OB-GYN man for cystitis. Alan had seen an orthopod the previous year for a sprained ankle he’d suffered in a hospital basketball league. Except for the medical secretary and the lab tech, there was the strong suggestion that Dr. Richter was the source of the illness. The fact that he’d seen five of the patients just before he developed symptoms had to be significant.
Marissa could explain the lab tech getting the illness by his sticking himself with a contaminated needle, but she couldn’t immediately explain Helen Townsend. Marissa had to assume that Helen had seen Dr. Richter sometime earlier in the week. She had come down with the illness just forty-eight hours after the doctor. Maybe he had spent a lot of time in medical records earlier that week.
Marissa’s musings were interrupted by the ward clerk, who said that Dr. Navarre had called to ask if Marissa would kindly come down to the hospital conference room.
Returning to the room where she’d started the day reminded Marissa of how long she’d been working. She felt bone weary as Dr. Navarre closed the door and introduced the other person who was present. He was William Richter, Dr. Richter’s brother.
“I wanted to thank you personally for being here,” said William. Although he was impeccably dressed in a pin-striped suit, his haggard face was mute testimony to his lack of sleep. “Dr. Navarre has told me your tentative diagnosis. I want to assure you that we will support your effort to contain this illness to the limits of our resources. But we are also concerned about the negative impact the situation could have on our clinic. I hope that you agree that no publicity would be the best publicity.”
Marissa felt mildly outraged, when so many lives were at stake, but Dubchek himself had said essentially the same thing.
“I understand your concern,” she said, uncomfortably aware that she had already spoken to a reporter. “But I think we have to initiate further quarantine measures.” Marissa went on to explain that they would have to separate the possible contacts into primary and secondary contacts. Primary contacts would be those people who had spoken with or touched one of the current eight patients. Secondary contacts would be anyone who had had contact with a primary contact.
“My God,” said Dr. Navarre. “We’re talking about thousands of people.”
“I’m afraid so,” said Marissa. “We’re going to need all the manpower the clinic can spare. We’ll also tap the resources of the State Health Department.”
“We’ll provide the manpower,” said Mr. Richter. “I’d prefer to keep this ‘in-house.’ But shouldn’t we wait until we actually have a diagnosis?”
“If we wait, it may be too late,” said Marissa. “We can always call off the quarantine if it is unnecessary.”
“There’s no way we’ll keep this from the press,” moaned Mr. Richter.
“To be truthful,” said Marissa, “I think the press can play a positive role by helping us reach all the contacts. Primary contacts must be instructed to stay as isolated as possible for a week and to take their temperatures twice a day. If they run a fever of 101° or over, they’ll have to come to the clinic. Secondary contacts can go about their business but should still take their temperatures once a day.
Marissa stood up and stretched. “When Dr. Dubchek arrives he may have some suggestions. But I believe what I’ve outlined is standard CDC procedure. I’ll leave its implementation up to the Richter Clinic. My job is to try to find out where the virus originated.”
Leaving two stunned men in her wake, Marissa left the conference room. Passing from the hospital to the clinic building, she approached the clinic information booth, asking directions to Dr. Richter’s office. It was on the second floor, and Marissa went directly up.
The door was closed but unlocked. Marissa knocked and entered. Dr. Richter’s receptionist was dutifully behind her desk. Apparently she hadn’t expected company, because she quickly stubbed out a cigarette and put the ashtray in one of the desk drawers.
“Can I help you?” she asked. She was fiftyish with silver-gray, tightly permed hair. Her name tag said Miss Cavanagh. Reading glasses perched on the very end of her nose, their temple pieces connected by a gold chain that went around her neck.
Marissa explained who she was, adding, “It’s important that I try to determine how Dr. Richter contracted his illness. To do that, I want to reconstruct his schedule for a week or two prior to his getting sick. Could you do that for me? I’m going to ask his wife to do the same.”
“I suppose I could,” said Miss Cavanagh.
“Did anything out of the ordinary happen that you can recall?”
“Like what?” asked Miss Cavanagh, with a blank face.
“Like his being bitten by a monkey or getting mugged in the parking garage!” Marissa’s voice had a sharp edge to it.
“Those things did happen,” said Miss Cavanagh.
“I realize that,” said Marissa. “How about anything else odd or different.”
“I can’t think of anything at the moment. Wait, he did dent his car.”
“Okay, that’s the idea,” encouraged Marissa. “Keep thinking. And by the way, did you make the arrangements for his African medical meeting?”
“Yes.”
“How about the San Diego meeting?”
“That too.”
“I would like to have the phone numbers of the sponsoring organizations. If you could look them up for me, I’d appreciate it. Also I’d like to have a list of all the patients Dr. Richter saw during the two weeks before his illness. And finally: do you know Helen Townsend?”
Miss Cavanagh took her glasses off her nose and let them hang on their chain. She sighed disapprovingly. “Does Helen Townsend have the same illness as Dr. Richter?”
“We believe she does,” said Marissa, watching Miss Cavanagh’s face. The receptionist knew something about Helen Townsend, but she seemed reluctant to speak, toying with the keys of her typewriter. “Was Helen Townsend a patient of Dr. Richter’s?” Marissa prodded.
Miss Cavanagh looked up. “No, she was his mistress. I warned him about her. And there: she gave him some disease. He should have listened to me.”
“Do you know if he saw her just before he got sick?”
“Yes, the day before.”
Marissa stared at the woman. Helen Townsend didn’t give Dr. Richter the disease; it was the other way around. But she didn’t say anything. It all fit into place. She could now relate all the known cases to Dr. Richter. Epidemiologically, that was extremely important. It meant that Dr. Richter was an index case and that he, and only he, had been exposed to the unknown reservoir of the virus. Now it was even more important for her to reconstruct the man’s schedule in minute detail.
Marissa asked Miss Cavanagh to start working on an outline of Dr. Richter’s schedule for the last two weeks. She told the woman that she’d be back, but if needed, she could be paged through the hospital operator.
“Can I ask you a question?” said Miss Cavanagh timidly.
“Of course,” said Marissa, with a hand on the door.
“Is there a chance I might get ill?”
Marissa had been suppressing the thought because she didn’t want to frighten the woman, but she could not lie. After all, the secretary would have to be considered a primary contact.
“It’s possible,” said Marissa. “We will be asking you to restrict some of your activities during the next week or so, and I’d advise you to check your temperature twice a day. Personally, however, I think you will be fine since you haven’t experienced any symptoms so far.”
Back at the hospital, Marissa fought off her own fears and her developing fatigue. She had too much to do. She had to go over the clinic charts in detail. She hoped to find a reason why some of Dr. Richter’s patients had gotten the disease and others hadn’t. Also Marissa wanted to call Dr. Richter’s wife. Between the wife and the secretary, she hoped she could construct a reasonably complete diary of the man’s activities during the two weeks before he became ill.
Returning to the fifth floor, Marissa ran into Dr. Navarre. He looked as tired as Marissa felt. “Dr. Richter’s condition is deteriorating,” he said. “He’s bleeding from everywhere: injection sites, gums, GI tract. He’s on the
