by Robin Cook
“Sit down,” she commanded, smiling at Curran, whom she obviously knew.
Jason guessed the woman to be in her upper thirties. She had small, delicate features with highly arched eyebrows that gave her an innocent appeal. Her hair was short and very curly. She wore a dark, demure dress with a lace collar. Jason had trouble associating her appearance with her position as one of the medical examiners of the city of Boston.
“What’s the problem?” she asked, getting right to business. There were dark circles under her eyes, and Jason guessed she’d been working since early that morning.
Detective Curran tipped his chair back and teetered. “Sudden death of a physician in a North End restaurant. Apparently he vomited a large amount of blood…”
“Coughed up would be a better term,” interrupted Jason.
“How so?” Detective Curran asked, coming forward with a thump. He licked the end of his pencil to make a correction.
“Vomiting would mean it came from his digestive system,” Jason said. “This blood obviously came from his lungs. It was bright red and frothy.”
“Frothy! I like that word,” Curran said. He bent over his pad, making a correction.
“I presume it was arterial blood,” Dr. Danforth said.
“I believe so,” Jason said.
“Which means…?” Curran questioned.
“Probably a rupture of the aorta,” Danforth answered. She had her hands folded in her lap as if she were at a tea party. “The aorta is the main vessel that leaves the heart,” she added for Curran’s benefit. “It carries oxygenated blood out to the body.”
“Thank you,” Curran said.
“Sounds like either lung cancer or aneurysm,” Danforth added. “An aneurysm is an abnormal out-pocketing of the blood vessel.”
“Thank you again, Curran said. ”It’s so handy when people know I’m ignorant.”
Jason had a momentary flash of Peter Falk playing Detective Columbo. He was quite sure that Curran was anything but ignorant.
“Would you agree, doctor?” Danforth asked, looking directly at Jason.
“I’d vote for lung cancer,” Jason said. “Hayes was a prodigious smoker.”
“That does raise the probability.”
“Any possibility of foul play?” Curran asked, looking at the medical examiner from under his heavy lids.
Dr. Danforth gave a short laugh. “If the diagnosis is what I think it is, the only foul play involved would have been perpetrated by his Maker — or the tobacco industry.”
“That’s what I thought,” Curran said, flipping his notebook closed and pocketing his pencil.
“Are you going to do an autopsy now?” Jason asked.
“Heavens no,” Dr. Danforth said. “If there were some pressing reason, we could. But there isn’t. We’ll get to it first thing in the morning. We should have some answers by ten-thirty or so, if you’d like to call about then.”
Curran put his hands on the table as if he were about to stand. Instead, he said, “Dr. Howard has alleged that the victim thought someone was trying to kill him. Am I right, doctor?”
Jason nodded.
“So…” Curran said. “Could you keep that in mind when you do the autopsy?”
“Absolutely,” Dr. Danforth said. “We keep an open mind in all cases we do. That’s our job. Now, if you’ll excuse me, I’d like to get home. I haven’t even had a chance to eat dinner.”
Jason felt a mild wave of nausea. He wondered how Margaret Danforth could feel hungry after spending her day cutting up corpses. Curran actually said as much to Jason as they descended to the first floor. He offered Jason a lift, but Jason told him he was expecting a friend. No sooner had he said it than the street door opened and Shirley walked in. “Some friend,” Curran whispered with a wink as he left.
Once again Shirley stood out like a mirage. For entertaining she’d dressed in a red, fitted, silk shirt-dress, cinched with a wide black leather belt. Her appearance bespoke so strongly of life and vitality that her presence in the dirty morgue was a collision of opposites. Jason had the unnatural urge to get her out of there as soon as possible, lest some evil force touch her. But she was resistant to his urging. She’d thrown her arms around him and pressed his head against hers in a genuine show of sympathy. Jason melted. His response surprised him. He found himself fighting back tears like an adolescent. It was embarrassing.
She pulled back and looked him in the eyes. He managed a crooked smile. “What a day,” he said.
“What a day!” she agreed. “Any reason you have to stay here?”
Jason shook his head.
“Come on, I’m taking you home,” she said, hurrying him outside to where her BMW was parked in a no-parking zone. They got in and the car roared to life.
“Are you okay?” Shirley asked as they headed toward Massachusetts Avenue.
“I’m much better now.” Jason looked at Shirley’s profile as the city lights illuminated it in flashes. “I’m just overwhelmed by all the deaths. As if I should be doing something better.”
“You’re too hard on yourself. You can’t take responsibility for everyone. Besides, Hayes wasn’t your patient.”
“I know.”
They drove for a while in silence. Then Shirley said, “It is a tragedy about Hayes. He was pretty close to a genius, and he couldn’t have been more than forty-five.”
“He was my age,” Jason said. “He was in my class in medical school.”
“I didn’t know that,” Shirley said. “He looked a lot older.”
“Especially lately,” Jason said. They passed Symphony Hall. Some affair was just getting out, and men in black tie were emerging on the front steps.
“What did the medical examiner have to say?” Shirley asked.
“Probably cancer. But they aren’t going to do the autopsy until morning.”
“Autopsy? Who gave the authorization?”
“No need if the medical examiner thinks there is some question about the death.”
“But what kind of question? You said the man had a heart attack.”
“I didn’t say it was a heart attack. I said it was something like that. At any rate, it’s apparently protocol for them to do a postmortem on any unexpected death. A detective actually questioned me.”
“Seems like a waste of taxpayers’ money,” Shirley said as they turned left on Beacon Street.
“Where are we going?” Jason asked suddenly.
“I’m taking you home with me. My guests will still be there. It will be good for you.”
“No way,” Jason said. “I’m in no shape to be social.”
“Are you sure? I don’t want you brooding. These people will undentand.”
“Please,” Jason said. “I’m not strong enough to argue. I just need to sleep. Besides, look at me, I’m a wreck.”
“Okay, if you put it that way,” Shirley said. She turned left on the next block, then left again on Commonwealth Avenue, heading back to Beacon Hill. After a period of silence, she said, “I’m afraid Hayes’s death is going to be a big blow to GHP. We were counting on him to produce some exciting results. The fallout is going to be especially tough for me, since I was responsible for his being hired.”
“Then take some of your own advice,” Jason said. “You can’t hold yourself responsible for his medical condition.”
“I know. But try telling that to the board.”
“In that case I guess I should tell you. There’s more bad news,” Jason said. “Apparently Hayes believed he’d made a real scientific breakthrough. Something extraordinary. Do you know anything about it?”
“Not a thing,” Shirley said with alarm. “Did he tell you what it was?”
“Unfortunately no,” Jason said. “And I wasn’t sure whether to believe him or not. He was acting rather bizarre, to say the least, claiming someone wanted him dead.”
“Do you think he was having a nervous breakdown?”
“It crossed my mind.”
“T
he poor man. If he did make some sort of discovery, then GHP is going to have a double loss.”
“But if he had made some dramatic discovery, wouldn’t you be able to find out what it was?”
“Obviously you didn’t know Dr. Hayes,” Shirley said. “He was an extraordinarily private man, personally and professionally. Half of what he knew he carried around in his head.”
They skirted the Boston Garden, then navigated the roundabout route to get into Beacon Hill, a residential enclave of brick-fronted townhouses in the center of Boston, whose one-way streets made driving a nightmare.
After crossing Charles Street, Shirley drove up Mt. Vernon Street and turned into the cobblestoned Louisburg Square. When he’d decided to give up suburban living and try the city, Jason had been lucky enough to find a one-bedroom apartment overlooking the square. It was in a large townhouse whose owner had a unit in the building, but was rarely there. It was a perfect location for Jason, since the apartment came with a true urban prize: a parking place.
Jason got out of the car and leaned in the open window. “Thanks for picking me up. It meant a lot.” He reached in and gave Shirley’s shoulder a squeeze.
Shirley suddenly reached out and grabbed Jason by the tie, pulling his head down to her. She gave him a hard kiss, gunned the motor, and was off.
Jason stood at the curb in a pool of light from the gas lamp and watched her disappear down Pinckney Street. Turning to his door, he fumbled for his keys. He was pleased she had come into his life, and for the first time considered the possibility of a real relationship.
CHAPTER 3
It had not been a good night. Every time Jason had closed his eyes, he’d seen Hayes’s quizzical expression just before the catastrophe and re-experienced the awful feeling of helplessness as he watched Hayes’s lifeblood pump out of his mouth.
The scene haunted him as he drove to work, and he remembered something he’d forgotten to tell either Curran or Shirley. Hayes had said his discovery was no longer a secret and it was being used. Whatever that meant. Jason planned to call the detective when he reached GHP, but the moment he entered he was paged to come directly to the coronary care unit.
Brian Lennox was much worse. After a brief examination, Jason realized there was little he could do. Even the cardiac consult he’d requested the day before was not optimistic, though Harry Sarnoff had scheduled an emergency coronary study for that morning. The only hope was if immediate surgery might have something to offer.
Outside Brian’s cubicle the nurse asked, “If he arrests, do you want to code him? Even his kidneys seem to be failing.”
Jason hated such decisions, but said firmly that he wanted the man resuscitated at least until they had the results from the coronary study.
The remainder of Jason’s rounds were equally as depressing. His diabetes cases, all of whom had multisystem involvement, were doing very poorly. Two of them were in kidney failure and the third was threatening. The depressing part was that they had not entered the hospital for that reason. The kidney failure had developed while Jason was treating them for other problems.
Jason’s two leukemia patients were also not responding to treatment as he’d expected. Both had developed significant heart conditions even though they had been admitted for respiratory symptoms. And his two AIDS sufferers had made very distinct turns for the worse. The only patients doing well were two young girls with hepatitis. The last patient was a thirty-five-year-old man in for an evaluation of his heart valves. He’d had rheumatic fever as a child. Thankfully he was unchanged.
Arriving at his office, Jason had to be firm with Claudia. News of Hayes’s death had already permeated the entire GHP complex, and Claudia was beside herself with curiosity. Jason told her that he wasn’t going to talk about it. She insisted. He ordered her out of his office. Later he apologized and gave her an abridged version of the event. By ten-thirty he got a call from Henry Sarnoff with depressing news. Brian Lennox’s coronary arteries were much worse but without focal blockage. In other words, they were uniformly filling up with atherosclerosis at a rapid rate, and there was no chance for surgery. Sarnoff said he’d never seen such rapid progression and asked Jason’s permission to write it up. Jason said it was fine with him.
After Sarnoff’s call, Jason kept himself locked in his office for a few minutes. When he felt emotionally prepared, he called the coronary care unit and asked for the nurse taking care of Brian Lennox. When she came on the line, he discussed with her the results of the coronary artery study. Then he told her that Brian Lennox should be a no-code. Without hope, the man’s suffering had to be curtailed. She agreed. After he’d hung up, he stared at the phone. It was moments like that that made him wonder why he’d gone into medicine in the first place.
When the lunch break came, Jason decided to check out Hayes’s autopsy results in person. In the daylight, the morgue was not such an eerie place — just another aging, run-down, not-too-clean building. Even the Egyptian architectural details were more comical than imposing. Yet Jason avoided the body storage room and went directly to find Margaret Danforth’s narrow office next to the library. She was hunched over her desk eating what looked like a Big Mac. She waved him in, smiling. “Welcome.”
“Sorry to bother you,” Jason said, sitting down. Once again he marveled how small and feminine Margaret seemed in light of her job.
“No bother,” she said. “I did the post on Dr. Hayes this morning.” She leaned back in her chair, which squeaked softly. “I was a little surprised. It wasn’t cancer.”
“What was it?”
“Aneurysm. Aortic aneurysm that broke into the tracheobronchial tree. The man never had syphilis, did he?”
Jason shook his head. “Not that I know of. I’d kinda doubt it.”
“Well, it looked strange,” Margaret said. “Do you mind that I continue eating? I have another autopsy in a few minutes.”
“Not at all,” Jason said, wondering how she could. His own stomach did a little flip-flop. The whole building had a slightly fishy odor. “What looked strange?”
Margaret chewed, then swallowed. “The aorta looked kind of cheesy, friable. So did the trachea, for that matter. I’d never seen anything quite like it, except in this one guy I’d posted who was one hundred and fourteen. Can you believe it? It was written up in The Globe. He was forty-four when the First World War started. Amazing.”
“When will you have a microscopic report?”
Margaret made a gesture of embarrassment. “Two weeks,” she said. “We’re not funded for adequate support personnel. Slides take quite a while.”
“If you could give me some samples, I could have our path department process them.”
“We have to process them ourselves. I’m sure you understand.”
“I don’t mean for you not to do it,” Jason said. “I just meant we could too. It would save some time.”
“I don’t see why not.” Standing up, Margaret took another large bite out of her hamburger and motioned for Jason to follow her. They used the stairwell and went up a floor to the autopsy room.
It was a long rectangular room with four stainless steel tables oriented perpendicular to the long axis. The smell of formaldehyde and other unspeakable fluids was overpowering. Two tables were occupied, and the two others were in the process of being cleaned. Margaret, perfectly at home in the environment, was still chewing her last bite of lunch as she led Jason over to the sink. After scanning through a profusion of plastic-capped specimen bottles, she separated a number from the rest. Then, taking each in turn, she fished out the contents, placed them on a cutting board, and sliced off a piece of each with a blade that looked very much like a standard kitchen carving knife. Then she got new specimen bottles, labeled them, poured in formaldehyde, and dropped in the respective samples. When she was done, she packed them in a brown paper bag and handed it to Jason. It had all been done with remarkable efficiency.
Back at GHP, Jason headed to pathology, where he found Dr. Jackso
n Madsen at his microscope. Dr. Madsen was a tall, gaunt man who at sixty was still proudly running marathons. As soon as he saw Jason, he commiserated with him about Jason’s experience with Hayes.
“Not many secrets around here,” Jason said a little sourly.
“Of course not,” Jackson said. “Socially, the medical center is like a small town. It thrives on gossip.” Eyeing the brown paper bag, he added, “You have something for me?”
“In a manner of speaking.” Jason went on to explain what the specimens were, and added that since it was going to take two weeks for the slides to be processed at the city lab, he wondered if Jackson would mind running them at the GHP lab.
“I’d be happy to,” Jackson said, taking the bag. “By the way, are you interested in hearing the results of the Harring case now?”
Jason swallowed. “Of course.”
“Cardiac rupture. First case I’ve seen in years. Split open the left ventricle. It appeared as if most of the heart had been involved in the infarct, and when I sectioned the heart, I had the impression that all of the coronary vessels were involved. That man had the worst coronary heart disease I’ve seen in years.”
So much for our wonderful predictive tests, Jason thought. He felt defensive enough to explain to Jackson that he’d gone back and reviewed Harring’s record and still couldn’t find any evidence of the impending problem on an EKG taken less than a month before Harring’s death.
“Maybe you’d better check your machines,” Jackson said. “I’m telling you, this man’s heart was in bad shape. The microscopic sections should be ready tomorrow if you’re interested.”
Leaving the pathology department, Jason considered Jackson’s comment. The idea of a defective EKG machine hadn’t occurred to him. But by the time he got to his office, he discarded the notion. There would be too many ways to tell if the EKG machine wasn’t functioning properly. Besides, two different machines were used for the resting EKG and the stress EKG. But in thinking about it, he remembered something. Like Jason himself, on joining the GHP staff, Hayes would have been given a complete physical. Everyone was.