by Peche, Alec
“Denver?”
“Actually, Denver overnight then probably Breck or back here depending on what I decide for processing my specimens or discover during the autopsy. The body is in Golden which is a suburb of Denver just as you head up into the mountains, but he died while skiing at Breck.”
“Wow that sounds interesting. Did he hit a tree?”
“No, had a heart attack at eleven thousand feet, in his early forties and a triathlete.”
“Hmmm, a decent way to die, but way too young. What is your gut telling you about this case?”
“Sudden heart attacks kill every day. Usually the patient has a weird arrhythmia that they can’t recover from, but I am still surprised given this guy’s level of fitness. A weird heart rhythm should have killed him before now or at least made him faint on occasion. So this second opinion may not be the open and shut case it appears on the surface. I’ll have to give some thought to how I would disprove such a theory.”
She had been looking at her computer screen while talking to Nathan and noted that David had returned her paperwork already, she would check for all the signatures and then it would be off to Colorado.
“My client just returned the signed documents so it looks like it is a go. I should be able to catch a flight tonight to Denver, I’ll call you back in thirty minutes after I have made arrangements and I’ll let you know my schedule. Would you and Arthur desire Trixie’s companionship tonight?”
“You know I get endless entertainment watching Arthur make Trixie his supplicant. I have to marvel over a fifteen pound cat subduing a sixty-five pound dog. I’m not planning on going anywhere for several weeks so we should be good. Where will you run your tests, in Denver?”
“With the airport just an hour away and frequent eighty minute flights to Denver, I was thinking about collecting my specimens and bringing them back here to process and then returning to Breck to look at the bigger picture if I find anything that doesn’t fit with the coroner’s pronouncement of death by a heart attack. It would likely be cheaper and faster for my client than for me to individually contract the tests out to labs in that city.”
“Sounds like a plan. If you do drop back here for a few hours tomorrow, let me know and Trixie and I will join you for a meal before your return to Colorado.”
“Thanks, love you,” and Jill ended the call.
She looked into flights, booked one but waited on the hotel for tonight. She would have about ninety minutes before she would have to head to the airport. She kept an autopsy kit packed and ready to take to her next location. Her kit even had a nice letter written to airport security in it since she found their inspection notice inside her kit with every flight. It didn’t stop the inspections, but nothing was out of place or missing.
Next she called the coroner’s office that was performing, or was scheduled to perform, the autopsy. Apparently they had so few deaths in Breck that bodies were transported down to the big city for examination. She had never met any medical examiner from the great state of Colorado, and she hoped they would be cordial.
“Hello this Dr. Jill Quint, may I speak to the medical examiner?”
“Just a moment, is this about a particular deceased person?”
“Yes, Joseph Morton.”
“Just a moment.”
Jill waited a few minutes and then a female voice came on the phone.
“Yes, this is Dr. Jones, how may I help you?”
“Hello Dr. Jones, I am Dr. Jill Quint. I am a former medical examiner from California and now I’m a consultant that provides a second opinion on the cause of death. Mr. Morton’s partner has hired me to provide that service and so I wanted to make arrangements to attend the deceased’s body tonight and perform a private autopsy.”
“Um, I have never heard of such a thing in this office or even in my career. I’ll have to check with someone else in this office. Tell me more about yourself.”
“I am a licensed physician in the State of California. I am board certified in Pathology and sub-boarded in Forensic Pathology. I also completed medical toxicology training, but I am not boarded in it. I worked for the State of California’s crime lab for fifteen years, resigning about five years ago. Since that time police departments and individual family members have hired me as a consultant. I can provide references from the San Francisco Police Department as well as the Special Agent in Charge of the San Francisco regional FBI office. If you’ll give me your fax number, I’ll fax those documents to you now.”
“Do you have the family’s written permission to examine the deceased’s body?”
“Yes, I’ll also send that to you. I am leaving California in about two hours for a flight to Denver and should be at your facility by eight this evening. I have my own equipment and require nothing more than access to the body and an empty stainless steel table. If you find for some reason that you cannot accommodate me, I’ll attend the body at the mortuary when it arrives there, but for best accuracy, I would really appreciate the use of your table and access to Mr. Morton.”
“This is a most unusual request. I’ll need to run it by my superiors and I would really appreciate any and all documentation that you can email me.”
“Thank you Dr. Jones. When I land in Denver, I’ll call your office to see if you’re going to give me access.”
“Yes, please do,” and the conversation ended.
Jill hated cold calls to medical examiners. She had such a rare occupation that most medical examiners would go their entire life and not cross paths with her. She had learned at the start of her career as a consultant to compile a packet that contained her credentials. The recently added recommendations from the FBI and SFPD put further shine on her curriculum vitae. She hoped that this Colorado medical examiner would not create barriers that delayed her attending the deceased.
She finished packing deciding she wouldn’t even try to locate a lab she could use in Denver; she would just fly the specimens back with her to do the analysis in her home lab. It was likely where she would have the best turnaround time for results. She then sent a second email to her friends and often partners in her consulting business. Angela had huge emotional intelligence and because of that could obtain state secrets out of just about anyone. Marie was an absolute whiz at finding common and obscure facts about someone on the internet, and Jo could make financial sense of any document and find the financial ticking time bomb. Nick’s talent was in security systems - hotel entry, cameras, etc. He might know how the pass system at the ski resort could be put to good use if they did have a crime on their hands. She often kept them updated about her cases, but at this point she didn’t need their help.
She packed everything up, piled Trixie’s bed, toys, and food in her car and stopped at Nathan’s house on her way out of town. He was used to her odd hours by now, and they would likely get together over lunch tomorrow while she was running tests. She left her car in the airport parking lot and traveled through security. It was perfect timing as she arrived at the gate just as boarding began. Eighty minutes later she was touching town in Denver and arranging a rental car for her trip to the medical examiner.
She called Dr. Jones from the airport, “Dr. Jones, this is Jill Quint. I picked up my car at the airport and need to start my drive to the location of Mr. Morton’s remains. What can you tell me about where I will be allowed to autopsy Mr. Morton?”
“Your call earlier created quite a conversation here.”
“Why?”
“We have never been asked to allow an outside consultant into our autopsy area. There are legal questions, resource questions, and ego questions.”
“Ego questions?”
“Yeah, what if you come up with something different than my ruling? It is like having an outside auditor review our body of work. Mostly our egos are on the line there.”
“So you’re not going to allow me to use your facility?”
“Actually, we are going to allow it. We verified your credentials and then did an inter
net search. We decided we might learn something from you, even hopefully if all it becomes is verification that we do good work. Do you need directions?”
“Thank you for your honesty and accommodation. I have your address programmed into my GPS, and it says I should arrive there in about twenty minutes.”
“We of course have security so just hit the bell when you arrive, and someone will bring you to Mr. Morton’s examination room.”
“Again, thank you Dr. Jones,” Jill said as she ended the call. She sent David a text to notify him of her arrival in Denver, and that she would not be traveling to Breck tonight.
She left the airport heading into the city. She had always liked the look of the tepees on the prairie architecture of the airport and corny western music that played on the tram that moved you between the boarding gates and the baggage claim. She had held off booking a hotel since she didn’t know her schedule and location for the evening. She might stay near the coroner’s office or she might stay near the airport. Twenty minutes later, she arrived at the Medical Examiner’s Office.
Chapter Two
She parked in the lot and pulled her testing kit out of the trunk. She wheeled over to the building entrance, and noted the bell that Dr. Jones suggested she ring.
She depressed the button and a few seconds later a voice called out, “This is the Medical Examiner Office, and how may I help you?”
“This is Dr. Jill Quint. I just spoke with Dr. Jones and she is expecting me.”
“One moment and someone will escort you inside.”
Jill stood in the cold darkness of the nighttime. Street lamps provided lighting to the parking lot as well as the front door, but beyond the perimeter of each light it was very dark. At this time of night most of the lot was empty giving Jill a little bit of a creepy shiver feel. However when she looked out, there were a few more cars than she might expect. Her imagination was far too fanciful to spend much time waiting. Fortunately, she heard the door snap open as someone beckoned her inside.
“Hi. I’m Al, are you Dr. Clint?”
“It’s Dr. Quint, and I am pleased to meet you.”
“Do you need some help carrying stuff?” Al asked peering out to the parking lot, perhaps looking for an open trunk.
“Thanks for your offer of help Al, but I have everything I need on wheels in this container,” replied Jill pointing to her autopsy kit.
“Okay, come on in and we’ll take the elevator to where Dr. Jones and the others are waiting for you.”
“Others?”
“Yes, several pathologists that were not working came in tonight to meet you.”
Great, thought Jill. She would have people in the way, being suspicious of every time she capitalized a letter in her notes for the case. That meant it would be a long night. Medical Examiners reacted differently when she indicated she wanted to review their work. Rarely was she welcomed, and often she met with hostility. She had just thought that the atmosphere was going to be better here based on her earlier phone call.
The elevator doors opened and Al directed her down a corridor and to an examination room on the right. He held the door open so Jill could easily enter with her wheeled case. A woman in green scrubs approached her.
“Hello Dr. Quint, I am Lucy Jones, a forensic pathologist with the coroner’s office. Let me introduce my colleagues,” and she performed introductions.
“Nice to meet all of you and please call me Jill.”
“As I am sure you have run into this before, we had a variety of emotions when you first called. After researching you and some of your interesting cases, we decided we all wanted to observe and learn from your forensic skills.”
Whew, thought Jill, this is going to be okay.
“Thank you and I hope I can meet your expectations. Let me describe for you my process before we begin with my examination of Mr. Morton.”
“Sounds good,” encouraged Lucy with a smile.
“Typically I get a call within twelve to thirty-six hours of death. It is equally split between whether or not an autopsy has been performed. In some cases no autopsy is required, and the patient’s family wants one, and in other situations the coroner has done an autopsy and the family is disputing the finding on a gut level. Sometimes it is a grieving process that drives the family, and often there is a family feud. Most of the time, I do a second autopsy at a mortuary because the body has already been moved to that location. I have a kit ready to go at all times and a laboratory on my property back in California. If Denver were farther away, I would contract with a local lab to process the specimens. In this case, I’m going to fly home on the first flight and process the tests myself, which will likely give me the best turnaround time for results.
“I often approach a case with the thought that this is a murder and how do I disprove that it is natural causes. I choose to be biased; something a medical examiner can’t do in their position. I believe all medical examiners are doing their best to identify the correct cause of death. Here is my reality - I will only work on this one investigation, until the case is closed. Since I was once in your position, I bet that each of you will likely go on to do another four autopsies tomorrow. I have more time and perhaps more testing resources to study Mr. Morton than you will ever be allocated given the usual workload of this office. That concentrated time gives me more time to think and pursue loose ends. I also have a team that supports me to go beyond this initial autopsy to investigating the murder itself. My average at the moment is that I agree with just over eighty percent of autopsy findings. I had a case two days ago, where no autopsy was performed by the county, nor did I do one as the patient so obviously died of natural causes. My work with that client was simply going over the patient’s medical record with her as an outside stranger. So my scope and examination varies with the circumstances of the case. Any questions so far?”
Dr. Jones and her colleagues just shook their heads “no”. They had their arms folded in front of their chests, a classic posture expressing that while they were listening and nodding agreement, they were really not happy to have her there.
“Dr. Jones, have you ruled on Mr. Morton’s cause of death yet?”
“Yes I completed the autopsy this afternoon. I ruled Mr. Morton had a myocardial infarction while skiing at a high altitude as the preliminary cause of death. As you know, I will wait a few weeks to get back all of the tests that I conducted.”
“Did you determine the cause of that heart attack?”
“No, I could see the damage to his heart muscle. I’ve observed that clinical finding on other heart attack victims.”
“As I mentioned, I would approach this case assuming Mr. Morton was murdered. Now I need to prove that it was natural causes, so I would need to look for a natural source of the heart attack. Thus looking for that source will be the focus of my examination.”
Jill could see that her statement resonated with Dr. Jones and several of her colleagues. They were slowly warming up to her method for approaching an autopsy. They now knew that it was very unlikely that she would overturn the cause of death. However, if she could not find a natural cause for that heart attack, then they would have to examine their processes in this office.
“Mr. Morton’s partner called me earlier today, obviously in the deep throws of grieving. Part of the problem for him in accepting his death was how he died. I am sure I wouldn’t be here if he had died in an automobile accident. The problem for David is that Joseph had no history of heart disease. He was forty-three, a triathlete, and he had been skiing for at least twenty years. His father and uncles are alive with no history of heart disease. So this heart attack came completely out of the blue for him and Mr. Morton’s family. I looked up the statistics on sudden death and for men ages thirty-five to seventy-three, it occurs in 191 of 100,000deaths. Given that wide age range, I would expect many of those 191 deaths to be in ages over sixty.
“In thinking about natural causes of heart attacks, at the top of my list are fatal arrhyth
mias. I’ll be evaluating the cellular structure of the heart for infection, defective genes like those that cause hypertrophic cardiomyopathy. I think most genetic mutations either show up well before a patient is forty-three or they affect other parts of the body such that would have prevented him from being a triathlete.
“I’ll also look for occlusions of major coronary vessels such as an acute thrombosis or atherosclerotic plaque. I’ll request his partner provide me with his prior medical record, which I presume that you have also requested. I’ll want to see his history and whether he has ever had an electrocardiogram. I’ll complete the autopsy with a variety of chemistry and toxicology tests.”
Jill ended her explanation and waited for questions.
“If your examination provides us with new or conclusive data, whom will you contact first?” asked Dr. Jones.
“If I find evidence that would lead me to think that I cannot validate a natural cause of death, I will contact you, Dr. Jones, first. While I was hired by David, I feel that I am not infallible. So I will call you with any inconsistent findings so that we can talk those through. Certainly if my collection of evidence impacts your ruling, I like to be able to tell my client what to expect for next steps, which is information I can only acquire from you.”
“That is good to know. I think you have answered all of our questions. Would you like some help with this autopsy?”
“Thanks for asking. I have been working alone now for five years so I am afraid that assistance might throw me off my approach so I’ll pass. I would like some help turning the body over. Usually I work in silence so I’ll try to narrate what I am doing for those of you watching me. If you all want to take a bathroom break or grab something to eat or drink, now would be the time, as I will need to spend about ten minutes to gown up, unpack my kit and lay out my specimen containers. If you’ll provide me a disposable gown, I’ll get started.”