With the accession numbers of Arnold's and Kevin's cases plus those of George Fontworth, Laurie had relayed them all to Agnes Finn. Laurie wanted Agnes to retrieve their frozen samples for culture and subtyping just as she was already doing with Laurie's case that morning and Riva's cases. Laurie thought it was important to see how closely they all matched.
Laurie had then made some important phone calls with the numbers Cheryl had gotten for her. First, she called Loraine Newman at the Angels Orthopedic Hospital. Laurie found her as accommodating as both Arnold and Cheryl had described. The woman graciously agreed to a meeting that very afternoon at two-thirty.
Next, Laurie had called a woman at the CDC by the name of Dr. Silvia Salerno, who was associated with the CDC's national library of MRSA strains that had been formed to identify genetic patterns in the subtype, in hopes of influencing prevention and control strategies. In addition, she was part of the CDC's Web-based National Healthcare Safety Network and had been the person to whom Riva had been referred. It was she who had had Riva's isolates subtyped.
"If I am not mistaken, they were a community-acquired MRSA, or what we call CA-MRSA," Silvia had said when Laurie had asked if she remembered the cases. "Let me look it up. Okay, here it is. CA-MRSA, USA four hundred, MWtwo, SCCmecIV, PVL. Now I remember it very clearly. That is a particularly virulent organism, maybe one of the most virulent we've seen, particularly with the PVL toxin."
"Do you recall Dr. Mehta mentioning that her two cases came from two separate hospitals?"
"I don't. I assumed it was the same institution."
"It was definitely two hospitals. Does that surprise you?"
"It suggests the two individuals knew each other or they each knew a third person."
"Meaning you believe these were not nosocomial infection?"
"Technically, for an infection to be considered nosocomial, the patient has to have been in the hospital for more than forty-eight hours."
"But that's only a technical definition. I mean, the patients could have gotten them from the hospital."
"Of course. The definition is more for statistical reasons than scientific, but getting such an infection within twenty-four hours of admission would suggest to me that they were part of the patient's own flora."
Laurie described her series, all of whose victims had died of MRSA within twenty-four hours and, of those whose subtyping was available, had died of community-acquired MRSA, which Silvia said backed up her contention that the bacteria were most likely brought in by the patients. Regardless, Silvia had specifically said she was interested in the cases and had been surprised not to have heard of the cluster. Offering to help in any way she could, she took Laurie's direct-dial office number, and promised to get back to her after she'd asked around to see if anybody at the CDC had heard about the outbreak. She'd also promised to have a second look at Riva's samples to determine if they were the exact same strain or merely close.
Finally Laurie had called the Joint Commission on Accreditation of Healthcare Organizations. Cheryl had not been able to get her a specific person to talk with, and after Laurie had been switched around numerous times, each time being given the name of someone else who could supposedly help her, she had given up, defeated for the moment by the bureaucratic mind-set.
Arriving at her destination, the taxi pulled up to the curb and stopped, and Laurie handed over the fare and the tip. As she climbed from the cab, she looked up at an impressive, modern highrise of green-tinted glass held in place by vertical ribs of green granite. The name, Angels Orthopedic Hospital, was inscribed into a pediment-shaped marble lintel over the front doors. A liveried doorman stood on the sidewalk. A sloping driveway led to a receiving dock, a service entrance, and a multistory parking garage in the rear.
The interior was even more impressive. It was more like walking into a Ritz-Carlton than a hospital, exactly as Jack described that morning. The floor was a mixture of hardwood and marble, and the information booth looked like a concierge desk, with two uniformed men sitting side by side in suits and ties. But what caught Laurie's eye more than the decor was the lack of people. There was no hustle and bustle like a normal hospital. Other than the two men at the information booth, there were only two people in the large lounge area sitting opposite each other on opposing, elegantly upholstered couches.
Laurie went up to the information booth and received the full attention of both gentlemen. She asked for Loraine Newman, mentioning her name and that she had an appointment.
"Certainly, ma'am," one of the men said. He picked up the phone, and after a brief conversation directed Laurie to a pair of interior doors to the left of the bank of elevators. "Miss Newman is waiting for you in administration."
Laurie followed the directions and pushed through the designated doors. The administration area was more utilitarian than the lounge area but still sumptuous compared to any hospital Laurie had ever been in. It was a wide, long room with glass-enclosed offices on either side, each fronted by individual secretarial desks. Most all the desks were occupied, but it didn't appear that much work was being done. Only a few of the secretaries were typing into their monitors, while most were chatting in subdued tones.
One of the secretaries caught sight of Laurie and asked if she could help her, but before Laurie could respond, a glass door to an office opened and an energetic woman wearing a white coat over a brown turtleneck sweater and skirt called out to her. She introduced herself as Loraine Newman before ushering her inside.
"Let me have your coat!" Loraine said. She was Laurie's height and build and even approximate age but had different coloring compared to Laurie's blond complexion. "Please take a seat," she said, as she placed Laurie's coat on a hanger and hung it inside a small closet.
Laurie sat down, and Loraine went behind her desk and did the same.
"I've never met a medical examiner," Loraine said with a smile. "I'm awed by what you guys do."
"We don't get out much," Laurie said. "Most of our scene work is done by our forensic investigators." She inwardly winced, recognizing Bingham would surely not appreciate what she was doing.
"How can I help you?" Loraine asked. "I suppose you are here because of yesterday's unfortunate MRSA death."
"That and more," Laurie answered. "I did the autopsy on Mr. Jeffries this morning. The extent of his infection was dramatic, to say the least, especially how quickly it consumed him."
"You have no idea how upset we are, and not only about the tragic loss of a life of an otherwise healthy man but also because it has occurred despite our making maximum effort to prevent it."
"I heard from one of my colleagues the efforts that you have been making. I imagine it must be discouraging, especially since you have apparently had eleven such cases."
"Discouraging is not a strong enough word. Did you find out anything at autopsy that might help us? When you called, I was hoping that was going to be the case."