Doctored Death

by P. D. Workman

  But first, there were new intakes to be done, email to process, reports to be printed, Dr. Wiltshire’s desk to tidy, and taking care of anything else that had happened during the night. In a bigger city, they might have a fully functioning night shift as well as the day shift but, as it was, they operated with only a skeleton staff to keep an eye on things at night. The staff being one person, usually rotating in from other departments. And that meant that sometimes things didn’t get done the way Dr. Wiltshire liked.

  Eventually, Kenzie felt like she could take a few minutes to start on her education about amyloid plaques and differential diagnoses for Alzheimer’s Disease. Unfortunately, it was noon. And who knew what the afternoon would bring. She already had a list of things that she would need to take care of. So, it was another sandwich from the lone vending machine, eating over her computer while reading through medical studies and articles.

  There were several theories about amyloid plaques. Everything from their being another prion disease like CJD, to being produced in response to attack by a virus or bacterial infection. It wasn’t necessarily as Kenzie had imagined, just a metabolic error or something that built up as people aged. While it was the most common cause of dementia, they didn’t affect everyone, like wrinkles or muscle degeneration.

  One takeaway from her study was that tau tangles correlated better with how advanced the dementia was than amyloid plaques. But Cartwright’s slides had shown extensive tangles, which suggested he should have had advanced dementia.

  Another study suggested that amyloid plaques were not a problem until they started to appear in the synapses between neurons. Plaques inside the neurons apparently did not cause the communications problems that a build-up between the neurons did. All of that made sense to Kenzie. If the impulses between cells were obstructed by protein deposits, the cells could not pass messages along.

  But once again, Cartwright’s results defied the study. He had extensive plaques in the synapses. By every measurement and predictor Kenzie could find, he should have been disabled by the amount of damage in his brain. It would not be surprising for someone to die from such extensive damage. What was surprising was that he had not experienced any symptoms until a few days before his death.

  Kenzie took notes and tried to come up with a hypothesis that made sense. Several of their theories so far had been disproved by the laboratory tests. She couldn’t predict when they would get the bacterial and virology swab screens back to give them a better idea of whether they were looking for an infectious agent.

  Dr. Wiltshire was at her desk just before Kenzie could finish her sandwich and clear away the work she was doing. “Oh, sorry, didn’t realize you were on your lunch break.”

  “No, it’s okay. I didn’t really take a break. But I thought I’d better have something to eat.” She wondered whether Zachary had or would actually have a slice of pizza as she had suggested. He hadn’t called or texted her all morning. That wasn’t particularly unusual, especially if he were engaged with a case, but she had hoped that she would hear something from him, just so she could stop being so anxious about whether he were okay.

  “Good thinking.” Dr. Wiltshire’s eyes lingered on the few bites of her sandwich that were left. She hadn’t seen him go to the vending machine or out for lunch. Had he brought his own lunch in, or was he, like Zachary, inclined to just work straight through the day without a thought of something to eat? She didn’t know how Zachary could do it.

  “I thought you would want to know that our John Doe has been identified,” Dr. Wiltshire offered, his eyes returning to Kenzie’s face. “Thanks to your insight on the fact that he might not actually be homeless and we should broaden our search to businesses in the area, not just services for the indigent.”

  “Oh, that’s good news! Who is he?”

  “He was a businessman living near the site where he was found. He lived alone, so he hadn’t been reported missing. The police are contacting his next of kin, so we may get transportation instructions today or tomorrow.”

  “They didn’t want anything else for their investigation?”

  “Who, the police?” Dr. Wiltshire shook his head. “No, why?”

  “I just thought that since he was killed by alcohol overdose and was found in a back alley... it’s a little more suspicious if he wasn’t actually a homeless man. If he was an alcoholic on the streets, it’s not hard to believe. But a businessman going home from work at the end of the day...” She shook her head. “I would think they would want to investigate that a little more.”

  “And they probably are. But they haven’t asked for anything else from our end. We’ve already collected all the evidence and established cause of death. Manner of death is accidental, unless I get other information.”

  “Yeah.” Kenzie scratched the back of her head, thinking about it. Alcohol toxicity was almost always accidental. Unless they had some kind of evidence showing that the alcohol had been forced down his throat, which they did not. His teeth had not been broken, as they might have been if a bottle were forced into his mouth. There were no bruises or defensive injuries to indicate that he had fought off an attack. “I guess so. I’m just surprised that it was someone white-collar.”

  “The rich can still be closet alcoholics and can overdose if they consume too much too fast.”

  “Yeah. But he wouldn’t be drinking at work, would he? They would catch on if he was drinking that much on the job.”

  “Maybe he went out for drinks with the boys after work. Hit a bar or two. Everyone heads for home, only he doesn’t make it. Maybe he continued drinking after they went home.”

  “But then wouldn’t they wonder what had happened to him if he didn’t show up at the office the next day?”

  “We don’t know that they didn’t. They may have called him to see if he was okay, but not reported it to the police or to the boss at work because they didn’t want to get him in trouble. They might say that he was sick, or that they don’t know what happened to him, to cover for him.”

  Kenzie nodded. “Yeah. I guess that makes sense.”

  It wouldn’t be the same with her friends. If one of them thought that she had drunk too much the night before and she had dropped out of sight, they would undoubtedly do more than just call her and cover for her. But it was different for women. They were more vulnerable. Her friends wouldn’t even have left her at a bar or let her walk home by herself if they thought she might have had a bit much to drink. But with men, it was different. They wanted to show their crew how invulnerable they were. How they could drink massive quantities without being affected. Walk alone at night as if it were nothing.

  She remembered how Zachary had been jumped after leaving a bar when on an investigation. He had been badly beaten by a gang of skinheads. Men were not invulnerable, even if they thought they were. Zachary and John Doe could both attest to that.

  “What was his name?”

  Dr. Wiltshire looked down at his hand, where he held a sticky note. “Jeremy Salk. We can update our records.”

  Kenzie nodded and typed it into her notepad. “I’ll do that.”

  28

  Dr. Wiltshire looked down at Kenzie’s notes. “You’ve been working on the plaques?”

  Kenzie nodded. “There was a lot to do today, so I haven’t spent a lot of time yet. But it’s interesting stuff. We never really covered the theories in school, just that Alzheimer’s Disease was caused by these amyloid plaques, and if you saw amyloid plaques, it was Alzheimer’s Disease.”

  “But things are rarely that simple in medicine.”

  “No, I guess not. There is the whole question of why people get these plaques. I thought that it was just a function of aging. Some processes in the body slowed down, and these plaques started to accumulate. But that’s not necessarily the case.”

  He nodded. He glanced around him. There was nowhere to sit down around Kenzie’s desk. People stood there to make inquiries or fill out forms, and then they left. They didn’t stay t
o chat.

  “Let’s grab the boardroom,” Dr. Wiltshire suggested. “You can still see if someone comes in.”

  Kenzie nodded and picked up her notes. She would hear if her phone rang. No need to call Julie in this time.

  They sat at the table and Dr. Wiltshire got comfortable. “So, what can you tell me?”

  “I don’t know how much of the theory you know...”

  “Pretend I know nothing. I’m a layman. You’re explaining it to Zachary.”

  “Okay.” That helped Kenzie to relax and feel less anxious about it. She didn’t want to be lecturing her boss, either assuming he was ignorant or that he knew something he didn’t. The permission to treat him like a layperson meant that she didn’t have to worry about offending him.

  “One of the most compelling theories is that amyloid plaques are actually a defense mechanism. Like fever. We see it as a symptom, something that must be treated to make the person well again. But when we artificially lower a fever, we are not letting the body use its own defenses. We should let it run its course, unless it is too high and endangers them.”

  “Right. So amyloid plaques could be a defense against what?”

  “There are several bacteria implicated and possible viral involvement as well. For example, we know that people suffering from dental infections are at a much higher risk for Alzheimer’s disease. There is a significant risk of bacteria making its way from the teeth to the brain and causing real damage. A brain infection puts the person’s life at risk.”

  “So the plaques may be a way to prevent bacteria from entering the brain, or they might interfere with the bacterial growth or be a sort of scar tissue caused by bacterial damage.”

  Kenzie gave a nod. “We don’t know why or how, but we know that people who have amyloid plaques are able to fight infections for longer. They are somehow protective and slow down the disease process.”

  Wiltshire nodded. “What bacteria appear to be involved?”

  Kenzie gave him the specifics. She paused. “Also, there is the possibility that they protect against some viruses as well. In particular, herpesviruses.”

  He considered. “Which herpesviruses?”

  “Human Herpesvirus 1, 6A, and 7. That we know of.”

  Dr. Wiltshire shook his head. “Which, all together, are endemic to what percentage of the population? Ninety percent?”

  “I haven’t been able to come up with a number for all three together. But yes... it is endemic. But not in brain tissue. Usually, our immune systems are effective in keeping herpesviruses out of the Central Nervous System. The percentage of the population with herpesvirus in the brain is much lower.”

  “So if the plaques were caused by a virus, the serology is not going to tell us what we need to know. We don’t need to know what viruses were in the blood; we need to run PCR on the brain tissue and CNS fluid.”

  Kenzie nodded. “But this is all theory, and we could still be looking at two separate issues—what caused the plaques, which may be benign, and what caused his death. He could still have died from a virus or bacterial infection, and the plaques have nothing to do with it.” Kenzie had her doubts about that, but it was a possibility. The literature confirmed that some people with amyloid plaques did not seem to have any AD symptoms.

  “Of course,” Dr. Wiltshire agreed. “We’ll pursue both avenues and, hopefully... come to a conclusion in the end.”

  29

  Despite how busy Kenzie was, she watched the clock, and when five o’clock rolled around, she put away her active projects and began the night shut-down procedure. Before the clock struck six, she was pulling into the garage and went into the house.

  “You home?” she called out as she walked in the door.

  She could hear Zachary moving around in the living room. He poked his head into the kitchen, looking at her and rubbing the bridge of his nose. He looked tired and drawn. He had probably not crashed on the couch during the day like he should have.

  “Yeah, I’m here. You’re home early.”

  “Well, I’m home on time. For once. After how crazy it has been this week, I decided I’m not spending any longer at the office today. Unless there’s an emergency, I’ll put in my time tomorrow and take the weekend off.” Considering the fact that she frequently put in at least one weekend shift, that was significant. She hoped it signaled to Zachary that he was an important part of her life too. That she was willing to make the time for him.

  “Sounds nice,” he said noncommittally. No inflection. No suggestion of something they should do together, since they would have the time. She hadn’t asked whether he had any surveillance he would need to be away for or if he wanted to drive out to see one of his siblings.

  “Did you have any plans?” she asked tentatively.

  “I don’t know. I’ll need to look at my calendar.” He didn’t pull out his phone to look and she knew he was just putting her off.

  “We could do something nice. Go out to Old Joe’s. A movie. Something we haven’t done for a while.”

  He nodded.

  Kenzie sighed. “What do you want for supper?”

  “Nothing. Whatever you like is fine.”

  “I’m not sure I’m even going to make anything.” Kenzie kicked off her shoes and hung up her jacket on the hook on the mudroom wall.

  “You don’t have to. Do you want me to order in?”

  “Not if you’re not eating.”

  Even though Zachary was giving her something of a cold shoulder, she could see his consternation over this statement. He knew that she got concerned when he didn’t eat, so it was something he could fall back on if he were angry and wanted to let her know it in a passive-aggressive way. He hadn’t exactly said that he wouldn’t eat supper, but he had implied it. On the other hand, he would be very upset if Kenzie didn’t eat because of him. Ordering in was one way that he nurtured her and showed that he could be a partner in their relationship, but if she didn’t accept his offering and intentionally went hungry because of him, he would obsess over it for days.

  Kenzie went to the bedroom to put down her bag and change into something comfortable. It might still be early in the evening, but she was going to pamper herself with a nice cozy set of jammies.

  When she finished and left the bedroom, Zachary was standing there in the hallway, looking as though she had caught him red-handed at something. He looked back the way he had come, then ahead to the bathroom, and didn’t know what to say. He had clearly wanted to continue their conversation but didn’t know whether to follow her or give her some space.

  Kenzie raised her brows. “Yes?”

  He just motioned to the bathroom and hurried past her. He shut the bathroom door and turned on the tap. Kenzie waited for a moment, then went back out to the living room. Zachary had learned a lot of different coping mechanisms in foster care, not all of them functional. She turned on the TV while she waited for him to sort himself out and decide to talk to her. He could keep pretending that he wasn’t upset with her, tiptoe around and act like everything was normal, and be increasingly anxious because of it. Or he could just get it off his chest and they might be able to enjoy the upcoming weekend.

  30

  Unfortunately, it was doomed to be a tense and awkward evening of avoiding speaking to each other unless absolutely necessary and pretending that everything was fine when they did speak. Kenzie eventually broke down and heated up the leftover pizza, which they both had some of.

  “How was your day?” Kenzie asked as she nibbled at her slice. “Work good?”

  “Yeah. How about you? Make any progress on that case? The... nursing home case?”

  “Not really. We’re waiting for a bunch of testing back. I did some research for it today, but I’m not sure how it will turn out. We may be seeing a problem where there really isn’t one.”

  Zachary nodded. He lifted his slice and smelled it, but didn’t eat. She waited for more questions, but there didn’t appear to be any forthcoming.

  �
�We identified that John Doe. You were right; he wasn’t homeless. He was just... in the wrong place at the wrong time. With the state of his body and clothes, the police assumed that he was homeless and that’s what they told us. They happened to be wrong, and we were operating under a false bias.”

  He nodded again and looked away from her, into the living room where he had a line of sight to the front window. He always sat in the same kitchen chair. In the beginning, she thought it was just habit. Zachary had a definite preference for sameness and rituals. But she had started to see that maybe it wasn’t just habit, but the need to be able to see as much of his surroundings as possible. To know if a stranger were lurking around the house, a car parked on the street that shouldn’t be there, any sign of emergency vehicles or other possible dangers. The kitchen only had a small window and a door into the mudroom and garage. The window faced a neighbor’s house. While it helped to brighten the room during the day, it wasn’t much of a view. Only the big living room window afforded him a good view of the street.

  “We were both pretty impressed that you could guess that he wasn’t homeless just from his hair,” Kenzie offered.

  “Not just his hair. The way he was groomed. His skin. A lot of little things.”

  “I guess that’s what makes you such a great private investigator. Being able to see all of those little things and draw conclusions from them.”

  Zachary shrugged off the compliment. He took his first bite of the pizza. Kenzie was nearly finished eating her first slice.

  “Nothing interesting for you today?” she prodded. “Talk to Heather or anyone?”

  “Talked to Heather,” he admitted. He had introduced his big sister to PI work, and she quite enjoyed the work she was able to do for him from her computer and phone. She didn’t do fieldwork like surveillance or accident reconstruction, or going to people’s houses or places of business to talk to them. The home-based work was enough for her.