyone--especially not
rookies--could manage the department in a crisis. Without knowing yet
who was coming in for the day shift, it was better I be there in case
Mrs. Cooper was right and the load got heavy. One pileup, and we
could be overrun.

But the thought of Michael poking around UH completely unaware of
Janet's suspicions left me uneasy. Besides, the hospital was less than
ten minutes away, and unlike St. Paul's, which was downtown, it could
be reached easily without using the freeway. I swung back out onto the
road, bypassed the on-ramp, and headed toward a route Janet had taught
me through quiet, still-deserted city streets.

Driving onto the large grounds of University Hospital was like a trip
back to the turn of the century. The sprawling stone institution,
built in the towering gothic style favored by Buffalo's early
industrialists, had initially been a county hospital housing both the
mentally and physically ill. It was surrounded by sweeping lawns under
ancient shade trees that once had occupied a small army of gardeners
and grounds keepers Now many wings were shut down to save money, and
the land was being auctioned off to developers.

The hospital itself had been acquired by the university in the fifties,
and the acute care portions had been renovated, rewired, and brought up
to snuff for the sixties. The high risk areas--ER, I.C.U, the case
room, and the ORs--had all been updated repeatedly since.

But changing times, economies, and ideology had led to the gradual
closing of the psychiatric portions of the building. Now they remained
dark and unused, cold gray structures with bars on the windows that
made me shudder. Janet once told me that some of the basement rooms in
these sections had earthen floors, and the places where inmates had
been chained to the wall were still visible.

Cars were numerous as people were arriving to make the 7:00 start of
sign-out rounds--the routine by which patients in hospitals the world
over are handed off to the day shift. I used my university ID to get
into the parking section for physicians, then ran for the front
entrance with the rest of the staff--mostly nurses, residents, and
orderlies, alongside the occasional doctor huddled in his or her lab
coat. The rain wasn't as heavy as before, but I managed to get pretty
wet anyway. Searing flashes of lightning crackled overhead, and
glancing up, I saw a light mist had wrapped itself around the upper
stories of the hulking building. No wonder they've got a phantom, I
thought, rushing through a massive arch that supported a pair of
gargoyles at its corners. While they guarded the doorway from up
there, down here two overweight security officers manning a metal
detector were doing the best they could to keep evil from entering the
premises.

The high-domed foyer and marble floor inside belonged to the era when
grand train stations had rivaled cathedrals and rail travel had held
the height of promise for the city of Buffalo. The evocative
construction had been a deliberate tribute to the railway barons who
had provided the bulk of the money to build the place. Today,
ironically, the structure was an unwitting memorial to what had been
the real pride and joy of those same barons--the once magnificent
Buffalo Central Station, now abandoned and disintegrating into ruin,
along with so much else in the East Side section of the city.

My leather soles slipped on the polished stone floor while others
around me flapped umbrellas and shook off the water from their soggy
overcoats. Pocketing my glasses, which had immediately steamed up, I
headed over to the house phones and dialed locating.

"This is a surprise," commented the operator, realizing I was calling
from inside the building. I didn't often have cause to visit. My
counterpart in ER here, William Tippet, was an insecure man ten years
my junior who seemed to get nervous anytime I came around.

As a result I stayed away as much as possible, and he kept joint
meetings about our shared residency program to a minimum. It didn't
help any that the residents called him Wild Bill Tippet behind his
back.

"Yeah, it's even a surprise to me. Did you ever locate Dr.

Popovitch?"

"Yes, I got off the phone with him a few minutes ago. We gave him your
number, but he called back and said you weren't answering."

I'd left my cell phone in the car, not wanting to use it in the
hospital.

He must have just missed me.

"He's now up in the records department for staff health. He said to
put you through if you rang again. I can get him if you want, or are
you going there in person?"

"Just tell me where it is, and I'll find him myself." I got
directions--third floor in one of the rear wings--and started out.

The bustle of activity in the corridors was familiar to any teaching
hospital. The clinicians who had been running alongside me moments
earlier were now striding through the hallways followed by groups of
sleepy-looking residents, interns, and medical students.

Already the quesrion-and-answer routine of clinical teaching had
started.

"What's the most common cause of fever two days postop?"

I heard one staff man snap as he swept by at the head of his
procession.

"Pneumonia!" called out someone a short distance behind him.

"What kind?" continued the staff man.

"Right upper lobe, from aspiration," came an answer from a bit farther
back in the line.

"Any other ideas?" I couldn't hear the reply as they moved out of
earshot.

The medical students hustling along at the rear were recognizable by
the shortness of their clinical jackets and the number of reference
manuals they kept stuffed in their pockets. Some were trying to thumb
through the well-worn texts for answers as they hurried to keep up with
the rest.

Surgical patients from all over the hospital were being taken by
stretcher to the OR for their early morning rendezvous with the knife.
There was a lineup of them outside the elevator. Most were already
beyond fear, snoozing under the effects of their preoperative sedation,
but a few chatted nervously as they waited with the orderlies who were
wheeling them to their fate. I used the stairs to save time.

As I climbed, the door on the landing above me pushed open and yet
another group of students in lab jackets started down the steps toward
me. Their instructor was still out of sight behind them, but I could
hear his voice.

".. . most still don't order enough blood cultures or the right
screening tests to reliably detect bacteremia..."

I'd reflexively stepped aside to let the group pass when I suddenly
recognized the voice at the same instant I saw the broad-shculdered
figure in a white coat follow the others through the door.

"You'll find out a lot of doctors aren't knowledgeable in their use of
lab tests--" Miller was saying when he caught sight of me pressed
against the wall. He froze, his mouth open in mid-sentence;

then his eyes narrowed, becoming hard and hurt looking. He swallowed
once and started down, saying nothing to me as he passed.

"Like I was saying," he continued, "as lab technicians you'll often
feel frustrated at the tests ordered by doctors .. ." He didn't look
back as he descended the rest of the stairs and strode out the door
below.

When he and his entourage were gone, I let my breath out. I hadn't
even been aware I'd been holding it. I felt a wave of perspiration
prickle out of my skin. The pain in Miller's eyes had been
frightful.

Staff health turned out to be on the same floor as administration in
this hospital. It was easy to tell which was which, even without
following the arrows and signs. I knew I was headed for the section
without the lush carpeting and oversized offices. The clinic was also
the only area where some people were actually at work. If this
hospital was like St. Paul's, the gurus of management wouldn't make a
showing much before 8:00.

At the front reception desk in the waiting room, clerks were busily
sorting charts and preparing for the day. In the hallway behind them I
could see nurses running in and out of a line of doorways carrying
equipment trays, presumably stocking up the examining cubicles. A
young man with crutches hobbled up to one of these nurses, who showed
him into a room.

Before stepping up to the counter, I had to pause.

Miller's single accusing stare had left me shaken. Feelings of guilt,
regret, and disgust over my decision to send his mother home had
flooded through me. I had to compose myself, force a smile, and keep
control of my voice to speak with an assurance I definitely didn't
feel.

A clerk looked up from her work and, seeing me standing in the
entranceway, asked, "Do you have an appointment?"

"No, I'm Dr. Garnet from St. Paul's Hospital. I'm looking for Dr.

Popovitch who's supposed to be here doing an audit," I explained,
walking up to her.
Her smile vanished immediately.

"I'm sorry," she said, frowning disapprovingly, "but Dr. Mackie told
me we were only to let Dr.

Popovitch and Dr. Graceton in to see our records."

That caught me by surprise.

"Janet's here?"

The lady's frown deepened.

"Not yet, but Dr. Mackie called a few moments ago and told us to
expect her as well. He didn't say a word about you or anyone else.
It's quite irregular as it is, you know, looking at staff medical files
even if it is a pan of a hospital audit If you are to be given access
to our confidential records, I'm afraid it will be only on orders from
Dr. Mackie."

"Look, I don't want to see any charts." I lied, but I had to reassure
her.

"I simply need to speak to Dr. Popovitch for a moment. It's business.
We're colleagues at St. Paul's and " "It's okay, Madge, he's
harmless," said Janet's voice from behind me. I hadn't heard the
elevator. She must have come up by the stairs the same way I had. She
swept toward us, the crisp lab coat she wore over her wrinkled greens
flowing after her like a cape.

"Believe it or not," she added, reaching me and fingering my own sodden
coat, "this bedraggled specimen happens to be all I could come up with
for a husband. Earl, meet Madge. She runs this place has all the
malingerers pegged even before the nurses and doctors get to them."

The transformation in Madge was instantaneous.

"Oh my gosh, you're Janet's husband. You should have told me, Mr.
Graceton, I mean. Dr. Garnet," she gushed, beaming me a warm smile.

"I've heard so much about you." Then she flushed and turned to
Janet.

"I'm terribly sorry about being so abrupt, but when he asked for Dr.

Popovitch " "Hey, think nothing of it, Madge. I treat him like that
all the time."

Janet chuckled, putting the poor lady at ease.
"I'll take responsibility for him," she further reassured her, leading
me by the arm through a nearby unmarked door.

"Nice meeting you, Madge," I called over my shoulder, letting myself be
dragged along, presumably into the records department.

The smile I got back from Madge let me know that the woman had no doubt
Janet would keep me in line.

"What are you doing here?" I asked as soon as we were out of sight and
walking through rows of filing cabinets.

"I phoned Cam this morning and got him to assign me to work with
Michael. I figured it was the best way to check out what we were up
against" She sounded nonchalant, but I felt a stab of alarm at her
revelation. To have rousted Cam out of bed and then insist on taking
time from her busy practice to work on the audit meant that her Phantom
idea must be disturbing her as much as it disturbed me.

"Did you tell Cam about what you thought about the three nurses " "Of
course!" she cut me off, sounding annoyed.

"The silly man told me I was nuts. He actually ordered me to keep my
mouth shut about it, as if I didn't know enough not to panic the whole
hospital.

He certainly won't listen until we get some solid proof about what's
going on." She was leading me around a corner and toward a small table
where I could see Michael studying a chart.

He looked up at the sound of our approaching voices.

"Does this guy know?" I asked, smiling at his surprised expression
when he saw me.

A few minutes later, we'd also failed to convince him.

"Listen, you two," he replied, frowning deeply, "how the hell can
Legionella be transmitted at will? And the idea that it's being used
as a weapon in some weird vendetta is crazy! Beyond crazy! I'm
surprised at both of you," he scolded.

"The last thing we need are sensational rumors."

The three of us were huddled together around his table--more a desk
meant for two--and we were speaking in terse whispers in case Madge or
anyone else entered unexpectedly. Michael kept looking nervously over
his shoulder, apparently more worried about being overheard than about
what we'd said. At one point all of us thought we could hear someone
in the rows of files behind us.

Thinking it was Madge or one of the nurses, we immediately hushed up,
but when I went to check, no one was there.

"And so what if all three women had complaints against them," he
continued to scoff.

"That puts them in the same company, unfortunately, with a lot of
doctors and nurses." Turning to me he added, "Christ, when you're away
and I'm acting as chief, there's at least one letter a week against
someone or another in our department who was stupid, callous, or
rude."

"Michael, these women were systematically cruel," countered Janet.

"Cruel in a way that's hard to catch, easy to deny, and almost
impossible to prove. But the patients know, Michael. They're the ones
who clued me in. Over and over, they told me the same basic complaint;
they were made to feel humiliated, helpless, and a burden in a hundred
nasty little ways by those three nurses."

"So they were women who pissed patients off. Hell, like I said, that's
apt to get them reported, not killed," snapped Michael. He was
becoming increasingly impatient.

"Aren't there other nurses your patients haven't liked? They didn't
get Legionella."

"These nurses pissed people off in a certain way," Janet shot back, her
frustration equally obvious.

"So why haven't these three got a high number of complaints against
them in common? That at least would be something objective to link
them together."

Janet leaned forward and stabbed at him with her finger.

"Michael I'll bet you've had similar trouble with lots of residents
who, when they're angry about something or somebody, take it out on
their patients maybe they rip a dressing off a little too aggressively
or catheterize someone too roughly then say, "What did I do?" You know
the game they're playing, Michael, and so do the patients, but let's
see you prove it. Most of my ladies didn't even bother making a
report. They simply vented their anger and swore they'd sign them
selves out the next time one of those three came near them."

Michael threw his hands up.

"Janet, do you know what people will say if you keep on with this?

"Next you'll be claiming a patient tried to kill those nurses with
Legionella instead of registering a complaint against them."" His
sarcasm was blistering even though he continued to whisper.

Janet's eyes flashed. It was time for me to intervene.

"Hey, Michael" I quickly admonished, "what the hell's the matter with "
Janet waved me quiet.

"What I'm saying, Michael," she whispered back at him through clenched
teeth, "is that three women have all come down with mysterious
infections neither you nor anyone else can explain. One of them's
dead, one's dying, and the only thing the three of them have in common
is they like to punish patients!"

Michael startled us both by slamming his hand down on the table.

"What I'm saying, Janet, is that Earl can't afford this kind of
talk!"

he thundered.

She jerked back from him, stunned.

He glared at me.

"Don't you realize how much trouble you're in?

Hell, half of last night's shift at St. Paul's does. I found out when
I got home from Cam Mackie's meeting and discovered I had an urgent
message to call Susanne." He took a breath and then exhaled it slowly
as be used to do with cigarette smoke before he quit.

"Rossit seems to be coming down on you a lot harder than you initially
realized," he stated. His frown deepened, but from what I now
suspected was concern, not anger.

"Susanne told me about the run he took at you in I.C.U," he continued
speaking low and quickly, "and that you'd both put it down to his usual
trouble making But by evening her nurses were hearing rumors that you
were going to be charged with everything from missing vital signs
through diagnostic errors to over prescribing antibiotics Susanne was
alarmed to the extent she thought you should be warned, yet felt
uncomfortable calling you herself. I told her I'd speak to you this
morning, but I've been lying awake half the night, unable to figure a
way you can respond to what Rossit's mounting against you. Besides
that, I've already heard rumors here that the woman's son. Miller, is
equally stirred up and hostile as well. So for God's sake, man, going
overboard with crazy stories about phantoms is the worst thing you can
do for your credibility right now!"

I was staggered by the alarm in Michael's voice. It was in such sharp
contrast to his easy reassurances yesterday that all would be well. Nor
had I expected Rossit's lighting into me to grow into his leveling such
damning broadsides against my reputation. That kind of assault was
beyond the usual way he'd lit into others who'd misjudged an infection.
Even Harold Miller's being so outspoken about my incompetence shook me
up, though God knows the man had cause.

Taken together, all this bad-mouthing served as a supreme wake-up call.
Rossit's antics in I.C.U yesterday his criticisms and threats of a
hostile case review were suddenly more chilling, more credible than
they'd first seemed.

Michael grasped both my shoulders and broke me out of my thoughts with
a little shake.

"I warn you. Earl," he said, his voice sounding strained, "if you
persist with this nonsense, you'll hand Rossit and Miller your own head
on a platter!"

I glanced over at Janet. She now appeared more startled than angry.
Chapter 6

I pulled away from the parking lot of University Hospital and started
driving toward St. Paul's. The wipers slapped the rain back and forth
more easily than before, like a pair of metronomes keeping time as I
batted my thoughts around.

I glanced in my rearview mirror and decided I'd learned a lot during my
visit to the gray building that was receding into the mist. I
certainly had a whole new understanding of how much trouble I was in. I
also had to admit that it was clearly going to be difficult to pursue
Janet's suspicions about the Phantom and protect myself from Rossit at
the same time.

Particularly galling was that I'd absolutely no idea why Rossit was
singling me out for such particularly vicious treatment in the first
place. Damn him anyway, I thought, wondering how much damage the
spiteful little man could do. To be honest, as much as I'd always
considered him a loathsome nuisance and a nasty troublemaker, I'd never
really believed until now that he'd be able to cause lasting harm to a
physician of my standing.

Working ER--being there day after day and pulling the tough cases
through year after year--gives a doctor a certain status in a hospital.
In my case I'd come to take it for granted that I didn't have to prove
myself anymore. I knew my clinical judgment and diagnostic skills
carried a certain weight with my colleagues, and I was used to them
turning to me for help when they or their patients were in trouble.

In other words, for years I'd presumed my track record gave me immunity
against having to defend myself in front of the likes of Rossit.

Apparently not anymore.

Could he actually help Miller convict me for negligence in a court of
law? Miller's behavior on the stairs and his mouthing off had made it
pretty clear his bitterness hadn't subsided any. Might the conviction
lead to suspension, even a withdrawal of hospital privileges? I
shivered and again felt a cold prickle of perspiration on my back.

I focused on threading my car through the traffic to get to St.

Paul's as fast as I could but seemed to hit every red light on the
way.

Listening to the wipers tick off the time only increased my impatience
at each stop.

Michael had held fast to his theory that the Legionella cases must have
originated from a source or case in the hospital that had been
overlooked or missed. As lightning continued to send cracks through
the morning gloom, part of me wanted to agree with him, wanted to
dismiss the alarming possibility of a phantom as little more than a
troubling fantasy fueled by thunderstorms, lack of sleep, and too much
caffeine.

But I couldn't. Each time I recalled Janet's unyielding insistence
that the three women had been attacked, my fears for her own safety
made my stomach clench like a fist. Michael's arguing with her about a
lack of proof had only increased that foreboding. He no more had proof
for his position than she did for hers. Until he found hard evidence
of an undetected source of Legionella, connected the three nurses with
that source, then explained how they'd all contracted the disease just
before leaving on vacation, I was going to find Janet's suspicions
impossible to ignore.

But my reasons for taking her suspicions seriously weren't going to be
enough to persuade others. No one would believe a murderer was on the
loose simply because Janet had seen a trait of cruelty common to the
three victims which everyone else had missed.

Except, of course, the killer.

Predictably, Janet and Michael had equally frustrated my concern for
their safety.

"If you're probing the work of a maniac, it could be lethal," I'd
argued.

Michael had scoffed some more, and Janet, once again seething at him,
snapped, "With reactions like that, who else but me could do the
job?"

For my sake, they had at least promised not to fight anymore and to be
careful. I'd ended up trying to ward off visions of someone prowling
after them as they worked.

Michael had readily accepted Janet's help. No matter how much their
perspectives differed, there was a lot of work to do. Charts of the
infected nurses, charts of the patients those nurses had come in
contact with, records outlining the ID investigation into possible
sources of the Legionella organism all had to be reviewed. But Michael
rejected my offer to stay and look through files with them.

"Are you kidding?" he'd exclaimed.

"A lot of people were edgy about letting me snoop around."

"You know, amalgamation paranoia," Janet had added, sounding resigned
to agree with Michael on this point.

"If you got caught, they'd shut down the audit and call us all
spies."

As if to underline their caution, when I'd stopped at Madge's desk to
use her phone on the way out, I'd noticed a stack of files placed
beside me with a piece of paper bearing Michael's name on top.

Waiting for St. Paul's to answer, I'd been trying to see what the top
folder contained, when a red-faced woman in a nurse's uniform had
whipped the entire pile away from me and off the counter.

"Well!"

she'd exclaimed and huffed off. Even Madge had protested, "Dr.

Garnet!"

"Sorry!" I'd pleaded, putting down the phone.

"Force of habit. I always check my charts when I'm on hold in my own
office. I didn't see anything honest! Hey, Madge, please don't tell
Janet!" I'd added, backing out of the room and trying to act the
harmless husband that Janet had introduced me as.

I smiled, recalling this performance, then quickly lost patience again
as I missed yet another green light. But instead of once more sitting
there and fuming over the slow pace, I thought of a call I could make.
I dialed the number for our I.C.U.

"It's Dr. Garnet," I announced when one of the nurses answered.

"Could you tell me the status of Phyllis Sanders, please?" Had she
survived the night was my real question.

"One moment, I'll give you the doctor who just saw her."

I braced myself. Normally a nurse would simply give me the re port.
Passing me on usually meant bad news.

"Dr. Rossit here," snapped the unpleasant voice.

Shit!

"Uh, it's Dr. Garnet, Dr. Rossit. I just wanted to have the nurse
give me a rep " "She's as good as dead. Garnet. Calling in and
wringing your hands over a near corpse isn't going to make you any less
negligent.

And it sure isn't going to make any difference when this case is re
viewed. I promise you I'll take care of that personally!"

He was practically screaming, his voice crackling through the receiver
and sounding ten times as venomous as what I'd endured yesterday. I
could even hear him breathing hard over the noise of the rain. Christ!
Susanne and Michael had been perfectly right. No matter how bad his
reputation was, this was definitely over the top. Nailing me to the
wall must be pretty lusty stuff for the little prick. A nasty
afterthought flashed through my mind. Maybe his loathsome practice of
hunting doctors who'd screwed up was the man's substitute for sex--the
result of small equipment "Rossit, either keep this professional or get
off the line and put somebody on who can!" I ordered. I knew that
he'd had his own problems with the ethics committee as a result of
other witch hunts he'd launched and been reprimanded several times for
unprofessional conduct. However he planned to get me, I could at least
make sure he was going to have to do it by the book.

I listened as his breathing slowed down.

"Now, Rossit!" I insisted.

The light changed. I had trouble concentrating as I picked my way
through the traffic. There was still no reply. I was about to hang up
in disgust when I finally heard him say, "What do you want to know?"

I want to know how she is, you asshole, I nearly screamed, but instead
I replied coldly, "How are her vitals?"

"Not much change. Her systolic's floating around ninety, the central
pressure's still down, and despite the ventilator, she's increasingly
hypoxic with respiratory acidosis. Did I mention her bicarb's falling
by the hour? You can guess the rest--low white count;

rising BUN, creatinine, and liver enzymes; decreasing urinary
output--like I said, she's kaput."

My anger at his callous description was quickly replaced by a sense of
hopelessness. Rossit had described the laboratory findings of
unchecked septic shock and circulatory failure. Her immunity was being
wiped out, her respiratory function was deteriorating, and she was
sliding into complete renal shutdown. I knew it was unlikely she'd
ever regain consciousness.

"What about a trial of rifampin?" I asked, knowing it would probably
be a futile measure.

Rifampin was an antibiotic initially used decades ago against TH.

Some recent articles had suggested it was effective in nonresponsive
cases of Legionella.

The unguarded suggestion absolutely ended our truce.

"Christ!

You hand out drugs like candy!" he exploded.

"What!" I exclaimed.

"It's hot dogs like you who are mostly responsible for drug-resistant
infections in the first place!" he screamed.

"From the beginning of this case you've shown a clear tendency to
overuse antibiotics, and I intend to order a full chart review of your
prescribing competency.

Such abuse is the main cause of virulent new strains--" I hung up on
him.

I arrived back at St. Paul's at 8:15. Casualties from a five-car
pileup on the expressway inundated ER.

"We need you in res us Susanne said, rushing by me with bags of blood
under her arm.

"Dr. Garnet," called the clerk from the nursing station, waving a
phone at me.

"Dr. Carrington wants to know if you need him down here."

"Yes!" yelled Susanne, answering for me over her shoulder.

I was pulling off my wet coat and running to catch up with her.

"What have we got?"

"Six casualties, two critical, this one's the worst," she summarized as
we entered the tiled, echoing room where we managed major trauma. The
chatter and noise matched the confusion. Residents and nurses in
surgical greens were circled around the pale lifeless body of a
middle-aged man, busily sticking him with needles and attaching him to
a web of tubes, catheters, and monitor wires. A high white cervical
collar immobilized his head and neck while a respiratory technician
struggled to pass a ventilation tube through his nose and on down into
his trachea. Yet another tube, this one transparent, was sticking out
of his upper left side and draining pure blood into a bottle under the
stretcher. These were all lifesaving procedures, but to the
uninitiated, the scene might have been a tableau depicting the agony of
torture.
"He's in shock with a flail chest on the left," continued Susanne.

"X rays have just been taken, but we don't have the developed nuns yet.
I added a pelvis; there's blood at the mouth of his urethra, and we
can't get a catheter up more than a few inches. OR's notified, and
ortho and urology were called as well as Dr. Carrington."

She'd just told me the man had broken enough ribs to detach a section
of his chest wall from the rest of his rib cage. I could see the
piece--like ad eli side of ribs the size of my hand--still held in
place by muscle and sinew, flopping in and out uselessly as he tried to
breathe. Shock meant he was bleeding from somewhere, and with blood
pouring out of his chest cavity, the source could be a lacerated lung,
a major vein, or even a ruptured aorta. The trickle of blood from the
man's penis suggested a severed urethra, probably caused by the jagged
ends of a pelvic fracture. Susanne's clinical savvy was better than
any other nurse's.

"You should have been a doctor," I told her, not for the first time, as
I quickly finished gowning and gloving up.

"Who'd be here to tell you what to do then?"

"Speaking of telling me what to do, thanks for calling Michael last
night."

She blushed but smiled her acceptance of my rather awkward
acknowledgment, then moved in to hang up the blood she'd brought.

Expressions of profound loyalty and deep friendship could hinge on an
instant in ER.

Seconds later I strode up to the head of the gurney and took over the
intubation from the struggling technician.

For the next short while the harsh world of blood, sinew, and broken
bones chased away any thoughts of Rossit or shadowy notions of a
phantom killer. It was particularly satisfying when I secured the
man's airway, an intubation far too difficult for the tech, especially
after I'd had to step aside during Sanders's intubation less than
twenty-four hours ago.

Once the patient was properly ventilated, I started firing the
questions--the tools of teaching since the time of Aristotle--to focus
the residents on what needed doing next.

"Okay, gang, where's he bleeding?"

While they shot back answers about the left lung, I rapidly palpated
the sternum, auscultated the rest of the chest, then tossed out more
questions.

"Is he still in shock?"

"Seventy-five over zip," answered one of the nurses.

"What about this chest tube pouring blood?"

"Clamp it?" a young man across from me answered hopefully.

"Good show." I grinned, moving on to palpate the abdomen and to select
my next pupil.

"Did anyone clear his cervical spine?"

"We took X rays, sir," replied a young woman on my right.

"They're not back yet."

"Did you do a rectal?" I asked her.

She flushed above her mask.

"Not yet."

"Now I'm going to show you where else this guy is bleeding out on you."
I slipped on some lubricant and inserted my index finger through the
man's anus. I felt a prostate bobble as free as a floating olive in a
martini.

I slipped out and let her perform the same maneuver. Her eyes widened
as she confirmed a transected urethra for the first time.

Then I squeezed the pelvis. Both halves slid free of each other and
gave a sickening grind.

I stepped back, "Your turn."

More wide eyes.

"Bottom line, folks: this patient needs a surgeon."

The nurses busied themselves recording neurological signs, and I
slipped yet another needle catheter into the man, this one through his
belly to check for free blood in the abdominal cavity. Negative.

Sean ran into the room as I was nipping X rays up on the viewer, and
together we confirmed our clinical impressions.

"Let's go!" he cried, reaching through a forest of IV lines and
grabbing the head of the stretcher himself to lead the rush to the
elevators. The nurses had piled portable monitors and an oxygen tank
onto the bed between the patient's legs and were still securing
drainage bottles when they started off. The respiratory technician was
on the bed itself, straddling the patient's chest with her knees,
bagging as they all went out the door and disappeared down the
corridor.

I stood for a moment in the empty room, savoring the triumph that
always follows a successful resuscitation. This is what I do and do
well, I thought. There was no other job in medicine I found sweeter
than saving a life. But the delicious glow of accomplishment was
quickly being replaced by a spreading sense of dread because two days
ago I'd sent the wrong woman home. Foul play at University Hospital
may have started the infection. Missing it was my fault.

I looked around that room where over the years I'd experienced
incredible miracles and witnessed unspeakable losses. The litter of a
major trauma case that inevitably ends up on the floor--the torn boxes,
the wrappings, the needle covers left lying in spatters of blood and
pools of various other fluids--suddenly made the place seem forlorn.
I've had two decades on this stage, I thought, my mouth going dry. I
had to swallow repeatedly before I could allow myself to think the
unthinkable--that I could lose it all.

The call I'd been dreading, but expecting, came early that evening.

I was still in my office finishing resident evaluations when Stewart
Deloram reached me.

"I thought you'd want to know she died half an hour ago."

I sighed into the mouthpiece but said nothing.

"Earl?"

"Sorry, Stewart. I knew it was likely, but still..."

After a few seconds of uneasy silence, he said, "I hate to have to say
this now, but you've got to watch out for Rossit. He was like a
vulture dancing around her body. I know he's usually badmouthing
someone or another, but I'm afraid he's after you big time on this,
worse than the usual mischief he gets up to. Frankly, he scares me."

I listened, not knowing what to reply. Although it was only
confirmation of what I already knew, his words caused my stomach to
tighten.

"He's gotten the post arranged for tomorrow morning," Stewart
continued, sounding as miserable as I felt, "and somehow he's gotten
the case on the schedule for Death Rounds this coming Monday."

"What!" I was speechless for a moment.

For us as healers. Death Rounds are our crucible, our place to be
judged. There the pathologist's scalpel has cut into the disease that
defeated us and revealed whether we'd been right with our treatments,
probings, and tests or we'd been wrong and our patient died because of
our mistakes. It's a rigorous arena where verdicts are rendered
starkly and accepted without excuse. Some doctors shunned the process,
but I couldn't have continued as a physician without it.

The alternative would be agonizing: to lose patients over the years yet
never know for sure if I'd killed them or served them well.

But a case usually didn't reach Death Rounds until weeks after the
autopsy. Preparing and processing the various slides took time, and
the backlog in pathology had tripled after Hurst's repeated budget
cuts.

"But they won't have tissue samples back by then!" I exclaimed,
totally disbelieving what he'd said.

Stewart sighed heavily before he replied, "Either Rossit's managed to
get some kind of priority, or he figures he doesn't need slides for a
lynching."

My breath caught midway, and my mouth went dry. Rossit's launching
such an assault on my reputation was bad enough, but it was another
matter altogether that he was somehow able to pervert the most serious
of hospital forums to his purpose.

"Stewart, what the hell's going on? How did he get pathology to agree
to that?"

"I don't know. Maybe it's the amalgamation."

"What do you mean?"

"Hell, you know these days it affects just about everything everyone
does," he said, disgust thick in his voice.

"Everybody's suddenly got an agenda to protect his own turf. Maybe
that's why Rossit's 5 doing what he's doing. He's got to know he
doesn't stand a chance of winning the ID chair against the likes of
someone as reputable as Cam Mackie. Probably he's trying to grandstand
this case to show up Cam, suggest yet another hospital-acquired
infection in a nurse at UH and that the ID department there was missing
something..." he trailed off, said nothing more for a few seconds,
then conceded, "but as to why pathology would go along with such an
early date, I've no idea." He sounded finished, then added, "Nor, for
that matter, do I understand why he's so rabid about nailing you for
negligence."

His last word made me wince. My silence must have given Stewart a clue
as to its impact "Hey, Earl," he quickly reassured me, "I don't agree
with the guy at all; you know that, and I'll say so, publicly, at Death
Rounds."

"Thanks, Stewart, I appreciate it." But his declaration sounded
forced, and I was feeling more and more alone.

"One other thing," he interjected. His tone seemed even more uneasy.

"I called Miller earlier this afternoon when it was clear his mother
was pre terminal He was here when she died. He was certainly
expecting her death--he took it very quietly, then signed for the
post--but I got the feeling that despite his exterior calm, he was even
more angry than he was yesterday."

More of what I already knew. My stomach obediently tied itself into a
new set of knots anyway.

"You think he's going to sue?" I asked, cutting to the point
ofDeloram's warning.

I heard him breathe out again but wondered if it was from his relief at
having finished the unpleasant duty of giving me a string of bad
news.

"I think you can count on it" was his quick reply.

I got locating to track down Janet at UH and told her the news.

"I'm sorry. Earl," she said softly.

She didn't have to say anything else. As physicians we both knew that
a patient's death, even an expected death, could force us to confront
things we'd rather not--our futility as doctors, our own inevitable
demise, the frailty of a human life. But in this case, I was feeling a
pretty high octane mix of guilt over my part in whatever killed Phyllis
Sanders and rage at whoever might have murdered her in the first
place.

"I want to hold you," Janet said quietly.

"Thanks, love," I answered, swallowing hard. Like a match added to
what I was already feeling, her sudden tenderness had igited an urge to
cry.

"Do you know how Miller took it?" she asked after a few seconds.

I told her what Stewart Deloram had said.

She stayed silent again, then quietly told me, "Michael and I saw
Miller today, just before noon, while we were checking out ID
procedures in the lab. I was surprised he was there at all, but he
said he preferred to work and keep his mind occupied. He admitted then
he knew there was little hope, but while it was strained between us, he
wasn't overtly hostile to me. Now Cam was there too, so Miller might
have been being careful, keeping his anger under control and out of
sight from his boss. Yet as time goes by and his grief runs its
course, his judgment of you may be less harsh," she said, sounding
hopeful. I couldn't tell if she believed what she was saying or was
simply trying to comfort me.

"What's Miller usually like?" I asked, flashing on the tormented look
he'd given me this morning.

"Brash and bright. Hell, he's more up-to-date on the latest in
clinical testing techniques than most physicians, including myself.

He's always badgering us to use the lab more appropriately, some times
to the point of annoyance, but he's usually right."

"I overheard him this morning, on my way up to staff health. He was
bad-mouthing incompetent physicians to his lab students. Does he often
talk like that, or was that diatribe inspired by me?" I found it hard
to keep from sounding angry.

"First of all you're not incompetent," said Janet dryly.

I snorted, skeptical of her attempt to set me straight but then
immediately felt a few of the knots in my intestines untangle them
selves while I waited for her to answer the rest of my question. Lady,
you do know how to play me.

"Unfortunately, it's probably a bit of both," she finally said.

"He's obviously pretty raw about his mother right now, but he also has
a reputation for being a bit critical of doctors, especially when he's
teaching. His father used to be an obstetrician here. It was before
my time, but the rumors are that Miller senior was an alcoholic and a
womanizer who lost his license. Apparently he also died as a result of
alcohol, in some kind of drunken fall. Most of us figure that's why
Harold's the way he is, overcompensating for the mistakes of his old
man. I hear he even once applied to medical school but was turned
down. He probably still feels he'd be a better doctor than most of
those he sees around him, and who knows, maybe he's right In any case,
he seems to have found areal niche for himself in laboratory sciences.
And having a stickler for excellence around the place is nothing to
complain about, so we try to take his dedication with a certain grain
of charity."

"But with that kind of background he's liable to sue simply to make an
example of me. Hell, he hardly needs Rossit to stir him up."

"Possibly," she said, her voice neutral. It was a tone she always
resorted to for telling hard truths.

"But don't jump to conclusions yet about what he may do."

Good advice, but tell that to my stomach, I thought, as I felt it start
to rearrange itself again.

"It still sounds like I shouldn't expect much," I commented glumly.

"Earl, I want you to do something for me right now." Janet's sudden
sharp tone snapped me out of my morbid worries.

"I'm down in the basement archives, where they keep old records. No
one's here, and I want you to come over. I've dug out the records of
all the staff who were attacked by the Phantom two years ago. Michael
still doesn't take me seriously, but neither of us found a shred of
evidence today that can explain the infections. I'm sure I'm right
about this. Earl. I want you to look at the charts with me. Maybe
you can find what I'm missing."

It was after 7:00 when I once again pulled into the grounds ofUH.

The weather hadn't changed much since my visit that morning. It had
stopped raining for the moment, but the mist had graduated to fog and
now descended all the way down the walls of the building.

The dimming effect, added to the dusk, had been enough to trigger the
sodium lamps. Inverted cones of yellow light illuminated the gray haze
that drifted through the parking lot and the many footpaths surrounding
the hospital. In a few weeks it would be fully night by this hour,
after we'd all adjusted our watches and stopped saving daylight for yet
another year. Maybe I wouldn't do it this time; I hated surrendering
to winter darkness.

As I walked to the front doors from my car, the air felt cool against
my face, and I enjoyed a few brisk lungfuls before flashing my identity
card at the sole security guard. A dozen other people carrying
bouquets of flowers and food baskets entered the large vaulted lobby
with me, but the huge echoing chamber seemed empty compared to the rush
I'd seen at the start of the day.

A woman with two children, each of them clutching a small bunch of
roses, studied a map of the hospital mounted on the wall. A massive
directory listing the locations of all the hospital departments was
hanging beside it; there was no one else around to give directions. A
nearby glass booth marked information was dark and had a handwritten
sign taped on the door, back in thirty minutes.

I'd already called home to say Janet and I would be late. Amy, our
nanny, was having dinner with Brendan.

"He likes the spinach, and I prefer the carrots," she'd told me as I'd
listened to his happy cries and smacks in the background.

"But if you two don't hurry, we'll eat all the applesauce and leave you
the yellow stuff. Neither of us likes that."

Then she'd held the receiver up to his ear and I'd gotten to say, "Hi,
Brendan," and listen to him gum the mouthpiece.

I found the archives on the directory and learned they were in the
subbasement by the old psychiatric wing. Terrific, I thought, studying
the map and figuring roughly how to get there.

The elevator took me down two floors and let me out in the middle of a
long deserted corridor that seemed to run forever in both directions.
While lit with occasional overhead lights, the passage had an arched
low ceiling, giving it more the feel of a tunnel than of a hallway.
There wasn't a soul in sight, and after the elevator doors closed
behind me, the place was silent as death.

"Jesus, Janet," I muttered under my breath, setting out in what I
thought was the right direction after my study of the map, "could you
have brought me anywhere more creepy?"

The air in the passage was absolutely still, the result of being two
floors below ground. The stone walls and ceiling only added to the
sense of weight pressing down from the hospital above. I wasn't
usually claustrophobic, but this place made the basement hallways at
St. Paul's feel absolutely spacious.

I came to an intersection. The archives should be off to the left, but
that hallway didn't look as used as the one I was in. It was certainly
less well lit, and the lights were spaced farther apart. The corridor
to the right was in complete darkness. The air at its mouth had a damp
musty smell, and a sign hanging from the arched ceiling warned, danger
I off limits to all personnel. I stared up that dark passage and
wondered if it led into the old abandoned asylum. Shivering, I turned
left.

The floor was concrete, and my shoes made muffled tapping sounds as I
walked. There were occasional doors set in the stone walls, and what
would be behind them besides storage rooms I couldn't imagine. I
passed two more intersections, then turned right at the third. The
microfilm archives should be at the end of the corridor.

But I came up to a blank wall.

Shit! The map had indicated left at the first intersection, past two
corridors, and then right, exactly as I'd done. I should be standing
in front of a door marked hospital archives. Instead it was beyond a
doubt the proverbial blank wall.

I retraced my steps a bit, trying the doors that I'd passed on my way
down the corridor. Most were locked, and those that weren't simply
opened into musty rooms stuffed with everything from boxes to old beds
and shelves of outmoded clinical equipment.

This place needs a garage sale, I thought, poking into yet another
disorganized storeroom.

"Janet!" I called, not feeling very hopeful. Did I get turned around
when I got off the elevator and start out in the wrong direction to be
gin with? It was the only explanation. I'd retrace my steps back to
where I started, then follow the same routine heading the other way.

I turned left out of the passage I'd been exploring and strode toward
the series of intersections I'd passed on the way in. Far up ahead I
could see where the corridor I was walking along extended into the
darkness. Toward what rooms with earthen floors and the remnants of
chains in the walls? I'd be glad when I found Janet. The complete
silence and stillness of the air in the place was oppressive enough
without imagining what kind of horrors had been carried out there in
the name of psychiatry.

I passed the first intersection and quickened my pace. The rapid
clicking sounds of my shoes matched my heartbeat as I walked. I kept
my eyes on the darkness ahead, knowing that's where I'd turn right and
be back near the elevators.

I passed the second intersection. In spite of telling myself to calm
down, I was nearly running now.

Suddenly, in the murky archway I'd been watching, I thought I saw
movement a shadow against a black background stepping away from the
light.

"Janet?"

There was no answer. I started to slow up, not taking my eyes off that
dark corridor up ahead.

"Who's there?"

Still no answer. I was stopped now, listening to my own breathing and
trying to see into that blackness farther back in the archway.

"All right, this isn't funny. Who's there?"

Silence. Complete stillness, except the sound of my own breath.

I started to back away, keeping my eyes on that corridor. I had seen
something. I was sure of it--a form in the dim light at the entrance
way.

I was all the way back to the intersection I'd just passed when the
lights went out.

I couldn't see a thing. I didn't hear a sound, not even my own breath
anymore. I was suddenly holding it in the stillness of that place. The
complete absence of light pressed against me. For a second I felt
dizzy, unsure of where was up or down. When I finally exhaled, the
sound startled me, it seemed so loud in my ears. I tried to inhale
through my open mouth, to make as little noise as possible.

Whoever was up ahead remained completely silent.

Then I heard the steps.

They were a softer sound than my own shoes had made. A kind of padding
sound, like a paw or a foot wrapped in cloth.

I wanted to scream at whatever was advancing toward me, but I didn't
dare give away where I was standing. Instead I crouched down and
removed my shoes. I'd been about a hundred feet from the mouth of that
corridor when the lights had gone out. The padding noise came steadily
toward me. How far away now I'd no idea. I reached blindly out to my
right side trying to feel the wall. Nothing.

I stood and took a step toward where I'thought the wall would be,
holding my shoes in my left hand and groping ahead with my right. I
still felt nothing.

The soft sound kept coming up on my left. I took two steps ahead, then
three, four. Still nothing. I must be in the intersecting corridor, I
thought, trying to fight off panic. I quickly took four more strides
into what I hoped was the side passage, then stood completely
motionless, attempting to take controlled breaths through my open
mouth. I slowly turned back toward the sound of the approaching steps.
Would whoever it was turn the corner and touch me? Or go by, heading
straight off down the passage in the direction I'd just come from?

I could feel my heart pounding, and the sweat in the small of my back
was like ice. The padding was very near, almost passing in front of
me. Then it stopped.

I didn't breathe, didn't move, didn't even blink in that complete
blindness. But I could hear whoever was there breathing. It was
little more than the sound of air moving in that totally stagnant
place. For those seconds my ears rang in the silence between his
breaths. If my stomach gurgled, I'd be discovered. I didn't know
there could be such absolute quiet.

Then the padding began again, moving off to my left and receding in the
distance. I still didn't move, but strained to hear the fading sound,
every last soft puff of it.

When I was sure I couldn't hear anything more, I felt for the wall on
my right, then worked my way back to where the passages intersected, my
hand telling me when I was at the corner. I stopped and listened for
any sound from the left but again heard nothing. I immediately turned
right and felt my way along the wall as quickly and as quietly as I
could. I couldn't see a thing and kept blundering into recessed
doorways as I rushed to reach the next corner and the corridor to the
elevators. I didn't think I heard any padding steps coming after me,
but I didn't stop to make sure. I could tell I was getting near the
final intersection because I started to smell the damp musty air.

Had I missed the turn? I wondered in a flash of new panic. Had I
blundered straight into the passage where the figure had come from and
into God knew what? The odor was cloying in my nostrils. It seemed so
much more pungent now than before, like wet earth. Had I missed the
turn? Just when I was about to stop and reverse direction, my fingers
slipped around the corner I was looking for.

I paused and listened. Nothing.

I made the turn and headed for the elevators. I switched the shoes to
my right hand and felt along the wall at my left so as not to go by the
sliding metal doors in the dark. I kept trying to be quiet but was
practically running again as I barreled ahead in the darkness. As I
remembered it, there were no obstacles to speak of that I'd crash
into.

Suddenly, way up ahead, there was a break in the blackness--a small
round white light set in the wall I was hurriedly feeling along.

The elevator button.

I redoubled my pace, keeping my eyes fixed on that tiny light, still
rumbling with my left hand on the wall at my side. I was almost
there--another twenty feet--and was about to run for the doors when I
felt my fingers slide over the top of another human hand.

Before I could scream, it had seized my forearm and yanked me forward.
I now rocketed toward that tiny light, head first. I felt another hand
grab me behind the neck and further propel me straight at it. It got
as big as a train light right between my eyes as my head crashed into
the metal door frame. After so much darkness the white explosion in my
brain was spectacular.
Chapter 7

The patient seemed to be doing well, at least that's what a man's voice
kept saying.

"... going to be fine, just a concussion..."

It must be somebody pregnant, because I could hear Janet sounding very
worried.

"Oh thank God!" she said.

"For a second I was even afraid he was dead, finding him lying down
there in the dark."

No, it couldn't be Janet's patient.

"He's" don't have babies. But I couldn't get my eyes open to see whom
she was talking about.

Whom had she found lying in the dark?

Then it came back in a rush.

The figure, the padding footsteps--someone had knocked me out.

My eyes flew open, and I sat up.

"What happened!" I demanded, ignoring the ache in my head and trying
to focus on the two faces in front of me.

"Oh, Earl, what a relief!" said the blur on the left. It was Janet's
voice again.

"Whoa there. Dr. Garnet, lie back," ordered the man's voice, and the
form on the right moved closer. I could feel his hands pushing gently
but firmly on my chest.

"You're okay, but it was quite a hit.

You've been out more than five minutes, as far as we can figure, and we
want to do a CT."

"Janet! What happened. Did he hurt you?" I asked anxiously, turning
again to the shape on my left.

"Who was it?"

My vision suddenly cleared in time to see her warm smile fade and the
concern in her gaze slowly turn to wide-eyed amazement.

"Pardon?" was all she said.

"Someone jumped me in the dark and knocked me out," I explained,
puzzled by her response.

"It must have been whoever was chasing me. Did he hurt you?"

"Oh my God," she exclaimed, suddenly looking alarmed and turning to the
young man beside her who I could now see wore a clinical jacket.

"Oh boy," he uttered, moving back from me.

"He's really confused.

I better get my staff man." He turned and walked out of the curtained
cubicle I was lying in. From the sounds around us-beeping monitors,
shouted orders, the spring and click noise of an ambulance stretcher
having its legs extended--I knew they'd gotten me toER

"I'm not confused!" I protested to Janet.

"What's he talking about?"

She gave me a smile as phony as Bre.

"Now just relax. Earl," she said, patting my hands and looking as if
she were about to cry.

I took her hands in mine." I'm all right, Janet," I told her
emphatically, sitting back up. My head hinted otherwise, but I ignored
the pain.

"Wait a minute," she protested, pushing me back onto my pillow.

I was wearing a neck collar, so my head and trunk flopped down in
tandem, like a wooden doll's.

"Ouch." I winced, the change in position setting my head throbbing
again.

"You're not to move. Earl," she cautioned, her tone of voice intense
and full of concern.

"What happened" I asked again.

When the lights had gone out, Janet told me, she had come out of the
archives department and felt her way back to the elevator. The room
actually was in the opposite end of the subbasement; I'd taken the
wrong direction to begin with, as I'd belatedly realized. She'd been
fumbling her way along in the dark like I had, but at a lot slower and
safer pace. When she'd heard a thud in the dark ahead of her she'd
been frightened but had continued to approach the elevator door, albeit
more slowly. She'd become terrified when she tripped over my body. She
had only realized it was me after she'd gathered her wits and pressed
the elevator button. When the door opened, a shaft of light had fallen
across my face. She'd checked my vitals, men gotten help, and
everyone, including Janet, had assumed I'd nipped in the dark and
knocked myself out.

When she finished speaking, I lay there, feeling her fingers stroke my
head, thinking. Should I tell her what had really happened? It would
scare her terribly, as if she wasn't worried enough as it was.

"What did they tell you was the matter with the lights?" I asked
instead.

"The maintenance people said a circuit breaker had closed down for some
reason," she answered, clearly puzzled by my question.

"When I ran for help to get you up here, one of them went to check the
panel. He turned the lights back on, no problem."

"Was that panel in the abandoned passageway leading under the old
psychiatric hospital?"

"I think that's what he said. I know he went up that way, but frankly,
I was too worried about you to pay much attention to anything else.
Why?"

"And the lights stayed on? They didn't short out again?" A faulty
breaker would likely blow a second time, but a single timely outage
would suggest a hand at the switch.

"No, they stayed on," she said, once more sounding a bit alarmed and
looking over her shoulder.

"Where's the damn staff man?" I heard her mutter.

I had to tell her. She had to know for her own safety.

"Janet, there's a point to what I'm asking. It's not brain damage.

I've got one more question. Are there other corridors leading back to
the elevator from the asylum end of the subbasement besides the one we
were in?"

"Earl, what are you going on about?"

"Janet, I'm okay," I insisted, grabbing her arm, and then I explained
what had happened.

When I finished, she didn't say anything for a few minutes.

Tears welled up in her eyes. Her lips quivered a few times.

"Are you sure it wasn't an accident? Maybe you tripped, and the force
of the fall only made you think you were pushed."

I hadn't imagined the hands on my back and neck, I thought, but said
nothing.

"And are you sure it was a person you heard when the lights went out,"
she asked, "not a rat that came on down the corridor in the dark? I
hear there are some big ones under the old asylum, and maybe--" "If it
was a rat, it was a two-legged one," I interrupted, speaking as gently
as possible. No matter how shaken she was about my being attacked, I
couldn't let her deny and rationalize away what had happened.

From now on there would be no more illusions about the need to be
careful.

"I could hear whoever it was breathing, Janet," I added, nudging my
point home while recalling those endless seconds with a shudder.

She sat on the edge of the bed, staring off at the curtains, then
abPeterOanent 65 sently brushed back a golden strand of hair from the
side other face.

I watched her lovely familiar profile as she stayed quiet with her
thoughts.

I could only guess at what she was thinking. Her greatest weakness was
her absolute belief in her own invincibility--her long hours, her
defiance of fatigue, her relish to take on cases none of her colleagues
would touch--all that made her great and yet could lay her low. She'd
been so sure someone had killed those nurses; still, it was completely
within her character to be equally incredulous that the very same evil
might strike back at her or at someone she loved.

She looked paler than usual, and under the harsh fluorescent lights the
fine lines of her forehead, jaw, and neck gave her the delicate
appearance of a porcelain figurine. So vulnerable, I thought, with a
sudden rush of apprehension for this strong woman who was such a force
in my life.

The muscles around her lips tightened, and she turned to speak.

"All right, here's what we'll do," she began, sitting up straighter,
appearing to take charge.

"Michael's right about one thing. Until we have proof that there is a
killer behind the Legionella cases, you can't afford to be telling wild
tales about a phantom." But her voice had a brittle edge to it that
occasionally broke and belied the determined expression on her face.

"Even if we told somebody what happened in the subbasement tonight,
they could dismiss it," she continued, speaking more quickly, almost to
herself.

"They'd say that the person you saw was some derelict who'd snuck in
and was trying to use abandoned parts of the old asylum as shelter or
that the person who shoved you into the elevator had simply acted
reflexively, to protect himself when you barged out of the dark, and
then panicked, running off when he saw you were hurt." She was
speaking ever more rapidly, as if racing through her thoughts aloud,
her tone harsher. I didn't like the desperation I heard.

"And who knows, maybe that's what happened after all--oh, Christ I'm
stupid!" she exploded, angrily snapping off her own train of
thought.

"I've probably gotten us both into something that's way over our
heads-something that at the very least needs the police. And for the
life of me I don't know how we're going to get a single shred of
evidence to make anyone believe us."

The words poured out of her, like the tears that started down her
cheeks. I'd rarely seen Janet cry. I sat up, rather awkwardly, and
put my arms around her. At first I felt her stiffen--she hated losing
control--then she hugged me back, hard. I felt her body start to heave
as she lost the battle to contain her sobs, and I felt my own tears
roll down my face onto her slender magnificent shoulders. I held her
like that until her crying ended and I felt her body relax against
mine. She never noticed when the resident came through the curtain
with his staff man, and I waved them away.

"I guess I don't have to tell you I'm scared," she sniffled when she
spoke again, "especially after what happened to you tonight. God, I'm
sorry. Earl, to have been so blind."

"It's okay," I reassured her.

"You were the least blind of all. No one else even thought of the
Phantom."

"Yeah, except you warned me about what might happen if we got close."
She pulled away and reached into her lab coat pocket for a tissue.

"But if that was the Phantom and my looking at those charts was what
brought him down on us, then there must be something in those records
that can help us find out who he is," she said slowly, starting to
sound less shaken.

"Hold it. Nancy Drew," I said.

"As your trusty sidekick, I've had enough knocks on the head for
tonight."

She smiled, gently ruffled my hair, then laughed and gave me an other
hug. The closeness felt good, but from my experience in ER I knew the
relief we were both feeling at that moment was the kind that always
follows a near miss. It was part of the shock, and temporary Already,
as I hugged her back, I was thinking. This guy probably gives out
worse things than bumps on the head, things like Legionella.

"Janet, who besides me knew you were going to look at the old files on
the Phantom cases?" I asked, still holding her.

Janet's expression strained again when she pulled away, and once more
her eyes filled with worry.

"No one. I was tired of being scoffed at," "So only Cam, Michael, and
I heard your Phantom idea?"

She nodded.

"Have you seen a lot of any one person today, someone who could be
watching your movements?"

"No," she answered quietly.

"Then how did he know you were there?" I asked, not expecting an
answer.

"Or could we be wrong in assuming whoever it was had gone down there
tonight to find you? Maybe the person was there for another reason,
and I disturbed him, wandering around."

"Wait a minute," Janet said.

"Are you changing your mind and saying that getting attacked tonight
had nothing to do with the Le gionella deaths, that those crazy excuses
I made up might be true?"

"Not at all. Whoever turned out the lights came at me and somehow was
waiting back at the elevator for me. And that judo push propelling me
into the door was certainly no panicky grab. At the very least the
person didn't want me snooping around. I'm just suggesting that maybe
it wasn't connected to your going over files on victims of the
Phantom."

"So apart from making me feel less guilty about that knock on your
head, where does that leave us? You're not seriously suggesting your
figure in the dark has nothing to do with the Legionella cases?"

I didn't answer right away. The menace I'd felt from that hideous
encounter was not at all in doubt, but if pressed, I had to admit I'd
only assumed the attack was connected to the nurses, especially with
Sanders's death fresh on my mind. But I couldn't rule out the
possibility that I'd stumbled onto a completely unrelated creep.

"It would be a pretty big coincidence, but you're right. It's a
possibility the attack tonight had nothing to do with the Phantom or
Legionella."

My admission left us looking glumly at each other across a spread of
white bedsheets. They reminded me of blank paper--a tabula
rasa--waiting for answers that wouldn't come.

It was an odd sort of letdown. If the attack was an unrelated fluke,
then Janet hadn't threatened anyone, wasn't in any immediate danger, so
far, but might be completely on the wrong track. In that case, we were
probably no closer to discovering why two nurses had died and certainly
weren't any nearer to stopping a lunatic who could kill with
Legionella.

Even more frustrating was that we had to live with the other
possibility:

we somehow had threatened a killer.

After a few moments, Janet raised her head.

"I need you here, Earl. You're the only one who believes me, and I'm
certainly not getting anywhere working with Michael. You've got to get
yourself officially named to his investigation. Then we can start from
scratch, together, and maybe you'll see something I've overlooked."

"Don't worry," I told her, trying to sound more confident than I
felt.

"If Michael doesn't listen to me, you can tell Donna on him.

She'll make him behave."

We got out of University Hospital's ER by midnight. The CAT scan and a
series of staff doctors declared that apart from an already forming
bruise, the blow hadn't done me much damage. On our way home Janet
agreed she'd do no more prowling around until I could be with her. We
again considered making a report about the attack to the police and
again decided against it. Even if they believed me, which, despite
Janet's skepticism, they might, the crime they'd be investigating would
be simple assault and nothing else. Besides, creating a fuss for the
hospital would only make it harder for me to get the access I wanted to
their records.

Later, in bed, I lay awake listening to Janet's breathing and pictured
that sinister figure in the hallway. Despite our second-guessing why
he'd turned out the lights and come after me, I couldn't stop thinking
he was down there because Janet was checking into the Legionella cases
and digging out the old files on victims of the Phantom.

What would he have done to her if I hadn't come along?

Possibilities out of a nightmare flooded into my thoughts and burned
away all possibilities of sleep. I got up, went downstairs to the
living room, and paced to control my fears. No one, I swore, not
Michael, not Cam, not anyone at University Hospital, was going to keep
me from protecting my wife.

But after putting a few miles on the carpet and tripping innumerable
times over Muffy, by 3:00 a.m. I still had no plan. That was when I
remembered Phyllis Sanders's autopsy was scheduled for 7:00.

During twelve hours on a slab in the morgue the flesh of the dead
becomes yellowed and white as the blood slowly drains toward the back
and pools in the skin behind the head, shoulders, and hips.

There it clots, suffusing those resting spots with large purple
blotches--a telltale pattern of how the body was initially lying after
death. Pathologists call this pattern dependent lividity, and it can
reveal whether a body subsequently was moved into a different position
and, if so, suggest foul play.

Phyllis Sanders had obviously spent an undisturbed night on her back.
She now lay naked on the dissecting table under the harsh light of the
operating lamp, awaiting her final medical procedure and hopefully a
definitive diagnosis as to the cause of her death, if the purely
medical cause of death could be called definitive. In her case, the
possible cause of the cause--a dim figure in the shadows-wouldn't be
discovered here.

Her eyes were closed, her cheeks were slack and hollow, and her mouth
was a gaping hole. Her gray hair lay splayed out over the glistening
steel of the table's surface and hung off its end, reminding me of how
she'd looked in ER. I found myself wondering how they'd protect those
long strands for the mortician if they planned to include her brain in
the post. The standard cutting procedure would involve an incision
across the top of her head from temple to temple and pulling the front
half of her scalp forward over her face to expose the skull.

I was dressed in greens, mask, and gloves and pacing impatiently,
having been in the chilled room for ten minutes and wondering what the
delay was. On the steel counters surrounding me were the rows of tubes
and glass beakers that would hold specimens of her various bodily
fluids. Other bottles filled with colored liquids stood waiting to
receive tissue samples from her major organs. Spread out near the deep
sinks at the end of one of these counters was an array of large
Tupperware containers, each half filled with formaldehyde, where the
major organs themselves would be placed once they were removed in their
entirety. The overhead vents hummed and did their best, but even
through my mask the familiar fumes of the preservative stung my eyes
and bit into my nose. Every now and then I also got a whiff of the
unmistakable odor of early rot.

Scalpels, probes, pickups, forceps, bone cutters, and a rotary saw lay
neatly arranged on a steel cart placed near the woman's chest.

This being an ID case, a plentiful supply of swabs and culture sets
were on a separate tray within easy reach. All that was needed was a
pathologist.

Finally I heard the sound of approaching voices coming from the
changing room on the other side of the doors to the autopsy suite. As
the conversation grew louder, I realized a heated argument was taking
place.

"I don't give a goddamn about whatever juice you managed to pull from
upstairs! Down here you're on my turf, this is my case, and it's my
policy that any attending physician or resident not only can be present
but should be encouraged to be present at an autopsy of his or her
patient--" The doors swung open and the thin figure of Len Gardner,
already in full protective gear, strode into the room. Of medium
height and build, he was in his early fifties. He should have been
chairperson of his department but was far too frank and honest to have
any political support at St. Paul's.

"Oh, hi. Earl," he commented cheerfully, winking at me over the top of
his mask. He gave his head a little nod in the direction of whoever
was following him, the corners of his eyes wrinkling merrily with the
smile I couldn't see. Then he suddenly stared at my forehead.

"Hey, that's quite a bruise. What happened?"

"I hit a door in the dark," I mumbled.

In huffed Gary Rossit, also fully garbed, but the visible portions of
his face and neck were deeply flushed. The effect made his head look
like a round beet enclosed in a cap and mask.

"Garnet's handling of this case is under review, and I insist you
comply with my wishes and bar him--" He broke off when he saw me, his
forehead flushing even redder.

I felt my own face grow warm.

"You wouldn't be trying to keep me away from the post, would you Dr.
Rossit?" I snapped. Having caught him in the act of doing exactly
that, I was furious. But I gritted my teeth knowing my mask at least
partially kept him from seeing how well he'd succeeded in making me
livid.

He glared back up at me, his pupils widening as I watched.

"You are both welcome to stay," Len interjected sternly, giving us a
precautionary glance that made it clear he wouldn't tolerate his domain
being used as a battleground. He reached overhead and snapped on the
microphone to record his running commentary of the autopsy. Rossit
eyed the device, the blacks of his eyes growing even bigger, but kept
silent. Whatever he had to say against me, I guessed he still
preferred it said behind my back and off the record.

Apparently satisfied that we would behave, Len stepped to the business
side of the table, picked up his scalpel, and looked down at his
subject.

"The patient is a fifty-seven-year-old female with no external markings
except needle punctures at the documented IV sites--the right and left
forearms--below the junction of the lateral and middle thirds of the
right clavicle, and at an arterial line inserted in her left wrist. The
central line has been left in place for verification of position."

This initial inspection included documentation that the various lines
had been properly inserted in her veins. Antibiotics injected outside
a vessel would simply collect in the surrounding tissue where they'd
pool and fail to reach the site of the infection.

"Likewise the endotracheal tube has been cut and the lower end left in
place..."

Len grasped her windpipe between his thumb and third finger at the
thyrocricoid--a tiny area in the upper end of the trachea covered by a
thin membrane--and brought the tip of his scalpel blade down to make a
vertical slice. As the skin and tissue parted, the orange tube so
expertly inserted by Michael two days ago came into view. I recalled
my own hesitancy trying to intubate her, which had necessitated his
taking over.

"... incision through the crico thyroid membrane reveals a properly
positioned endotracheal tube..."

And so it went: the preliminary to what we were all here to see-her
lungs.

Len's scalpel made a sweeping cut from her upper right chest across to
her sternum and down to her pubis. Her flesh pouted open along the
path of the blade, the cleanly sliced edges forming a bloodless trench
the color of sushi. He made a similar cut above her left breast,
joining his initial incision and completing a Y that would allow him
access to both thoracic cavities and the abdomen. His expert use of
the blade had penetrated not only dennis but also more than half an
inch of glistening subcutaneous fat. Abandoning the knife for a large
pair of tissue spreaders--an instrument resembling scissors with curved
blunt probes instead of blades--he deftly widened and deepened the
fleshy trench along its length. In the thoracic region it took him
seconds to reveal me white striations of sinew and the pearl gray sheen
of underlying bone. Working lower down over her belly, he brought into
view the darker gray of peritoneum--a fibrous sheath holding back her
intestines and other contents of her abdominal cavity. He continued to
give succinct explanations of all he did, the easy flow of technical
jargon consistent with his years of experience.

"Double glove if you haven't already. I'm going through the chest
wall," Len advised us.
Both lungs were liable to be full of pus. The extra layer of latex was
protection against an incidental tear midst such septic material.

Rossit and I complied, reaching for the dispenser box at the same time;
then we both impatiently insisted the other hurry up and use it first.
I caught a glimpse of us struggling to pull rubber over rubber in our
reflection from the glass doors of a nearby cabinet. Positioned back
to back, we looked like dualists gloving up to mark off twenty paces. I
heard Len muttering behind his mask--something about rectal orifices.

Len picked up the rotary bone saw--a hand-sized tool fitted with a
two-inch round saw blade--and switched on the motor. He bent over his
patient again and touched the top of each rib with the whirling saw
blade, making only a partial cut so as not to disturb the structures
underneath. At each contact with bone there came a high-pitched whine,
not unlike a dentist's drill, that made me cringe.

While Rossit and I watched, he reached for his rib cutters, stainless
steel shears any florist or chef would die for, and finished snipping
completely through the ribs. Their freed ends sprang upward, allowing
access to the lungs.

"Good God!" he exclaimed, stepping back from the cloying stench that
rose out of the open cavity, staggering all of us, even with our
masks.

Swallowing and trying not to gag, I peered at the right lobe. The
surface, already blackened by years of cigarette smoking, was blistered
with abscesses--some of them open and draining. The entire organ was
floating in a yellow pool of debris similar to what I'd suctioned out
of her airway two days ago. The left lung appeared much the same, with
the exception of the top half of the upper lobe.

"She must have been breathing and oxygenating through that until she
died," pronounced Len, pointing at this partially spared segment.

His voice lost its practiced neutrality. He spoke slowly, clearly
shaken.

The extent of the spread of the infection and the degree of tissue
damage we stared at was truly alarming. Len nevertheless picked up his
scalpel and proceeded to prepare the trachea, lungs, heart, and
esophagus for removal en bloc. Identifying each major vessel and
structure as he cut, he freed, then lifted this large dripping assembly
from the chest cavity and placed it on an adjacent smaller table
equipped with a drain. As he went to work on her right lung, removing
it from the rest of the dissection, I swallowed a few more times and
managed to ask, "Have you ever seen an infection this aggressive
before?"
"No," Len answered quickly, then added, "except... well, at least not
recently, not in patients who weren't immunocompromised somehow, and
even then, not as completely unchecked as this...."

His voice trailed off, and the lines in his forehead formed into deep
vertical furrows as he looked up from his work.

"But I saw cases somewhat similar during my residency in the early
seventies, when methicillin-resistant staphylococcus first emerged,
before vancomycin became the treatment of choice. Those pneumonias
went fast too." He looked back down and resumed his cutting.

"But you had this lady on vancomycin, didn't you?"

"Among other things," I stated quietly, glancing at Rossit. I hoped
the mere mention of what I'd ordered wasn't enough to start him on
another diatribe about my use of antibiotics.

"Any signs of resistance so far, Gary?" Len asked without looking away
from the incisions he was making.

Rossit darted his eyes my way, then just as abruptly looked back across
the table.

"The organism in her sputum was coagulase positive, confirming staph
aureus, and the preliminary disc diffusion screen suggested methicillin
resistance," he admitted to the top of Len's head. The way he coldly
rattled off the technical terms indicated he resented being made to
reveal that vancomycin seemed to have been the right choice after
all.

Well, well, I thought, feeling a flash of satisfaction. Rossit would
be forced to put his attack against my prescribing patterns on hold, at
least until we received confirmatory tests.

He admitted as much when he added, "But that procedure isn't as
accurate as the minimal inhibitory concentration method using a full
twenty-four hour incubation and broth dilution." This mouthful of
terms made him pause for breath.

"Any intelligent comment about Dr. Garnet's choice of therapy will
have to wait until tomorrow," he concluded sarcastically, finally
looking at me.

"Yeah, yeah, Rossit," I shot back, "and heaven help me if the minimal
inhibitory concentration method doesn't validate the use of vancomycin!
Get a grip, Gary! You'll probably end up having to admit it was a
reasonable call."

"The erythromycin, even rifampin was there any antibiotic you didn 't
think of?" he retorted.

Len was ignoring our spat.

"... slicing through the hilum, severing the main stem bronchus,
pulmonary artery, and divisions of the pulmonary vein, thereby
completing the removal of her right lung..."

He lifted the sodden organ, placed it on several pieces of paper towel,
then cradled it in his gloved hands and set it on a balance for
weighing. After recording the reading, he sliced open each of the
lung's three lobes, spreading the meaty halves and inspecting their
interior. His hands moved slowly, so as not to spray any organisms
into the air.

Suddenly his running commentary ended in mid-sentence. He stood
frozen, transfixed by what he saw.

His unexpected reaction immediately made Rossit and me shut up, and we
both strained forward to see what he'd found.

Across from me I heard Len whisper, "Holy shit!" Rossit muttered
something else on my right. But my eyes were fixed on the horror in
Len's hands.

The inside of the lung was virtually destroyed. Its entire central
structure--arteries, veins, and airways--had been converted into a
brownish black mush. No circulatory pathways remained that might have
carried antibiotics to the sites of the infection. But even if they
had, the destruction of tissue visible to the naked eye meant the
airways leading to alveoli, the microscopic sacs where life-giving
oxygen passed into the blood, were no more. What little tissue had
survived was confined to the periphery of each lobe. It had a reddish
color--the sign of diffuse inflammation--and was coated with
blood-streaked bubbles, a result of the leaky lung syndrome I'd
suspected during her resuscitation. In the middle section of the lobes
were more dark cavities where the abscesses we'd seen penetrating the
lung's surface first developed. Any remnants of tissue still intact
around these holes had a coating of yellow slime.

I stood mesmerized by what I saw and didn't realize at first that Len
had resumed speaking.

".. . the congested tissue appears diffusely inflamed and exudes a
serous sanguineous fluid in the outer segments. Slightly deeper is
extensive evidence of early cavitation. Most of the central parenchyma
and vascular structures, however, have been replaced by liquefied
necrotic debris--" His voice wavered, and he stumbled over the dry
terminology, which, while accurate, belied the enormity of what had
happened to Phyllis Sanders.

"The debris gives the appearance of two infectious processes, one
causing a diffuse lobar pneumonia, the other a more consolidated
infection, with evidence ofphagocytic tissue destruction more typical
of staphylococcal organisms--Jesus Christ! What the hell's going on
here?" he finally broke off and simply stood staring down at what
defied his attempt at a cold clinical description.

For a few seconds no one spoke.

Then I realized what I'd heard--two processes.

"Could it be Legionella, Len, followed by staph?" I blurted out,
clearly startling him out of his fugue. I glanced at Rossit. He was
simply standing there, repeatedly swallowing, with his eyes riveted on
the open lung. Two processes. Try and rip into me for mentioning
Legionella now, Rossit, I thought, almost giddy with the possibility of
suddenly turning the tables on the obnoxious little man.

"It's something plus staph," Len replied grimly after a few more
seconds.

"It'll take a microscopic examination of tissue samples to determine
the exact sequence for sure." He paused, looking back down at the
grisly specimen he still held.

"But one thing's certain," he went on, his voice regaining its usual
authority, "staphylococcus wouldn't get this big a toehold on an intact
lung, even a smoker's lung, without some process first attacking the
pulmonary tree and making breaks in the lining through which the staph
could penetrate."

"Like LegionelW I repeated.

"Really Garnet," interrupted Rossit, "will you drop your obsession with
bizarre scenarios--" "I think Legionella is a hell of a good clinical
suggestion, Gary," declared Len, placing the lung in one of the plastic
containers, then stepping around from his side of the table and coming
to stand over a considerably startled looking Rossit.

"Dr. Garnet was incredibly astute to recognize from the beginning we
might be dealing with two separate organisms here," he continued, his
usually taciturn voice rising.

"And as for 'bizarre scenarios," this case is already bizarre!"

he bellowed.

I could see Rossit's chin flutter overtime under his mask-whether
trying to swallow or find words, I couldn't tell. His forehead and
neck flushed an even deeper crimson than when he'd first seen me at the
start of the autopsy. He made a few more attempts behind his mask at
whatever he was trying to do with his mouth, then spun around and
strode from the room.

Len stood with his hands on his hips, somehow looking bigger as he
watched the vanquished little man disappear between the swinging
doors.

"Like I told you, Rossit," he muttered, "here you're on my turf, and
this is my case!"

"I wish I'd done that," I said cheerfully, stepping up and patting him
on the back.

"Just watching you felt terrific."

"Oh, Earl," he exclaimed, turning and looking at me, as if he'd
forgotten I was in the room.

"Sorry for the outburst."

"I want to thank you for standing up for me," I told him.

"I was beginning to fear I might not get a fair hearing. Rossit's been
on my case big time since I... well..." I paused and looked over at
Phyllis Sanders's corpse. Staring at her eviscerated trunk with the
severed rib ends bent outward, I felt a sudden letdown and realized
whatever petty little battle I'd won here just now with Rossit hadn't
really mattered, because no matter what else Gary Rossit might try to
pin on me, what I had to answer for in Death Rounds wouldn't change.

"... since I sent her home," I finally said, trying to keep my voice
from betraying how morose I felt, putting my guilt into words. Her
disfigured body made me remember how she had stared at me in ER. Look
at what you 'we done!

Len stepped back to the autopsy table. There was a great deal of work
to be done yet.

"Don't worry," he answered, beginning to cut free the left lung.

"That little bastard won't use me, this department, or Death Rounds to
railroad you or anyone else if I can help it. That's why I put him on
the spot--a reminder that questions about the management of this case
could be asked of him as well as by him. If we're right and there are
two major infectious processes here, he's not only going to have to
explain why he didn't catch on but why he was haranguing the one
physician who did. And if our tissue samples confirm Legionella,
you're going to come out of this looking like a genius," he declared
enthusiastically as he carefully placed the left lung on his scale.

A genius with a dead patient, very possibly a murdered patient.

Dare I tell Len?

All I had were Janet's remarkable observations and a creepy tale about
a figure in the dark. In medicine we called such evidence anecdotal.
Interesting and sometimes considered, it usually didn't count for
much.

Better stick to the plan, I thought. Get into University Hospital as
soon as possible and find some real proof. An idea suddenly occurred
to me.

"Is this infection unusual enough for us to warn UH about it right
away?"

He didn't answer immediately.

"It's the possible combination of organisms that's strange here," he
finally replied.

"I've seen Legionella by itself kill in twenty-four hours, and staph
pneumonia can certainly be lethal within forty-eight hours, but having
them together?

I never heard of it."

"But should we warn UH about what we found now?" I repeated, hoping
that an alert about two such serious organisms would force University
Hospital to allow Michael to add people--including me--to his
investigation.

Len stared over at the right lung lying in one of the Tupperware
containers.

"Not right away," he said at last.

"At least not until we get full culture and sensitivity results, and
not until I see tissue samples under a microscope. If we are dealing
with MRSA or Legionella or both, then immediately state health gets
involved, and they'll be jumping all over UH and St. Paul's in a big
way. To raise all those alarms with everyone just on the appearance of
her lungs ..." He shrugged, then added, "But I've got to admit--so
much tissue damage so fast..." He shook his head and went back to
slicing off the different specimens he'd need to solve the riddle.

Damn! Maybe I should haul Michael in here myself, I thought, force him
to look at the telltale organs, and let them frighten him into
listening. But the gory things weren't finished with me yet. A
terrifying question shot through me like a chill. Was this what the
person who'd come padding toward me in the dark had intended for me? Or
Janet, if I hadn't come looking for her? Might her lungs have ended up
like the specimens in front of me, infected and devoured from within?

I wanted out of the autopsy room. I wanted to get away from Phyllis
Sanders's remains and call Janet. Maybe she shouldn't even be at UH
working until we had figured out what was going on or unmasked whoever
was prowling around in the subbasement. Then I remembered all three
nurses became ill while away from the hospital and felt even more at a
loss what to do.

But I slowed my breathing and forced myself to focus instead on a final
question I had meant to ask Len. It had nothing to do with Janet, but
I still wanted to know.

"How did Rossit get you to give this case such an early date in Death
Rounds?" I asked him pointblank.

He looked up from his cutting, an annoyed frown underlined by the top
of his mask.

"For Christ's sake, give us some credit. Earl!" he ordered gruffly.

"Rossit did. He knew we wouldn't go along with him, so he convinced
somebody else whom we had to listen to."

"What do you mean?" I asked, truly puzzled.

"Hey, I'm supposed to be the guy around here with no political smarts,
but even I could figure that one out."

"Len, what the hell are you talking about?"

"There's one other person in this hospital who was hot to put you on
trial for this case, and Rossit knew we couldn't refuse him."

"Who's that?" I asked, my mouth going dry.

"Your good friend Paul Hurst, our acting CEO. Hurst ordered us to put
Sanders on Death Rounds for Monday."
Chapter 8

"It's only a presumptive diagnosis, Janet, until we get confirmation by
culture results," I told her over the phone. I'd gone back to my
office after the autopsy and finally tracked her down between
deliveries in the UH birthing center.

"But Len Gardner is certain there was a preliminary infection prior to
the staphylococcus, and Legionella's a good bet."

"How'd Rossit like that?" she asked, her sarcasm evident.

"Speechless!"

"Does that solve your problem with him?"

"Not really. I found out he's linked up with Hurst to nail me at
"What! How'd you find that out?"

I told her about the call Len had gotten. from Hurst.

"Jesus Christ," she exclaimed.

"Rossit and Hurst--those two lizards deserve each other. But if you
were right about the diagnosis, won't that shut them up?"

"It'll take some of the steam out of Rossit, but I did send the woman
home, Janet. He'll push that to the max, and whichever way you dress
it up, at the very least I made a lethal error in judgment. As for
Hurst, well, you know how dangerous he can be if anyone or anything
threatens the good name of St. Paul's. He'd love to get rid of me at
the best of times, so I'm sure he'd be particularly willing to throw me
to the wolves over this."

Complete silence was Janet's answer to that reminder. Hurst had once
gone as far as to make me a suspect in a homicide investigation at St.
Paul's to divert the police from discovering some of the more sleazy
secrets in the place. As things turned out, the real killer was
eventually discovered, but I'd exposed just how ruthless Hurst could be
in pursuing whatever he thought would protect the hospital's reputation
and his place of power. We'd been wary enemies ever since and probably
would remain so for life.

"It stinks!" Janet said vehemently, interrupting my gloomy musings.

"How can Hurst get away with that kind of crap? Why don't all the
other wienies who call themselves chiefs over there stand up to him?
Are you and Scan the only two with..."

Her outburst went on for more than a minute. Whenever she sprang to my
defense like that. it meant she thought I was in a lot of trouble. But
right now I was a whole lot more worried about her safety than my
career.

"... more women on that council of yours would put an end to his smarmy
nonsense--" "Janet," I interrupted, "the only important thing right now
is what's going on at your hospital. I'm even beginning to think it's
dangerous for you to continue working there." I hadn't intended to
blurt out my worst fears. But I kept seeing Sanders's corpse, and I
couldn't shake the sounds of that creeping figure in the dark. My
pacing the carpet last night hadn't helped either. I'd imagined enough
"what if nightmares for a Wcs Craven festival.

"Earl!" she exclaimed, sounding appalled, "I couldn't leave my
practice!" Her silence made me feel I should have known better.

"Besides," she added in a much softer voice, "those nurses became ill
away from the hospital."

Startled to hear her echo my own thoughts from earlier that morning, I
reexperienced the same panicky fear I'd had then; there was no safe
place for her. I felt my courage collapsing in a rush.

"Don't think I haven't taken precautions," she quickly added, "and
Cam's insisting everybody in the hospital pay strict attention to
isolation procedures until this business is sorted out."

I wasn't at all reassured, and Janet must have sensed it.

"Look, Earl, there's nowhere we can run to," she persisted.

"Our best chance is to see if we can find out how those two women were
killed. There's got to be a common link, someone with a connection to
all those cases."

It sounded hopeless.

"But you couldn't find it. That may mean it's not there."

"I won't accept that until you go over the files of the Phantom's
victims with me." Her voice was getting a clipped edge to it that
warned she was digging in her heels.

But out of fear, I could be stubborn too.

"Hell," I persisted, "if there was something incriminating in those
files, they may have been stolen last night."

"They're fine. I checked first thing this morning after I had the same
worry."

The thought of her going back down to that basement, even during the
day, abruptly refilled my head with nightmares.

"Janet! I thought we had a deal! You agreed you wouldn't do any thing
alone " "Relax. I had security accompany me to open the room."

I tried another tack to dissuade her.

"Well then, if those records held such incriminating evidence, don't
you think whoever's behind this would have taken them last night to
keep you from looking at them anymore? Maybe the fact he left them is
proof that further checking is pointless."

"Maybe he couldn't risk going back to get them, what with all the
excitement you caused down there and electricians prowling around the
place," she replied sweetly.

I knew I wasn't going to budge her. Her determination was steel once
she made up her mind about something important. Clearly she'd decided
we were continuing the hunt.

She listened to my silence for a moment, then added, "Earl, I know last
night scared you, deeply, just as it scared me. And the autopsy today
must have been gruesome for you. I can only guess at how all that has
left you terribly frightened for me."

She paused, giving me time to mutter, "You got me pegged again,
lady."

"But I'm not being stupid," she continued, ignoring the wise crack.

"One thing I've done today is broadcast that Michael and I found
nothing. I've told everyone here that the investigation was a complete
waste of time and that's why I'm back at work. Even what happened at
the elevator, I said, was the result of your imagining noises and
having a panic attack."

"What!" I couldn't believe I'd heard her right.

"Janet! You didn't," I protested.

"I don't want people at UH thinking I get panic attacks.

I'm a chief of ER, for Christ's sake. Wild Bill Tippet will have a
field day teasing " "Well excuse me!" she interrupted, laughing.

"One minute you're worried about my life, but the next, your reputation
takes a little ding, and you get all upset!"
She'd gotten me.

"I'm not upset," I objected, feeling foolish.

But within seconds I'd joined her in laughing at myself. With one yank
of my own ego she'd distracted me out of my fear. For a brief moment I
felt my anxiety lessen a notch. God, she knew how to handle me.

"Good, because it's a small price to pay," she concluded.

"Now, whoever's behind the infections won't see you or me as a
threat."

Still pretty thin protection, I thought But thanks to Janet, I was a
little calmer. Maybe I was prone to panic attacks. If so, Janet was a
better remedy than Ativan any day.

"Have you talked to Michael yet?" she asked in a firm voice, making it
clear we were switching away from the topic other safety.

Part of her remarkable spirit was her capacity to not dwell on a
problem that nothing more could be done about for the moment.

"Things we cannot change," she would repeatedly remind me when I bogged
down in worry that was futile. It was one of the ways she had of
finding enough courage for us both.

"No, I'm phoning him right now," I replied. Determined to match her
bravery, I added, "Either he lets me in officially, or I do a BE on all
your records tonight."

"Not alone you won't!" she snapped.

"Our deal goes both ways."

"Hey, just kidding," I answered.

"There's no way I'd go back into that basement by myself." But I'd
thought about it if Michael balked on me and if that's what it was
going to take to identify a murderer.

Along with the return of my nerve came resignation. Until this killer
was caught, neither Janet nor I could be safe. I said good-bye, then
tried to reach Michael through locating. They couldn't find him.

By midafternoon I'd worked through the usual menu of a busy day in
ER--heart attacks, asthmatics, hemorrhagic shock, and a half dozen
complaints of abdominal pain. The MVAs had kept rolling in, a few
strokes arrived, and the psychiatric emergencies--some of them
violent--were many, due to the storm. Between these big cases were the
legions of minor problems, everything from colds to VD. But it was a
good thing no one asked me the patients' names. I'd like to think I'd
been kind and reassuring, yet in the heat of restoring breath,
restarting a stalled heart, or replenishing lost blood, I remained
obsessed with Janet's safety.

I returned to my office again and again to try to reach Michael but
each time had no luck. I kept wondering if I should head over to UH
after my shift to look for him. Sitting at my desk, puzzling over what
to do, I absently flipped through a pile of mail my secretary had left
for me. Most pieces--notices of various meetings, bureaucratic
shuffles, receptions-- I tossed into the recycling bin. I'd
scrupulously attended all these things in my greener years but long
since learned they were a total waste of time. However, today a memo
intended to summon me to a special meeting at 4:00 that afternoon of
hospital physicians, the chiefs, and Hurst regarding "the pending
amalgamation and the growing dissent of the medical staff at St.

Paul's" caught my interest, especially the sole item on the agenda: a
threat from physicians to withdraw services if the merger process
continued.

Maybe Hurst had finally gone too far, I thought. He could play us off
one against the other individually and had done so successfully for
years, but perhaps with all the doctors angry at him at once about the
same thing, he'd be in for a rough ride. Maybe some of the wienies
Janet had alluded to were finally going to stand up to him.

My phone interrupted this fantasy. Hoping it was Michael, I answered
before the first ring was complete.

"Yes?"

"Dr. Garnet?" was the startled response. I recognized the voice of
one of the residents.

"I'm sorry, I thought you were someone else," I explained.

"What can I do for you?"

"Well," she started, sounding embarrassed.

"We're all waiting for you in the classroom. You're supposed to give
us a talk at three today?"

Shit!

I quickly glanced at my calendar and saw I was scheduled to give the
residents a session on "The weak and dizzy patient in ER" from 2:45
until 4:00. My watch said I was already a quarter of an hour late.

"Yes, on dizziness, right? I'm just getting my notes together," I
lied.

"Tell the others to have a coffee and I'll be with you in five
minutes."

We plan such seminars weeks in advance, and it was a topic for which
I'd already built up quite a file of teaching cases. I'd even planned
on including Phyllis Sanders's story to demonstrate the importance of
checking for orthostatic hypotension and at least ensure others would
learn from my mistake. But today the whole thing had slipped my
mind.

I'd need her chest films, I thought as I headed for the door. They
were probably still in pathology. Len would have used them to
correlate the radiology findings with what he discovered in the lung
itself.

I decided on the run that I'd pass by the morgue and retrieve them
before meeting the residents. Damn Michael anyway! Why couldn't I
reach him? Not knowing if he'd now agree to let me help Janet was one
of the reasons I was so distracted.

I descended a back staircase to the basement and came to the dimly lit
corridor leading to the dissection room and halted. I al ways found it
oppressive walking through this passage, set apart from the busier and
newer sections of the hospital. But after what happened last night, I
felt my heart start to pound and my respirations quicken.

"Not again," I muttered. I'd had the same reaction going into the post
early this morning but had overcome it. I stood there a moment, once
more trying to slow my breathing. No way was I going to give credence
to Janet's cover story by giving in to the flutterings of panic I was
beginning to feel.

I fixed my thoughts firmly on getting the X rays and meeting my
residents, brought my respiration back to a respectable rate, and
stepped into the corridor. To tell the truth, it was nowhere near as
cramped or as old as the one at UH the initial construction of St.

Paul's began in the late thirties but it still pressed in on me. I had
to concentrate to keep from thinking that the lights would suddenly go
out or that someone was waiting for me in the darkness at the end of
the passage. It didn't help any that the tangle of pipes, conduits,
and ducts just above my head seemed coated with sixty years of dust and
spiderwebs. Every now and then I could hear scurrying noises from deep
within this jumble, but in all the time I'd been coming down here, I'd
never seen for certain what lived up there.
I passed the heavy wooden doors of the walk-in freezer where bodies
were kept pending an autopsy or a pickup by a funeral home and peeked
into the brightly lit room where we'd been working earlier The empty
tables, counters, and floors were gleaming from a re cent cleaning, but
no one was there.

The adjacent changing room was also empty, so I walked farther down the
hallway toward the pathologists' and secretaries' offices.

Len's cubicle was one of the first in a long line of doors. I could
see a light under the sill, so I knocked and let myself in.

"Hi, Len, sorry to disturb " It wasn't Len in the office. I
immediately recognized the broad shoulders and closely cropped blond
hair of Harold Miller who was standing in front of Len's desk with his
back to me. As he turned at the sound of my voice, I saw he was
holding a sheet of paper with the format and familiar outlines of the
human form used for our autopsy synopses. He seemed mildly surprised
to see me, but returned his gaze to the document in his hand and went
on reading it "Mr. Miller," I said, appalled to have barged in on the
last person I'd have either expected or wanted to see here, "I'm sorry,
but I was looking for Dr. Gardner."

"So was I," Miller answered without looking up.

I felt uncomfortable just standing there.

He added, "I was here arranging the release of my mother's body to the
funeral home and wanted to know what he'd found during the post." He
still didn't look up.

I started backing out of the office when he suddenly tossed the paper
he'd been reading onto Len's desk, looked me directly in the eye, and
said, "I see you were probably right all along about there being two
infections."

"Pardon?" I asked, not immediately catching on.

His expression remained frozen, revealing neither the hurt nor the
anger I'd seen in his face the morning before.

"It's in Dr. Gardner's preliminary report on Mother's autopsy this
morning," he explained, gesturing with his thumb back toward Len's
desk.

"You took it from his desk?" I asked, dismayed, then quickly feeling
foolish. Reading a person's notes on his mother's autopsy might not be
too polite or appropriate, but it was a hell of a lot less an offense
than sending a sick woman home from ER.
"I'm sorry about your mother's death, Mr. Miller; I truly am," I said,
but on hearing my own words, I immediately felt overwhelmed by their
inadequacy. It reminds me of a glass coffin, and you put her there,
echoed in my memory. Nothing I could ever say or do would make up for
what he'd lost on account of me.

He remained silent.

I turned to go.

"Once it was too late to help her, you were pretty damn on, clinically
speaking," he called after me.

I kept walking. This kind of encounter wasn't going to end well no
matter what I said. There was no way it could.

He followed after me.

"You certainly impressed me more than the others," he continued,
hurrying up and striding along beside me.

"As a lab tech I get a pretty good take on a physician--who knows what
to order, who follows through, who's up-to-date--that kind of thing."

I stopped and turned to face him.

"Look, Mr. Miller, I know this must be one of the worst periods in
your life. I don't think this kind of conversation is going to help "
"Doctor Garnet, I don't expect any help from any conversation with you
or any other doctor here. I only expect the simple courtesy of your
standing there and hearing me out," he stated.

The blank expression on his face canceled out the hurt look in his eyes
that I remembered from the morning before on the stairs. Neither did
he seem to be angry. I felt pity for him, and he was right about one
thing; the least I could do was stand there and listen.

"Do you want to come to my office and talk?"

"No, here is fine," he said.

I only now noticed we were standing opposite the freezer doors. I
hoped he wouldn't realize how near we were to his mother's body.

"In fact, I may be able to help you," he continued.

"What?"

"I'm only a lab tech. Dr. Garnet, but I keep up with the literature,
especially diagnostic testing and screening procedures; this is more
than a lot of physicians I work under do. Dr. Gardner's comments in
his report indicate that the staph infection hadn't seemed to respond
at all to the vancomycin you'd been astute enough to order.

Rossit's still trying to verify whether the strain was methicillin
resistant, but there's another form of resistance that nobody seems to
have thought of."

To talk so clinically about his mother's case seemed to me an eerie
kind of defense against grief.

"Three months ago," he continued, "the CDC published an advisory to
screen staph infections that failed to respond to vancomycin for
evidence of decreased susceptibility to that drug as well," he told me,
his voice taking on an easy authority that I wouldn't have normally
expected from a laboratory technician, even in a less-charged
setting.

The CDC is the Centers for Disease Control in Atlanta, staffed by the
national experts on infectious diseases. I knew about the advisory;
I'd heard the residents talking about it. It had been published in the
Mortality Morbidity Bulletin, an excellent bimonthly report ex posing
troublesome new medical puzzles or twists in the presentation of old
familiar problems that had recently killed or maimed patients somewhere
in the world. I had about a year's worth of is sues piled up in my
office, waiting to be read.

"What are you getting at?" I asked, intrigued.

"I'm saying the staph organism that killed my mother should also have
been tested for decreased susceptibility to vancomycin. Dr.

Mackie has had me update our own techs on the new protocol for such
cases already. But according to my mother's hospital chart and the
autopsy synopsis I just read, that hasn't been done here." He studied
me for a few seconds, as if waiting for my reaction to his remarkable
pronouncement. When I neither said nor did anything, he added, "The
test still should be ordered, for obvious public health reasons."

As he watched me further, I felt uncomfortable again and couldn't
decipher what he was watching me for--a response to the information
he'd revealed? A recognition of his knowledge and intelligence?

And then he completely disarmed me.

"You see. Dr. Garnet," he said with a sudden gentleness, "I couldn't
help her when she was still alive. But I want her death to be handled
properly. I want whatever killed her identified and tracked down, by
the book. If her death were to point out the need for screening to
prevent the same infection from hurting anyone else, well, at least
that's something ..."

His words trailed off, and tears welled up in his eyes. He spun around
and walked away.

I finished my seminar with the residents a few minutes to 4:00.

I'd been so distracted after my run-in with Miller that I'd nearly left
pathology without retrieving Sanders's X rays, which was why I'd gone
down there in the first place. I'd had to rush back to Len's secretary
and have her dig out the films, but the effort was worth it.

Seeing those lungs nearly whited out by infection so soon after a
seemingly benign initial visit had a profound impact on my proteges.
That radiographic image taught them more about the penis of missing
postural hypotension than hours of listening to lectures or reading
textbooks ever could.

Back in my office I made a quick check with University Hospital.

Locating still hadn't heard from Michael. I left yet another message
for him to phone me right away.

I put my hands behind my head and leaned back for a stretch. The
bruise on my forehead had begun to throb and it hurt to move my neck,
but with less than four hours sleep, only coffee for breakfast, and no
lunch, I figured I should be grateful that I didn't feel worse.

Nevertheless, I groaned aloud when I stood up.

The notice for Hurst's meeting with the hospital physicians was lying
on my desk where I'd left it. Should I go? I didn't have much stomach
for politics at the moment, but in all honesty, I was increasingly too
preoccupied with worry about Janet and waiting for Michael's call to be
much more use in ER. The encounter would at least be a distraction, I
thought, and besides, maybe I could help give Hurst something else to
think about besides dumping me as chief of ER.

Before leaving, I took a few minutes to hunt up my copies of the MMB. I
was curious about the article Miller had quoted, both as to its content
and as to how accurately he had interpreted it. Also, I had to admit I
wanted to discover something else a lot less scientific. If the man
who held my career in his hand was capable of discerning a balanced
medical argument, maybe he'd give me a fair shake.

Flipping through my pile of back issues, I quickly spotted the title I
was looking for "Interim Guidelines for Prevention and Control of
Staphylococcus aureus with Reduced Susceptibility to Vancomycin." The
article itself was brief, and I took it with me, stuffing it into my
lab coat pocket as I hurried from my office and headed toward the
auditorium.

A special meeting of Hurst and all the physicians at St. Paul's was
rare. Hurst could barely abide the interference of regular hospital
committees into the way he ran St. Paul's. And doctors were usually
loath to get involved in hospital politics. They barely had time for
the day-to-day issues in their own departments scheduling, teaching
doing shifts, and the never-ending struggle to keep their clinical
skills up-to-date. Speak of downsizing or budgetary restraints and
their eyes would roll upward.

"That's what chiefs are for," my own staff would say, "to protect us
from having to deal with all that garbage."

Stepping through the large oak doors at the rear of the steeply raked
amphitheater, I was struck by the size of the turnout. The place was
packed, every seat taken and the aisles lined with clinicians in lab
coats sitting on the tiered steps. They were a vociferous lot,
sounding more like a right crowd waiting for the start of a match than
a group of professionals.

The place was a great choice of venue, for the doctors. Six hundred
seats in a steep curved bank towered above Hurst and his band of
cronies all of whom were bunched together on the small stage below. I
could tell the man knew he had trouble from the large number of board
members he'd brought with him. I recognized most of them from previous
social functions, but they'd looked a lot more comfortable then than
they did now sitting on folding metal chairs and peering up at the
noisy ranks of white coats above them. There had even been a touch of
theater in the lighting. While the stage was harshly lit, the
spectators were in semidarkness. Hurst kept squinting at us while
shielding his eyes, but I doubt if he could recognize a specific face.
As I sat on one of the upper steps, the single word "trial" popped into
my mind to describe the spectacle--the kind of trial in which the
jurors render verdicts with stones.

Someone in the second row stood and made his way toward the podium.
Even before he stepped into the spotlight, his frizzy red hair and
large physique gave him away.

"I'd like to call this meeting to order," said Scan into the
microphone, igniting a round of applause, cheers, and whistles. Some
of the board members clutched their briefcases to their chests and
looked nervously at one another. Hurst, his face always a pale shade
of gray, scowled disapprovingly at us and looked positively ill under
the overhead lights. His forehead had an unhealthy sheen in the
glare.

More than a decade ago a heart attack had brought an end to his
surgical career, but since then he had found his niche in
administraon.

During my tenure as chief over the last eight and a half years I'd
watched him become more and more obsessed with his pursuit of absolute
authority over the hospital. He was ruthless in cutting budgets and
trimming deficits, and in a world where hospitals were subject to
hostile takeovers and closure, the board loved him for it -called him
dedicated. Clinicians had other names for his management style and
either feared him, submitting to his decrees, or held him at bay,
challenging him whenever he risked patients' lives in his drive to get
them out of hospital quicker and sicker--to save a buck.

The enthusiastic clapping became rhythmic, and a few voices took up the
chant "No! No! No!" They were joined by more and more until the
entire room was booming with the defiant shout.

Hurst sat back in his chair, made a pyramid of his fingers, and tapped
his lips, seemingly keeping time with the protest all around him. His
eyes were fixed on the floor and he remained motionless, but I knew
that pose from previous encounters; he was livid.

The other board members were shifting uneasily in their chairs,
whispering to each other, and shuffling their feet, all the while
looking repeatedly at Hurst and then back out at the crowd in front of
them. They seemed as astonished by his immobility as by our raucous
behavior. Finally Sean held up his hands and spoke again into the
microphone, "Okay everyone, come to order now, settle down..."

The room gradually grew quiet.

"Fine," said Sean brightly.

"Let's get right to the point. We, the clinicians of St. Paul's
hospital, are here to issue an ultimatum to you. Dr. Hurst," he said,
turning and gesturing toward the stony-faced former surgeon, "and to
the members of the board," he added, opening his arm farther to include
their part of the stage, "who, I may say, I'm glad to see have joined
us and have turned out in such numbers."

Scan was smiling and speaking as pleasantly as if he were honoring the
visitors. Some were obviously confused by such effusive politeness in
a hostile encounter and returned his smile, then checked themselves and
retained the same severe expression Hurst had adopted.

"As far as we are concerned, there will be no merger of our clinical
departments with UH. This whole operation has been engineered by
accountants and managerial gurus, with all the decisions coming from
above. That approach may make sense in companies," opined Sean, again
turning toward the board members, most of whom were CEOs of their own
corporations and industries in Buffalo.

"It would even be a sensible way to amalgamate the administrations of
our two hospitals, which, by the way, the majority of us here would
support."

I wasn't sure, but I thought I saw Hurst flinch at the mention of
merging his control of St. Paul's with the CEO of another
institution.

"But clinical departments aren't like companies. Academically and
professionally each of us is his or her own CEO when it comes to taking
care of a patient. We have the ultimate responsibility for that life;
we cannot and will not surrender that autonomy. Neither will we allow
our departments to be reorganized by anyone but ourselves. We're the
ones with the competence to assess how our clinical units best work to
deliver safe and timely care, not some time-and-motion expert. And we
will not accept that our departmental leadership be parceled out to
another institution. That's a formula to guarantee a department won't
make its needs heard at the budget table. Shutting us up isn't going
to save money, Dr. Hurst; it's only going to lead to misinformed
decisions, misspent funds, and a patient clientele denied the equipment
and resources it really needs. Do whatever you want with the other
services in the two hospitals--laundry, catering, distribution, and
supply they seem perfect things to merge. But our clinical departments
must retain full thickness."

There were immediate murmurs of approval from everyone in the audience.
Hurst suddenly flushed. The board members looked puzzled, clearly not
familiar with the term that had caused such a buzz around the room.

"Full thickness" was a surgical expression known to all the doctors in
the amphitheater, including Hurst. It referred to a skin graft that
restored all levels of tissue. Sean meant that our clinical
departments and departmental leadership would remain completely intact,
chiefs included, or there would be no deal.

"I needn't remind you," concluded Sean, "you can merge and amalgamate
all you want, but you need physicians if you want to have a hospital."
With that comment he walked from the podium and took his seat.

The applause from his colleagues this time was long and loud, though
decorous, as befitted the seriousness of what we were faced with. Sean
had lifted our opposition to the plan from petty worries over turf to
the vital connection between saving lives and solid medical
representation at the level of financial planning. Some of the board
members were whispering to one another and nodding. A few reached into
their briefcases, pulled out notebooks, and were busily writing. Hurst
hadn't budged, and he was no longer tapping his lips with his fingers.
But his eyes looked molten with rage.
Stewart Deloram, who had been sitting beside Sean, stood up, seemed to
sway a few minutes, then recovered his balance and strode to the
podium. I recognized a few other chiefs in the front row, who over the
years had been willing to oppose Hurst when it had been necessary. Sean
must have recruited the lot of them to help him lead today's effort. I
wondered why he hadn't approached me, since we'd been so effective
joining forces for these battles in the past. The proof of our
successes was the enmity of Hurst that we'd incurred in the process,
and without a doubt we were certainly considered his two most vexing
chiefs.

I glanced over at our old adversary again. He still seemed to be
smoldering in his chair since the board members had obviously responded
positively to Sean's opening remarks. Watching him fume, I quickly got
a pretty good idea why Sean hadn't included me in his offensive this
time. If he'd heard about the Sanders case, he probably figured I had
enough trouble as it was.

"To the members of the board, welcome," said Stewart when he reached
the microphone. He broke off to cough into his hand, then continued,
turning to face his guests but pointedly ignoring Hurst.

"I'm Dr. Deloram, chief of Intensive Care at St. Paul's. My job
today is to help you better understand our grave concerns over the way
this merger is shaping up. In a minute, I'm going to let you ask
questions or say anything..."

As Stewart spoke, he kept having to clear his throat and turn away so
as not to cough into the microphone. He must be getting a cold, I
thought, and noticed he looked a bit pale under the stage lights. I
absently gazed around the audience and spotted here and there some of
the chiefs Hurst had in his hip pocket. They were slouched down in
their chairs, probably hoping their master wouldn't see them but no
doubt just as scared of what their own department members would do to
them if they'd skipped the meeting.

Stewart had another coughing fit, took a sip of water, and went on
speaking.

"... but let me first ask you, if you were a patient in our I.C.U, who
could best assure that the equipment and personnel needed to pull you
through were there? An accountant? An absentee chief looking out for
his own department at UH? Or a chief who was present..."

Then I saw Rossit sitting a few rows ahead of me leaning forward with
his chin resting on his hands. Even in the half light I could see the
continual movement of his jaw muscles. He mustn't be too happy with
something, I thought, watching the familiar chewing motion.

Stewart finished speaking with an apology to his audience for sounding
so wretched, joked about being a shoemaker poorly shod, then croaked an
invitation for questions.

"Jesus, someone should send him home to bed," I muttered to no one in
particular while watching him give his microphone to one of the
visitors on the stage who'd raised his hand. This man had his chair
closer to Hurst than the rest, and I'd noted he hadn't been among those
nodding and taking notes at the end of Sean's remarks.

He, like the others, seemed vaguely familiar.

"Thank you. Dr. Deloram," he began, "but I feel compelled to explain
why this merger is necessary..."

There were groans and the sounds of shuffling feet throughout the
auditorium. We'd had these explanations ad nauseam, and the familiar
phrases were like Sominex.

"Partnerships,"

"greater efficiencies," "better clout with HMOs and regular
insurers"--the mantra went on against the rising mutter around me.

"Can it!"

"Give it a rest!"

"Christ, not again!"

But this speaker seemed undaunted by the hostility he was incur ring.
In fact, he seemed encouraged by it, raising his voice and bull dozing
on while the volume of the protests around him increased.

"... their bargaining power means lower rates, and that means less
income for the hospitals..." I suddenly recognized him. He wasn't a
member of the board but one of the hospital lawyers. He'd once
accompanied Hurst to a meeting with other lawyers to discuss the
hospital having been named in a lawsuit against ER.

I quickly looked over at Hurst. He was in the same fixed position as
before, his fingertips at his lips, but his eyes were roving over the
increasingly unruly audience and he was starting to smirk. Suddenly he
placed his hands on the sides of his chair and appeared to be about to
get up. But he paused halfway out of his seat, and as I watched, his
expression changed. He raised his eyebrows, dropped open his mouth,
and, bringing his hands up from his chair, raised his palms to the
heavens a perfect parody of shock and dismay. But that little smirk
had given him away.

"Excuse me!" I said, rising from my place on the stairs.

"I want to know who you are, sir." I pointed at the man with the
microphone.

He stopped in mid-sentence and stared at me.

"Yes, you," I insisted.

"Tell us who you are!" I continued to point at him. But out of the
side of my eye, I could see my outburst had been in time to catch Hurst
still halfway out of his chair. His white face instantly went crimson,
but he slowly sank back into his seat.

"Are you a member of the board?" I persisted, continuing to face the
startled lawyer.

"Me?" he asked, glancing nervously at Hurst.

Everyone had gone absolutely still, the doctors probably more than a
little uneasy about what I was up to and no doubt wondering whether I
would embarrass or hurt their attempt to win over the board members.
The businesspeople themselves looked puzzled, and one of them
volunteered, "This is Norman Baker, an attorney for the hospital. His
law firm is representing St. Paul's in the merger." His tone of voice
clearly implied he hadn't a clue why there would be anything wrong with
the lawyer being here.

"I simply want us all to know who he is," I countered.

"As a member of the law firm handling the merger, he obviously has a
vested interest in the process quite different from that of the board
members," I explained.

"Now just a minute!" exploded Baker.

"Dr. Garnet!" roared Hurst, leaping out of his chair.

"Relax, Dr. Hurst," I interjected before he could get started.

"And you too, Mr. Baker. This meeting was called, among other things,
to allow the physicians to express their deep concern over the merger,
not to give yet another lawyer another chance to lecture us on why
legal takeover specialists think it's a good idea. That the board is
also present to hear these concerns, and hopefully to ask questions
about them, gives added value to this meeting. It's simply too good an
opportunity to waste--an opportunity to assure that the choices made in
the coming weeks are fully informed choices. What better way to assure
that the best possible decisions will be taken for the future of St.
Paul's?"

I'd only intended to stop Hurst from scuttling the meeting. I'd been
sure he was going to engage in a show of mock outrage at our rudeness
in front of the board and then lead the lot of them out of there. He
knew full well how fed up we all were with proclamations from above,
and he certainly could predict how we'd react to yet another harangue
about why the merger was good for us. I even suspected Baker had been
told to deliberately try to antagonize us to give Hurst the excuse he
needed. I'd seen Hurst pull similar stunts and engineer his acts of
indignation before but had learned to keep an eye out for that little
smirk which always preceded them.

But what I hadn't counted on was the applause that followed.

Even some of the board members rose to their feet and clapped.

Hurst remained seated, his hands once more in the shape of a pyramid
and his fingers rapidly tapping his lips. But there was no trace of a
smirk now as he glared up in my direction. Baker leaned forward,
whispered in his ear, then picked up his briefcase and stalked off the
stage. Around me my colleagues went on clapping. I caught Sean's eye
as he stood at the front of the stage. He raised his arms, joined his
hands over his head, and pumped the air with them like a triumphant
boxer. Then, still smiling at me, he used his right index finger to
point at his temple and make little circles--the universal sign that he
thought I was crazy.

I might have found Sean's gesture more humorous if I hadn't seen Rossit
arrive at the front of the stage at that moment and exchange a few
words with Hurst as he pointed toward where I was sitting. The two men
then looked in my direction, while Hurst nodded and spoke into Rossit's
ear.

"A regular pair of lagos," I muttered to myself. When Hurst turned to
leave through a door down at the stage level, I watched Rossit push his
way back to the foot of the aisle I was in and start up the steps
toward me, scowling the whole way.

As he jostled past, he snarled, "Fuck up this merger. Garnet, and
you'll make yourself a lot of powerful enemies!"

I was halfway to my feet and trying to control an urge to run after the
little bastard and pummel him. He had reached the top of the stairs
when I heard a crash on the stage below and someone screamed. I
whirled in time to see Stewart Deloram fall onto the podium, toppling
it over, and roll off it onto the floor.
Chapter 9

Six hundred doctors and nobody moved for the space of a few heartbeats.
Then about a hundred of us tried to take charge.

I sprinted down the steps two at a time but was so stiff I nearly took
a tumble myself.

Stewart was being swarmed by his rescuers.

"Get a stretcher!"

"Is he breathing?"

"Get a pulse?"

"Get back!" Sean was yelling as he knelt at Stewart's head.

Elbowing my way through the circle of white, I could see Stewart
himself struggling to sit up. His face was the color of paste, and
glistening dots of perspiration spread across his forehead.

"Lie back, Stewart," I commanded, pushing gently on his chest and
reaching for his wrist. The front of his shirt was damp with sweat,
and his pulse, difficult to feel, was rapid. I noticed blood starting
to pool on the floor from a gash behind his ear. Sean grabbed a packet
of tissue from his lab coat pocket and applied pressure to slow the
bleeding. There was also a stench of feces in the air.

"Let's get him toER I yelled.

"Call them for a stretcher stat!"

"This'll need a few sutures," added Sean calmly.

My main concern was for Stewart's vital signs. Still coughing, he
seemed to be breathing okay, but clearly he had a low pressure. He
moaned, looked around with a puzzled expression on his face, then
reached for his head with his right hand.

"Hold it, Stewart," I restrained him.

"You fainted and have a cut there. Do you feel pain anywhere else?" I
knew he was in his late thirties, so a heart attack was unlikely but
not impossible.

"Earl," he said weakly.

"What happened?"
I repeated, "I think you just fainted. Do you have pain anywhere?"

"Only my head," he answered, reaching for it again.

9S

"Hold it, Stewart," said Scan.

"I've got to keep pressing until we sew you up in ER."

Stewart obediently but weakly let his hand flop to his side.

"Stewart, do you have a history of heart trouble or of any other
medical problems, like diabetes, ulcers, or lower GI bleeding?"

The differential for dizziness and fainting snapped into my
head-cardiac, metabolic, vascular.

"No, nothing. Earl, just this cold, and--Oh Christ!" he exclaimed,
raising his head and looking down with disgust at the wet crotch of his
trousers.

"Don't worry about it," I tried to reassure him.

"It happens." But not usually with a simple faint. With a seizure or
a full cardiac arrest, yes, but I hadn't seen any shaking movements and
he'd obviously had a pulse from the moment I got there.

"I've had diarrhea since a few hours ago." He groaned.

"It's part of this flu I picked up, but this is embarrassing."

He'd not been coughing on the phone last night, I thought.

"I only felt dizzy when I got up to speak," he continued.

"Until then, apart from the usual muscle pains and a slight headache, I
didn't feel that bad, for a cold."

His words sent an icy shiver up my back.

The stretcher arrived, and as we hurried toward emergency I kept my
fingers on his pulse while Sean kept up his chatter as he continued
pressing on the laceration.

"You know, I usually let the students practice on cuts like this.
You're getting pretty V.I.P care for a simple case of the runs, what
with two chiefs taking..."

But my insides were turning to ice.

"While Sean's doing his artwork, I'm going to run a few tests,
Stewart," I told him breezily when we got toER hoping my
everything'sgoingtobeall-right tone kept him from realizing what I was
suspecting.

Two days ago I never would have thought about it, because until two
days ago, it would have been impossible. But any doubts I had that I
was overreacting vanished moments later. As we worked on Stewart,
starting IVs, drawing bloods, and rechecking his vitals, I happened to
glance up and saw Rossit standing at the door, looking on. The
expression on his face looked as grim as I felt. There was no trace at
all of the hostility and anger that had been part of whatever game he'd
been playing over the last few days. In fact, if I had to put a name
to what I saw in his black unblinking stare, it would be fear.

Well, this is a change, I thought rather bitterly, knowing full well
that he'd resume our hostilities whenever it next suited him and I
couldn't ever drop my guard against the little troublemaker. But for
that moment I was willing to bet we both expected the same results from
Stewart's tests--a low white count, a low sodium and albumin, and a
near normal chest X ray.

"I don't have to explain it, Michael, and I don't have any more time
for this kind of crap." Locating had finally found him for me in the
general records department at UH. Our conversation was not going
well.

"I've just admitted Stewart Deloram to his own I.C.U with a presumptive
diagnosis of Legionella, I could have been killed last night by whoever
came after me in the subbasement, and I don't even want to think about
what he might have done to Janet if I hadn't come along. Now when the
hell are you going to admit there's something more going on than a
missed water sample?"

"Is Stewart going to be okay?" he asked, refusing to answer my
challenge.

"Who knows. He's loaded to the gills with erythromycin and the
infection's early, but it's alarming as hell he could even have
contracted Legionella in the first place. And if it is Legionella,
we're also just seeing the prodrome. The pneumonia won't develop until
tomorrow. So far there no evidence of staph."

Not only had Rossit and I agreed there were no clinical indications for
more antibiotics at the moment, the real irony was that he and I had
then stood side by side and lectured the residents about the perils
ofoverprescribing and cautioned them to rein in their urges to throw
everything at an infection "just in case."
Michael stayed silent, then asked, "Could Stewart have gotten it taking
care of the Sanders woman?"

"Michael, you know secondary person-to-person spread has never been
recorded," I snapped back.

"Now you 're inventing unheard of scenarios and all the while
dismissing Janet because she's dared to suspect something you'd never
heard of!" I was losing patience by the minute with his stubborn
refusal to admit what we might be up against.

"Earl, calm down. I meant could an accidental aerosol of Legionella
have been created from a problem with the ventilation or from
incomplete sterilization of equipment used on her."

1 took a deep breath and lowered my voice.

"They're checking that out now, but so far there been no evident breech
of isolation and sterilization procedures."

"But it's possible," he persisted.

"Not probable, Michael. Stewart's young, healthy, even less likely
than those three nurses to contract Legionella."

"Are they checking where he lives--" "Yes, Michael, yes! You realize
you're going down the same blind alleys they already went down at
University Hospital?"

This at last shut him up. But in the silence between us, I realized
something.

I didn't know why or where it happened specifically; perhaps it was
last night when someone tried to crack my skull open. Or was it
witnessing the utter devastation of Sanders's lungs this morning? Or
maybe it was seeing Stewart fall victim to an inexplicable infection a
little more than an hour ago. But over the last twenty-four hours I'd
passed from considering that a killer was possibly on the loose to
absolute certainty that I was in pursuit of someone very real, very
clever, and very evil. Perhaps it was the impossibility of making
anyone else believe that murder had been committed that had made me so
sure.

I'd begun to feel Janet and I were battling a superb defense--a
protection set up by a killer who knew how the medical community would
interpret and investigate these infections and deaths. A killer who
was convinced that fidelity to science would practically forbid any
investigator from thinking the infections were deliberately
inflicted.
It was as if the very bizarreness of the infections was a taunt, a
tease, an arrogant flouting of the murderer's method--a demonstration
of the murderer's certainty that no matter how strange or inexplicable
the infections might be, adherence to accepted medical thought would
prevail, and no one would ever suspect the killer's existence because
no one would dare contemplate that murder had ever been done.

Paranoia? Maybe, but that reaction described Michael's behavior
perfectly and Cam's and probably anyone else's I could think of whom we
might try to tell about the Phantom.

I was so lost in thought, it took a few seconds to realize Michael was
talking to me again.

"... but Janet's been telling everyone what happened in the basement
was just a panic attack."

"That's only a ruse," I answered, suddenly feeling hopelessly tired.

"I didn't know you got panic attacks."

"Will you forget goddamned panic attacks!"

"All right! All right! You don't get panic attacks. But didn't you
hear anything I said yesterday about what this kind of Phantom talk
could do to your credibility? Besides, Janet doesn't exactly seem to
be sharing your worry anymore. She's broadcast all over the hospital
that our audit is a waste of time, which, by the way, I don't
particularly appreciate. Just because I don't buy her Phantom idea, we
still have to find a source of " "Damn it, Michael!" I was snapping
again.

"I told you it was a ruse!" Once more I took a few seconds to try to
calm down.

"Have you talked to her yourself today?" I asked through clenched
teeth.

"No, I haven't seen her at all. But she's obviously been feeding the
gossip network," he replied brusquely, letting me hear how miffed he
was with her.

"Well if you had, Michael, she'd have told you she's only saying that
stuff to fool the creep who attacked me last night into thinking she's
backed off." The receiver might have been Michael's neck, I was
squeezing it so hard. I relaxed my grip and watched the blood rush
back into the skin around my knuckles. Still, I couldn't let go of my
fury with him for being so thick.

"You didn't see that woman's lung. It made me scared for anyone at
University Hospital, including Janet and you. Now I'm scared about
what's going to happen to poor Stewart. And I'm going to stay scared
every time Janet goes to work and every time she comes home and goes
near the baby." I let my frustrations pour out of me.

"Belter yet, Michael, put yourself in Janet's position. You don't
think she isn't frightened, at least if not about herself, then
certainly about Brendan?" Then I let fire my final shot.

"Whether you're right or. God forbid, she is and I'm more and more
convinced she is you could at least give Donna and your unborn child
the same concern."

I heard Michael grunt like he'd been hit, then listened to him breathe
for several seconds.

"Ouch," he finally answered. Then added, "God, how could I be so
blind!" A few more seconds passed.

"I'm such an asshole! Donna's right, I've got the sensitivity of a run
away truck once I get my head set on a clinical problem." He was
speaking more and more rapidly and sounding increasingly chastised.

"Damn, I'm sorry Earl; I just never clued in on how this might be
affecting Janet and you personally. Will you forgive me? And will
Janet? Oh my God, Donna will kill me for this if she ever finds out I
was so insensitive. I'll find Janet and apologize to her myself.

No! Better yet, I'll send her flowers in the morning and then
apologize. For God's sake, don't let her tell Donna."

While his self-reproach built up steam, I recalled something about
jackasses and two by fours, but now that I had his attention, I
pushed.

"Michael, it's time to cash in all those markers you've chalked up with
the accreditation board and get me named to this audit. Or threaten
Cam if you have to. Tell him we're sitting on another presumptive
diagnosis of Legionella related to the Sanders case. Impress on him
that I'm his best chance of finding answers before culture results make
the outbreaks official. If he still isn't moved to cooperate, tell him
I'm going public by noon tomorrow unless I've got carte blanche to find
out what's going on over there."

Michael's silence was encouraging. Figuring I had him cornered, I hung
up before he could change his mind.

I heard sirens approaching. There were at least two, maybe more.

If they were all ambulances heading to our ER, I knew I'd be called to
help within minutes. I was starting for the door and pulling my
stethoscope out of my lab coat pocket when I noticed the MMB article
slide out with it and fall to the floor. I paused to pick it up,
glanced at the summary on the first page, then started to slip it back
into my pocket Had Miller been accurate in his precis of it? The
blended waitings of the sirens were closer but no ambulance was here
yet Neither had Susanne run in to fetch me. I had a moment still.

Unfolding the article, again I skimmed through it. The brief synopsis
described a case report from Japan of the world's first-ever infection
by a methicillin-resistant, vancomycin-inhibiting staphylococcus
organism. The key word was inhibiting. It ultimately succumbed to
vancomycin but only at very high doses. What had made this case
alarming, the authors stated, was that in the past, organisms on the
way to becoming fully resistant to a specific antibiotic had often
demonstrated this inhibiting effect first. Historically, the emergence
of a fully resistant strain of these organisms almost invariably
followed, usually within two years. Should the same pattern repeat
itself this time, the resulting staphylococcus bacteria, resistant to
both vancomycin and methicillin, would be virtually un treatable

Any new antibiotics that might be useful were at least two or three
years away from use in humans. The authors then brought the issue even
closer to home. The first vancomycin-inhibiting strain ofMRSA in the
United States was reported by a hospital in Michigan, a second by a
hospital in New Jersey. In both cases the organisms had responded to
large doses of antibiotics, and no outbreaks anywhere in the world had
been reported since.

One of the sirens had become much louder than the rest. Suddenly it
cut out, and seconds later I heard the vehicle roar into the ambulance
bay.

Getting ready to leave, I flipped over to the last page. A single item
in the final list of recommendations was what I was looking for.

Exactly as Miller had reported, in a case like his mother's, in which a
staphylococcal infection had failed to respond to vancomycin, the
organism should be rechecked for this new trait of reduced
susceptibility. There was even a hot-line telephone number at the CDC
where any instances of the strain were to be reported immediately.

I tossed the article onto my desk. The rest of it looked rather
technical and would require more time than I had at the moment. I had
a hell of a lot more to worry about than some theoretical super bug
coming at us from the other side of the world two years in the
future.

But as I was heading out the door and running toward ER, on impulse I
thought, why not call bacteriology and ask that vancomycin be included
in Rossit's special sensitivity tests already under way for the Sanders
case? According to the CDC, the minimal inhibitory concentration
method he was using a determination of the times a culture of the
organism can be diluted and still resist a given antibiotic was the
only reliable way to screen for the inhibiting strain.

Rossit would probably be furious at me for meddling with his lab
studies, but at least the gesture of adding the antibiotic to the group
being checked might please Miller. After all, if Rossit hadn't been so
busy bad-mouthing me, he could have kept St. Paul's up-to-date on this
latest protocol for staph infections himself, the way Cam had done for
University Hospital. I asked the clerk at triage to phone in the
order.

The next hour I spent working with every available resident and doctor
in ER resuscitating a dozen seniors suffering from smoke in halation.
Their residence had burnt to the ground. The culprit responsible for
the fire, an eighty-year-old man repeatedly caught smoking in bed, was
brought in later a charred corpse held together by a body bag.

As I was filling out his death certificate, our telephone clerk
transferred a call to where I was sitting.

"Bacteriology department for you Dr. Garnet, line three."

It was a technician.

"Dr. Garnet, I'm sorry to bother you, but the clerk told me you wanted
the staph organisms from the Sanders case checked for an inhibitory
effect on vancomycin?"

"That's right."

"Well, I thought I'd better tell you, it's already been ordered."

"Really? How come that's not on her chart?"

There was a pause.

"Gee, Dr. Garnet, I hope I'm not in trouble."

Another pause. By now I recognized the voice of the technician who'd
done the initial Gram stain on Sanders's sputum sample and who'd been
so excited about finding staphylococci.

"You see, it wasn't exactly an order," he continued, sounding
sheepish.

"It was actually more a suggestion from Dr. Mackie over at UH. He
phoned yesterday morning, said he'd consulted on~ the case, and
recommended we do the test since Harold's mother wasn't responding to
treatment. It's the routine in his department, and should be here too
if you ask me."

"Did you check with Dr. Rossit?" I asked, glad this innocent couldn't
see my wicked grin.

The complete silence on his end of the line answered my question
Finally the young man dared to say, "You know how he is. Dr.

Garnet. Besides, Dr. Mackie's going to be the new overall chief soon,
isn't he, when the merger goes through?"

Not if Rossit can help it, I felt like warning him, for despite the
popular expectation that Cam would prevail on merit, I'd seen hospital
politics favor the Rossits of this world all too often. Ambition was
an easier currency for boards and CEOs to manipulate than the harder
mettle that resided in a man like Cam. I tried to keep my voice
neutral when I replied, "You must have inside sources that I don't."

I'd been about to hang up when the tech said, "Dr. Garnet, I wonder if
I could ask you a favor?"

I immediately felt my guard go up.

"Yes?" I replied cautiously.

Over the years, as a physician and a chief, I'd been asked a lot of
favors. Most had been legitimate, but some, especially those from
people I didn't know, had been embarrassingly inappropriate and some
had been outright illegal.

"Well, since you were going to order it anyway..."

"Would it help your peace of mind if I put my name on the order I
volunteered, chuckling at the simplicity of the request.

"Would you? That'll be great! The test probably won't come to
anything, but I never know what Dr. Rossit is going to be angry about,
especially these days."

Another little sin on my tab wouldn't matter much, I thought while
hanging up.

Before leaving that evening, I dropped in to see Stewart. It was an
eerie feeling gowning up to visit him in the same glass chamber in
which we'd put Phyllis Sanders.

At first Stewart appeared in surprisingly good spirits and seemed more
intrigued by how he could have contracted Legionella than frightened by
his infection. But as we talked about the conventional investigations
into the organism's source I'd no expectations they'd find anything I
soon discovered Stewart's underlying fear when he began to cough from
the effort of speaking. As his hacking made him progressively short of
breath, his eyes filled with alarm, and he asked, "Do you think when
the pneumonia comes I'll get as bad as she was?"

"Of course not Stewart," I bluffed.

"Early treatment's the key to a mild and uneventful course. And
remember, she had a secondary staph infection as well."

He looked away without saying anything more and stared through the
glass walk of his isolation room into the dim light of I.C.U. The gray
semidarkness of evening was visible through the large outside windows
behind the nurses' station. He knew as well as I did that evolving
respiratory conditions get worse at night. And as a physician, he knew
what could go wrong. I figured he had to be thinking of the Legionella
cases he'd seen in the past. It would have been impossible for him not
to remember chest X rays he'd viewed that had shown the lungs whited
out by the disease. He'd certainly have seen the remains of the
infection at autopsy often enough, though I thanked God he hadn't
witnessed the particular horrors of Phyllis Sanders's post today. Even
with antibiotics on board, he had no way of knowing for sure what lay
ahead for him.

All the while I desperately wanted to ask Stewart some leading
questions about who might have done this to him. But should I? In his
vulnerable state, he might not be as skeptical as his colleagues, and
talking about the Phantom could needlessly add to his fears.

"Stewart," I began, choosing my words carefully, "if the infection is
related to the Sanders case, then your exposure had to have happened in
the first hours after her admission. Was there ever anyone around you
using an aerosol at that time?"

"No, I went through all that with Rossit."

"Do you use any nose sprays for allergies?"

"Again, like I told Rossit, no."

"Did anyone visit Sanders from UH on that first day?"

"Visitors? Besides her son? No. She was in no shape for visitors.

You know that. Unless you consider Cam Mackie a visitor."

"Was anyone else here, during those hours an orderly, a nurse, someone
dressed in isolation garb you might not have recognized who shouldn't
have been?"

"What do you mean?"

"Could some unauthorized person have come in here and been around you
and Sanders, and you not have realized it? In my own department all
sorts of people in greens come and go they're al most invisible without
my noticing it."

"I don't know. It's possible I suppose, but we're a lot smaller and
more controlled than ER. The nurses would be pretty quick to ask
anyone they didn't recognize what he or she was doing, especially if
someone tried to get into this room," he answered, sounding a little
morose and looking around him. I suspected he still couldn't quite
believe he'd ended up a patient in his own domain.

"Is there anyone who you've seen around a lot outside of here who may
have been following you or want to do you harm?"

"What!" He stared at me, an expression of amazement creeping over his
pale face.

I immediately backed off.

"Nothing, forget about it. I was just kidding a bad joke about how
shit disturbers like you and Sean could expect Hurst to keep an eye on
you. You guys really got him nicely at the meeting today."

He looked puzzled but seemed to accept the question as a failed attempt
to make him laugh. I decided that I couldn't ask him any thing more
without scaring him silly or leaving him convinced I was crazy.

When I stopped at the nurses' station to check his chart, I learned
everyone working in I.C.U had gone on oral erythromycin as prophylaxis
against Legionella, despite Rossit's best attempts to assure them it
wasn't necessary. Not a bad idea, I thought. Maybe Janet and Michael
should do the same thing.

All the way home I kept wondering how someone from UH could have gotten
near Stewart and infected him without his knowing. De spite his
protests to the contrary, I was sure he'd be as oblivious as I to the
legions of anonymous hospital workers who were around us every day.
They could come and go like ghosts or like a phantom. I began to feel
overwhelmed again by how nebulous our killer was.

Might it be impossible to ever pull him from the shadows? Could he go
on forever, moving undetected through the faceless echelons of a
hospital, and continue to murder?

I felt a little less hopeless when I remembered Cam had been with
Stewart and Sanders during those critical hours. Maybe he had
recognized someone he knew from University Hospital, someone he might
normally pay no heed to at UH but who may have stuck out in his mind
because he or she was at St. Paul's. I'd ask him tomorrow.

It was only at the entrance to my house that I asked the big
question.

Why was Stewart chosen as a victim? I couldn't think of any
conceivable motive pertaining solely to him. Then a nasty possibility
concerning myself popped unbidden into my head. Perhaps it was a
demonstration, a show of power, a message from the killer that he could
get anyone he wanted, including people on my turf, and I couldn't do a
thing about it.

The relief Janet showed when she learned I'd soon be with her at UH
quickly evaporated when I told her what had happened to Stewart.

She was also as disturbed as I was about the implications of the
attack. Like me, she no longer included an if daring our discussions
of the killer.

I related the rest of the day's events during our dinner together,
although it felt more like a debriefing than table talk. I wanted to
make sure I hadn't overlooked anything significant.

Janet was quiet afterward, then said, "There is something that doesn't
add up. It's Rossit. Why would he want the amalgamation to go
ahead?"

I'd been too preoccupied about Stewart to have given much thought to
Rossit's peculiar antics at the meeting.

"How do you mean 'doesn't add up " "Whatever he's cooking up with
Hurst, given the likelihood he'll lose his job as chief to Cam once the
merger goes through, I'd have figured he'd be cheering you on, not
threatening you or anyone else who was trying to stop the
amalgamation."

I leaned back as I thought more about Rossit.

"He may not be as completely out of the running against Cam as everyone
thinks," I finally answered.

"What?"

"Politics can be screwy, and Hurst might figure it would be easier to
make deals with a self-serving guy like Rossit than it would be with
Cam."
"That sucks," Janet said.

"It super sucks when you think he's probably making the same
calculation about every chief, including yours truly, and will only
support those he's sure he can control."

"Christ!" she muttered, downing her drink club soda, in deference to
both recent and planned efforts at keeping Brendan from being an only
child.

"If Rossit thinks he's got some kind of arrangement with Hurst," I
resumed, "then he might see the merger as an opportunity and not a
threat."

Janet received this observation with raised eyebrows, leaned back, and
seemed to savor it for a while.

"I see what you mean," she finally allowed.

I picked up my own drink, a Black Russian, acknowledged that the rules
of pregnancy weren't fair by raising my glass to Janet, then swirled
the ice, took a sip, and added, "What / don't get is Rossit's
extraordinary ardor in trying to nail me for the Sanders case. It's
gone way beyond his usual mean streak, and for the life of me, I can't
see how my downfall could benefit him."

Janet had winced at the word downfall.

"Has he ever teamed up with Hurst before, during any of these other
vendettas he's carried out?"

The image of Rossit and Hurst huddled together, whispering and pointing
toward me, sprang to mind. I shuddered, then answered, "No, at least
not that I know of."

Janet settled back in her chair and twirled the stem of her glass with
her left hand.

"So," she began, holding out her right thumb, about to start counting
something, "Rossit has outdone even his own smarmy standards in his
attempt to crucify you." She held up her index finger alongside her
thumb.

"He's even recruited Hurst's help, an unusual step for him, to get you
into Death Rounds almost immediately." Her middle finger joined the
other two.

"And he's a fan of the merger, as though against all odds he has some
trick up his sleeve whereby he could prevail over Cam." Pour fingers
were now in the air.

"Hurst's support could be part of that trick, but Rossit's got to know
my hospital's going to fight as hard as yours to dominate the merger.
He's got to be counting on something more than Hurst's get ting his
wish list to help him win the day." The fifth finger she pointed at
me, with an expectant look. It was my turn to provide a piece of the
puzzle.

"What could be Rossit's additional hidden trick?" she asked.

Our problem solving often proceeded this way, an idea at a time, layer
by layer, back and forth. But usually the topic was interpreting a
work of art, where to go on vacation, or how to redecorate the house.
Yet it seemed as good a method as any to help unlock what ever might
help us get a grasp on our killer who no one else even suspected
existed.

And unlock something it did. Another inconsistency, a big one that
Stewart had noticed, flew into focus. I sat up and snapped my
fingers.

"Janet, you're a genius. If Rossit needed another trick, something
more to assure his advantage over Cam, why did he keep ridiculing my
diagnosis of Legionella in Sanders's case?"

"What do you mean?"

"Look. One of Cam's most important responsibilities as chief of ID is the control of hospital-acquired infections. He'd already been unable
to explain two cases of Legionella involving nurses from UH. What
better way for Rossit to undermine Cam's credibility than to discover a
third? By doing so, Rossit could imply that University Hospital had a
recurrent problem with the deadly organism and that Cam couldn't solve
it. A scare about un contained Legionella, if it became public, would
frighten away patients, shatter public confidence in UH, and be a
disaster for the hospital's contracts with HMOs. With the potential
for such a catastrophe tied to Cam's reputation, the board might hand
the chair to Rossit instead."

I stopped for breath and took a big gulp of the Black Russian.

Janet frowned, whether at what I was saying or at my wolfing down
forty-proof alcohol, I was too caught up by what I was thinking to
pause and ask.

"So why wasn't Rossit shouting the possibility of Le gionella from the
rooftops since day one," I continued in a rush, "or at least since
first thing this morning in the light of our autopsy findings The case
should have been like a gift to him, the 'extra trick' you said he
needed to 'win the day' over Cam. Instead of ridiculing me for
suggesting Legionella, he should have been encouraging me to confirm
the diagnosis." I caught my breath.

"But it was almost as if he'd wanted to suppress any mention of the
organism. Why would that be?"

Janet grimaced, then shook her head.

"I've no idea," she said quietly.

We sat for a while without speaking, Janet frowning at the rising
bubbles in her drink, me slumped back in my chair and letting my eyes
roam around the cozy dining room. We ate here with the lights low and
candles lit whenever we managed to be home for dinner at the same time,
to claim at least a little tranquillity despite our insane schedules.
The little flames from the candelabra bathed the room in a soft glow
that was particularly canning. While they nickered and reflected off
the rich mahogany surface of our table and the surrounding furniture, I
found myself looking at a chess set we kept on a nearby buffet for the
occasional after-dinner game. The candlelight projected shadows of the
chess pieces against the wall and made them move and sway as in a
dance. The effect was eerie, as though some tactical strategy that
defied my understanding were being played out while I watched.

Just as when I played Janet, I thought idly. She always beat me.

Her moves inevitably caught me by surprise and seemed to anticipate
anything I could throw at her. Like the Phantom, she too was a master
of defense.

I continued to watch the shadows of the chess pieces on the wall,
letting my thoughts move with them, this way and that.

The Phantom's only slipup so far was that he hadn't counted on someone
like Janet making me connection between the three nurses.

The turrets of a castle appeared and receded, followed by the shape of
a horse's head, followed by the flicker of an afterthought.

Perhaps he had after all.

If he was such a master tactician, surely he'd have taken into account
that someone might see what Janet saw, link the three nurses together,
and become suspicious about what was happening.

Wouldn't he then have been circumspect enough to try and prevent that
from happening?

"Janet," I said, startling her, "if you hadn't known Sanders had
Legionella but thought she simply had a staph infection, would you have
made the connection between her and the other two nurses?"

She thought a minute.

"I don't know. Maybe, maybe not. It certainly wouldn't have leaped at
me the way it did when you mentioned Legionella. Why?"

"Because maybe I missed something. I haven't given much thought to
where Phyllis Sanders might have contracted staph on top of the
Legionella," I continued.

"I simply assumed she must have already been carrying the organism like a lot of hospital workers unknowingly do, harboring it under their
nails and up their noses. I knew the bacteria wouldn't have penetrated
into her lung and taken hold if the Legionella hadn't first created
breaks in the protective surface of her bronchi, but I never once
thought that the staph infection had been anything but a fluke. Now
I'm not so sure. What if he's also found a way to infect his victims
with staphylococcus?"

"What! Why would he want to do that?"

"To vary the infection. Such a strategist would have been wary that a
third case ofLegionella could tip his hand and lead to some one figuring out the connection between his victims, exactly the way it did
with you. He still had to use the Legionella to set up the staph
infection, but once the staph became an overwhelming pneumonia and all
that pus became apparent, it was reasonable to expect no one would
think ofLegionella."

Janet stared at me, as if daring me to go the next step.

I took the dare.

"Obviously, however, the killer would be vigorously opposed to anyone
who did think of it."

Janet became very still.

"You're not serious?"

"The killer would behave toward me exactly as Rossit has from the
beginning doing everything in his power to suppress a diagnosis of
Le^t'oneZ/a in Sanders."

She looked astonished at what I was saying.

"My God!"

"His 'hidden trick' might have been to infect personnel at UH, knowing
full well how it would reflect on Cam. But two things went wrong. She
came to St. Paul's, instead of going to her ownER and I found the
Legionella."

After days of snapping at mists and shadows, I felt I'd finally clamped
down on real flesh and bone. I sat perfectly still, astonished that
I'd actually come up with my prey. horrified by what I thought I'd
uncovered.

"There's one problem," Janet said in a cool quiet tone that was scalpel
sharp. She immediately seized all my attention. Over the years I'd
learned it was the voice she reserved for disagreeing with a
colleague's opinion when her own diagnosis was bad news an un expected
cancer, a fetal deformity, or an unpleasant secret that her sharp
intellect had discerned.

I braced myself.

"How do you explain his selecting only people who punished patients she
asked.

I couldn't.
Chapter 10

That Friday morning I was driving into St. Paul's an hour later than
usual. It was stop and go on the so-called freeway, and as far as I
could see, row on row of taillights, three abreast, blinked the
on-and-off rhythm of our progress toward the stumpy skyline of downtown
Buffalo. A few shafts of sunlight penetrated the otherwise leaden sky
and roved over the city like silver beams searching out first one
building, then another. I didn't mind the slow pace much, because I
had a lot to think about.

Janet and I had talked long into the night about Rossit.

"You're simply pinning motives onto the parts of his behavior you can't
explain," Janet had declared.

"Apart from giving me nightmares, it does nothing."

"But that's exactly how you started with the three nurses," I'd
protested.

"Earl, don't take this personally, but you're just not as good at
intuitively seeing things as I am" had been her reply.

I'd nearly slipped an ice cube down the back of her dress. Then I'd
come up with another possibility, equally dark and troubling.

"What if Rossit has resurrected the Phantom, taught him whatever is the
lethal ID technique that's being used here, then put him to work
seeding infections at University Hospital? That way the motive would
be Rossit's, but the killings would still have the hallmark of the
Phantom, selecting victims who were punishers."

"Still a problem," Janet had promptly replied in that same cutting
tone.

"Why would Rossit have his Phantom infect Stewart Deloram? And from
what you described, Rossit seems as shocked as you are about that
infection."

She had me stumped again.

"Maybe the monster he's created is out of control," I'd mumbled.

At that point she'd declared, "You've been watching too many horror
movies," and had ordered us to bed.

Before obeying I'd called I.C.U to check on Stewart.

"He's coughing more and experiencing some increased difficulty
breathing. But his pressure's holding," his nurse said.

"If he's awake, say hello from me."

Then we'd overslept until 7:00 a rare event, only possible be cause
neither of us had gotten called... by Brendan or our hospitals.

I crawled through an interchange where I turned onto the Kensington
Expressway, but the switch in routes didn't let me drive any faster. I
spent five minutes passing a golf course, then another five
contemplating an adjacent cemetery. I wondered if it were some kind of
weird retirement package. I halfheartedly listened to the radio and
continued to brood over my thoughts from last night.

There was no denying Janet's observations. Just as I'd learned to
trust her insights, I'd grown to respect those same instincts when she
declared something didn't make sense. But I couldn't ignore my own
intuition either, whatever Janet thought of it. Maybe parts of my
ideas about Rossit were right, I thought. Maybe I had only some of the
motives wrong, or the motives right and some of the players wrong, In
the light of day I had to admit that the idea of Rossit recruiting a
murderous Phantom to advance his career was a bit much.

Surely there'd have to be a hell of a lot more at stake for someone to
be that crazy, even Rossit.

After I finally reached the exit ramp, I inched toward the hospital
through congested streets and listened to the news, the weather, the
sports scores it took one block for each and then a business re port.
Some spokesperson for the Buffalo Chamber of Commerce prattled away for
five minutes about the booming economy, low un employment, and billions
in investment that the business community hoped to attract to the city
in the coming years. Except nobody can get to where they work, I
muttered, leaning impatiently on my horn after a delivery truck blocked
my way. A cacophony of other horns joined in. I winced at the noise
and thought that maybe the bunch of business leaders at the meeting
yesterday could do some thing about traffic.

I recalled the sight of them all sitting there behind Hurst and smiled
at how I'd thwarted him and Baker, the hospital lawyer. Except the
forces behind the merger were nothing to smile at. There had been a
lot of power on that stage and a lot of money. It was the kind of
board hospitals liked to have these days made up mainly of CEOs, best
suited for the business of medicine, and loyal to the chain of command.
This usually meant they saw the hospital CEO as one of their own and
would back him to the hilt.

"Hurst's kind of people," I said aloud, breaking the monotony of the
traffic noise, and wondered if our little revolt yesterday would really
accomplish anything. Again I thought of Hurst huddled with Rossit, and
Rossit's angry warning. Fuck up this merger, and you' II make yourself
a lot of powerful enemies. I don't know why he was so worried about my
little speech having any lasting effect. Seemed to me he should have
also given the same advice to the other six him dred doctors in the
room.

Unless it was exposing the Phantom that threatened the amalgamation or
at least Rossit's own interests in it, or Hurst's, or others like
Hurst. If I were going to consider other motives, the merger it self
represented a huge opportunity for power and money. The resulting
complex would have an operating budget of half a billion a year. That
was a lot of influence and a lot of motivation for a whole new group of
players. Hurst and his cronies would be wanting to come out of the
amalgamation process with the upper hand and as much control as
possible over the new venture. It was a pretty heady prize, but was it
dazzling enough someone would commit murder for it? I found myself
revising who might have recruited whom and set off on an even more
macabre chain of thought. What if it were Hurst, or Hurst and members
of the board, who had recruited the Phantom to help destabilize
University Hospital, to give St. Paul's a huge advantage in the
amalgamation? Rossit might have been persuaded in exchange for the
promise of the chair, to develop and then teach the Phantom the
infection technique. Later, when things went wrong, he would have been
ordered to prevent Janet and me from exposing the Phantom at all
costs.

Loud honking behind me made me realize I was still stopped after the
light had turned green. I hit the accelerator, sped across the inter
section, then immediately was back in my stop-and-go routine, not
unlike the way I was thinking over my latest bizarre scenario. While
there was enough power and money at stake to make a motive for murder
seem feasible and the ghoulish scheme was consistent with Hurst's and
Rossit's recent behavior to discredit me, it still failed to explain
why Stewart Deloram had been infected. Besides, I figured Janet would
be about as enthralled with a conspiracy theory as she had been with
the monster-out-of-control idea.

"Now it's too much X-Files," I could imagine her saying.

I quickly snapped back to reality at a few minutes before 8:00 when a
bulletin cut into the regular chatter on the radio.

"The administration of St. Paul's has just announced a temporary
closure of its emergency department due to some unscheduled maintenance
problems. Ambulances are currently being rerouted, and the public is
advised to use ER facilities in other hospitals until the situation is
rectified. And now back to the weather. More rain will be..."

"What the hell?" I muttered, reaching for my car phone. It rang
before I could start punching in the number of ER.

"Garnet here," I answered briskly.

"Have you been told what's up?" It was Susanne.

"Not a goddamned thing! What the hell's going on?"

"We don't know. The radio announced we were closed about the same
moment Hurst's office called looking for you a few seconds ago. His
secretary said to get you pronto!" As Susanne spoke, I could hear the
PA in the background asking a string of names, all of them chiefs, to
report immediately to the boardroom.

"What do they mean, 'unscheduled maintenance'?" she demanded,
obviously up set.

"There's nothing broken here."

"I've no idea. I'll call Hurst's office right now. I should be
arriving in five minutes, traffic permitting."

I one-handed the steering wheel, kept an eye on the road, and managed
to dial a bakery before I finally got the number right for Hurst's
private line.

Busy!

The light at Main and High Streets was unusually long. I kept pressing
my redial button, my frustration rising as each repeated at tempt ended
with that same annoying buzz. The light changed, and once again I shot
across an intersection only to get ensnared in yet another tangle of
cars halfway up the next block. Stone and brick office buildings
loomed over me on each side of the street, adding to my sense of being
blocked in. Exasperated, I called back toER The clerk passed me to
Susanne immediately.

"I can't get through to Hurst. Do you know what's up yet?"

"No, but somebody's really spooked," she reported, sounding shaken. The
change in her voice from minutes earlier was alarming.

"All the patients in the department are suddenly being moved to an
empty ward that was closed down during last year's budget cuts.

And get this. We've all been ordered not to leave ER, while every
orderly transferring patients is wearing gloves and a mask. Somebody
better tell us damn quick..."

As her words continued to come in a rush the radio suddenly caught my
attention again. "... My, the gremlins are certainly plaguing
Buffalo's hospitals this morning. We have news of another closure.
This time University Hospital is advising all its obstetrical patients
that the delivery rooms and attendant wards are going to be out of
service until at least this afternoon. Any of their patients who go
into labor during..."

"Susanne, I've got to hang up. I'll be there in minutes." I cut her
off, not even having heard her last few words. I did some more
one-eyed, one-armed driving while punching in the number of Janet's
case room.

"Just a minute. Dr. Garnet," answered a clerk who sounded as rattled
as Susanne. In seconds Janet was on the line.

"I've no idea what's up. Patients and babies are being taken to
another wing in the hospital, the orderlies and nurses accompanying
them are wearing gloves and masks, and it's scaring the shit out of
everyone." She sounded furious.

"No one's told you anything?"

"Nada! We're waiting for Cam now. Waiting, hell! We've been ordered
to stay here until he comes."

My car was finally nosing into the entrance of St. Paul's.

"Did you hear they've done the same thing with my ER?" I asked while
cutting off a red four-by-four with tires as big as my car and slipping
into one of the few remaining parking spaces ahead of it. The driver
honked angrily and roared off to another part of the lot.

"Oh my God. You don't think--" "I don't know, Janet." I cut her
off.

"I've got to run. I'll call you as soon as I learn what's happening
here."

My mounting sense of alarm made me fumble my car keys and drop my
briefcase while I hurriedly locked up. The elements-Janet's case room,
my ER, and people in both places running around in gloves and
masks--had only one thing in common, Phyllis Sanders. Thoughts of more
Legionella victims swept through me like a chill as I ran for the
entrance to emergency. On the other side of the lot I could see the
huge red RV still circling, presumably trying to find a spot.

Everyone in the department immediately surrounded me.

"... some official from the state health board took our patient lists
from Monday until now."
"... ordered a call-up of all our staff that have worked during the
last five days."

"... labs called and said we're going to get our hands, fingernails,
and noses cultured."

The barrage of comments was coming from a group of twenty doctors,
clerks, nurses, and residents who were all understandably angry, some
quite wide-eyed with fright and a few already wearing masks and
gloves.

"Look, I don't know anything more than you guys do," I said, pushing
through them and moving toward the nurses' station, "but if you'll let
me through to a phone, I'll find out."

Orderlies wearing protective gear were wheeling patients on stretchers
past us and out of the department. Susanne was trotting alongside,
reassuring, "It's just a precaution, until they get some maintenance
problem checked," but the patients looked bewildered anyway. A
security guard at the door pointedly stopped Susanne be fore letting
the others through.

"I wasn't going to leave!" she said impatiently, pivoting away from
him and striding back to the nurses' station.

"By what authority can they keep us here?" she demanded when she got
up to me.

"I don't know," I answered her. On my way in I'd already been warned
by a security guard not to try to leave. He couldn't tell me why and
had refused to say what would happen if I did. I turned to the
clerk.

"Where's this state health official who took your patient lists?"

"Search me," she said.

"He wouldn't come near us without gloves and a mask on. He even put
the books in a plastic bag. Are we quarantined or something?"

Without answering, I stepped over to the counter behind us and grabbed
a phone. I finally got through to Hurst's secretary.

"Oh, Dr. Garnet," she said, her voice drenched with disapproval.

"Dr. Hurst definitely wants to speak with you."

As I waited on the line, through the windows of the nurses' station I
saw a group of men and women wearing masks, gloves, and gowns enter the
department carrying baskets of culture tubes. Some I recognized as our
own lab techs, even with the protective gear, while the others, about a
dozen in all, were strangers to me. Four of them went immediately into
the resuscitation room. The rest walked up to Susanne and started
talking to her and pointing to the cubicles where we normally see
patients.

Hurst finally came on the line.

"Well, Garnet, you really put your foot into it this time," sneered
that familiar harsh voice.

"If you'd spent nearly as much effort attending to emergency cases as
trying to sabotage my efforts to run St. Paul's--" "What the hell's
going on?" I roared.

Out in the hallway Susanne, the rest of our staff, and the lab techs
all swung around to stare at me.

"I suppose you'd better join us," continued Hurst on the phone, "but
you're about as welcome as the plague. I trust you'll wear suitable
clothing to protect the rest of the hospital from being contaminated
further by your carelessness!" He slammed the phone in my ear.

"Up yours," I said into the dead line, taking out my fury at him by
banging down my receiver as well.

Susanne and her group turned away from me and started talking earnestly
to one another, occasionally looking over their shoulders in my
direction. I was about to walk over and see if the newly arrived techs
knew what was happening but was interrupted.

"Who's Dr. Earl Garnet?" boomed a loud male voice from near the
triage area. The group with Susanne went quiet again. I instinctively
moved to leave the nurses' station and identify myself when I stopped
mid breath on seeing the man who wanted me. Big was not a good enough
description. The man filled the far end of the corridor.

He was bald, black, and laden with half a dozen metal suitcases, one
under each arm and a pair in each of his very large hands. He was
dressed in a yellow-and-black jogging outfit that looked more expensive
than one of my best dress suits, and on his feet were a pair of
well-worn hiking boots that gave him a military air. I figured he
could have worn pink bunny slippers and I'd probably still have had an
urge to salute him. He was that kind of man. I was relieved to see
him smile when I went into the corridor to greet him. A gray mustache
accented the friendly expression he fixed on me.

"Dr. Garnet?"

he asked politely.

"Yes," I said, walking toward him and offering my hand. As I got
closer, I better appreciated the mass of the man's shoulders hunched
over by the weight of the cases he was carrying. I could also see some
lines around his eyes that suggested he was nearer my age than I'd ever
have guessed from his superb physique.

He too was wearing latex gloves but didn't free one of his hands to
shake mine.

"Excuse me. Dr. Garnet. I'll just set my equipment over by that row
of stretchers against the far wall," he responded, stepping by me and
striding to the nearest gurney where he hefted his cases onto the
mattress. He quickly snapped open the smallest one, took out a stack
of surgical masks and a box of latex gloves, then went back to where
Susanne and the staff had gathered with the technicians.

"I'm Dr. Douglas Williams," he introduced himself in a voice that
could reach the cheap seats in Carnegie Hall. He needn't have bothered
raising the volume. He'd had everyone's attention since he entered the
department.

"As a precaution, until we find out what's going on here, would
everyone please put on masks and gloves from this fresh supply. Don't
use the ones in your ERas they may be already contaminated." As he
spoke, he distributed the protective gear he'd brought as nonchalantly
as a waiter might pass out hors d'oeuvres at a cocktail party.

"What have we been exposed to?" asked one of the nurses nervously,
breaking the silence and igniting an immediate echo of the same
question from everyone standing in front of him.

"I know this is upsetting," he answered, handing the remaining gloves
and masks to Susanne and quickly raising his hands to quiet the sudden
outbursts of questions, "but we're making sure the department hasn't
come in contact with a resistant form of staphylococcus again."

"Shit! All this for an MRSA case?"

"Why the extra fuss? We never evacuated patients before."

"Or closed ER for that matter."

Susanne frowned at me as Williams pressed on with his reassurances.

"That's right; it's nothing you haven't handled before," he said,
almost managing to sound bored while he looked around at everyone and
smiled.

"We're just using a stricter protocol this time."

He caught my gaze and held it, still smiling, but I felt I'd gotten a
direct order to bite my tongue.

"Now," he continued, looking directly at the group of technicians,
"some of you are from state health and some are from the hospital, but
for this job you'll work my way. Do nasal passages, hands, and
fingernails--all of them on everybody."

He stepped back to retrieve another of his suitcases as he talked.

"I

want you to use these to get under the nails and scrape," he ordered,
pulling out sterile packets of thin, wiry culture sticks normally used
to insert up the male urethra and cu Iture for VD. A few of the men in
the room winced.

"Dr. Garnet, I'd like to speak with you in your office," he ordered,
handing me a mask, slipping one on himself, then offering me some
gloves.

"And I could sure as hell use a coffee," he added, indicating with his
large hands that I was to lead the way.

"Some jerk cut me off in the parking lot and I spilled the one I had
all over my dash."

* * * "Do you think they'll buy it?" he asked me as soon as we were be
hind closed doors in my office. We'd grabbed two coffees from a pot
the nurses kept brewing twenty-four hours a day. In here he seemed to
think it was safe enough for us to lower our masks and load up on
caffeine together.

"Not for long," I warned.

"There's too much experience out there for anyone to believe you'd
close ER simply because we treated a case with MRSA. Better we level
with them now if you want to keep everyone calm and cooperating. Better
yet, you can start by leveling with me." I moved to sit behind my desk
and offered him one of my visitors' chairs. Standing, he made my
office look puny.

"What have you been told?" he asked bluntly, settling into a seat
opposite me.

"Not a goddamned thing!"

"Hey, don't get pissed at me. I was rousted from my motel about
forty-five minutes ago because I happened to be in Buffalo heading up a
university field trip to trace botulism in ducks," said Dr.

Williams curtly.

"I don't even belong in the Hospital Infections Pro gram, but when your
ID guy Russet?"

"Rossit," I corrected.

"Yeah, Rossit. Well, when he called Atlanta on our hot line about the
culture results at 6:45 this morning, they rousted the program director
" "You're with the CDC?" I interrupted.

"How come you didn't say so?"

"Because then everyone would know this was the big deal it is and
really get scared shitless."

"Have there been more Legionella cases?" I asked, sick with imagining
that the Phantom must have unleashed his organism on a large scale in
both hospitals. Maybe my notion of him going berserk wasn't so crazy
after all. Janet at least had been right about this being out of a
horror movie.

"How many?" I braced for the answer.

"What?" snapped Douglas Williams. He was so startled by my question
he nearly sloshed his coffee into his lap again.

"What are you talking about, Legionella?" Another chill was starting a
slow crawl up my spine.

"Why are you here?" I asked, not answering his question and keeping my
voice as steady as I could He spotted the MMB article I'd left lying on
my desk, frowned, and tapped it with his forefinger.

"We're here because of this," he answered, seeming puzzled by my own
confusion.

"On the reports they faxed me, you're listed as the doctor on record
who was astute enough to order the sensitivity fe checked by the
minimal inhibitory concentration method. You obviously suspected
something."

"What?" It was my turn to nearly slosh my coffee.

"The vancomycin sensitivity test you ordered on the staphylococcus
organism in a patient named... Saunderson?"

"Sanders," I said without thinking. My voice sounded far off. My
throat was too dry to swallow.

"My God, we've got a vancomycin-inhibiting strain."

But it couldn't be. How could the Phantom have been involved with such
an exotic organism? It was too rare, too improbable. Even testing for
it had made sense in only an academic way, and the most compelling
reason for me had been Miller's peace of mind.

While my thoughts raced, I grew even more queasy. Williams was
continuing to look at me as if I were nuts.

"Holy shit," he said, running a large hand over his shiny head, "you
really don't know what's happened this morning?"

It was still an effort to keep my voice steady, but I tried.

"I presume it's another vancomycin-inhibiting strain of MRSA from the
patient Phyllis Sanders, like they had in Tokyo, Michigan, and New
Jersey."

He looked at me and swallowed.

My queasy feeling graduated to the burn of bile rising in the back of
my throat.

"I hate to be the one to break the news to you. Dr. Garnet," he
began, speaking quietly, "but what your ID man discovered this morning
in the test you ordered seems to be the super bug itself--a
staphylococcus organism completely resistant to everything."

My instinctive reaction was more denial. Now I was sure there'd been
an error. A too zealous lab tech must have misinterpreted the culture
results. Then came fear, like nausea, waves and waves of it, despite
my best effort to resist the realization sweeping over me. A killer
with a super bug It wasn't possible. The organism was some
theoretical nightmare in an article. How could it be here?

"March out in front of your troops," Williams was instructing me, "and
cheerfully be among the first to get cultured." But I was having
difficulty focusing on what he was saying. I barely noticed he was out
of his seat and leaning over my desk until I felt him lever me out of
my chair, his left hand wrapped easily around most of my upper arm.

"The organism's unstoppable?" I asked, my own voice sounding distant
and shaken. It was a silly question, born out of my refusal to accept
what I'd just heard. That aspect of a super bug needed no repeating.

But Williams, obviously unaware of the full implications of his
bombshell, ignored my incredulity and instead marched me back toward
ER, instructing, "The key to getting through an operation like this is
bluff--big, bold-faced lying bluff--that you are calm, in control, and
not feeling a shred of panic. We have to make sure that not a single
bacterium of that organism has passed onto one of your staff or is
lying in wait somewhere in your department. Until then, ERis closed.
So plug in your happy voice. Chief. Your surgical mask will hide how
miserably glum you really look."

The scope of what he was setting out to do so staggered me I could
barely grapple with how the Phantom figured in it all.

"Dr.

Williams, there's more you have to know. Something much graver is
going on here than you suspect--" "Hush! No talking in front of the
children," he whispered curtly as we joined my own staff assembled in
the area that several technicians had set up to conduct testing.

Soon a good five inches of a ten-inch Q-tip was up my nose and moving
through places I didn't know I had way in there.

"Don't move. Dr. Garnet," ordered a steely-eyed woman glaring at me
over the top of her mask.

My eyes were streaming with tears while she finished probing my left
nasal passage.

"Just give me a minute before you start on the right," I heard myself
beg, but my mind was swirling with other thoughts, rushing ahead,
unbidden, to grasp the terrible new dimensions of killing that such an
organism implied.

The technician sighed, rammed the swab she'd been using into its
container, and splashed the charcoal medium back up onto the front of
her gown.

"This is going to take forever," she complained to Williams. In a far
corner about a dozen other previous victims were commiserating,
identified by their red eyes above their masks, some of them still
tearing. Obviously I wasn't the first to complain.

Williams nodded toward the unhappy group and told the woman in front of
me, "As soon as they've recovered, start getting them organized to help
take cultures with you. We're going to need everyone on the ER staff
to pitch in given the huge number of patients we'll be calling in for
testing."

My God! I hadn't thought of this bacteria breaching isolation pre
cautions and reaching the public. The idea sent a veneer of cold sweat
down my back.

The technician nodded, coolly uncapped yet another long Q-Tip, and eyed
my nostrils. After she'd finished reaming the other side of my nose,
scraping under my nails, and swabbing the backs and palms of my hands,
I immediately reapplied my mask and gloves.

"We ask all ER personnel to remain on the premises and in isolation
garb," Williams announced, "until Dr. Garnet and I return from some
serious paper shuffling upstairs in the boardroom." Murmurs of
discontent protested this order, but he kept on speaking, his massive
voice easily rising above the angry muttering.

"Today'sexer else is going to include the call back and screening of
hundreds of patients. Since all of you will assist with the taking of
these samples, I suggest you get ready." He turned toward the door,
crumpled up his empty Styrofoam cup and lobbed it twenty feet into a
wastebasket located in an empty examining cubicle. At the entrance we
paused to remove our protective gear, dropping everything into a large
card board drum. Activating the automatic doors, he flashed his ID to
the security guard stationed outside in the corridor.

"Dr. Garnet's with me!" he snapped.

"ER personnel have to put on clean protective gear to go into the rest
of the hospital. Dr. Garnet." The guard gestured toward a cart
stacked with masks, gowns, and a box of gloves. Such precautions,
called reverse isolation, were meant to protect the rest of St. Paul's
from anyone in ER already infected.

"Okay, Chief, take me to your leaders," quipped my escort when I'd
finished dressing.

Some of the people we passed in the hallways gave me curious glances.
Even in a hospital, anyone outside a work area with gloves, a gown, and
a mask in place was a little unusual.

"You might as well hang a goddamned bell around my neck," I muttered to
Williams, but he ignored me.

A few colleagues, recognizing who I was despite the mask, stepped up
and asked what was going on.

"Oh, we seem to have a problem with MRSA again," I told them breezily,
trying to hide my own anxiety and increasing my pace so as not to give
them time for more questions.

"But why did you close emergency?" one of them called after me.

I turned, shrugged, and, walking backward a few steps, said, "Hey, it
wasn't my idea. Someone must have overreacted."

In my heart, I desperately hoped someone had. I kept recoiling from
visions of what a serial killer could inflict with this microbe.

Again, I grasped at the straw of human error.

"Maybe there's a more likely explanation, like a mix-up in the lab," I
exclaimed, resuming my stride alongside Williams.

"After all, its so improbable that the staphylococcus found in Sanders
is some dreaded strain fore shadowed by an outbreak in Japan. Shouldn't
we redo the culture first " "Of course," he cut me off with a wave of
his hand.

"A whole crew's on the way here from Atlanta not only to do that but
also to double-check and reconfirm everything about the woman's
infection, both here and at University Hospital where she worked. City
and state health officials should already be on both sites setting up
what we'll need. But if you don't mind my asking, if you were
suspicious enough to order the test in the first place, why are you so
skeptical about the results?"

"Someone else thought of the test. I simply agreed to sign the order
was all I answered. I was suddenly reticent to tell him the heart of
the matter. After all, blurting out that the organism which ate away
Sanders's lungs was not only unstoppable but also in the possession of
a maniac wasn't exactly going to establish my credibility with the man.
Better to be cautious about how I broach the subject of the Phantom, I
decided, and said instead, "It's too fantastic." I continued "Even the
MMB article implied that if such an organism did occur, it wouldn't
happen until two years from now. How could it have gotten here from
Tokyo so fast?"

"Those authors actually said within two years. Full resistance to an
antibiotic has developed in some bacteria only three months after the
emergence of an inhibitory strain. And distance is no barrier to an
organism these days. Jet travel's just like an overnight shipping
service for bugs; it can carry them from point A to anywhere on the
planet within twenty-four hours. But this one probably didn't get here
from Tokyo."

We joined a large group waiting for the elevator.

"What do you mean?" I demanded.

"I thought you said you read the article."

I felt my face redden as I shook my head and admitted, "I only glanced
at it."

"Have you heard of the process called conjugation?" he asked.

Again I shook my head.

He folded his arms in front of his chest and began to explain.

"Different types of bacteria in close proximity can pass genetic
material from one organism to another. The nightmare scenario
described in the article was a vancomycin-resistant enterococcus, VRE,
passing its gene granting vancomycin resistance to
methicillin-resistant staph. One of these genes--VanA--has already
been inserted experimentally into the DNA of Staphylococci aureus in a
laboratory. Though the researchers were using recombinant DNA
techniques--adding specific enzymes to break the DNA strands of the VRE
organism to isolate the VanA gene, then inserting that gene into the
DNA strands of MRSA bacteria--their success in creating the super bug
in a test tube strongly suggests the potential for the same transfer to
occur naturally in real life through conjugation."

He paused, like all good teachers do when they're about to deliver a
punch line.

"The circumstance by which it could happen in humans is chillingly
simple," he continued, looking down at me.

"Both VRE and methicillin-resistant staph organisms can reside side by
side in the human intestine. Since conjugation is a process occurring
all the time, sooner or later it would release the specific genes
conferring resistance in VRE, including VanA, and then incorporate
these DNA fragments into the DNA of the methicillin-resistant staph
organism.

The next time this person didn't wash his hands after wiping himself,
the new bug would be in circulation."

When the elevator door opened, nobody moved to get on. I'd been so
intrigued by Williams's description, I hadn't noticed that the dozen or
so people who were waiting with us had gone silent. His voice had
easily carried to every one of them, and they were responding by
backing away from me in my isolation outfit The closure of ER and the
transfer of patients by orderlies wearing ID protection already had the
hospital buzzing. Rumors of this conversation would be like kerosene
on fire.

"Well, thank God we don't have anything like that here," I declared
loudly, stepping into the elevator.

"Makes our little MRSA case seem routine."

I think I sensed the group relax a little, but not one of them got in
the car with us.

"That was a slick recovery back there," Williams complimented me after
we'd reached the floor where the boardroom was located.

"There's enough possibility for panic as it is, without my setting it
off. We can't afford any; there's so much to be done in the next hours
and days." We were trudging over the beige pile that stretched
everywhere throughout the administration suites.

"I keep forgetting how my voice carries. Comes from working with
ducks; they don't care what I say." He glanced at me out of the side
of his eyes and snapped his fingers.

"That reminds me. I cut you off back in ER to keep you from scaring
your own staff. You mentioned something much graver going on here than
I suspected. It sounded serious."

I'd already decided there was no way I could convince him here and now
that Sanders was murdered. Besides, the containment exercise we were
rushing into had to be carried out anyway, and knowing about the
Phantom wouldn't change how we'd do the screening.

We turned a corner and approached a massive set of double oak doors
which, reaching as high as the ceiling, guarded the inner sanctum of
the boardroom. The thought of those closed minds behind that set of
doors only reinforced my decision.

"It's complicated," I told him.

"I'll talk to you about it later, when we have more time."

To make him believe anything, I'd need him alone, and I'd certainly
need him away from Rossit and Hurst. And I'd need him in a very
private place where we wouldn't be overheard or interrupted.

He shrugged.

"Okay. It has to wait. Right now our job is to keep these turkeys in
line," he instructed, jerking his thumb toward where we were headed.

"Administrators are always the biggest obstacle in any hospital
outbreak--denying, blaming, covering their asses-like they can bluster
the bugs to death." Without breaking his step, he banged the tall
panels open and strode through the high arched frame like a one-man
assault team.

"Morning!" his loud voice thundered even before the noise of the doors
hitting the wall could die down.

"I'm Dr. Douglas Williams from the CDC, and as of now I'm in charge of
this investigation."

Everyone standing around the room immediately froze. Rossit and Hurst,
who'd apparently been talking together, gaped at Williams.

A half-dozen men and women I didn't know--presumably the local city and
state health officials Williams was expecting--stood with coffee cups
suspended at various distances from their mouths.

"If you'll all please sit down, we have a great deal of material to
cover," Williams added, lowering his voice but not his authority. The
chiefs present, eight or nine of them representing the areas most
affected by the scare, quickly began taking their seats. Sean was
there for surgery and gave me a wink, but the usual twinkle in his eye
was missing. Len Gardner, already sitting at the long mahogany table
in front of a stack of documents, presumably records of the Sanders
autopsy, smiled and nodded his greeting. Arnold Pinter, chief of
internal medicine, looking more startled than usual, scrambled to find
a chair near the far end where Hurst regularly sat and hunched down in
his seat. The outside officials and the remaining chiefs from
obstetrics, gynecology, anesthesia, geriatrics, neonatology, and
pediatrics quietly found places for themselves.

I surveyed the expectant faces staring back at Williams. It looked to
me as if he most definitely had his turkeys in line.

Except Rossit.

"This is an extreme pleasure and a surprise to have you here. Dr.
Williams," he gushed as he rushed up and grabbed the man's big right
hand, trying to pump it with little effect.

While I watched, a frown began furrowing its way across Williams's
massive forehead.

Rossit took no notice and persisted, "I had no idea our problem would
rate such a distinguished world authority as yourself." Turning to the
men and women around the table, he explained, "Dr.

Williams is a genius at studying the transmission patterns of an
infection and determining if a particular vector rodents, fleas, ticks,
that sort of thing is behind its spread among humans. Why, his work in
the Southwest on the Hanta virus..."

While Rossit lavished on the praise, Williams glowered down at him and
appeared increasingly annoyed. I couldn't help thinking that if he'd
plucked Rossit up and put him on his shoulder, together they would have
resembled the strong man and Tom Thumb from old circus posters.

"Let's get to work!" Williams commanded, gruffly putting an end to
Rossit's blatant attempt to suck up to him.

The little man flushed and his chin began its familiar chewing motion,
but he took his seat without uttering another word.

Fueled by my earlier speculation about Rossit, I found myself studying
his face. Normally I would have dismissed his obsequious behavior as
simply another try to win some political advantage or other. But this
morning, the possibility of a darker agenda sprang to mind. If Rossit
did know the secret behind Phyllis Sanders's death and was trying to
keep it hidden, wouldn't he be eager to get into Williams's good
graces, I thought, and attempt to influence the investigation that
might expose that secret?
Chapter 11

An eight-hundred-bed teaching hospital like St. Paul's employs more
than three thousand people. A challenge, a threat, or a clear and
present danger to any community of that size can mobilize its citizens
into actions beyond their daily routine. Usual jobs take on an added
importance, and the change is evident immediately in the corridors.

The pace of walking is quicker, carts of supplies arrive at their
destinations faster, conversations are briefer and limited to orders or
instructions. There's a snap to everything. Even more unusual,
meetings are kept short and to the point.

Not long into our own session with Williams, we were interrupted by the
technician responsible for screening in ER. She reported that at least
a dozen of our staff had symptoms of colds-runny noses, sore throats,
coughs--but none of them was very ill at the moment. Williams
nevertheless ordered these people quarantined and asked that I assign
some of my emergency physicians to check them out. We both agreed they
probably only had the flu, but if they had any purulent nasal discharge
or sputum, we would have to sample it. Gram-stain it, and look at it
under a microscope to make sure they weren't actively infected by
staph. Even if these slides were negative, showing no evidence of
gram-positive cocci in clusters, this group still had a problem. Flu,
or influenza, was also known to inflame and damage bronchial airways
enough to let staphylococcus penetrate into the underlying lung tissue,
just as the Legionella had done in Phyllis Sanders. Anyone with the
flu who as a carrier was also harboring the fully resistant super bug
was vulnerable to developing a full-fledged infection by the fatal
organism.

Along with everyone else, they would have to wait forty-eight hours for
their culture results.

I insisted on leaving the meeting and personally delivering Williams's
verdict to the affected people in ER. I tried to reassure them that we
were simply taking precautions but watched uneasily, fearing the worst
for them, while they bravely made cracks about being off to Club Med
and were led away into one of the wards previously closed by Hurst As
an added precaution, I advised the physicians who would be examining
them to make sure no one had signs ofaLegionella prodrome.

They were debating how to decolonize anyone found to be a carrier when
I returned upstairs. The usual measures involved little more than
repeatedly cleansing their hands and nails with bactericidal soaps and
applying copious amounts ofmupirocin ointment, a salve normally used
for cuts and scrapes of the skin, to the mucous membranes of their
noses. Unfortunately, these treatments were notoriously ineffective in
eradicating nasal carriage sites.
"With the new strain, they may have no effect at all," Williams advised
solemnly. Incredibly, there were no other conventional decontamination
techniques to help modern hospitals deal with carriers.

"If any of your personnel do prove to be harboring the super bug we
might try some experimental alternatives, albeit unsavory ones," he
added.

"For example, slipping a tube through the mouth, up over the back edge
of the palate, and into the posterior nasopharynx, then flushing a
concentrated saline solution or bactericidal soap anteriorly through
the passages would, theoretically, lavage the organisms out the front
of the nose."

The thought of it made me gag.

Williams then decreed that we'd have to screen all patients who'd been
in the ER since Monday, including the friends and relatives who
accompanied them. I knew from our statistics that four days' worth of
ER visits was nearly eight hundred patients, most of them having had at
least one other person with them.

"Are you aware of the work hours and resources we'll need to culture
sixteen hundred people?" I demanded, my eyes locked directly on Hurst.
I didn't want him giving us only half of what we'd need.

For my trouble I was told to set up forty culturing stations in the
hospital auditorium and to man them with my remaining staff from
emergency--doctors, residents, nurses, aides, orderlies, technicians,
and clerks--who were not showing any symptoms of the flu.

But they were to continue wearing protective garb, in case there were
any carriers among them.

"Of course the cost of screening emergency department personnel and
patients will be paid out of your ER budget," Hurst declared, avoiding
my stare. He turned toward Rossit and muttered something behind his
hand.

When Rossit replied, his voice was just loud enough for me to hear
snippets of what he was saying. "... if he'd treated the god damned
Legionella... might have avoided this mess..."

I felt my face flush all the way into my ears as I controlled my
anger.

ER itself would remain closed until cultures taken from all the sites
tested on the premises proved negative and the facility had been washed
down with bactericidal soaps, just for good measure.
The meeting concluded with everyone dispersing to carry out dozens of
tasks. Off-duty personnel from the rest of me hospital were summoned
to help process all the specimens we would be collecting Additional
microscopes and culturing equipment had to be scrounged up from all
over the city. Since bench space in the bacteriology lab would be
overcrowded with people doing Gram stains and plating cultures, tables
were set up in the corridors where rows of technicians prepared to
examine hundreds of slides under the many borrowed microscopes.
Volunteers were found to keep the records straight, sort the collected
data, and enter the results into computers.

Yet as I watched so many of my colleagues mobilize against this
organism, I was increasingly haunted by the fact that none of them knew
it could be wielded by a killer. My resolve to make Williams see what
I feared we were really up against grew by the hour.

But in the committee, we continued to lie. Our cover story explaining
the massive screening effort was particularly disingenuous.

"We're evaluating existing isolation practices, making sure none of our
patients or visitors in ER are at risk, by testing our response to a
recent case ofmethicillin-resistant staphylococcus." Maybe,
technically, it wasn't exactly a falsehood, but it sure as hell wasn't
the truth, and I felt dirty each time I repeated it Finally, Williams
attempted to omit outside publicity.

"No bulletins over the airwaves," he insisted.

"Better we initially contact everyone we can by phone, keep the
explanation low key, but stress they are obliged to come in to St.
Paul's by order of the health department We recruited every secretary
in the hospital to do the telephoning, and by 9:30 we were organized
enough to begin calling in the first groups of patients.

All in all, logistically, it was an impressive response, but the truth
remained that in an age of miracle drugs we were reduced to fighting
this bacteria with little more than the weapons our forefathers used
against pestilence soaps, salves, and isolation.

Her eyes tearing, her face grimacing in pain, she was trying to pull
away from me.

"Mommy!" she screamed. I got the culture swab out of her nose just as
she started to sob uncontrollably.

"What are you doing to her?" cried her mother, sliding protective arms
around the little girl's chest and head while glaring angrily at me.
The child's name was Cynthia, she was six years old, and she'd had the
misfortune of being in our ER for a sore throat the same day Phyllis
Sanders had been admitted. She was in her mother's lap, and they were
both seated in front of me at one of the culturing stations.

The testing of hands, nails, and nostrils one swab per site took
minutes. The reassuring and comforting took forever. After an hour
I'd barely managed to take samples from six people.

"I'm sorry," I said to her mother. Then, facing the lime girl, I
cajoled "Cynthia, you're a brave young lady. I know it's unpleasant,
so take a little break before we do the other nostril." While I
talked, I inserted the swab I'd just taken into a tube of charcoal
culture medium.

"No, I don't want it," cried Cynthia, burying her face in her mother's
shoulder.

Her mother cradled her head and rocked her slightly.

"Couldn't we leave it. Doctor? You've got samples from me, and after
all, you said the chances of us getting it were remote. Why hurt her
again?"

"We must get one more, I'm afraid," I told the mother. To the back of
Cynthia's head, I added, "A few more seconds, and I'll be through. You
know, when they checked me this morning, I yelled twice as loud as you
did."

She peeked out at me.

"And I've got special friends in the cafeteria who will give ice cream
to anyone braver than me."

She studied my eyes. Being masked, gowned, and gloved, my appearance
didn't lower people's anxiety any, but Cynthia must have seen something
she liked, because a minute later I had my samples.

"My name's Garnet," I told Cynthia's mother.

"Tell the cafeteria to put the ice cream on my tab."

"Can I tell them I was braver than you?" asked Cynthia eagerly,
exuberant now that her trial was over.

I laughed.

"You sure can."

"When will we know the results. Doctor?" asked her mother.

"The cultures take two days. As I said, it's unlikely we'll find
anything."

"But what happens if you do?"

"Oh, usually they use bactericidal soaps for the hands, and there's an
ointment that can be applied topically for organisms found in the
nose," I replied casually, trying to sound matter-of-fact.

"Thank you. Doctor," said Cynthia's mother, appearing comforted as she
turned toward the exit and followed her daughter, who was already
skipping happily out the door.

I finished labeling my specimens from Cynthia and summoned the next
person in line. An elderly black woman with a cane slowly made her way
to my table.

"Hi, I'm Dr. Garnet," I greeted her, "and I just need to take a few
cultures. Rest assured there's nothing to worry about. Now, if you'll
tilt your head back..." As I explained the procedure and set to work,
I thought. Lord help us if anyone becomes infected and these people
find out how they were lied to.

Other problems were already starting.

The quarantined group had initially been cooperative, concerned for
their own safety and not wanting to endanger their families at home.
But then Rossit had begun insisting they have their noses lavaged right
away without waiting for the culture results, contrary to what Williams
had suggested. Suddenly the cover story that we were simply checking
the effectiveness of our MRSA containment procedures was no longer
sufficient to ensure everyone's submission, even to the reasonable
measures that Williams had intended.

First there was a murmur, then a howl of protest against our authority
to violate their personal liberty, subject them to forced confinement,
and impose treatments on them without their consent.

"Rossit's a fucking idiot!" Williams bellowed when I alerted him to
the trouble.

Or a saboteur, I thought.

Williams and I went into the ward where the suspected carriers had been
isolated and tried to calm them down, assuring them Rossit wouldn't be
allowed to lavage their noses, but it was too late. Teams of lawyers
had already been summoned by the parties on both sides of the argument,
the employees' union and the department of health.

They descended on St. Paul's and went at each other tooth and nail
somewhere upstairs.
"Nobody talks to reporters but me," Williams growled at a hastily
reconvened session of our special committee. Rossit didn't attend.

But shortly afterward a very hostile media arrived, probably alerted by
one of the individuals unhappy with the quarantine. Soon local news
bulletins were also ripping into the validity of the health department
demanding that citizens submit to the tests being done at St. Paul's.

The call-in shows were the worst "Civil liberties versus state health.
Is Big Brother now Big Doctor? When the men and the women in the white
coats take 'knowing what's good for us' too far..." one commentator
blared. Everyone in the auditorium heard him over a portable radio that
a nurse had brought in. Williams happened to be there at the time,
giving an interview to a newspaper reporter in an attempt to add some
balance to the debate that was raging.

"Turn that crap off," he yelled, then walked away shaking his head,
looking more worried than I'd seen him so far.

By early afternoon the open revolt against compulsory compliance,
stoked by the local broadcasters, was resulting in fewer and fewer
patients agreeing to come in. Yet even when me whole operation was
threatening to collapse, Williams persisted with his order that we keep
the lid on what was really happening.

"I'm afraid the panic would evacuate the hospital," he warned, "and
patients too unstable to be moved could die."

"But evacuation's illogical," others on the committee protested.

"So's panic," retorted Williams.

"You've seen the media zoo here today. Imagine how they'd play up an
unstoppable organism that can kill in forty-eight hours and is carried
unknowingly in the noses and on the hands of hospital personnel. The
first impulse of patients would be to sign themselves out, and family
members would insist on it. Do you really think you could control that
kind of hysteria with clinical logic and measured reassurances?"

As uncomfortable as I'd been with his deception, his stalk predicon of
what a candid disclosure might unleash left me even more alarmed.

But then the entire exercise was salvaged in a totally unexpected way
by pure luck and a nasty bit of gossip.

Small groups of patients were still responding to the call-up, enough
to keep some of us busy despite the hue and cry, and a young resident
was taking cultures at a table situated near my own. Suddenly he
turned to some of his colleagues who were waiting for subjects and
declared rather loudly, "I don't for a moment believe what they're
telling us."

Smart lad, I thought, continuing to take swabs from a young girl's
fingernails.

"In fact," he continued, "I just read an article that might explain
what they're really looking for."

He instantly had my attention. His buddies looked interested as well,
and any patients within hearing distance visibly perked up. I also
noticed a reporter with a microphone who'd been trying to get
interviews look over from where he'd been reading his notes.

"It's staphylococcus all right, but a new MRSA strain."

I was about to throw down my culture swab, run over, and quickly
whisper that he keep his theories to himself when he pronounced, "It's
a nasty, virulent bug recently reported in Ontario, Canada, that
infects thirty percent of its carriers. I'll bet some Canadian shopper
has brought it down here."

I sighed my relief and went back to culturing fingernails. The
so-called Ontario strain had been around for years, was causing a prob
em just over the border in Toronto but fortunately hadn't been reported
here yet. Most important, it was sensitive to vancomycin.

But seconds later the reporter had his microphone in the resident's
face, beaming while the young doctor expounded with absolute certainty
about the Ontario strain of MRSA.

"Oh yeah," a few of the other residents added, proceeding to
corroborate that they'd either read about or had attended a lecture on
that same organism.

Some nurses who also had overheard the conversation quickly joined in
the interview, expressing their own alarm and explaining they had
friends caught in Williams's quarantine. In the ensuing discussion the
residents reassured them that while aggressive, this bacteria was still
sensitive to vancomycin and could be treated.

Soon a rumor about the "Ontario strain" swept through St. Paul's and
rapidly established itself as the official "secret" reason behind the
patient recall and the need to quarantine some of the personnel.

By 2:30 the rumor had been on the news, frightening people enough to
come in, but, since the newscaster stressed the organism could be
treated, the panic that Williams had feared was avoided. By 3:00
compliance was soaring, but the lawyers upstairs, I was told, continued
to wrangle.
"I couldn't have planted a better story if I'd tried," Williams
commented, grinning in relief when we finally had a private word
together late in the afternoon. We were standing in the corridor
outside the auditorium. Patients were arriving, everything at the
testing stations was running smoothly for the moment, and there was a
lull in the incessant demands on both of us. I'd asked him to meet me,
determined to convince him about the connection between Sanders and the
other Legionella cases.

But it was not to be.

"Dr. Williams," Hurst interrupted from twenty feet away. He strode up
to us, ignoring me but taking Williams by the arm.

"Your CDC colleagues have just arrived from Atlanta. They're waiting
for you upstairs," he informed him curtly.

Williams excused himself and quickly walked toward the elevators.

Hurst waited until the man was far enough down the hall not to hear.
Then he glared at me and said very softly, "My only consolation in this
mess that you've caused is that I'll finally be rid of you."

Then he pivoted and hurried after Williams.

"That's about what it was like here, except mothers with newborn babies
are a whole lot more panicky," Janet said over the phone after I'd
described my own day's activity. I'd called her during a break for
supper. As a member of the Infection Control Committee at University
Hospital, she'd received the same confidential briefing about the super
bug that morning as I had and had spent the day taking cultures much as
I had done. She was tired, her voice sounded strained, and like me,
she was frightened.

"What about the rest of your staff members?" I asked.

"Much the same as at St. Paul's--a few women showing symptoms of what
is probably the flu are spending forty-eight hours here in a closed
ward as a precaution until the cultures are finished. But we got one
break. For the past few months since the Legionella cases, Cam had
stepped up screening programs for all possible hospital-acquired
infections, and the most frequent testing was for MRSA. All the
personnel on the obstetrical unit were checked five weeks ago and
everyone was negative then, including Sanders. That meant she'd only
been a potential risk as a carrier going near patients and other staff
for the three weeks before her vacation."

"That also narrows when she herself was infected," I added.

"If we traced her activity in that period, we might get some idea as to
how she contracted either Legionella or staph."

"Yeah, if we can ever get any of these CDC types to consider she was
murdered. That kind of 'tracing' needs a lot of work hours."

"Did you talk to any of them about the Legionella cases?"

She sighed.

"Not yet. And there's no way anyone's going to consider anything today
but the super bug I figure we'll have a better chance when the initial
screenings are done and everyone's sitting around waiting for results.
But I think Michael's finally as worried about the connection between
the three nurses as we are. He attended our ID meeting this morning.
After Cam dropped the bombshell about Sanders's staph organism, Michael
leaned over and apologized for rejecting my scenarios simply because
they were bizarre and previously unheard of. He looked quite shaken
and asked where the records of the Phantom's previous victims were.

I've been too busy reassuring mothers and culturing tiny noses to see
how he's doing."

I felt a flash of alarm.

"Should he be down there alone?"

"Hey, I still can't tell that friend of yours anything. I asked him me
same question. He laughed, and said, "No Phantom's going to make a
move with the CDC all over the place. These guys are like the
cavalry,"" Janet mimicked, catching the impatient tone Michael used
when anyone opposed him.

"I suppose he's right," she added, sounding nervous.

Maybe, I thought, maybe not. The cavalry wasn't looking for the
Phantom, didn't even know he existed, and that could still leave him
room enough to be dangerous, especially if all the scrutiny was making
him feel threatened.

Janet interrupted my thoughts.

"Right now I've got to get back to work. By the way, my secretary told
me there was a bunch of flowers in my office this morning. I never got
there to read the card. Did you send them?"

"No." I laughed.

"They're part of Michael's apology."

"Ah, too bad. And here I was ready to meet you in the parking lot, as
a show of my appreciation, and fool around with you in the back of your
car. We would have worn masks, gloves, and gowns, of course, but
nothing underneath."

By 9:00 p.m. we were finished screening for the day. Attempts to reach
those who had been missed were to be continued on Saturday.

The dozen people with the flu who were in quarantine had finally
accepted the wisdom of their being there, though none were aware yet
that they were waiting for cultures of an un treatable organism. But
what to do with all the rest of the staff while we waited the
forty-eight hours for our culture results was less clear.

"If they are carrying the organism somewhere--under their nails or
secluded far up a nostril--and they go home to infants or children who
might have a cut or scrape on their skin, then they theoretically could
be putting those children at risk," Williams had explained gravely
during our morning session.

A flash of alarm had shot through my chest as I immediately thought
ofBrendan. Had I already exposed him?

"I suggest a second facility be set aside for those staff members who
may wish a voluntary quarantine," he'd continued, "away from those
already at risk."

It had probably been an overreaction, but I'd immediately called Amy
and ordered her to bathe Brendan for an hour, scrub the rails on his
crib, and hot wash every article of clothing, bedding, toy, or any
thing else that might touch him. Then, after thinking about it more
coolly all day, I decided to play it safe in a more logical way and
told Janet that I was staying in the hospital. But once I was alone in
the barren room, outfitted with nothing more than a bed and mattress
rolled out of storage, I felt so forlorn I nearly changed my mind. The
musty, stale odors of a disused building permeated the ward, though it
had been hastily cleaned and just as hurriedly heated. Not many people
had accepted Hurst's accommodation, but occasionally in the interior
stillness I heard the hollow sound of someone's cough or a toilet
flush. Outside a storm was brewing again. The wind raided panes of
glass and whistled through gaps in the wooden frames around the
windows; those noises didn't help my mood any. Yet in stead of running
home from that stark place, I lay there and forced myself to arrange
the fragmented thoughts I'd been struggling with all day into some kind
of logical perspective.

It seemed clear to me that natural conjugation couldn't have produced
the super bug in Sanders. I remembered reading or hearing somewhere in
premed statistics that random chance virtually never was responsible
for two rare events occurring simultaneously. The odds against a new
organism selecting Phyllis Sanders as its first victim over the nearly
four billion other souls on earth were just that four billion to one.
The odds of an organism appearing by chance for the first time ever on
the planet in the middle of a deliberately inflicted Legionella
infection in itself a previously unheard of phenomenon were ludicrous
beyond consideration. For these two extraordinary events to have
happened in the same individual, something had to have made them happen
together, and the obvious "maker" in this instance was the killer. But
how to convince Williams of this? Or anyone else?

Whoever this killer was, I suspected he had to have access to a genetic
laboratory with the capacity to alter the gene structure of bacterial
DNA or at least to the end products of such a place. No body at St.
Paul's that I knew of, not even Rossit and certainly not Hurst, would
normally have the opportunity to even get near that kind of esoteric
equipment let alone possess the skills to use it. I'd have to ask
Janet if she knew of anybody at UH with that kind of expertise. I also
had no idea if any work of that nature was being done at the university
and would have to check there as well.

Droplets of rain pinged against the windows. In the harsh reflection
of the overhead lights they looked like oblique scratches being slashed
across the pane.

I thought of Michael's suggestion that the Phantom would have already
retreated into the darkness with the arrival of the ID experts.

I doubted it. No one else even knew he existed, and we'd spent the day
carrying out a drill never intended to trap him. Our running about
probably seemed to him as if we were scrambling around on a web of his
making, the pattern unknown to us, while he lurked at its edge, out of
sight, waiting, and gloating.

I was startled by a sharp sound. Was it a rap on my door? A product
of the raging storm outside? Or something... someone I wanted to
avoid?

I'd taken off my protective gear. Instead of putting everything back
on to see if somebody was there, I called out, "Yes?"

No answer.

I immediately thought of a dark figure and the sound of breathing.

"Who's there?" I yelled again, trying to remember if I'd snapped the
lock shut or not. As I got off the bed I quickly looked around for
some kind of weapon, but the room held nothing, not even a phone.

Feeling both foolish and increasingly frightened, I picked up one of my
shoes and held it up in the air by the toe while I started to creep
forward. I was holding my breath, and all I could hear was my own
heart as I moved my hand toward the lock. I froze midway. The handle
was slowly turning, the door opening.

"Shit!" I muttered, scurrying backward, my shoe still held on high,
until my back pressed against the wall behind me. Standing in the dark
corridor was a tall slender figure wearing a surgical mask, gown, and
gloves who was taking off a lab coat.

Janet gave a low chuckle and said softly, "Now that's no way to greet a
lady who's come to offer you a little affection." She stepped into the
room, then came toward me, dropping her coat as I put down my shoe.

"You scared me half to death," I whispered, slipping my arms around
her. I quickly discovered she'd dressed exactly as she had promised,
the feel of her naked body under her greens making me catch my breath
and quickly igniting my hunger for her. We kissed greedily. As I slid
my hands lightly over her back and down between her hips, she stood on
her tiptoes, letting my fingertips feel her heat and readiness, even
from behind. Her own hands reached for mine, then glided them up
across her stomach to circle around and touch her nipples, already
erect from my kisses. We continued to propel our desire for each other
with our hands, our mouths, and our words.

By the time we were on the bed, she was trembling. She slid me into
her with a deep thrust that unleashed a long low growl from her throat;
the sound and feel of her seared through me like lightning.

While outside the storm surged and shrieked, we writhed, rode, and
urged each other up ever higher waves of ecstasy, until, fused in a
glorious instant, we lifted ourselves over the top and descended,
clinging together, into the freeing, pulsing release that comes to
souls whose joining is blessed by love and driven by a healthy dose of
lust "I don't suppose this place has room service" was Janet's first
comment after we had breath enough to talk.

"I wouldn't even drink the tap water. It's brown with God knows what
from the pipes."

"Well," she exclaimed, throwing off the covers and hastily starting to
pull her greens back on.

"This lady of the night is going back to UH where I can at least have a
shower."

Outside the storm continued as intense as ever, the wind buffeting
against the windows and peppering the panes with rain so driven it
sounded like particles of sand blasting the glass.

"By the way, I may have at least one piece of good news," she in formed
me as I watched her continue dressing.

"Harold Miller was at our ID meeting this morning. He'd come in after
Cam had notified him at home about the organism that killed his mother.
Cam made a point of stressing to us that the only way this organism
could be stopped was by decolonizing it from contaminated surfaces in
the hospital and from human carriers. He was looking right at Miller
when he reemphasized that once this particular bug took hold
clinically, there wasn't anything anyone could do to stop it.
Obviously he was calling on us to be vigilant, but I also got the
impression he was specifically telling Harold to stop tormenting
himself with the idea that his mother might have been saved if you
hadn't sent her home."

I winced, but I was also relieved that at least Cam seemed to be on my
side. His support might prove important if Miller took me to court.

"So what's the good news?" I asked, immediately regretting how harshly
I threw the question at Janet.

"Hey, I'm not the bad guy here, and neither are you," she reproached me
gently as she finished pulling on her white lab coat over her otherwise
revealing garb.

"Sorry, Janet," I said, reaching for her hand.

She sat down on the side of the bed and continued to speak while
stroking my head.

"The good news is that after the meeting, Miller came up to me and
asked that I tell you he's sorry for reacting so harshly. He didn't
say anything more and he's of course still looking pretty shaken about
his mother's death, but I think he may be seriously reconsidering his
initial anger toward you. In fact, he seems instead to be focusing
that anger more toward the organism we're up against. He insisted on
coming back to help set up all me screening that had to be done, and
the man worked like a demon all day, pitching in with taking samples
whenever he wasn't running off to deal with some snag or other in the
lab. I suppose it's his way of striking back at what killed his
mother." She leaned over me, gave me a soft kiss, her lips still full
from our lovemaking.

"So you see, as I told you, things might work out with him after all,"
she whispered.

I felt a mix of relief, surprise, and puzzlement.

"But if I'd clued in that first day, hit her with a dose of
erythromycin before the staph took hold--" She silenced me by gently
placing her fingers on my lips.

"Stop beating yourself up. Wait until they find out in Atlanta about
the incubation and prodrome of this bug and if anything you might have
done would have made any difference." Then she got off the bed and let
herself out of the room.

By noon Saturday, we had taken culture specimens from most of the
remaining patients who were recalled for screening. We had not yet
reached about fifty cases but would follow them up by home visits.

By Saturday evening, preliminary culture results showed no
vancomycin-resistant organisms in either staff or patients but
suggested the possibility that a few of the hospital workers were
carrying MRSA. Some of them were already under quarantine. Those at
home were called in, and they all were subjected to bactericidal soaps
and intra nasal mupirocin ointment.
By Sunday afternoon, all the cultures taken on Friday were con firmed
to be negative for staphylococcus resistant to both vancomycin and
methicillin. And there wasn't any evidence of the
vancomycin-inhibiting strain that had been discovered in Japan.

The only positive findings were confirmations of the MRSA carriers
already identified by the preliminary results. The ER itself was given
a clean bill of health and would open that evening.

All in all, as far as the men and women from Atlanta were concerned, it
was an unbelievably good result. The super bug they'd been
anticipating with such dread had come out of nowhere, claimed a single
victim, and then vanished without a trace, at least without the sort of
trace that could be detected by culturing nooks and crannies of rooms,
sundry pieces of equipment, and the hands, nails, and nostrils of
anyone who'd been near Sanders. At a 4:00 p.m.

wrap-up meeting, everyone was clearly buoyant with surprise and
relief.

"We lucked out," the gray-haired chairperson of their hospital
infection group kept saying, slapping his colleagues on the back and
congratulating them on a well-run operation. Rossit and Hurst watched
this good cheer nervously at first, then seemed to realize that they
were now likely to end up looking good, given how the operation had
gone, and tentatively joined in the handshaking. For me, just getting
to shed the protective gear we'd been stuck in for over two days was a
cause for celebration. Particularly annoying had been the way my mask
trapped the humidity from my breath, constantly steaming up my
glasses.

I found Hurst's demeanor toward me controlled and cold as usual. I
hadn't seen him since he'd muttered his threat to be rid of me, but
there was no evidence this evening of the overt malice I'd felt then. I
had to admit, the more I'd thought about the encounter, the more I'd
found it puzzling. Hurst rarely attacked me or anyone else directly,
let alone announced his intention to do so. His preference was to
sandbag his adversaries from behind the scenes, in ways that were
easily denied and hard to prove. I would have expected him to simply
let the blame for the Sanders case give him the excuse he needed to
dump me as chief, without ever having to confront me directly. Had the
angry words slipped out spontaneously, spurred by his fury about all
the negative publicity for St. Paul's? Or had he deliberately tried
to rattle me, as some sort of distraction? His steely expression gave
me no answers.

Williams was nowhere to be seen.

"Probably back with his ducks," one young woman from the CDC team told
me jokingly when I inquired where he was. Her crack at his expense
produced a few other laughs from her colleagues, but I doubted they
were mocking him. Rossit's recognition of him two days ago, even with
all the obsequious antics, had suggested there was much more to
Williams than some obscure study of botulism in ducks.

The chairperson from the CDC called the meeting to order, but while
some of the group excitedly reported on the work already under way in
Atlanta to isolate VanA genes from the organism's DNA, and others
outlined the myriad studies that would be performed on the cultures and
autopsy specimens taken from Phyllis Sanders, I was thinking
ofLegionella again.

I'd dropped by the labs just before the meeting. Over the weekend the
protracted process of special cultures and immunofluorescent staining
procedures that I'd ordered on Sanders's sputum had finally produced a
positive result, but the result had gone unnoticed in all the
excitement.

If I could just get this group to consider the Legionella cases in
their investigation, I thought, it might be a first step in getting
them to realize what was really happening. When the discussion focused
on how the CDC labs planned to investigate the aggressiveness of the
super bug and determine which factors might predispose carriers to
becoming infected, I passed my results around the table and challenged,
"What about the fact that Phyllis Sanders also had Legionella before
the super bug took hold? And what about there being two other
unexplained cases of Legionella at UH in the last six months? I take
it you're also aware that the physician caring for the Sanders woman
himself came down with a presumed case of Legionella a few days ago,
though his cultures aren't ready yet. Are you going to look at this
pattern?"

Rossit and Hurst immediately scowled at me. For interrupting?

Or for touching on what they preferred no one look at too closely?

The distinguished chairperson from the CDC frowned as he regarded me
from his end of the table.

"What you're raising are serious issues, of course, but I assure you
the CDC is not here to deal with a few cases of Legionella. Your
distinguished and most competent local ID authorities can and will
guide you, as they always have, on such routinely reportable
infections." I presumed his emphasis on the word routinely was a not
so subtle way of saying don't bother him and his superstars with small
potatoes. That stuff he obviously left to underlings.

A young man wearing red suspenders to which a Buffalo Public Health ID
badge was pinned seemed suddenly to recognize his role and piped in,
"We'll certainly be looking into those cases. Dr. Gar net And I can
assure you and the rest of this group that we'll be spending some time
at University Hospital, since Phyllis Sanders worked there. We've
already suggested to Dr. Cam Mackie that all personnel at UH be
screened immediately for staphylococcus, just to take no chances.
Perhaps we can look into rechecking the place for Legionella at the
same time, although Dr. Mackie assured us they'd already done that.
Sanders could have acquired the Le gionella anywhere. Whatever the
case, I must tell you that we are most satisfied with Dr. Rossit's
measures in response to the unfortunate Legionella case involving your
own I.C.U director."

Rossit beamed. Both he and Hurst had also seemed pleased about the
attention University Hospital was scheduled to get.

"Of course we will be determining the infectivity of this bug," the
chairperson said, bringing the discussion back to the big issues that
he was here for.

I tuned out the doctor-speak about the percentage of carriers likely to
come down with the disease as high as thirty-three per cent in other
strains and thought about the Phantom. I shivered.

We had to track him down... had to.

After the meeting broke up, I was dying to get home and see Janet and
Brendan, but I had a few more jobs to do. I managed to get the
telephone number where Douglas Williams was staying from a member of
the departing CDC team, claiming I wanted to thank the man for the help
he'd given us on Friday. Then I went up to the library, plugged into
the computer Med-Line program that indexed all major medical
publications, and punched in the key words "infectious diseases,"

"patterns of occurrence."

"vectors," and the name "Dr. Douglas Williams." This particular
search program summoned a list more than three pages long of abstracts
of articles.

Glancing at me titles, I picked a few that particularly interested me,
had the librarian dig them out, and spent the next hour reading. I
learned a lot about what the man was good at from reviewing his
previous work. I began to have a glimmer of hope that his expertise
might be a whole lot more helpful than the CDC's.

Finally I stopped by I.C.U, but Stewart was sleeping. The nurses
assured me he was stable and promised to tell nun I'd dropped in to say
hi.

The phone woke me near midnight that same evening. I was in my own bed
at home, but at first I'd briefly thought I was back in that accursed
room at the hospital where I'd spent the last two nights. I fumbled
with the receiver, heard a nurse from St. Paul's excitedly identify
herself, and shook myself out of a deep sleep to concentrate on her
words.

"... yet he's febrile, in acute respiratory distress, and shocky,just
like the Sanders woman," she exclaimed, "but he won't let us intubate
him until you get here."

I instantly thought of Deloram.

"You mean Stewart's going shocky?" I blurted out, immediately wide
awake and sitting bolt upright.

"But he was stable when I--" "No, Dr. Garnet, I'm calling from ER!"
she exclaimed, her voice suddenly cracking with what sounded like
barely controlled sobs.

"It's Dr. Popovitch. He was brought in by ambulance a few minutes
ago. He's septic, wheezing like hell, and everyone's afraid he's about
to shut down his airway and have a respiratory arrest. But he's
refusing to let anyone intubate him until he can talk to you. Please
hurry. He's so hypoxic he's out of his head. He keeps insisting
someone has deliberately infected him."

My drive into St. Paul's was a blur of rain, speed, and gut-tying
fear. Michael, septic, in shock just like Sanders, the nurse had
said.

How could he have let anyone near enough to infect him? Was he going
to die like Sanders? Who was next?

Half the time I couldn't see through the torrents pouring over the
windshield despite the wipers, but there was little traffic, and each
time I thought of Michael's arresting before I got there I went
faster.

The car shuddered and pulled from side to side as the wheels plowed
through deep collections of water lying across the road. My hands
strained to control the steering wheel but I refused to slow down.

"Damn your stubbornness, Michael!" I yelled as spray roared up against
the underside of the car. But it was myself I blamed. Why hadn't I
screamed my bloody head off days ago and forced everyone to face what
Janet had suspected from the beginning? We might have frightened off
the Phantom. Why the hell had I even listened to Michael's concerns
about my credibility and what Rossit could do to my career?

The car nearly careened out of control as I sped down the off ramp and
flew through the deserted downtown streets. Don't die, Michael. Don't
you damn well die, I swore, tears welling up in my eyes and blurring my
vision even more.

He stopped breathing seconds after I ran into the resuscitation room. I
think he might have seen me as I burst through the door. His bearded
face was lolling, his eyes were bulging as he stared in my direction,
and one of his arms, hanging down off the stretcher, rose limply toward
me, then dropped back. Despite a forest of TVs pumping him with fluid,
the vascular collapse from sepsis had left his huge body looking as if
it were made from glistening rolls of paste.

Circled around him, a silent group of green-clad residents and nurses
in protective gear stood alongside their neatly arranged trays of
tubes, scopes, and ventilation equipment, waiting to resuscitate him
from what was clearly an imminent arrest His eyes seemed to slide
toward this array of instruments that would soon be in him and his
facial muscles jerked into what appeared to be a look of terror, but it
was the start of a seizure accompanying the complete halt of his
respirations. It quickly spread through the rest of his body, curling
and uncurling his limbs into cruel shaking spasms, then dropping him
like a lifeless doll.

The team was already on him. They struggled to pry open his jaws still
clamped shut in the seizure's aftermath. While pulling on my own
protective gear, I watched the monitors as his pulse dropped to thirty
and his oxygen levels plummeted. Alarm bells started going off one
after the other as other vital signs fell.

"We can't get his mouth open to intubate," yelled an anesthesia
resident in panic.

Another resident at his side was trying to shove a tracheal tube into
Michael's nose and attempt a blind intubation down through his
nasopharynx. In his nervousness, he forced the delicate maneuver,
failed to get the airway, and produced a hemorrhage. It didn't last
long. The near dead don't have the blood pressure it takes to bleed.

All the monitors were flat but for an occasional heartbeat.

The nurses were beside themselves, screaming useless instructions.

"For Christ's sake, get a tube in him!"

"I've lost his pressure. Pump him!"

"What about atropine for the bradycardia?"

But what he needed was an airway and ventilation. I finished snapping
on my gloves, stepped to the head of the stretcher, and shoved aside
the residents.

"Give me a soft nasal pharyngeal tube," I ordered the nearest nurse.
She handed me a flexible six-inch hollow piece of latex the size of my
little finger. I added some lubricant and slid it easily up the
nostril that wasn't bleeding. I felt it readily curve down along the
contours of the nasopharynx and its tip push past the base of his
tongue, which had fallen back to block his airway.

There was a slight rushing noise through the near end of the tube that
was still sticking out of his nose. His chest muscles and diaphragm
were reflexively starting their movements of breathing again, now that
the way to the lungs was open. But the effort was weak. We helped him
out with a ventilating bag, the residents pressing the mask to his face
to avoid leaks while I forced oxygen through the nasal tube, into his
airway, and filled his lungs.

His pulse and blood pressure rose immediately, the seizure in his jaw
broke, and his mouth dropped open, the muscles slack. Within minutes
we had him intubated the regular way, on a respirator, and ready for

I.C.U.

The nurse who'd spoken to me on the phone led me into the corridor
outside the resuscitation room. Her eyes were red, and she still was
having trouble keeping her voice from shaking.

"Will he make it?" she asked.

"I hope so" was all I could tell her.

Then she started to cry and turned away.

"I'm sorry," she said, fumbling for a tissue, "but I've never had to
resuscitate one of our own before. And Michael's such a powerhouse
here. It's hard to see him like that..." Her voice trailed off, and
she had to use her tissue again.

"He was barely able to talk more than a whisper," she continued when
she had control over her tears, "and even then, he could only gasp out
a word at a time. As I said, he was obviously delirious.

But he was desperate to speak with you. He got increasingly afraid he
wouldn't hold out until you got here and begged for a pen and notepad."
She reached into her pocket and handed me a folded piece of paper.

I thanked her, quickly turned away, and unfolded what was a scrawled
message. The Phantom is real. Check the charts! The pattern!
PART TWO

Prodrome
Chapter 12

A glance at my watch told me it was 1:00 a.m. I was at a loss what to
do. I wanted to know what charts Michael had been checking-wanted to
see them for myself--but didn't even know for sure which charts he
meant. Janet said on Friday he'd gone to look at the records of the
Phantom's first victims--the same records Janet had wanted me to see
the night I got attacked in the subbasement. But he'd done that a
couple of days ago. Had he found something else in the meantime? Had
he been poking around during the weekend?

"Dr. Garnet," one of the nurses said, touching my arm.

I was leaning against the wall just outside the res us room, still
staring at Michael's note, lost in desperate thoughts.

"Dr. Garnet," I heard her repeat, "we put Dr. Popovitch's wife,
Donna, in the grieving room, to give her some privacy. She came in
with him in the ambulance and is obviously upset Could you speak to her
about her husband?"

At that moment an orderly wheeled Michael out of res us and down the
corridor toward the elevator that would take him to I.C.U.

He was completely still, the tube protruding from his mouth distorting
his lips and cheeks into a grotesque sneer that made me think of the
rictus of death.

"Oh, Michael, my poor friend," I said softly, watching the winking
lights of the monitors recede up the dark passage.

I tried to prepare what I would say to Donna as I crossed the waiting
area. Even at this hour there were more than two dozen people in the
place, waiting either to see a doctor or to receive lab results and the
final verdict of their examination.

When I opened the door to the grieving room. Donna looked up, saw me,
and said, "No!"

"He's alive. Donna," I quickly told her.

"We got him full of IVs

he's breathing on a respirator and being pumped full of erythromycin as
we speak." I walked over and put my arm around her shoulders,
continuing to talk, afraid to give her time to ask questions. I didn't
trust my usual capacity to hide from a family member how frightened I
was for his or her critically ill loved one.

"He'll be in I.C.U and you can see him there in a few minutes. But
remember, he'll be sedated to keep him comfortable on the respirator.
When he gets a bit better..."

While I talked she stared at me, her brown eyes brimming with tears.
Black curls, cut off at shoulder length, framed her attractive face,
but fear had driven away the flush of pregnancy. The contrast between
dark hair and pale skin left her looking ghostly.

"What does he have. Earl?" she interjected.

"And tell me straight what it means, especially if there's any risk for
the baby."

In other words, cut the crap. I took a breath and leveled with her.

"We presume he has Legionella," I told her solemnly.

"Healthy adults like you shouldn't get it. There's never been a case
recorded of person-to-person transmission, so you and the baby are in
no danger."

She seemed to sit up straighter, swallowed, and tremulously asked,
"Isn't that what killed the nurse from UH whose infection he was
investigating?"

"She had two infections. Donna, one of them a very virulent form of
staphylococcus It's not the same with Michael. His airway wasn't full
of pus when we intubated him. We'll do a Gram stain on the scanty bit
of sputum he does have just to be sure, but I'm certain it will be
negative, unlike what we found in the nurse." A little later, so as
not to scare her more now, I would suggest she be screened for staph,
simply as a precaution.

"But this morning, he just seemed to have a cold," she said, shaking
her head and looking at me as if I were to provide answers about how he
could have become so ill.

But the answer I had--that someone had deliberately infected
him--wouldn't do her any good.

"Donna, was he complaining of any symptoms on Saturday?" I asked
instead.

"No, not at all. He spent the day at UH going over records. He even
seemed fine Saturday night, though I thought he was preoccupied by
whatever he was looking into."

"Why? Did he say anything?" I asked eagerly.

"No, it's just that he was quiet all evening. Normally we play cards
or watch a movie, but he insisted we go for a walk instead. If he said
three words the whole hour we were outside, I couldn't tell you what
they were. We just strolled along, and when I asked him what was the
matter, he simply told me that the audit wasn't going the way he'd
hoped and that he'd have to go back in to UH on Sunday."

"How sick was he this morning?"

"Not very. He had a mild cough and complained of a bit of diarrhea,
but neither seemed like much. The only thing unusual was his being
concerned about it at all. He never takes care of himself, even when
he's obviously too ill to work. So when he said he was going to pick
up some antibiotics, I was pretty surprised."

"Did he?"

"Yes, I've got them here." She reached for her purse.

"Then he came home in the middle of the afternoon, went to bed, and
told me if he wasn't feeling better by morning he was going to check
into ERas a patient. That shocked the hell out of me, because he still
didn't seem too bad. I actually kidded him that he was going soft in
his young middle age and that I expected better stuff when I robbed the
cradle." She was fumbling for the pills and starting to cry.

"Maybe if I'd checked on him sooner, he wouldn't have gotten so bad.
But I let him sleep, and only when I went to get into bed around
eleven, did I realize how wheezy and hot he was. When I could hardly
wake him up, I called an ambulance." She sobbed, handing me a
container full of red-and-black capsules, then groping back in her
purse until she found a handkerchief.

I recognized what those capsules were without looking at the
label--erythromycin.

While I comforted Donna and let her finish crying, my thoughts were
racing. Michael must have suspected as early as Sunday morning that
he'd been infected with Legionella. But he couldn't have been all that
sure. Otherwise he would have admitted himself to emergency for IV
antibiotics then, not simply put himself on oral erythromycin. What
pattern in what charts had he subsequently seen that convinced him
there really was a phantom? Or had he seen something previously and
only later realized what it meant? In fact, maybe the pattern didn't
strike him until he was on the way toER by ambulance. If he'd been as
certain about the Phantom earlier in the day as he obviously was when
he arrived in ER, wouldn't he have told me, or Cam, or someone? Slowly
a horrible possibility dawned on me. It might have been his own
progression through a vague prodrome to the brutal characteristics of
respiratory distress and septic shock from Legionella that had finally
convinced him there was a killer--when he knew beyond all doubt what he
had and that he had become a victim of the Phantom.

Damn your skepticism, Michael, I thought. Despite his belated
willingness to look at records for traces of a murderer, his stubborn
doubts that anyone could transmit Legionella at will must have
continued to dog him over the weekend. I prayed his delay in getting
help wouldn't cost him his life.

I escorted Donna to I.C.U and led her to the door of the isolation room
where the staff had put Michael. There I helped her to don the
protective clothing, followed her in, and stood behind her as she gazed
down at her husband. His chest rose and fell to the rhythmic hiss of a
respirator, his body full of tubes and lines, and his every sign of
life wired into a tiered bank of monitors behind his head. Her tears
flowed silently as she hesitantly ran her gloved hand through his hair,
but she remained erect standing at his side.

"You can leave me alone with him now, Earl," she commanded softly, the
steel in her voice catching me by surprise.

Looking back as I left I.C.U, I saw she hadn't moved. She remained
motionless in that lit chamber, the beginning swell of her pregnancy
suggested by the green gown enveloping her. Off to the right, I could
see a similar room, only dimly illuminated, where the form of Stewart
Deloram stirred and turned in a restless sleep. How many more glass
coffins would there be? I thought angrily, cursing the monster that
had done this.

I roared out of the parking lot at St. Paul's and headed for UH with
one objective. I was going into the hospital and I was going to find
what Michael had discovered. I didn't care if I had to jump the
security guards, break a window, or smash locks. Pussyfooting around
had cost too much. As for fear of running across the Phantom, heaven
help him if I did. I was in a rage.

The storm hadn't let up any, nor had my speed. Once more the car
rocked as I flew through water-clogged streets and screeched around
corners. Occasionally under a street lamp I saw my spray fly up to the
front steps of the old gray stone houses that hugged me sidewalks in
this part of town.

Thankfully part of my brain continued to serve me rationally.

Halfway to UH I had a better idea than committing a BE. Driving
one-handed, I fished out of my coat pocket the telephone number that
I'd made a point of getting earlier that evening, though I never
expected to be using it so soon. I nicked on my overhead light so I
could see the numbers and quickly punched them into my cellular. It
took about a dozen rings, but finally Williams's sleepy voice boomed
out of the receiver, "This better be good."

"Dr. Williams, it's Garnet. We've got a serious situation here, and I
need your help."

"Now?" he queried. I could just imagine the expression on his face.

"Yeah, now. I haven't got time to explain how or why, but I've got
reason to believe the infections that killed Phyllis Sanders were
deliberately inflicted. Most likely two other nurses where she worked
were similarly infected with Legionella in the last six months. One of
them died. Three days ago, as you know, the I.C.U doctor treating
Sanders inexplicably contracted what we presume is Legionella, and an
hour ago I resuscitated my best friend, a doctor in my ER.

He's in septic shock, also presumed to be from Legionella. His only
risk factor was poking around UH to try to find out how the other
infections got started!" My frustration and anger had exploded out of
me as I talked. I paused for breath and drove, straining to see
through the windshield, listening to the silence my outburst had
provoked on the other end of the connection.

"Have you been drinking?"

"Christ!" I screamed at him, almost losing control of my steering.

"I am not some weirdo," I yelled at him.

"You ought to know that from being in St. Paul's just one day." How
hospital personnel react to a doctor on his or her own turf always
gives a pretty quick and reliable take on a physician's reputation, for
better or worse.

"Did anyone besides Rossit and Hurst imply anything but a favorable
impression of me?" I wasn't above arguing shamelessly on my own
behalf, hoping he hadn't run across a few of my other enemies. I was
desperate for his help. Overhead a roll of thunder drowned out the
sound of the rain on my car.

He chuckled.

"Actually, it was those two turkeys trying to badmouth you that added
most to your credibility."

I felt a glimmer of hope.

"But what in the world makes you think such a wildly improbable story
could be true?"

"Because the three nurses had a habit of being malicious to patients,
and I think there's someone at UH who's taken a deadly exception to
their cruelty."

"What?"

I again imagined his incredulous expression from the tone in his
voice.

"Because there's a history of someone punishing punishers in that
place, but never this lethally," I answered.

"Look, I don't expect you to believe this without evidence, but Michael
Popovitch found something in the last few days that convinced him we're
up against a serial killer. He didn't have time to tell me what it was
be fore he arrested, and I must get at those same files he was looking
at."

"But how can I " "By calling the security guard at the front door, men
saying that you're in charge of the CDC investigation of the hospital
and you suddenly need this additional information. Order him to let me
in and give me whatever I want."

"That will never work."

"It won't work if we wait until morning. Security would make me go
through channels once all the regular staff are in. But if you make
the request tonight, when the night guards are alone, we might pull it
off."

"But I told you I'm not even part of the hospital infection group "
"You also told me the only way through a situation like this was
bluff," I shot back.

"Big, bold-faced, lying bluff! Now was that little speech also just
some of your bluff, or are you for real?" I held my breath, one-handed
my way through more small lakes forming over the road, and waited for
his reply.

"I don't know. Garnet," he said over the noise of the spray, "all this
is flaky as hell " "Listen to me!" I cut him off again.

"I looked up some of the papers you wrote. Your specialty seems to be
analyzing unusual pat terns in the spread of infectious diseases and
determining whether a vector a carrier like a rat, a mouse, or a tick
on a deer is responsible for the spread of otherwise inexplicable
outbreaks. I think what we have here is an inexplicable series of
infections where the 'car rier' is a serial killer. If you can track
down a four-legged vermin, maybe you're perfectly qualified to find a
two-legged one so we can put a stop to him. Simply adopt the same
perspective you've used to discover vectors in the other bizarre cases
you've solved."

There was complete silence for at least thirty seconds. Then I heard
him chuckle again.

"You impress me. Dr. Garnet. You really impress me. Give me a few
minutes to get the security people at UH on the phone and I'll see what
I can do. In case this crazy idea of yours works and you actually find
something worth looking at, where can I meet you tomorrow morning?"

I told him.

A few minutes later I was in the parking lot of UH. As I listened to
me rain drum on the roof and gave Williams some time to work his magic
over the phone, I began to make a mental list of what I'd look at first
Check the charts! Michael had written. To begin with I'd have to find
out what charts he meant Then hopefully I'd discover the pattern that
had led him to believe the Phantom was real. But as I organized my
plan it dawned on me that whatever that pattern was, it mustn't have
revealed the killer's identity. Otherwise, he'd surely have scrawled a
name on the note he'd been so desperate to write.

I glanced at my watch and decided it was time to go. Williams
shouldn't have needed more than five minutes to succeed or fail in his
bluff. I glanced up at the forbidding building I was about to enter
and thought seriously about taking a tire iron out of my trunk and
carrying it under my raincoat, for protection. As angry as I was, I
was still chilled by the thought of going alone into that isolated
realm of subterranean corridors where the records were kept. But I
remembered the metal detector at the front door, resigned myself to
using only my wits for self-defense, and ran through the rain toward me
entrance under the watchful eye of the gargoyles.

Williams had bluffed as promised.

"Yes, Dr. Garnet, we've been expecting you. It must be pretty
important for the CDC to bring you out on a night like this." Of the
two guards on duty, it was the one with more stripes on the sleeve of
his uniform who spoke to me. His colleague stood behind their desk,
not at attention but not slouching either. To my surprise, they were
both wearing surgical masks.

"Who ordered those?" I asked, pointing to their faces after I'd
flashed my identity card and signed their book for after-hours
visitors.

"No one. It's just this business of checking everyone for infection,
and now with two nurses dead, well, we're all pretty nervous.

Dr. Mackie insists we're in no danger but has given permission to
everybody working here to wear a mask if they feel more secure, for
now. Even a lot of the patients have requested them."

They'd clearly overreacted. But as Williams had cautioned on his first
day, people weren't always rational when it came to deadly microbes.

"Where do you want to start?" asked the senior guard.

"Administration," I answered.

"I'll need the minutes from the last two years of the Infection Control
Committee. We'll find them wherever they keep the records of all
confidential meetings."

The hospital carried out these proceedings under the umbrella of
quality assurance and, as such, records of them were immune even to
subpoena by a court of law. The powers that be meant such
confidentiality to assure frankness in exposing and correcting
mistakes, which they thought to be more important than lawsuits in
protecting the health of patients. Nevertheless, if any of this
information leaked or got out by accident, individuals could use it in
a court case, and so the hospital guarded such documents the most
closely of any of its secrets.

But the security man nodded without question, his partner wrote our
destination beside my name, and we set off in the direction I'd taken
last week when I'd met Janet and Michael in staff health. This time I
ended up in the lushly carpeted section of that wing, where the
administrators obviously looked after their own comforts, whatever else
they did. My guide led me down a hallway paneled with rich dark wood,
checked his key ring, and unlocked a heavy double door opening into a
large room lined with shelves holding nothing but black binders, rows
and rows of them. Each shelf had a sign designating which committee
its contents were from, and each binder had a label designating which
year's proceedings it contained. In an age of computer hackers, most
hospitals preferred to keep a single copy of this kind of material on
paper and locked in a vault. The only reason such records were kept at
all was that accreditation boards demanded documentation of quality
assurance activities. Michael would have access to these as a state ac
creditor Williams must have sounded mighty impressive to get me in
here.

I quickly found the two volumes I needed, and while the guard looked
on, I found the minutes that dealt with the incidents from two years
ago. Skimming them and working forward to the subsequent follow-up
meetings, I saw nothing substantial that Janet hadn't al ready told me.
I jotted down what I'd come for the chart numbers of the victims.

After returning the binders to their places, I spotted another shelf
containing the minutes for Death Rounds at UH and shivered. My own
appointment with that process at St. Paul's for Phyllis Sanders's case
was scheduled to begin in about five hours.

After the guard locked up, I had him let me into the record room in the
nearby staff health clinic. I'd obtained the numbers of eighteen
charts, and if any of them were recently active, they would be on file
there. I found two and signed them out. The remaining sixteen should
be downstairs in the archives where Janet, and presumably Michael, had
studied them.

I found myself tensing as we rode the elevator toward the
subbasement.

I had to concentrate on keeping my breathing steady, and when we
arrived with a definitive lurch, I felt my back dampen with sweat The
guard stepped out and held the door for me. I swallowed, men forced
myself to move. My eyes inadvertently focused on the steel frame of
the elevator entrance where my head had been rammed. Once in the
corridor, I found myself staring down the well-lit passage off to the
right where, in the distance, I could see the darkened entrance that
led to the basement of the abandoned asylum. But mere was no movement
in those shadows tonight.

"This way, Doctor," my escort said, starting to walk in the opposite
direction. I turned and hurried to stay beside him, trying not to keep
looking over my shoulder. The route we followed was a mirror image of
the one I'd taken four nights ago, except this time we arrived at a
door marked archives at the end of our trek. The guard unlocked it,
snapped on a light, and let me into yet another room filled with rows
of shelves lined with files, but it was much larger than me other two
rooms I'd just visited. The air was hot, the place smelt of dust, and
there were plenty of places for someone to be standing unnoticed.
Feeling as foolish as if I were checking under the bed, I made the
guard wait until I walked up and down each aisle, making sure no one
else was there. When he left, I locked the door and stood in the
stillness, listening to his retreating steps. I looked around and
realized, as Janet had told me, there was no phone. My own cellular
was back in the car, as usual. Out of habit, I never brought the thing
into a hospital to avoid the risk of scrambling a monitor or resetting
a respirator. The faint sound of the elevator doors closing in the
distance confirmed I was on my own.

I shoved away all thoughts of someone creeping up to my door and
focused on finding the remaining charts. As I located them, I spread
one out after the other on a large table and nipped through each
dossier to entries dated approximately two years ago. It was an easy
matter to locate the clinic visits I was looking for.

There were three types of events.

About ten of the victims had reported explosive vomiting with no other
symptoms or signs to explain a cause. They were all isolated
incidents, each had occurred shortly after they'd eaten a meal in the
cafeteria, and in each case no one else who'd eaten the same food had
reported any problems. Some were nurses, some were orderlies, some
were technicians, and they'd all worked in different areas of the
hospital.

There were five episodes of an acute syndrome involving dizziness,
sweating, tearing, slowing of the heart rate, urgency to urinate,
nausea, abdominal cramps, and small pupils. Again a variety of people
with different jobs were involved, but this time they all worked in
physiotherapy or rehabilitation.

The third grouping of cases were brief, solitary hallucinogenic
experiences in three nurses from the psychiatry department The three
occurrences were months apart, and none of the subjects had a history
of mental illness or drug abuse.

I leaned back in my chair, stretched my arms and legs, and once more
felt the ache of too little sleep. But my mind was revving. This was
familiar turf for me--basic toxicology. Janet was right. Some agent
or other had made these people sick, and while any alert physician
could make an educated guess, it was routine work for an ER doctor to
look at the signs and symptoms and figure out exactly what those agents
could be.

The ten cases of explosive vomiting suggested an obvious cause.

Ipecac--a rather tasteless syrup that we formerly administered to
overdose patients in order to induce vomiting--could have been added to
a sauce or gravy poured over the victims' food. Even though we hardly
ever used it anymore, it could still be found in most hospitals. A few
of the victims had actually expressed the suspicion something had been
slipped into their meal, but the attending doctors had mostly concluded
it was mild food poisoning, viral gastritis, or malingering.

The three psychiatric cases I thought could be explained by a mild
short-acting hallucinogenic. Psilocybin, a form of mescaline, or
peyote, its naturally occurring precursor, came to mind. Though I
rarely saw overdoses of these substances these days--they weren't
usually found on the current much deadlier menu of street drugs-they
could be obtained in special places, such as on university campuses.

Both substances existed in pill or powder form, they both had a bitter
taste that might go undetected if mixed with something like strong
coffee, and they both weren't usually included in an initial drug
screen. Given the perpetual pot of heavy-duty caffeine found on most
psych wards, it wouldn't be hard to slip a dose of either sub 7 stance
to an unsuspecting victim in a cup of that particular brew. I'd want
to ask these nurses if anyone had offered them a coffee shortly before
they'd hallucinated. The notes indicated that all three had raised the
possibility they'd been given something. One of the examining
physicians had written Hallucinogen? on one of the nurses' charts but
hadn't pursued it Several other doctors put the next two episodes down
to stress.

The complex syndrome that had afflicted the physio and rehab workers
was in fact the most straightforward of all. The symptoms and signs
brought to mind an acronym we teach the residents SLUDGE BAM made up of
the first letter of each symptom and sign produced by organic
phosphate, or insecticide, poisoning. Not all the signs were there
they wouldn't be in a mild exposure but enough were to make the
diagnosis: Salivation, Lacrimation, Urination Diarrhea, Gastritis,
Esophagitis, Bradycardia (or slow heart rate). Airway distress, and
Miosis (the clinical term for small pupils). The attending physicians
recognized this possibility in the differential, or list of probable
diagnoses suggested in their notes, and had explained the episodes as
accidental exposures to an un known source of pesticide. Checks of the
work area, however, had failed to turn up any trace of organic
phosphates. I made a note to visit these people while they were on the
job.

Most victims of accidental insecticide poisoning I'd treated in ER had
absorbed the stuff through their skin. One woman had simply sprayed
her bathroom floor, then walked on it in her bare feet. Perhaps there
was something in the routine of workers in physio and rehab that
exposed their skin to this type of contamination.

At first I found it puzzling that the examining doctors had given so
little credence to all the victims who'd suggested they'd been
attacked, but a glance through previous entries in their charts
suggested why. The majority of them were frequent visitors to the
health service with nonspecific trivial complaints fatigue, dizziness,
vague aches and pains that on investigation never turned out to be
significant. In short, the Phantom's victims seemed to also have in
common the trait of malingering not the basis for a lot of credibility.
I remembered my own suspicions about Phyllis Sanders. What was it her
son had said about her? She never minimized anything.

I glanced at my watch. It was 3:00. My usual limit of staying alert
easily on an overnight shift without having to fight off sleep was
around 4:00. After that I could be jolted awake by a hair-raising
emergency but wasn't mentally fit for much else. Tonight, however, I
was charged with energy. Instead of chasing shadows I was finally
faced with puzzles that I had the expertise to answer. These charts
and their two-year-old secrets were like manuals outlining how the
Phantom had carded out his deeds. Until now he'd managed to keep those
means of attack hidden, just as he still succeeded in keeping his means
of infecting people concealed. It was the Phantom's trade mark, his
key to invisibility. If no one knew an attack had been made, there was
no attacker; if no one knew a murder had been committed there was no
murderer. By exposing his means from two years ago, I'd breached that
cloak of anonymity a little, given him form, and brought him a bit into
existence. In other words, I'd gained a step on whomever I was
pursuing.

But it was a step on an old trail. As tantalizing as these records
were no doubt Michael had recognized everything I had they contained
nothing beyond what had happened back then. Certainly they weren't the
files that convinced Michael this same creep had found a way to wield
deadly organisms, one of them previously un known, with stealth and
specificity. He had to have found something more, some bridge between
the previous attacks and the recent infections The pattern he
mentioned must have been in other charts somewhere else. If I was
going to make Williams a believer, I had to find those charts.

I got out of my chair, groaned as my knees and back lodged their own
protest against no sleep, then started pacing to loosen up and better
think what to do next. The silence of the place magnified the sound of
my shoes on the linoleum floor.

I'd interview all these people as soon as I could if they were still
around, I thought. The two whose active charts I'd found upstairs
would be no problem, but the fact that the other sixteen files had been
out of circulation long enough to have been put back in the archives,
especially after showing a pattern of frequent visits, might mean those
people no longer worked here. I returned to the table and started
making a list of the eighteen names, addresses, and tele phone numbers.
Not wanting to stiffen up again in the chair, I wrote standing up. As
I worked, the ancient pipes running across the ceiling gave an
occasional clank. The scratch of my pen across the notepaper provided
the only other sound in that deserted place.

Once, reaching for another chart, I inadvertently pressed my weight
against the table and caused it to shift. The screech of its metal
legs scraping across the linoleum sounded like a blast on a trumpet and
made me jump so abruptly that the file flew out of my hand. Christ, I
thought, decrying my own skittishness, let me finish and get out of
here.

While I continued to scribble, I began to think where I might ask the
guard to let me look next. Janet had said the sort of cruelty that
this group practiced was hard to prove and not often reported. But
what if that wasn't entirely true? Perhaps some of their victims had
complained, were on record somewhere as having done so, and might be
well worth talking to. I'd at least get a gauge as to the degree of
anger they felt toward their punishers, perhaps even a sense of whether
that anger could be motive enough for revenge. But there was another
even more likely possibility to be explored. Who had these victims
complained to? Was there someone in the process of hearing such
complaints who'd decided to administer a little rough justice on his or
her own outside of official channels?

Either way, if anyone had ever leveled charges against any of the
people on the list I was compiling, their personnel records would
probably contain a copy of any such complaints and the name of the
patient who had complained. That's where I'd ask to go, the personnel
department, I decided, rushing to finish with the second-to-last chart
and feeling ecstatic at the sensation of finally making some headway.

If I wasn't so sensitized to sounds in the eerie silence of that
subbasement or if I hadn't been so on edge, I might never have heard
the familiar distant hum. It came more through the walls and overhead
ducts than through the air. It was so far away that for the first few
seconds my mind processed it out as an unimportant noise. Only when it
ended and was followed by the faint distant rattle of the doors sliding
open did I realize the elevator had come back down.

I felt a wave of alarm sweep through my stomach, then tried to reassure
myself. Perhaps it was only the guard doing rounds or coming to check
on me. I stood absolutely motionless. Maybe someone needed an old
chart from this very room for a patient who had just arrived in ER.

But no steps came my way.

I quietly walked over to the door and listened. Still nothing.

Okay, I thought, forcing myself to breathe slowly. The elevator may
simply have come down empty, sent by someone who had gotten off at a
higher floor but also pushed the subbasement button by mistake.

Maybe. I wanted to grab my list and get the hell out of there. I tip
toed back to the table; added the final name, address, and telephone
number; and returned to the door jamming my notes into my pocket.

There wasn't a sound outside. I turned the lock as slowly as possible,
but it opened with a loud click. I froze, ready to twist it shut again
if I heard the approaching thud of running footsteps. Nothing came. I
pulled the door open a crack and peeked out. Thankfully I was at the
end of this particular corridor, so even with the sliver of a view I
gave myself, I could see enough to tell no one was there.

I stepped out and made my way toward the first intersection.

Holding my breath when I got there, I slowly looked around the corner
and down the next hallway. It was also empty. I turned left and crept
along, passing two more intersections with equal care. When I got near
the long corridor where the elevator was located, my real trepidation
began. Even though I was at the opposite end of where the passage led
to the basement of the old asylum, I couldn't help but imagine that the
figure I dreaded seeing was out there waiting for me. My heart raced
faster than ever and my breathing once more quickened. I pressed my
back against the wall and prayed that the lights wouldn't go off again.
I don't know how many seconds I was standing there, rapidly loosing my
battle with panic, when I heard something something so faint and far
off I wasn't sure it was real.

It was whimpering a steady, repetitive whimper. It was coming from
down the corridor that I was bracing myself to enter. While I
listened, it kept getting farther away until I could barely hear it any
more. Tom between fear and my determination to see what it was, I
forced myself to look.

A hundred yards away near the far end of the long passage I could see
the back of a person in greens pushing something. Even from that
distance I could make out two horizontal white straps tied be hind the
person's head, indicating a surgical mask. The whimpering was the
sound of squeaky wheels on a supply cart of some sort.

I let out my breath, once again feeling foolish at having become so
alarmed at a simple noise. Probably an orderly getting something out
of storage, I thought. I stepped into the hallway and started for the
elevator.

Then the figure in the distance abruptly turned right without looking
back and entered the tunnel leading into the asylum.
Chapter 15

I froze in midstep. Why would an orderly go in there? The place was
posted off limits. It was hardly a suitable location to store
supplies.

My thoughts raced ahead unchecked. Was it the figure who'd attacked
me? Maybe even the killer himself? After poring over two- year-old
traces, had I suddenly stumbled on him returning to his present lair?
Or was it simply someone ducking into the deserted tunnel for a
cigarette? The nonsmoking nineties had driven nicotine addicts into
back doorways among the garbage pails in most hospitals that I knew of.
A dark tunnel on a cold rainy night would be a luxury.

Whoever he was, he'd either presumed he was alone or didn't care.
Either way, he didn't know I was here, and I felt a heady rush of
excitement. The advantage was clearly mine. If this was the creep
who'd put Michael in I.C.U, then maybe I could take him by surprise,
hunt him down and crack his skull. The prospect rekindled my fury and
abated my fear. Damn you to hell, I thought bitterly as I started for
the ominously dark entranceway up ahead.

I needed a weapon. There was nothing in the hallway. I quietly opened
a few of the doors as I went, looking for something, anything I could
wield. Nothing. As I passed the elevator doors, now closed again, I
saw the overhead indicator light read SB, telling me the car was still
there in case I needed a quick getaway. There also had to be stairs
somewhere, but I hadn't seen them.

I continued along the hall, still searching for something to protect
myself with. But opening door after door, I found only furniture or
stacks of boxes which I hadn't time to explore. I was about forty
yards from the tunnel entrance and was increasingly careful not to make
any noise.

I came up on an alcove full of pails, mops, and cleaning supplies.

I found a wooden push broom and settled on the handle, unscrewing it
from the brush. As I crept the rest of the way to where the dark
passage led off to the right, I took some practice swings with the
hardwood stick and was satisfied I could certainly whack my quarry's
head enough to stun him.

At the junction, I paused before turning the corner and listened for
the squeak of the cart. I heard nothing, nor could I detect the
telltale smell of tobacco. Only the pungent odor of damp earth seeped
into my nostrils. Nevertheless, if I'm wrong about this, I thought,
I'm going to give some poor slob one hell of a Smokeenders program.

I got my staff ready, holding it up over my shoulder to swing like a
bat, and stepped around into the center of the passage.

The lamps from the corridors behind me sent light about twenty yards
into the darkness. No one was there. I moved to me far wall, pressed
against the rough cold stone of the century-old construction, and crept
forward. I usually swung a baseball bat left-handed--once a year at a
charity game between the staff and the residents--and needed my back
against this side of the tunnel to get a good shot at whoever came at
me.

Yet again I neither heard nor saw anyone.

As my eyes got used to the dark, I could see enough to continue farther
up the passage, but I knew there would soon come a point where it would
be pitch black. What then? I was beginning to have second thoughts
about my impulse to come up here.

I proceeded about another thirty yards when I saw something glinting
dimly up ahead. It looked like a barrier of some kind, stretched
across the entire passage, from the roof to the floor. A few more
steps brought me close enough to see it was made of heavy wire mesh,
like the fencing around a school yard or tennis court but with much
smaller openings. It was held in place against the dark stones of the
ceiling, walls, and floors by a tighter-colored cement, suggesting it
was erected in a more recent era. In its center was a door-size gate,
also made of mesh, and kept closed by a heavy U-shaped latch. There
was no lock, and when I lifted the catch, the gate swung open with
barely a creak. It was obviously kept oiled. Now why the hell was
this barrier put here? I wondered, stepping through.

I kept going forward but was rapidly ruiming out of light. Finally I
had to stop, barely able to see my own hand in front of my face. I
stood in the dark and held my breath so as to hear better, but not a
sound came from the darkness up ahead. For all I knew, the figure was
familiar with his way around the massive old building and could be
anywhere. One thing I was certain of. This was no one sup ping off
for a smoke.

The air here was perceptibly cooler than before and felt slimy against
my skin. There were more odors now too, the metallic hint of damp rock
joining the moist earth smells wafting toward me. I once again
imagined me basement rooms with dirt floors where they used to chain
inmates to the stone walls. The reminder of those poor souls left me
chilled to the bone.

I also began to feel foolish standing there with my broom handle.

Even if I were idiotic enough to press ahead, I could fumble around in
the dark all night in this place and still never find him. But I'd be
damned if I was about to turn around and go home. At the very least I
might find some answers, such as who'd bashed me into the elevator and
the reason why. But far more important, if it was the killer, I wasn't
going to miss my chance to stop him here and now. There would be no
more glass coffins if I could help it.

I turned and looked back the way I'd come. The light from the distant
entrance gleamed off the rough-hewn walls and stone floors like
moonlight on water. It shone through the wire mesh, throwing it into a
shadowy relief, making it appear softer, like a web strung over the way
out. But the sides of the passageway, where the floor met the walls,
remained in shadow, and as far up the tunnel as I was, that space was
ink black. I could lie there, undetected, and wait for who ever it was
to come back. I'd then be behind him as he walked toward the light.
When he stopped to open the gate, I'd be in a perfect position to jump
him.

Or I could stay hidden and follow after him until he reached the
corridor where I'd at least see who it was. If I knew him, chances
were no surgical mask would keep me from identifying him. If he
spotted me and ran off, I'd give chase. If he attacked, I'd be
ready.

I'd also have better justification for splitting his scalp open.

While I thought about these next moves, I realized my initial fury was
giving over to a colder, more critical, far more effective anger.

Obviously clobbering whoever it was without warning ran the risk of
letting him come up with some cock-and-bull story about why he was down
here. I might even end up giving him a chance to charge me with
attempted murder. Icertainly had no real proof that who ever I'd seen
come in here was the killer. Hell, apart from Janet, poor Michael, and
maybe Williams, no one else even thought there was a killer.

I crouched down and felt the surface of the cold stones. They weren't
outright wet but damp enough to be hard on my joints as well as my
muscles. I stretched out facedown, managed not to groan, and tried to
fit the bony parts of my hips against uneven hollows in the rock wall
at my side. I'd keep the white of my face shielded by my arms as he
went by. My stick was in my right hand.

I lay there listening to the absolute silence, figuring I'd have no
trouble hearing his approach, with or without his cart, but I'd have to
breathe as silently as I could to avoid detection when he was beside
me. I glanced at the luminous dial of my watch, easy to read in the
total darkness. It was a few minutes after 4:00.1 was ready.

I awoke with a start. The first sensation I had was of total pain the
second I tried to move. I wasn't sure at first where I was. Something
scrambled over my right foot, tugging on my trousers. Then I
remembered everything and bolted upright. I exhaled a loud groan as
all my muscles shot into spasm, and in the dim light I saw the humped
outline of a large rat scurrying about my feet.

"Shit!" I screamed kicking at it with both feet, then frenetically
propelling myself backward.

It shrieked, either in surprise or rage at being disturbed, and
scuttled off into the darkness. I hadn't made contact enough to hurt
it any and wondered if it would charge back at me. Keeping my eyes
fixed on where it had disappeared into the black passageway, I backed
up to the gate, let myself through, and slammed it behind me. I now
knew what the barrier was for--to contain the rats.

I was shaking--from revulsion of that thing crawling over me while I
slept, from being bone cold and stiff, from my muscles recoiling into
spasms every time I tried to use them. My teeth were chattering, and
besides everything else I really had to pee. I managed to get my wrist
steady enough to read my watch. It was a few minutes after 6:00.

Mist had replaced the rain but it was still dark when I raced back to
St. Paul's. My driving hadn't improved any, and my mood was as foul
as my breath.

I'd blown a God-given opportunity to put a face on this nightmare and
was furious with myself.

At the entranceway to that accursed tunnel, I'd stood around as long as
I could, freezing, hopping from one foot to another, and wondering what
to do. Was he still somewhere up there? Or had he already gone back
out, passing me in the dark as I lay sleeping? Possibly But in the
silence he probably would have heard my breathing, unless it was
muffled by my head being facedown on my arms. Had he instead left the
asylum through some other unguarded exit--an unlatched window or
unlocked door known only to him? Maybe he needed a way to come and go
without security knowing he was in the building.

I shot through the remaining pools of water in the street, sending
great cascades arching away from the car all the way to the sidewalk.

Despite an overnight scouring from the storm, the stone fronts of the
houses remained stained and shabby in the passing glow of my
headlights.

The meeting I'd arranged with Williams was to have been at 6:00 in my
office. I'd intended to explain why I thought a serial killer was
infecting people and hopefully to show him some specific leads from a
night of going through records at UH. Now what he'd hear was how I'd
armed myself with a broomstick, followed some orderly pushing a cart
into an abandoned asylum, and then fallen asleep! I took my rage at my
own stupidity out on yet another puddle, roaring through it and
scattering it into a million droplets.

I had hoped if I could at least create the suspicion in Williams's mind
that the infections were caused deliberately, we could then use Death
Rounds to sound the alarm together--convince some members of the
meeting that Michael had been attacked, show them his note which I
still carried in my pocket, and get them to consider that something
deliberate and sinister was behind the infections.

"Bloody pathetic," I muttered, given how hopelessly naive that idea
seemed now.

I spotted Williams's big four-by-four parked near the entrance to ERas
soon as I pulled into the doctors' lot at St. Paul's. When I got
closer, I saw the big man himself was waiting in the driver's seat,
pouring himself a coffee from a large thermos. He eyed my car
suspiciously for a few seconds after I pulled up beside him, probably
recognizing from my vehicle that I was tine jerk who'd cut him off
Friday. Nevertheless, he saluted me with his cup when I got out,
smiled, and started to step down from his much higher cab. I inwardly
winced when I saw how immaculately dressed he was in a blue blazer, a
white shirt with crisp-looking cuffs, and a hand-painted tie of the
kind I never even bothered to price when I went shopping.

My own outfit--the slacks, shirt, and sports jacket I'd spent the night
in--were smudged and wrinkled from lying on the stone floor.

The bottom of my right pant cuff was torn where the rat had pulled it.
Even though I'd tried to brush my teeth with my finger in the first
washroom I'd found back at UH, my mouth still felt like a toilet. I
needed a bath, a shave, and a change of clothes, and I hadn't time to
get any of them.

Williams looked me up and down in astonishment when I walked up to him.
His eyebrows arched; his nose wrinkled.

"Decided to look our best for the ordeal, have we?" he commented
wryly.

"Come on, we've got to talk," I said, turning toward emergency.

My watch told me Death Rounds started in twenty minutes. The trouble
was, I wasn't sure I could convince Williams even if I had twenty
hours.

In my office Williams sat across from me and poured us each a coffee
from his thermos while I called I.C.U and asked about Michael.

No change--still shocky, on a respirator, and unconscious.

Then I dug out an electric razor that I kept for the times I worked
overnight in ER and started to explain the connection between three
nurses with Legionella and the so-called victims of the Phantom from
two years ago.

By the time I got to my being attacked five nights ago in the
subbasement, half my stubble was gone, and Williams was frowning hard
enough to send furrows all the way up to the front of his shiny,
immaculate scalp. The furrows deepened during my resume of what I
found in the archive charts and my speculation about the probable
agents used in those first attacks. When I told him I'd followed
someone into the abandoned asylum a few hours ago, it was enough to
make him lean forward, massage the grooves in his forehead with his
free hand, and mutter, "Jesus Christ!"

I'd no idea whether he believed me or thought I was crazy.

Nevertheless I barged ahead with the rest, including how I'd stupidly
fallen asleep lying in wait in the dark. As I talked, I ran my fingers
over my chin feeling for any patches of whiskers I'd missed with the
razor. Unable to find any, I pressed the off button, putting an end to
the buzzing, and in the silence between us, outlined what records at UH
I thought we should go through next. When I stopped speaking, a glance
at my watch told me we were ten minutes from the start of Death
Rounds.

Williams remained motionless in his chair, staring at me with a fixed
look of incredulity. I found his silence unnerving but said nothing. I
figured this decisive man wouldn't keep me waiting long for his verdict
on whether I'd have his help.

As he sat there thinking, I took out a bottle of aftershave lotion to
splash on my face. If I dumped the whole lot over my head, I thought,
it wouldn't be enough to hide the aroma from the rest of me. I reached
into my office closet and found a crisp white lab coat to pull over my
soiled clothing.

"How did you know about the three nurses and those other workers being
cruel to patients?" Williams suddenly demanded. My back was turned to
him and his voice caught me off guard.

I hadn't mentioned Janet's role in perceiving that the Phantom was
active again. Nor had I admitted that it was nothing more than my
faith in her ability to see what others had missed that formed the
foundation of my early suspicions. But I decided to go for broke and
risk winning him over by being as candid as possible.

"My wife's an obstetrician and gynecologist at UH. She realized her
patients all had trouble..."

While I explained I watched his eyes, again looking for some hint as to
how I was doing. I got none.

He leaned back in his chair when I finished, studied me some more, then
asked, "And neither you nor your wife attempted to re port this
idea?"

"Of course we did. No one believed us. No one wanted to."

"Do you have any suspicions about who this killer might be?"

My mind flashed on Rossit, on Hurst, on the powerful interests behind
the amalgamation.

"Not really," I answered. My speculations though disturbing, were so
nebulous that I figured I'd lose Williams by even mentioning them.

He rubbed the angle of his jaw with his little finger and again seemed
to consider me from head to toe.

"Well, I can see why no one listened to you," he commented after a few
seconds.

"Your story sounds crazy."

I felt a resurgence of all my pent-up fear and frustration.

"God damn it!" I blurted out angrily.
"I'm sick of these sanctimonious scientific blinkers you guys wear. My
best friend's upstairs, maybe dying. He scoffed at our warning too "
"Hey!" he commanded sharply.

"Hold your horses. I didn't say / didn't believe you. I said your
story sounds crazy. You already won me over last night when you
suggested I analyze me Legionella cases as if an unknown vector was
involved. Maybe it's a killer, maybe it isn't. But you were right
about one thing: I would consider a carrier in any other outbreak where
it wasn't clear how a bug was being passed around."

His measured response took a few seconds to register. Then came a
surge of hope that he might become our ally in this. If Williams gave
our case any credibility at all, help could be at hand.

"You mean you think you can convince the CDC to investigate what's be
hind these infections," I asked, "including me possibility that they
were deliberately inflicted?" We'd finally have a chance to launch a
proper hunt for this murderer.

"With that story?" Williams gave a derisive laugh.

"No way! But I've got an idea how we can get them to go over that
asylum with a fine-tooth comb. It might flush out the character you're
looking for or it might not, but it'll be a hell of a lot more
effective than creeping around the place in the dark with a
broomstick."

My expectations thudded back to earth. The disappointment must have
shown in my face.

"Hey, come now," he said, pushing himself out of his chair.

"There's no time for sitting around and becoming discouraged. We don't
want to get the crowd at Death Rounds doubly angry at you by making
them wait. And when we get there, stride in fast, try and sit away
from the others, then keep your legs under the table. After all," he
chided with a wink and a grin, "who's going to believe someone with
B.O." dirty trousers, and a shredded cuff?"

Despite, or maybe because of, the absurdity of my position, his ribbing
made me laugh.

"Yeah, my mother would be shocked!

Imagine, not having had a bath or a change of underwear before I head
off to save my career and stop a serial killer."

But the wisecrack didn't ease the increasing tightness in my gut.
The specter of the killings and the attempted killings had so dominated
the last few days that I'd repeatedly shoved any fears I had for my job
into the background. Yet I had no illusions about what lay ahead.
This was undoubtedly Hurst's most determined attempt to unseat me, and
I'd never been at such a disadvantage or felt so targeted Nor could I
shake my suspicions, vague as they were, that he and Rossit were
somehow involved in the murders and that they wanted my credibility in
tatters in case I found out enough to try to expose them. But figuring
it pointless to reveal such nebulous fears to Williams, I instead kept
faking a bravado I most definitely didn't feel.

"Being a fancy dresser like you might impress the hell out of your
ducks, Dr. Williams, but it'll take more than hiding my scruffy outfit
to keep the likes of Hurst and Rossit from ousting the likes of me.
Now, if you were to pick up those two birds for banding and a botulism
check, then release them back into a swamp somewhere, (hat would get
them off my back for a while."

His grin widened into a wicked smile as we marched out of my office and
started toward the pathology department in the basement corridor the
number of residents clutching cups of coffee and scurrying alongside us
didn't help my apprehension any. It was a sign that attendance at the
session would be good. On rounding a corner, I saw a clutch of people
outside the entrance to the seminar room, some of them carrying in
stacks of folding chairs.

I instinctively slowed.

"Quite a lynch mob," I muttered.

"Relax," Williams said quietly, putting his hand against my back and
gently urging me forward.

"Most people are probably here to find out why this case caused such a
stir."

Inside the long narrow room about twenty people were crowded around an
extended central table and another group was hastily arranging a second
ring of folding chairs against the wall. Some of my own staff
approached me to inquire about Michael, most of them having been told
about his admission as they passed through ER.

More than a dozen people were gathered around a huge silver coffeemaker
parked in a corner on a steel cart. The rich aroma from its steaming
contents was tinged with a hint of formaldehyde fumes.

These were emanating from seven loosely covered Tupperware containers
spread out along the center of the big table. Through their
translucent sides I could see the dark shapes of what would be Phyllis
Sanders's major organs--lungs, heart, liver, spleen, kidneys, brain,
and a flat coil of something that I presumed was intestine--all
marinating in a cloudy brown fluid.

Williams nodded toward the far end of the display. There sat Rossit
holding a gavel, ready to chair the meeting, his eyes fixed on me. To
his right was Hurst, also staring my way while leaning back in his
chair, his arms folded across his chest, and the corners of his mouth
giving the slightest suggestion of a smirk. Like a malevolent Mona
Lisa in drag, I thought angrily. Beside him was Baker, the hospital
lawyer. All three were dressed in dark suits. There wasn't a noose on
the table in front of them, but the scene reminded me of the quickie
saloon trials depicted in old westerns.

Halfway down the table I also recognized the woman from the CDC's
hospital infection group who'd given me Williams's phone number. She,
too, was watching us. Free of her former protective gear and sporting
a crimson pantsuit, she stood out in the midst of all the white coats
and was almost as stylishly dressed as Williams.

But when I nodded hello, she scowled, jumped up, and strode over.

"What are you doing here, Douglas?" she demanded frostily, facing
Williams and ignoring me. Without giving him a chance to respond, she
added, "I was designated to detail this wrap-up."

"Just making myself available, Doris," he answered curtly, "in case
there were any complaints about how I handled the first few hours of
the operation. Believe me, I don't want your job."

She flushed, appeared about to speak, then abruptly spun away and
returned to her place at the table. Obviously turf was an issue even
within the prestigious halls of the CDC.

"Everybody's going to be fighting to grab a piece of the fame from this
case," Williams lamented, shaking his head as we found two empty chairs
against the wall.

"Even if we had some decent evidence to support your claim about a
phantom killer, which we don't, it would still be hard as hell to make
Doris or anyone else back off from their rush to publish and get them
to seriously consider the story."

His gloomy prognosis left me trying to tuck my grotty-looking pants as
far out of sight under my seat as I could while I surveyed the room and
cast about for some better strategy to make people listen.

As expected, I recognized a few staff members with whom I'd had blowups
in the past. More reassuring was seeing Susanne and one of our rookie
nurses sitting against the wall opposite me. Susanne nodded to me, but
the pale, young blonde woman at her side sat motionless, her unblinking
stare riveted on the Tupperware.

From her frightened expression, I figured she was the nurse who'd
ignored Phyllis Sanders's complaint of orthostatic dizziness, there to
confess her mistake and face her reckoning, just as I was. It didn't
seem to be making it any easier on her that the ultimate responsibility
and blame for sending the woman home fell on me.

Seeing Cam dart into the room jolted these gloomy thoughts out of my
mind. He strode over to Doris, shook hands, and bent down to talk to
her. Uh-oh, I thought, hoping he hadn't already discovered my entry
into his confidential records. Maybe he'd shown up only to report on
the screening results from University Hospital. But as he talked to
Doris, her scowl returned and she nodded toward Williams and me. He
returned my gaze, then strode over to tower above me.

His blue eyes were blazing, and he didn't look happy.

"Security told me you were snooping through the minutes of my Infection
Control Committee last night!" he challenged, his angry voice loud
enough to make people around us stop talking and glance up at him. At
their abrupt silence Cam looked around nervously and seemed to become
aware of the scene he was starting to create. He moved his mouth
closer to my ear.

"I was also told you'd been in the archives until an hour ago," he
continued in a fierce whisper, his fury now sibilant but clearly
undiminished.

"I went down there. I saw the files that you were looking at! I
already warned Janet to stop trying to dredge up that Phantom nonsense.
But for you to pretend to be from the CDC, violate our security, and
breach confidential information--that's enough to at least charge you
with unprofessional conduct, if not criminal trespassing." He was
literally spluttering, his fists clenched between us, his red face
inches from my own.

"Hey, Cam, ease up," I protested, instinctively recoiling. While I'd
expected him to be annoyed at what I'd done, Icertainly wasn't prepared
for him to be this angry.

"I was there to find--" "You're no better than a lying thief--" "Dr.
Mackie!" interrupted Williams in a whisper loud enough for half the
room to hear. He leaned over and placed his huge hand on Cam's
forearm.

"Dr. Garnet didn't impersonate a CDC official. I ordered him in."

Cam jerked his arm free and retorted aloud, "You no longer had any
authority over this case. Dr. Williams! I'm particularly appalled
that you'd betray your fine reputation by aligning yourself with the
garbage ideas..."

While he ranted I felt increasingly dismayed to see him so upset.

He was visibly shaking, and under the glare of the fluorescent lights I
could see particles of perspiration glistening in the pores below his
blond hairline. What could be making him react like this? There was
nothing so startling in his Infection Control Committee records that
Janet hadn't already told me. Perhaps it had been my going through the
medical records of the Phantom's first victims that had set him off?
But why should he be so outraged about that?

Some people in the room were growing quiet again as his angry words
once more started to attract attention.

"Settle down. Cam!" I implored under my breath. As baffling as his
behavior was, the last thing my credibility needed here was a public
spat with the man.

But the sound of my voice made him worse. His blue eyes grew so dark
that I feared for a second he might actually try and grab me.

Instead, he again leaned close to my ear and warned, "If you think I'm
going to let you or Janet undermine University Hospital and harm me or
my department by dragging up those old Phantom stories " "Cam!" I
interjected again, determined to put an end to our scene.

"Michael Popovitch was admitted last night in septic shock from what we
presume is Legionella. Just before he went into respiratory arrest, he
scribbled this." I reached into my shirt pocket and pulled out
Michael's cryptic note about the Phantom.

Cam frowned at the unfolded piece of paper as I held it before his
eyes, took it out of my hand, then turned pale.

"Oh my God," he muttered.

"That's why I went through those records. Cam," I pressed as gently as
I could.

"I was trying to find what Michael saw."

But he looked at me with such a blank expression on his face, I wasn't
sure he'd even heard me.

At that moment Rossit slammed down his gavel and brought the meeting to
order.
Chapter 14

The people who'd been waiting outside found seats while some other
latecomers tipped the large coffeemaker to try and dribble the final
dregs into their styrofoam cups. Conversations throughout the room
died down. A few more residents rushed in and found places where they
could lean against the wall.

Rossit began, "We will open this special Death Rounds with a particular
welcome to our distinguished visitors from the CDC, Drs.

Doris Levitz and Douglas Williams."

Williams nodded his acknowledgment to the greeting. Doris Levitz
flashed the room an icy smile, pointedly ignoring Williams.

Most of the people who'd been watching Cam and me were now paying
attention to the proceedings. A few had exchanged puzzled looks and
whispered together before shrugging and turning toward Rossit. But Cam
remained standing, staring at Michael's note.

"I also wish to welcome our colleague Dr. Mackie from University
Hospital," continued Rossit.

"The unfortunate case we will examine today has touched both our
institutions."

At the mention of his name Cam gave a start.

"Right," he answered, then vaguely looked around. He walked stiffly to
where some of the medical students were perched along the top of a
counter. They made an opening for him.

The practice in these sessions was that the residents present the case.
Rossit gave the floor to the young man who tended to Phyllis Sanders on
her first visit. He stood and, reading nervously from prepared notes,
related the apparent benign findings of both his clinical exam and the
many lab tests he'd ordered. He then put her initial chest X ray up on
a viewing screen, answered a few questions from the staff doctors about
its negative readings, and sat down.

Rossit glanced at Hurst, turned back to the resident, and asked, "Tell
me. Doctor, why did you order all these tests if you figured this
woman wasn't very sick?"

The resident flushed.

"Well," he started, "she kept insisting I check her more carefully,
that she was sicker than I thought" "Obviously she was right!" snapped
Rossit, with a wave to the containers on the table.

The resident started at the callous remark. There were a few chuckles
in the room, while others gasped. I felt myself bristle.

"Tell me," Rossit continued, "what was the attitude to this patient on
that day?"

The resident's mouth hung open.

"Pardon?" he asked.

"You heard me," persisted Rossit, his voice cold.

"We all know how a demanding patient can be taxing on the staff of a
busy ER. I want to know how the nurses and doctors reacted to her."

"I don't know how to answer that. Dr. Rossit." The resident's voice
was strained. He looked in my direction, his eyes wide with alarm.
Rossit's reputation for savaging doctors included stories of how he
occasionally ripped into residents. There wasn't a sound in the
room.

The little man leaned forward.

"Did you consider her a GOOMER, Doctor?" he asked snidely.

I went molten.

"Now just a goddamned minute, Rossit!" I bellowed, leaping out of my
chair. GOOMER was a despicable acronym used by cruder members of my
staff, sometimes, inexcusably, even by doctors, in referring to
troublesome patients. It meant Get Out of My Emergency Room, and I
loathed the term. Unfortunately, the residents inevitably learned it
on the job, and some thought it cool.

Rossit flew back in his chair in exaggerated surprise at my reaction.

Hurst made a pyramid with his fingers in front of his lips, but I
caught a glimpse of his snide smile. The rest of the upturned faces
around me simply looked dismayed.

"Would you care to add to that comment. Dr. Garnet?" asked Rossit,
eliciting another round of chuckles from those in the audience who were
fans of this kind of spectacle.

I cursed myself for getting suckered into a stupid outburst and tried
to recover some shred of dignity.

"I'm sorry for my loss of self-control, Dr. Rossit, but the term
GOOMERis contemptible, and anyone working in my ERis taught to despise
both the phrase and the attitude it stands for." I managed to keep the
tremor in my voice appropriate, but inside I was raging.

"I also wish to point out that badgering the residents is no longer an
acceptable way to teach!" At 5 tack me, you prick, if you will. Hell,
I'm the guilty one. But leave my students alone!

I heard a few murmurs of approval as I sat back down. Rossit shrugged,
and we moved on.

At his invitation the young nurse beside Susanne stood up, introduced
herself as Miss Johnston, and haltingly recounted the fateful moment
when Phyllis Sanders got out of her ER bed, complained of being dizzy,
and was wheeled from the department. While Rossit listened
attentively, Johnston kept glancing over at him, her apprehension
obvious. When he was about to ask questions again, Susanne leaned
forward, cleared her throat loudly, and glared at him.

He paused at the sound, eyed her warily, then gently explained that he
simply wished Nurse Johnston to clarify a few details for him. It
seemed even he knew one of the basic rules of medicine never piss off
the nurses.

Turning back to Susanne's protegee, he managed to elicit a piece of
information that I was curious about.

"Phyllis Sanders was an experienced nurse," he commented.

"Did she protest that her orthostatic dizziness was important and
should be checked out?"

Nurse Johnston flushed.

"Yes."

"And what did you do then?" There wasn't a hint of judgment in his
voice.

The young woman swallowed, looked over at me, and answered, "I told her
that Dr. Garnet was one of the best physicians in the hospital and
that she could trust his judgment." Her voice quavered.

"I

also assured her that if he said it was safe for her to leave, she
could go home without worrying about anything." At that point her
tears flowed down her cheeks. She reached for a tissue and dabbed at
her eyes.

"Sorry," she muttered.

She sat down and Susanne put a comforting arm around her narrow
shoulders. The silence in the room was like ice.
Rossit let it hang there for what seemed like an eternity. Hurst
studied the people across from him, his mouth completely hidden behind
his fingertips.

"Now for the return visit," said Rossit somberly.

The story of the resuscitation went by like a bad dream. Referring to
our ER record, Rossit made it a point to note that Michael had stepped
in to take over the intubation.

"Was there any particular anomaly in her airway that made it a
difficult procedure for you. Dr.

Garnet?" he asked.

I shook my head, answering, "No," choosing to ignore his insinuation
that I'd flubbed a key step in the resuscitation for no good reason.

I knew that he was deliberately trying to chip away at me, but there
was nothing I could do about it. I would only make things worse if I
rose to his bait and tried to defend myself.

Rossit took it on himself to outline Sanders's clinical course in
I.C.U. Up to me point of her death, he'd measured her lab values every
few hours, and his review of these results reduced her dying to a
process of numbers.

"By the time we got her, death was inevitable," he concluded. Here I
had to agree with him.

Next Rossit turned the session over to Len Gardner, who nipped open the
Tupperware containers and began explaining his autopsy findings. He
started with Sanders's lungs, demonstrating features unique to the
destructive process of both Legionella and staphylococcus.

I'd no need to view any of it again.

My eyes wandered instead to the other specimens--Sanders's liver,
spleen, kidneys, intestine, and brain--in which I could see
abscesses.

".. . hematogenous spread by septic emboli," Len explained, switching
on his slide projector to show us death at the cellular level.

A feathery pink-and-blue dotted image of normal lung as it appeared
under a microscope filled the screen at the far end of the room. Len
then clicked the slide carousel forward and portraits of the little
killers themselves appeared--slim red-stained rods for Legionella,
bulky blue clusters of "grapes" for staphylococcus. The most telling
image of all came next. It revealed clusters of staphylococci pouring
through a tear in the lining of a small airway and flooding into the
underlying lung tissue. Closer inspection showed the damaged area was
already teeming with rods of Legionella.

"It's a two-step process," explained Len.

"Legionella prepares the way;

staph ends the day," he added, putting the deadly serious teaching
point into a silly rhyme, which none in the room would ever forget The
next few slides demonstrated over and over where each of these
organisms had visited other tissues in other parts of Sanders's body.
They flashed by like snapshots taken of a pair of travelers at
different stops on their voyage.

The room broke into applause at the end of Len's presentation.

"He's terrific," said Williams, his huge hands contributing greatly to
the show of appreciation.

I sat there thinking that the Phantom had virtually slaughtered her
from within, cell by cell, organ by organ. I glanced over at Rossit
and Hurst They looked relaxed and unconcerned, occasionally whispering
together and smiling. If either of them was involved in the killing,
it was hard to imagine they could show such indifference before so
graphic a display of the victim's remains. Cam on the other hand was
transfixed, his expression grim, his eyes locked on the table as Len
recovered the lineup of entrails in their containers.

While Rossit introduced Dr. Levitz to reveal the culture results, my
attention remained on Cam. His behavior had me completely baffled.
When Janet had told me he'd scoffed at her suggestion about the
Phantom, I'd assumed she'd encountered the same scientific skepticism
we'd initially run up against in Michael. But Cam's reaction this
morning was clearly a lot more than that, and I had no idea why. I
also didn't know how I could continue my search for what Michael had
discovered at UH if Cam made good on his threat to report me for last
night's visit. Even if he didn't go to the extent of pressing criminal
charges but said anything at all about it to his CEO, I'd be lucky if I
could get shown the way to a washroom in his hospital, let alone be
given access to yet another roomful of confidential records.

Levitz began her introductory comments concerning VanA genes, the
conjugation process, and inhibitory strains, but for me the words
quickly became a buzz.

Perhaps Janet could carry out what I'd intended to do myself check the
personnel files of the people on the list I'd compiled in the archives
and look for the names of patients who'd made complaints against them.
But would Cam try and stop her too?

If you think I'm going to let you or Janet undermine University
Hospital and harm me or my department by dragging up those old Phantom
stories... If she did agree to go on searching through charts, she'd
have to make sure Cam didn't know about it.

As I watched him sitting with the medical students, he stole an other
look at Michael's note, then crumpled it up and dropped it in a nearby
wastebasket, pointedly scowling at me as he did so.

You can't simply toss this away. Cam, I thought, feeling annoyed at
his gesture and wondering all the more why he was so determined to keep
us from dragging up those old Phantom stories.

Levitz continued to drone on in the background about organisms
exchanging genetic materials in someone's intestine.

I tried to stop myself from rushing to conclusions about Cam's motives
the way I had with Rossit and Hurst. Unlike those two, he certainly
had no reason to be linked to the Phantom. I also knew Janet thought
the world of him, and often I trusted her judgment of someone more than
my own. In deference to her, I decided not to speculate about a man
who was both her colleague and friend. It felt more comfortable to
give him the benefit of the doubt, until Janet or I found out what was
bothering him.

At that moment Levitz delivered her punch line. "... a confirmed super
bug a vancomycin-and methicillin-resistant staphylococcus..."

All around me were gasps and exclamations of surprise.

"My God!"

"Why didn't they tell us?"

"Are we safe?"

Rossit and Hurst immediately joined Levitz in uttering assurances about
the negative screening results.

"Why were we lied to?" someone yelled.

"To avoid panic," boomed Williams at my side, adding his voice to the
other three giving reassurances and calming people. With his help the
uproar gradually subsided, and Rossit slowly reclaimed control of the
meeting.

"Dr. Levitz," he began, "I'll ask you in your capacity as a
representative of the CDC to pronounce on the last issue of this case.
It's our policy in Death Rounds to assess if the death under review was
preventable or not."

Without hesitation and pointedly not looking in my direction, she
answered, "The only way we can stop this organism is through
prevention.

This woman's staph infection might never have gotten a toehold in her
lung had Legionella been diagnosed properly, then treated aggressively
during her first visit, and the CDC feels our report of this case must
signal that message to other physicians everywhere in the country.
Accordingly, unless studies into the organism's aggressivity
categorically prove otherwise, our write-up in the Mortality Morbidity
Bulletin will stress that (he initial attending physician might have
averted the woman's death if he had acted appropriately."

I felt she'd cut my windpipe. No amount of mental preparation could
take away the actual blow of being judged responsible for a preventable
death in front of my peers. But she'd done worse than that. It seemed
I was going to be made an example of--turned into the CDC's poster
boy--for letting the bug of the decade into the United States.

For the next few seconds I sat immobile, feeling my face burn and
sensing every eye in the room turned on me. I felt Williams's large
hand press on my arm and heard his voice declare something loudly to
those around us, but I wasn't paying attention. While he talked, I
stared straight ahead, not wanting to face anyone I knew, certainly not
anyone who worked with me or whose opinion I cared about. I started to
resent Williams's prolonging the ordeal by talking on and on. Why
didn't he just shut up, I thought, so everybody would leave and I could
run the hell out of here?

But he didn't shut up, and despite my trying to tune out everything
around me, some of what he was saying filtered through.

"I think you're all missing a piece of a bigger picture here," he
insisted.

"If you count them up--this patient Phyllis Sanders, Drs. Deloram and
Popovitch from St. Paul's, and two other nurses from University
Hospital who I've been told were diagnosed as having Legionella earlier
this year--you've got a concentrated pattern of Legionella infections
in a group of five otherwise healthy hospital workers that hasn't been
explained. Dr. Rossit, you and your colleagues have got a
responsibility to look at this group as a whole."

I noticed Cam's face immediately crease into a frown at the mention of
the other cases at UH.

Rossit seemed caught by surprise.
"Oh," he said, "of course, if you--" "Good! Now here's what I think,"
Williams cut in.

"The first three cases seem related to University Hospital. Even Dr.

Popovitch's infection may have been contracted there as he's been doing
an audit on the premises since last week. Perhaps there's a source in
the place that's been overlooked."

The effect of this comment on Cam was electric.

"Wait a minute," he protested, his eyes growing dark with fury again.

"I've personally supervised two extensive screenings of every water
delivery outlet in that hospital. You can't just fly in here and
smear--" "Hey, Dr. Mackie, I'm sure there's no Legionella organisms
where you've looked. It's where you haven't looked that I'm worried
about."

"What do you mean?" demanded Cam.

"I've had a report that some of your staff at UH go into the abandoned
asylum. Maybe for a smoke, maybe for legitimate purposes--I don't know
the reasons why. The point is, I'm sure there are reservoirs of
stagnant water throughout that place. If your people are entering
those premises on a regular basis, that could be your source."

From the astonished look on Cam's face, I could tell the idea had never
crossed his mind.

"Well, I'll be damned," he muttered.

"What do you think. Dr. Rossit?" asked Williams, taming to address
the chairperson.

"Me? I think it's a very perceptive observation and the place should
be screened from top to bottom immediately." From the gleam in his eye
I suspected he thought trouble for Cam at UH was good for him and St.
Paul's.

Even Hurst chimed in.

"I wholeheartedly agree with Dr.

Williams's and Dr. Rossit's endorsement of the search."

"Dr. Levitz, what's your opinion?" inquired Williams.

"After all, it is your call."
His deferral to her authority was astute. It put her back in charge,
and her smile indicated she seemed to appreciate the gesture.

"Of course it has to be done," she replied.

"We should make it a priority recommendation."

"Very clever," I muttered to Williams out of the corner of my mouth.

"All of it's very clever."

Rossit adjourned the meeting, Doris scribbled something on a pad, and
Cam eyed me angrily before following everyone else out of the room.
While I didn't have a clue why he remained so hostile, his reaction to
Williams's suggestion was in obvious contrast to Rossit's and Hurst's
enthusiasm for the idea. Obviously for those two, a search of the
Phantom's domain held no fear.

After the meeting I refused to talk to anyone, even Williams, and
instead retreated to my office for refuge. I didn't lock the door, but
I sure as hell wasn't encouraging any visitors. I had too much work to
do twisting paper clips into pretzels.

I knew I wouldn't be fired from my position as chief today. I wasn't
even named in Levitz's final pronouncement, nor would I or the patient
be identified in her published report. That's not how these things
were done. But Hurst had the verdict he needed. In spite of the
confidentiality of Death Rounds, whispered conversations afterward
would name me and help shape the hospital's own collective judgment on
the part I'd played in Sanders's death. Time, along with the
inevitable gossip surrounding the MMB article, would do the rest. When
my annual review for reappointment by the board came around in a few
months. Hurst could simply refer to "that unfortunate business in ER,"
and everyone would know what he meant. He could then add something
about St. Paul's not being able to afford a hint of scandal or
incompetence involving the chief of emergency if its ascendancy over UH
was to be assured at this critical juncture in the amalgamation
process.

I shuddered, recalling other power struggles in which I'd witnessed the
careers of colleagues summarily derailed by similar asides.

My torn cuff caught my eye, reminding me I hadn't showered or changed
yet. Glancing at my watch I was surprised to see it was only 8:25.
Death Rounds had lasted a little over an hour. The ordeal had felt
like an entire day's work.

In the end I hadn't any idea how to counter Hurst's probable strategy
to get rid of me. Nor had I any clearer grasp of whether it was part
of a larger conspiracy by him and Rossit to cover up their involvement
in the killings. I had to admit, though, that their relaxed demeanor
in front of Sanders's remains and their eager acceptance of a search of
the asylum weighed against the idea. In fact, their behavior was so
contrary to what I would have expected, it crossed my mind that perhaps
the two of them were simply playing their usual dirty hospital politics
after all. Rossit wanted the chair. Hurst wanted rid of me, and they
made a deal to help each other get what they wanted. That was simple
enough to withstand even Janet's skepticism But I still couldn't
entirely put the darker possibility out of my mind.

As for Cam's behavior, I again refused to let my speculation about him
go any further until I talked to Janet. Her perspective would keep me
from straying into nightmare scenarios. Thinking of her, I immediately
remembered she didn't know about Michael yet I knew no matter what I
said she'd be horrified and would once again blame herself for
instigating a hunt for the Phantom without having anticipated the
possibility of a backlash. Michael's grave condition only confirmed
that this maniac, despite some twisted mission to avenge cruelty, would
kill any innocent who threatened him with exposure.

I called locating at UH and, while waiting on the phone for Janet to
answer her page, toyed with the idea of delaying telling her that I'd
gone back to the archives. I knew she'd be furious with me for going
in there alone, especially after she learned what happened to Michael.
But I quickly realized I had to warn her about Cam's reaction to that
visit. He might assume that she'd put me up to it and tear a strip off
her the same way he had torn one off me.

I decided definitely not to tell her about following someone into the
asylum. For that bonehead play, she'd kill me herself.

The receiver clicked in my ear.

"One moment please, Dr. Gar net," said the operator.

"I'll connect you with the nurses' station in the case room."

After more waiting and more clicks, a woman's voice answered, "Case
room."

"Hi, it's Dr. Garnet. I'm looking for Janet. Is she busy?"

"Oh, I'm sorry, Dr. Garnet, but she's down in emergency. I'll
transfer you " "No, don't bother. Just tell her to call me as soon as
she's free." I wasn't going to break my news to her while she was in
the middle of some case.

"No, Dr. Garnet, you don't understand. She's in emergency as a
patient. She signed herself in this morning because she woke up with a
cough and a bit of fever. We were a bit surprised because she didn't
sound too bad when she called in to transfer her cases " Whatever else
the woman said, it was to air. I didn't even hang up the receiver
before I darted out the door.
Chapter 15

The emergency department at UH was one of the areas the hospital had
renovated recently. Countertops and work spaces were pleasing curves,
the color scheme blended soft pinks with pale greens trimmed by gray,
and plants were everywhere. The effect no doubt made the people
working there feel better, but it didn't do a thing for my fear. Nor
did the sight of everyone wearing surgical masks make it easy to stay
rational.

Still breathless after running in from the parking lot, I said to the
clerk at the receiving desk, "My wife. Dr. Janet Graceton, is here.

Can you tell me which bed she's in?"

"Oh yes. Dr. Garnet, she's already been transferred to I.C.U, but if
you wish to speak with the doctor who saw her--" "No thanks," I
uttered, spinning around and heading toward the elevators. Here, as in
my own hospital, I.C.U was on the fourth floor.

But when I got into the main corridor leading to the elevators, I saw a
crowd of people already waiting in front of the large brass doors. I
took the stairs instead.

I kept telling myself that Janet had to be okay, that if she'd
contracted Legionella it was in the early stages yet, that we'd be
starting the treatment early the way we had with Stewart. But what if
she also had the other, the staph?

"Please, no, not that. Not that!" I pleaded to myself as I pounded up
the stairs.

Behind me I heard the door that I'd just gone through fly against the
wall with a bang.

"Dr. Garnet!" came an echoing shout accompanied by the sound of
whoever it was running up the steps after me.

I leaned over the railing and saw it was someone in isolation garb.

The instant he looked up I recognized him from his close-cropped blond
hair, even with his surgical mask on. Already in a state of near panic
over Janet I groaned out loud at the prospect of another encounter with
Harold Miller.

"Look, Mr. Miller, this isn't really the time to talk to me. My
wife's just been--" "I know. Dr. Garnet," he interjected, jogging the
rest of (he way up to where I was standing.

"When I heard she was in, I did the sputum cultures on her myself. I've
been helping out with the screening program here, so I was around "
"You've seen her? How is she?" I almost grabbed his shoulders.

He was a head below me, standing one step down.

"That's what I wanted to tell you, not to worry. She looked how my
mother must have been that first visit, you know, not too sick."

I felt a jolt of anger. If he was going to start putting me on the
defensive about his mother again, I was past being empathetic about
it.

I turned away and continued on up the stairs, hoping he wouldn't
follow.

But follow he did, and his insistence on talking as he kept pace behind
me set my nerves on edge.

"I wanted to tell you. Doctor Gar net," he went on, "that I don't
think anything could have saved my mother, even if she had been
diagnosed properly at the very beginning given what the second organism
turned out to be."

I couldn't quite make out if he was blaming me or forgiving me, or even
if I'd heard him right, but I remained focused solely on get ting to
Janet.

"Mr. Miller, please, not now," I told him as nicely as I could,
speaking to him over my shoulder without slowing down. We were passing
the second-floor landing.

"I'm just trying to apologize. Dr. Garnet, for accusing you the way I
did!" he practically shouted from a few steps behind.

There was something desperate in his voice that stopped me.

When I turned to face him, I found the pain in his eyes above the edge
of his mask hard to look at, and I immediately regretted my initial
abruptness.

"Mr. Miller," I stammered, "please excuse me for snapping at you, but
we both have great personal problems at the moment and " "That's why I
wanted to tell you now. Dr. Garnet, so you wouldn't have to worry
about me and be wondering what I was going to do.

You've got enough pressure on you, given the scare of the outbreak and
now with Dr. Graceton's falling ill. I want you to know I realize you
were up against an unstoppable organism that had never been encountered
before. I even understand better now about your missing the Legionella
prodrome."

Some of his words sounded a little rehearsed, as if he'd written
certain phrases out and then memorized them to use on me. But however
clumsily he was going about it, he seemed determined to put me at
ease--a gesture that was as surprising as it was magnanimous--even if
it was not something I had time for at the moment.

I forced myself to stand there and listen, despite my wanting to get to
Janet. After all, I reminded myself, although I hadn't seen a notice,
it was likely he'd only just buried his mother on the weekend.

Janet herself would blast me if I showed the smallest sign of cutting
short any effort on his part to make peace. She had predicted that he
would soften and that his hostility would subside while I'd remained
skeptical. Icertainly never expected an apology. I didn't deserve
one.

He seemed to relax as it became evident he wouldn't have to chase me
anymore. His choice of words became less stiff.

"Or.

Mackie explained to me that sending my mother home had been an error in
judgment, not outright negligence on your part, and that I shouldn't
try to damage you in court." He stopped for breath, "Everything I've
learned about you since tells me you're a first-rate doctor. That's
all I wanted to say. I know you want to see Dr. Graceton, and I won't
hold you up a second longer. She's also tops in my book. If there's
any need of more laboratory work for her, it would be an honor if you'd
let me handle it personally. When it comes to testing procedures, I'm
known for not hurting patients. That's one of the reasons I was named
chief technician. Dr. Mackie's areal stickler about us not hurting
patients."

Without another word he turned, descended the stairs, and went out the
ground floor door.

I should have been relieved, but I felt guiltier than ever. The whole
time he was talking, beyond the sound of his insistent way of speaking,
I kept being reminded of his mother's voice. At first I wasn't sure
what it was they had in common--a pattern of inflection, certain
rhythms of speech, shared phrasings--but I found it annoyed me. Then I
had it. There was a certain tone that the two of them shared. In him
it was only a hint, a vocal ghost of what had been a blatant trait in
his mother. I probably would never have picked it out in his speech at
all if I hadn't met Phyllis Sanders first.

But what I'd heard an echo of was her whining, the note of discontent
that ran through everything she said, her means of announcing her
disappointment in life, her way of implying the question Are you going
to disappoint me too ?

Disgusted with myself, I resumed my climb to the third floor. In the
face of a difficult and generous deed by her son and in the light of
what that same resentment of mine might have cost his mother, I still
had enough spite in me to dislike even a reminder of her voice.

As I ran the rest of the way to I.C.U, I had a fleeting thought about
Cam's speaking to Miller on my behalf. Maybe, after having gone to the
trouble of defending me, he felt betrayed by my breaking into his
files, and that was why he was so angry this morning. But my
preoccupation with Janet quickly shoved aside any further questions
about his strange behavior.

The isolation rooms in I.C.U were identical to the glass coffins at
St.

Paul's elevated, situated against an end wall, and brightly lit com
pared to the subdued lighting throughout me rest of the unit. They
also appeared small and claustrophobic, and as I approached the only
chamber that was occupied, I felt my stomach knot. Through the windows
I could see the backs of half a dozen residents wearing protective gear
crowded around the bed, blocking my view of Janet. But nearing the
door, I could hear her well enough.

"Please stop, stop it," she sobbed, then her plea exploded into a
retching cry followed by gagging, coughing, and the rasp ofstridor the
rattling wheeze of in drawn breath through an obstructed windpipe. The
sound sent a chill through me. Something must have blocked her upper
airway.

One of the residents uttered, "Christ! Get some atropine."

"What's happened?" I demanded from the doorway, frantically grabbing a
gown from a pile on a cart and reaching for a mask. But as I pulled
them on none of the residents answered me. Instead they started
barking out panicky orders to each other and remained bent over the bed
where I heard Janet continue to cough and struggle for breath.

"Turn her on her side!"

"Suction her!"

"It's laryngeal spasm. She needs atropine!"

"Tell me what's going on!" I shouted as I strode into the room still
pulling on a pair of surgical gloves.

A nurse turned from the bed and tried to block my way.
"Sir, you aren't allowed in here right now," she snapped at me, placing
the flat of her hands on my chest and pushing.

I brushed them off.

"Like hell I'm not," I snarled, shoving by her.

"I'm Dr. Garnet, her husband."

"You are not a doctor here!" she cried out in a shrill voice.

Ignoring her, I slid between the residents and saw Janet lying on her
side, her face practically purple, and her entire upper trunk and neck
straining to draw a breath. A thin plastic suction catheter dripping
with saliva and vomit lay hissing on the covers in front of her.
Scattered across the bed were unused culture bottles, swabs, and
slides. My alarm rocketed. These dolts must have been trying to
suction her trachea for a sputum sample. The muscles in her larynx and
vocal cords had responded by locking into a protracted spasm and
cutting off her airway. She might even have aspirated vomit into her
lungs.

Fighting back my own panic, I reached for her neck. It was bulging
with strands of tendons and webs of muscles as she struggled to gasp in
a breath. I managed to palpate the pulse of her carotid artery, but I
could count two seconds between each beat beneath my fingers.

Through clenched teeth I ordered the nurse who'd tried to bar my way,
"Get me two milligrams of IV atropine stat!"

She simply stood there.

"Move, you idiot!" I screamed at her, beside myself with fright.

She flinched, then turned toward a set of open shelves at the head of
the bed where there were labeled trays of different drugs in
single-dose vials.

Janet's eyes were bulging at me. I didn't know if she could see, but
she grabbed at the front of my gown while her entire body bucked
rhythmically in her continuing struggle to draw a breath. I clasped
her hands to my chest. They were cold and slippery with sweat.

"Janet, it's Earl. I'm going to give you something to restore your
airway. Just a few seconds more and you'll be breathing."

The nurse slapped two small brown vials down onto a nightstand and
glared at me over the top other mask.

Fuck you, I thought, turning for help to the residents instead.

"Get me a ten-cc syringe and twenty-two needle filled with normal
saline," I snapped at the young man on my right. To the woman beside
him I added, "You get the crash can ready and prepare to intubate, in
case what I'm going to try here doesn't work." I spun around to face
their colleague on my left, "You draw up ten milligrams of midazolam
and a hundred milligrams of succinocholine. We may yet have to sedate
and paralyze her." They jumped to obey. After the mess they'd made,
it obviously mattered little to them who I was, as long as I saved
their patient and their asses.

More hideous rasping noises continued to come from Janet's throat--the
sound of air sucked through an opening in the vocal cords no bigger
than a slit. We probably had another thirty seconds before she'd start
to seize. Cardiac arrest would follow. Right now she was still
conscious and in agony.

"Hold her firmly and keep her head steady," I told the three remaining
residents, "but don't hurt her, you hear me!"

"Yes, sir," they mumbled in unison under their masks.

Janet's eyes widened even further with panic as they pushed her down
and grasped her head between their hands.

"I'm here, Janet; this will help you," I reassured, trying vainly to
sound calm. Inside I didn't know if I could do what I had in mind.

Fear of failure was constantly present in any race to win back an
airway or recapture a heartbeat, but the terror of losing Janet jangled
my thinking, un steadied my hands, and corroded my nerve.

Atropine would reopen her airway by blocking the neuronal pathway that
was keeping the larynx in spasm, but the IV route took time. A
resident handed me the syringe that I requested, the inch-long needle
glinting under the ceiling lights. I squirted out a few ccs of saline,
snapped open the brown vials, and drew the atropine up into the
cylinder. Then I grabbed an alcohol swab from the nightstand and, to
the gasps of the residents, ran it over the front of Janet's larynx. I
was going to inject directly into her neck. I'd never treated
laryngospasm this way before, but I'd put needles into the trachea to
freeze it for intubations of head trauma cases and I'd shoved atropine
down endotracheal tubes during cardiac arrests. I couldn't think of
anything that would work faster.

"Janet, if you can hear me, close your eyes, love!" I commanded, my
voice shaking as I located the landmarks of the crico thyroid
membrane--the thin "window" covering the opening where access to her
windpipe would be easiest--and brought the needle point up, pressing it
against the overlying skin. She seemed to stare at it and increased
her efforts to break free.

"Hold her," I yelled.

They steadied her movements, and I shoved the tip of the needle hard
enough to penetrate her skin, pulling gently back on the plunger as I
advanced the point A tiny stream of bubbles flowed up into the cylinder
indicating I was through to her airway. I angled the needle toward her
larynx, pushed the plunger as hard as I could, and yanked out the
emptied syringe.

Ten seconds passed. Her movements grew feebler and her eyes, still
open, fluttered up under her lids.

From the resuscitation cart I grabbed a black rubber ventilating mask,
connected it to an oxygen outlet, and pressed it to her face. I
squeezed the attached bag in an attempt to force air down her lungs,
but there was resistance against my hand. It meant her larynx was
still closed.

Another ten seconds passed. Her eyes were nearly shut, her skin was
blue, her limbs were starting to jerk.

"Get ready to sedate and paralyze her," I ordered, but my own voice
sounded far away while my panic continued to mount. If she seized, her
teeth would clamp together and her body would start heaving with
convulsions so powerful that we'd break her bones if we tried to hold
her down. We'd only be able to intubate her after the drugs or the
severe lack of oxygen broke off the pulsing muscle contractions. That
might take more than a minute, enough time to put her into cardiac
arrest.

I squeezed the bag once more. Again the resistance remained so firm I
couldn't budge my fingers. Then I felt a release, the bag responded to
the pressure of my hand, and I saw Janet's chest rise. I squeezed
again and again, each time pushing oxygen more and more easily through
her opened airway and into her lungs. Over and over I ventilated her,
watching her skin quickly turn back from blue toward pink. Soon she
was stirring, moaning, and shoving the mask away as she rapidly resumed
breathing for herself. She coughed repeatedly, but didn't expectorate
much. When I listened to her chest, she was wheezing, but the sounds
were distributed uniformly, probably from the infection, and there was
equal air entry into the bases of both right and left lungs. It would
take an X ray to be sure, but I didn't think she'd aspirated.

When she finally stopped choking enough to speak, she looked at me
incredulously and croaked, "You put a bloody needle in my neck!"

Tears came to my eyes as I laughed to keep from crying.
"And you scared me half to death," I said, leaning over and putting my
arms around her.

The residents shuffled nervously and the nurse looked on
disapprovingly. I ignored them all. They'd account to me later, I
swore, but I didn't give a damn for anything at that moment except to
feel Janet against me. Yet I was also thinking like a physician. Her
breathing was still labored, presumably from her developing pneumonia.
While I held her, I reflexively checked the IV, making sure her
movements hadn't dislodged it. I noted the label on the overhead bag
read Erythromycin. I was resetting its flow rate with one hand when I
saw Cam standing at the door watching us all.

He was wearing protective gear, but his eyes above his mask were
dilated and dark with rage, exactly as I'd seen them earlier this
morning For a second I thought it was the sight of me again that was
making him furious, but he swung that fierce gaze toward the residents,
"What me hell have you been doing to Dr. Graceton!" he screamed at
them.

The bunch of them seemed to flinch, but one in particular averted his
eyes and tried to edge behind the others. Cam must have seen the
movement as well, because he immediately singled him out.

"You!

Tell me what happened or I'll suspend the lot of you and make sure you
never set foot in this hospital again."

The young man froze, and the others moved away, leaving him standing
alone in front of Cam. His face reddened above his mask all the way to
the upper tips of his ears.

"Well?" demanded Cam, towering over him.

"I thought we could do a simple aspirate with a small catheter," he
began to explain, sounding plaintive.

"I did it all the time on patients in recovery during my anesthesia
rotation--" "Those patients are already sedated and intubated!" roared
Cam.

"What the hell made you think you could do the same to an alert
patient?"

"None of us had experience with midazolam to put her to sleep, and I
figured without her intubated we shouldn't freeze her gag reflex--"
"Jesus Christ, lord save us from what you call thinking. And the rest
of you did nothing to stop this genius from nearly killing Dr.
Graceton?" he yelled, turning to the others.

"How dare any of you stand by and not attend to a patient's pain before
an invasive procedure--any invasive procedure at all--you understand
me! You damn well don't hurt patients. I've half a mind to put tubes
down your throats and let you experience what you just put Dr. Graceton
through. Disgraceful!

The lot of you are on probation as far as I'm concerned."

Now all the residents flushed crimson above their masks. Some grew
wide-eyed while others glared furiously at the one who'd performed the
suction.

"You don't go near a patient of mine without discussing it with me
first," continued Cam, his voice lower, but his tone as hard and
unforgiving as ever, "and you don't write an order without it being
countersigned immediately by a staff person. In forty-eight hours you
bozos will present what you did here today to a special grand rounds on
laryngospasm in front of all your colleagues in our residency program.
Now get out of my sight!"

They filed out of the room without looking at each other. Some were so
dazed they had to be reminded to remove their gowns and masks at the
door while the others flung their clothing into the disposal bin and
stomped off. The nurse quietly tried to follow them, but Cam wasn't
finished with her either.

"Hold it," he told her brusquely.

"You've got some explaining to do as well. What were you thinking of,
letting those clowns proceed the way they did? They were obviously in
over their heads. Who even ordered a tracheal aspirate?"

She stopped moving toward the door and turned to face him. I only now
took areal look at her. She was dark-haired with a few strands of
gray, tall, and as far as I could tell rather slim looking, but
whatever physical attributes she had hidden under her costume, I'd
already decided that her disposition was nasty. A name tag over her
left breast told me we should call her Miss Brown.

"It's your own policy. Dr. Mackie," she replied in a sweet singsong
tone that sounded belligerent Cam exploded, "Doing tracheal aspirates
on unmedicated patients is not my " "Getting proper sputum samples is,
especially since we've had so much trouble with infected personnel
lately. I saw a note in her chart saying the sputum sample they got in
ER was scanty."

It was Cam's turn to go beet red.

"Legionella, as you should know better than anyone. Miss Brown,
doesn't produce much sputum."

His voice vibrated with the same barely controlled anger I'd heard him
direct at me this morning.

"My guidelines for getting proper sputum samples are meant to be
applied with clinical judgment."

"I'm only a nurse. Dr. Mackie. It's not up to me to know which rules
you want used and when " I felt Janet lift her head off my chest.

"That's a crock. Cam. I told her that Harold Miller had taken samples
in ER and that the scanty sputum was to be expected. She refused to
listen." Even weakened by what she'd been through, Janet's tone had
the scalpel-sharp bite she saved for unpleasant truths.

"Why, Dr. Graceton," the woman protested, "you can't expect to give
orders when you're a patient " "But I can give orders. Miss Brown,"
bellowed Cam, "and since you're so good at following rules, here's one
for you. Until I can haul you into a morbidity review about what you
did here, you're no longer to have anything to do with nursing Dr.
Graceton. Come with me, and I'll arrange it with your supervisor! By
the time I'm through with you, you'll never work in an I.C.U again!"
He stormed from the room, practically ripping his protective clothing
off at the door be fore heading to the nursing desk.

Brown flashed a murderous look at Janet, then followed after Cam. She
flung her own gown, mask, and gloves on the floor beside the designated
bin.

"Jesus Christ" was all I could say. I'd seen bungling before what the
residents had pulled was the sort of near disaster that happened from
time to time, unfortunately, in a teaching hospital but Nurse Brown was
outright scary. She deserved everything that Cam had threatened her
with, if not outright dismissal. The residents would probably learn
from this. What Cam had in mind for them made it un likely any of them
would ever screw up doing tracheal suction again.

But I doubted any amount of disciplinary action would ever make Brown
into the sort of nurse I'd want near Janet, me, or anyone else.

Yet seeing Cam once more fly into a rage, even over a serious
infraction, I was left feeling ambivalent and uncomfortable about him.
He was a chief in this hospital. He knew a public blowup could badly
disrupt a critical-care unit and interfere with the staff's calm and
concentration. No one was immune to being angry I'd also wanted to
scream at both Brown and the residents but his performance only added
to my doubts about his tendency to lose control. My first impulse was
to transfer Janet away from the bunch of them.
"Janet, let me get you out of here and to St. Paul's, where I can as
sure you no one like Brown or these residents will get near you."

"You'd deliver me to the hands of Gary Rossit? No thank you."

The recollection of him sitting beside Hurst at Death Rounds and
grinning up at me flashed through my mind.

"Of course not," I quickly agreed.

"Being around him is totally out of the question. But whoever the
Phantom is, you're vulnerable here. I can get someone else " "Stop it.
Earl!" She leaned back out of my arms and looked me in the eye, a
stern expression crossing over her face.

"Stewart Deloram wasn't safe at St. Paul's, and I told you before,
running away is not an option." She took a breath, as if to continue
speaking, then seemed to change her mind. She put her head back
against my chest.

"As for the residents and nurses," she added, sounding a little softer,
"I'm sure Cam will make certain there won't be any more screwups by
them. Besides, it's my infection that's got me scared now. De spite
Stewart Deloram doing well, I don't know how bad I'm going to get, and
I want Cam taking care of me."

I continued to stroke her hair and cradle her against me, glad she
couldn't see the tears that I felt brimming in my eyes. Her straight
forward admission of yet another of my fears that no one knew for
certain how ill she might become nearly made me lose the puny grip I'd
managed to keep on my emotions.

As I clung to Janet, I looked through the glass in the front of her
room and watched Cam standing in the nurses' station with his back to
me. The overly tall man was engaged in an animated conversation with
Brown and another nurse who I presumed was the supervisor.

Whatever I thought Brown deserved, I continued to be troubled by the
way he kept waving his hands about while stabbing at the air between
them with his index finger. Obviously he was still beside himself with
fury. The image of his face at Death Rounds, distorted with rage and
inches from my own, wasn't hard to recall. I'd given him the benefit
of the doubt then. It was altogether something else to suddenly have
him as Janet's physician now that she'd been attacked.

Even when he was focused on the residents, I'd felt disturbed by being
in such close quarters with him.

Perhaps it was the shock of having had to resuscitate my own wife,
perhaps it was having seen my best friend put near death not twelve
hours earlier, perhaps it was the frustration of not being able to
prove this killer even existed, certainly it involved my instinct to
protect those I loved above all else--whatever the blend of reasons, it
was a potent fuel for a rush to judgment.

In a flash any inclination I had to be balanced and fair was gone.

Suspicions that I'd tried to keep in check resurfaced with a vengeance
and images I'd tried to suppress or explain away flew to mind--Rossit
and Hurst glibly chatting before the remains of Phyllis Sanders, the
powerful business group ringing Hurst as he manipulated his way through
the amalgamation meeting at St. Paul's, a shadowy figure creeping up
on Janet "Do you have any idea who might have gotten close enough to
infect you?" I asked through clenched teeth trying to keep my voice
steady and my stomach down.

"No," she replied meekly.

"I've been racking my brains about that To give me Legionella, whoever
it was would have had to make me inhale a contaminated mist or spray,
but no one's been near me and me alone with anything even resembling an
aerosol. At other times, when I'm in close quarters with staff members
doing procedures, I'm wearing a mask, gloves, and a gown." She paused
and after a few seconds added, "It's so frustrating, knowing that
sometime in the last few days I must have come face to face with me
Phantom!" Then she started to cry.

I was ready to kill whoever had attacked her.

Turning from the window and nuzzling my head against hers, I asked,
"Does Cam always get as mad as he did just now? I've never seen even a
hint of that kind of temper whenever I met him with you." Thinking the
unthinkable was no longer out of bounds.

She sighed, then took a few seconds to answer.

"Don't judge him too harshly. He's fanatical about kindness to
patients, the way we all should be, but for him, well, it's a special
cause."

I felt a chill run through me.

"What do you mean a special cause?" I persisted, finding it
increasingly hard to keep my voice even.

"It's personal. Earl," she replied, "something he once told me in
confidence that he doesn't like talked about. It's got nothing to do
with the Phantom, trust me." She was no longer crying, but she still
sounded shaky. I don't think she suspected the impact her words were
having on me.

The chill became a prickle of dampness on my back as I recalled some
other words Harold Miller had said at the end of our conversation on my
way up here. At the time I was so desperate to see Janet I'd hardly
paid attention. Dr. Mackie 's areal stickler about not hurting
patients.

I considered very carefully what I was about to say.

"Janet, I know that you don't think I'm good at speculating and that
you have a great deal of confidence in Cam, but his behavior this
morning at Death Rounds was bizarre." I paused, waiting for her
protest at even a hint of my being about to speak negatively of her
friend, but I felt her body stay relaxed against me. Cautiously, I
continued, "He was furious that I went into the archives last night and
looked through all the old charts of the Phantom's first victims " "You
what!" she exclaimed sharply, pushing herself away from me again. She
immediately began coughing.

I quickly tried to explain.

"Yes, I went through those files, Janet. I had to. After Michael was
admitted " "Michael?" she croaked, barely able to find her voice as
her coughing spell continued.

"What do you mean Michael was admit ted?" She was sitting bolt upright
now.

Damn! In all my concern for her I'd forgotten she didn't know about
Michael. Icertainly hadn't wanted to spring the news on her like this.
I reached for her hand. The gesture made her look doubly alarmed.

"Janet, we admitted Michael last night in septic shock from what I'm
sure is Legionella" I told her, watching her eyes widen.

"There's no sign of staph, but as of this morning he was still
unconscious and on a respirator."

She uttered a little cry. For the next few seconds all she said was
"Oh no" over and over while her horrified expression grew until her
blanched face looked like a silent, openmouthed mask.

"But how?"

she finally demanded.

"Where?" Her voice was high and tremulous.

"Any time we got near any organisms in the lab we were in protective
gear. Cam and Miller made sure of it They're both adamant about that
kind of thing, especially now. Oh, why did I get him into this!" she
wailed.

I took her back in my arms and rocked her.

"What about Donna?" she asked.

"Shaken but holding up when I left her last night."

Between more of her coughing bouts, we sat in silence, hanging onto
each other. I wanted only to let her rest and comfort her, but comfort
her with what? My thoughts continued to rage with questions about Cam,
and I was increasingly convinced she'd be in danger if she stayed here.
But without hard evidence I was unlikely to budge her belief in him.

"Janet, about Cam," I began again, "you've got to listen to me. I
swear he's covering up about the Phantom." This time I pressed ahead,
not wanting to give her the opportunity to interrupt.

"Not only is he trying to keep us from drawing attention to the attacks
from two years ago, but when I got Williams to instigate a search of
the asylum, he seemed most unhappy about that as well. You tell me, if
he's not got something to hide, what's he afraid we'll find?"

Janet lifted her head from my chest and gently cradled my face in her
hands.

"Will you listen to yourself?" she said softly.

"I know that it's because you love me and that you're frazzled by the
fact I've been infected" she took off my glasses, kissed me on my
forehead above my mask "and having had to rescue me from those doltish
residents must have scared you silly." She kissed me again, this time
on my eyes, then brushed her lips across my ear while moving her mouth
closer to my neck.

"Will you listen to yourself?" She brought her head up, still clasping
my face in her hands, and, staring me right in the eyes, said, "Come
on, get off Cam's case."

Before I could sputter an answer, I was startled by the sound of
someone clearing his throat behind me.

"Earl, you've got to let her rest," said Cam from the entrance to the
room. Sitting on the bed holding Janet, I'd been facing the other way
and hadn't seen him return. He was already in clean protective gear;
that meant he must have been putting it on just outside the door while
we were talking. His voice was polite, but his presence filled me with
anxiety. As I stood up and looked at the man who had be come such a
dreadful enigma to me, I wondered how much he'd heard of our
conversation.

"I'm sorry. Cam," I protested, making no attempt to hide my hostility,
"but I need to talk with her, and under the circumstances--" "It's
okay. Earl, Cam's right," Janet cut me off.

"You should go now and let me sleep. Kiss Brendan for me." She was
giving me an order. She pushed herself away and lay back on her
pillow. I was disturbed by how drawn she looked.

"That despicable nurse won't bother you anymore, Janet," Cam told her,
speaking very quietly.

"I've arranged for only our best I.C.U staff to take care of you from
here on. Anything medical I'll do myself, that is..." He let his
voice trail off and looked sideways at me.

"That is, if you still want me as your physician," he concluded,
turning his eyes back toward her.

"Of course. Cam," she said, sounding surprised but shooting me a
warning glare, making it very clear I was to stay silent.

"Who else would take care of me but you?"

Cam glanced over at me again, and my stomach writhed like a bunch of
cold snakes. But I stood there saying nothing, racked by confusion
about what to do as much as gripped by panic. He in turn seemed to
relax a notch and stepped closer to the bed.

"That's settled then," he said, taking Janet's hand in his.

What if I confronted him, I wondered, tried to scare him off by
throwing all my suspicions at him here and now, even without proof? How
would he react?

"I now order this beautiful woman to sleep," he was proclaiming with a
warm smile, "which is an important step in getting her back on her
feet." He'd reverted to the pleasant self-confident tone I was used to
hearing when he'd kept me laughing at dinner parties.

While Janet's returning smile revealed how comforted she was by this
brilliant physician's physician, I felt warning bells going off
throughout my head telling me to be very, very careful. Since she was
staying put, if I opened my mouth and threatened him, I might end up
placing her in more danger than if I kept quiet. Perhaps I'd already
said too much if he'd eavesdropped on most of what I'd been saying to
Janet before he came into the room.

He straightened to his mil height, gave her a friendly wink along with
a final pat on her hand, and then turned toward me. As pleasant as his
expression seemed, his eyes were hard as blue ice.

"Now Earl," he said quietly, gesturing to the door, "how about meeting
me in my office after my clinical rounds, say, about eleven? I think
you and I should have a chat about what happened at Death Rounds this
morning."
Chapter 16

I needed proof that Janet would believe, even if it pointed to Cam.

I figured the best way to get it was to pursue my original plan--go
back through the confidential files of University Hospital and find
whatever Michael had discovered. Even if the pattern hadn't told him
who the killer was, that same evidence that had convinced him there was
a killer could perhaps point Janet and me toward a name.

Except now I'd have to somehow do an end run around Cam to get to those
files.

I decided to take my problem to the top, and in Janet's hospital that
meant I had to go down to the third floor and meet with Reginald Fosse,
the CEO. His office was housed in the plush confines of the
administration wing.

While walking from I.C.U to the stairs and descending one flight, I
worked out the details of what I would say. By the time I was striding
over the thick carpets, my torn pant cuff napping, I'd concocted a
scheme made up of a bit of blackmail, a touch of bribery, and a whole
lot of bluster.

Reginald Fosse had diplomas for a master's in business administration
and a master's in health-care administration hanging on his wall, but
no M.D. As such he was part of the managerial breed that has taken over
the running of hospitals in the United States during the past ten
years. This group has served shareholders in publicly traded providers
of health care well, but its impact on the health of the nation has
been less clear. Every hospital it kept out of bankruptcy hasn't
necessarily been a victory for the sick, especially when it did it with
disastrous money savers such as the ill-fated one-day obstetrical-stay
policy for a delivery. Janet had fought against that loopy idea, and
Fosse, to his credit, had listened to reason before state legislation
forced him to.

He was a pleasant enough looking man. The top of his head was balding,
he had a few strands of white hair that he kept combed over it, and his
midriff bulged over his belt. But the grandfatherly wire-rimmed
glasses he wore perched on the end of his nose made him seem
comfortable with his middle age and his smile was full of warmth. He'd
agreed to see me right away and expressed his concern about Janet,
obviously having already been informed of her admission.

A hospital CEO who is not an M.D. must rely on doctors for advice on
medical issues and can end up feeling at a disadvantage against the
brightest and best clinicians in the place. Nevertheless, smart CEOs
will recruit the support of these doctors to obtain the soundest advice
possible on medical matters, while keeping their own council for
managerial decisions. Too often, however, out of insecurity, a non
physician manager will try to exert his or her authority by battling
doctors and blocking anyone with clinical competence from gaining too
much political influence. These CEOs tend to surround themselves with
wimps and weaklings and reap the inferior caliber of advice appropriate
to such circles. Over the years, from Janet I'd learned Fosse leaned
slightly toward this latter school of thought. As I took the chair he
offered me in his sitting area, I thought of a way I might turn the
tendency against him.

Looking around, I found it hard not to admire the man's office.

The room was big, the rose-colored rug under my feet was thick, and his
windows were full sized, though almost all I could see through them
were the other wings of the hospital, a patch of the grounds, and
beyond that, curling tar paper on the rooftops of nearby houses.

His dark mahogany desk was about as large as the entire floor space in
my own spartan work area back at St. Paul's.

The photos hanging beside Fosse's two diplomas showed him smiling and
shaking hands with a variety of people, none of whom I recognized. In
most of them he was also holding up an oversized check with lots of
zeros behind the first number, donations, presumably--often the only
way to finance innovative programs, new construction, or
state-of-the-art equipment now that the profits of Health Maintenance
Organizations went more to Wall Street than into patient care.

I thanked him for his concern about Janet and then in twenty minutes
told him everything I knew about the Phantom: the events from two years
ago, the Legionella infections of the nurses, Michael's infection and
his note, and Janet's infection. Without other doctors around to
inform him that I was crazy, my fantastic tale seemed to overwhelm him.
During the telling of it he leaned more and more off the edge of his
seat, and when I made it clear that I feared more at tacks, a sheen of
perspiration appeared on his scalp that turned his hairdo into a series
of wet strings. I then implied that while I didn't have any evidence
that I could take to the police, I'd have to report Michael's illness
and all that had happened here to the state accreditation board, so
they could name a replacement for Michael. Even if they didn't believe
a killer was on the loose, I explained, once they learned of the
infections, they'd be officially obliged to redo their accreditation.

By the time I finished with him he looked thoroughly frazzled as well
as frightened.

"But why couldn't we continue the search informally, the way Dr.
Popovitch was doing for Dr. Mackie?" he blurted out after a few
seconds.
"If someone's doing the hideous things you claim, we can't wait for
outsiders to get going on the problem. At least it would give us a
chance to get at whatever Dr. Popovitch discovered and to see what
we're up against." His tone was almost pleading and while I'd no doubt
his main priority was preventing further infections, I suspected he was
also thinking a lot about damage control for his hospital's
reputation.

I continued to set the hook.

"Of course, that was my first preference I told him, "provided we moved
quickly, but Dr. Mackie has adamantly refused even to consider the
possibility that someone is infecting personnel in your hospital. He's
left me no choice."

Fosse blanched anew at this piece of news.

"He's what?"

I told him about Cam's reaction to my having tried to look at the files
in the archives, without revealing my suspicions about Cam.

"Jesus Christ!" he exclaimed after removing his glasses and rub bing
his eyes. He looked increasingly troubled as I talked and didn't even
question how I'd gotten access.

"May I make a suggestion?" I figured it was time for the bribe.

"Since I'm going to be around here a lot on account of Janet, why not
let me continue to go after the files Dr. Popovitch found? I'd be
discreet and could report solely to you. You'd have to overrule Dr.

Mackie, of course, but I don't see you've got any choice."

His worried expression shifted into a mask of cool neutrality.

Since he wasn't a doctor, I guessed he'd never cross a physician as
important as Cam without having at least some m.d.s from his own
hospital lined up on his side of the argument.

"Well, Dr. Garnet," he began while the muscles in his face squirmed,
"I appreciate the offer but it's a difficult time for you " "I know how
you can get another of your chiefs here to wholeheartedly back the
plan," I interrupted. I let him stare at me a few seconds, just to
whet his appetite, before adding, "I'll do anything to stop this
killer, because until he's stopped, I'm convinced Janet's life is still
at risk. Trying to convince the police or anyone else that he exists
is hopeless unless I find whatever Dr. Popovitch discovered." I
wanted him to know what was at stake in case Cam tried to intimidate
him into backtracking.

Finally, having suitably prepared him, I offered what I felt certain
neither he nor the chief I had in mind would refuse.

"Here's what I propose. Tell your chief of emergency, William Tippet,
that I'll support his being named the new joint chairperson of
emergency medicine in return for his granting me temporary privileges
in his department and appointing me to do a special audit. He can call
it something vague, such as a joint project comparing mortality rates
of ER cases common to both our hospitals. Unofficially he can play it
down and say it's really just a courtesy, meant to give me something to
do while I stay near Janet That should keep my poking around from
raising too many eyebrows and would give you the reasons you'd need to
counter any howls of protest from Dr. Mackie. It won't fool him, but
he won't be able to give you much heat either."

Posse looked interested. I knew William Tippet would jump at the
chance to be overall chairperson. Wild Bill's longtime insecurity
around me would make the opportunity to finally prevail irresistible to
him. And Fosse himself would much prefer one of his wimps to be
chairperson of a key department like ERAt this stage, neither of them
would have any idea Hurst was in the process of dumping me anyway.

"I'll speak with Tippet," he said after a few seconds.

"Where can I reach you?"

I gave him my numbers. While I was shaking hands with him at the door
to his office, I asked, "By the way, do you know of any reason why Dr.
Mackie should be so defensive about the Phantom story?"

"No, not at all," he replied without hesitation.

His answer had seemed straightforward enough; his eyes certainly hadn't
flickered from my own, nor had his voice changed in tone. But in the
last half hour it was the first time this institutional politician had
said anything to me without at least a few seconds hesitation. If he
weighed the truth so carefully, might his answer at the ready be a lie?
In any case, I didn't believe him.

I descended to the first level basement and headed toward Cam's office,
which was located near the labs. As near as I could tell, with all the
twists and turns in the hallways, I was directly over the subbasement
wing where I'd spent the night. Unlike the subbasement, however, this
level had been renovated, and the corridors were wide and well lit. I
was five minutes early for our eleven o'clock chat CENTER FOR
BIOLOGICAL INVESTIGATIVE STUDIES declared 8 large wall-mounted sign in
gold lettering at the entrance to Cam's domain. Beside it someone had
pasted up a more modest Labs, written by hand on a piece of cardboard.
The pompous version probably hadn't made it clear that this was the
right place to hand in a lowly sample of pee or give a specimen of
blood.

The rooms I walked by were each as big as a three-car garage, and in
every one of them was a labyrinth of scientific equipment bedecked with
flashing lights and endless displays of digital readouts.

HEMATOLOGY, BIOCHEMISTRY, VIROLOGY, CYTOLOGY, and BACTERIOLOGY read the
signs over each doorway. These various areas of expertise would
together determine the thousands of individual clinical measurements
done here daily--the levels of sodiums, potassiums, sugars, proteins,
red cells, white cells, and dozens of other ingredients in the human
body--that would help quantify the diagnostic mysteries of the more
than eight hundred patients lying in the beds upstairs. Through the
open doors over the hum of the ventilation system I could hear the
casual chatter of busy lab workers, mingled with the incessant summons
of beeping monitors, warning buzzers, and timing bells. Along the
corridor where the air didn't circulate as well, my nose tingled with a
stinging aroma of unrecognizable chemical reagents mixed with the
familiar scent of coffee. Occasionally I got a whiff of an
all-too-recognizable stench, such as the one that emanated from a
string of carts loaded with half-filled urine cups.

I also noticed that here hardly anyone was wearing a surgical mask, as
opposed to the way a majority of personnel were in the rest of the
hospital. Probably Cam's influence, I thought He'd made a point of not
wearing one himself once we left Janet's room.

"If we don't act rationally through all this and encourage others to do
so by example, we're in danger of ending up with outright panic," he'd
declared over loudly in the nurses' station, making sure they heard him
before he walked out of I.C.U.

Down here the only people I saw through the various lab windows wearing
masks, a usual precaution when working with potentially airborne
agents, were either working directly with flu ids that might splash or
plating organisms onto petri dishes under ventilating hoods in the
bacteriology lab.

Through yet another open door I saw into a classroom and caught sight
of Harold Miller taking nasal swabs from about a dozen people in
housekeeping uniforms. Another thirty or so were lined up waiting in
the hallway outside. UH was clearly carrying out its commitment to
screen every single worker in the hospital.

In fact, the entire place was a superb testimony to the competence and
exemplary leadership of Cam. It was impossible to reconcile the man in
charge of these works with the monster I'd been making him out to be.
Yet, on seeing all the technical prowess under his control, I couldn't
help thinking that if anybody were able to find a way to use microbes
as murder weapons, perhaps Cam could here.

I paused outside his closed door and focused on how I intended to
handle myself. Whatever he had to say about what happened at Death
Rounds, I'd be trying to get a sense of whether he was lying.

If the chance came, I'd press him about why my poking into the business
of the Phantom upset him so, but I'd have to be careful on that topic.
He'd obviously be upset enough when he learned that I'd already been to
Fosse behind his back. It might enrage him further if he realized I'd
then come down here to try to catch him out. Above all, I had to make
sure my feinting with him didn't precipitate a further attack on
Janet.

He was waiting for me.

His office was both spacious and luxurious, equal in every way to
Fosse's. It was paneled with dark wood, lined with wall units of
bookshelves, and carpeted with rich blue broadloom. In one half of his
large room was a sitting area, as there had been in Fosse's, defined by
a couch and matching easy chair. Occupying the other half was a desk
that looked about the size of the CEO's, but behind Cam's, tastefully
positioned off to one side, was a potted tree.

Natural light came in through a long narrow line of windows at the
level of the ceiling, about the only clue we were in a basement,
Thin-slatted Venetian blinds dressed up the effect, and track lighting
gave the room a soft illumination that was easy on the eyes.

The final result seemed to be the hospital's way of stating, "You are
honored as a world-renowned physician."

"Have a seat," he said, casually indicating the couch. He walked over
to a wooden hutch, slid open a panel door to reveal a small fridge and
a row of glasses.

"Would you like a Coke, or can I have my secretary get you a coffee?"

"Nothing, thanks," I said, far more coldly than I intended.

He stopped in midreach for a glass, turned to look at me with no trace
of a smile left on his face, and slowly closed the door to his minibar
without taking anything for himself.

"Right," he said, his own cool tone seconding mine and making it clear
we were both finished with niceties.

He came and sat on the arm of the easy chair beside the rather low
couch where I was sitting. The higher perch made him tower over me. I
wondered if he had deliberately designed his seating arrangement to
achieve this effect as a way of intimidating troublesome col leagues.
I'd read somewhere that Lyndon Johnson used to pull that trick.

"You really went over the line last night, Earl," Cam began.

"Here I defend you to Miller, and you return the favor by sneaking
around behind my back. Why didn't you come to me? After all, you "
"Janet came to you, remember? You wouldn't listen."

He grimaced.

"Look, I'm willing to allow you were distraught over Michael and
influenced by that crazy note of his " "Crazy!" I interrupted, leaping
to my feet and forcing him to look up at me instead. His mouth dropped
open in astonishment.

"I'll tell you what's crazy," I continued, practically yelling.

"It's you continuing to ignore Janet's warning that these infections
are connected to the Phantom business!" So much for being careful, I
thought, as I let fly my anger.

He started leaning back from me as I brought my face closer to his.
Give him a taste of his own tactics was all I could think; I bored in
on him until I was inches away.

"Then Michael got infected, and now Janet's been infected, yet you
still don't seem to get it. Worse, you continue going around like she
and I are the enemy for pursuing the one idea that might get to the
bottom of what's already a nightmare."

Cam's face flushed.

"Now wait just a goddamned minute!" He got to his feet. He was taller
than me again.

"No, you wait just a goddamned minute! This is about people's lives.
Cam, patient's lives, Michael's and Janet's lives. Speaking on behalf
of patients, I have to be professional. On behalf of a friend I can be
as nasty as it takes, and on behalf of Janet, I'm going to be your
worst nightmare!"

I was screaming up at his face and couldn't stop. Fear, lack of sleep,
the possibility he had infected Janet--all combined to drive my rage
way over any point where I could control it. Hell, after days of
frustration and stalking shadows, I suddenly didn't want to control
it.

He stepped away, his expression quickly reverting from anger back to
openmouthed shock.

I pressed in on him.

"You want to charge me with trespassing, you go right ahead. I'm past
it all, Cam! I don't give a fuck anymore for your reputation or mine
or either of our hospitals." Got that?" I stabbed the front of his
chest with my finger.

"I only care now about keeping Janet safe and bringing down this
killer, no matter whom I have to talk to or how loud I have to
scream!"

His face had drained to white. I'd backed him up against a wall loaded
with plaques, citations, awards, and degrees. A cautionary voice from
deep within me said, "This is crazy," but I was beyond caution, not
even capable of listening to what was left of my own reason.

"So tell me. Cam, what are you really up to? You were livid that I
saw the records from the Phantom's first attacks. They're quite
something, aren't they? I even figured out how he did it. He's real,
Cam. As real as can be!"

"This could jeopardize Janet!" insisted that inner voice, sufficiently
loud this time to snap me out of my tirade. I stood for an instant,
breathing hard and fighting to regain my self-control. My outburst was
anything but what I'd planned; for a few seconds I think I was probably
as close to losing control as Cam was at Death Rounds, but I was
rational enough to realize something. My anger had given me a
momentary edge on him. I quickly decided I'd test my suspicions even
further and throw some more of them in his face to see what he did.
Afterward I'd do whatever it took to protect Janet.

"So I have a warning for you. Cam," I continued, "just like you had
one for me this morning. Explain to me right now why you seem so
determined no one investigate the Phantom--what you're afraid we'll
find--or you're liable to end up being investigated yourself."

He reacted as if I'd punched him in the gut. His color drained even
further to a dusky gray that was alarming to look at. I felt I'd hit a
bull's-eye.

"Well, which is it going to be?" I continued.

"Do I yell my head off about the Phantom, the infections, and you
trying to cover it up until someone somewhere listens, or do you level
with me?"

If I got any closer to him, it would be indecent. I spun away and
walked over to the hutch where I slammed open the wooden door, grabbed
a Coke out of his fridge and pulled the tab off the can with out
looking at him. I took a swallow and felt the cold liquid run all the
way down to the pit of my stomach. The sensation reminded me I hadn't
had breakfast yet. I glanced at my watch. It was 11:10.

When I did turn around to face him, the one word to describe him was
deflated His eyes, usually so fierce, looked as faded as denim.

He moved away from the wall, eyeing me warily.

"You've got it all wrong. Earl. You've certainly got me wrong." He
sounded shaken and was circling around me, putting the couch between
us, as if he were afraid I might spring at him.

"I admit I went over the top at you before Death Rounds. Let me
apologize for that I should have been more understanding." He was
almost pleading. He extended his hand tentatively, reaching over the
back of the couch, like an opponent at the end of a tennis match
reaching over the net.

I figured it was a good time to push for answers.

"Why were you so enraged that I was looking at those charts?" I
demanded.

"You've seen them. You've got to know that those people were all
attacked by someone."

"I didn't want stories about the Phantom starting up again." He
started to withdraw his hand, then pointed it at me.

"Don't you realize the panic that could cause? It would have been bad
enough to have rumors that someone was spreading Legionella. And now,
after our scare about the super bug a story like that would be
catastrophic." He spoke quietly, but the urgency of his tone was
impossible not to hear. An act? Maybe not. Panic was a legitimate
concern, as Williams was forever stressing.

"Why were you so furious about the asylum being searched?" I demanded,
letting my impatience sound while paying close attention to the
expression on his face.

There was a flash of the familiar blue in his eyes.

"I was furious that you had probably been spreading tales about the
Phantom to Williams you must have told him something fantastic or he
never would have helped you get into those records but again I
apologize for my anger. You had Michael's note and, well, I can see
why you did what you did, but that doesn't make it right." His voice
sounded strained and he seemed ill at ease, remaining be hind the couch
while shifting his weight from one leg to another. If any of this
behavior was because he had something to hide, I really couldn't tell.
For all I knew, it could mean he had to take a leak.

"You still don't accept," I persisted, that the Phantom is responsible
for the infections."

He shook his head.

"No, I don't accept that notion at all." He took a deep breath and
said, "Look, Earl, there's no point in our battling over this. We're
on the same side. Won't you please accept my apology for being so
angry with you about the archives and let it go at that?"

"I'd like nothing better. Cam, except you haven't explained a
thing."

He sighed, then moved around in front of the couch, and sat in the low
seat he'd initially given me.

"At least sit down. Earl. We have to talk about Janet If you can't
accept my apology, do you want me to withdraw from her case? I can
suggest a number of excellent members on my staff who could take care
of her, but I still would prefer she remain under my--" "Before we talk
about Janet, answer me this." I was determined not to let him shift
the topic away from the Phantom.

"Do you think those people whose charts I saw last night were attacked
or not?" I remained standing, looking down on him.

He grimaced once more, then answered, "Yes, I believe someone was doing
something to those individuals, but that has nothing todo--" "And do
you think those individuals were chosen because they'd been cruel to
patients?"

He swallowed." Really, there's no point in this--" "Answer me, damn
it!"

He looked up and seemed to study me.

"Yes," he said after a few seconds. Then he added, "All those
individuals had questionable reputations for their work with patients.
None of them ever had anything proven against them, but they shared a
tendency to generate a lot of complaints from people in their care,
just as Janet told you."

"So someone was punishing the punishers?"

"Yes," he admitted, after a second's hesitation.

The silence between us then was total. I felt a wave of exhilaration,
like I'd gained yet another step on that two-year-old trail, then
wondered if I'd bullied him into acknowledging the existence of the
Phantom back then, or had he his own reason for suddenly leveling with
me, at least about that? His expression was neutral, telling me
nothing.

I kept pressing.

"How can you admit there was a Phantom yet not see that Phyllis Sanders
and those two other nurses, so Janet tells me, were exactly the kind of
punishers he was singling out two years ago?"

His eyebrows arched at the mention of the other nurses. He sighed in
exasperation.

"I knew Janet would tell you all about Brown, just as she told me about
the trouble her patients had with Sanders and the OR nurse."

Brown? Janet hadn't told me anything more about Brown. Good God! I
thought Did he mean Brown was one of the Phantom's Legionella victims.
One had survived, I remembered, and if I recalled correctly, she'd been
from I.C.U.

"But it isn't relevant," continued Cam, "because I keep coming back to
the same starting point. There's simply no way these bugs can be
selectively made to infect individual people." He slammed his fist
into his palm as he made his point. He was sitting more erect,
becoming aggravated again.

As surprised as I was over his remark about Brown, I didn't have time
to dwell on it. As soon as I saw I was starting to shake him up, I
honed my attack and went after him even more forcefully.

"Because you say it can't be done doesn't mean somebody hasn't found a
way!"

"Christ, Garnet, I give up with you," he exclaimed, pushing himself up
off the couch and starting to pace in front of me.

"You're obsessed with this!"

"Then what did Michael find?"

He continued to stride back and forth, waving his arms.

"I don't know what he thought he found. Hell, he was sick, out of his
head.

Let me be blunt." He came to rest standing behind the couch again.

"I know bacterial organisms better than you do," he said pointing once
more at me.

"When I say it can't be done, I mean that everything science has
discovered about these organisms says it can't be done."

My anger surged.

"Maybe you'd be a little less scientifically pure if it were someone
from your family in I.C.U," I shot back at him.

This time his eyes ignited into blue fire.

"You have nothing to teach me about having someone in I.C.U!" he
snapped.

"I know a hell of a lot more about that kind of pain than I hope you
ever will." He leaned across the couch toward me again, but unlike
before, he kept his hands gripped onto the cushions, like talons. I
could see the tendons in his fingers straining into the material.

A loud knock on the door broke the silence as we glowered at each
other. Before Cam could answer. Miller stuck his head into the mom.

"Doctor Mackie, I'm sorry to interrupt, but could I see you for a
minute?" As he asked the question he was already in and closing the
door behind him. I wondered if he'd heard us arguing.

He walked over to where we were standing, his surgical mask hanging
loosely around his neck and his eyes showing the same tormented
expression I'd seen earlier. He nodded toward me.

"Excuse me. Dr. Garnet, I won't take a minute." To Cam he said, "The
bacteriology technicians tell me you're organizing a search of the
asylum for Legionella. I'd consider it a personal favor if you'd let
me be in charge of the team."

Cam frowned.

"But Harold, you should be on leave. I know you want to help, but in
this case, follow my advice and go " "Please, Dr. Mackie. I'm better
off at work than sitting at home thinking about her."

I turned away and took a few steps over to the wooden hutch, ostensibly
to find a place to toss my empty can of Coke, but I felt un comfortable
eavesdropping on his pain.

While he made his case for staying on the job, I tried to tune out me
conversation a bit more by studying a collection of photos on top of
the hutch. They were of a man and a boy doing various outdoor
activities siding, hiking, canoeing but over a period of years.

While the man was consistently an older version of Cam, the boy aged
through a series of shots from being a child to becoming Cam as a young
man. There were no recent pictures.

"You're sure, Harold?" I heard Cam ask from behind me, his voice
sounding full of doubt "Believe me, all I want is a chance to find out
how she got infected Miller answered forcefully.

"By the way, who thought of searching the asylum?"

Without hesitation Cam said, "Why, Dr. Garnet here had some thing to
do with that suggestion. I really missed the boat not thinking of it
myself. Maybe he also has some advice about what you should be looking
for in there?"

He hadn't sounded sarcastic. When I turned to face him he stared at me
rather impassively. There was no longer anger in his eyes. If
anything, he looked sad. He added, "In fact, maybe he'd like to do the
search with you."

I nearly stopped breathing.

"Pardon?" was all I could say, not believing what I'd heard. I
studied Cam's face again for some hint that he was toying with me, but
his steady gaze revealed nothing but that strange funereal stare.

Miller on the other hand, looked astounded.

"Dr. Mackie, with all due respect, it's dirty work in there, getting
water samples from rusty pipes and crawling around some of the spaces
we'll have to go through " "Of course, that's up to Dr. Garnet," said
Cam, not taking his eyes off me.

What was Cam doing, proving he had nothing to hide or daring me to come
and find it, sure that his cloak of secrecy could withstand even my
scrutiny? But if he was so secure with his ability to escape
detection, why had he been so upset about my going through the files?
He never would have aroused my suspicions if he hadn't made such a big
fuss in the first place. Once more I studied him.

"What about it. Earl?" he prodded, his expression still neutral and
indecipherable, except for his somber-looking eyes.

"Would that make you feel better about Janet pursuing what infected
her?"

I didn't know what to say.

"All right" was all I managed to answer My insides were in turmoil as
I still tried to figure out what he was up to.

"Okay, Harold," said Cam, turning to his protege and putting his hand
on the young man's shoulder.

"I know you'll do the most thorough job possible, though personally I
think you're pushing your self too hard right now." He paused, then
very softly added, "Maybe it's fitting that you and Dr. Garnet hunt
down the organism that took your mother."

Harold still appeared stunned at having me thrust on him. At first he
didn't say anything, looking from Cam over to me.

"Harold?" repeated Cam.

"Yes!" replied Harold with a start, seeming to snap out of what ever
he was thinking.

"You're right. Maybe it is fitting."

Cam asked, "When do you think you'll start?"

Miller was suddenly all business.

"We'll have to coordinate with someone from the engineering department.
We'll need plumbers, diagrams of the water system, extension cords and
lights I don't know what all. Also, our own day shift is strained to
the limit with screening everyone in the hospital. I thought we could
ask some of our people to work a double shift and go into the asylum
during evenings."

Cam nodded his approval, then asked him, "Can you be ready by this
evening?"

"I don't know. I've personally got another hour's worth of screening
scheduled, but I could start organizing a team right after that's
finished. I suppose it's possible we could get started tonight" Cam
turned to me.

"Will you be around. Earl?"

"Sure," I answered, unable to believe I was volunteering to spend
another night in that hideous place. Harold continued to look
unenthusiastic about the prospect of baby-sitting me, but he took my
phone numbers and told me he'd call at the end of the day when he knew
what time we'd start. He then thanked Cam and left.

Cam stared at the closed door for a few seconds.

"How do you think he's handling it?" he asked, turning toward me.

Before answering, I noticed he was frowning and seemed much more
troubled than he'd revealed while Miller was with us in the room.

"I don't know," I answered tentatively.

"Grief is such an individual thing. He seems driven to work during
what should be his period of mourning for her."

Cam grimaced.

"Driven--that's the word for it The poor boy's acting like he's
determined to track down the infection that killed his mother by
himself. I swear he's cultured more people here during the screenings
than any other technician on staff at UH. He even wanted to lead the
team we sent to check out his home where his mother lived with him, but
I insisted on doing that job myself." Cam shook his head.

"I just hope I'm doing the right thing in letting him take on so much."
The gentleness in his voice was almost fatherly.

Feeling especially sheepish after our right, I said, "Uh, Cam, I
appreciate your having spoken to him on my behalf. He met me on my way
in to see Janet. It seems he's not blaming me so much anymore, thanks
to you."

Cam seemed pleased.

"Good! It's important he get beyond that" "You also made quite a
gesture, including me in the search. I appreciate--" "I did that for
Janet's sake," he said with a dismissive flick of his hand.

"The one good thing that came out of your going to Williams was that he
saw what I'd missed. His suggestion about checking the water outlets
in the asylum was brilliant. After Death Rounds I went immediately to
our CEO and got him to authorize it. That's what I was doing before I
learned Janet was admitted and saw you in I.C.U.

Maybe now you'll be convinced I didn't oppose the search, only your
crazy stories."

This time it was my turn to stare openmouthed at him. I'd presumed
he'd announced the search because it was forced on him. Unless what
I'd just heard was an act, he actually seemed hugely enthusiastic about
it.

He sighed.

"It's my hope. Earl," he continued, surprising me by speaking very
slowly, very gently, "that if you believe I've nothing to hide, then
maybe you'll not prevent me from taking care of Janet.

She's going to need good care. Earl, and I think I can give it to
her.

But if you and she do decide to transfer to another hospital, please do
it quickly, before she's too ill to make the trip. Another measure I
strongly advise you to do is to put your baby on a prophylactic dose of
erythromycin. Infants are in the vulnerable group, and even though
person-to-person spread without an aerosol isn't suppose to happen, we
still protect those at risk. Obviously he's been in close proximity to
his mother. You and the nanny should be okay, but, well, with the
unexplained spread to Deloram, Popovitch, and now to Janet, maybe you
should protect yourselves too, until we make sure we're not up against
some new pattern of natural transmission."

I found it hard to process all the information he was giving me. He
sounded kind, caring, and empathetic, but his eyes were saying
something else. I felt transfixed in their blue glare, like a rabbit
in front of an oncoming truck.

"Cam, wait a minute " He waved away my attempt to speak.

"There's just one thing you must agree to do. Abandon your talk about
the Phantom and give up your hunt for whatever you think Michael found.
I can't have you stumbling around and possibly setting off rumors. If
you give me your word on that, I won't report your unauthorized entry
last night.

After the drubbing you took at Death Rounds today, that's the last sort
of trouble you need. What do you say?"

I couldn't say anything.

He looked at his watch.

"You'll have to excuse me. I've got a lecture to give that started
fifteen minutes ago. Make yourself comfortable here and think over my
offer. Let me know what you decide about Janet as soon as possible."

With that, he was gone from the room.
Chapter 17

Well, well, well, I thought. That was about as subtle as being hit by
a truck.

Like me, he obviously wasn't averse to a bit of bribery and blackmail,
but I had to think I was better at it. The real question remained.

Was he a monster reeling me in, or was he an honorable man trying to do
what he thought was right for Janet, for his department, and for his
hospital? In the final analysis I had no idea.

My stomach rearranged itself a few more times, then clamped back down
on the cola I'd treated it to five minutes ago.

I'd found nothing that would persuade Janet that Cam shouldn't be
trusted. She'd be furious about his crude attempt to blackmail me and
would have no qualms telling him to his face that he was pigheadedly
wrong about the Phantom. But she'd buy his excuse that he was frantic
to keep rumors from panicking the hospital. Cam himself could claim,
"I explained everything to him, gave him carte blanche to explore the
asylum, and he still won't believe me." Janet was then likely to
invoke her often-used marital right to consider me a part-time dolt and
blast me for continuing to suspect the man.

What's more, she might be correct.

I had to wonder if my judgment wasn't skewed by lack of sleep and if I
wasn't stirring up nightmares about the man for nothing. Being
surrounded by Cam's gallery of personal photos and testimonials didn't
make me feel any easier. It somehow seemed doubly offensive to be
sitting in his own sanctuary and sullying it by thinking evil of him.
If he was innocent, he had a perfect right to be outraged by my
sneaking into his files. I knew that Janet would say I was off beam to
call his reaction over the top, especially after he'd tried to help me
with Miller.

My back and legs hurt even from sitting still, while my head started
throbbing and reminded me I'd better get to bed. If I wasn't careful,
I thought, I might end up snoring on Cam's couch. I forced myself to
stand up, groaning loudly as I did.

Maybe all my suspicions were wrong, I continued to muse, even the ones
about Rossit and Hurst But that vein of thought immediately led once
more to the hideous possibility that the killer was a complete
stranger.

Hoping to settle my stomach and find something for my headache, I
wandered over to Cam's millibar and checked if he kept some antacids or
acetaminophen stashed with the cans of pop. I had to settle for a club
soda. As the bubbles tried their best to be my breakfast, I ruminated
once more about the killer being a man or woman I didn't know. The
roots of his or her motive, however twisted, would be beyond anything I
was aware of or could ever hope to figure out, and his or her identity
perhaps impossible for me to ever uncover.

The thought made me shudder. I could never protect Janet against such
an anonymous menace, even if I was with her twenty-four hours a day.
Anyone--an orderly, a resident, a nurse--could slip her something
during the routine maintenance of her IVs. The possibilities gave me
me creeps--injected potassium to stop her heart, short-acting
paralytics to stop her breaming, a syringe full of air through her
intravenous line to block the flow of blood to her lungs--but this
killer would probably use his trademark: completely resistant
staphylococcus. I didn't know how he had infected Phyllis Sanders
without her knowing it, but I knew how I could do it to a woman full of
IV lines as she lay sleeping. I'd inject the organism directly into
her bloodstream. Once more an image of that shadowy figure from the
subbasement spiraled into my mind, except this time he was creeping up
to Janet's bedside. My stomach lurched toward my throat I marched over
to Cam's desk, my resolve on fire. I'd join in the search of the
asylum tonight if I could, but getting the files that Michael had found
remained my top priority. If going through the asylum did manage to
flush out whoever I'd seen down there, without those records and the
supposed proof they contained that a murderer was at work, I wouldn't
be able to turn him over to the ponce;

officially there were no murders to charge him with. For the moment,
everything depended on Fosse and Tippet not being able to refuse my
offer and Cam's being kept ignorant of it until it was a fait
accompli.

Nor could I let Cam report me for unlawful entry. One whiff of that
kind of trouble and Fosse wouldn't have anything to do with me. I had
to let Cam think he'd cowed me into backing off.

I scrolled a piece of printer paper out of Cam's desktop computer setup
and wrote:

Dear Cam, Sorry for the misunderstanding, and thank you for your
helpful suggestions about prophylactic erythromycinfor Brendan. As for
Janet, she has absolute faith in you, and I know of no better physician
to get her through this ordeal.

Earl

If only it were so simple, I thought. I knew Cam would decode my
carefully chosen words and know I was still suspicious as hell.

Maybe that wasn't such a bad thing. The balance between his thinking
I'd acquiesced, yet knowing I was onto him might be enough to keep him
in check for a while if my worst fears about him turned out to be
true.

Then, in case my powers of subterfuge and intimidation weren't all I
hoped they were, I dug out a yellow pages from one of his desk drawers,
looked up a private security company, and arranged for a uniformed
guard to be at the door of Janet's room twenty-four hours a day.

Out in the hallway I passed by the classroom where Miller was still
busily screening staff members seated at a row of desks. As he moved
from person to person--hunching over each of them, culturing and
plating, rhythmically getting the job done--he seemed to keep everyone
relaxed, and none of his subjects ended up wincing with tears running
out of their eyes as had many of the people I'd cultured.

I found myself wondering if he should be trying to work off his grief.
Doubtful, I decided, thinking like a clinician. Frenetic activity
wasn't always the best solution to mourning. It could delay his coming
to grips with his mother's death and actually prolong his sense of
loss. Perhaps I'd have a chance to talk to him tonight about it,
during the search.

I was about to walk away when I thought. Better make sure we don't
give the Phantom advance warning we're coming.

"Mr.

Miller," I called into the room, "could I have a word?"

He looked up from where he was about to take another culture.

"Sure," he said, walking over to the doorway carrying the partially
open packet of swabs.

"I wonder if you could avoid broadcasting the search of the asylum and
ask the other workers you recruit not to mention it as well."
"Oh?" he asked, cocking his head.

I quickly invoked a little more authority.

"To avoid panic," I whispered.

"Dr. Mackie says we must avoid panic at all costs."

He quickly nodded in agreement.

"Of course. Good idea. I'll call you when we're ready."

He turned back to his work, and I scooted upstairs to I.C.U. I had
questions for Janet regarding Brown... and Cam.

"You aren't starting to pin motives on Cam now, are you. Earl?"

Janet demanded crossly.

She was coughing more than before and beginning to wheeze loud enough
that I could hear the high-pitched mewing sound without a stethoscope.
But she wasn't too sick to immediately sense what I was up to when I
started asking her about Cam's special cause.

"No, not at all," I lied.

"Now how about answering the question.

Or perhaps you'd like to explain what Cam meant when he said, "I knew
Janet would tell you all about Brown."" She started at the mention of
Brown.

"Earl, I swear, if you've embarrassed me by insulting Cam with one of
those conspiracy theories of yours--" "Do you want me to ask him
myself?" I interrupted.

"You wouldn't dare!"

I made a move toward the door.

"Watch me!" As much as I'd expected her not to take my suspicions
seriously, I felt too dred and frayed to be very patient. I was also
bluffing; I didn't intend to stir him up about anything right now.

"My God!" she declared, her eyes widening.

"You seriously doubt him?"

She could only see the upper half of my face over the top of my mask,
but it must have shown her enough to make it clear I was deadly
earnest.

She immediately stopped sounding angry and implored, "Earl, whatever
you're thinking about him, I know it's out of fear for my safety, but
he's not capable of hurting anyone--" "Janet, just tell me how Brown
figures in this and explain why kindness to patients is such a special
cause for Cam. I'll make up my own mind about what it means." Not
meaning to be as curt as I sounded, I tried to soften my tone.

"We can't afford anything less than the same critical thinking you'd
apply to a medical problem."

She gave me a puzzled look.

"You know what I mean," I added.

"You're refusing to do a complete differential on all the possibilities
of who this killer is."

She started at the reprimand. The allusion to a physician failing to
consider all the diagnostic possibilities when attacking a clinical
problem was a low blow. But after another coughing spell, she
reluctantly agreed to tell me what I wanted to know.

"She's the I.C.U nurse who survived the Phantom's attack of
Legionella."

So I was right, I thought, yet the revelation remained startling.

Janet continued.

"Today's little effort, I'm sure, began as payback for my trying to
nail her in the past about her little games and ordering her away from
my patients. Except this time, she was stupid enough to make those
residents mess with an airway and got herself in way over her head."

I couldn't believe what I was hearing. I remembered Cam had said she
should know the sputum would be scant.

"You mean what happened was deliberate?"

"I doubt she meant to put me into laryngospasm. She certainly never
nearly killed anyone before. She's always been just a petty tormentor,
and, as I told you, she probably didn't realize that the residents
would bungle things so. Wanting me to choke and retch my guts out
during an uneventful tracheal aspiration would be more her speed. It's
ironic. I couldn't put her out of business for what she did with my
patients, but what she pulled with me got so out of hand it will
probably finish her, certainly in I.C.U as Cam said, if not altogether
as a nurse at UH."

I was speechless.

"She could have killed you! If any part of this was deliberate, she
should be charged with medical assault!"

Janet started coughing, then only partially recovered her voice.

"Think about it. Earl," she rasped.

"This was a classic example of how Brown and the others like her got
away with their nasty crap, though never with anything so lethal. But
even here she did nothing more than show a note about scanty sputum
written by someone in ER to the residents and then inform them of the
ID directive about proper culture samples. We may know what she was
really doing, but who can prove it, let alone have her indicted for it?
Even in the morbidity review. Cam will probably only get her charged
with a major error in judgment. But at least it will be enough to
label her officially as trouble and keep her out of critical-care
areas. Even if she isn't fired now, she'll finally be on such a short
leash her days here will be numbered."

Her days may be numbered, period, I thought. Messing with someone when
they were helpless was indeed liable to make people very angry if my
own anger was any gauge.

"Why didn't you stop the residents?" I asked Janet as gently as I
could. I still found it hard to believe how any of this could have
happened.

"You're not known for being overruled easily."

I saw her bristle.

"Because," she answered icily, "I didn't catch on at first that it was
Brown who'd put the residents up to it" After a few seconds of cool
silence she added, "Besides, I was determined to be a good patient and
do what I was told, not act like a doctor and get special treatment.
When I did start to protest, the resident who wanted to suction me kept
insisting that he'd done it this way before and that he'd be in and out
before I knew it. It sounded wrong, but I'm a gynecologist, not a
respiratory specialist. It was only after that catheter was down my
throat that I realized they didn't know what they were doing."

I knew what she meant. Doctors invariably have a hard time finding the
right distance to take either from their own care as a patient or from
the care of a family member. Being too close and interfering could be
as much a disaster as standing too far off and ignoring well-honed
instincts that something's wrong. The dynamic was hard on the treating
doctor as well. The physician's physician had to be a very special
breed.

"And what about Cam's cause?" I asked as unobtrusively as I could.
That I suspected her friend was, I knew, painful to her. It would be
even harder on her to tell me anything that she knew would add to those
suspicions.

I watched her expel a long breath and lean back on her pillow.

"His father was a hemophiliac," she began matter-of-factly, but in a
hoarse whisper that was painful to listen to.

"The man actually worked in this hospital as a lab technician. You can
imagine how Cam grew up, witnessing the man suffer with crippling
bleeds into his joints that sometimes only morphine could ease. Once
Cam was in medical school, he learned the true extent of his father's
pain when he saw firsthand the incessant needles and invasive
procedures all hemophiliacs are forced to endure. Besides, remember
the attitude about giving narcotics to these people back then. It was
pretty judgmental, and most hemophiliacs had to put up with a lot of
insinuations that they were faking pain to get a fix."

I knew exactly what she meant. I'd witnessed that kind of ignorance
even in my ownER What kind of impact could it have had on a son,
knowing that his father was subjected to the indignity of having to
prove again and again he was in pain?

"I think Cam became a director of laboratory services precisely because
of his father," Janet continued.

"I suppose he sees it as a chance to make sure that, at least in his
domain, no one suffers the sort of unnecessary pain that was inflicted
on his dad."

"Is his father still alive?" I asked, remembering the lack of recent
photos back in Cam's office.

"No," Janet answered solemnly.

"Like so many hemophiliacs in the early eighties, he became infected
with HIV from improperly tested blood products. He died about ten
years ago."

It all made terrible sense.

"Janet, do you realize what you're saying?"

I asked, my throat so dry I could barely speak.

She pulled back from my chest and looked at me with a hard blue stare
that outdid anything Cam had fired my way in the last few hours.

"What I'm saying. Earl," she said, her cutting tone sounding through
the hoarseness, "is that the experience turned him into a fine and
caring doctor I trust with my life. He is not some twisted fiend
hell-bent on revenge, and if you had any sense of intuition of your
own, you'd know I'm right."

The only sense I had was that it was pointless to argue with her.

Minutes later I was advising everyone in the nurses' station that I'd
arranged for a security guard to be at the entrance of Janet's room and
that he'd be logging anyone who went near her. I didn't give them any
reasons and got more than a few raised eyebrows, but nobody protested
out loud. I also gave strict orders that no one, not even Janet, was
to send the guard away. After our talk about Cam, I didn't have the
nerve to tell her what I'd done to protect her.

Half an hour later I was in I.C.U at St. Paul's looking at Michael
through the window of his isolation room. As alarming as it was again
to see him so helpless, I was also appalled to see that Gary Rossit had
taken over his care. He was in the cubicle inserting a long thick
needle under Michael's right clavicle to serve as a conduit to his
central venous system.
The nurses assured me the little man was hovering over Michael like a mother hen, then gave me a brief synopsis of the
treatment he'd ordered. It seemed complete and included rifampin, the
second-line antibiotic used in patients desperately ill with
Legionella--the same one that he'd lambasted me for suggesting in
Sanders's case.

Michael's most recent chest X rays--taken about an hour ago-were up on
a nearby viewing box beside the ones done last night when he was
admitted. The whited-out areas were clearly larger, indicating the
infection was spreading. I blocked out images of lungs in Tupperware
that tried to crowd in on my thoughts.

The nurses found it reassuring that as of yet his sputum hadn't turned
copiously purulent "It may be too early for staph," I told them, while
thinking it may already be too late for my friend.

I turned back to the cubicle as Rossit threaded a plastic catheter into
Michael's sub clavicular vein. Two residents watched with rapt
attention a set of fluorescent green numbers and curving lines
appearing on a small overhead monitor. These were the pressure
readings that confirmed the tip of the catheter was gliding through the
right-sided chambers of Michael's heart and into the large pulmonary
artery leading from the heart to the lung. Rossit could now determine
Michael's huge fluid requirements in the presence of septic shock and
hydrate him properly without overloading his circulatory system.

As far as I could tell, Rossit was making Michael one of his master
efforts. The most aggravating thing about enduring the little man's
bullshit over the years was getting a glimpse of what a good doctor he
could be when he pulled out all the stops, then seeing him revert to
his nasty one-upmanship once he'd pulled off yet another of his miracle
saves.

But today there was another possible explanation for Rossit's
attentiveness.

If he were involved with the killings, he might be hovering over
Michael to assure his death at the first opportunity.

Rossit caught my eye through the window and quickly turned away.
Whether the reaction of a man guilty of murder or simply that of a
creep who had loaded the dice against me at Death Rounds this
morning--either way he didn't seem happy to see me. Fresh from my
showdown with Cam, I was primed to take on little Gary.

I put on a protective outfit and stepped into the room.

"Dr. Rossit, I'd like a word in private, please." Turning to the
residents, I asked, "Would you two gentlemen excuse us?" My tone of
voice made it an order, not a request.

They quickly left, taking only seconds to discard their gear at the
door.

Rossit eyed me over the top of his mask.

"Look, Earl, about this morning--" "Shut up, Rossit! I just got back
from admitting my wife to I.C.U in University Hospital. She's also
been diagnosed with Legionella, and I'm in no mood for your crap!"

"Your wife!" he exclaimed. From the part of his face I could see, his
shock seemed genuine enough.

"Surprised, are you, Gary?" I shot back.

"I wonder. Because I think someone deliberately infected her, just
like someone probably deliberately infected Michael and Stewart
Deloram. Now I'm not sure why Stewart was a target, but I think
Michael and Janet were attacked because they were trying to expose
whoever had also infected the nurses from UH. Am I going too fast for
you, Gary, or do you know this already? Stop me if you do."

I was standing over him, making him look up at me, and I felt a glint
of satisfaction at seeing his pupils widen ever so slightly. I was
scaring him.

"Earl, for God's sake, what are you saying--" "I'm saying I'm going to
expose this killer. In the meantime, nothing further had better happen
to Janet or Michael, is that clear?"

I refrained from my urge to tap him on the top of his head with my
fingernail.

"You can't be serious," he protested.

"What I'm serious about, Rossit, is that you better be at your healing
best with Michael here. I'm going to be double-checking every molecule
of stuff you put into him, and there damn well better not be any
suspicious incidents. Got me?"

This time I did poke my index finger into his chest, then spun around
and strode out of the room. I didn't look back as I discarded my gear
into the bin at the door.

"You're crazy. Garnet," I heard him shout from behind me, "certifiably
bonkers, crazy!"

I called the same security company and made identical arrangements for
Michael's room as I had for Janet's. The nurses were just as puzzled
as their colleagues had been at UH, but once again I gave orders, not
answers. I signed out for the rest of the day and headed home to
sleep. It was 2:00 p.m." but I was fighting to keep my eyes open and
knew I wasn't safe to see patients in ER. On my way out I

stopped at the hospital pharmacy to get Brendan, our nanny, and myself
some erythromycin.

As I stood at the counter and waited for the pharmacist to prepare the
medication, I wondered about my own chances of being attacked by the
Phantom. Michael and Janet had done little more than discreetly look
through old records, yet that was enough to provoke this killer. I'd
just confronted the two people I suspected most and practically accused
them of murder. Even if I was wrong about Cam or Rossit, it was a
pretty good bet that if this maniac was close enough at hand to have
known what Michael and Janet were up to, he'd know what I was doing as
well. I tried to convince myself that, unlike Michael and Janet, I was
sure to be ready for any move he made against me. But I also decided
it was time to finally tell Williams about my list of suspects, short
as it was, just in case things didn't work out the way I hoped. After
all, he was the only other person left standing who was suspicious
enough about the infections to take over the hunt. I'd phone him
tonight, when he was back in his hotel.

In case things didn't work out the way I hoped--I cringed as I thought
of the phrase. It was one I sometimes used to prepare a patient for
the possibility of death.

Brendan was asleep when I got to the house, and I resisted picking him
up and rocking with him. The Phantom could add making me afraid to
touch my own son to his list of victories.

After I showed Amy, our nanny, how to give him his medicine-the
banana-flavored liquid looked a lot easier to down than the big
red-and-black capsules Amy and I had to cope with--I spent time
explaining to her that Janet was stable and the medication for us was
simply a precaution. She looked worried and asked a lot of questions
about Legionella, but most of those questions were about what early
signs she should watch for in Brendan.

My long overdue shower came next. I turned the nozzle on full and
stepped into the heat, steam, and noise. For something like a second,
enveloped in the force and feel of the water pounding down on me, my
mind washed itself free and gave no thought to the gaAering dangers
outside.

Finally, sitting on the side of my bed, barely able to stay awake, I
phoned I.C.U at University Hospital and learned from one of the nurses
that Janet was sleeping, her condition no worse.
"By the way, the first of your guards is here," the woman added.

"He's big, I'll grant you that."

"Good," I replied sleepily.

"And your wife's hopping mad at you about it."

Muffy jumped up beside me as I put down the receiver and lay back,
ready to surrender my mind to sleep for a while. Tonight, I thought,
if Miller kept his team quiet, we might grab the shadowy figure
prowling around in the asylum and put an end to the need for guards.

Lingering on, the image of that dark shape trespassed into my dreams. I
was chasing it through dark passages lined with stone walls and floored
with earth. However fast I ran, the form ahead disappeared around
corners and turns in the endless maze. Some of the passages must have
come back out behind me, because soon, whoever I was hunting was behind
me, and I was running for my life.

The ringing wouldn't stop. It went on and on, louder and louder,
piercing the blackness and hurting my ears. I knew it would go away if
I waited long enough, yet every time it sounded, I got pushed closer to
opening my eyes. One more ring and I'll take a look, I promised, but I
let three more go by. Finally my eyes did open, and all I saw was
black. It was night, and the luminous dial on the alarm clock read
9:10.1 nailed around with my hand, found the phone, and managed to get
the receiver end to my ear. Cam's voice startled me awake.

"Earl, get over here as fast as you can!"

I was instantly on my feet.

"What happened to Janet?" I believe I yelled the question.

"It's not Janet," he said quickly, his voice tremulous.

"I think I found what Michael Popovitch discovered. You were right all
along, but I have to show you, and I want Williams here as well. Do
you know how I can reach him?"

I switched on the bedside lamp, found my jacket where I'd dropped it,
and fished out the paper with Williams's number.

Once I'd given it to him, he ordered, "Meet me in my lab!" then hung
up without waiting for my reply.

Twenty minutes later, at 9:32,1 sped onto the grounds of University
Hospital. Despite my recent practice at driving fast through
waterlogged streets, it took me five minutes longer than what Janet
boasted was her usual time to make it in for a delivery. I'd spent the
difference at stop lights, fighting the impulse to run the red. While
waiting at one intersection, I'd called my answering service. Among
the messages that had piled up over the afternoon was a request I call
Mr. Reginald Fosse as soon as possible.

Through the tall trees and thinning fall leaves overhead I could see
the lights of the massive building and its various wings spread wide
and high into the darkness. The floodlights placed around the bases of
the great stone walls made each of the sections appear separate and
suspended in the mist, almost floating, like a huge cube ensnared in
the surrounding branches. It was a wonder Fosse's fundraising efforts
hadn't capitalized on the eeriness of the place to turn it into a theme
park by night that reverted to a major teaching hospital by day.

I found a parking space beneath the gargoyles. Though it wasn't
raining, the mist was thick enough to leave particles of water on my
windshield, and the air was so cold that I could see my breath.

Huddled in my overcoat, I hurried from the car toward the entrance.

I kept trying to fathom what could have caused such an about-face by
Cam. And what had suddenly made him enough of a believer that he'd
gone off in search of what Michael had found in the first place?

Whatever had happened, I still didn't trust Cam and was glad that he'd
called Williams to join us.

It was after visiting hours, so security once more made me sign in at
their desk. Since it was the evening shift, the guards weren't the
same as on the previous night, but like the others, these two were also
decked out in surgical masks. The one checking out my ID said, "Oh,
Dr. Garnet, you'll need us to let you into whichever records
department you'll be requiring."

"Pardon?" I said, not understanding.

"Your special audit for Dr. Tippet," he explained, sounding a little
puzzled, probably at my own show of surprise.

"I presumed that's why you're here. We received the memo from Mr.
Fosse late this afternoon saying we were to give you whatever access
you needed."

"Oh, right," I acknowledged. Wouldn't it be ironic, I thought, if the
hard-won access was no longer necessary?

"Actually, I was called in to see Dr. Mackie tonight," I explained.

"I'm to meet him in his lab."

His eyebrows shot up.

"So that's where he rushed off to. Christ, he was on his way out of
the hospital around six when he came over to our desk, asked to see our
sign-in book. After glancing through it, he ran for the elevators." He
leaned forward and whispered, "Is there a problem? I hope there's not
more people from the hospital with that deadly infection. I heard one
of the doctors from here came down with it this morning." I could hear
the fear in his voice.

"Could someone carrying that bug have signed in here and exposed us?"

"No, not at all," I lied.

"I'm sure that business is under control by now." But I was thinking,
what would Cam have wanted with the sign-in book? I finished writing
Bacteriology Lab as my destination and rifled back through a few pages
but couldn't see anything in today's entries that I could imagine being
of interest to him. Shoving the ledger back toward the guard, I
figured I'd probably find out what it was in a few minutes from Cam
himself. One thing I noted before closing the page was that Williams
hadn't arrived yet.

It wasn't until I got off the elevator in the first level basement and
started down the deserted corridor toward the labs that I realized what
I should have thought of earlier.

Perhaps Cam hadn't gone off searching for what Michael had found after
all. What if he had absolutely nothing to show me and had lied about
it to bring me here? I slowed my steps and involuntarily looked over
my shoulder.

Lighting in the wide hallway in this part of the hospital was bright,
and the shiny floor gleamed for as far as I could see. No one was in
sight. Apart from the receding noise of the elevator as it returned
upstairs, there also wasn't a sound, and the quiet of the place made me
feel uneasy. I stopped walking when I reached Cam's elaborate sign.
Standing beside the words biological investigative studies, I stared
ahead into the complex of laboratories where he was waiting for me.

We wouldn't be entirely alone, I told myself. There would be at least
one lab technician on duty for emergencies, perhaps more than one if
the caseload upstairs in ER was heavy. Plus Miller should be about
somewhere, preparing to go into the asylum; only that minute did I
remember he was supposed to have called me.

But staring down the long passageway that led into the labyrinthian
series of rooms, I didn't see a single figure come out of any of the
doors or hear anyone talking. Perhaps the technicians were upstairs in
ER, I thought, taking bloods. As for Miller, perhaps he was also
somewhere else in the hospital, lining up the electricians and plumbers
he needed. Or maybe he'd gone ahead to start the search without me. He
certainly hadn't seemed too keen to have me along. In any event, it
was possible I'd end up alone with Cam down there after all.

Do I go back upstairs and wait for Williams? What if Cam hadn't even
called him? Telling me he was going to phone him could have been
another lie, said to reassure me just enough that I'd agree to come and
not be too wary when I went into his lab.

I instinctively moved to press my back against the wall and kept an eye
in both directions. The stillness of the place was increasingly
oppressive, and I began to feel stirrings of the same panic I'd nearly
succumbed to one floor below in the far more claustrophobic confines of
the subbasement. I was thinking perhaps I should get the security
guard to accompany me when the silence was abruptly broken by the sound
of a phone ringing far off in the labs.

Someone calling for a technician, I thought. One of them might be
somewhere down here despite the place appearing deserted. I swallowed
and began walking toward the persistent trilling.

I passed by the doors to hematology. The lights were on, but no one
replied when I poked my head in and called, "Hello!" I only heard the
gentle murmur of machines, t got the same result at bacteriology. The
sound of the phone continued to come from a room farther down the row
of departmental signs. I reminded myself that during evening hours
back at St. Paul's I'd often had to let it ring for ever before
getting an answer, but nevertheless I felt more than wary as I
continued along the corridor. Up ahead was the bacteriology lab.

When I got near, unlike in the other rooms where the lights were on, I
could see only blackness on the other side of the glass door.

This wasn't unusual. Unless a life-threatening infection was in
process upstairs, no one would be doing cultures or plating Gram stains
at this hour. But the ringing phone was clearly behind this door. I
turned the knob. It was unlocked.

I pushed it open and looked inside.

"Hello?" I said to the darkness, feeling like an idiot a very scared
idiot.

The only sound besides that incessant ringing much louder now was the
soft hum of the ventilating hoods. I could see the illuminated digital
settings for temperature and humidity control above a row of incubators
on the counter nearest to me. At the far end of the room was the blue
glow of a computer terminal someone had left on.

The noise of the phone was coming from near there. The back of the
room was black as pitch and nothing at all was visible in those
recesses I felt around the inside wall near the door but couldn't
locate a light switch.

The ringing kept on. Was it Cam, calling to tell me to meet him
somewhere else? Or had he been suddenly summoned upstairs for some
emergency? My alarm rocketed as I immediately thought of Janet. Maybe
he was phoning me about her. I quickly made my way toward the sound of
the phone, using the blue light of the distant computer as a beacon.
Once I got near the screen, I found the receiver easily enough by the
glow. It was a single line and had no indicator lights.

I picked up.

"Hello, Dr. Garnet here!" My voice sounded overly loud as I broke the
quiet around me.

At the other end of the connection was only silence.

"Hello?" I said again.

Nothing. Then I heard a whisper, a breath more than a voice, but
coming through the silence of that open line, the soft words were as
distinct as the chill that went through me.

"Look around you!" I heard whoever it was command, followed by a click
and the annoying buzz of a dial tone.

I practically dropped the receiver as I turned and got ready to run.

I wanted out of there.

But something caught my eye that stopped me cold.

Two words were now blinking on what had been a completely blank
computer screen a few seconds ago.

I stared at them.

This time the chill up my back was like a shot of electricity.

They read, Janet's Dead.

I screamed.

I would have run to I.C.U, but my legs felt like water.

The phone. I grabbed the receiver, my hands shaking, and punched in
the number I already knew by heart.

"I.C.U," answered a nurse coolly.

I felt so nauseous that when I opened my mouth to speak I gagged.

"It's D-Dr. Garnet!" I managed to stammer.

"Has something happened to my wife, Janet?" The effort nearly made me
vomit.

"One moment. Doctor," she said coolly, and put me on hold.

"Oh my God," I kept saying, feeling the burning liquid rise to the back
of my throat. They've gone to get a doctor to give me the news, was
all I could think.

I heard the phone receiver click. The shapes in the dark room swirled,
and I had to support myself with a hand on the counter.

"Hello, Dr. Garnet?" came the woman's voice I'd heard a few seconds
ago.

"Janet's the same, sleeping but coughing, and when she's awake, her
chest is uncomfortable. But she's certainly stable.

Did someone tell you otherwise?"

I couldn't talk.

"Dr. Garnet?" she asked again.

"Thank God" was all I could manage to say.

"Sorry," I added, and hung up, too rattled to explain. I looked back
toward the computer screen, feeling gutted by the impact of those
hateful words.

It was blank again.

I ran to a nearby sink and threw up.

Why was Cam doing this to me? was all I could think after I finished
heaving. He must be insane, bringing me here, then putting me through
that kind of terror. But he'd no longer be able to deny it was him.
Yet he had to know that, must have wanted to reveal himself as well as
traumatize me. Why?

I finished rinsing out my mouth and could think only of getting to
Janet, but I saw there were now more words on the screen.

This time I felt like heaving the monitor against the wall.

"Fuck your mind games!" I yelled at it, not even wanting to give him
the satisfaction of reading them.

But I did.

Look in the microscope, and see how she "II die!

"Son of a bitch!" I exploded, reaching for the phone to call security.
Maybe they could trace what terminal these messages were coming from
or at least be a witness to what I was seeing. I told the guard only
that I needed him urgently.

But when I looked back at the screen, it was blank again.

If Cam had appeared in front of me at that moment, I'd have ripped his
face off. I started to pace, feeling more enraged by the second yet
impotent to do anything. How dare he play with my deepest fears!

Striding back and forth I caught sight of a tiny light from one of the
back counters behind the incubators. It was screened from the door,
and I hadn't noticed it when I first arrived.

I immediately knew what it was and felt sick with fear again.

I was looking at the reflector light of a microscope left on, and I was
sure it was the next item of this loathsome show-and-tell game.

"Damn you!" I cursed aloud. Once more I wanted to walk away and not
submit to his terror by doing exactly what he intended me to do. But
once more I succumbed. I made my way through the dark to that tiny
light. My eyes were adjusted now, and I could make out the counters
enough to maneuver around them. I came up to the binocular eyepiece,
leaned over to look through it, and saw what I'd been dreading.

The field was filled with blue-colored cocci in clusters resembling
bunches of grapes.

When I looked up, I noticed a petri dish sitting off to one side of the
microscope. In the ambient light of the reflector lamp I could make
out that the growth medium was abundantly spotted with the gray rings
of bacterial colonies. Even though they were covered by a transparent
lid, and my mind told me they probably weren't airborne, I found myself
holding my breath and backing away. But not before I'd read the
sticker label applied to the lid that indicated these bugs were growing
vigorously in a soup of nutrient well laced with both methicillin and
vancomycin.

If that label wasn't a lie, the petri dish was loaded with the super
bug

All I could think of was Janet, and Len Gardner's macabre rhyme from
Death Rounds: Legionella prepares the way; staphylococcus ends the
day.

"Oh my God." I moaned. She could be infected with both after all. Her
sputum might not be purulent yet simply because it was too early.

"No, please no!" I continued to murmur. The un treatable organism
might already be spilling through breaks in the lining of her airways
and setting up to destroy her lungs, exactly as the autopsy slides had
demonstrated.

I could hardly breathe.

By the time I staggered back to the computer terminal, I found yet
another message waiting for me.

You have seen my work.

I'm forced into the open.

The punishers will be punished all at once now.

It's incubating in fifty who deserve it.

More will follow.

Evacuate the innocents before it's too late.
PARTTHRJEE

Sepsis
Chapter 18

I didn't move, couldn't even drag my eyes from the screen. My ears
seemed to amplify the sound of my own breathing, and I felt my tongue
catch against the dry insides of my mouth when I tried to swallow. I
don't know how long I had been standing there-seconds? a
minute?--staring and not wanting to believe what I was seeing, when I
sensed someone behind me. I started to spin around, my hands
reflexively drawn up in front of my face, and nearly screamed when I
saw a figure walking toward me in the dark. Then I heard a familiar
voice.

"Is that what Mackie found?" Williams asked.

"Son of bitch, you scared me!"

"Whoa!" he said, stopping while still a few feet away.

"Man, are you ever jumpy. Why are you in the dark anyway? Turn some
lights on and maybe you won't be so skittish. What the hell's this?"
He moved closer to the computer. The blue light bathed his head in a
dark glow that accentuated his broad cheeks, furrowed eyebrows, and
curved down mouth. The result turned his expression into a frowning
mask of polished dark wood.

"Oh my God!" he exclaimed as he read.

"Where's Mackie?"

"I don't know." My mouth was so dry I could barely speak.

"He actually called you?"

Williams quickly straightened from peering at the screen.

"He said he thought you were right all along, that the Legionella
infections were deliberately inflicted. But this?

"It's incubating in fifty'?

C'mon! Is the message for real, or is someone stringing us along?"

"You tell me. It appeared after I got here." I quickly related what
had happened when I arrived, trying to keep my voice steady. He hadn't
heard about Janet's being infected by Legionella and was visibly shaken
by the news. I didn't accuse Cam outright, but by the time I told
everything else, his absence was becoming more peculiar by the
second.

Williams glanced at the colonies of bacteria in the petri dish, then
looked in the microscope.

"So why isn't Mackie here?" he demanded.

"Guess!" I snapped.

The harshness of my response made him start. He looked up from the
binocular eyepiece, clearly puzzled. After a few seconds he said,
"You're not suggesting..." As his voice trailed off, his face seemed
to work in slow motion. His jaw sagged, his eyebrows rose, and his
forehead molded itself into a maze of wrinkles.

"Jesus Christ! You seriously think it's him?"

"Let's just say I've got a lot of unanswered questions about the man's
behavior since this morning." Williams's expression grew more
astonished as I explained my suspicions.

"Holy shit!" was all he said at first. He began to pace and
repeatedly rubbed his hands over his scalp. Finally he said, "I have
to tell you. Garnet, I've got a few problems with the idea of Mackie's
being the killer. For starters, why would he suddenly contact us,
terrorize you about Janet in particular, and in effect reveal his
murderous crusade, especially after being so successful at keeping both
it and his identity hidden?"

It was a troubling question.

"I don't have a clue why," I admitted.

"But if part of his reason was that he wanted to single me out for an
extra dose of panic by threatening Janet, I've got to tell you, it
worked."

"I'll grant you this. If Mackie doesn't walk in here pretty damn soon,
what you've just suggested will sound a lot less off the wall than it
does at the moment. But you haven't a shred of proof--" Williams broke
off and glanced at his watch.

"Damn!" he muttered, starting for the phone.

"It's less than fifty minutes until the shift change at eleven o'clock,
and that means we have to decide right now whether we let people go
home. No matter who's behind this, we've got to assume these bacteria
are what he claims they are until we can do confirmatory tests. If we
act promptly, we'll have at least half the hospital workers effectively
in quarantine. Keeping the workers who are here now and not scaring
off the night shift before we can grab them as well will be tricky if
not outright impossible."

While continuing to talk with the speed of a machine gun, he picked up
the receiver and punched in enough numbers for long distance.

"As far as patients, visitors, and families of workers--" "Wait a
minute," I interrupted.

"How can you even consider keeping people in the hospital with a killer
on the loose? He's al 3 ready threatening to infect more victims. In
fact, you may end up locking him in here with us."

Williams's hand froze over the phone.

"Jesus!" he said, aghast, staring hard at me.

"I hadn't thought of that. We'll have to protect them somehow. But
there's no question we need the quarantine--" He stopped and spoke into
the mouthpiece. From his side of the conversation I quickly learned
he'd reached Doris Levitz at her home in Atlanta.

I was left eyeing the colonies in the petri dish. We needed
confirmation fast whether they were for real. A simple Gram stain
would tell us immediately if they were staph. But a culture with
sensitivity studies would take two days, and without that kind of
proof, no one would believe that we were dealing with a fully resistant
strain of staph. What if we were to confirm which antibiotics were in
the culture medium? Identifying drug levels was a routine procedure
for a big city ER, and I knew that within the hour we could at least
verify whether these bacteria were growing in a soup of methicillin and
vancomycin. Nobody would ignore that finding.

But staring at the small gray patches on the dark brown agar made me
imagine similar colonies teeming with microbes all along the lining of
Janet's airways, ready to follow the Legionella into the tissue of her
lungs. Or what if he was yet to plant them in her and was on the way
to her room at this very moment?

"Shit!" I raced over to a wall phone with more than one line and
called I.C.U.

"Has Dr. Mackie been in to see Janet?" I blurted out as soon as a
nurse answered.

"Why, no. Dr. Garnet. Not since this morning." It was the same
woman I'd spoken with ten minutes earlier.

"Is something wro--" "Please let me speak to the guard I hired! Have
him take the call from her room." While waiting for them to get a
phone to her cubicle, I thought. They must think I'm nuts. When he
picked up I told him there'd been a new threat and ordered him not to
let anyone near Janet, Dr. Mackie included. Then I hung up.

Williams was still talking with Levitz.

"... we'll need the National Guard as well as the police," he said,
"and certainly every available city and state public health official.

You've got to get the CDC to give us a hot-zone treatment for this
place, Doris! That means the mayor's office and the city's entire
disaster response team will have to keep the community under
control."

My head swam listening to him, and I slumped against the counter,
staggered by the implications of locking up an entire hospital.
Everyone would have to be in isolation from everyone else.

University Hospital would be rendered a prison. Thousands of us
orderlies, clerks, technicians, nurses, doctors, and patients would be
gloved, masked, and gowned.

"Here's the kicker, Doris. His message says More will follow.

This creep's liable to be in our midst, moving about, selecting
victims, trying to punish the punishers and anyone else who gets in his
way, so don't tell me I'm overreacting..."

The questions multiplied. It seemed such an illogical move Cam's
declaring himself so openly if he intended to continue killing in
secret yet this madman, if anything, was logical in his tactics.

For Cam to be the killer, there had to be area son why he would set up
what we'd found here, call us in, and then choose to disappear.

What was I missing?

"Besides, Doris, we don't even know how long we have before the first
cases might hit!" Williams was yelling now.

"What do you propose we do for the people already incubating the damn
bug?

Hell, Garnet's wife may be one of them. By the time we got the results
of culturing everyone again the way you're insisting, we could have a
pile of corpses and be doing autopsies. I warn you, unless we
quarantine everyone now and wait until those who get it die, we haven't
got a chance to keep the organism within these walls " He broke off
when he glanced my way. He'd said nothing I couldn't figure out for
myself, but his blunt statement of it jacked up my fears for Janet
until the effects of panic and adrenaline were all I could feel.

From the way he was staring at me, my fright must have shown in my
face.

"Call me back when you've got confirmation for the quarantine!"

Williams barked and slammed down the receiver. His own face sagged,
and into his eyes seeped a terrible look of pain.
"I'm sorry, Earl, I didn't mean that to be as hard as it sounded. I
had to shock them. They were talking about waiting for a
forty-eight-hour confirmatory test."

"Help me find some way to protect her," I demanded, barely able to keep
my voice from shaking.

"The CDC has to know everyone in the world who's working on resistant
staph. E-mail them all anyone who's published anything about the super
bug over the last year. Maybe one of them's found new answers that
aren't published yet. The old answers salves and soaps can't be all
there is." I hated the pleading in my voice. I'd heard it so often
from patients and families who couldn't accept (here was nothing more
to be done.

He just stared at me, shook his head, and turned his palms to the
heavens.

"I'm sorry. Earl; I don't know what to tell you." He sounded unsure
and hesitant, the authoritative tone I'd grown used to as he'd taken
command over the last few days completely gone.

"That sort of update we do all the time. I'll make sure that Doris
rechecks for new replies, but as of last Friday, when we first got the
call from St. Paul's, there was nothing hopeful in the pipeline.
Certainly no new antibiotics will be ready for at least two years. A
group in Denver is trying to develop a vaccine; the idea is to produce
antibodies against the toxins by which staph does its damage to human
tissue--" "A vaccine! Listen, if it's life or death--" "Earl!" he
interrupted.

"They're barely starting to test it on mice.

Even if they had it ready for humans, remember, it's a vaccine! It
would take at least two weeks before it started being effective.
Anybody infected now..." his voice trailed off.

I felt my anguish for Janet grow so profound and dark that I couldn't
move.

Williams turned away quickly, but not before I glimpsed a glistening in
his eyes that I thought was tears. He obviously found it as difficult
as I always did to tell hard truths.

"Dr. Garnet?" called a familiar voice at the door.

I turned and saw Reginald Fosse coming toward us. His worried
expression gave his face a whole new set of creases. Behind him was
the security guard I'd summoned.
"Dr. Mackie isn't here?" Fosse asked.

"He phoned and said he'd found the evidence you were after. Scared the
hell out of me!"

It was hard not to notice the man was dressed in a cowboy outfit.

He saw us gawking at him.

"I was in the middle of a fundraiser," he quickly explained, pointing
to a card pinned to his left breast pocket which read Buffalo Line
Dancer Society--HOOPERS FOR

HEALTH DOLLARS.

"And you are?" he asked, stepping up to Williams with his hand
outstretched.

Williams introduced himself, showed Fosse the message on the computer
screen, and began to explain what he intended to do about it.

I took the guard aside. He didn't know how to trace E-mail, but he did
manage to give us light, finding the switch that had escaped Williams
and me. He reluctantly agreed to check all the offices in the other
labs to see if any computer stations were left on only after receiving
multiple reassurances that he wouldn't "catch something" simply by
looking around "down here." I assured him he'd be fine but didn't ask
him if he had a habit of being vicious to patients.

By then the way Fosse's color was draining from his face, leaving it a
shade whiter than lard, I knew he'd understood there'd be no more
hoofing for the moment.

"Quarantine? Police? The mayor!" he shrieked at Williams." What the
tuck are you talking about, 'quarantine'?"

Williams towered over the pudgy middle-sized man between us.

"What I mean, Mr. Posse, is that if those threats you just read are
carried out, your whole hospital may be ground zero for what could be
the worst institutional outbreak since before the advent of penicillin,
and, like in those times, we've got dick all to fight it with!"

At that moment Harold Miller walked into the room.

Fosse's back was to the door.

"Why, this could be a prank," he was saying, gesturing at the screen.

Williams exploded.

"Testing the specimen we found in the petri dish--" He stopped himself
on seeing the young technician standing in the room. He took Posse by
the elbow, whispered something to him while nodding toward Miller, and
led the administrator over to the microscope.

I quickly walked over to where the young technician was standing.

He was wearing a jogging outfit, much more modest than those worn by
Williams, and his close-cropped hair was wet, as if he'd just taken a
shower after a workout.

"Dr. Mackie left a message on my answering service about an hour ago,"
he said in a low voice.

"It said he'd found out something about the Legionella infections." He
eyed the two men arguing and whispered, "What's up with them?"

I shrank from telling him. Not only would he learn that his mother's
death was murder, but hearing that Cam might be involved would probably
be equally devastating to him. From what I'd witnessed this morning.
Cam had seemed to be a father figure as well as a mentor.

"We've got a problem on our hands. Someone's threatened to use
microbes against certain personnel in the hospital" was all I said,
promising myself that I'd take him aside shortly and level with him.

Even in ER I needed a moment before breaking bad news to find the right
words, and I was usually a lot less rattled there than I felt now.

That Cam's display of caring could have been a sham was bad enough.
That he might have comforted the son after murdering the mother was
heinous beyond telling.

"A threat? What kind of a threat?" he demanded, growing excited.

"Actually it's good you're here," I continued, ignoring his question

"Find a quiet phone somewhere and call in as many technicians as you
can reach. I'll explain later, but we're going to have to mobilize a
huge operation in the labs tonight and, among other things, start a
massive re screening program." I spoke as rapidly as possible so as
not to allow him room for questions.

"By the way, what happened about searching the asylum? I never got
your call."

Miller frowned at my evasions.

"The earliest I could get a team organized was for tomorrow morning,"
he replied, glancing over to where Fosse, now red-faced, was
gesticulating and speaking in terse whispers to Williams. When I still
didn't explain what they were fighting about. Miller's expression
became an outright scowl, but he left to do what I'd asked.

"just a petri dish and a microscope slide," Fosse persisted, no longer
keeping his voice down once Miller had gone out of the room.

"I repeat, how do we know it isn't some hoax rigged up to scare us?"

The CEO's ongoing denial infuriated me.

But Williams handled him.

"Pay attention, Reginald!" he snapped.

"I'm going to teach you what it means to have fifty men and women
wandering around your building with the super bug growing in them."

Fosse looked increasingly alarmed as Williams, already towering over
him, drew closer.

"Staph in particular gets around by touch," he continued.

"It likes to live on hands, under fingernails, in groins, and up
noses." As he talked, he ran his right thumbnail under the finger
nails of his left hand, crudely gestured with the thumb at his own
crotch, then wiped it across the opening of his nostrils.

Fosse's mouth dropped open at the unseemly routine.

But Williams wasn't finished with the lesson. He held up the ex tended
thumb until it was an inch from Fosse's face. Fosse cringed, snapped
his mouth closed, and pulled his head back.

Williams kept him cowering like that a few seconds, then softly asked,
"Now are you really willing to go home, kiss your family good night,
and tell them all's well?" He brushed his thumb across Fosse's lips.

Fosse shrieked, ducked under Williams's arm, and started to back
away.

"Nowju-just a minute!" he sputtered, spitting out and wiping his
saliva away with the back of his hand. Looking wildly from Williams to
me, he declared, "You two can't bully me like this! I insist we get
Dr. Mackie here."

"Earl," Williams said, "I've no more time to argue with non-doctors."
He made the last word sound like an epithet.
Fosse reacted as though he'd been slapped.

"How dare you speak--" "Whoa! Settle down, both of you," I ordered.

"Are you going to tell him what you suspect about Mackie?"

Williams asked, his voice coldly neutral.

Fosse released Williams from his glare and turned to me.

"What does he mean?" he demanded, his hostility unabated.

I hesitated a moment before replying. Not understanding why Cam had
abandoned his secrecy increasingly bothered me. Without that, I knew,
I didn't have a good grasp of what had happened tonight. Maybe the man
in front of me had the answer.

"Mr. Fosse, why was Cam Mackie so defensive about my looking into the
matter of the Phantom?"

He flushed an even deeper shade of red, then stammered, "I... I told
you, I've no idea--" "When I asked you in your office today, I think
you lied when you said you didn't know. I want you to level with me
now!"

"Oh, God! Cam couldn't do this--" "Why was he so goddamned uneasy?"

"Look, I don't want to discuss--" "Tell me!"

Fosse swallowed.

"Why is it important? After all, a great man's reputation is at
stake."

"Could he have been afraid I was about to stumble onto some proof he
couldn't deny, something that would make it so obvious he was
responsible for the infections that he knew he could no longer hide his
guilt?"

"No! It was nothing like that. They were simply old rumors, never
proved--" "What was he afraid I'd find?"

Fosse swallowed a few more times. Then he seemed to slump.

"All right," he said, taking a big breath and letting it slowly run out
of him.

"Two years ago, because of what happened to his father and because of
his well-known abhorrence of anyone being cruel to patients ..." Fosse
paused for yet another large intake of air, ".. . there were whispers
by some that he might be the one behind those events attributed to the
Phantom."

Whispers from two years ago. As startled as I was at the
revelation--it certainly could be the reason that Cam hadn't wanted me
dredging up stories about the Phantom--I doubted the old rumors would
have been enough to make Cam give up his cover if he were the killer.
But they were enough to make me walk back to the phone and pull an end
run around my own confusion. Fosse's protests, and all the
institutional denial a place the size of University Hospital could
muster. Let the professionals sort it out, I decided as I called the
police to report that a death threat had been made against my wife.

"What are you doing here. Dr. Garnet? Is Janet okay?" asked a group
of case room nurses who were on their way to work.

I was back in gloves, mask, and green gown again, waiting at the front
security desk for the homicide detective I'd spoken to. It was 10:40,
and already people on the night shift were arriving. Despite my
outfit--Williams had declared that as of now everyone in the hospital
must put on protective gear--some of the women who worked with Janet
had recognized me as they flashed their identity cards to the guards.

"She's the same," I told them, "and thanks for asking. I'll give her
your regards." I'd detoured through I.C.U on my way to the main
entrance.

Janet had been sleeping, but I'd hastily skimmed through her chart and
grilled her nurses until I'd satisfied myself that for the moment there
were no beginning signs of staph. Yet there was no lessening of my
panic, knowing full well it could be too early to tell. I also knew
that my only chance of stopping the organism was to figure out how he'd
put it into her if he had, and, if possible, how to get rid of it
before me infection started. If Phyllis Sanders's course was typical,
I had very little time to do so. It had at least been reassuring when
the private guard told me that so far no one had even tried to get
anywhere near Janet.

Her case room colleagues didn't hide their quizzical looks at my
costume as they hurried on their way, and I was glad they hadn't time
to ask questions about it, which I didn't want to answer. They'd find
out soon enough, once everybody from the night shift was safely
inside.

The detective who was on his way to take my report was the only cop I
knew personally in Buffalo. I'd managed to convince the police
dispatcher who'd screened my call, after a bit of an argument, to track
him down for me. Within minutes, much to that dispatcher's surprise.
Detective George Riley of homicide had agreed for me to be patched
through to him.

"Hi, Doc," he'd said sleepily.

"This can't be good news."

I'd helped him last year during the investigation of our former CEO's
murder. I had mixed feelings about the man. He was as much a
bureaucrat as a detective always protecting his ass against his
superiors but he'd listened to me when none of the other investigators
had, and I figured I needed that kind of help right now. After hearing
only the brief description that someone was trying to kill Janet and
perhaps others with a deadly bacteria, he'd sounded in credulous but
had agreed to come at once.

As I stood there waiting for him, the stream of workers, mainly nurses,
continued to file into the building. They remained relaxed as they
passed the security guards, obviously still unaware that they were
walking into a quarantine.

Even before I'd left the lab, Doris Levitz had phoned back confirming
the CDC agreed to throw its weight behind the measures that Williams
had demanded, and Fosse had succumbed to the inevitable.

On my way up the stairs there had been an announcement on the PA that
all staff currently on duty would remain at their posts during shift
change and that supervisory personnel were to assemble in the
auditorium at midnight for further instructions.

"The hospital has been ordered to remain on standby, pending further
information about a possible external disaster," declared the carefully
worded announcement Speculation was probably going on right now about
what to expect a plane crash, a bus accident, a bombing somewhere yet I
doubted anyone would guess immediately that they themselves were the
potential victims and that they were about to become prisoners.

The minute they were told to put on protective gear, however,
suspicions would skyrocket. But it was after the midnight meeting when
they'd finally be told about the Phantom that I expected all hell to
break loose.

The security guard who'd come back from checking the offices whispered
to me that he'd already been ordered to have his men position
themselves at the exits of the building and not let anyone leave.
Before hurrying off, he also advised me that he hadn't found any open
terminals but that Mackie's unit was still warm.

I moved closer to the front doors and relished the cool night air on my
forehead. Wearing the gown over my clothing felt hot, and the mask, as
usual, was stifling. But it was thinking of Cam and what lay ahead
that had my brain on fire. The one question why would he admit now
that he was the killer? continued to plague me as I readied myself to
report him to the police.

I inhaled deeply, trying to pull through my mask traces of the cool air
that were drifting in from outside. The extra puff of oxygen didn't
give me new answers. The only reason I still came up with was that he
must have figured I was about to stumble onto something current which
would reveal he was guilty of causing the infections.

A porter pushed a cart stacked with surgical gowns, boxes of gloves,
and masks up to the security desk.

Getting ready for the party, I thought grimly.

All the officials Williams had summoned and anyone else not slated for
quarantine would now have to enter and leave the hospital in exactly
the same way we entered and left me room of an infectious patient,
putting on protective gear before stepping into the place, and
discarding the outfit into bins on leaving. The process would be a
giveaway as to what was going on. At the moment, thankfully, I didn't
see anyone so much as glance at the supplies parked off to one side.

There was still no sign of Riley

"Come on," I muttered, growing increasingly impatient. I restlessly
leaned against one side of the door frame, then the other, and watched
the security guards checking BD. Anybody missing his identification
badge had to sign in, just the way I'd had to, as any visitor would,
before the guards let him pass.

The sight of those people writing in the book reminded me about Cam's
glancing through it earlier that evening and then running back into the
hospital. Watching a nurse hastily start adding her name to tonight's
page, I wondered about what had set him off. Icer tainly hadn't seen
anything very telling in the few pages I'd skimmed through. Yet three
hours later he'd called us all and started his show rolling.

Then I thought. Sign in, just as I'd had to, as any visitor would, and
felt a prickle of excitement run up and down my back. My God, could it
be that simple? I quickly stepped over to the desk, grabbed the book
from the startled nurse, and flipped back to the pages covering
Saturday and Sunday.

There in front of me was what Cam must have seen.

Michael had inadvertently left an itinerary of the rooms where the
guards had let him in to look at records this past weekend. Every
department, every room, every place was listed with his signature
beside it--Archives, Personnel Records, Administration, Vault for
Confidential Minutes, Staff Health Records, Laboratory Services,
Microfilm Repository. I could follow his route.

My excitement mounted even more as I wondered if that's what Cam had
done. Had he followed Michael's "trail" and discovered it led to
evidence that he knew would expose him? Michael might not have
discerned who the Phantom was from what he'd found, but Cam could have
felt threatened enough to think he'd been forced into the open.

Then my mind leaped to the most tantalizing possibility of all.

Anything that had so convincingly overcome Michael's skepticism about a
phantom infecting people must have laid to rest his biggest objection
to the idea: not knowing how it could be done. Had he found out the
killer's method? That could be key to saving Janet's life, to saving
many lives, perhaps even Michael's own if it wasn't already too late.

I started to tremble, trying to decide what would be the fastest way to
proceed. If Michael had signed for anything in each department he'd
checked, there might be an individual record on-site. Or, perhaps, the
clerks who'd come to work this morning would remember whatever
documents they'd found left out for refiling. I could barely contain
my eagerness to get started.

"Doc, Doc," a voice said repeatedly from behind.

"Doctor Garnet!"

It took Detective Riley several tries before he penetrated my racing
thoughts.

"Whoa, Doc, you're losing me. Begin at the beginning, and take your
time."

We were back in the lab, seated at the desk where the microscope was
located. I was in such a rush to go after my new leads that I was
having trouble relating the events of the last week in a way that Riley
could follow.

He was a large man, and looked uncomfortable stuffed into a gown, mask,
and gloves. Under the lights I could see perspiration forming on his
forehead below the line of his thick dark hair. I'd had to help him
pull everything on before we'd come down here, and knew his clothes
were damp to begin with from the fog outside. Sitting there, ready
with his pad and pen, he dwarfed the lab stool, its spindly legs much
shorter than his own.

I settled myself down and tried to explain my story in a more logical
fashion. I could hear Fosse on the phone across the room calling the
hospital leadership personally chiefs and board members insisting that
they come immediately, saying only that they'd be told about the crisis
when they arrived at the midnight meeting. I knew the board members
would be allowed to go home again, but the chiefs would be walking into
the quarantine where they'd be held with the rest of us.

I managed to lead Riley through everything, from Phyllis Sanders's
infection, through the history of the Phantom, the events in the
subbasement, the subsequent infections of Deloram, Michael, and Janet,
and the happenings tonight, including what I'd just discovered about
the sign-in book at the security desk.

"Those records could save lives," I stressed, "but we've got to
hurry."

He immediately called security and ordered them to seal the rooms that
Michael had visited.

I kept the rest of my account factual and, at Riley's request, omit ted
for the moment any mention of the various suspicions I'd had about
Mackie, Rossit, and Hurst. But by now Cam's failure to show up made it
almost impossible not to speculate out loud about his being involved.
When Riley himself finally raised the question. Fosse, between calls
to his board members, protested from his side of the room that he still
couldn't believe it.

Throughout the rest of my statement, Riley took occasional notes and
frowned repeatedly but interrupted only when he needed explanations
about the bacterial organisms involved. When I came at last to showing
him the message still on the computer, he whistled, then commented,
"Jesus, Doc, your story is one hell of a lot more than a threat against
your wife! I'm way over my head on this one."

"I know, but believe it or not, I was having trouble getting the CEO
here to move on it," I explained, nodding toward Fosse but keeping my
voice down.

"I called you because I could at least report the threat against Janet
myself. Things seem to be moving better now."

At that moment Williams appeared in the doorway and motioned to me to
join him. He, too, was masked, gowned, and gloved and had been with
Miller and his techs running tests on the contents of the petri dish.

"We did a Gram stain on the colonies and confirmed they're definitely
staph," he told me, "and we've detected the presence of both
methicillin and vancomycin in the growth medium of the petri dish. To
put it bluntly, the organism's practically marinating in the drugs, and
it's still flourishing like hell."

The grim news was nothing more than I expected. I took him completely
by surprise, however, when I told him about the sign-in book and what I
expected that lead to give us.

"Fantastic," he replied, his eyes lighting up.

"But we'll need more doctors," I told him.

"It took Popovitch two days to review all that material what about the
other ID specialists on staff here?"

"Already called in to help out with the quarantine but we can switch
them to going through records. They're familiar with the Legionella
cases, so they should be able to spot anything that Popovitch was able
to see. But I'll need your help at the meeting be fore you join
them."

"Hey! That search could save lives " "Listen! There's going to be one
hell of a squawk about what needs doing here, and there's a whole lot
more lives at stake if we can't make this quarantine work. I need
someone local with credibility who will back me up."

"But I don't work at UH."

He winked at me and shrugged.

"So? You're the only Buffalonian I know with credibility who'll back
me up. That means you still get the job." His eyes flicked over to
where Riley was now standing be side the stool.

"Who's he? The dick you called?"

"Yeah," I answered rather absently, not at all pleased to be pulled
from the search.

"He's from homicide. I imagine he'll want to talk to you."

I introduced Williams to the detective, and as I anticipated, Riley
asked Williams how seriously he took the threats against Janet and the
other personnel in the hospital. I watched Riley's eyes widen as
Williams outlined the full extent of a hot-zone operation.

While the two men talked, I overheard Fosse discussing the situation
with the mayor and the chief of police in what must have been a
conference call. He was requesting that every available officer be
used to surround the hospital. The police were to arrive without
lights and sirens and take up their positions in the dark with as
little noise as possible. He then had a similar conversation with the
governor, asking for the National Guard to be on standby.

By this point Williams and Riley had fallen silent and were listening
along with me to Fosse's end of the conversation.

"We've allowed the evening staff one phone call each to advise their
families they won't be home," he was explaining, "but haven't told them
why yet, only that we're preparing for an emergency. I expect the shit
will hit the fan in a few minutes when we start giving information and
announce the quarantine. We'll be in much worse trouble by morning
when the city wakes up. What we'll do with the day shift I've no idea
yet, and once the media gets hold of the story, I don't know how we'll
handle it all."

At that point all of us started to put in our two cents worth and, at
the end. Fosse reversed his request to the governor. I heard him
settle on a thousand troops, the first of them to arrive by dawn.

Never was there any mention of how much force either the police or the
soldiers should use if someone panicked and made a run to escape the
hospital. But Riley brought it up. He leaned over and whispered, "If
any poor bastard does take off, what the Christ are we supposed to
do--shoot him?"

"Sorry, Janet, but something's happened, something big. I'm here with
the police."

Her eyes shot open and she groggily pushed herself up off her pillow
into a half-sitting position, then shielded herself from the light with
one of her hands.

"What?"

She sat stock-still as she learned of the threats against her and the
hospital, her face a porcelain mask. She remained almost as
inscrutable on hearing of Cam's disappearance. When I told her Fosse's
revelation that Cam was once suspected of being the Phantom, she
declared, "Those rumors must have been pretty few and far between. I
never heard them." Her tone was like ice, but she was suddenly
blinking more, and I knew she was fighting back tears. Yet as I
described the other extraordinary events cascading into place around
the hospital, she seemed to bring even that subtle giveaway of emotion
under control.

When I finished, she stared at me in absolute silence, her gaze now
unblinking. Only her glistening eyes and her pupils widening with fear
or anger or both continued to betray the depth of her turmoil.

The quiet went on long enough to make Riley squirm. I could hear his
leather shoes squeak behind me on the linoleum floor. Finally all she
said was, "Cam couldn't do this."

"Why do you say that, ma'am?" the detective asked.

She looked at him as if he were an idiot for questioning her.

"Because, I know the man," she replied softly, as softly as the cutting
sound a scalpel blade makes in flesh.

"He isn't insane, he isn't a killer, and he would never even imagine
something so monstrous as what's happening here." She looked at me.

"Earl, I swear I don't understand why he's disappeared, but if you've
ever trusted my instincts, trust them now. It's not Cam! If the
police waste their time pursuing the wrong man, it's exactly the sort
of thing that the real Phantom would count on, especially if he intends
to continue killing!"

While Riley questioned Janet further, I went back downstairs and met
Williams scurrying off to his meeting.

"Coming?" he asked, though it sounded more like an order.

"No, I've got something to do down here first." He started to frown.

"But I'll be along in just a few minutes."

"Good," he snapped, his forehead unwrinkling.

"By the way, the police have formally taken over from hospital
security. They've already found out that between six and nine tonight
Mackie had several security guards let him into some of those same
rooms and departments that Popovitch visited. It also seems Mackie was
in such a hurry that every place he went he left anything he looked
through in a pile for refiling." Williams started to turn toward the
stairs.

"I've briefed the ID group as best I can about what they should keep an
eye out for," he said, speaking over his shoulder as he rushed away.

"Don't be late!"

"Best I can my ass," I muttered, resenting Williams as he disappeared
through the stairwell door.

"Best for Janet would be to put me in with the ID group right now."

I found Miller in a classroom where he was briefing his technicians on
what would be required of them tonight. Telling Janet about Cam had
been difficult enough, but I knew her mettle. Steeling herself for
whatever had to be faced was her nature. How Miller would take what I
had to tell him, I had no idea.

I interrupted his session, asked if I could have a private word with
him, then took him far enough down the hall that no one would
overhear.

"In better circumstances I'd wait until you had an hour to spare and
take you to an office where you could sit down, but there's no time.
What I'm going to reveal to you may start to become common gossip in
twenty minutes, as soon as Fosse and Williams begin their meeting, and
I don't want you to find it out by chance. Brace yourself, because I'm
afraid the news is bad." I took a breath, and told him everything in a
rush.

Despite my attempt to prepare a few phrases beforehand, the words I
said sounded hard and distant, as though they weren't my own. They
seemed instead like fragments from some temble story told by someone
else.

"Cam Mackie's disappeared ... he might be behind the threat to the
hospital... somehow caused all the Legionella infections... may have
infected your mother with the two organisms that killed her..."

As I spoke, I kept thinking I must be ripping him apart.

But Harold Miller reacted with silence, exactly as Janet had done.

His stillness was uncanny, as though he had brought every cell in his
body to a standstill and focused himself entirely on listening to how
his mother had been destroyed. He didn't get angry, he didn't cry, he
didn't even show astonishment. He seemed to absorb what I was telling
him the way a black hole absorbs light.

I placed a hand on his shoulder to comfort him, but his muscles felt
like bundles of high-tension wires vibrating under my fingers. I cast
about for something to say that might soften the impact of what I'd
just hit him with.

"Janet doesn't believe he's done any of it. She's convinced it's all
the work of someone else," I told him, not fully understanding why I
did. I suppose I felt if he knew someone else had believed in Cam,
still believed in Cam, he might feel less singled out for betrayal.

"Do you think he murdered my mother?" was all he asked, as though he
couldn't process anything I'd said after that single revelation.

"I honestly don't know what to mink," I admitted.

"Some of what happened tonight doesn't add up, even though I confess
I've had terrible suspicions about Cam myself. But Janet's adamant
he's innocent, and her instincts are disturbingly good."

He looked at me with that dreadful torment in his eyes which I'd grown
so used to seeing.

"Thank you for telling me this. Dr. Garnet.

You've no idea what your and Janet's efforts to get at the truth be
hind my mother's death mean to me. Not many people would do as much."
His voice trembled, the sound of it resonating with strain.

His vocal cords must have been stretched tight as a drum.

We talked a few more minutes. He kept the forced steadiness in his
voice from cracking, and his attempt to comfort me after I'd given him
such devastating news suggested a remarkable inner strength on his
part. But during our brief conversation, I recoiled from the darkness
and pain I felt simmering beneath the surface of his disciplined
manner.

He excused himself, explaining he had to get back to his staff. As I
watched his powerful shoulders recede down the hall, I could still
sense the extraordinary strength I'd felt in them. He was like a
volcano ready to erupt.

A ripple of alarm ran through me. I'd been so concerned about the
anguish he'd feel when he learned his mother had been murdered, I never
thought what he might do about it. I hoped to hell he didn't find Cam
before the rest of us did.
Chapter 19

One of my patients once gave me a brutal insight into the bond between
healers and the sick.

"Doc, it's a matter of risk. I have it.

You don't. You can empathize or sympathize as much as you're able, but
at the end of the day, it's me who does the suffering, maybe even the
dying, while you never have to agonize about getting out of here alive.
None of you can know how I feel."

I glanced at my watch as I hurried upstairs. It read 12:20. By now
everyone at Fosse's meeting knew exactly what it felt like to wonder
about getting out of here alive.

The hospital sounded like a hive that had been poked with a stick.

In the stairwell I could hear running footsteps echoing down at me from
the floors above. Doors slammed in the distance. On entering the
corridor I heard murmured conversations coming from inside a long row
of offices. Phones were ringing. When I crossed the main foyer and
headed toward the auditorium, I saw two uniformed police officers at
the entrance, struggling into protective gear. Some of Posse's
invitees were scurrying along with me. In our gloves, masks, and
surgical gowns, we looked like latecomers to some bizarre midnight
costume ball.

All of us could hear the yelling up ahead well before we got to the
auditorium. Two shifts of supervisors, all the chiefs, and a complete
turnout by the board members shouldn't add up to more than a hundred
and twenty people. But it sounded like Fosse had ten times that number
in there, and all of them angry.

Those with me seemed hesitant to go in. I stepped up, shoved open the
doors, and saw pure bedlam. Williams was up onstage with Posse, and
both men were desperately calling for quiet. Below them was a herd of
people, all of them in protective gear, milling about the front of the
stage, yelling.

"Noway!"

"I'm outta here!"

"This is the United States, asshole!"

Scattered throughout the auditorium were a few dozen people who weren't
joining the crowd. Up against the far wall I saw Riley, huddled with
three gray-haired men. They were all staring incredulously at the
scene in front of the stage. One of them turned and tapped Riley on
the shoulder, motioning him to lean his head closer so they could talk.
Through the gaps between the back ties of the man's gown I could see
flashes of his dark blue uniform.

People in the crowd, still bellowing, started to turn and head toward
the door where I was standing. A hundred and twenty people wasn't a
huge number, but as a substantial portion of them approached, they
looked like a mob to me. Over the tops of their heads I saw Williams's
and Fosse's eyes grow big as saucers.

"Wait!" yelled Fosse.

The wild bunch was no more than twenty feet from me now and seemed
pretty determined to walk out and defy the two men's authority.

Riley's comment flashed through my head. What are we going to
do--shoot them ?

I hoped no police were in position yet.

I grabbed a chair, stood on it, ripped off my mask, and thought of the
most outrageous thing I could say.

"Hold it! I'm contaminated," I screamed.

It was as if I'd cracked a whip over every head. The group froze, and
within seconds their angry shouts trailed off until there was complete
quiet in the room.

I seized the advantage.

"Some of you know me. I'm Dr. Earl Garnet, and my wife. Dr. Janet
Graceton, is admitted upstairs in I.C.U with a diagnosis of Legionella,
thanks to the creep you've just been told about."

The people closest to me pressed back against the rest of the crowd.

"Get by him!" someone in the back murmured.

"So what if he's infected? We're wearing protective gear!" yelled
someone else.

It would be seconds before they'd all start pushing their way through
the doors behind me.

"Think of the people you're going home to!" I shouted.

"They're not in any protective gear." They kept edging toward me.

"Some of you may already be carriers. Forty-eight hours, that's all it
would take to be sure you're safe--both for yourself and anybody you
touch. For God's sake, act rationally like the health professionals
you've always been."

"Why should we sit around and let some maniac infect us?" demanded a
man near the front.

"Right!"

"Exactly!"

"Let's go!"

They surged forward.

"I know which of you he's going to kill, even which of you he may
already have infected!" I yelled.

That stopped them.

"What!"

"You're kidding!"

"How can you know he's already infected some of us?"

They still sounded hostile as hell, but they remained where they
were.

"I also know how we can stop him," I added. Seeing the lot of them
ganged together in isolation dress had just given me an idea.

"If you'll all take your seats again," I suggested, replacing my mask
and stepping off the chair, "then I'll tell you exactly what I think we
can do."

Fosse looked at me with a skeptical stare when I climbed up on the
stage.

"This better be good!" Williams muttered through his mask.

I stepped up to the podium and began speaking without even waiting for
people to take their seats. I knew my hold on them was tenuous.

"For reasons I haven't time to go into now, we know this killer has a
very specific agenda. All his victims are what I would call punishers,
colleagues who enjoy being cruel to patients." I quickly outlined the
type of abuse involved.

"If we isolate them immediately, confine them all to a specific
high-security ward, then I think we'd not only have taken any current
carriers out of circulation, we'd also have a good chance of preventing
him from infecting any others for the moment. It's only an initial
measure, but it would at least keep us safe for tonight and give us
time to organize a better plan."

At first no one spoke.

Then came murmurs of disbelief.

"out of his mind..."

"... why would anyone kill over delayed pain meds..."

A woman glared up at me from the front row.

"Supposing what you say is true, and from what you've told us so far
that may be supposing a lot, do you know these 'punishers' by name?"
she demanded sarcastically.

"No, but they know who they are, and I'll lay you odds so does everyone
who works with one of them."

"Why would they step forward or agree to be locked up?" called out a
man in the back row.

"The best reason in the world--self-protection. Turning themselves
over to us would be their best bet to keep from being killed.

Of course, if any of them don't see it that way, I'm sure their
colleagues could be persuaded to hand them over. Who wants to be near
a potential target?"

"They could run," he persisted.

"They could already be infected," I shot back.

"Without our help to decolonize them, they're dead. The CDC also has
the means to pull in any experimental therapies that might exist
against this bug, in case decolonization doesn't work." I knew I was
resorting to bold-faced lying bluff, but if I didn't tempt the
punishers into coming forward by offering them false hopes, I doubted
they'd step up and identify themselves in exchange for salves and
soaps.

"Cooperating with us is their only chance of surviving if this killer's
already got to them," I declared without batting an eye. I'd lost a
few of my scruples during my battle with the Phantom.

More questions poured out, and Williams started helping me answer them.
My ideas outraged some, brought on the derision of others, but no one
left the room. The longer they discussed a plan about how to curtail
carriers and prevent more killings, I figured, the less likely they
were to cut and run. But it was disaster planning raised to the level
of a jazz riff. I kept making up answers as they asked questions,
throwing out solutions without a thought, afraid to stop in case the
first hesitation would cause doubt and the whole scheme would collapse
around me.

Maybe it was the result of too much coffee, too little sleep, or a
whole lot of wishful thinking, but shortly after 2:00 A.M. even the
lawyers in the crowd--there seemed to be a disproportionate number of
them on the board of UH--were giving their cautious approval to what
we'd come up with.

"Put it this way," one of the lawyers said, "by the time we get through
the screaming with the civil liberties types, you folks will have your
forty-eight-hour culture results. We've got enough stalling power to
give you that."

We'd first concentrated on immediate measures for everyone already in
the hospital--steps that were intended to get us through the night and
into the next day. All staff would be screened immediately and remain
quarantined on the wards where they worked. They in turn would screen
all the patients on those wards. The cultures would not only be
processed by the labs at UH but by every bacteriology facility in the
city; this would provide resources enough to test everyone immediately
and simultaneously. Those at risk for being targets, the punishers,
would be rounded up and placed in separate wards; Fosse would open a
wing for them that had been closed as a cost-cutting measure. They'd
remain there under protective guard until all cultures were proven
negative or until those who were already infected became ill. While
waiting, the high-risk group would be offered prophylactic erythromycin
and the sort of decolonizing procedures Williams had suggested back at
St. Paul's-bactericidal soaps, mupirocin ointments up the nose, and
nasal lavages. To reduce the risk of spreading the super bug into the
general population of the hospital, anyone who did fall sick in that
ward would be cared for by those who remained well, minimizing the need
for additional personnel to go in and out of that particular quarantine
area.

It was the Phantom's perfect irony, I thought--punishers taking care of
punishers.

Throughout all this talk, Riley had been joined by more and more
gray-haired men. The surgical gowns hid their rank, but each new
arrival seemed to bring the ones already there to attention, and I
could imagine the ever-increasing amounts of gold braid under the
already bulging sleeves of their protective wear. The last of these
men to enter the room stepped up to the podium, introduced himself as
the deputy chief of police, and assured us that University Hospital was
now surrounded with enough police officers to prevent anyone who
refused to cooperate from getting through their lines.

Left unsaid, again, was how they'd stop anyone who tried.

He then explained that each supervisor would be accompanied back to his
or her ward by two police officers. More could be summoned in an
instant if the so-called punishers didn't agree to come along to the
wing that Fosse had designated for them.

We even managed to convince ourselves that we could avoid transferring
out the patients, for the moment. While new admissions and emergencies
would be directed to other hospitals as of now, in the morning Fosse
would stress to the media that these safeguards were precautionary
measures only, that the patients already here would be perfectly safe,
and that staff using reverse isolation techniques would continue to
care for them. The "threats," he would emphasize, were only against
specific hospital personnel, all of whom had been taken off duty and
placed in isolation for their own protection.

Planning for beyond the morning was more problematic.

"... direct the day shift away from UH to alternative quarantine
facilities..."

"... what about separating out the punishers from this group as
well--they're most at risk to be carriers ..."

".. . live-in contacts of all our staff should be screened, maybe
quarantined..."

"... contact all workers who are at home before they start coming in.
Instruct them where to report..."

"... we'll need a communications team. Some clerical staff will have
to be called in to help us here..."

The strategy slowly took shape, the amount that needed doing outside
the hospital being clearly greater than what we had to accomplish
within, with one exception.

"But the killer may be locked in quarantine here with us," protested a
young nurse in the front row. Her lone voice brought absolute silence
to the room.

Then someone else asked, "Do the police know anything about who's doing
this or how he's managing to infect people?"

"The police are investigating," Fosse replied coolly.

The evasion prompted someone to yell, "There's a fucking maniac on the
loose. Fosse. We've got a right to know when the police think they'll
nab him."

"Right!"

"What are the police doing about this psycho?"

"How the hell can you say it's safe for any of us to stay here?"

Noisy shouts of agreement and demands to be told what the police knew
continued to come from everywhere in the room. Unruliness was
threatening to erupt again when Riley got a nod from one of his
superiors and hopped up on the stage.

"Hold it!" he yelled, his hand up to the group as if they were
oncoming traffic.

"I'm Detective Riley and am leading the investigation into who's
responsible for the threats made against people in your hospital. We've
got two jobs to do here. One's in your hands-to keep everyone safe
from this bacteria. Mine's to nail the creep, as Dr. Garnet so
appropriately called him. I also think Dr. Garnet's plan is the best
way for the moment to keep everyone safe from this killer.

Within the confines of your own wards, you'll immediately know if an
outsider has entered your area and we can grab anyone who shouldn't be
there in seconds. I suggest the sooner you get back to your floors and
get organized, the quicker we'll make it impossible for whoever's doing
this to get to you. To answer your question about what we are doing to
apprehend him, we've called up every available police officer in the
city to work on this case and have even alerted the FBI, requesting
that they check their national files for any individual or group with a
history of terrorizing hospitals. As for pursuing local leads, we
intend to start interviewing your staff in groups, floor by floor,
tonight."

He must have had a lot of practice in settling down a crowd. A low
rumble of mutterings rolled through the room, then once more voices of
reason replaced voices of rage.

"... what if we also move the staff that is here now away from UH, once
outside sites are provided for everyone not yet in quarantine.

That would take away the killer's hunting ground..."

"... pull all our staff from patient care immediately..."

".. . It'll take days to round up enough staff from other instituons
to replace them all, but if the patients knew we were working toward
that end, they might be reassured enough we wouldn't have to move them
at all..."

"Where's Dr. Mackie? Why isn't he here by now?" someone called out
from the middle of the audience. I recognized him as one of the
department heads at UH but couldn't recall his name.

Fosse answered without hesitation, the lie at the ready.

"We haven't been able to locate Dr. Mackie to inform him what's
happening yet."

The meeting was then adjourned, and everyone started to file out the
door. Out of the general noise I heard one voice murmur, "Doesn't this
sort of remind you of that Phantom business two years ago?"

"It's not how the Phantom infected all those people that I'm asking you
about. I want to know how you two would do it," Riley demanded. He'd
asked Williams and me to stay behind in the auditorium for a few
minutes. While Williams was half sitting on a large table at the far
end of the stage sipping a coffee, I was leaning against the podium,
and the detective was pacing the distance between us.

All three of us were squabbling over the best way to stop a killer.

"Shit!" growled Williams.

"How he did it or how we'd do it, what's the difference?" He kept
glancing at his watch, making it obvious he had far more pressing
things to do.

"I told you; we don't know."

I also had no time for whatever distinction Riley was trying to make,
its usefulness escaping me entirely. I was already angry that the
meeting had delayed my own attempt to discover Michael's find.

"Look, Riley," I began, trying to keep my impatience from souring what
little civility was left in the room, "I told you before that lives may
depend on our figuring out how he plants the staph organism on his
victims. What little time we may still have to use that information is
running out fast. If either Dr. Williams or I have any new ideas,
we'll page you immediately--" "No, you look, damn it!" Riley
interrupted.

"Catching this creep will save lives. Mackie's nowhere to be found in
the hospital, and we had no better results when a dozen of my men
searched the asylum.
Unless this Phantom of yours is so stupid that he's hanging around
waiting to get caught, the only way we'll get him is if you two help me
learn how he works. I've got to know what he thinks, what he needs,
and how he has to prepare in order to strike his victims.

With information like that maybe I can anticipate his moves and ambush
him."

"But that's why you've got to let me at those records--" He cut me off
with an impatient wave of his hand.

"I've got a man checking regularly with that group of ID specialists
who are down in the archives. They keep saying it's slow work. Hell,
your friend took two days to find whatever it is we're after. I need
information right now!"

"So?" said Williams.

"Your little pep talk doesn't change the fact we don't know how he does
it. And every minute you keep us here, the greater the chance this
quarantine will fall apart."

The sides of Riley's jaw muscles bulged against the ties of his
surgical mask.

"Let me tell you how cops work. Doctor," he replied through what
sounded like clenched teeth.

"When we don't know how a crook has done a job, sometimes we go to the
scene and figure out a way to do the crime ourselves."

Williams snorted, "Well that explains a lot."

Oh, Jesus! I thought.

"Come on, Douglas! We're all tired and scared. We don't need to start
snarling at each other."

"Sorry," he said immediately, "but I have to get upstairs." He stepped
away from the table.

"And I'm afraid I've got to bring you with me. You did a fantastic job
of settling people down here tonight when I wasn't able to, but that
was just a preview. No one on the floors is going to take the news
that they've been slapped into quarantine any better. We're both going
to have to run all over the building talking down reactions just like
the one you saw here. We blow it, and there'll be a major stampede out
of the hospital."

"No!" I started to object.

"You can't keep me from the chart search--" "For Christ's sake. Earl,"
Williams snapped, brusquely silencing me, "get the priorities
straight!" Before I could say anything in reply, he spun around and
laced into Riley.

"As for you. Detective, I know you've got to be as scared as I am
about what can happen if a few hundred people charge that police line.
We also both know that despite orders not to hurt them, all it takes
for a disaster is one nervous rookie who un holsters a gun, or a
panicky citizen who struggles too long in a choke hold. Even a worse
possibility. Lord help us, is that someone does get safely through and
carries the bug into the city. By the time we'd track down anyone who
was a carrier, who knows how many times he or she has picked their
nose, then reached out and touched someone."

Riley put new levels of stress on the ties of his mask.

"All the more reason. Doctor, to give me what I need now," he insisted
in a quiet voice, showing remarkable restraint.

"Those people upstairs are going to be a whole lot easier to keep in
line about the super-bug if they expect we're about to nail this--how
did they put it?-'maniac." You got a pretty good preview of that
reaction as well!"

Williams crossed his arms in front of his chest, still gripping his now
empty cup, and glared at Riley. From the eyes up he looked anything
but happy, yet he stayed put.

Riley continued.

"As I was saying, solving the same problems that the crook had to solve
in order to carry out his crime can put us on a similar wave length."

Williams groaned.

Riley stepped up to within a foot of nun and became even more
pedantic.

"Occasionally it makes us do the same as the guy we're after--walk
where he walked, touch what he touched, that kind of thing. Who knows
what traces of himself he left behind--a hair, a torn fingernail, a
shoe print even. The point is, when we can get that close to where our
quarry's been standing, sitting, climbing, and so on, there's no
telling what we'll discover about how he committed his crime." He was
eye to eye with Williams.

"Now let's get to work.

As you can see, you're not the only one with things to do tonight!"

Williams let his exasperation show by heaving a huge sigh.

"Your little game won't change the fact that we don't--" Riley pivoted
to face me.

"How would you get the bugs?" he snapped.

"What?"

"I said, how would you get this super bacteria he's using?"

"I couldn't," I answered.

"It would take some kind of skill in recombinant DNA techniques."
Concentrating on what Riley wanted became difficult as Williams's grim
warning about hysteria spreading throughout the hospital began to work
on me. Any fleeting optimism I had that we might get control of the
situation suddenly seemed stupidly naive.

"Is there anyone here or at the university who could do that kind of
work?" pressed Riley.

I turned to Williams.

"Is there?"

He continued to glare at Riley.

"Not that I'm aware," he replied.

While his gaze transmitted a thousand volts of fury, to my surprise he
actually sounded resigned to sitting through the exercise.

It was Riley's turn to exhale with exasperation.

"Try to focus on how you'd do it with what's at hand," he instructed,
catching us both in a stern glower that probably only cops were
licensed to use.

"Stick to what's here, what's done as a matter of routine in the
hospital.

This guy's bamboozled the lot of you with these bugs for a long time
and used them to commit two murders without anyone knowing.

That suggests his method was simple. Most brilliant crimes are.

The more complex schemes tend to fall apart."

Williams leaned back against the table again, cocked his head, and
said, "Okay, I'll play your little game, since that seems to be the
only way you'll let us out of here. If I were this creep and I wanted
to make a super bug without getting too fancy, I'd think about using
the natural way--conjugation. Bugs lying around together in a tube of
shit--now that's pretty low tech." He crumpled his styrofoam cup and
flung it the width of the stage into a cardboard box full of refuse.

Then he gave me a sly wink and cracked, "Trouble is, I'd have to hang
around a lot of assholes waiting for the product."

Riley exploded.

"Goddamn it, Williams, if you don't start cooperating, I'll slap an
obstruction--" "We're wasting time!"

"I'm warning you, obstruction of justice ..."

Williams's smart remark had set off an idea. I tuned out his wrangling
with Riley and quickly thought it through. After what was admittedly a
brief analysis, I began to feel in my bones it was an idea that could
work.

"Oh my God!" I exclaimed, my excitement erupting.

Williams and Riley immediately stopped arguing and stared at me.

"What?" asked Riley.

"You're right, Douglas. Conjugation--Cam could use it!" And so could
Rossit, I thought fleetingly, rushing on with my explanation.

"Just plate MRSA and VRE in the same petri dish and let them grow
together. Keep growing the mix over and over, until sooner or later,
it happens. The two organisms exchange genetic material..."

My voice trailed off. It was so simple--so
sick-in-the-pit-of-my-stomach, chillingly simple.

"Jesus Christ, Garnet, that's it," exclaimed Williams, slamming his
hand on the table and jumping up out of his slouch.

"Routine screening for MRSA and VRE could have given Mackie the
organisms he needed to start with."

"What do you mean?" demanded Riley.

Williams ignored him and kept right on talking to me.

"Suppose you or I were culturing someone with MRSA. What's to stop us
from keeping a swab on the side and culturing up our own private stock
of the organism? We could do the same while working up a carrier with
VRE. We'd have the ingredients."

Turning my way this time, Riley insisted, "Explain, damn it!"

I was pumped. My mind raced through the next steps of how it could
work. I picked up where Williams left off.

"Plate the two organisms on a culture dish together. Let them grow
side by side. Then add a dose ofvancomycin. If any staph bacteria
survived, he'd know that his MRSA had acquired the VanA or VanB gene
from the resistant entero cocci and that he had the super bug It could
take a lot of tries, but sooner or later, he might find that it had
happened. All that'd remain for him to do would be to plate more and
more cultures of the surviving staph organism, and presto, he'd have
his supply--enough super bug to infect this whole hospital."

"Jesus!" repeated Williams.

"He could do it in a couple of petri dishes slipped in among the
hundreds done here daily. Or even if he had kept it off-site of the
lab, he could hide a supply out of the way and wouldn't require much
more than an incubator like the ones kids use to hatch baby chicks. The
whole setup's at the level of a school science project."

"He could move it around on a cart," I added, thinking about my
encounter in the subbasement.

"What about the LegionellaT Riley asked. He'd stopped trying to get
explanations of the technical jargon. He must have decided he'd
finally gotten Williams and me on too good a roll for him to keep
interrupting us.

"Same way," answered Williams. All his hostility toward the detective
vanished. It had been replaced by the exuberance of discovery.

"Screening. Water supply sites are notorious for harboring that bug;
we find it even in hospitals that claim they're clean."

I remembered Michael's telling me the same thing--a week ago back in my
office when he'd insisted that he come here to investigate the source
of the nurses' infections. It seemed a lifetime ago.

"It wouldn't be impossible to find a contaminated water source,"
Williams continued, "confirm it by special culture, then let the
organism multiply in samples of the water. As long as he kept them
from being heated past seventy-seven degrees centigrade--that's the
temperature Legionella's killed at--he could end up with a
super-concentrated solution of the stuff by simply letting his
specimens sit around, not too hot, not too cold."

"One more question," Riley said.

"Why go to the trouble of making the super bug Why not be content with
killing people by using LegionellaT" It was a good question, but I was
able to answer it without hesitation because once having climbed inside
the Phantom's way of thinking, it was possible to see things from his
point of view.

"Legionella offers a chance to be treated," I said with unseemly
excitement.

"The super bug is a sentence to certain death. If the purpose, besides
killing, is to increase the terror of the victims, what's more
horrifying than knowing that you're going to die within days, and that
you'll die choking? If your purpose is to panic an entire hospital,
hell, the choice is obvious. Legionella's scary. The super bug the
stuff of nightmares."

I caught Williams staring at me and nodding in agreement. His eyes
conveyed incredulity as he admitted, "I'm amazed we managed to figure
out so much!" He even apologized to Riley.

"That's a hell of a neat trick you have there, getting people to know
what they think they don't know," he said in a very sincere tone, then
couldn't appreciate why Riley and I were laughing at him.

But not even Riley had tricks enough that we could solve how the
Phantom managed to infect people with these bugs.

The three of us were headed upstairs. We were hurrying along the
corridor leading away from the auditorium when I asked the detective
what he figured were the chances of picking up Cam in short order.

"If he's alive, not bad."

"What?"

None of us broke stride, but Williams matched his step to Riley's and
mine, placing the detective between us.

"Explain," he said curtly.

Riley answered.

"Right after you and I first talked, we sent a patrol car over to his
apartment. He's not there of course, but his bank books and passport
are. He lives alone, yet seems to be friends with a lot of his
neighbors, so we had a nice-sized group, including his landlady,
telling the officers that they hadn't seen him tonight. As I said,
he's also nowhere to be found in the hospital.

If your theory's right and he is the killer, then he's hiding out
somewhere not too far away, probably getting ready to pounce.

That's still our number one theory as well--we've issued a warrant to
bring him in for questioning--but it will take more than theories
before we can convince a judge to let us do areal search of his rooms,
his office records, his car--" "Then why did you say he might be dead?"
I asked.

"Dr. Garnet, you should listen to your wife. She knows how to look at
all the possibilities, not just one or two. After we talked awhile,
she began to wonder if he hadn't been flamed."

"What?" I felt the snakes in my stomach spring to life and start
coiling into knots.

"Consider it," Riley said.
"Mackie, if he's innocent, may have found something, just as he
claimed, which revealed not only that there was a phantom at work but
also who it was. His sudden disappearance could have been engineered
to keep him quiet."

"Jesus Christ!" The notion demolished every thought I'd had about the
man. I was speechless. The possibility of his being set up had never
occurred to me. I looked across at Williams. His frown was headed
into the front half of his scalp. I guessed he hadn't included the
idea in his differential either.

We were entering the main foyer. Our shoes clacked on the marble
startling the two security guards at the desk. I could see a uniformed
police officer standing at ease outside the glass doors.

Riley went on talking.

"Your wife also remains convinced that until tonight Mackie was
steadfast in his conviction that the infections couldn't be deliberate,
so, like Popovitch before him, he must have found something that
changed his mind. Dr. Graceton had an interesting suggestion, too,
about why he might have been so defensive about the Phantom besides his
fear that you'd resurrect the previous rumors. What if back then he
dropped his investigation into those events simply to let those same
rumors die out as quickly as possible? Wouldn't he feel guilty about
doing so? The point she's making is that the man could be entirely
innocent of being the Phantom, and you would still have struck a nerve
in him when you started to poke about in the archives."

"You and Janet seem to have had quite a talk," I said.

He ignored my comment as we hurried along.

"The one thing your wife and I are in complete disagreement on is
whether the murders are connected to the amalgamation of your two
hospitals."

My surprise at her telling him that theory must have shown in my
eyes.

"Oh yes, she told me your suspicions, all right. Except she's pretty
skeptical about them. But I have to side with your idea; half a
billion budget is a lot of motivation for anybody to do anything.

Don't you worry, we'll look into this character Rossit, and of course
Hurst; I remember him from when we were investigating the murder of
your former CEO. As far as all those captains of industry on your
board, well, I can tell you for a fact that taking care of business in
this town can get pretty rough."
"Except they wouldn't destroy the spoils of their victory," I said
without thinking. The realization had just popped out, unbidden, al
most before I'd known the thought was in my head. Riley and Williams
were looking at me sideways, puzzled expressions on their faces. I
quickly explained.

"Hurst and his friends would want UH left intact so they could dominate
it."

"Maybe not," Williams countered.

"At least not if they didn't want to share the half billion."

Riley and I both looked sideways at him.

He explained while all of us kept up the brisk pace, "Some hospital
mergers I've witnessed actually abandon one of the two institutions and
create a single super hospital If UH crumbles, then St.

Paul's becomes the biggest show in town. How far would your board.
Hurst, and guys like Rossit go to win that kind of prize?"

By the time we finished chewing over that possibility, we'd reached me
third floor by elevator and were in the corridor passing some windows
overlooking the grounds. Williams rushed on ahead toward the nearest
ward, but Riley paused to look outside and I paused with him. I could
see human forms reflecting the unmistakable glint of badges. Here and
there police officers wandered into lighted areas where the amber glow
of sodium lamps illuminated the little white plumes of their frosty
breath. For about a second these wisps would drift along before
dissipating and blending in with the haze of gray fog that filled the
night. Farther back in the darker areas under the trees I caught the
reflected glimmers of blue and red above the occasional gleam of white
paint, the pattern repeating itself over and over-police cars.

Standing there, I found myself wondering if the Phantom was again out
there somewhere, beyond the circles of police, past the mist, gloating
once more over the impact of his work on the hospital.

But was it Cam, forced out in the open, the advantage of his
invisibility ripped away? Or was it Rossit, as an agent for Hurst and
his board, executing the takeover that Williams had suggested? Or was
it someone else, as Janet thought, who still evaded me, the master
controller, his invisibility assured because he'd just offered us Cam
as a scapegoat... with my help.

Williams and I had no method as we attempted to calm people and keep
everyone rational. We simply made it up as we ran from floor to floor,
pleading the same arguments we'd used on the fly earlier in the
auditorium and at St. Paul's last week, coaxing, cajoling,
intimidating, and when that didn't work, we called the cops. We tried
to teach a few of the clinical chiefs the things to say, hoping they'd
exert some leadership, but they were too rattled themselves to be of
much use. They stared at me blankly as I implored, "For God's sake get
a grip. If we don't settle people down, someone's going to bolt and
inadvertently carry that organism out of here. At least help us get
everyone cultured."

Armed with a specific task, these "leaders" seemed to collect their
wits enough to get working, but I found myself fuming at them for their
feeble performance. It was clear the kind of weak leader ship Fosse
had encouraged.

Everywhere Williams and I went, we initially met panic, defiance, and
anger what we'd seen in the auditorium but tenfold.

Physical scuffles broke out as some nurses tried to storm out of their
wards. Orderlies had to restrain their own colleagues. Hallway
shouting matches woke up the patients who soon learned enough fragments
of what was happening to become panicky themselves.

Fosse at least had had the foresight to cut off outgoing phone lines.

But then the already explosive mood was fueled by outraged men and
women screaming that they'd been foiled in their attempt to contact
families, lawyers, and even the media.

The dynamo that came to the fore in the crisis was Harold Miller.

He was everywhere, leading his small army of technicians into each and
every ward, starting them off collecting cultures, then demonstrating
the technique as he got the rest of the staff screening one an other
and the patients. Culturing and plating throughout the night, he was
always explaining what he was doing, was always reassuring his
subjects, and was forever offering little courtesies. More than once I
saw him help people tie their masks back on or provide them with a
fresh one instead. He, more than anyone, got us through the culturing
that had to be done during those early hours.

The worst was rounding up the punishers. Some who were too frightened
to resist stepped forward and begged our protection. Others were
turned over to us.

"Looks good on you, Rachel!" a rather grandmotherly looking nurse
screamed at a frightened and much skinnier, younger col league who was
being led away.

"You goddamned bitch, I'll get you for this!" Rachel screamed back.
The rest of the nurses on the ward and some patients who'd been wakened
by the ruckus promptly booed and hissed Rachel as she was paraded off
the floor. It was certainly rough justice, and probably a few
innocents were rounded up with the guilty. I winced when it occurred
to me how many lawyers would be employed in definitely sorting out what
we were doing tonight.

At one point during the evening I was asked to see three nurses who had
complained offlulike symptoms, but on examining them, I found that none
had a postural drop in blood pressure or the bio chemical changes
consistent with a Legionella prodrome, and none of them had findings
suggestive of a staph infection. They asked about antibiotics, and I
told them, "Medically it's not indicated. But if you think you might
be a target of the person making these threats..." I let the
suggestion hang there.

When they vehemently denied they were "like that," I assured them again
that they needed no medication, but the encounter reminded me to take
the second capsule of my own prescription.

Through all of this, I kept racing back to I.C.U where I'd look up
Janet's latest vitals on her chart and would check with me nurses that
they'd seen no sign of her cough turning purulent. Despite there being
no change in her condition and the guard at her door reporting that no
one had tried to approach her, I'd run back to the floors haunted by my
own proviso--it's early yet.

By 4:00 a.m. an eerie lull had settled over me hospital. Eventually,
again paralleling what had happened in the auditorium, most people had
settled down, started cooperating, and wanted to do what was best for
themselves and their families. Culturing was mostly complete. About
seventy people were under special protection.

Apart from some individuals who tried to get by the guards, and a few
who actually made it to the grounds before they were stopped by the
police, the quarantine was intact.

To say we couldn't have hoped for better was true, but it was more an
admission of how precarious the best we could hope for was. With the
morning shift due to arrive within three hours unless we diverted them
elsewhere, we all knew we were teetering toward worse.

I paused in front of the same window Riley and I had looked out of a
few hours ago. The fog was thicker now, but I could still distinguish
me shapes of police officers on patrol. The area under the trees,
however, where I'd caught glimpses of their cars before, was so thick
with shrouds of gray that not even the overhead sodium lamps could
penetrate the gloom. Yet I could tell something new was happening out
there. Through the panes of glass in front of me the persistent
guttural growl of diesel engines made itself heard-the kind of noise
I'd have expected from heavy equipment at a construction site.

The National Guard was moving into position.
Chapter 20

Fifteen minutes later Williams reached me by phone.

"The ID guys have found something," he said curtly.

"They're in archives."

When I walked in the door of that familiar room, I saw a half dozen men
and women standing with Williams in front of three tables that had
charts spread over them. A tall gray-headed man was directing his
comments mainly at Williams. While he spoke, a few of his colleagues
were sipping from coffee mugs, having untied the bottom of their masks
so that they could lift them up each time they drank. A large silver
thermos sat on one of the tables in their midst.

The aroma of the fresh brew was tantalizing, but no one offered me
any.

Riley stood off to one side, and if the way he was giving the ties to
his mask a good stretch test was any indication, he was obviously
unhappy. When he saw me enter, he walked over and whispered, "These
guys mean well, but frankly, between you and me I don't think they'll
find squat. They're too ... too ... well, doctorish.

They're looking for medical inconsistencies, not murder."

I held a finger up to my lips, signing he should keep quiet, and
focused on what was being said.

"... Dr. Mackie had left out a few hundred charts sorted into
different piles," the elder physician was explaining to Williams,
gesturing to the tables.

"A few hundred!" exclaimed Williams. His frown shot into previously
unfurrowed territory.

"We figured he couldn't have gathered so many without help, so we
called the clerks who work here."

Behind me on a table was a phone that had a yellow Buffalo P.D.

sticker on it. I thought about how much more comfortable I would have
felt if I'd had that with me when I was here the other night.

".. . They told us Dr. Mackie had stormed in around six p.m.,
catching them just as they were leaving for the day. He had with him
records from our own Infection Control Committee and had marked on them
three lists of charts which he insisted the clerks pull. We discovered
the first list was for the charts of patients who'd been screened after
being exposed to Phyllis Sanders in the ten days be fore she became
ill. He'd then sorted those into piles arranged ac cording to which
patients she'd cared for on the last day before she left on vacation,
on the second to the last day, the third last, and so on. The second
list was, we found, for the charts of patients exposed to Brown during
the ten days preceding her Legionella infection.

He'd arranged them the same way and repeated the procedure with the
charts of patients who were exposed to the OR nurse prior to her
pneumonia. Remember, these two nurses had also left on vacation a few
days before their illnesses."

"That's interesting," said Williams.

"How did you guys see all that?"

The older man reached for a chart on a nearby pile, flipped it open to
some blue-colored pages, and pointed.

"We found the pattern by looking at entries in the nurses' notes for
each file. But that's all we got." He handed the chart to Williams
and continued, "What I hoped to see was a single nursing act that
Sanders and the two others had each performed during the days when they
would have been ex posed to Legionella. I thought perhaps we'd find
they were infected during a specific procedure. Unfortunately, all the
nursing procedures listed in these charts were routine dressing
changes, monitoring vital signs, administering medications and nothing
stood out. Cam must have been after something else."

Williams nipped through a few pages, then closed the file and handed it
back.

"Then we'll keep looking through these for that something else," he
said.

"I'll stay and help you."

There was a murmur of appreciation from the others sitting around the
room. One of the women in the group stepped up to Williams.

"Is it true that Dr. Mackie's a suspect..." At that point her voice
lowered beyond what I could hear.

When I turned to look at Riley I could see he was anything but pleased
with the results he'd just heard. He leaned over to me, his eyes wide
with alarm.

"You see. Doc! They found nothing, just like I told you. You've got
to get me more than this, and I mean now, or your Phantom's going to
get his chance to deal out another round of infections like he
threatened." He sounded both frustrated and more than a little
desperate.

"Why aren't you checking out some of the other places Dr. Popoviteh
visited?"

I knew exactly where I'd start.

"Mr. Fosse, what got Cam Mackie off me hook two years ago when he was
suspected of being the Phantom?" I asked. We were in his office. I'd
dropped by to advise him I'd be working just outside his door,
revisiting the vault where confidential minutes were kept, then going
into the human resources department. I'd thought it wise to let him
know I was there, not that he heard noises and figured the Phantom was
back. Before leaving I'd decided to ask about Cam.

"Two things, really," Fosse answered, leaning back in his chair,
"though one raised a few eyebrows. The whisperings about him started
to pretty well die down when an attack occurred while he was lecturing
out of town. What made people suspicious again was that there was
another attack two weeks later, also on a day he was away. That caused
a few nasty comments about the timing of the two occurrences being a
bit too convenient for him. But the gossip ultimately ended when,
after those two episodes, the events stopped entirely. Everyone
eventually assumed the Phantom business was over and put it behind
them."

"Was anyone else a suspect at the time?"

"No," Fosse answered with a shake of his head.

At that moment his phone rang. He was soon engaged in a conversation
about the plans to receive the day shift at a number of outside
facilities, and I stood up to leave while he was ticking off his
orders.

"... have our eighty supervisors each call twenty of their people at
home from lines that are still open in administration. Tell them that
there's been a threat but the situation's under control, and then
direct them to where they're to report. I'm expecting all my chiefs
momentarily, to further discuss strategy for the people here..."

That was one group I didn't want to get stuck with again, I thought as
I scurried out the door.

The vault full of confidential minutes now had a strip of yellow police
tape across it, making it necessary that I have both a security guard
and one of Riley men get me through the door. Once in, I retrieved the
volumes containing the minutes of Cam's Infection Control Committee.
They were, as I expected them to be, in their proper place on the
shelf, since Cam would hardly need to look up records of his own
meetings.

I hadn't paid much attention before to the order in which the Phantom's
different methods of attack were used, but I quickly checked now which
type of attacks had occurred when Cam was out of town. On both
occasions the symptoms had resembled a SLUDGE BARN syndrome, the result
of organic phosphate, or insecticide, poisoning. In fact, from Cam's
committee minutes it was easy to see the overall chronology of the
attacks. There seemed to be two phases. Provoked psychoses and
incidents of induced vomiting were intermingled in a haphazard fashion
over an initial period of four months. But then, the Phantom's
activities had ended with a consecutive string of five insecticide
poisonings, including the last two, for which Cam was away.

I leaned back in my chair and thought about the pattern: five
insecticide poisonings in a row--three while Cam was in town, followed
by the two when he was away--then no further activity from the Phantom
for two years. The sequence certainly intrigued me.

At first I wondered if Cam had developed the insecticide method of
attack after perfecting the other two techniques, then got an
accomplice to carry it out a few more times during the out-of-town
speaking engagements. But the alibi occurring twice was too clumsy,
and Cam would have known it was. Fosse had probably put it mildly when
he said the pair of convenient coincidences "raised a few eyebrows." So
why had those last two attacks been timed like that?

I thought for a while longer. Complex scenarios suggested themselves,
again involving accomplices, but none of them rang true.

The Phantom's brilliance at keeping himself invisible went totally
against the notion of his resorting to sharing his secret with someone
else and rendering himself vulnerable to being exposed by that
person.

Frustrated by the vagueness of it all, I pushed out of my chair and
started to pace. One thing that struck me clearly, as an ER doctor,
was how significantly more dangerous the insecticide poisonings
were--potentially lethal in fact--compared to the effects of ipecac or
a short-acting hallucinogen. Vomiting or seeing things for half an
hour almost seemed appropriate tit for tat against the kind of petty
cruelty the Phantom had singled out for punishment. After all, the
cruelty, though vicious and inexcusable, wasn't a killing offense.

Even Janet had insisted her ordeal at the hands of the residents hadn't
at all been typical of what Brown, and presumably the other punishers,
had usually indulged in.

It felt strange to be even commenting on appropriateness when referring
to the acts of a maniac. Yet switching to pesticides was a definite
escalation, taking the punishment to a level where it could kill, even
though the crimes remained minor. If such an irrational step-up had a
logic to it, I couldn't figure it out, and I finally concluded the
reason must be buried in whatever madness drove this psycho.

No other revelations leaped off the pages at me. Before leaving, I
quickly flipped ahead to more recent entries in the minutes and located
the sessions that had investigated both Brown's Legionella infection
and that of the OR nurse who'd died. I learned nothing new from the
committee's conclusions but scribbled down the chart numbers for each
nurse's medical files. I wanted to go through the cases myself.

I paged the same guard-cop tandem I'd had before and got by more yellow
tape to enter the personnel department. It was actually a set of
offices I counted nine in all behind a main entrance door.

Eight of the rooms were evenly divided on either side of a long hall
way. The ninth, located at the back of the complex, was the largest
and contained the files. I made my escorts wait while I verified no
one was lurking anywhere, even looking into a large oak armoire full of
coats which was by the main door. When I checked the file room I could
see that Cam had evidently skipped these records as well; there were no
folders lying around to indicate that he'd been here before me. But I
knew from the sign-in book that Michael had, so I sent the two
uniformed men away, both of whom seemed amused by my skittishness,
locked myself in, and got to work.

I stuck to my plan and, using my list, dug out the personnel files of
the Phantom's first targets from two years ago. Six had already left
the employ of the hospital, but their files were kept, as were all
hospital records even those of the dead for the possible eventuality of
legal action. Of them all, I found that only three had ever had
official complaints leveled against them and that none of those
complaints had resulted in disciplinary measures.

The alleged infractions were exactly the sort of petty things I'd come
to expect one complainant reported being repeatedly roughly handled
during dressing changes, another told of being verbally abused whenever
she requested her pain medication, a third had been ridiculed for
wetting the bed after her requests for a bedpan had been ignored. All
three accused nurses had denied any intent of wrongdoing and were let
off without so much as a reprimand.

Obviously Janet was right about the cruelty being hard to prove, and it
certainly was clear why most patients wouldn't even bother to report
it.

The absence of so much as a nasty note in any one of the other fifteen
files put to rest my earlier idea that the Phantom had encountered all
eighteen punishers as a result of formal complaints being brought
against them. I nevertheless wrote down the names and addresses of the
three patients who had filed charges, in case I wanted to reach them. I
was curious to know if they'd also discussed their problem informally
and off the record with someone outside normal disciplinary
procedures--someone to whom other patients might also have complained
about a punisher rather than pursue the matter through proper
channels.

But it was when I started paying attention to dates again that I got a
big surprise. The three complaints I'd been looking at were made
several months prior to the first attack by the Phantom, and the three
people named in those complaints were his first targets.

I felt a prickle on the back of my neck.

What's more, each attack occurred within weeks of the hearings into
those complaints--hearings that had failed to take disciplinary action
against the punishers.

Like electricity on a rheostat, the prickle grew to a tingle.

I couldn't explain much else I'd encountered tonight, but I felt I was
looking at what had sparked the creation of the Phantom. The sudden
clarity after so many vague leads began to make me feel heady.

The membership of the disciplinary committee was included with the
rulings, but I didn't recognize a single name. That didn't diminish my
excitement much. I already knew the Phantom was operating outside this
committee, and even though the proceedings were suppose to be
confidential, if UH was anything like St. Paul's, confidential
proceedings usually leaked like the Titanic.

"What have you got?" said a familiar voice from a few feet behind
me.

I jumped a foot and screamed as loud as I could. Whirling in midair, I
saw it was Williams.

"Jesus Christ!" I roared at him.

His eyes wrinkled merrily at the corners, the result of a smile which
his mask kept me from seeing. Obviously he was amused at his effect on
me.

"Will you stop doing that?" I asked him crossly.

"How did you get in here anyway?"

"The door was open," he said casually.

"Fosse told me where you were."

"What do you mean the door was open? I locked it."

His eyes became a little less merry.

"Sorry, but I found it open.

Maybe you didn't do it right."

"Bullshit I didn't do it right!" I exclaimed, striding out of the room
and down the hallway toward the lock in question. I was halfway there
when in burst Fosse, looking wide-eyed above his mask, followed by half
a dozen other people in protective gear. One of them was holding a
brass lamp upside down, waving the base in the air like a club.

"What happened?" Fosse demanded, breathing hard as he pulled up.

"We heard a horrible scream."

"That was me," I said curtly, glaring at Williams.

The large man immediately said, "Sorry," then explained what had
happened and apologized again, especially to me, for having upset
everyone. But while he continued to settle Fosse and the chiefs down,
I stepped over to the door and verified I indeed knew how to set the
lock properly.

"Someone unlocked this door while I was working in here," I said over
my shoulder. The group quickly fell silent as I turned back to them
and added, "Maybe whoever it was sneaked in, then left, or maybe the
person's hiding right now in one of those rooms behind you." I'd
spoken coolly, looking past them toward the eight darkened doorways on
either side of the long corridor.

"Shit!"

"No!"

"You're kidding, right?"

The bunch of them reflexively drew together, forming a circle with
their backs to the center.

"We'd better look," said Williams quietly, no trace ofthejokester in
his voice now.

He moved toward the first door, slowing as he approached it, then
slipped his hand around the edge of the frame. When the light snapped
on Fosse and the others followed behind like a timid posse, the one
holding the lamp in the air at the rear.

It was hard not to laugh as they repeated this procedure before they
peeked into each room. I started to feel a little foolish at having
been a bit too spooked by an unlocked door. I found myself staring at
the armoire beside me, almost embarrassed at wanting to look in it
again, especially after having endured knowing glances from the guard
and the cop when I'd checked it not forty minutes earlier. I'd make
sure Williams and his bunch were at the other end of the hall where
they couldn't see me when I stole a look this time, I decided. I was
probably going to take enough of a ribbing as it was when the little
search I'd sent them on came up empty.

I was looking left toward the passageway, leaning forward a little,
checking to see that the others were out of sight when I stepped up to
the heavy wooden doors and pulled on the latch. The panel exploded
open with such force that he must have had his leg raised at the ready
to kick it out. The full weight of the wood smashed into the right
side of my head, then my upper body, throwing me against a desk that
was behind me. All I saw coming out of the cabinet was a raised lab
coat held up as a screen before it was thrown roughly over my head like
a sack. I was immediately squeezed by a pair of arms pinning my own
down. I tried to yell but all my breath had been knocked out of me,
and I couldn't see because of the coat over my head. I felt my self
yanked to my feet, then one of the arms let go, only to return and
deliver a hard punch right into my solar plexus. If there'd been any
air in my lungs to begin with, it would have roared out of me with a
bellow and brought the others running. As it was I doubled over,
making little more than gagging noises muffled by the coat over my
head. I couldn't breathe in and lost even more air when I started to
gag on my vomit. I then felt him grab me by the scruff of the neck and
yank me forward, still bent over. I've been here before, was all I had
time to think before I smashed head first into something very hard.

Except this time I didn't lose consciousness. He probably hadn't been
able to get me up to speed and the coat had blunted the blow, but I
nevertheless collapsed into a gasping choking ball. By the time I got
the coat off my head, the door leading out of the complex was closing,
its motion slowed by an overhead arm attached to a pneumatic cylinder.
I was halfway to my feet when Williams came trot ting up the hallway,
the lines in his forehead furrowed into question marks. The noises of
an oak door against a skull or a fist hitting a gut weren't all that
loud, but I guessed it had eventually been enough to get his
attention.

"Get him," I croaked, still doubled over as I pointed toward the door
just when it clicked shut.

The large muscular man was out of the room like a shot. Even with the
carpets I could hear his steps pounding down the corridor as he gave
chase. I staggered over to the doorway.

"Call security," I rasped at Fosse, who'd finally made it up from the
rooms in the rear.

His "leaders" hung back about twenty feet behind him.

"And Detective Riley, fast! Tell him the killer just ran out of
administration."

I was now breathing a bit, but not well. At least I didn't think I was
going to vomit any more.

I got to the door, more or less erect, and started after Williams.

He was just exiting the far doors that led out of administration and
into the rest of the hospital. Whoever we were chasing was already out
of my sight. I started to jog, my breathing quickly becoming more
labored and disgustingly noisy. By the time I got to those same doors,
even Williams was nowhere to be seen. I stepped into the outside
corridor, hoping that the linoleum floor there would amplify the sounds
of running feet enough for me to tell which way they'd gone. Nothing.
I located the nearest stairwell and threw open the door just in time to
hear the clatter of quick echoing steps coming from way below me. They
were suddenly cut off by the noise of a door slamming.

I started down.

Two floors below was main, or ground, level. I stuck my head out the
door of the landing and listened. There were no sounds of running.

At the first level basement, it was the same. This creep must have led
Williams into the subbasement, I thought, feeling my fear mount as I
headed down that final flight. I didn't know how quickly Fosse was
getting reinforcements organized, but I was sure he didn't know which
direction Williams and I had taken once we were out of
administration.

I braced myself as I opened the door and prepared to step into that
oppressive corridor. But I wasn't prepared for what awaited me. The
subbasement was in complete darkness... again.
Chapter 21

"Williams!" I yelled.

There was no sound.

"Williams!" I screamed.

Still nothing. I was standing in the stairwell, holding the door open,
letting the light from behind me flow into the blackness of the passage
in front of me. I didn't have a clue what part of the subbasement I
was in; I hadn't seen any stairs the other times I was here.

I kept hoping to hear the sounds of guards or police on the stairs
above.

"Can anybody hear me?" I yelled up into the silence.

"We need the police down here!"

No luck.

Maybe whoever it was had led Williams back to the upper floors by
another staircase or had gotten far enough ahead of Williams to jump on
the elevator, wherever that was; I still didn't have my bearings.

All he'd have to do then, presuming he was in protective gear, was step
out on any floor and become one of the fifteen hundred other people now
wearing masks, gloves, and gowns.

I'd just about convinced myself I could return upstairs with a clear
conscience when I heard a moan coming from far up the dark corridor.

"Williams!" I cried once more.

"Are you all right?" No answer, not even another moan.

"Shit!" I muttered, looking for something to jam the door open. I
ended up using one of my shoes for want of anything else. I then
removed its mate and once more resorted to gripping it by the toe,
ready to use its heel for a weapon. As prepared as P d ever be, I
peered into the darkness up ahead and went creeping toward where I'd
heard the plaintive sound.

I tried not to think of what the Phantom might have done to Williams. I
tried to think even less about his waiting by Williams's body, using
the moan to lure me to the same fate.

I kept to the center of the hall for as long as the light behind me
illuminated my way. Then I turned a corner and was unable to see a
thing.

"Williams!" I called again. As before, no answer. But I reasoned he
couldn't be too far off if indeed it was he who had made the sound.

I pressed ahead, my right hand feeling along the wall, the shoe ready
in my left, the darkness absolute.

Twenty feet later I literally fell over him.

"Damn!" I exclaimed, going down hard on my knees. But I franc ally
started feeling with my hands, finding his feet, his legs, rapidly
working up to his neck. I palpated around for his carotid artery. He
had a pulse. I supported his head between my hands and brought my ear
up to his mouth. He was breathing. But when I reached his bald scalp,
even through my gloves, I could feel the warmth and slipperiness of
blood--a lot of blood.

"Oh Christ," I muttered.

I found the laceration by feel. I could slip my fingertips into it. It
was deep, about two inches long, and on the front part of his
forehead.

He must have turned to face his attacker just before he got hit with
something. I gently slid the end of my index finger across the bottom
of the wound, feeling for any depressions in his skull or jagged edges
of bone. There were none, but that didn't mean a non-depressed
fracture was ruled out.

The main problem was hemorrhage. I couldn't feel any pulsing of an
arterial bleed through the latex of my gloves, but any cut to the scalp
could bleed heavily. I wadded up a corner of my surgical gown into a
makeshift pad and pressed it firmly against the laceration. I prayed I
wasn't pushing pieces of skull into his brain.

There was nothing else I could do except try to stop the bleeding.

I couldn't drag him out myself and at the same time keep his head and
neck stable, his airway open, and his laceration properly tamponaded.
As it was, I could still feel his blood flowing through my fingers
despite the pressure I was applying.

"Help!" I screamed, hoping someone on the stairs would hear me through
the door I'd left open.

"Help me. I've got an injured man here!"

Sooner or later my cries had to attract someone--had to, damn it!
But no reply came.

Then, from away in the darkness far up the corridor, as softly as a
breath, I heard what made my blood run cold.

Laughter, a low, easy, rolling chuckle--distorted by the walls, it
echoed toward me and was as chilling as ice. Then it ended, cut off by
the distant sound of the elevator doors closing.

* * * Riley assured me his officers had found us in less than five
minutes, but as I sat there in the dark, it felt like hours. Williams
had even started to come to before they'd run up to us, but I hadn't
let him move. Once we got him toER and into the capable hands of Wild
Bill Tippet I could see the laceration, though bloody, was a pretty
routine affair that would be made right by a bit of sewing. A
subsequent CT scan confirmed there was no fracture or evidence of
underlying hemorrhage in the brain.

"Do you think I'll have a scar?" inquired Williams, eyeing the
needlework in a mirror before a dressing was put on it.

Tippet fluttered around us the whole time like a nervous hostess-I
always seemed to have that effect on him--and reassured me endlessly
that the only reason he'd missed the midnight meeting was that he'd
felt he should stay with his troops in ER.

"Keep them calm, that kind of thing," he kept insisting, talking at
double speed. He actually seemed deflated when I admitted I hadn't
noticed his absence. But I did notice now that he was wearing two
surgical masks instead of one. I suspected his own fear of being in
close contact with possible carriers from other parts of the hospital
was the real reason he hadn't shown up.

I didn't hold his fear against him. Everyone was frightened and
growing more so by the hour. I think that's why I didn't tell anybody,
not even Riley, about the laughter. I'd no intention of scaring any of
them any more than they already were.

But I couldn't protect myself from remembering that sound. It had
seemed so unforced, as though my cries for help had been a source of
real amusement to him. This Phantom might claim to be avenging past
cruelties, but that laugh was as sadistic as any I'd ever heard.

I did tell Riley about hearing the elevator go up.

Nevertheless, he made his men search the subbasement and walk through
the asylum again. As I expected, they found nothing.

"You sure there's no place someone could hide?" pressed Riley when his
team reported back to him. We were standing outside ER, waiting for
Williams.

"Sewers, passageways, septic tanks?"

The men winced, and I saw one of them wrinkle his nose under his
mask.

"We didn't see any sewers or septic tanks," one of them answered, "but
we went into everything a man could easily fit through. Besides, why
would he bother to hole up there anyway?"

The officer gestured toward his gown and tugged at his mask with his
glove.

"What with our costumes, I've never seen a better place to hide in
plain sight."

"Not if you're already well known," snapped Riley.

I interjected.

"That's the point. It couldn't have been Cam. I al ready told you I
heard him take the elevator. That meant this guy did go upstairs to
hide in plain sight. Like you said. Cam couldn't have done that and
counted on going unnoticed. He'd have had to stay well hidden
somewhere else."

Riley spun around to face me.

"If you're going to go running after a murderer. Doctor, which by the
way, nearly got your friend Williams in there killed, when are you
going to team to consider all the possibilities?" He was fuming, as
usual his jaw muscles bulging under the straps of his mask as he
pretended to give me a second to come up with an answer.

"Think, Garnet! Mackie could have sent the elevator upstairs empty, as
a ruse, then tiptoed off in the dark and retreated to his hiding place.
Now for God's sake, leave the physical pursuit of this maniac to me and
concentrate on tracking down what your friend Popovitch found. I've got
enough to worry about be sides baby-sitting you!" He swung his fierce
stare back to his men.

"And one of my many worries, gentlemen, is whether you did a thorough
search, given your obvious attitude that he wouldn't be there
anyway."

At 6:30, still stinging from Riley's rebuke, I was back in the
auditorium, alongside Williams and Fosse, facing the same group of
supervisors and chiefs who had been here not four and a half hours ago.
This time even Wild Bill Tippet had shown up, double masked of course.
Only the board members were absent; they had presumably gone home to
bed.

Williams, up and about with a dressing on his head, elicited a little
self-congratulatory cheer from the audience when he announced, "Good
job, everyone. You've kept the quarantine intact so far." But the
mood quickly became somber again as he reviewed the arrangements to
eventually relieve them of their duties taking care of patients and
transfer them out to external quarantine facilities.

"I doubt anything will happen before the end of the day. With the load
we've already put on surrounding hospitals and medical personnel, it
will be a while before we find enough staff to replace you and free up
enough spaces to receive you."

As the meeting broke up, I heard someone mutter, "Where the hell's Cam
Mackie? Shouldn't he be here?"

Somebody else quipped, "Maybe he's hiding in the fog, with the army."
The guy got a halfhearted laugh from his colleagues.

Though Fosse had blocked outgoing phone calls, no one, it seemed, knew
how to block E-mail. At 8:00 a.m. every electronic media outlet in
Buffalo began reporting that they had received an anonymous message
containing a threat against University Hospital.

Bulletins followed about the place already being surrounded by both the
police and the National Guard. Within minutes parts of the actual text
were being read on air by a half-dozen radio stations.

/ have infected the staff with a bacteria called staphylococcus which
I've made completely resistant to all known antibiotic treatments. This
organism can be transmitted to patients by touch, and once it
penetrates the body, is unstoppable, resulting in certain death. The
first fifty carriers will become ill in the next twenty-four hours.
Protect your loved ones. Evacuate the patients.

At that moment all our plans to save UH came crashing down.

Ten minutes later an assembly of media trucks, reporters, and TV
cameras had rushed in to take up positions outside the army and police
lines. Beyond them was an ever growing gallery of people-hundreds of
them, some still in dressing gowns, some with children, and more
arriving by the minute. The gray morning light had thinned out the fog
enough that I could see all the way to the edge of the grounds. Past
that point the newcomers seemed to materialize out of the mist.

What I couldn't hear or see from my vantage point--the third floor
window I'd been at previously--t learned from the cacophony of all the
radios and TVs around me.

".. . increasing numbers of people here, all of them calling out
names, presumably those of loved ones inside, whether patients or
staff..."

".. . we are trying to confirm that a terrorist has contaminated
University Hospital..."

"... while we have no casualty numbers yet in this fast-breaking story,
we've learned that it could be a disgruntled employee who has released
bacteria into the water supply..."

People near me huddled in small groups, watching and listening to the
various broadcasts, their expressions showing more alarm by the minute.
I could see all our work to keep people calm coming un done before my
eyes.

"It's not true," I started to protest.

"They've got it wrong, all wrong!" But the more I implored them to
stay calm, the more it seemed the newscasters pumped up their fears,
and the more pan icky some of them became.

On the TV screens cameras had zoomed in on patients at windows holding
up signs written on sheets saying get me out of here! save us! help
us! The effect on the crowd was electric. A roar went up outside that
I could hear through the glass in front of me and over the nearby TV
and radio noise. The sound quickly organized into a chant.

"Get them out! Get them out!" The rows and rows of people weaved back
and forth in the mist for a few minutes, seemingly undecided, then
surged forward, pressing in on the lines of soldiers The reporters
were caught between the two and didn't seem to know in which direction
to point their microphones and cameras.

"Get them out! Get them out!" The cry became a cadence for the mob's
advance.

The troops started to back up, but rifles were unshouldered and pointed
upward, over the heads of the oncoming men, women, and in some cases
kids, probably in their teens. I could now hear the cries of the
officers.

"Steady, men. Steady!"

The inner line of police had linked arms, and more officers were
standing firm across the parking lots in front of the hospital as the
soldiers backed toward them. Gone were the police hats; they'd been
replaced by helmets. And the ranks of officers held their riot sticks
out in front of them.

"Get them out! Get them out!"

Most everyone around me grew still as we watched the nightmare unfold
below us.

"Someone do something!" murmured a woman at my side.

The lines drew closer together.

"Oh, God! Stop them!" cried a man standing behind me.

From down the hallway came a shriek, "That's my husband! And my
son!"

The PA overhead howled with electrical interference, then boomed, "Your
attention please, everyone! For the sake of your families outside,
settle down, move away from the windows, and take down those signs!
This is Dr. Douglas Williams, of the CDC.

I'm about to be patched into every radio and TV station out there, and
my voice will be carried over the PA systems on their mobile
units..."

As if to give credence to his claim, the excited chatter of me
commentators from all the nearby portable radios and screens suddenly
gave way to his voice, and Williams was speaking at us from hundreds of
sources. More electronic howls filled the air outside, and the man's
message rolled over the grounds like the word of God.

"Everyone stop! Stop now. Your family members and friends in
University Hospital are safe. Look up! They've moved away from the
windows because they don't want you to rush the hospital and endanger
yourselves."

While he talked, the TV cameras zoomed in on the now dark panes of
glass, showing that no one was standing directly behind them. As they
held there, new signs began to appear: stop! don't do

THIS! WE'RE OKAY!

The chanting down below was diminishing. Most faces in the crowd were
upturned, and people had stopped moving forward. The inner lines of
soldiers and police stood fast.

Williams's voice continued to work its miracle.

"First of all, no one is even infected yet. We are simply doing
cultures on everyone..."
As I stood by the window I began to breathe again. It looked like we'd
dodged another bullet... well, another rocket.

But another one was already on its way.

"Dr. Garnet," said a nurse at my elbow.

"I was sent to get you."

She led me away from the window. I didn't like the look in her eye.

"About a dozen people in the special quarantine ward seem to be coming
down with Legionella," she told me in a hushed voice.

I scribbled a message to Riley. Get more men on the door to special
quarantine. It's starting! I gave it to the nurse who had found me
and told her it was for his eyes only.

The wing Fosse had opened up contained two wards, each with twenty
rooms, four beds to a room. I noticed a few newcomers were being led
to these quarters.

"Day people," explained a nurse.

"They weren't contacted in time to be directed elsewhere."

Even through my mask I could tell the place was beginning to have the
odor of too many people not having had a shower. Fosse would have to
arrange for changes of clothes and toilet articles to be brought in for
everyone here as soon as possible. Civility often started with a bar
of soap.

Two members of Cam's department who hadn't been in the archives had
already confined the suspect cases I was to see in three rooms at the
end of a corridor. As I got near, no one had to tell me that their
symptoms included diarrhea.

"We're sorry to call you. Dr. Garnet," said the younger of the two
physicians after they'd both introduced themselves, "but we know you've
seen the only other case involving both organisms the Sanders woman
and, well, the whole situation is so bizarre we wanted your opinion, to
make sure we weren't over diagnosing anyone."

They weren't. While none of the twelve was very ill yet and they all
had flu like symptoms similar to those of the three nurses I'd seen
last night, they also demonstrated postural hypotension and the
slightly abnormal blood results namely low sodiums and albumins, with
slightly elevated white cell counts characteristic of early
Legionella.
None of them could believe something so serious could begin so
benignly. Over and over I heard, "Except for a bit of dizziness when I
stand up and the occasional rush, I don't feel that bad. Doctor." But
they were scared.

"Will I be all right?" they kept asking.

"I'm certain you will," I kept saying.

Some studied my eyes, and I'm sure they saw the lie. My dread of what
would become of them in the next twenty-four hours was so strong that
they couldn't have helped but sense it.

After examining everyone, I huddled in the corridor with the two ID
specialists. I knew there was nothing I could tell them about the
conventional treatment of Legionella or staph that they didn't al ready
know. What they wanted from me were my observations on how these
particular Legionella and staph infections varied from the norm.

"Smokers will get it the worst, of course, but even the young ones
could be in trouble. The usual age ranges don't seem to apply," I
advised them.

The older of the two I estimated he was about my age raised a skeptical
eyebrow.

"That's hard to believe." His junior colleague flushed above his mask.
I suddenly sensed that there was a dispute between the two men and I'd
been called in as a third opinion.

"Look, I'm just telling you what I've seen," I said to the skeptical
one.

"Like you, I can't explain how these people are being infected."

The younger specialist whistled.

"Man, however this creep's doing it, he must be giving them a hell of a
dose over a protracted period of time " "What else?" the older man
asked me, cutting off the speculation of his younger colleague.

I answered quickly, not wanting to get drawn into their right.

"Even to know whether the oral erythromycin we started them on last
night has some attenuating effect, we'll have to wait and see.

However, I think you can expect the IV treatments they're on now to
work well with the nonsmokers, as far as the Legionella infections are
concerned. But staph remains the real problem for them all. The first
sign of it will be their sputum turning purulent. At that point,
they're terminal,"

While I wrote my clinical notes--the other staff confined to the ward
had prepared charts for each of their sick colleagues--I could tell the
nasal lavaging had begun. Gagging noises started coming from the
direction of the rooms I'd just left, and as I endured the sound, it
was all I could do to keep myself from retching.

No sooner had I walked out of the ward and headed for the exit than a
figure ran toward me from the opposite hallway.

"Dr. Garnet," yelled an unpleasantly familiar voice.

"Wait, please!"

She came right up to me and grabbed the front of my gown. Her eyes
looked frantic.

"Please, Dr. Garnet, I don't belong here. They didn't reach me at
home in time to direct me somewhere else. Now that I'm here, they say
I've got to stay. You've got to make them let me out!"

I reflexively put my hands on hers and tried to pull them off me.

"Really Miss Brown, this is not appropriate. Whatever you think, (his
is for your own safety--" "Safety!" she shrieked.

"I just found out that whoever's doing this--some are saying it's the
Phantom again--has already tried to kill me once, that he gave me my
Legionella infection. I've got to get away. He'll get me again, I
know he will!"

"Miss Brown!" I said as loudly and as sternly as I could without
actually yelling.

"Get a grip on yourself, and think. He can't get you with Legionella.
It has a way of granting immunity, through your white cells, and you're
protected. But he's also got a staph organism that no one can treat,
and your safest place right now is here. Remember, you got ill last
time when you were on vacation. We don't know that he didn't infect
you outside of the hospital. In this ward you're under guard."

"No, please," she persisted, holding my hands in a viselike grip, "I'm
sorry about what happened to your wife. Please, it was an accident.

I never meant that to happen. I never ever wanted that!"

All at once I felt so angry that I had to use every ounce of
self-control I possessed not to tell her how much she disgusted me.
"I

told you, get hold of yourself!" I was shocked by the hardness (hat I
heard in my own voice. Over her shoulder I saw Miller and his team of
technicians being allowed past the guards and into the hallway where
Brown and I were standing.

I don't know if he heard much of our exchange, but he stepped over and
said, "Hi, Dr. Garnet. Quite the job, isn't it?" His mask couldn't
completely hide the pouches that had formed below his eyes from lack of
sleep, but there was no evidence of fatigue in his voice.

"Can I be of any help?"

I nodded at him, then suggested, "I'm sure Nurse Brown would appreciate
it if you did the screenings on her yourself." I released her hands
and stepped away. She looked from me to Harold Miller, her fear still
very evident in her eyes.

Miller stepped over to her, took her by the elbow, and gently said,
"I'll be glad to. Come, we can do it over here on this bench."

While I discarded my protective gear at the doorway in exchange for a
clean set, I watched Miller carefully help the woman off with her
gloves and begin culturing her left hand. She nervously raised her
right fingers to her mouth and started biting on her nails. He shook
his head and pulled her arm back down in her lap. I could hear him
talking quietly as he worked, and though I couldn't make out the words,
he must have been saying the right things, because I thought I saw
Brown's shoulders relax a little.

I quickly ran to I.C.U and again checked on Janet. Once more her
vitals were stable and her sputum remained non purulent but this time I
sensed all the nurses were more guarded in their replies to me.

I knew why instantly. Lurking unspoken among them was the knowledge
that today or tomorrow, as the pneumonia ran its course, they'd know
whether Janet had also been infected with staph. They were
instinctively taking their professional distance from both of us,
preparing themselves to have the clinical objectivity they'd need if
the worst happened. Janet was awake when I went into her cubicle.

"From the eyes up, you look worse than me," she said hoarsely, then
started coughing uncontrollably.

I ran through the night's events, but not wanting to frighten her more,
I left out the attack on me and Williams. Fosse had had the telephone
lines reestablished, so we then called Amy at home. She was desperate
for word of us, having watched all (he TV coverage, but we settled her
down with multiple reassurances that we were okay. When she held the
receiver up to Brendan, we made tender noises at our son and listened
to his happy babble, escaping for a few blissful minutes the nightmare
that had trapped us. After hanging up, the feeling of being cut off
from him hit me like a weight. From the desolate expression in Janet's
eyes I knew she was battling a similar feeling. I don't know who broke
into tears first, but we held each other for what seemed like a long
time be fore either of us could stop.

"Call and check on Michael," Janet quietly ordered me when we'd both
dealt with our sniffles in the aftermath.

I punched in the number for St. Paul's intensive care unit and endured
the usual wait for someone to pick up the phone.

"I.C.U," answered a woman's voice.

"It's Dr. Garnet. I'm calling to inquire how Dr. Popovitch is
doing."

"One moment please," she said coolly and put me on hold.

Oh Jesus, I thought. Janet immediately sensed my alarm.

"I'm on hold," I whispered to her.

The phone clicked.

"Earl, it's Stewart Deloram speaking."

My fear reached the screaming point.

"Stewart, why are you there?"

"I'm half back in the saddle, helping out a bit," he said quickly.

"But I'm afraid I've bad news. Michael's sputum became purulent
overnight. We've done Gram stains of course, and the only glimmer of
hope is we can't see staph. The pus may be debris from parts of the
lung where the Legionella has knocked off the circulation, but in any
case he's not doing well."

The words thudded on me like rocks at a stoning. I could barely
speak.

"Does Donna know?" I asked. Janet's eyes widened in panic on hearing
the question.

"He's alive," I whispered, covering the mouthpiece for a second.

"Yes, of course. She's handling it very well."

There was nothing more to say. Stewart was initiating the routine to
prepare the family for death.

"Stewart, I'm glad you're there," I told him, then hung up before he
could ask me anything about the situation here.

This time Janet and I didn't cry. I think we felt too emptied by the
shock. We simply held each other and rocked.

* * * Williams had prevented a riot, but he hadn't managed to defeat
his greatest nemesis--panic. Despite his best attempts to get everyone
to stay rational--me media, the crowds of people outside, and most of
all the politicians--he couldn't convince them that the isolation
procedures and the plan to replace our own staff with outside personnel
were measures enough to keep the patients safe.

It was a little after 10:00 when I found him standing by the same
window I'd been looking out earlier. He was slumped against its frame,
shaking his head, and staring at the scene below.

"The mayor and governor folded to the pressure," he said forlornly
without turning his head.

"They've ordered the evacuation of the patients."

Below us was the largest number of ambulances I'd ever seen parked in
one place. The drivers were lounging against the doors, chatting and
waiting--all of them wearing masks, gowns, and gloves. Farther out a
few dozen army trucks had been backed up to the edge of the parking
lot, their tailgates down. Those drivers were also in protective gear
as they relaxed, sat around, and in some cases even snoozed in their
cabs. The media and crowds had pulled back toward the outer edge of
the property. Half hidden in the mist, they stood quietly observing
us, waiting for our next move, like a chorus fallen momentarily silent
but still ready to offer its commentary.

"We're to start moving out the patients at 10:30," Williams informed me
as he walked away.

Once the word was given to get ready for the evacuation, the patients
had gotten more nervous, not less. During the hurried preparations, I
saw masks half tied, gowns left open at the back, and gloves not pulled
up properly over the ends of sleeves. If by a remote chance one of the
evacuees had already contracted the super bug these half-assed measures
wouldn't be much protection against it being spread around once he or
she got outside.

Those who could walk milled about the exits while waiting to leave,
some pushing their own IV poles. Those who weren't mobile sat in
wheelchairs, orderlies standing at the ready. Staff had transferred
the bedridden to stretchers and would roll them to the backs of the
waiting trucks. It looked like the starting line for a bizarre race.

Williams had told me that hospitals all over the county were making
isolation facilities available to receive our transfers; even military
installations had opened up. Off-duty medical personnel from other
institutions, called in to take over, would care for the patients we'd
be sending them. The staff of UH, including those not in the target
group, were meant to remain in quarantine here, until the culture
results cleared them to leave.

At 10:30, floor by floor, they started out. Despite shouted orders to
go slow, the people who could walk inexplicably rushed to get
downstairs, crowded into elevators, or tried to pass the person in
front of them as if a few seconds longer in the place could be fatal.

The ones on wheels were at the whim of their drivers. The whole
process was as frantic as if someone had cried, "Abandon ship!"

I was asked to join with other physicians to assess high risk patients
in critical-care areas--unstable car diacs patients in shock, those on
respirators, the list was endless--and pronounce on their suitability
for transfer. It didn't take long to see that in some cases the trip
would kill them. On the issue of no risky transfers being made the
physicians stood firm. I.C.U here would remain fully operational,
security would be provided around the clock, and nobody would be
allowed near any of the remaining patients without an order
countersigned by two other doctors. Acute resuscitations would only be
done by the two intensivists on site. In other words, no one could
come close to a patient on his or her own initiative and slip them
something.

We were also told there'd be no replacement of our I.C.U staff by
outside people. The other hospitals were so overloaded by our
patients--both the ones we'd sent them and our share of the new
emergency cases that came in daily from all over the city--they no
longer had personnel to spare.

Janet insisted on staying.

"I.C.U will be one of the safest places in the city," she said sadly.

I told her that she was probably right but that I was keeping the
private security guard at her door, just in case.

I watched the final stages of the evacuation from what had become my
usual vantage point on the third floor. Lines of patients were still
winding their way across the grounds to the waiting trucks and
ambulances. Overhead I could hear the sounds of helicopters, the
staccato of civilian rescue craft mingled with the unmistakable
wall-pounding window-rattling thudding of a large Blackhawk provided by
the army. The fog had lifted enough for them to transport the sicker
cases.

We'd lost. He'd won.

Patients, not doctors, nurses, or any other kinds of staff, were the
true lifeblood of a hospital. It was patients who gave the hospital
its purpose, its mission, its reason to exist. As I watched from my
spot high above, they streamed out the doors, the long lines looking
like rivulets of fluid flowing away from the sides of the wounded
institution. In my mind I heard his terrible low rolling laugh, and I
couldn't help thinking that just as I'd seen him destroy Phyllis
Sanders from within, cell by cell, I was seeing him exsanguinate
University Hospital bleed it out, patient by patient.

The only person I knew who had reason to hate this place so much was
Cam Mackie.
Chapter 22

I kept having to steel myself for what lay ahead.

Just as the fate of Janet and Michael would be decided within the next
forty-eight hours, so too would the outcome of the detainees at
University Hospital. Some of those already infected with Legionella,
if they were carrying staph, would be dead, while others would know
they were dying. Others still would be told they were carrying death,
even though they were not yet ill, and would be kept from leaving.
Although the vast majority would ultimately go home, their cultures
negative, the dreadful uncertainty affected everyone and hung over the
hospital like a fearful shroud.

Meetings were hastily called to flesh out how the dying would be
handled. How much should we tell them? Did they want a final visit
with their family members? Should we allow them to touch? Could
mothers hold their children one last time? Should we then culture the
family members and hold them in quarantine? What about counseling?

I saw people coming out of a planning session. Their eyes were huge
and white in dark sockets.

Overhead the Blackhawk pounded the air with its rotors as it came and
went, carrying away six stretchers at a time.

And all the while we struggled with how to stop the killer from
infecting more victims.

"You have to figure out how he does it," Riley kept demanding.

But no one could.

While Williams and the ID specialists continued to search for the
unifying link in the archive files, Riley ordered me to visit every
other department that Michael had been let into.

"But take one of my men with you," he added, glaring at me like a stern
parent.

Even when Doris Levitz and her group from Atlanta finally arrived in
the early afternoon, Williams managed to persuade them that their most
pressing priority should be to help out with the work going on in the
archives. I saw his point. Those files involved the largest amount of
data to be gone through, and unlike Riley, I hadn't dismissed the
importance of what we might find there.

Every few hours I continued to call I.C.U at St. Paul's. Michael
remained in limbo, connected to life by a respirator, hovering near
death. Deloram still clung to hope because he couldn't find staph in
the debris he kept suctioning out of Michael's endotracheal tube. After
I hung up, I remembered to take my third pill oferythromycin.

I checked in with my ownER and found out from Susanne that they were
coping. I answered her questions about UH as best I could, but when
she asked if Janet and Michael would be okay, my own fears were so near
the surface I found it impossible to answer.

The Blackhawk was thundering overhead on yet another of its trips, and
I used the noise as an excuse to end the call, claiming I couldn't
hear.

I then joined in the paper chase and spent the afternoon tracking down
what Michael had looked at. The Blackhawk continued to come and go,
its sound making itself heard everywhere I went, including the
basement. By evening, after about two dozen trips, I heard it no
more.

The ID specialists were repeatedly called away to the special isolation
ward as more nurses and orderlies developed signs of early Legionella.
I learned from Williams that there were another ten cases and that some
of the infected women I'd seen in the morning were already showing
evidence of severe respiratory distress.

"Purulent sputum?" I asked.

"Not so far," he answered.

During the evening Cam's disappearance increasingly became the subject
of whispered conversations throughout the hospital.

From the fragments I heard, half the gossipers thought he was the
killer, while the other half were as adamant as Janet about his
innocence.

I made calls to I.C.U at St. Paul's almost every hour now. Nothing
had changed, but I felt certain I was on a death watch.

By 10:001 could no longer keep my eyes open and had a cot put in
Janet's I.C.U cubicle beside her bed. After yet again checking her
chart and grilling the nurses to confirm there'd been no change in her
sputum, I fell asleep holding her hand.

Michael lived through the night. I called St. Paul's as soon as I
woke up, using the phone at the nurses' station so as not to disturb

Janet. But his condition was otherwise unchanged from yesterday
evening.

I showered in the surgeons' changing room, switching my over ripe
clothing for OR greens and putting on clean protective gear.

Another day in the dungeons, I told myself after grabbing a coffee and
heading into the subbasement. The pleasure of the caffeine was doubled
by the brief respite from the mask that I enjoyed each time I lifted it
to drink.

Though it was only 7:00 a.m." I found Williams in the archives
explaining to Riley what his group had found after working all night
"... it wasn't something the charts had in common that was there.

It was something that wasn 't there."

Riley nodded at me as I joined them. Williams went on speaking.

"Each nurse had participated in a sterile procedure on a patient
sometime during their last few days at work."

"I thought you said all the stuff they did during that time was
routine," Riley said.

"We did. What wasn't routine was that on each occasion, the sterile
procedure had never been ordered by anyone."

Now he had Riley's attention.

"Go on."

"The procedures themselves were varied. A dressing change, a culture
of a suture site, a bladder catheterization to obtain a sterile
specimen. But in each case there was never an order for the procedure
entered on the patient's chart. Nor was there any clinical evidence of
a suspected infection according to the doctor's notes on any of the
charts."

"How could unordered things be done to patients, and no one catch on?"
asked Riley.

Williams explained.

"These procedures are so ordinary, a nurse wouldn't even check a chart
to see if there was a request."

"Wouldn't the person asking have to be a doctor?"

"No, anyone in the care chain another nurse, an assistant nurse, a
medical student could catch the targeted nurse, say that a culture or a
dressing change was to be done on so-and-so, and ask the nurse to help.
Even a porter might turn up with a requisition and claim the lab had
sent him to pick up a sterile urine specimen from the lady in room such
and such that they'd lost the one from a few days ago.

A nurse would oblige."

"What if someone did notice there was no written order?"

"Mistakes aren't common, but mix-ups do occur. Sometimes the old joke
about getting the enema meant for the person in the bed next to you
isn't far from the truth. Occasionally the confusion has serious
consequences, like medication being given to the wrong patient.

But on the level we're talking about, these procedures are very benign,
common as dishwater, and, apart from the bladder catheterization,
wouldn't cause any upset even if the patient knew they'd been done in
error. What's puzzling is that these procedures all required the nurse
in each case to don protective gear. Their contact with the killer
must have occurred when they weren't protected.

Riley's eyes widened.

"One of those nurses. Brown, is alive.

Does she remember anything about it?"

"Unfortunately no, but we only talked with her briefly. Perhaps you'll
want to spend more time questioning her. As I said, though, with the
procedures themselves being so ordinary, it's unlikely a nurse would
remember doing one or another. We even called the patients.

They couldn't recall such minor events either; this isn't surprising
given everything else that was probably done to them while they were
here."

"But the person initiating the procedure could be with the nurse he'd
targeted while that procedure was being done?"

"Like we said--another nurse, a resident, a porter waiting for the
specimen--anyone of them could be in the room and none of them would
have their presence recorded on the chart."

"Can either of you think of how someone could use those procedures to
infect the nurse?" Riley asked us.

"Unfortunately, not yet," Williams answered.

I simply shook my head.

Riley remained excited, despite our failure to furnish him with the
killer's technique.
"I can get my officers to go over old duty rosters and question
everyone present on the wards when those unauthorized procedures were
done," he declared.

"With exact times and dates, it's just possible someone might remember
something!"

He looked over at me.

"Did you get to those other areas where Popovitch had been?"

"Yes I did," I answered.

"It turns out that Cam had been there as well. He'd left Nurse Brown's
chart out in staff health, and in the repository where they keep former
records of the deceased, I discovered he'd left out the old charts of
Sanders and the OR nurse. But I didn't find anything as dramatic as
what Dr. Williams came up with."

"You didn't disobey me and go back there alone?" Riley snapped, his
eyes suddenly clouding over.

"I had one of your men posted on the door, as you ordered," I reassured
him. I reached under my gown, slipped my cellular phone out of my
pocket, and held it up for him to see.

"Besides, I can always dial nine-one-one."

Williams laughed, but the scowl on Riley's face only deepened, Since
the attack on me and Williams, Riley had been adamant about precautions
for our security. He would have been even less pleased to hear what I
hadn't mentioned--that his man had been repeatedly called away to help
his colleagues settle the frequent disputes that we'd seen breaking out
all over the hospital. Not surprisingly, with the patients gone and
nothing to occupy them, many of the staff were finding the wait an
unbearable strain, especially those confined to the wards where the
Legionella cases were breaking out. There was also trouble involving a
few people with previously unknown drug or alcohol dependencies, and
some particularly nasty encounters occurred when some of them started
going into withdrawal.

Whatever the cause, squabbles sometimes became physical and required
the intervention of many police officers at a time. I'd finally sent
Riley's man to fetch the portable from my car, just in case I needed
help fast during one of the frequent times he was away. Since I.C.U
and the isolation wing were the only parts of the hospital still
functioning, I'd felt it was safe to use the device this far from dose
places.

"Please continue," Riley said.

"Everyone here thought it was blind luck that two weeks before
contracting her pneumonia Phyllis Sanders had been screened for staph
and found to be negative. My own wife commented on how fortunate that
was, because it meant the hospital only had to screen the OH patients
and newborns who were on the ward during that two week period. What's
odd is that when I checked the charts of Brown and the OR nurse, they
also had negative screening results dated two weeks before they
contracted Legionella" "What's the significance of that?" Riley
asked.

"The fact they were screened is not unusual. With MRSA's being a
problem in a lot of hospitals these days, such screening is common.

But the timing for all three, I think that might be more than
coincidence."

He sighed.

"Can't you just tell me what it means?" He was starting to sound
impatient again. Being forced to rely on medical experts for
information rather than doing his own investigative work seemed to be
driving him crazy.

"I wish I could. A clerk named Madge in staff health who was called in
to help was pretty talkative after she'd ended up sitting around doing
nothing all day. Through her I was able to check out the whole process
by which screening is carried out. I wanted to see how it could be
used to target three specific nurses at precisely two weeks before each
left on vacation, but frankly I'm mystified. The whole operation is so
loose--wards are done randomly and many people are involved in the
taking of specimens--that I've no idea how the killer could have
manipulated the routine so precisely.

Maybe your men could interview Madge and find something I missed."

Riley didn't say anything at first. While Williams had given him a lot
to think about, I felt that I'd been less helpful.

But the detective apparently thought otherwise. His eyes shed the
defeated look they'd had five minutes ago.

"Thank you. Dr. Garnet," he acknowledged with a nod.

"I'll talk to Madge myself. Maybe I can get her to tell me how she'd
go about setting up a screening timed to a specific nurse's vacation."
He gave me a wink and added, "You know my method." Turning to
Williams, he asked, "What are you going to do now?"

"Continue checking these charts," Williams said, patting one of the
stacks on the table beside him.

"Sometimes lab requisitions are initialed by whoever does the test.
We're hoping the Phantom may have supped up and shown a requisition to
his target as a way of getting her to do the procedure."

After Riley left, I asked Williams, "Are there new cases upstairs?"

"Yeah, seven more were diagnosed with Legionella overnight-five
orderlies, a doctor, and yet another nurse. His range of victims is
wide."

"What about purulent sputum in the cases from yesterday?"

"None," he answered.

"It's still too early."

Purulent sputum developed in four of the nurses before midmorning.

Six more followed the same course early in the afternoon. I heard
later that they all knew what it meant without being told.

Throughout the rest of the day whispered accounts about how they were
doing kept coming from the ward and were relayed throughout the
hospital.

"... emotionally, she's taking it amazingly well, simply asking for a
priest..."

"... desperate with fear, but who wouldn't be, knowing you're going to
die?"

"... can't accept it at all, raging one minute, sobbing title next,
unable to get her breath..."

We heard that all of them were deteriorating medically agitated from
air hunger, plucking at their nightclothes, wracked with wheezing while
coughing despite frequent treatments with bronchodilators and high
concentrations of oxygen. The descriptions gave me visions of
Sanders.

Statements of wishes were hurriedly obtained from them regarding what
resuscitation measures they wanted performed once they stopped
breathing. Some were adamant "No tubes down my throat" Others couldn't
face the issue and became hysterical when it was raised.

Husbands were told their wives were dying; wives were told their
husbands were dying. Counselors quickly met with family members to try
to prepare them for visits. Staff explained isolation procedures in
hastily arranged meetings.

"Of course families can touch, except infants and the very elderly," a
doctor or nurse would say, "provided you accept that you'll be screened
and kept quarantined in your home afterward."

The reports of what was going on became more disturbing as the
afternoon drew to a close.

The plea heard most often from the victims was, "Don't let me die
alone."

"I beg you, sedate me, sedate me, please," one of the nurses had
sobbed, "so I won't break down in front of my children."

No one wanted to risk bringing infants into the hospital. Fosse
ordered arrangements made instead so that families could carry their
babies across the grounds and approach the outside windows of the
isolation wing. Nurses and orderlies took mothers in wheelchairs or on
stretchers to the ground floor and allowed them to take off their masks
so they could try to smile at the tiny bundles held up to them on the
other side of the glass. Two nurses had to support one woman as she
leaned forward to catch a glimpse of her little son while her husband
lifted him toward her. She bravely managed to smile down at him for a
few minutes, then collapsed completely, racked by sobs and wailing, "I
want to hold him. I want to hold him." Cleaning crews standing by to
resterilize the place couldn't bear to watch.

The two ID specialists I'd met on the ward yesterday shared identical
expressions now, no difference of opinion evident in their haggard,
haunted looks. They both kept joining us in the archives during the
intervals when nothing further could be done medically, and counselors,
along with men of God, had moved in to replace them at the bedside.

"I can't stand it on that floor," the middle-aged one confided, "but
hunting the bastard who did this helps keep up my nerve to go back
in."

The outbreak of purulent pneumonias only increased my vigilance over
Janet's progress ... and my despair. During ever more frequent visits
to her I kept fighting back images of what those families were going
through a few floors away. Nor did I want to speak about them with
her. Their agony was so close at hand and could so easily become our
own that I couldn't bear to acknowledge it.

Rather I made small talk, called home with her to speak with Amy and
Brendan, or simply held her hand.

I brought her news of Michael each time I came. If I stayed with her
for more than an hour, she wanted another update before I left. I made
those calls from the nurses' station, not to put her through the agony
of hearing a one-sided conversation as before. But it was still hard
on her. She would watch me through the window of her cubicle for my
nod that he was still alive.

Afterward Janet and I would huddle together, helpless in a modern I.C.U
and left to praying that we'd all be passed over by the contagion in
our midst.

What kept me searching through records was my certainty that Michael
had found proof of how the Phantom infected people. I'd also begun to
suspect from our own piecemeal progress that the pattern which had
revealed this proof to him might not be found in some single set of
charts or solitary collection of records. Rather, I thought, it could
be the kind of pattern that emerged only after he'd looked at a lot of
sources and gathered together observations from all of them.

Around 10:00 that evening, after making no further breakthroughs with
the charts in archives, I took a new tack. If Cam was the killer, then
what had been done to his father in this hospital was the sole reason
behind the vendetta. Could his targets have had a direct link to the
way his father had been treated here? Perhaps Phyllis Sanders had been
his nurse. Perhaps Brown as well. She was young, but might have been
involved just before the man died. In the later pictures of Cam with
his father that I'd noticed in his office, Cam had appeared to be in
his mid-to-late twenties. I presumed that meant his father had died
around ten years ago.

The man's chart, I speculated, could hold a list of the intended
victims. Not only would we then know who needed special protection,
but we could also be ready to grab Cam when he came for those whom he
hadn't yet infected.

"It's worth checking," Williams agreed wearily when I told him my
idea.

"We're not getting any further here."

I figured Mackie senior's record would be stored on microfilm in the
repository with all the other dossiers of the long dead. Security and
the police said that they'd let me back in but they couldn't spare a
man to stay with me right then.

"Fine, I've got my phone," I told them. I'd also noticed on my
previous visit that the door to the room had an inside bolt, probably
from the days when a photographer worked on-site processing film and
didn't want to be disturbed.

Once I got inside, it took me a few minutes to figure out the index
system, but in no time I was spooling the chart of Mr. Stephen Mackie
through the view finder. It was a sobering experience. The entries
were a record of one man's encounter with one of the great scandals of
U.S. health care and with the plague of the century.

Page after page documented his ordeal with hemophilia, me record
showing repeated visits toER for treatment of painful bleeds into his
joints. On each occasion he had received an IV administration
ofcryoprecipitate, a preparation of the clotting factor he lacked which
was collected from the blood of multiple donors, and on each occasion
he'd had to fight for adequate treatment of his pain. The nursing
notations made me wince. Suspect patient is exaggerating complaints of
discomfort: try placebo saline. In other words, they'd injected simple
salt and water, subjecting him to hours of agony before giving him the
morphine he'd needed. These entries went on into the eighties and
continued through the years in which thousands of hemophiliacs like him
had been infected with AIDs through cryo-precipitate prepared from
contaminated blood. The policy of paying individuals to give blood,
which always encouraged indigents and street people to donate and lie,
was never wise, but it was outright negligence to have continued the
practice long after word was out in the streets that "Slims" or the
"Gay Plague" also was occurring in mainline drug addicts.

Cam's father, I read, was diagnosed in 1985, after a bout of protracted
fever, diarrhea, and weight loss. At that point he was forced to stop
working in the labs, and his visits toER increased His course was
typical and quick--treatment then was primitive, limited to drugs like
immuran--and he fell victim to the ravages of previously rare
infections that became a familiar litany to physicians from the
mid-eighties on: bizarre pneumonias caused by a protozoan organism
called Pneumocystis carinii--treated in those years with tetracycline
and Septra but never completely defeated--or lumps of other protozoa in
the brain, a condition called toxoplasmosis gond ii which produced
seizures as they ate into the neuronal circuitry-again diminished by
toxic drugs that I could barely pronounce, and again never completely
eradicated.

Each event took a piece out of him, left him farther down the slope
toward death. Here too the nurses' notes were telling, to his credit.
Patient cheerful, optimistic, spent time chatting with his son.

A few days after one such entry he died--3:10 a.m." Monday, August
31,1987.

I'd found no signature of Phyllis Sanders or Brown or any of the other
names I'd been keeping an eye out for. My idea was wrong.

But I'd learned a lot about Cam's father and liked all of it. I also
had a good idea of the forces that had shaped Cam, but whether it was
for the better, as Janet believed, or for the worse, I still didn't
know.

I was returning the roll of microfilm to its receptacle on the shelf
reserved for Af's when my eye caught another name on the index card
posted for that section. Miller, Mrs. Phyllis Sanders. Below that I
read Miller, Dr. Carl.

It took me a moment to realize what I was looking at. The chart of
Phyllis Sanders was still on the table where I'd been looking at it
yesterday. It wouldn't be microfilmed. Then I understood. When she'd
resumed the use of her maiden name after her husband had died, they had
made a new file, the one I'd already seen. In effect, she'd buried the
medical record of Mrs. Carl Miller alongside her dead husband's. I
wondered if it had helped her bury the memories of living with an
alcoholic.

The silence in that room was absolute, befitting a record hall for the
deceased. Not even overhead plumbing dared to disturb the stillness.

I felt drawn, almost morbidly compelled to know more about the woman
who'd become such a nemesis in my life. My impulse to look at the
record made me uneasy, as if I'd caught myself wanting to find
something in her past that, if I learned it, would explain or excuse my
inexcusable reaction to her. Bet I wasn't in the habit of trying to
hide from my mistakes. Part of the psychological price of going to
work in ER every day was learning from my errors in judgment and living
with having made them. I'd like to believe my compulsion to look at
her record came from another impulse, a need to understand her, to do
her the justice of seeing beyond what I'd found so annoying about her.
It was a service I owed her, maybe even one I owed myself.

Spooling through the clinical notes of an alcoholic's wife is
predictably agonizing. Her depression, her anxiety, her need for
ever-increasing amounts of antidepressants and tranquilizers--the
entries read like an Al-Anon brochure. She too had had many visits
toER--for sprains, bruises, and even for a few black eyes--all the
events accompanied by improbable explanations of clumsiness, tripping,
or walking into a door. Social workers had interviewed her several
times about whether she was being subjected to physical abuse at home,
but she'd adamantly denied it One therapist had interviewed Harold in
his mother's presence when he was around ten years old. Questions
about his eating, sleeping, and performance at school had gotten pretty
ordinary answers.

The interviewer noted that Harold appeared well cared for, that he
answered inquiries forthrightly, and that he appeared to be
appropriately affectionate with his mother. This interviewer then
documented asking a question of Harold about whether he was prone to
accidents. Both he and his mother denied this. At the bottom of the
page the interviewer had written No evidence of need for intervention
on child's behalf, but FU?

I spooled ahead, yet as far as I could see, no follow-up had
occurred.

Had the social worker backed off, because Cari Miller was a doctor on
staff, or was there nothing to follow up? Even if there hadn't been
legal cause for concern, growing up between Carl and Phyllis Miller had
to have been difficult for Harold at best. No wonder he was so
awkward.

Phyllis had fewer visits to staff health after that and no more visits
toER with suspicious bruises. Had Carl Miller stopped abusing her?

It was unlikely, but maybe the threatened intervention of the social
worker had frightened him. The chart ended with a minor entry about
her receiving a hepatitis B vaccination sometime in 1985. I'd been
spooling so quickly at that point I didn't realize at first that her
chart was finished, and I overshot into the portion of the film showing
Dr. Carl Miller's chart. There wasn't much to see in the section I
inadvertently looked at a few scanty notes documenting his visits to
staff health dated years apart, occasional blood results showing his
worsening liver enzymes, and a few referrals to psychiatry for what had
been coded as stress but were probably attempts to get him help for his
alcoholism. None of the appointments had been kept.

I knew I had no business looking at his file, but I was tempted to keep
going. It was, after all, the subtext of Phyllis Sanders's story.

Nothing would excuse the way she'd vented her anger on helpless
patients and had become a punisher, but abuse begets abuse.

I brought more of his chart into view.

What I expected to see was a chronicle of increasingly frequentER
admissions for the catastrophes of excessive drinking GI bleeds,
pneumonias, seizures, delirium tremens, cirrhosis but he must have gone
to another hospital for those. What I was looking at was a single ER
entry on the night of his death. Like ten percent of alcoholics, he
died by trauma in this case a tumble down his basement steps, resulting
in a fractured skull. He'd been pronounced DOA in emergency. An
autopsy had confirmed the fracture and determined that the cause of
death from the trauma was a massive intracranial hemorrhage, aggravated
by the way cirrhosis leaves drinkers prone to bleeding.

I rewound the microfilm, sending me pages of Carl and Phyllis Miller's
epitaph whirling backward in a blur. Looking through their record
hadn't entirely been a waste, I thought, depressed by the misery
conveyed in those pages. It had certainly increased my sympathy for
Harold.

Minutes later I'd returned the film to its slot and was out the door
going down the corridor when my cellular rang. Surprised, I flipped it
open, only to hear Williams yell, "Garnet! He's infected a nurse after
she'd been put into isolation."

"What!"

"I'm in with her now. It's not pneumonia; it's a cellulitis of her
hand. We got enough pus for a Gram stain; it's staph."

I could hear a woman shrieking in the background.

"Who the hell's that?" I asked him.

"It's her," he answered.

"We're trying a cocktail of antibiotics, but I'm not optimistic. She's
just heard from the surgeons what has to be done. The cellulitis is in
her right hand. The redness and swelling were present locally around
her nails when she got up this morning she noticed it when she went to
change gloves but she's a nail-biter and has irritated them before, so
she didn't think much of it. It still didn't bother her too much
during the day, but she woke half an hour ago with high fever, marked
swelling locally, and lymphangitis present halfway up her arm."

Lymphangitis blood poisoning they used to call it is in fact an
inflamed lymph duct, or channel, carrying a clear fluid full of white
cells, called lymph. The condition is recognizable as a red line that
starts at the site of a local skin infection and then extends along the
course of the underlying lymph duct, usually proximally, or in this
case up the infected limb. You died, lore had it, when the poison
reached your heart, which was presumed to be shortly after the red line
reached your trunk.

Today we know that people die when the organisms and their
tissue-destroying toxins flood from the original site of infection into
the bloodstream and seed themselves everywhere throughout the body. Yet
we still use the red line as a marker of how the infection is
proceeding and as an indication of how it's responding to antibiotics
Prior to the discovery of penicillin, however, doctors used the
progress of the line to determine when and where to amputate.

The screaming and sobbing in the background became words.

"... I knew he'd get me! I told Garnet he'd get me! And now you're
going to cut off my fucking arm!"

It was Brown.
Chapter 25

"Don't come up here," Williams insisted.

"You're the last person she wants to see."

"How do you know she was infected after being quarantined?"

"We're pretty certain. It's around thirty-six hours since she was
screened on arrival, and there's absolutely no growth in her
cultures.

Somehow he's infected her since then." The screaming started to
crescendo in the background.

"I've got to go," he snapped, and the connection went dead.

Despite Williams's warning, I was determined to go upstairs and talk to
Brown, no matter how much it upset her. The ordeal she faced was
ghastly, but with so much at stake and with so few leads, she had to
answer my questions.

I continued to hurry through the oppressive passageways, following a
set of turns which I was used to by now, and was completely lost in
speculation about how Brown had been infected. Cam couldn't have done
it by going on the ward in person, I thought as I rounded a corner and
headed down a particularly musty section of hallway.

His six-foot-five-inch frame would have been too easy to spot.

Maybe he'd contaminated the ward--left colonies of staph where people
would touch them during the times they wouldn't be wearing gloves, such
as when they were showering. There was an article in the MMB once, I
recalled, that documented an incident in which an MRSA outbreak was
traced to a soap dispenser in an OR. And I'd check with Miller, I
decided, to find out if there was any way that Cam could have tampered
with the specimen after Brown's screening.

I was somewhat startled by the sound of a door slamming somewhere
around the next corner. Instinctively I slowed. Down here it didn't
take much to crank me up into a full panic. Echoes of that hideous
laugh raced through my mind and fed my sudden fear that the lights
would go out again.

The repository was located in its own region of this netherworld, away
from the archives, so it wasn't any of Levitz's group or the ID
physicians who'd been working there. I heard another door close-this
time the sound seemed closer--and I thought I could hear approaching
footsteps. It could be one of Riley's men doing another search, I
thought, but I'd nearly had my head split open twice now, and I wasn't
going to take any chances. Tiptoeing, I backtracked, hoping to make it
to the repository where the door had a bolt. Whoever had come after me
in the human resources department had had a key, perhaps even passkeys.
I kept watching the corner as I retreated from it, moving along with my
back to the wall. Another door closed, and the footsteps came closer
still. I wasn't going to make it to the next turn in the corridor and
out of sight before whoever it was saw me. Reaching behind my back I
tried one of the doors I was passing. It was locked. I moved more
quickly now, less conscious of noise, only concerned about getting
away. I tried another door. It opened. I backed inside, found myself
in a small room full of boxes, and quickly locked myself in. I stood
in the dark and tried to control my breathing as the steps and the
sound of doors opening and closing came nearer. Was he looking for me
again? Was it merely one of Riley's men after all? I heard the rattle
of a nearby handle that was tried and didn't open. The steps then
continued, coming nearer, nearer. I was next.

I leaned my weight against the door and held my breath. I heard the
knob turn, feeling the movement transmitted through the ancient wood as
I pressed on it with my shoulder. The possibility he could probably
kick it to splinters if he knew I was in here flashed through my mind.
He gave the handle two more hard twists, then walked away.

I let out my breath, hardly able to believe he'd passed me by. My
first impulse was to let him get out of earshot and then call Riley on
my cellular. Let the police nail him, I figured. Then I thought, what
if the police don't get here quickly and quietly enough, and we lose
him again? I heard more doors opening and closing, the sound receding
each time. I quickly recovered my nerve, took a breath, and as
silently as I could, released the lock to open the door a crack.

He was thirty yards away, just rounding the next corner and passing out
of sight. But this time he was close enough I could tell immediately
who it was, even from the brief glimpse I'd gotten of him.

Gary Rossit was prowling the subbasement of University Hospital.

I felt as if an earthquake had rumbled through my head, toppling all my
ideas and suspicions about Cam's being the killer. Dashed as well was
Janet's theory that the Phantom was some unknown figure who'd framed
Cam. The sight ofRossit resurrected the notions I'd had about him in
the first place that he was involved in a brutal plan to sabotage
University Hospital. The possibility I could have been right all along
was almost as big an upheaval to me as seeing him there. But how had
he gotten in?

I didn't have time to stand around and try to answer that question.

I could hear him making his way down the next corridor as he continued
to open and close doors. I decided I'd call Riley as soon as I learned
what Rossit was doing or where he was headed and ran on my toes to
where he'd disappeared into the next corridor. There I peeked just in
time to see him pass from sight into yet another passageway.

I continued after him, wondering if he were after me. Possibly, except
he wasn't using much stealth. In fact, all the noise he was making
made it an easy matter to follow him. I thought again about calling
Riley. But what would the detective grab him for, slamming doors? All
at once I had to backpedal in my thinking. Even his being here
wouldn't give the police reason to arrest him. For all I knew he might
have walked through the front door and signed in. As the chief of the
infectious disease department at St. Paul's, he'd certainly have a
joint appointment at this hospital, the way I had. Now that I thought
about it, given the circumstances, especially with Cam's disappearance,
it was perfectly natural he might come in, offer to look around, and
see what he could see. When I peered into the next passage, I saw he
was past the repository and crossing the far inter section, heading
straight into a part of the subbasement I'd never entered before.

Better tag along, I thought But I had to wait a while to let him get
farther ahead of me in this next section it stretched into the distance
as far as I could see until I could safely follow from a long way
behind and use recessed doorways to hide in. I'd no idea where we were
headed, and the manner in which he kept poking around, sticking his
head into every room he could, I began to wonder if he had any specific
destination in mind. He seemed instead to be searching for
something.

Lucidly for me the overhead lights were dim and spaced far apart, so I
had lots of shadow to cover my moves while I skirted along the wall
from doorway to doorway. Here and there rows of boxes were stacked to
the ceiling, affording further cover when I needed it.

As we progressed in tandem through this lengthy tunnel, I kept looking
beyond where Rossit was peeking into yet more rooms until eventually I
could make out where the passageway ended against a larger door than
the rest which was illuminated by a solitary lamp hanging over its
portal. Between it and where I was standing in one of the shadowy
spots, there was very little light and many more piles of boxes, but if
I didn't want to be seen when he started back, I figured I'd better get
into a hiding space now. Although Rossit was short, his torso and arms
had always given me the impression of considerable strength, and I
didn't savor the idea of his finding me down here while I was spying on
him. I even wondered if I hadn't al ready had a taste of how powerful
he was two nights ago when I'd had my own arms pinned, my gut slugged,
and my head rammed into a door.

I found a dark area behind one of the nearby stacks of boxes and
crouched down, still keeping an eye on Rossit making his way toward the
end of the passage. When he arrived in front of that final door and
reached for the handle, I figured he'd give a quick look, like he'd
already done to a few hundred other rooms down here, and then return
toward me. Watching him slowly push it open, I got ready to hunch over
in the shadows. But instead of simply glancing in, he stood at the
threshold a few seconds, then stepped inside, leaving the door open
behind him. I waited for about a minute, watching, thinking he'd come
out any second. He didn't.

Overhead some pipes clanked. Otherwise the place was completely quiet.
I began to feel cramped staying in one position and tried to shift my
legs to make them more comfortable. As I waited, an ever so slight
hint of something pungent and overripe penetrated my mask and invaded
my nostrils. Probably a rat had died behind the boxes I was kneeling
beside.

Suddenly from the room Rossit had gone into I heard a creaking noise,
like rusty hinges. Then there was silence again. Was there an other
door out of there? I kept my breathing slow and shallow so I'd detect
the slightest sound that might indicate he was still inside.

Nothing.

The pipes overhead clanged especially loudly, making me jump, then fell
quiet again. I still couldn't hear anything coming from the room.
Fearing I'd lost him, I stood up and began creeping very stiffly along
the right-hand wall toward where I'd be able to see by the half-open
door. The odor I'd noticed before persisted despite my moving away
from the boxes and began to cloy in the back of my throat. I was about
ten feet from the entrance when I heard a soft noise. I froze in
midstep.

It was a scraping sound, muffled, not anywhere near, but definitely
coming from the other side of that door. It kept repeating, as if
someone were pushing something. My first thought was that there might
be containers somewhere in that room similar to the many boxes that
lined the hallway and that Rossit was moving a bunch of them around for
some reason. When the scraping continued, I crept another five feet
until I could see partly through the doorway. A ceiling light inside
revealed a medium-sized storage area filled with stacks of storm
windows and more piles of boxes.

In my line of sight against the far wall, though partially hidden
behind yet more boxes, was a long table half covered with a white sheet
that had been folded back on itself. Visible on the table was a large
metal cube of some kind, about two feet square. Beside it I recognized
racks of test tubes, bottles, and stacks of petri dishes.

Parked in a corner of the room, also half hidden behind some
containers, was a small supply cart.
My pulse rocketed into triple digits. Son of a bitch, he's brought me
to his lair! I tried to keep my breathing steady. The scraping
continued to come from somewhere behind the door, and I could hear
Rossit grunting now as he worked. But I couldn't see him. Whatever he
was dragging around in there, it was heavy. That odor still hung in
the air, and though it wasn't perceptibly stronger, its persistence
began to make it repulsive. I stopped breathing through my nose but
knew the scent was continuing to fill my mouth. It remained there a
few seconds, nearly beyond the range of my sense of smell, but not
completely. Soon I began to detect traces of it again as the aroma
seeped up the back of my throat and floated into the posterior regions
of my nostrils. Since my first anatomy lab nearly thirty years ago I
was sensitized to even a hint of that distinctive stench, no matter how
many flowers they put out in a funeral parlor or how high they turned
up the vents at the autopsy lab.

It was time for the police. I readied myself to tiptoe down the daric
hallway behind me. I'd phone Riley as soon as I was far enough away to
be out of earshot, probably when I'd locked myself safely in the
repository. The cops could then come and collect Rossit, the lab
equipment, and, I knew, much worse. But I'd barely taken a few steps
when the scraping noises from deep in the room abruptly stopped. In a
flash I feared he'd heard me and was coming. Reflexively I ducked
behind some of the nearby boxes. No sooner was I crouched down than
the silence was ripped by loud retching noises, followed by the
thudding of running feet.

I pressed myself back against the wall where it was darkest and huddled
into a ball with my face cradled in my arms. I allowed myself a wide
enough slit for one eye to peek through. The door flew open the rest
of the way, banging noisily against the inside wall as Rossit bolted
from the room. In the fraction of an instant he passed under the
overhead light I glimpsed vomit streaming from under his mask and down
the front of his gown. His eyes were as wide as saucers with black
bull's-eyes in them. Then he was tearing away in the semidarkness, his
labored breathing loud and full of whimpering sounds, his shoes
slapping against the floor.

The echo in the place amplified the noises of his retreat as he got
farther away in that long corridor. I got up from my hiding place and
watched him go. Silhouetted against the distant light where the
hallway joined the rest of the hospital, he gave the illusion of
running in place.

It wasn't the behavior I expected from a murderer. Come to think of
it, if this was his lab, why had he spent so much time poking his head
into all the other rooms on the way to it? Leave the questions to the
cops, I readily decided, pulling out my cellular and dialing the
security desk.

"This is Dr. Garnet," I announced as soon as I heard the receiver pick
up.

"You know I'm working with Detective Riley."

"Yes, sir!" came the reply.

"I've accompanied you myself to the basement."

"Listen up. By no means let a Dr. Gary Rossit out of this hospital,
you hear! He's on his way toward you. Stop him, no matter how much he
protests. Alert all the guards at the other entrances. Now!"

"Right away, sir!"

"And notify Riley--" The buzz in my ear told me he'd hung up.
Obviously, for him, an order was something to be jumped to.

"If only we could get the residents to obey like that," I said out
loud, wanting to break the leaden quiet that pressed in on me.

Rossit had passed out of sight and sound, leaving me listening only to
the occasional "thunk" of an overhead pipe. I continued to take in air
by mouth, but nothing I did could keep away all traces of the telltale
smell and nothing would lessen the terrible dread I felt about entering
that room. Nevertheless, I walked up to the fully open doorway and
stepped in.

At first I saw only more storm windows and boxes. Then, looking over
the top of a particularly large pile of cartons stacked in the middle
of the floor, I could see a three-quarter-size metal door set in the
far wall. It was open, but the area it led to was in darkness. I
recoiled from looking in. The smell where I stood was already much
more powerful than it had been outside, and mouth breathing left me
actually tasting the odor of rot. I needed a few minutes to let my
olfactory senses accommodate to the aroma; pathologists always taught
us never to run from a stink but rather stay in the room a few minutes
and let it become bearable. Sometimes it worked; sometimes it didn't.
The trick was to get through the few minutes. I walked over to the
table and tried to focus on the items laid out on its surface while
fighting the urge to throw up.

It was almost as Williams and I had predicted. The large cube-shaped
object was an incubator with a thermostat and a heat lamp. It was
probably intended for hatching chicks and was open on top, but he'd
laid a big cookie sheet over it as a cover. Inside was a rack of half
a dozen shelves--again some kind of kitchen accessory. On each of
these shelves were a dozen petri dishes, every one of them learning
with bacterial colonies. His equipment looked more like the stuff of a
cooking class than the tools of murder.

I lifted the bed sheet off the other end of the table and discovered
four closed preserving jars full of water. I presumed these were his
supply of Legionella. Bundles of culture sticks and collection tubes
were lying on trays, and boxes of gloves and masks were within easy
reach. But when I removed the sheet entirely I found myself looking at
something I didn't understand. Half a dozen surgical masks were spread
out side by side. Near them was a box of thirty-cc syringes fitted
with very small number 25 needles. I picked up one of the masks, yet
couldn't see anything special about it. When I put it down, however, I
realized I had a little moisture on my gloves at the tips of my
fingers. When I examined the other five, I discovered they were all
damp as well. Had he spread them out to dry? But why were they wet in
the first place?

I'd have to figure it out later. At the moment I had as good a hold on
my stomach as I was ever going to have, and it was time to get on with
what I'd come in here to do. I walked over to the entrance of that
small chamber. Pathologists must simply have lousy noses, I concluded
as I resorted to holding mine and trying to swallow at what seemed like
once every second.

I knelt down and peered into the darkness. The tiny space was barely
five feet high at the zenith of a low arched stone ceiling.

Braced for the worst, what startled me was that I didn 't see the
corpse I'd been smelling. Instead I was looking at another bunch of
large boxes randomly placed about the floor, if floor was the right
word. It was nothing but dirt. There was enough light streaming into
the cramped space from behind me that I could see where many of these
boxes were shredded near the bottom, some of them with holes in their
sides the size of a cat. Their contents were probably documents,
because chewed strands of paper trailed out from those holes onto the
ground like streamers. Were these containers what I had heard Rossit
dragging around?

It took my eyes a few seconds more to see the scrape marks where he'd
hauled them off an area of darker, coarser earth compared to the gray
powdery soil surrounding it. This patch was a few feet wide, and at
the far end I could make out a small spot where the dirt was especially
roughed up and scattered. Without giving myself time to think about
it, I took a breath, went in on all fours, and crawled toward the
freshly disturbed ground until I was looking down at what seemed like a
shallow depression of mud. There was absolutely no sound in here, and
the weight of the whole hospital seemed to press in on me. I gritted
my teeth, and tried to push aside the wet dirt with my gloved hand.
After letting my eyes adjust again to the lack of light, I could make
out that the mud had earth-caked features. The rats hadn't had to dig
down more than a few inches to chew on Cam Mackie's face.

I broke into a sweat despite the cold clamminess of that closed space,
and when I had to breathe, the air was so putrid that my throat
involuntarily seized. Desperate for a breath, I backed out as fast as
I could.

He was waiting for me. I had started to get up when I caught a glimpse
of his crepe-soled shoes behind me on my left. I tried to wheel around
and get my arm up to protect myself. But I was still partially bent
over, and the ceiling light was behind him, so all I could make out was
a silhouette and the shape of the shovel he was holding in the air like
a bat. The instant before he brought it down on my head I realized he
was too tall to be Gary Rossit.
Chapter 24

When I next opened my eyes, I was staring at my crotch. My head was
lolling on my chest; the slightest effort to raise it sent spears of
pain up my back and into my skull. I was leaning forward against some
kind of restraints--duct tape, it looked like--around my chest and
arms. My hands were bound behind my back, and I was strapped into a
chair with my legs lashed together, also with duct tape.

Three strikes and you're out, they say. On this occasion I figured I
was out for a long time. The numbness I felt in my hands, arms. and
legs and the stiffness I could feel in the parts of me that weren't yet
numb were the result, I knew, of being cramped in this position for
quite a while.

I tried to take inventory of how badly I was hurt. Definitely some
things were wrong. When I tried to look sideways, I could detect a
lump that I judged to be the size of a walnut. It seemed to be growing
out of my forehead and bulging down over my left eye. That didn't
worry me much. A hematoma, or goose egg, always looked worse than it
was. More disturbing was a complete lack of sensation on that side of
my face, which might mean nerve damage, and that could be permanent. I
made a few more painful attempts to lift my head enough that I could
see my surroundings. More spasms seared through the upper half of my
back from the bottom of my skull, making me wonder if he hadn't also
injured my neck. After crying out with the pain a few times, I
realized that I was hearing with only my right ear.

The large door to this room was now closed, and my attacker had placed
me not too far from the table where he'd cooked up his particular brand
of death. As I looked around, I could feel that my surgical mask was
much tighter across my face than I was used to, the added pressure
against my nose making it hard to breathe. Whoever hit me must have
retied it, I thought, but I remained baffled about why he would have.
It certainly wasn't out of any concern for my health. I was bothered
by the top of the mask biting into my cheeks just below my eyes, so
several seconds passed before I realized my glasses were gone. I
looked around; they were lying by my feet, smashed.

I noticed something else was gone as well, or at least was barely
noticeable the smell. No mask, however tight, could have protected
against that reeking odor. I tried to look behind me, and by peering
under my goose egg, I was able to see that the metal door leading into
where Cam was buried was closed and sealed with duct tape. Leaning
against the wall beside it was a shovel coated with traces of fresh
earth. I shuddered. Cam's face, I presumed, had been reinterred. I
also saw that some of the boxes that had been piled in the center of
the room were gone. Maybe the killer had used additional containers to
better cover the grave this time, though I doubted anything would keep
the rats away from it for very long.

I'd been so wrong about Cam, and Janet had had him pegged right all
along. Like father, like son Stephen Mackae wasn't just remarkable for
the way he'd conducted himself through the hideous ordeal chronicled in
his chart. He also deserved credit for getting Cam through it intact
free enough from bitterness that he could make his father proud and
become the man and doctor Janet knew him to be. Now Cam lay in the
earth, slaughtered. Had I inadvertently set him up to be the Phantom's
scapegoat? The question seared into me.

I began coming to grips with the fact that Rossit wasn't the one who'd
knocked me out. There was no mistaking that the silhouette I'd seen
was the wrong height to have been him. It made sense now, too, his
looking into rooms the way he had. He'd no more known where this
secret workplace was than I had. What he was doing here, I'd no idea,
though I wouldn't put it past him to have blustered his way past the
guards for no better reason man to grab some publicity for himself.
local expert in infectious diseases steps forward to help out during
crisis was exactly the kind of headline I could imagine him going
after. Maybe he'd even figured out as much as Williams and I had and
knew what kind of equipment to look for.

Damn! If I hadn't kept everybody focused on the asylum, probably
Riley's men would have found this place as well.

But they had searched the entire hospital at least once, I recalled,
after Cam disappeared. Maybe there'd been no odor then; the rats
hadn't yet done their hideous work. Even if the police had looked into
that little crypt, they wouldn't have seen the fresh earth with the
boxes over it. Another possibility was that they never saw the
entrance to the crypt at all. There were sufficient containers nearby
to have made a big enough pile that it would have hidden the door
altogether Likewise the table. The police probably had glanced in,
seen only boxes stacked to the ceiling, and gone on with their
search.

The slightest movement of my head sent new pains coursing through my
skull, and I was having increasing difficulty breathing through the
tight mask. Had my attacker decied it like this to make it hard to
breathe? Or yell?

"Hey! Help me!" I screamed at the top of my lungs. My cry was a bit
muffled, but the mask wouldn't keep me from shouting if that's what he
was worried about. I doubted he would be, though, when I thought about
the chances of anyone hearing me. No one was in the subbasement these
days, let alone nights, except those of us going through records. Even
then, except for me and my trips to the repository, everyone else was
usually in the archives at the other end of the hospital.

But someone who came specifically looking for me might hear.

Rossit should have told the police about this place by now. Surely
they'd gotten him after I'd called them to pick him up. But where were
they? I'd certainly been here longer than the ten minutes or so it
should have taken for him to have reached the front door and for them
to have gotten back down to this room.

"I'm in here," I screamed, thinking maybe the would-be rescuers had
taken a wrong turn, but my little burst of hope that someone was on the
way quickly faded in the answering silence. What had happened when
Rossit got upstairs? Was it possible he would have not told the police
about this place?

I started to feel twinges of panic over what this killer would have in
store for me when he returned. I strained my wrists, arms, and legs
against the tape, but the more I forced, the more I felt bound by them.
My breathing quickened and I began feeling suffocated by the mask. I
tried to bend my head far enough to one side that I could rub the
bottom tie loose from my jaw with my shoulder, but I only man aged to
send my neck muscles into their worst spasms yet. I screamed once and
then had to hold my upper body completely still to avoid more of the
same. I ended up staring directly at the table so laden with death.
The sight of it added to my anxiety, and an unbidden thought slithered
into my mind. Could he already have infected me while I was
unconscious?

Now it was all I could do to keep my panic from going right out of
control. I desperately screened the tabletop. Had anything been moved
or used? It took me the better part of a minute to realize one of the
six surgical masks was missing. The other five remained spread out,
presumably left that way to dry. But dry of what? I tried to steady
my breathing, but it shot up again as another question raced into my
head. Where was the missing mask? My entire body broke out in a sweat
as the realization came. He hadn't retied mine.

He'd replaced it with the one missing from the table--one that he'd wet
with something!

My gaze nicked over me contents of the table for some hint of what that
something could be. I stopped at the syringes, then the bottles. This
time I knew with the suddenness of a chill. The water!

Oh my God! That's how he was giving people Legionella. The
contaminated water--it was in the mask! The steps raced through my
head with terrible clarity. He'd injected it into the inner layers,
then let the outsides dry enough so no one would feel or notice the
wetness.

Once the mask was on his victim, the humidity of exhaled
breath--trapped in the nearly closed space behind the mask-would mingle
with the contaminated moisture in those inner layers.

The result would be moist humid air teeming with Legionella, and every
time the victim breathed in, he or she would draw the deadly mix
directly into the lungs.

With rocketing terror I realized that was why he'd tied my mask so
tight--to maximize my exposure!

I'd no idea how long I'd been breathing in Legionella. Inhaling the
organism in such a concentrated form within such a closed space for an
extended period of time would be how he'd achieved the massive
exposures needed to infect otherwise healthy adults. I had to get that
infested thing off my face!

I bent my head sideways again and despite the searing jolts of pain
tried frantically once more to catch the bottom edge of the mask with
my shoulder and get it up off my chin. Nothing budged. I looked
around for something else I might use to snag it on if I could only
rock the chair near it but saw nothing handy at the same height as my
head. Then I spotted the shovel. The blade. If I tipped the chair
over and somehow wiggled to where it was leaning against the wall, I
might be able to hook a corner of that blade onto one of the ties on my
mask and rip it off.

Every breath I took felt hot and moist. Thinking of what I was
inhaling only made me breathe faster. By sheer force of will I
concentrated on what had to be done despite my fear. I initially
verified that I could at least rotate my hands and feet enough to
manage a few inches of up-and-down motion with both my arms and lower
legs. As I prepared to tip myself over, I figured if I got to the
shovel, I could possibly get rid of my ties as well as my mask.

I calculated that the best strategy was to land on my side. Flat on my
back I'd be like a turned-up turtle unable to right myself; if I went
forward, I might land on my face and be knocked out again. I started
lurching my upper body from side to side against the tape restraints.

At first I got no movement at all, but then I won some leverage by
throwing in a little hip action, and in no time the chair was rocking.
I kept increasing the size of the arc I was tipping through, wanting to
go over toward the left, to be as near as possible to the shovel. But
I misjudged, and ended up teetering for a few seconds toward me right,
trying to reverse my momentum before toppling in that direction anyway.
Crashing to the floor I felt pain explode through my shoulder as I
landed on it, and I let out a roar. For a few seconds I lay there with
my eyes closed, sure that I'd broken it, but the telltale nausea that
accompanies a fracture never came. When the throbbing finally began to
subside a bit, I opened my eyes.

And blinked. And blinked again. I couldn't accept what I saw. Refused
to. But it wouldn't vanish. He had been lying behind a row of boxes
near the table, not so much hidden as simply out of sight from where
I'd been placed in the chair. I was looking into the face of Gary
Rossit.

That he was dead I had no doubt. There was that unmistakable stillness
about him--no breath, no sound, no twitch or flicker of movement in the
smallest strand of muscle that always betrays life.

His head was toward me, his mask half off, and I could see the purplish
color of his skin, suffused with blood that no longer flowed.

His eyes, fixed and staring, bulged more than they had in life, and his
mouth hung slack in death. His hair was matted with blood at the back,
but not a lot. If the bleeding had been the result of an encounter
with the shovel, the blow may have knocked him out, but I doubted it
had killed him. I couldn't see his neck from where I lay, but his face
had all the features of someone who'd been strangled.

He must have been ambushed after he'd run from here, I thought, my mind
slowly working its way back up to normal speed.

I'd spoken so harshly of him so often over the years, especially in the
last ten days and as recently as a few minutes ago. Yet I felt
outraged that he too had been murdered. Whatever I thought of him as a
man, he'd had a skill that could save lives, and he'd used it, however
it had been twisted up with vicious politics and the perpetual chip
he'd carried on his shoulder. In a world where there were those who
protected life and those who took it, he'd still been enough of a
doctor to put himself mostly on the side of the angels.

I was going to stop the monster who did this, before he took any more
lives.

The way I was lying put my back to me shovel, which was about twenty
feet away. It was going to the longest twenty feet I ever traveled.

Using my shoulders and the few inches of up-and-down movement I had in
my legs, I managed to make enough pushing motion against the floor that
I rotated myself until my head was pointed in the direction I had to
go. Then, using my shoulder as a kind of nipper and digging in with
the bit of a knee hold I got on the floor, I humped on my side toward
that blade, propelling myself, chair included, barely an inch at a
time. I hurt everywhere. I was sweating with the strain of each move
and breathing hard, always breathing hard and inhaling Legionella.

At first I wasn't certain I was even making any progress, but gradually
I halved the distance, then quartered it Each time I heard one of the
overhead pipes clank, I was sure it was him returning. If by some
miracle I got myself untied before he got back, I needed a plan to deal
with him. Continually listening for sounds at the door, I kept humping
and pushing toward that shovel, all the while figuring what I could do
to nail him. Finally I was a few feet away, then inches, then had my
head right up against the blade. I couldn't help thinking that it had
been in the earth alongside Cam's decomposing body but forced my self
to maneuver my right cheek to the top of the steel edge by straining my
head away from the floor. I pressed hard into the shovel, hoping some
part of the mask would catch or rip, and moved my head down. The steel
hurt my skin, but nothing on the mask gave way. Suddenly the shovel
shifted, and the handle clattered to the floor.

"Shit!" I exclaimed aloud, to ease my frustration.

I eyed the curved blade now lying on the floor, me handle away from me.
I rotated around until my back was to the shovel, and my feet could pin
its handle to the baseboard. Then I wiggled and humped some more until
I got my bound wrists alongside the blade, got a hand on either side of
it, and managed to push the tape binding my wrists up against its edge.
Wedging the shovel against the wall, I kept pressing as hard as I
could with my wrists, drawing the tape up and down on the semi sharp
steel. The metal kept scraping my skin, but soon I felt a little
separation between my wrists, driving me to work harder and faster
until, with a lurch, I felt them spring apart. My upper arms were
still bound to the chair, but I could bend my elbows, stiff as they
were, and slowly brought my forearms around from behind.

By flexing my neck, I managed to bring my hands enough toward my face
to curl my forefingers under the bottom straps of the mask. When I had
my grip, I wrenched and tore the straps off. The mask now flapped in
front of my mouth like a banner hanging off my nose, still attached by
the upper ties. A few more flexes and twists of the neck brought me
near enough that my fingers could rip me rest of it away, and the
hideous covering wafted to the floor.

I took gulps of air like a man who'd been underwater, so much so that I
made my head woozy. I had to force myself to once more slow my
breathing and started clawing furiously at the tapes around my arms and
trunk. Within minutes I had them off, then freed my legs as well.

Of course my cellular phone was gone. Even the erythromycin I'd been
taking for two days had been confiscated. I'd no idea what time it was
because my watch had been smashed, probably when I'd raised my arm to
protect myself. I stumbled over to the door, barely able to move.
Knowing full well I was probably locked in, I turned the handle and
pulled. As expected, I wasn't leaving that easily. Nor was this door
one of the feeble wooden ones I'd hidden behind in the corridor. It
was large and metal, and I knew I wouldn't be kicking my way out of
here either. Instead I resigned myself to carrying out the plan that
I'd come up with while I'd been slithering across the floor. I started
to get ready.

Five minutes later I was back in the chair, hopefully close enough to
the same place he'd left me in. I'd taken a clean mask from the box on
the table and had stuffed the remains of the one I'd ripped off my face
into my pocket. I'd returned the shovel to its original position
against the wall but had rejected using it as a weapon. I'd first
thought of hiding and braining him with it when he came in but had
realized he might first open the door a crack, see I wasn't in the
chair, then slam it closed, locking me in again for who knows how long.
I had to lure him into the room, then get him. Yet if I was in the
chair, twenty feet was too great a distance to reach the shovel and
take him by surprise. So I'd looked around for an alternative weapon,
something closer to the chair and abundant enough in the room that he
wouldn't notice one of them was in a little different position than
when he'd left. I'd made my choice, had placed it so I could grab it
readily, and then had reapplied the duct tape around the front of my
legs, trunk, and upper arms.

I held my hands behind the chair, took a final glance around the room,
and settled down to wait
Chapter 25

Someone once said the prospect of being hanged in the morning
concentrated the mind. Waiting in that chair, watching the door, and
feeling the stillness of Rossit's unseen remains and Cam's nearby tomb,
it wasn't hard to think like a condemned man expecting the executioner.
Except I doubted I had until morning. Occasionally the pipes clanged,
as time passed my arms and legs once more stiffened up, and bit by bit
I began to piece together the events of the last ten days in a way that
finally made sense.

The initial step was to realize that I hadn't pursued the Phantom, that
in reality I'd been subtly led to him and to the connections that had
pointed at Cam. Once I accepted that starting point, the rest of what
I'd seen and learned since Phyllis Sanders first came into my ER simply
flowed into perspective.

Scapegoating Cam, I now figured, had probably been part of the killer's
plan from the beginning. I also began to grasp the sweep of that
plan--how this killer had set up the execution of punishers and the
collapse of University Hospital. But the scheme had started with the
business of the Phantom; that whole episode of two years ago had been
carefully created for the sole purpose of making Cam a suspect for what
was to come.

I once more crawled inside the killer's skin and figured how he'd set
it up.

The initial tit-for-tat attacks against punishers who had gotten away
with their cruelty were the kind of benign retributions that allowed
hospital gossipers to say, "I know it's wrong, but they deserved it."
When whispers inevitably turned to who might be responsible, it
wouldn't be too shocking a leap to include Cam's name on the list.
Probably the killer had waited until those whispers had begun and then
had escalated the attacks to potentially lethal events with the use of
insecticides. That move would lead gossipers to realize that whoever
the Phantom was, he was capable of far more dangerous acts than anyone
had initially thought. Afterward came his most ingenious maneuver of
all the too convenient double alibi It would focus speculation on Cam
but still leave him off the hook enough that nobody would accuse him
openly. Once that seed of doubt about the man was sown, the Phantom's
activities were suspended and the suspicion was allowed to lie dormant
for two years, until the killer was ready to start his now deadly game
of infecting punishers.

As part of his plan the killer had probably meant all along for someone
to recognize the pattern of the Phantom at work when the infections
began to occur, and all along he'd counted on someone resurrecting the
old rumors that would make Cam a scapegoat for murder mass murder.
Except Janet, after recognizing that some one was once again punishing
the punishers, had resisted going down the false trail that had been
laid out to incriminate her friend.

I'd been more obliging.

I'd even offered up other suspects besides Cam on my own Rossit, Hurst,
the entire board of St. Paul's hell, I'd become a fund of false leads,
a voice directing the police to everyone but the killer, leaving the
true Phantom free from suspicion, safe from detection.

In that dreary room I anguished that if I'd been more attentive to
Janet's instincts, two of the "suspects" I'd fingered might still be
alive.

I knew who was going to come through that door. He'd always been close
at hand, ostensibly helping, feeding me just enough bits of information
to keep me diverted toward Cam. I'd just begun to guess his motive why
he would kill punishers, including one in particular, and then seek to
destroy this hospital when I heard the key in the lock. At the sound I
tried to drop my head, slouch forward, and feign being unconscious
still, hoping that when he came near enough to check me, I'd take him.
But I had to move carefully not to dislodge the duct tape, and he had
the door open too quickly.

"Well, well," declared Harold Miller.

"Finally awake, are you?"

He sounded like a host greeting a guest who'd overslept. He was
carrying a tray of culture sticks which he took over to the table.

"It's about time. Garnet. After all, I didn't hit you that hard." I
didn't answer him, didn't even react. I wanted to size up the best way
to make him come near.

"You'll be interested to know I've been busy finishing my 'work," so to
speak."

I felt a rush of alarm. Son of a bitch, I thought, he's been infecting
more people. I had to get back and warn anybody he'd been near.

"Trying to kill them makes you a worse creep than they ever were," I
snapped, hoping to goad him into coming closer.

But he didn't rise to the bait.

"Oh, I don't particularly care who I kill to bring down this place.
Using punishers as victims was mainly to make it look like Mackie's
work. Your arrival here did make it necessary to speed up my schedule
though," he continued breezily, "but don't worry, I got it done. Even
had time for the finishing touches, so to speak, on our star patient in
I.C.U. She was so grateful."

Janet! Oh my God! He'd infected her again.

"What have you done?" I cried out. The possibilities tore through my
mind like bullets--his infecting her skin, re closing her lungs,
slipping the super bug directly into her IV. I felt my head swim, my
heart race, my breathing quicken again. It was all I could do to keep
from leaping at his neck and strangling him.

"Maybe you've figured out how I've been doing it," he mocked while he
puttered with the culture swabs and other screening equipment he'd
taken off the tray.

"Damn you to hell. Miller! What have you done?"

He stopped, turned to face me, and leaned back against the table with
his arms folded across his chest.

"You're not talking very nicely to me. I'm most disappointed. Garnet.
I've been looking forward to regaling you with the finer points of my
work, not fighting with you." As he spoke, he watched me with those
dreadful eyes, but now a fire shone out of the sadness.

I nearly sobbed aloud, I was so frantic.

"Tell me what you've done to Janet."

"Some follow-up cultures, as a precaution was what I suggested to her.
She agreed, and I swabbed her nasal passages like I usually do when I'm
screening people," he replied offhandedly.

"What did you do?" I screamed at him.

He chuckled, easily, hideously.

"As I said, I simply screened her."

Screening! The three nurses had been screened before they became
ill.

"I had to," he added, his voice suddenly hard.

"You yourself told me she never accepted that Mackie was me killer,
even after I made you suspect him. Once you turn up dead, she'll be a
relentless pursuer--too bright and dangerous for my good--so I screened
her."

Desperately, I fought to control my panic. I had to get beyond his
game of cat and mouse, or he'd go on taunting me with his refusal to
tell about Janet. I grabbed the first idea that came to mind. Seconds
ago he'd sounded inclined to boast. Maybe I could trick him into doing
some bragging. Trying not to show even a nicker of fear, as coolly as
I could I said, "I thought so, Harold. You can't tell me what you did
to Janet, because you never got near her you couldn't have not without
written orders by two doctors or getting by a security guard at her
door. You may kill me, Harold, but about her, you're bluffing, and
your pathetic mind games disgust me."

Make him defend himself, I figured, and he might blurt out what he'd
done.

I figured wrong.

The impact on him of my defiance was immediate. His eyes darkened, and
he started to uncoil from leaning against the table like some king
cobra getting ready to strike.

Oh Christ, I thought, immediately realizing my mistake. I'd been so
desperate about Janet I'd violated the first rule of ERin dealing with
an agitated psychotic. I'd challenged his sense of control.

His powerful shoulders seemed to hunch up.

"Listen to me, you fuck," he shrieked, "or I'll finish you off with the
shovel right now!"

His rage so startled me I rocked back in my chair and almost brought my
arms forward to protect myself, thinking he was about to fly at me.
Instead he angrily pivoted and strode over to the shovel. Grab bing it
with both hands, he turned and started for me, waving the blade in the
air and eyeing my head like it was a ball on a tee. As I got ready to
leap away from him, I realized in an instant that even if I made it to
the door, he'd nail me in the fraction of a second it would take to
open it.

He stopped advancing about four feet to my side and enough in front of
me that he couldn't see my wrists weren't taped, but he'd come well
within range to finish me with one swipe. Our eyes locked, and I saw
in them a terrible excitement, as if all his pain and despair had been
assuaged by this instant of ultimate control where he could decide if I
lived or died. Even if I didn't bolt, he might kill me anyway, simply
for my defying him. I seized on the one ad vantage I had left and
decided if I was about to die, I'd go down thinking like a doctor.

"Am I feeling what your father made you feel, Harold?" I asked as
gently as I could.

He kept the shovel in the air, but his eyes changed. The fire that so
often appears in the eyes of me insane dimmed ever so slightly. In ER
I always relied on that dimming, as an indicator of how well I was
doing, whenever I had to talk down people who were in Miller's state of
mind. I kept speaking as gently as I could.

"I saw your parents' old files. He was abusing you, wasn't he?"

No answer. The shovel remained in the air.

"Your mother didn't stop it, did she? No one from this hospital did
either. The one time a social worker from here spoke to you about it,
she didn't follow up. Somebody at University Hospital should have
known that you'd be too scared to tell the truth, that you'd had to
lie, that you'd been made to say everything was fine, that you'd been
forced to hug your mother and smile."

The blacks of his eyes began to glow again, but he had a faraway look,
as if his fury were being stoked by some distant agony.

"Did your mother frighten you into not reporting your father? Did she
say he'd hurt you more, hurt both of you more if you told?"

He seemed to rock back on his heels and leave whatever distant place he
was remembering, then focused his gaze once more on me. He nodded but
remained silent. Through the transparency of his gloves I could see
his hands straining as they kept their grip on the shovel handle. I
felt I was dismantling a bomb. If I touched on the wrong memory, his
fury could explode.

"The hospital should have pursued their suspicions," I continued, "but
it failed you there, didn't it, Harold? Your father hadn't lost his
license yet and was still on staff then. Do you think that's why the
social workers backed off and went easy on your parents, because both
of them worked here?"

This time he spoke.

"He gave me a session anyway, even after I did lie, and as usual she
just hid upstairs." His voice had changed, had altered to an extent
that surprised me. It was free from any hint of his mother's wheedling
tones. I was shifting something in his disturbed mind, but if for the
better, I couldn't tell. Whatever my impact, I was certain that for
the moment my talking to him was all that was keeping me alive.

He kept his grip on the shovel, the blade at the ready.

"What did he used to do to you?"

The question seemed to go by him. He didn't respond at all, as if he
hadn't heard it. I'd often seen that kind of reaction in ERas well,
when I was after emotionally charged information. From my experience,
I knew it was best to let people alone for a moment then, giving them
time to wrestle with the pain of recall. As I waited for his answer, I
felt I had moved our standoff onto more familiar turf, despite having a
shovel held at my head. Eliciting a history from hostile and violent
patients--in effect getting them to tell their story was part of a
day's work in ER. But in this case, the questions and their timing had
to be exactly right.

"How did he hurt you?" I repeated as gently as I could after what I
hoped was an appropriate interval.

The fire in his eyes roared back to life in the here and now. The
shovel blade began to move through little test arcs.

"He called it punishment," he replied, his voice full of venom but
still free of Phyllis's legacy.

"Down in the basement was where it happened. He rarely left more than
one or two marks on me. Not only did he know how to hurt me so nothing
would show, but one of his hits was good for a thousand threats; the
fear was the same. Sometimes I felt relief when the blow finally did
come; imagining it, constantly expecting it, was more horrible than
physical pain." He broke into that chilling laugh.

"I think you probably know firsthand what I mean," he taunted, waving
the shovel near my face. Then he abruptly stepped closer, still in
front of me, and said into my ear, "You know I can and will use it.
Garnet." His voice was all at once as cold as the grave, and his eyes,
so near mine, continued to glow like a pair of black coals.

Get him now, my impulses screamed. But I didn't know how to
decontaminate Janet yet He moved back, and my only chance to grab him
so far was gone.

He continued speaking from a few feet in front of me. "/ lived with
knowing what he could do, anytime, day or night."

I kept my eyes on the shovel. His hands were now tightening and
relaxing his hold on it while he talked.

"Sometimes he'd get me out of bed and take me down there keep me there
for hours while he drank and ranted. His specialty was humiliation ..
." His voice trailed off and his black stare seemed far away again.
This time his eyes were also filled with a strange incredulity, as if
he still couldn't believe what his memory was showing him even after
all these years.

In the fullness of his silence I held my breath. I'd no idea what he
was going to do. As I watched, his forehead became covered with a
sheen of sweat and turned the color of paste. It felt like minutes be
fore he resumed speaking, but it probably had been only seconds.

"I

used to call for my mother to come and help me, but she just stayed in
her room upstairs." His voice had changed again, was thin and little,
like a child's.

"I think she figured if he had me, he wouldn't hurt her. When he fell
asleep, men I could sneak out on my own, but I was always terrified
that he'd wake up and come after me again.

The next day she 'd look me over and say, "See, it wasn't so bad," and
then start the refrain, "We mustn't tell. We mustn't tell."" He
started striding back and forth in front of me, continuing to talk, no
longer as a child, his voice hard again. He'd swung the shovel over
his shoulder but still gripped it.

"By the time I was fifteen, I had some muscle in my arms and shoulders.
Do you know what I did to stop him?"

Before I could answer, he'd pivoted and swung the shovel full force at
my head!

I'd less than a second to jerk my neck back and felt the cold steel fly
by my face.

"Christ!" I roared at him. Fright set my heart accelerating. I
braced for his next strike and readied myself to jump out of its way.

But he simply stood there staring at me, his gaze coldly neutral.

I couldn't tell if he'd intended to finish me off or if the miss was
deliberate a part of the thousand threats he wanted me to endure before
he finally delivered a killing stroke.

"One swing, Garnet, and it was finally over," he declared softly.

The words seemed to float across the space between us.

"Used the baseball bat he'd given me for my birthday and hit the home
run of my life. On that night, I had peace from hating him. She put
him at the bottom of the stairs and made it look like a fall.

"Always good to have a nurse in the family," she used to say. But if I
thought I was free of being frightened or that the hatred wouldn't
return..."

Oh my God was all I could think.

"... threatened to turn me in unless I catered to her, doted on her,
looked and acted the devoted son. She was obsessed that / had to make
up for his abusing her..."

He spoke in a rush now, as if pressured to get the misery out.

"As I got older, she tightened the leash. She actually declared my
life was hers to control, since without her keeping me safe from the
cops I wouldn't have a life."

I still couldn't make a break for it, not with him pacing between me
and the door.

"She forced me to try for medical school, expected me to become her new
Dr. Miller, said that I was his son, that I'd have to reverse the
humiliation she'd endured at UH when he was boozing and fucking around
on her. But I got turned down anyway."

I tuned out his rant and eyed the weapon I'd put within reach, but knew
I couldn't get to it as long as he held (he shovel.

"I managed to get hospital laboratory sciences. She made more threats
about the police to make sure I came to UH when I graduated.

Even then I was her slave."

The torrent of words streaming from him was the stuff of delirium.

His pace of walking back and forth picked up tempo. The fire in his
eyes became alarmingly bright.

"And I wasn't free from hating him anymore. Flashbacks--I was in the
basement with him again and again and again--left me so full of hatred
that I wanted him alive so I could kill him again and again and again!
I wanted that release."

He stopped pacing and stood directly in front of me. The shovel was
back on his shoulder, but the two-handed grip hadn't changed.

Anytime, I kept thinking, he could strike anytime.

From the rage I saw in his eyes I figured only a syringe of haloperidol
could bring him down now.

Once more I got ready to jump out of the way.

But once again, he fooled me.

"The beauty of it. Garnet, is that it worked," he declared in a soft
voice.

I flinched I was so startled to hear him speak after being so sure he
was about to plant that shovel in my brain. This was his game again, I
realized, the thousand threats he'd once endured and had now learned
how to make, probably liked to make. Sadistic--like father, like
son--he'd become what he hated.

"I couldn't be so obvious as to make Mother my first target for the
super bug he continued, his voice dreamy.

"I'd tried depositing it on those other nurses first but only managed
to give them Legionella. Did you know it was a two-step process?" He
didn't pause for my answer, neither did his gaze waver from mine.

"I timed everything before their vacations so they'd be away from the
hospital when they got sick and there'd be less scrutiny to cope with
while I perfected my technique. When you told me Mother had staph,
though, I had to hide how excited I was. It was fitting she got it
first."

He paused, and I held my breath. Whatever demons he was exorcising
while he talked, he was skirting around the edges of what I needed to
know--his technique.

"I knew immediately you were smart, and maybe a threat--that silly
bitch would have to go to your hospital--and I nearly choked when you
said right away you thought she also had Legionella. At that moment I
wasn't at all sure that you'd fall for the Phantom business I'd set up
or that you wouldn't see right through the rest of my scheme, so I
brought a special mask to St. Paul's that I intended to give you. But
luckily for me you'd screwed up on her first visit. That gave me a
huge psychological advantage. I gave the mask to Deloram instead, just
to muddy the waters." He gave a teasing laugh, me sound of it cold.

"You're going to love it when I tell you my secret about the masks.
I've become very good at handing one to a colleague after pretending to
take it from the regular pile."

Handing out masks to others before putting one on yourself was a point
of etiquette doctors practiced without even thinking about it.

He could have given one to Michael and Janet the same way.

"Over the next few days, with a few timely hints from me, you began
suspecting Mackiejust as I'd planned for someone to do. Then I was
ready, finally, to infect punishers en masse and bring down University
Your technique with staph, damn it! How'd you get them with staph?

He'd slipped into that faraway state again. I didn't move, didn't even
blink, not wanting to do anything that would catch his attention and
shut him up.

"Doing it drove away the flashbacks," he continued, almost sounding
reasonable.

"I know they'll probably return, but I can go on with my work somewhere
else. Being a chief technician who's had experience with the super bug
ought to make me a hot commodity for any hospital in the nation.
Wherever I go, I'll be in charge of screenings. Who knows? Maybe
picking off a punisher now and then when he comes back to haunt me will
be enough next time."

I wasn't thinking much beyond getting myself out of this room. If I
failed, I knew I was dead, either by getting my head smashed or by what
he'd infected me with. But it had never once occurred to me that he
could somehow walk from here, especially if he killed me, and not be a
suspect. That his madness extended to taking this horror to other
hospitals left me reeling. Was it possible? The police would
eventually find our bodies. Could they actually end up reconstructing
a story that let Miller slip away? I didn't see how. Sooner or later
someone would surely piece together what had happened like I did, but
Miller hadn't made many tactical errors and the mere fact he thought he
could get off scot-free meant he'd probably seen a possibility I'd
missed.

"You know what's interesting about a swab. Garnet? I can be plating
out organisms in the nasal mucosa of my subjects, giving them staph
instead of culturing for it, and nobody can tell the difference."

His words hardly registered at first. I was busily figuring how I'd
make my move, flexing and un flexing my leg muscles, getting ready,
when what he was saying washed over me with the clarity of ice water.

"I keep a special pile of infested swabs with me, ones I've already
dipped into my cultures of the super bug No one notices I seem to have
some culture sticks set aside on my tray as I work. I can infect
anyone I want with a colony of staph, and it can lie dormant for weeks,
until I hand out a dose of Legionella."

My first thought was. God help me! He'd infected Brown right before
my eyes. My second? That it was definitely time to go!

I leaped from the chair with a scream and then pivoted left. I got a
glimpse of the total astonishment in his eyes, then of the shovel
starting through its arc toward my head. Already turning, I dropped on
one leg and rolled farther toward where I'd left a storm window partly
pulled off the rest of the pile and ready to be grabbed. The shovel
grazed off my back passing over me as I twirled under it. Too
terrified to feel my stiffness, I got to my feet without looking behind
me and reached for the window. I got a hand around each side near the
bottom of its frame, raised it over my head, and pivoted again to face
him.

He was already coming at me, his shovel raised for another strike.

He started his swing, but I got the side of the window in the way of
the oncoming handle and blocked it. Wood on wood, the blow caused the
pane of glass to shatter, some shards of it faling out and showering
down around us, the rest remaining in a jagged rim around the inside of
the frame. The shovel struck the cement floor with a loud clang.
Miller retained his grip on it and immediately started raising it
again.

But my window was already in the air. I brought the frame with the
sharp glass fragments down around his head at the level of his eyes and
pushed as hard as I could.

He screamed as the points found their way into flesh and sockets.

The shovel clattered to the floor and he tried to grab the frame with
his hands, but he couldn't before I raked it farther down his head
toward his neck. Some pieces of glass broke out of the frame and
remained embedded in his flesh. Others held firm in the wood, slicing
through his mask and lacerating the underlying skin. By the time they
reached his jugular, he was pouring blood from his face and had
shredded his hands trying to grab around what had become a halter of
pointed glass daggers. Screaming and begging "No!" he groped blindly
for me, more blood and pieces of latex flying off his palms as he
flayed the air trying to find my arms. As soon as I saw his powerful
fingers coming at me, I gave the frame another hard shove, felt the
glass go farther into him with a little lurch, and knew I'd punctured
something. I made a final thrust, then released my grip on the
window.

My last push sent him staggering backward. His hands flew to his
throat and his scream became a whistling gurgle as he went stumbling in
reverse across the room. The sound told me I'd sliced his windpipe. He
crashed against the work table and ripped it toward him as he slid to
the ground. The contents fell around him and onto his bloodied head
and neck. Even the incubator toppled over, landing upside down on his
face. He was thrashing, choking, and continuing to make wet, rasping
noises through his severed trachea.

Blood spurted into the air and gushed over the floor. He clawed wildly
at his neck trying to dislodge the frame and the shards of glass that
had impaled him. I watched as he inadvertently shoved the incubator
away from where it had fallen.

Harold Miller would probably survive his punctured trachea.

Even the copious outflow of blood could be stopped if we hurried.

But what he wouldn't escape were the contents of the dark brown ooze
that was spreading across his skin. The overturned petri dishes had
spilled their lethal culture media into his deep and multiple wounds.
Chapter 26

I found both the key to the door and my phone in one of his pockets.

He made a weak grab for me as I retrieved them, but lack of oxygen and
loss of blood had rendered him harmless. Within two and a half minutes
of my call. Wild Bill Tippet arrived with his res us team and went to
work on him. Since Miller was a "gusher," Tippet's now being triple
gloved, double masked, goggled, capped, and gowned was appropriate.

They intubated, got IVs running, and tamponaded the bleeding sites as
best they could. Working around all the embedded glass and infested
agar medium was hazardous at best. Then they made a run with him for
the OR. Riley arrested him on the fly, reading him his rights while
trotting alongside the gurney. When the detective warned his new
prisoner that anything he said could and would be used in a court of
law against him. Miller, unable to talk but still half conscious, gave
the detective a baleful look as if to say You 'we got to be kidding.

In the OR they'd sew up his trachea, repair torn arteries or veins of
size, and clamp, ligate, or cauterize the rest, whatever it took to get
the bleeding stopped. But from the beginning we all knew we were
working on a dead man.

Why bother? Williams best explained everyone's thinking on the
subject.

"Keep the son of a bitch alive in case we need to know something from
him about what he's done!"

I later learned that shortly after they wheeled him out of the OR, they
wheeled Brown in, unable to wait any longer before they amputated her
right arm just below the shoulder.

I raced to I.C.U and woke up Janet, quickly telling her only that the
killer was Harold Miller, that I'd explain everything afterward, but
that right now she must immediately undergo a nasal lavage with
bactericidal soaps through the posterior pharynx. Struggling to get
her eyes open, she in turn gave a little scream when she saw my
battered face. Still half asleep, she proceeded to give her own set of
orders, demanding that I immediately find someone in ER to take care of
my own problems and that the nurses were to get her a "real doctor"
before she'd even discuss the matter of lavages. After a few seconds,
however, what I'd said seemed to sink in.

"Harold Miller was the Phantom?" she exclaimed incredulously.

"Killed his own mother? Infected all those people? But he was just
here less than an hour ago, taking swabs--Oh my God!"
After I agreed to have my lavage done with hers--I'd no idea whether
he'd swabbed me as well--she consented. As we gagged and spat
together, then applied copious amounts of mupirocin ointment up our
nostrils, I prepared myself to tell her Cam was dead.

She took the news quietly, but that didn't mean she took it well. I
think she'll probably rage in her soul until the end of her days
against the wrongs that led to her friend's dying. Her silence, I
suspected, was a reflection of how she'd already resigned herself ever
since he'd disappeared to the fact he was dead, though she never said
it outwardly. Instead she let me comfort her, then comforted me over
and over that I was not the cause of Cam's murder or Rossit's.

Afterward we never talked again about how I'd suspected Cam.

Strangely, I didn't feel that moratorium was because she blamed me for
those suspicions. Rather I think it was her way of telling me that she
didn't have to talk about it, that she accepted what I'd done as
reasonable and in good faith.

I was having greater difficulty dealing with it all. I kept dwelling
on how I could have done things differently. Even Williams and Riley
tried to reassure me to the contrary during my formal statement with a
police stenographer, but I knew I'd go to the end of my days wondering
if either Cam or Rossit or both would still be alive had I not thought
them capable of murder.

"Intravenous erythromycin and copious nasal lavages," Williams
immediately ordered for anyone who'd been screened by Miller and also
exposed to a mask he offered.

But instead of running around helping him get everything done, I became
a patient tethered to an IV pole, receiving my prescribed intravenous
erythromycin to prevent my contracting the Legwnella that Miller had
exposed me to. I kept my cot alongside Janet in I.C.U but slept
fitfully. By 5:00 a.m. I was awake for good. Since I could wander
throughout the hospital by pulling my wheeled mast with its dangling
bag and plastic tubing along at my side, I slipped out of the unit and
squeaked my way down the corridor to where I got a coffee from a
vending machine. Then I poked into abandoned rooms until I found a
phone to call St. Paul's I.C.U.

"It's remarkable. Dr. Garnet," the nurse said, "Dr. Deloram's hope
about the purulent sputum not being from staph proved founded; the
culture's negative. Better yet. Dr. Popoviteh's vitals are stronger.
His fever's down, and most important, his blood gases are improving. It
looks like we might even try to start weaning him off the respirator
later today, though that will be a long process."

I found the elevator, rode it down to the ground floor, and pulled my
pole with its wheels squealing in protest across the large deserted
foyer to the front doors. The guards knew who I was and let me stand
in the doorway where I could enjoy the early morning air. I was still
enveloped in a mask with my usual protective gear and would be obliged
to remain so until several rounds of cultures on me proved negative.
But at least the mist felt good on my forehead, and it being Thursday,
I could hope to be free of masks and such by the weekend.

Standing below that massive stone facade, I looked up and saw the
underside of the chins of the gargoyles. The granite sentinels peered
off into the predawn night. I felt like yelling up at them, "The
threat is over," but I didn't, of course, and they never wavered in
their vigilance. Together, we watched the sun come up.

Late in the morning we discovered that the results from previous
screenings had been tampered with. All the current victims now dying
from staph pneumonia were recorded as having been negative two days
before, which was impossible. We had to start re culturing everyone in
the hospital. On the positive side, the prophylactic erythromycin had
slowed the emergence ofLegionella cases. Only five more people
developed the prodrome, and the course of their illnesses remained
mild.

Ultimately none of the victims Miller had infected with staph during
his last round of screenings showed any traces of staph on culture
after being lavaged so promptly, including Janet and me.

But the dying wasn't over yet. During the next few days three more of
the earliest victims, already severely ill with Legionella, died of
staph pneumonia. The final death toll from the super bug was thirteen,
not including Phyllis Sanders.

Williams's rule of thumb regarding release from quarantine was "Three
negative screenings and you're free." By Sunday morning ninety percent
of those who'd been confined were cleared to leave.

The CDC supervised a review and clean-up of every square inch of the
hospital.

"We'll eventually give the place a clean bill of health," Doris Levitz
said over coffee one morning.

"But will the public?" asked Williams, the front half of his scalp
registering his skepticism in multiple wrinkles.

I thought of the gargoyles peering off into the distance and wondered
if they would become sentinels looking in vain for the return of
patients.

Sunday also marked the day Janet got out of I.C.U her Legionella in
full retreat. I never developed any symptoms at all and was equally
grateful that the numbness was gone from the left side of my face. My
hearing, I was assured, would be back to normal within a few days.

The hospital had virtually no patients now, and Janet chose a room in
OH where she could have the company of some of her colleagues and
friends. Since I could be wherever I parked my pole, I also checked
into OH, to much teasing by everyone on the ward.

"Who knows," Janet said coyly when we were alone in our room, "maybe
nine months from now we'll be back here for real."

We were on the phone constantly with Amy and Brendan, reassuring Amy
that we'd both be home in a few days and cooing at Brendan. We wanted
to see him so badly, but we wouldn't budge until even theoretical risks
from Legionella to an infant were well past.

"By the way," Amy told us, "since you haven't been here, Muffy's been
sleeping in Brendan's room, guarding him like he was her own pup." Amy
held the receiver up to Mufiy's ear, and we heard her barking excitedly
at the sound of our voices.

I'd continued to check on Michael every few hours and been reassured he
was making progress. But I wasn't prepared for the call that came to
our room that evening.

"Earl, it's Stewart Deloram. I've got someone here who wants to speak
with you. Hang on a minute."

I heard rustlings, then I could hear him breathing for a few seconds
before he spoke, as if it were difficult for him to get the receiver
into position.

"Boy," Michael rasped, "that was harder than giving up cigarettes."

On hearing my friend's frail voice, my eyes filled with tears.

"Michael, you are amazing! Simply amazing," I told him.

He gave a sound in return that was half chuckle and half wheeze.

"Gotta go," he said.

"They seem to think I shouldn't talk for long.

Better humor them. Bye, Earl."

When I hung up, Janet needed no explanation. My side of the
conversation was enough to make her eyes sparkle. We hugged, laughed,
and cried, sharing our joy.

That night we slept in the same bed. Despite the narrow mattress and
the fact that our IVs kept getting tangled we managed to resume our
campaign to keep Brendan from being an only child.

"He says he wants to see you," Williams told me.

"See me! Did he say why?"

Riley answered.

"Miller's not saying anything to us, anything at all. Who knows what
the creep wants? My advice. Doc? Don't bother. You've been through
enough."

It was late Monday morning, and we were having coffee together in the
otherwise deserted cafeteria. The area, along with I.C.U and OH, was
one of the few that had been declared clear of staph. As a result, we
were free of protective clothing as we sat around and talked, and it
felt wonderful, despite the grim business we were discussing.

"I agree with Riley," Williams chimed in.

"We've pretty well put together what happened. There's no need to talk
to him. He'll be dead in twenty-four hours, anyway."

Undoubtedly he would, I thought, and I might end up wondering about
what he wanted to tell me for the rest of my life.

"Why don't you two fill me in on what you've figured out," I suggested.
I wanted to think over whether I'd see Miller.

"For starters, what happened the night Cam disappeared?"

Riley looked at Williams, got the nod to do the honors, and started.

"We figured that Miller overheard Cam Mackie when he called you and
Douglas. Maybe Mackie even confided to Miller what he'd found in the
charts, not realizing that he was talking to me killer. If that was
the case. Miller would be faced with a crisis. He already had to know
that his mentor was brilliant enough to beat every one of us to
figuring out the rest of it. But the fact that Mackie had already
zeroed in on evidence of how the three nurses were infected in a matter
of hours--evidence so complex, I remind you, it took the rest of us
days to find--must have convinced Miller that his own exposure could
occur just as quickly. According to our preliminary path report, he
probably only knocked Mackie out in the lab, then finished him off by
strangling him to death sometime before burying his body. The crime
scene investigation will tell us more for sure. That chamber, by the
way, was a root cellar at one time."

"We timed it out," joined in Williams.

"Miller could have carried an unconscious Cam Mackie to that room,
killed him, then raced back to the lab with the samples of staph that
he set up for you and me to find. Once his display was ready, he
probably used Mackie's office, dialed the number of that single line
phone, and waited until one of us answered. When he heard your voice,
he started sending those messages. I bet he preferred your getting
there first, because he could terrorize you about Janet. Distracted,
you were more likely to jump to the conclusion he wanted you to make
about Mackie."

Riley took over.

"While you and Douglas were figuring out what to do and dealing with
Fosse, Miller had time to slip back to his hiding place, bury Mackie,
and cover the grave with boxes. Then Miller returned to the
bacteriology lab, claiming Mackie had also telephoned him."

I remembered how Miller had looked freshly showered that night when
he'd arrived at the bacteriology lab. The thought of him having just
washed up after killing and burying Cam sickened me.

"What about the asylum?" I asked.

"Was he ever there?"

"Probably," Williams said, "until you spooked him that first night you
ran into him. The second time you saw him with the cart, we think he
could have been getting ready to move. Given how little equipment he
had, it would have been an easy matter--a couple of trips at most."

While refilling our cups from a silver serving pot, I asked, "Did
anyone figure out how he used the screening process to set up the
targets?"

Riley grinned.

"I worked this one out with Madge in staff health."

He took a sip of coffee and settled back in his chair, obviously
enjoying the chance to show off his discoveries.

"Screening is done a ward at a time, but the exact date of each call-up
is at the discretion of several people in that clinic, depending on how
busy they are.

Once a notice goes out, the nurses have two weeks to get their cultures
done, at their convenience and without an appointment, either in staff
health or in the labs. Madge thinks Harold Miller faked a message from
staff health, notifying the floor where his target worked--I.C.U, the
OR, or in the case of his mother, OH."

Riley's use of the abbreviations of our lingo made it hard for me not
to smile.

"That started a screening process when it suited him," Riley continued,
"shortly before each of his targets was scheduled to leave on vacation.
Since the only thing staff health cared about was that every nurse in a
high risk area got a minimum number of cultures per year, they'd never
be bothered, maybe not even notice that an extra set had been done."

"But the nurses he'd targeted wouldn't necessarily come to him for
their cultures," I said.

"The screening itself gave him an excuse to seek them out a few days
later and reculture them.

"Bad sample," he'd say.

"Got to do it over.

"Then he'd use one of his swabs contaminated with staph."

Williams joined in.

"The timing of the screening was one of the things that tipped off your
friend Popovitch. I talked to him briefly on the phone. The other
clue was the unordered procedures that required me targeted nurses to
get into protective gear, including masks. Like you, he found both
those 'coincidences' suspicious. Then he started to figure how it
could be done, just as you and I did, but it wasn't until he was being
resuscitated, with everyone wearing masks and taking cultures,
including from inside his nose, that the exact technique struck him. He
sounds like quite a guy. He said that he would have written you a
longer note but his residents were impatient to get him full of
tubes."

"Amazing" was all I could think to say, remembering how near death he'd
been at that moment.

"You know," Williams said, "it astonishes me how well Miller covered
his tracks as the Phantom before he resorted to insecticides. I
suppose it doesn't matter now, but I couldn't turn up anyone who could
connect the ipecac to him. Even his targets from psychiatry couldn't
recall if Miller had been around shortly before they'd started
hallucinating.

We placed him in physio and rehab, though. He was down there a lot
around the time of the insecticide poisonings, claiming to need therapy
for a sore back. I think I figured out how he did it too. While I was
interviewing workers in the department, I observed their routine.

They sometimes leave their wet thongs unattended and off to one side
while they're in the whirlpool baths with a patient. Miller probably
watched his intended victim until he had a chance, then sprayed the
target's footwear with domestic pesticide. It's as though he became
more visible once he became more lethal, but..." The large man
shrugged.

"Ah, what the hell am I going on for? It's over, thank God."

I thought of a final question.

"Riley, could Miller have gotten away with making you think Rossit was
the killer, presuming you eventually found both our bodies?"

Riley grimaced.

"Think about what nearly happened with you and Miller, Doc. Suppose
he'd gotten one good whack at your head before you got him. You both
could have died in there. Miller probably thought he'd make it look
like you'd strangled Rossit while trying to escape from him, but that
the head injuries you sustained in the process were too grave for you
to get yourself out of the room afterward. To have set it up, all he'd
have to have done would be to smash you into a coma, position you near
Rossit, then let his organisms work on you. In time, either they or
the results of the head injury would finish you off. When we came on
the scene, we could very easily figure that Rossit was the Phantom and
that he'd caught you snooping in his lair... with a tragic result."

Williams added, "Even if the police found you before you were dead, you
wouldn't be in any condition to talk."

We sat in silence for a while, sipping coffee. Whether Miller had that
grisly fate in mind for me I'd never know for sure, but it would be the
stuff of future nightmares.

Eventually we began chatting about more pleasant things, like going
home. We were almost comfortable with each other after what we'd been
through together. I'd also noticed how Riley had started calling
Williams by his first name. Considering the way they'd been so testy
with each other before, I commented on their apparent friendliness
now.

Williams smiled.

"It turns out we have a common interest in football."

"Common!" Riley exclaimed excitedly.

"Doc, you're with someone famous. I only recognized him when I finally
saw his face without a mask. This is Spider Williams, one of the
greatest quarterbacks in the history of Michigan State. What an arm he
had! My dad and I used to drive a hundred miles just to see him
play."

"Thanks, sonny," Williams said.

I joined in the laugh--I figured Riley was ten years junior to Williams
and me--then left them to their discussion of old plays and long ago
victories.

I had something more current to do.

I'd decided to meet with Harold Miller for no better reason than my own
peace of mind, an aid to putting the ordeal to bed.

As I approached his brightly lit cubicle midst the dim lighting of
I.C.U, I couldn't help but think of the time when I saw Phyllis Sanders
in an identical setting at St. Paul's. Pulling on isolation garb at
the door to his room, I watched two nurses ministering to him.

One of them fiddled with the dressings around his neck and over many
portions of his face. In most cases the gauze was soaked through with
reddish brown stains. The other nurse adjusted a pad which had been
secured over what should have been his right eye;

I'd been told by the residents that it had been removed surgically,
there being nothing viable after it had been enucleated by glass during
our struggle.

The skin around his head and upper trunk that wasn't covered with
dressings was scarlet and puffy, as if he'd been scalded rather than
infected But as soon as I stepped into the room, the smell of the
putrefying flesh left no doubt that infection was the underlying
process.

His coughing was paroxysmal, and rather than use a steel basin which
one of his nurses held out to him, he let me resultant sputum roll down
his chin.

"My head," he moaned.

"My head." On his arms and legs were more red swollen areas, some of
them also covered by gauze, these too saturated through, but with
yellow seepage.

Looking at him, I could think only of the state of the organs I'd seen
at his mother's autopsy. It was telling testimony to me destruction
that was raging through his own body now. The staph bacteria had
obviously been carried from his infected skin into his blood stream and
throughout his body. His lungs would be riddled with cavities of pus,
his head pain was probably the result of developing brain abscesses,
and further sites of infection were setting up deep within his skin and
bone, giving rise to the sores over the rest of him.

As I approached his bed, he was staring off to one side, his remaining
eye having the same faraway look I'd seen in the subbasement.

"Harold, it's Dr. Garnet," said one of the nurses.

There was no response. He simply lay there. I leaned over him.

"Mr. Miller, I was told you wanted to speak to me."

I wasn't even sure he could hear. But seconds ago he'd been lucid
enough to complain about his head.

"Does he respond?" I asked the nurses.

"Sometimes," the nearer one said, "when he wants to."

As if to underline her point, he suddenly spoke, but without moving his
head or shifting his gaze.

"I want to speak to you in private."

The two nurses quickly finished up what they were doing and left.

He slowly turned to look at me.

"I obviously don't have much time," he rasped, "and it's hard to talk.
I think there's an abscess starting in my throat."

His voice had a slightly muffled tone, as though he were speaking with
a hot potato in his mouth, a sure sign of pharyngeal swelling.

"What did you want, Mr. Miller?" I was determined to keep this short
and get out as quickly as possible.

"I heard Williams and Riley talking about what you're putting yourself
through." He went into another paroxysm of coughing.

When it subsided, he said hoarsely, "She wanted to go back to your ER
that evening. Dr. Garnet, but I dissuaded her."

"Pardon?" I said, not sure what he was talking about.

"My mother. She told me over the phone she was going to return to St.
Paul's and tell you personally about her dizziness--she thought you
were so nice and that you'd want to know--but I talked her out of it.
If it hadn't been for me, you would have had her at your doorstep a few
hours after she'd been discharged, describing her orthostatic drop to
you."

I felt baffled, repulsed, and intrigued at one and the same time.

But I made no show of my reactions, merely shrugged, then watched
intently as he struggled for a deep breath. To my shame, I wanted to
hear more.

"And Mackie, he was slated to die," Miller said with difficulty.

"Part of my plan to make him a scapegoat, whether you thought he was
guilty or not. He had to disappear, to make it look like he'd gone
into hiding but was continuing to kill. Except I had to get rid of him
that night on the spur of the moment... to keep him from exposing me...
and I didn't have time to get his body to a safer hiding place."

"And Rossit?"

"Well, his opportunism got him to the wrong spot at the wrong time. Of
course, if I hadn't left that door unlocked when I ran for a shovel...
Who would have thought of rats?"

I couldn't listen. It was too morbid.

"Look, I don't know what--" "I murdered them, not you!" he said
abruptly.

"Why are you telling me all this?" I was so bewildered by his
declarations that I couldn't think of anything else to ask.

But he didn't answer. He simply turned his head, his gaze once more
traveling far away.

"Why?" I repeated.

Nothing.

He lay completely motionless, and I saw under the glare of the overhead
lights a sheen of perspiration break out over his forehead.

Although it could have been the result of his fever, I suspected it was
because Miller was back home, in that basement, with him.

* * * I discarded my protective gear, walked to the door of the I.C.U,
and turned to look at him in his cubicle. He slowly brought his stare
back around, his one eye burning into me.

Was he out of his mind? Probably. Had he tried to absolve me?

Sounded like it. But it also could have been a con, telling me what he
thought I wanted to hear. Why? I'd no idea. Except I could think of
little else but him as I stood there. Maybe that was the point of his
show--to plant a final hook in my thoughts so I'd never be quite free
of wondering about him.

I heard the sliding doors glide open behind me, then close.

"I figured you'd go see him." Riley was at my shoulder.

"Did he reveal anything important?"

Important? For the police, not at all. For me, I couldn't tell yet.

Perhaps in time I'd sort out whether his last act toward me was noble
or in some way malicious. But I doubted that would lighten the load
I'd carry for the deaths of Cam and Rossit.

"Not really," I finally said.

I stood watching Miller in that chamber until he shifted his gaze away
from me, once more casting it into the distance.

"It does look like he's in a glass coffin," I muttered.

"Pardon?"

"It's what he said when he first saw his mother in isolation at St.
Paul's--that it reminded him of the Snow White story she used to read
to him when he was a child."

Riley said nothing at first. When he did speak, he seemed to be
choosing his words very carefully.

"Doc, what happened to him as a kid was an atrocity, and in my book
those two so-called parents are among the worst kind of lowlifes I deal
with. But however it started, he's a grown man now--and a killer. That
means he plays by adult rules, or else other innocents, like Mackie,
pay the price."

My rules as a doctor were so different from Riley's as a cop. Do no
harm; comfort always; treat pain; and whenever possible, cure the
illness or injury at hand. Those were the fundamentals of my code. I
knew that Miller was beyond the help of any measures from that realm,
but it felt like such a failure simply to deliver him into Riley's
domain and its justice.

"Do you know what that isolation room reminds me of?" Riley asked.

I turned in time to see a look of satisfaction pass over his face
before he answered.

"An execution chamber."
Epilogue:

Ten Months Later

Mortality Morbidity Bulletin Monday September 1 Update:
Vancomycin-Resistant MRSA

A second outbreak afStaph aureus resistant to both vancomycin and
methicillin has been reported in the United States. The infections
occurred in a hospital in Philadelphia and have resulted in six deaths
so far. While local health authorities are stressing that there is no
danger to the community at large, quarantine measures have been
instituted for all staff and patients at the afflicted institution. The
first known encounter with this un treatable organism occurred in
Buffalo, New York, late last year, but under unnatural circumstances-a
deranged individual had acquired the bacterium and was using it to
deliberately infect personnel at a university teaching hospital.
Although the present outbreak is spontaneous, a CDC spokesperson says
that the lessons learned during the previous incident are pertinent to
the situation in Pennsylvania. As a result the CDC has created a task
force reuniting the physicians and officials who were instrumental in
containing the problem in Buffalo and have dispatched them to help out.
Unfortunately, fallout from the crisis won't necessarily end once the
infections are dealt with by these experts. In Buffalo, even after
officials ultimately gave the affected hospital there a clean bill of
health, public confidence was so shaken by the prospect of the super
bug recurring on its own that the venerable landmark never reopened and
most of its staff and programs had to be transferred to a nearby
faculty. It is feared that the hospital in Pennsylvania may face a
similar fate.

The next issue of the MMB will focus on what the natural occurrence of
this much-anticipated and much-dreaded super bug means for Americans
who must undergo hospitalization in the foreseeable future. Our update
will include the transcript of a planned interview with the leaders of
the appointed task force Dr. Douglas Williams of the CDC and Dr. Earl
Garnet, chairperson of Emergency Medicine at the newly designated St.
Paul's University Health Center in Buffalo.
A CONVERSATION WITH

Q. Peter, you made your debut as a novelist in 1998--with Lethal
Practice. Would you give us a thumbnail description of your life
before Lethal Practice?

A. Much of my routine was similar to the one I have described for Earl
Garnet--working ER shifts, teaching, attending meetings, and keeping
the department functional. It's a pretty typical job description for
any ER chief--the thrill of working the big cases interspersed with the
mundane business of making sure everything is stocked, staffed, and
ready for whatever comes through the door... twenty-four hours a day,
every day of the year.

As with most ER doctors, the rest of my life rotated around the
schedule that regulated our shifts. Ask an ER physician to do anything
socially and he or she will probably consult this document even before
checking with their families or companions to see if they're free. As
much as I miss the clinical work and the teaching, Icertainly don't
miss the hold which that infernal piece of paper had over my comings
and goings during the last twenty years. However, since leaving ER to
make time for writing, I seem to have fallen under the sway of a new
tyranny called "the deadline."

When I wasn't in ER, the rest of my working week was spent tending to
my private practice, which I continue to care for today.

As much as possible, then and now, I retreat to our country home with
my family on weekends.

Q. What inspired you to embark upon a writing career?

A. My kids ask me that all the time.

"Why write books?" they demand to know--when I could be spending time
on really important activities, such as playing with them or doing
computer games.

The easy answer is that I thought ER would be a great location in which
to set a modern thriller. I have always loved mystery stories told in
the first person--especially work by the masters, such as Chandler and
Hammett. I knew that by using the immediacy of the device, I would let
the reader actually become an ER physician and experience his
excitement, his fears, and his doubts. I couldn't resist the fun of
introducing someone very evil into this special world and seeing what
would happen.

But my young sons don't buy that stuff. I then appeal to their own
love of storytelling, and I explain that I share that love. But they
reply, "Sure, we all love stories, but why do you want to be one of the
people who writes them?"

Once, when they were grilling me on the subject in front of one of my
friends from medical school days, she silenced them with the best reply
I've heard so far. She said, quite matter-of-factly: "Because he has
to."

Q. And why fiction rather than nonfiction?

A. From nonfiction we learn what has been and what is. In fiction I
like how we can play with what might be.

Q. On the pretext that writers, including novelists, "write what they
know," how much of your first two novels is based on your own
experience as a doctor in charge of a hospital emergency room?

A. My job as a writer of fiction, I think, is to create a medical world
that is realistic, as opposed to being real. Any doctor doing any
writing must protect patient confidentiality above all. That being
assured, I made up the medical setting of my stories much in the way we
create teaching cases for the residents. In those, no one's medical
history is recognizable, but the realities of the problem being
observed are accurate. My experiences as a chief exposed me to many of
the ethical, political, medical, and economic issues at play in most
modern ERs. I then made up fictitious scenarios involving some of
those same issues and set their forces loose in my stories. The
not-surprising result is that I've received comments from all over
America that "it's just like my hospital."

One way or another, these days we all seem to be looking at variations
of the same difficulties in ER.

Q. ER physician Earl Garnet is the emotional and intellectual center of
your first two novels. In what ways is your protagonist similar
to--and completely unlike--his creator?

A. Garnet is married to an obstetrician; so am I. Garnet has a son;

I have two. Garnet has a large poodle; our family has two. Garnet and
I share a love for a log home on a little piece of paradise in the
mountains an hour from our respective cities. One of the things I
liked about being chief was that I could hire the best and brightest
emergency physicians I knew, and Garnet is a tribute to them.

Am I like Garnet? Icertainly identify with his commitment and his
passion to be good at what he does, but I'm probably more like a Garnet
wanna-be. When I first became chief and announced my intent to hire a
physician who was very much of Garnet's caliber, one of my friends in
ER gave me an astonished look and blurted out, "You can't be chief over
him! He's better than you!"

One thing's for certain: I'm a better doctor for having had the
privilege of working with the Garnets of the world.

Q. The concept of "death rounds " is really provocative. In your novel
of that title, Earl Garnet says, "Some doctors shunned the process, but
I couldn 't have continued as a physician without it."

In effect, is this you, Peter Clement, speaking as well? How
widespread is the practice of death rounds ? And why do some doctors
shun it?

A. That quote is me speaking. I was taught early on that the autopsy
was the ultimate tool of quality assurance, and that all deaths,
especially the ones we think we understand, can teach us our failings.
On a personal level, I always felt I gained an edge as an emergency
physician by subjecting myself to that kind of review. The next time a
similar case came through the door, I could react to the problem with
just a bit more certainty, precision, and speed.

Most hospitals have some form of morbidity and mortality review-they're
also called M&Ms. Unfortunately, they aren't always applied
systematically to all cases, and sometimes these forums are conducted
in an aggressive manner, the physician responsible for the case being
put on the defensive and nobody learning anything except that it's
better to cover up errors to protect your ass.

I always felt the secret to making death rounds work was to keep the
sessions from becoming too accusatory and, if a mistake in the
treatment of a patient was found, to focus comments on how all of us
could avoid making that same error in the future. In most instances,
only a fool would fail to grasp that he or she could have made a
similar slip in a second of inattentiveness, and when a death was ruled
preventable, no one dared point accusingly at the physician who was
responsible.

But the process, even when it's kept civilized, is tough to endure.

A physician who tends to be insecure about his or her clinical skills
in ERis liable to be afraid to face such revealing scrutiny.

Unfortunately, it may be that very sort of scrutiny by peers that could
either elevate the physician's competence and confidence to a level
that would render them safe for ER work--or reveal once and for all
that he has no future in critical-care medicine.

Q. You chose a pseudonym for your novels. What was the thinking behind
that decision?

A. Peter Clement is my first and middle name, given to me in honor of
my grandfather. I wrote under this name as a way to help keep my
writing activity separate from my activity as a doctor, and to
establish from the outset that it would be as inappropriate for anyone
to call my place of practice about my books as it would be to phone
Ballantine in New York about making an appointment to see me for a sore
knee. At my medical office I have partners, 5 busy secretaries, and
phones that are already kept busy by patients trying to reach all of
us. A promise I made myself was not to let my work as an author
intrude on my colleagues and patients.

Q. We know that your philosophy (about keeping your real identity
secret) has changed recently. How do you account for this
about-face?

A. I never intended to keep my real identity secret, like some kind of
"Anonymous." I wanted merely to keep it from being revealed in local
media until I could inform most of my patients and get everyone at my
hospital accustomed to the idea I was now writing medical thrillers. In
particular, I needed enough time to assure my patients I'd still be
their doctor.

As it turns out, everyone--my partners, my hospital colleagues, my
patients--everyone is delighted with my new career, and local publicity
has been tremendously responsive, while at the same time being
sensitive to my continuing role in the community as a physician.

Q. What's the game plan for you--and Earl Garnet--after Death Rounds?

A. I'm starting to work on a third novel, rebalancing my time for
medicine with my time for writing. As for Earl Garnet, I'm sure he'll
be around ER somewhere.
M.D." is a physician who headed an emergency room at a major
metropolitan hospital and now maintains a private practice. He is also
the author of Lethal Practice. He is married to a physician and has
two sons.