One of her worries before they had been living together was that one day, she would return to his apartment to discover his suicide. Every time she went back, she had a little twinge of pain and tightness across her chest as she held her breath and opened the door. Especially on those blacker days. There had been one time...
“Kenzie?”
Kenzie looked over at Zachary, suddenly aware that he had said something, but she had been too lost in her own dark thoughts to hear him. She had to stop doing that. She was a happy, upbeat person. She didn’t want to change into someone who was always worrying and having morbid thoughts.
“Sorry? I guess I was thinking about the case.”
“I shouldn’t interrupt you. I was just wondering if you wanted to get something to eat. When we get home, or a drive-through or coffee shop on the way?”
“No. I’m not hungry yet. I’ll get something at the office. Like you say, Dr. Wiltshire will probably bring in some donuts or pastries. Bad for me, but...”
“When you get up that early, you burn off extra calories. So really, you need them,” he offered.
Kenzie nodded. “Yeah. Exactly.” She smiled
He didn’t say anything for a few beats. His expression was still serious, his jokes delivered deadpan. He glanced over at her, saw her watching him.
“Are you okay?” he asked.
“Yeah, fine. Why?”
“Nothing. Just wondered if you were okay.”
“Sure.” She didn’t tell him the direction of her morbid thoughts. Dwelling on his potential suicide was not the way to help keep him from sliding farther into depression. Let him think that she had just been occupied with thoughts of the new case.
“How was he? Or she?” Zachary asked, with a jerk of his head back the way they had come. “Your... new client.”
“Well, pretty dead. Certainly not feeling any pain.”
“I just mean... you didn’t say what kind of death it was. It wasn’t anything violent? Something that upset you?”
“No. Nursing homes see a lot of deaths. It’s only natural. This one was in the independent living unit, so he wasn’t wasting away sick with something. And nothing violent. Just died in his own bed.”
“Natural causes?”
“That will be for Dr. Wiltshire to determine.”
“But, I mean, it looked like natural causes?”
“Yes. And I’m sure it was. But we’ll need to check out all the possibilities, just like with any other unattended death.”
Zachary nodded, not turning back to her as he drove. In a few more minutes, he was pulling into the parking space in front of Kenzie’s house. They both got out of the car.
“Do you need anything from the house?” Zachary inquired.
“No, I have everything I need for the day. Just got to grab my baby.” Kenzie indicated the garage.
“Okay.” Zachary stood there as if uncertain what to say or do next. Kenzie covered the few feet between them and gave him a hug.
“Thanks for looking after me. I’ll be fine the rest of the day. Just the usual stuff at the office. So you don’t worry about it.”
“Nothing to worry about,” Zachary agreed with a shrug. As if he were the calmest, coolest guy ever. But of course he would find something to worry about. He always did.
Kenzie used her key fob to open the big garage door. She hopped into her car and smiled as the engine roared into life. It made her feel warm all over. She really did love that little car. It wasn’t very often anymore that she thought about Lance Reacher, the private investigator she had known before Zachary. He had suggested that Kenzie really needed something flashier than the boring little compact she had driven then. Who cared about maintenance costs? Gas mileage? Foreign parts? Those were not the things she was thinking about when she got behind the wheel. What she was thinking of was how she loved the power of the car, the silky red paint job, and, in the summer, driving with the top down. She would pay what she had to. She had a trust fund if her salary at the medical examiner’s office didn’t support it.
She backed the car out. Zachary was still standing on the sidewalk, watching for her departure. Kenzie waved at Zachary as she left him behind.
On her way there, Kenzie’s phone buzzed in her bag, but she ignored it. There weren’t likely to be any emergencies in the few minutes it would take her to get to work. If it were Dr. Wiltshire, he could wait until she arrived. If Zachary had some last-minute concern, she could call or text him to reassure him once she was at her destination. For a few minutes, she was just going to relax.
Kenzie turned the radio up to drown out any additional buzzes from her phone.
When she arrived at the office and pulled into her reserved parking space, she pulled her bag into her lap and dug the phone out. She looked at the screen, expecting to see Dr. Wiltshire’s number or Zachary’s. Instead, there was a long list of missed calls, some of them Zachary’s and some of them her security company or a blocked number. Kenzie knew immediately what had happened.
She swore under her breath.
She couldn’t very well call the blocked number back. She tried Zachary first to try to calm him down.
There was no answer on his phone.
Kenzie hung up when it rolled over to voicemail. She dialed her security company and identified herself.
“Ah, Miss Kirsch,” the male phone operator greeted after getting her passphrase and other confirmations of her identity. “Thank you for calling back. We’ve had a call out to your home. Everything is fine. The police and our representative are on the scene, and as far as we can tell, nothing has been harmed or stolen. But there is a male subject who claims that he lives there, and...”
“Yes. Yes, Zachary lives there. He’s not a burglar. I armed the system when we left early this morning, and he must have forgotten to disarm it when he got back.”
“That can happen,” the man admitted. “Everybody has false alarms sometimes. There is a warning period after the system has been triggered to allow you to turn off the alarm before the police are alerted. Does your friend have the code to arm and disarm the system?”
“Yes. I haven’t been able to talk to him yet. I don’t know whether he panicked and forgot the code or if he just didn’t notice that he’d triggered it in the first place. I’m really sorry about this.”
“I’m very glad that nothing was stolen or damaged. Your system has been silenced and reset. We will have our representative confirm to the police on the scene that your friend is authorized to be there and can be left in the home...?”
“Yes, please. I’m really sorry. It won’t happen again.”
Although chances were, it would happen again. Kenzie had set off the alarm more than once herself; Zachary was bound to trigger it again too.
“Listen, can I add Zachary as someone authorized to talk to you to have the system reset? If anything goes wrong and he’s around instead of me, he should be able to deal with it.”
“We can do that, of course,” he agreed politely. “I will need his full name and particulars, and we will need to set up a passphrase for him. It shouldn’t take more than a few minutes.”
There was a beep in her ear. Kenzie pulled the phone away from her ear to peer at the screen. There was a call incoming from Zachary.
“I’ll have to call you back with that information. I need to take another call now.” She hung up on the man without waiting for an answer, taking Zachary’s call. “Zachary. I’m sorry. Are you okay?”
“Yes. I’m fine.” He was terse, his voice clipped but toneless. Definitely upset.
“The security company will be calling to give the police the all-clear and then you can go back inside the house.”
“They already have. Which is why I’m no longer in handcuffs.”
The phone operator must have sent out a text or some other remote notification to his man on the scene while still on the phone with Kenzie.
“They put you in handcuffs? Zachary, I’m sorry. I never th
ought they would do that. I didn’t even think to remind you about the alarm when we got home.”
“I should have remembered. Or at least noticed that it was beeping,” Zachary said with disgust. “I didn’t have a clue there was a problem until the alarm started whooping full-force. If anyone in the neighborhood wasn’t yet awake at six...”
“These things happen,” she said, echoing what the security guy had said to her. “I’ve set it off before too. I’m going to get you added as a person authorized to give them the all-clear and have the system reset, okay? So that if it happens again, they’ll talk to you instead of just having the police arrest you.”
“That would be nice,” he acknowledged, voice still tight.
“I should have thought to do it before. I don’t know why I didn’t.”
In fact, she had thought about it, but had disregarded the need. She hadn’t anticipated that Zachary would set it off when she wasn’t around or that the police would react the way they had even after Zachary explained that he lived there. It was one more thing that she had thought would be better if she could just keep it under her own control.
“I am sorry,” she repeated to Zachary.
“Not your fault. Well, you’ll be wanting to get to work now, so I’ll leave you to it...”
“You’re okay?”
“I’m fine.”
“Okay. We’ll talk later. Have a good day...”
34
Kenzie had made notes of the things that needed to be followed up on immediately with Sexton’s postmortem, calculating the rate at which he would have lost heat in the ambient temperature of the room in the nursing home and drawing blood to check for insulin. She browsed through a number of internet articles on angel of death killings and wrote down a few medications favored by nurses and doctors who killed. If Jason or one of the other nurses had had something to do with Mr. Sexton’s death other than ignoring his medical needs, she wanted to know right away. They did not want to be guessing about it months later or exhuming his body to look for something else.
They proceeded to the gross examination of the body, looking for any other bruises, puncture wounds, or anything else indicating what the conditions had been like at Champlain House. Like Cartwright’s body, the gross examination was unremarkable. He had a few minor bruises like everyone got—especially people who were over eighty and tended to bruise more easily as a result.
“Hypotheses?” Wiltshire asked as he began the Y incision.
“Nurse Jason’s description sounds like a stroke or a seizure. So I’m inclined to think something neurological. Of course... it could be whatever it was that Cartwright died of. They were both in the same unit, dying within days of each other, both with similar early symptoms of dementia before their deaths.”
“Right,” Wiltshire agreed with a nod. “Anything else?”
“Angel of death killing. Or some drug self-administered. I still find it interesting that the dog was in each of the men’s rooms at the time of their death or shortly thereafter. Why? Did they call her? Did she sense something? Did something she did trigger their deaths? I haven’t had any luck identifying a parasite or other condition that might have come from the dog.”
“What could a dog have that would give them neurological symptoms and such a quick death?”
“I don’t know... rabies? But the dog wasn’t acting like it has rabies. They are supposed to be violent and aggressive.”
“There have been cases where the animal has not shown signs of aggression, but has been unusually friendly. It really doesn’t matter which, as long as their saliva transfers the virus from one host to the next.”
“Do you think these men had rabies?”
“I doubt it. But they were showing signs of dementia, maybe delusion. The nursing staff noticed that Mr. Cartwright wasn’t eating or drinking and had an IV for Mr. Sexton. Problems with drinking and swallowing are red flags for rabies.”
Kenzie remembered petting and scratching the dog and letting it lick her hand. She tried to remember whether she had washed right away. Whether she had any cuts on her hands that would have allowed a virus to get into her bloodstream. She shuddered at the thought. But Wiltshire had said no, he didn’t think the men had died from rabies.
Kenzie watched as Wiltshire proceeded to examine and weigh each organ. If he saw anything unusual or educational, he would point it out to Kenzie, having her examine it and asking questions to help direct her to the right answers.
The heart and lung tissue were not quite as healthy-looking as Mr. Cartwright’s had been, but they still looked pretty good. They didn’t find anything to show that a clot had traveled to the heart or lungs. The big vessels feeding into Sexton’s heart were partially occluded with fatty deposits, but they didn’t find anything to show that one of these had been the cause of his death.
In due time, Dr. Wiltshire moved from the torso to the brain. He gave Kenzie a brief nod. Now they would see whether there were any other similarities in pathology between the two latest nursing home patients.
Kenzie drew closer to watch the careful removal of the top portion of Sexton’s skull to expose the brain. She and Dr. Wiltshire both bent close to examine the surface of the brain for signs of intracranial bleeding or any other obvious signs.
“This one was in his bed,” Wiltshire said aloud, “so no fall or bump on the head to confuse the issue.”
Kenzie nodded her agreement. Both of them moved around the table, making what observations they could.
“Some age-related shrinkage,” Kenzie observed.
“Yes. But not drastic changes like you might see with Alzheimer’s Disease.”
Kenzie nodded. She was eager to get some samples of the brain tissue to see if it showed the same amyloid plaques as Cartwright’s did. But she didn’t say so. She let Dr. Wiltshire continue to direct the postmortem, going through it one step at a time, unhurried, careful not to miss anything or to jump to any conclusions.
Finally, he nodded to Kenzie. “Okay. Let’s get some slides, swabs, blood and CNS samples, anything that might help point us to an answer. If this is some brain disease that we have not yet recognized, we need to get it pinned down. Is it something known or unknown? Or are we chasing after something that is not there?”
He and Kenzie worked together to gather all the samples that they could conceivably need to run.
“Can I...?” Kenzie started, indicating the microscope.
Dr. Wiltshire nodded. “Of course. Please.”
Kenzie hurried over to the bench to prepare the slides and secure them to the stage of the microscope. She took a deep breath and looked through the eyepiece. It took a few moments to focus on the cells. Kenzie let out her breath in a whoosh.
“It’s almost identical. Extensive amyloid plaques and tangles.”
Dr. Wiltshire approached and Kenzie moved to the side to allow him to look through the eyepiece to study the sample.
“Identical,” he repeated. “What are we missing here? This is not the dementia unit. These are not Alzheimer’s patients. These men did not come from the same background or experience. Why would they both have plaques with no noticeable Alzheimer’s Disease until a few days before death?”
“It could be a coincidence.”
She could tell Dr. Wiltshire did not like the idea. “Granted. But we need to look for other explanations first.”
“Something in their environment? Or it’s some genetic thing and they are actually related?”
“Could be old Vermont families. Intermarriages over generations. There are genes known to be associated with Alzheimer’s Disease, but none of them are great predictors. Environmental... sounds more likely. But what in the environment could have caused this pathology? There are possible links to DDT and other toxins, but this is not an area with high levels of pollutants in the air.”
“And that’s Alzheimer’s Disease, not non-Alzheimer’s amyloid plaques.”
He squinted at her. “Is that what we’re ca
lling it?”
“Tentatively.” Kenzie shrugged, embarrassed. She wasn’t trying to name a new disease or condition, just to label the signs that they were trying to understand. It wasn’t like she was writing a paper on it. Thought it might be a good idea to, once they had a better handle on what they were seeing.
“Ideas? What could be in the environment to cause the development of these plaques?”
“Do you think that they developed rapidly or slowly?” Kenzie ventured. It was something that she had been puzzling over. These were old men. The plaques could have been developing for years. Or they might have developed very quickly, like the symptoms the men had experienced before death. Was the rapid development of dementia symptoms followed by death symptomatic of how quickly the amyloid plaques were growing?
“Difficult to form any hypothesis on the limited information that we have,” Dr. Wiltshire mused. “Are these the only two patients with these signs? It seems unlikely that we would find the only two men and that they would die so close together in time and space. How many of the physician-attended deaths during the last few weeks have had similar pathology? How many deaths that we may have put down to accident or natural causes and never knew they had amyloid plaques because we didn’t examine the brain? If it is slowly-developing, then why did these two men die within a week of each other? Coincidence?”
“Maybe. But I think it must be rapidly developing. And if it is...” Kenzie didn’t like the conclusion this led her to. “Then everyone in that nursing home is potentially at risk. Whatever toxin or pathogen they were exposed to, everyone else in that building could also have been exposed to.”
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