FBI and CDC had become involved with the "situation" in Syracuse.

 

Dave knew the CDC would be providing support from Atlanta. They didn't have the manpower to send people up to Syracuse, not after the cuts they'd suffered in the latest budget from Washington, and they'd be able to provide the most assistance from their state-of-the-art labs. Besides, they could rest easily knowing they had one of their own, someone they'd trained themselves, on the case.

 

The FBI was a little harder to suss out. Someone had gone and killed someone. Once the person from Gifford Street who was missing a spleen, who had already lost a leg, passed away, the case became a multiple homicide. Ken insisted it was a serial killing, because it had taken place over the course of two different acts, but Dave wasn't interested in the difference between the two. He just wanted people to stop dying.

 

He'd have thought the FBI would be all over it. He knew the Sheriff's Department and the City police had jointly requested assistance. While the FBI was willing to help from Quantico, however, they would not be sending agents to Syracuse to assist. The current federal government had issued a directive that all agencies were to focus exclusively on fighting Islamic extremism, and had trimmed budgets to match that priority.

 

That meant there were precious few resources to spend on an individual with no apparent religious or political agenda who was killing people across Onondaga County.

 

That didn't mean some Syracusans didn't benefit from the situation. The national press descended on Syracuse like a plague of locusts. Dave was a big fan of freedom of the press. He welcomed the way they questioned the handling of the meningitis outbreaks, even when they proved to be uncomfortable questions. He more than welcomed the way they pushed back against federal callousness.

 

He just wished the different outlets hadn't sent quite so many people. They took up space at most of the hotels in the area, so grieving and anxious relatives had to deal with prurient reporters sticking cameras in their faces in the lobby or near the elevators before they'd even gotten their coffee. They crowded the restaurants and then criticized local cuisine, because it wasn't New York or Atlanta or Los Angeles standard fare.

 

And none of them, not a single one of them, knew how to drive in Syracuse-style inclement weather.

 

That meant more wrecks. Sometimes that just meant traffic delays as they—and the appropriate rescue personnel—tried to get them, their rental cars, and their equipment out of the way. Sometimes that meant more people in the ER, taking up space they needed for meningitis patients. Dave tried not to resent that, but he couldn't help it. He'd lived in the area long enough to have absorbed some of the local attitudes toward "outsiders" on the roads.

 

They endured another outbreak, this time at Baldwin House Nursing Home over on Lodi Street. Dave could only be surprised there wasn't an outbreak there before now. Central New York had plenty of perfectly good skilled nursing and rehab facilities. People who couldn't afford them, or who'd been kicked out of the others due to behavior or safety issues, got sent to Baldwin House. The place was a nightmare, and Dave had seen more than a few outbreaks of varying types at the facility.

 

Elderly people weren't usually at high risk for contracting meningitis, but Baldwin House had been cited ten times in five years for overcrowding. Sanitary issues continued to be of concern too and, when Ken found a glass vial in the same place where the "clean" tableware was kept, Dave just shook his head. He couldn't have expected any better.

 

This latest outbreak was sudden, hard and overwhelming. Many of the residents at Baldwin House were vulnerable for one reason or another, either simply by virtue of their extreme age or by virtue of the fact that they'd been fighting other opportunistic infections for however long. They hadn't gone into a skilled nursing facility because they were healthy.

 

Some had lost the ability to communicate and, since the nursing home had so many more patients than it could care for, those patients got the short end of the stick. Dave wound up having to go into Baldwin House and test each and every resident for meningitis, accompanied by a team of nurse practitioners, residents and interns who could help him.

 

It took him twenty-four hours, working non-stop. Ken pushed back on that, because Dave was pregnant and he needed to take better care of himself, but what exactly was Dave supposed to do here? At least a third of these people couldn't speak for themselves. Dave couldn't just leave them to die in pain and agony. He couldn't turn to someone who could well have been his grandfather and say, "Sorry, I get that delays in treatment increase your chance of complication by two hundred percent, but I'm sleepy and I'm growing a cute little baby, so tough toenails."

 

Ken ultimately settled for bringing him smoothies when he thought Dave should eat.

 

Dave was more than happy to go home at the end of his twenty-four hours and get some sleep. The PCR machine worked quickly to analyze the lumbar punctures, but there were so many that he still had a few hours to close his eyes and rest up before he had to get up and do it all again. After all, there were still staff members to consider. And family members.

 

When he got up a few hours later, he headed back to the hospital. It wasn't a moment too soon. One out of every four lumbar punctures that had come back from Baldwin House was coming back positive for meningococcal disease.

 

That meant a hundred and fifty new patients, each of whom already needed critical care.

 

Dave wanted to cry. He knew some of that was hormonal, and he shouldn't beat himself up about that. The rest of it was frustration, which was perfectly reasonable under the circumstances. He shouldn't beat himself up about that either. The biggest question was, what were they going to do with all of these sick people?

 

He massaged his temples, needing to break the tasks down into manageable units. His first priority needed to be the most critically ill patients. They had two that needed to be put into the intensive care unit right away. Fortunately, or unfortunately, Silver Oak had exactly two beds available in Intensive Care.

 

Hopefully no one else would present with an injury that required that level of critical care, and none of his other patients would take a turn for the worse.

 

Next, he had to consider the remaining patients. Some still had only flu-like symptoms and a stiff neck. He turned to one of the emergency nurses, Regina. "Can you do me a favor? We've got an influx we can't handle. I need you to call all the other hospitals in Onondaga County."

 

"All of them?" Regina looked over the lines of patients, on gurneys and in wheelchairs, who lined their halls. "Got it."

 

"Rick?" He called out for his boss, Dr. Wade. "We've got to start diverting ambulances away from here. I get that people want to come here first, but right now we've got twenty open beds, three of them are in Obstetrics so we can't use them, and we've got a hundred and fifty patients to find beds for. Some of them are going to have to stay in our treatment bays until we can put them someplace."

 

Rick's mouth flattened out into a long, grim line, but he nodded. "What about other nursing homes and rehab facilities?"

 

"If we can find any that will take our patients, that's great. I'd rather minimize the amount of driving I have to do, but I think Community has an ID specialist. I know University does. He's an ass, but he's there. We can see if they'll pitch in and help." Dave rubbed at his face. "I doubt we'll find any available beds. There's no way they're going to keep Baldwin House open. They'll have to find places for all those residents."

 

"Right." Rick winced. "Noor, could you call County Dispatch please and tell them to divert ambulances? We cannot take patients at this time. We'll also need additional ambulances to take patients out to other hospitals." He grimaced. "Fortunately, they're still in the middle of negotiating that acquisition by Regent. I have no idea how we're going to pay for all this. But hey—we can worry about that later."

 

Rick and Dave went about the task of triaging meningitis patients. Rick might have been the supervisor, but in this case Dave was absolutely the one in charge. They had other doctors in the ER too and Rick called some of the staff from Gerontology down to the ER to help out. Dave gave them a crash course in staging meningococcal disease, and they were off to the races.

 

It still took eight hours to sort through all of the patients and the eight hours were Dave's vision of Hell. Some patients were suffering from dementia and they didn't deal well with being in the new environment and surrounded by strangers. They weren't shy about letting people know about it either. Some sat and cried, some moaned and yelled, and a few of the men got aggressive.

 

Dave only had to take one punch from a ninety-four year old man who was convinced he was making unwanted advances on the woman next to him for Ken to step in. The old man, who apparently thought the year was 1939, could pack quite a punch even if his balance was sufficiently off that he needed to use a walker. Ken didn't lash out at the guy, but he got an ice pack for Dave's face and made sure to keep himself in-between Dave and any patients as much as he could.

 

Direct care providers from Baldwin House were, for the most part, more than happy to help out with their residents. That was a real godsend to Dave, who had to navigate sometimes volatile patients who were sometimes unable to communicate for themselves and who didn't always have their medical history with them. Unfortunately for Dave and the rest of the Silver Oak staff, the Baldwin House administration was much less forthcoming.

 

"It's probably their lawyers making them clam up." Ken rubbed gently at Dave's shoulders to try and help him to relax. "Also, you need a better union rep."

 

"Then their lawyers should be fired. And our union rep is just as much of a workaholic as the rest of us. He's out there right now, trying to calm down a patient we only know as Mrs. B. That's what her wheelchair says. None of the Baldwin House staff will go near her." He shuddered. "I truly hope they shut that place down. I get that it's a confluence of things making it this way; it's not one person's fault, but holy crap this is a nightmare."

 

"You've probably got another couple of hours in you if you're still using words like 'confluence.'" Ken chuckled. "What about the families of the loved ones involved?"

 

Dave sighed and pinched the bridge of his nose. "So, the lawyers or the administrators aren't giving us the patients' files. We're just going on hope that the staff members know enough, or can remember enough, that we get their original diagnoses right and we don't mix their meds. A few are already our patients and we're calling their families already. The ones who come from other hospitals, we're working on that too. It's just taking longer, and the damn nursing home isn't helping."

 

"I don't think I've ever seen you this pissed." Ken grinned at him and kissed his cheek. "It's put some color back in your cheeks. I kind of like it. Once you've sent all the good people on their merry way though, you need to go home. You can work on staff members tomorrow, okay? The machine will be processing their lumbar whatevers while you sleep and eat right anyway."

 

"I have to take care of these people, Ken. They're my patients, and someone's killing them!"

 

Ken snapped his fingers, like a light switch had just gone off. "Someone is killing them, aren't they?"

 

"Well, yeah." Dave bit his lip. "That's the whole problem. None of these people should be here. They should be in their safe space, watching courtroom shows in the dark after lights out."

 

"Okay, maybe not. No one should watch that." Ken gave a full body shudder. "But that's the thing. The only time the killer tried to hide what they were doing was with Nick Barrett."

 

"Stuck it in his bag, if I remember. After that, the vials were left out in the open. And the outbreaks have been larger." Dave looked up at him. "They want people to know this is being done to them."

 

"And look at the people this person is going after." Ken held up three fingers. "We've got inmates at the jail. We've got folks in public housing. We've got old people, stuck in the absolute worst nursing home in the county."

 

Dave clutched at his stomach as it turned. "Throwaway people. They think these are throwaway people."

 

"Right? They could choose to release this at, say, an SU basketball game. That would be easy. Except then they're not sending a message. Then they're targeting 'normal' people. It's not a moral argument anymore." Ken closed his eyes and bowed his head. "I think we can draw some inferences about who we're looking for now."

 

Dave dragged Ken back into his office. "This probably doesn't need to be public consumption."

 

"No." Ken chuckled and shook his head. "We're looking for someone who is used to thinking of himself as superior somehow. He's not going to have a problem playing God. He likes it."

 

Dave fell into his chair. "That could be… well. I don't like to think badly about anyone in the medical profession, but it's not an uncommon attitude with some doctors. Especially surgeons, I guess. When you've got the patient lying there, and you know they're a crap person, the temptation to just let them go can be overwhelming."

 

"Not for you." Ken sat down in one of the other chairs and leaned forward, elbows on his knees.

 

"Even for me." Dave slouched in his seat. All of the energy drained out of him. "I'm not a surgeon, of course. But I'd be lying if I didn't get tempted sometimes, to make a little error with medication. There was a guy who came in once and I knew he was abusing his kids. It would have been easy to smudge the dose on his morphine. No one would have known I'd done it; he'd have gone out happy and out of pain."

 

"Did you do it?" Ken didn't move.

 

"Of course not." Dave snorted. "It would have been wrong. The temptation is there, sure, but you don't actually do it. You run around with enough ordinance to star as three action heroes. You walked in here, the day we met, with a damn shotgun. You must have the urge, sometimes, to take matters into your own hands."

 

"True." Ken relaxed back into his seat. "But I don't. And neither do you. This guy does."

 

"He's got a point to make, and he's using people he considers expendable to make that point." Dave closed his eyes. "I wonder who else he considers expendable?"

 

***

Ken all but had to drag Dave home. He waited to do it until the last of the people from Baldwin House had been evacuated to other hospitals, but he put his foot down once that had happened. It was all well and good for Dave to be worried about his patients, and it pretty much cemented that Dave wasn't a suspect. Dave was still pregnant, and needed to be careful with himself.

 

Even if Dave hadn't been pregnant, he would have needed to take better care. With a caseload like this, Dave wasn't going to be done with the meningitis outbreak for a good long time. He'd already been working on it for weeks. He needed to pace himself. If he wouldn't pace himself on his own, then Ken would just have to help him.

 

The next morning, they got up and headed back to the office. Dave had gotten a decent night's sleep and that was good, but his usual good cheer was more than a little bit diminished. "What's wrong?" Ken poured out some coffee for both of them. He'd sneakily read up on pregnancy restrictions while Dave was off working on his lumbar puncture marathon, and it turned out it was perfectly okay for pregnant people to drink coffee during pregnancy. They weren't supposed to guzzle it, but a couple of cups in the morning shouldn't be a problem.

 

Of course, Ken wasn't a doctor. But Dave accepted the cup with a shy, happy little smile, so it was okay.

 

"I'm just trying to think of people who could be capable of doing something like this. It's not… Syracuse is a city. It's a medium-sized city. It's not New York or Los Angeles, but it's not Mayberry either. That said, the medical community isn't that large."

 

They sat at the breakfast bar. "No," Ken agreed. He couldn't quite figure out what his boyfriend was getting at. "No, it isn't." Maybe some more coffee would help.

 

"The killer has to be someone we know. They know enough to know how meningitis is spread." He swallowed. "And they know enough to choose targets they don't mind seeing die."

 

"Okay." Ken sipped from his coffee. He waited for a moment to see if Dave was going to expand on his thoughts or not.

 

Dave stared into his coffee cup for a moment. "Any time there's an illness, there are always signs. Sometimes they're too small to be seen with the naked eye, but a complete metabolic panel or a complete blood chemistry would pick them up like that." He snapped his fingers. "Or else the symptoms are obvious. They're just minor, or vague enough they could be anything. You know? Like, everyone passes gas, but it's only when you get diagnosed with GERD that you know your particular gas issue was a symptom of something bigger."

 

"I'll take your word for it." Ken stared at his boyfriend. Were all of their early morning conversations going to involve gas?

 

Dave huffed out a little laugh. "It's a minor symptom, and maybe someone could have diagnosed the condition earlier if they'd realized it was a symptom. But it didn't seem all that odd to anyone at the time. Or maybe it did, but not weird enough to comment on." He went back to staring into his coffee.

 

"You're not going to see the killer's face at the bottom of a cup of dark roast, babe." Ken patted Dave's back. "For one thing, it's not even your job to find the killer. It's your job to help cure the patients. And if you can help find the killer, with science, that's awesome. But getting into the head of a sick puppy like that? No, that's not on you. That's on me."

 

Dave rested his head against Ken's arm for a moment. "Yeah, maybe. It's a natural reaction though. That, 'What did I miss?' thought. We're going to find out who it was and it's going to seem like we should have known the whole time. I'm going to be so mad that I couldn't have figured it out a month ago and spared all these people from having to go through all of this that I'll probably just explode and make a big sticky problem for Housekeeping."

 

"Hey, don't go creating problems for Housekeeping now. Those are some good guys." Ken grinned.

 

"They're the best." Dave made the saddest face Ken had ever seen. "I'd hate to make a mess."

 

"You're adorable when you're sleepy. Come on. Let's think about the baby." He put his hands on Dave's belly. "Hey, you in there! What kind of a nursery do you want, huh?"

 

Dave laughed. "They don't have ears yet. Or an optic nerve. Or a brain." He gulped from his coffee.

 

"They're a slacker then." Ken pretended to glare, but his smile couldn't be contained. It was too easy to fall into this kind of easy teasing. "Come on. Let's go see what the day has in store for us."

 

They got dressed and headed into Silver Oak.

 

It didn't take long for Ken to realize the moment of levity that morning was going to be a needed memory throughout the rest of the day. Three of the elderly meningitis patients had died during the night—both of the ICU patients and a third who'd suffered a stroke. The administration at Baldwin House was still trying to hold back patient records, so notifying the families was going to be a huge challenge.

 

Four staff members from Baldwin House had also tested positive for meningitis as well. They denied being sick, but they couldn't deny the test results. Or their fevers. Finally, one of them broke down and confessed she had symptoms, but couldn't afford to take time off. "I'm working three part-time jobs just to keep a roof over my head. And none of them has to offer me health insurance, because they're all part-time jobs." She held her head, which must have been throbbing, in her hands. "This is going to break me."

 

"I'm sorry." Dave reached out and put a hand on her arm. "I can promise you we're going to do everything we can to help you. But you can't go and work with other people until your tests come back clear. You're very sick. You need help."

 

The four were admitted wherever space could be found. It wasn't together, but somehow Ken doubted they'd mind. If he had to wear a hospital johnny, he certainly wouldn't want his co-workers anywhere near him.

 

He didn't get any better news from the lab. Granted, he hadn't been expecting better news from the lab, but he'd been okay with having no news. Getting bad news was worse than having no news at all.

 

He got a call from Kristen over at the crime lab. "Hey, handsome, I've been working on the vials you sent over."

 

Ken sighed. "Awesome." He rubbed at the back of his neck. "So you've found the killer's fingerprints, I can go down there in a hazmat suit and arrest him, and then we can all go out for nachos and beer?"

 

"I might have the killer's fingerprints." Kristen sighed. "I've got a lot of fingerprints, Ken. As near as I can tell, anyone who's had any contact with the epidemiology lab at the med school over the past semester has touched those vials. Which, for the record, is bad. It means no one has washed those vials."

 

Ken found his voice after a moment. "No, that can't be right. Dave is a fanatic about washing up. He scrubs his hands raw just doing the dishes. It goes with the territory." He swallowed. "You said they've all touched the vials."

 

"Yeah. Dozens of prints, so they must have touched the vials more than once." Kristen paused. "Sorry, Ken. I wish it could be more helpful news."

 

"Actually, that is helpful." Ken tapped his hands on the desk. "Tell me, did you find any other prints on the vials?"

 

"Well, no. The various students' prints and the victims' prints, but that's it. None of the prints were smudged either. It didn't look like anyone had been trying to clean the vial or trying to handle it with gloves."

 

Ken sucked his cheeks in. "So either our killer is so slick he can drop a glass vial filled with a bacteria, without breaking it and without leaving his own prints, or…"

 

"Or he's one of the students." Kristen's voice went up an octave, like she'd just processed a cup of coffee. "Could be the professor too."

 

"Nah. He's got a good alibi for two of the bacteria drops." Ken blushed, grateful Kristen couldn't see it. "Hey, you know what? Why don't you go ahead and send me that report? I can narrow it down from there."

 

He caught up to Dave during a break between admissions and rounds. "How are the patients?"

 

"As well as can be expected. I need to go head out to the other hospitals and check on the remote patients next." Dave gave him a hug. "Why?"

 

"I'll come with you." Ken glanced around. He didn't think any of his suspects were on the list. "Let's hit Community first. It's the farthest away; we can have a good talk on the way back."

 

"Um, okay." Dave went along with Ken, apparently not all that worried. No, that was wrong. Dave trusted Ken. It was a heady responsibility and Ken needed to remember it.

 

When they got to the car, Ken proved his bona fides by telling Dave about Kristen's call. "So we know the killer is one of your students," he said, to sum up. "There weren't any other fingerprints on any of the vials. Also, seriously? Not washing the vials?"

 

Dave rolled his eyes. "Did you ever take a lab class?"

 

"I took a crime lab class." Ken kept the car going south and west, toward Community General Hospital. Technically, it was Upstate University Hospital at Community General now, but no one thought of it that way. Community had always been Community, and it probably always would be. That was the problem with communities that didn't change much. No one forgot anything.

 

"Okay. Well, we don't exactly have a giant vat of meningococcal bacteria in the back somewhere that we take samples from for class. I showed you the supply we have for the semester. People don't have an assigned test tube just for them. We grab a sample, we work with it and then, at the end of the semester, the samples are destroyed." He shook his head. "And remember? The samples were all accounted for."

 

"They were." Ken deflated for a moment, but then he perked up. "Is there any way someone could have put another, empty vial in the rack? Or maybe grown some of their own bacteria?"

 

"Why would they do that?" Dave made a face, like he'd just smelled something bad.

 

"I don't know. Maybe so they could release a whole bunch of meningitis on unsuspecting communities?"

 

Dave covered his mouth with one hand. "Okay. True." He turned white as a sheet. "Oh my God. One of my students is a monster."

 

"Who's teaching your class right now?" Ken scratched his head. "I mean, you're barely leaving Silver Oak as it is."

 

"Dr. Tennyson. He's semi-retired now, but he agreed to help out while this is going on." Dave closed his eyes. "I can't believe any of my students—why would you go into Infectious Disease if you're just going to do something like this?"

 

"Hey, I'm sure they've got their reasons." Ken gripped the wheel. "They're probably absolutely batshit reasons, but I bet they sound great in their head."

 

Dave huffed out a little laugh. At least it put a smile back on his face. "So. The baby."

 

That was a much better topic. "Yeah. The baby. Do you think the baby will like horses?"

 

"Horses?" Dave blinked at the non sequitur. "I think they're mostly going to poop and sleep for the first few months. Beyond that, I have no clue."

 

"My mom runs a horse barn." Ken kept his eyes on the road. "She boards horses, trains them, the whole shebang. And, ah, I told her. About us. About the baby."

 

"Oh." Dave stared, wide-eyed, through the windshield for a moment. "I have honestly never thought much about the whole family meet-up thing. It just hasn't been an issue, on my side, for a long time. And it won't be." He paled again. "How did she take it?"

 

"Better than I thought she would. She wasn't thrilled about the whole pregnant out of wedlock thing, but I think she was more worried that I'd turn into my dad. Which I won't, so." He swallowed.

 

"No. You wouldn't." Dave put a hand on his arm, grounding him. "You're the best." He sighed. "I have no idea if the baby will like horses. Right now, the baby mostly seems to like cheese."

 

"Cheese?"

 

"Cheese." Dave made a pained face. "I'm careful with my diet; I try not to screw it up and eat unhealthily, but I've been craving cheese like there's no tomorrow. I don't even like cheese."

 

"Huh. You should talk to a doctor about that." Ken laughed when Dave shot him a vicious glare. "Oh my God, that's precious. You should see the look on your face."

 

"I'll head down to Obstetrics and make an appointment with Carter Idoni. He's the best and he's another omega like me. Anyway." Dave tried to keep his glower up, but he couldn't seem to do it.

 

They pulled in at Community and checked in with their liaison doctor on site. Dr. Gottschalk was an older man, with a face like a bird, and he frowned at Ken like he'd been caught taking an extra cookie from the jar. "I'm glad you're here. We're starting to see signs of complications in some of these elderly patients, and I'm not sure how that matches what you've seen in some of your other patients."

 

Dave grimaced, but followed his counterpart up to the ward. "We've seen a normal rate of complications, but they're elderly which does have an effect. Have you consulted with the gerontology department?"

 

"That's a good idea. We'll bring them in right away."

 

"I can't take credit." Dave grinned at the bird man. "Rick Wade's the one who called them in with us. It's easy for us to get kind of used to doing things in a silo, right? Anyway, let's see what we're dealing with."

 

Ken tried not to spend more time than he had to with these examples of human misery. He couldn't help them, and he didn't need to get any more details about their symptoms. It wouldn't help him build his case.

 

Instead, he found himself comforting family members outside the hospital rooms. Some family had been found for some of the Baldwin House patients, although it was hard to say how much good that was doing. The families were angry. They were angry at the nursing home. They were angry at the authorities, for letting this happen to their loved ones. And they were angry at the killer.

 

"Are you doing anything to find him, besides going around to the different hospitals?" screamed one angry woman.

 

"I am. We've got some leads, but these things take time." Ken sighed. "I wish it were as easy as just swabbing someone's hands for bacteria, but it isn't. We will prosecute. This person will pay."

 

"Not enough," she spat.

 

Ken couldn't have agreed more.