by Robin Cook
“How so?”
“The first case was this well-known psychologist.”
“Sara Cromwell.”
“Supposedly, it was a brutal murder during a sexual assault.”
“I saw the knife, remember?”
“That was what threw everybody for a loop. You see there was no other wound, and she hadn’t been raped.”
“How could all the blood that was described come from that single, nonfatal stab wound?”
“It didn’t.”
Jack stared at Laurie with a slight smile of anticipation. Laurie stared back. She was in no mood to play games. “So where did it come from?”
“Any ideas?”
“Why don’t you just tell me?”
“I think you’d be able to guess if you thought about it for a minute. I mean, you did look at how gaunt she was, didn’t you?”
“Jack, if you want to tell me, tell me. Otherwise, I have to make my call.”
“The blood was from her stomach. It turns out there was a fatal engorgement of food, causing a rupture of her stomach and the lower part of her esophagus. Obviously, the woman had bulimia, and pushed herself over the edge. Can you believe it? Everybody was convinced it was homicide and it turns out to be accidental.”
“What about the knife sticking out of her thigh?”
“That was the real teaser. It was self-inflicted, but not on purpose. In her final moments, while she was puking blood and putting away the cheese, she slipped on her own blood and fell on the knife she was holding. Isn’t it too much? I tell you: This is going to be a good case to present at our Thursday conference.”
For a moment, Laurie stared at Jack’s satisfied face. The story had touched a chord in her inner life. There had been a time when she’d had self-esteem problems after her brother’s death, causing her to have a brush with anorexia and bulimia. It was a secret she hadn’t shared with anyone.
“And my next two cases were equally intriguing. It was a double suicide. Did you hear about it?”
“Vaguely,” Laurie responded. She was still thinking about bulimia.
“I tell you, I have to give old Fontworth credit,” Jack said. “I’d always considered him less than meticulous, but last night he seemed to have done a bang-up job. With the double suicide, he found a heavy Mag-Lite flashlight on the front seat of the SUV along with the victims and was smart enough to bring it with the bodies. He also noted the driver’s-side door was ajar.”
“What was important about the flashlight?” Laurie asked.
“Plenty,” Jack replied. “First of all, let me say I was a bit suspicious when there was only one suicide note. In double suicides, it’s usual to have two notes or one that is written by both parties. I mean, it makes sense, since they are doing it together. Anyway, that put up a red flag. Since the note was presumably from the woman, I elected to autopsy her first. What I expected to find after the fact was something toxicological, like a knock-out drug or the like. I didn’t expect to find anything on gross, but I did. She had a literal indentation on her forehead just above the hairline that was curiously curved.”
Jack paused. His smile returned.
“Don’t tell me the flashlight and the indentation matched.”
“You got it! A perfect match! It seems that the whole affair was an elaborate setup by the husband, who had prepared the scene and probably even wrote the note. After he knocked out his wife, got her into the passenger seat of the SUV, and started the engine, he probably went back in the house to wait. When he thought enough time had passed, he returned to check that his wife was dead, but didn’t realize how quickly one can succumb to carbon monoxide if the level is high enough. Climbing behind the wheel, he rapidly fell unconscious and ended up joining his wife.”
“What a story!” Laurie commented.
“Isn’t it ironic? I mean, it was supposed to be a double suicide, and instead the manner of death turns out to be homicidal for the wife and accidental for the husband. Forensic pathology certainly can surprise.”
Laurie nodded. She distinctly remembered having the same thought before she started her overdose case.
“Even the police case is turning out to be opposite of what was expected.”
“How so?” Laurie asked.
“Everybody has been assuming it was a case of justifiable homicide by the police, since the police acknowledged shooting him a number of times, but Calvin just told me that as near as they can determine, it was suicide. They’ve been able to ascertain that the victim shot himself through the heart before he was hit by any of the police rounds.”
“That should help quiet the neighborhood.”
“We should hope,” Jack said. “Anyway, it was an interesting morning, to say the least, and I just thought you’d like to hear that we’ve had a rash of cases this morning where the manner of death was the opposite of what was expected. With that said, are you going to pop down for some lunch soon?”
“I don’t know. I’m not terribly hungry, and I’ve got a lot to do.”
“Well, maybe I’ll catch you down there. If not, I’ll see you later.”
Laurie waved at Jack as he disappeared down the hall. She turned her attention back to Sean McGillin Sr.’s phone number. She thought about what Jack had said about forensic surprises and considered what that could mean for Sean McGillin Jr. She’d expected his manner of death to be natural, a fatal clot or fat emboli or even a congenital anomaly. Since she’d not found anything of the kind, at least so far, she was now entertaining the idea that the cause of death could’ve been accidental, such as an unexpected late complication with anesthesia. But if the cause of death were to be truly opposite, like the cases Jack had just described, it would have to have been homicidal.
Laurie mulled the idea. It seemed far-fetched, but then she thought about Sara Cromwell and how only minutes earlier, she would have thought it totally far-fetched that her manner of death was accidental. Sean Jr.’s autopsy had already surprised her with its lack of findings. Could the case surprise her once more? She doubted it, but then again, she couldn’t rule it out completely.
four
DESPITE LAURIE’S CONCERNS to the contrary, the phone conversation with Dr. McGillin turned out be surprisingly civil. He had accepted that the autopsy had failed to show any pathology with unexpected equanimity. It was as if he had taken the information as a compliment about his adored son, corroborating the idea that the boy was indeed perfect, inside and out.
Having expected to be angrily chastised for not delivering on her promise, or at the very least anticipating having to weather passive-aggressive disappointment, Laurie felt even more beholden to the man when he maintained his composure. He had even gone to the extent of thanking her for her efforts on his son’s behalf and for spending time with them in their hour of need. If she had been willing before to bend the rules by providing the man with the cause of his son’s demise, she’d now become determined to get him that information.
After hanging up the phone with Sean Sr., Laurie spent some time pondering the case while staring blankly ahead at her corkboard with its various notes, reminders, and business cards. She tried to think of a way to speed up the process, but her hands were tied. She had to wait for Maureen and Peter, and hope that they would respond to her appeal.
Time melted away effortlessly. Riva came in and said hello as she dumped folders on her desk and took her seat. Laurie returned the greeting by reflex without turning around. Her mind by then had switched to Jack and his irritatingly insouciant joviality, and what that meant about their relationship. Although she hated to admit it, it was becoming progressively apparent that he was happy she’d decided to leave.
In a circular fashion, thoughts of Jack brought her back to Sean Jr.’s case as she recalled Jack’s comments about forensics occasionally revealing that the causation and manner of death were the opposite of what was assumed. Laurie again considered the possibility that Sean’s death could have been a homicide. She couldn’t hel
p but remember several infamous episodes of serial homicides that had occurred in healthcare institutions, particularly one rather recently that had continued undetected for an unconscionably long time. Such a scenario had to be considered, although she recognized that all the involved patients in those series were aged, chronically ill individuals and that there was an inkling of an imaginable, albeit sick motive. Not one of the victims had been a vigorous, healthy twenty-eight-year-old whose whole life was still ahead of him.
Laurie was certain that homicide was extremely implausible, and she wasn’t going to worry about it, especially since Peter’s toxicology screen would pick up an overdose of insulin or digoxin or another potentially lethal drug akin to those implicated in the previous institutional murders. After all, that was what the toxicology screen was all about. In her mind, Sean Jr.’s death had to be either natural, which was most probable, or accidental. Yet what was she going to do if the microscopic and the toxicological turned out to be negative? Such a concern seemed reasonable, considering the autopsy itself had been so surprisingly clean. From her experience, it was rare not to find some pathology, even in a twenty-eight-year-old, and even if the abnormalities were not associated with the demise.
To prepare for such an eventuality, Laurie needed as much information as possible. Although the usual course of action in such a case would be to wait for the microscopic and the toxicological to come back, she decided to be proactive to save time. Impulsively, she snatched the receiver and called down to the forensic investigator’s office. Bart Arnold picked up on the second ring.
“I posted a Sean McGillin this morning,” Laurie said. “He was an inpatient over at the Manhattan General. I’d like to get a copy of his hospital chart.”
“I’m aware of the case. Did we not get what you need?”
“The forensic investigator’s report is fine. To be honest, I’m on a fishing expedition. The post was negative, and I’m a little desperate. There’s kind of a time constraint.”
“I’ll put the request in immediately.”
Laurie replaced the receiver while racking her brain in hopes of coming up with something else that would be useful if everything turned out to be negative.
“What’s wrong?” Riva asked. She had swung around in her desk chair after overhearing Laurie’s conversation with Bart. “Knowing how tired you are, I thought I’d given you straightforward cases. I’m sorry.”
Laurie assured her officemate that she needn’t apologize. Laurie admitted that she was creating a problem when there really wasn’t one, probably to keep from obsessing about her social life.
“Do you want to talk about it?”
“You mean my social life?”
“I mean Jack and what you did this morning.”
“Not particularly,” Laurie responded. She waved a hand as if swatting a nonexistent fly. “There’s not much to say that you and I haven’t hashed over before ad nauseam. The reality is that I don’t want to be stuck in a never-never-land relationship, which is what I’ve been settling for over the last couple of years. I want a family. It’s that simple. I guess what’s really irking me is that Jack is being such an ass by acting so blasted cheerful.”
“I’ve noticed,” Riva agreed. “I think it is an act.”
“Who’s to know,” Laurie responded. She laughed at herself. “I’m pathetic! Anyway, let me tell you about the McGillin case.” Quickly, Laurie related the whole story, including the details of the conversations she’d had with the parents and then subsequently with Jack.
“It’s not going to be a homicide,” Riva said emphatically.
“I know!” Laurie agreed. “What’s bothering me at this point is not being able to live up to the promise I made to the parents. I was so sure I’d be able to tell them today what killed their boy, and now I have to sit on my hands and wait for Maureen and Peter. My compulsiveness is driving me batty.”
“If it’s any consolation, my opinion is that Jack was right about the microscopic being the key. I think you’ll find the pathology in the heart, especially with a strong family history of elevated LDH and heart disease.”
Laurie started to concur, but her phone rang. Twisting around, she answered it, expecting some quick tidbit of information on one of her cases, which is what the vast majority of her calls were about. Instead, her eyebrows arched in surprise. Covering the mouthpiece, she looked back at Riva and whispered. “You’re not going to believe it! It’s my father!”
Riva’s face reflected equal disbelief. She hastily motioned for Laurie to find out the occasion for the call. Phone contact was restricted to Laurie’s mother, and that was rarely at work.
“I’m sorry to disturb you,” Dr. Sheldon Montgomery said. He spoke in a resonant voice with a hint of an English accent, despite his never having lived in Great Britain.
“You’re not disturbing me,” Laurie answered. “I’m sitting here at my desk.” She was intensely curious why her father was calling, but resisted the temptation to ask directly, fearful such a question would sound too unfriendly. Their relationship had never been anything special. As a self-absorbed, workaholic cardiac surgeon who’d demanded perfection from everyone, including himself, he’d been emotionally distant and generally unavailable. Laurie had tried vainly to break through to him, constantly pushing herself to excel at school and in other activities, which is what she thought he wanted. Unfortunately, it never worked. Then came her brother’s untimely death, which Sheldon blamed on her. What little relationship they’d had deteriorated even further.
“I’m at the hospital,” he said. His tone was matter-of-fact, as if he was telling her the weather. “I’m here with your mother.”
“What is Mother doing at the hospital?” Laurie asked. For Sheldon to be at the hospital was not out of the ordinary. Although he was retired from private practice now that he was in his early eighties, he still frequently went to the hospital. Laurie had no idea what he did. Her mother, Dorothy, never went to the hospital despite being active in various hospital fund-raising activities. The last time Laurie remembered her mother being in the hospital was for her second facelift fifteen years earlier, and even then, Laurie had learned of the admission after the fact.
“She had surgery this morning,” Sheldon said. “She is doing fine. In fact, she is rather chipper.”
Laurie sat up a bit straighter. “Surgery? What happened? Was it an emergency?”
“No. It was a scheduled procedure. Unfortunately, your mother had a mastectomy for breast cancer.”
“My word!” Laurie managed. “I had no idea. I just spoke with her on Saturday. She didn’t mention anything about surgery or cancer.”
“You know your mother, and how she likes to ignore unpleasant issues. She was particularly insistent on shielding you from unnecessary concern until this was behind her.”
Laurie looked at Riva with disbelief. As close as their desks were in the small office, Riva could hear both sides. Riva rolled her dark eyes and shook her head.
“What stage was the cancer?” Laurie asked solicitously.
“A very early stage with no apparent nodal involvement,” Sheldon said. “Things are going to be fine. The prognosis is excellent, although she’ll have to undergo further treatment.”
“And you say she is doing well?”
“Very well indeed. She’s already taken some nourishment orally, and she’s back to her old self by being genuinely demanding.”
“Can I speak with her?”
“Unfortunately, that would be rather difficult. You see, I’m not in the room at the moment. I’m at the nurses’ station. I was hoping you’d be able to come over here to see her this afternoon. There is an associated aspect to all this that I would like to discuss with you.”
“I will be right over,” Laurie said. She hung up the phone before turning back to Riva.
“Is it true you had no idea about any of this?” Riva asked.
“Not a clue. There wasn’t even the slightest hint. I don’t
know whether to be angry, hurt, or sad. Actually, it’s pathetic. What a dysfunctional family! I can’t believe it. I’m almost forty-three and a doctor, and my mother still treats me like a child about illness. Can you imagine, she wanted to shield me from unnecessary concern?”
“Our family is just the opposite. Everybody knows everything about everybody. It’s the opposite extreme, but I don’t advocate it, either. I think the best is somewhere in between.”
Laurie got up and stretched. She waited for a moment of dizziness to pass. Her fatigue had come back with a vengeance after sitting at her desk. She then got her coat from behind the door. When she considered the differences between her family and Riva’s, she thought she would pick Riva’s, although she certainly wouldn’t choose to live at home like Riva did. She and Riva were the same age.
“Want me to answer your phone?” Riva asked.
“If you won’t mind, especially if it’s either Maureen or Peter. Leave any messages on my corkboard.” Laurie got out a package of Post-its and plopped them on her blotter. “I’ve got to come back here. I’m not going to take my suitcase with me.”
Laurie stepped into the hall and briefly considered going down to Jack’s office to tell him about her mother, then decided to skip it. Even though she was certain he’d ultimately be sympathetic, she had had quite enough of his levity and didn’t want to risk having to deal with anymore.
On the first floor, Laurie took a quick detour into the administration office. Calvin’s door was ajar. Unchallenged by the two busy secretaries, Laurie glanced in to see the deputy chief hunched over his desk. A standard-sized pen looked like a miniature in his huge hand. She knocked on the open door, and Calvin raised his intimidating face and drilled Laurie with his coal-black eyes. There had been times when Laurie had clashed with the deputy chief, since he was both a stickler for rules and a politically savvy individual willing to bend those rules on occasion. From Laurie’s perspective, it was an untenable combination. The occasional political demands of being a medical examiner were the only part of the job Laurie didn’t like.