by Robin Cook
Laurie laughed and chatted about the case for a few minutes before switching to her real interest. As she’d spoken with Kevin concerning Moskowitz, she asked if George remembered doing Antonio Nogueira some two weeks earlier.
“Give me a hint,” George responded.
“I’m guessing at the details, since I don’t know them for certain,” Laurie said, “but I believe he would have been relatively young, he would have been within twenty-four hours of having surgery at the Manhattan General, and he would have been suspected of having suffered some sort of cardiac catastrophe.”
“Okay, I remember the case: a real teaser. I found zilch on the post and nothing to hang my hat on with the microscopic. The folder is up on my desk, waiting for toxicology possibly to come up with something. Otherwise, I’m going to be forced to sign it out as a spontaneous ventricular fibrillation or a massive heart attack that was so sudden and so global that there wasn’t any time for pathology to develop. Of course, that means whatever caused it had to magically disappear. One way or the other, the heart stopped. I mean, it couldn’t have been that his breathing stopped, because there was no cyanosis.” He shrugged and gestured helplessly with his hands.
“So the microscopic didn’t show much in the coronary vessels?”
“Minimal.”
“And the heart muscle itself looked normal? I mean, like something capable of causing a sudden lethal arrhythmia. Was there any sign of inflammation?”
“Nope! It was completely normal.”
“Do you mind if I look at the folder later this afternoon?” Laurie asked.
“Be my guest! Why the interest? How did you hear about it?”
“I heard about it from Janice,” Laurie said. “I’m interested because I had a case surprisingly similar yesterday.” Laurie felt mildly guilty about not mentioning the two other cases, but not guilty enough to bring them up. For one thing, her suspicion that they were connected in any way was purely speculative, and second, at this early stage she couldn’t help but feel proprietary about what she was beginning to think might be some kind of series.
Leaving the ID office, Laurie descended a floor and sought out Marvin. She found him in the mortuary office. As she had hoped, he was already in his scrubs.
“Are you ready to rock and roll?” Laurie asked. She was eager to start.
“You’re on, sister!” Marvin said as if it today was a rerun of the previous day.
Laurie gave him Darlene Morgan’s accession number before going into the locker room to change into scrubs. She was excited. It was the first time in her career as a medical examiner that she hoped to find nothing on the autopsy, meaning Morgan would be like McGillan, Nogueira, and Moskowitz. The longer the series idea played out, the better the diversion it would be and the less apt she’d be to agonize over personal unpleasantries.
Leaving the locker room, she crossed over to the storage room and rescued her battery pack from the charger. Fifteen minutes later, she was in the moon suit and pushing into the pit from the anteroom where she’d gloved. There was only one case under way. She had no trouble distinguishing between Jack and Vinnie, since Vinnie was shorter and considerably slighter. Jack was peering through the viewfinder of a camera set on a tripod. Laurie tried not to look at the tiny, naked infant splayed out on the table. Laurie blinked by reflex when the camera’s flash went off.
“Is that you, Laurie?” Jack called out. He had straightened up and turned in her direction in response to the sound of the door closing.
“It is,” Laurie said. Not finding Marvin in the autopsy room, she twisted around to look through the wire-embedded glass in the door leading out to the corridor. Marvin was approaching with a gurney in tow. At the back, pushing, was another mortuary tech, Miguel Sánchez. Laurie guessed there had been a problem. Marvin was customarily super-efficient and invariably waiting for her.
“Come on over here!” Jack said with some excitement. “I have something to show you. This case is a corker.”
“I’m sure it is,” Laurie said. “But I think I’ll let you tell me about it after the fact. You know that autopsies on children are not my cup of tea.”
“I’m pretty certain this case is another one like those yesterday,” Jack said. “I’m more than ninety percent sure the cause and manner of death are going to surprise everyone. I’m telling you, it’s textbook!”
Despite her distaste for dealing with kids in the autopsy room, her professional curiosity urged her over to Jack’s side. With some difficulty, she made herself look down at the hapless child. Just as Riva had described, the poor little girl appeared bruised, abraded, and burned over much of her tiny body, including her face. The awfulness of the image made Laurie sway slightly, as if dizzy. She spread her feet to stabilize herself. Behind her, she heard the door open, followed by the squeak of the wheels of an old gurney as it was pushed in.
“What if I told you the whole body X-ray of this infant was completely negative for fractures, old or new? Would that influence your thinking about this case?”
“Not particularly,” Laurie said. She tried to look in at Jack’s face, but it was difficult with the overhead lights reflecting off his plastic face mask. They hadn’t seen each other or talked for almost twenty-four hours, and when they first met that morning, she had hoped for something other than a repeat of his playful professorial role.
“What if I told you that in addition to the X-ray being normal, the frenulum is intact?”
“It certainly wouldn’t negate what I’m looking at,” Laurie responded. Despite her repugnance, Laurie bent over and looked closely at the skin lesions, particularly where Jack had made a small incision through one of the abrasions. There had been no blood or edema. All at once, she knew now what Jack was implying when pointing out signs that suggested abuse was not at issue. “Vermin!” she said suddenly. She straightened up.
“Give this lady a prize!” Jack said like a carnival barker. “As expected, Dr. Montgomery has expertly corroborated my impression. Of course, Vinnie isn’t convinced, so we have a five-dollar bet riding on finding nonspecific evidence of an asphyxial death when we do the internal part of the autopsy, and everybody knows what that would imply.”
Laurie nodded. The chances were good that the child in front of her had died of sudden infant death syndrome, or SIDS, which shows signs of asphyxial death on autopsy. Although on first glance she had thought all the skin lesions had been inflicted prior to death, she now guessed they were most likely postmortem damage caused by a variety of vermin, such as ants, cockroaches, and possibly mice or rats. If this indeed proved to be the case, then the manner of death was not homicidal but accidental. Of course, that didn’t lessen the tragedy of the young life lost, but it surely had very different implications.
“Well, I better get cracking here,” Jack said as he detached the camera from the tripod. “This child was maimed by the circumstances of poverty, not abuse. I’ve got to get her parents out of jail. Keeping them there is like adding insult to injury.”
Laurie made her way over to where Marvin was aligning the gurney next to one of the autopsy tables, trying not to dwell on her disappointment about Jack’s blithe repartee and apparent mind-set. She also couldn’t help but wonder if Jack’s case was another preternatural hint to remind her that things were not always quite what they seemed at first glance.
“Did you have some trouble?” Laurie asked Marvin as the two techs moved the body onto the autopsy table. Marvin positioned the head on a wooden block.
“A slight hitch,” Marvin admitted. “Mike Passano must have written down the wrong compartment number. But with Miguel’s help, we found the body in short order. Any special requests for this case?”
“It should be straightforward,” Laurie said as she checked the accession number and name. “In fact, I hope it turns out to be a mirror image to the first case we did yesterday.” Marvin shot her a perplexed glance as she started the external exam.
Laurie’s trained eye began reco
rding her observations. The body was that of a Caucasian woman in her mid-thirties with brunette hair in a normal distribution who appeared to have been in good health, although slightly overweight, with extra adipose tissue across her abdomen and on the lateral aspect of her thighs. Her skin had the usual pallor of death and was lesion-free, save for a few innocuous nevi. There was no cyanosis. There was no evidence of recreational drug use. There were two freshly sutured incisions on the lateral surfaces of her left knee and no signs of inflammation or infection. A capped-off intravenous line ran into her left arm, with no extravasations of blood or fluid at the site. An endotracheal tube that was correctly positioned in her trachea protruded from her mouth.
So far, so good, Laurie said to herself, meaning the external exam was comparable with Sean McGillan Jr.’s. She took the scalpel offered by Marvin and began the internal portion. She worked quickly and intently. The activity in the rest of the room receded from her consciousness.
Forty-five minutes later, Laurie straightened up after tracing the veins in the legs up into the abdominal cavity. She had found no clots. Other than several insignificant uterine fibroids and a polyp in the large intestine, she had found no significant pathology and certainly nothing that would have explained the woman’s demise. Exactly like McGillan, she would have to wait for the microscopic and the toxicological if she was going to find a cause of death.
“A clean case,” Marvin commented. “Just like you wanted.”
“Very curious,” Laurie said. She felt vindicated. She looked around the room, which had practically filled during her intense concentration. The only table that wasn’t in use was immediately adjacent to where Jack had been working. Apparently, he’d finished and left without so much as a word. Laurie wasn’t surprised. It seemed consistent with his recent behavior.
At the table on the other side of hers, Laurie thought she recognized Riva’s diminutive frame. When Marvin went out into the hall to get a gurney, Laurie stepped over to check. It was Riva.
“Interesting case?” Laurie asked.
Riva looked up. “Not particularly, from a professional point of view. It’s just a hit-and-run on Park Avenue. She was a tourist from the Midwest, and she was holding on to her husband’s hand when she was struck. He was only a step ahead of her. It always amazes me pedestrians aren’t more careful in this city, considering how fast the traffic moves. How about your case?”
“Extremely interesting,” Laurie said. “Almost no pathology whatsoever.”
Riva looked at her officemate askance. “Interesting and no pathology? That doesn’t sound like you.”
“I’ll explain later. Meanwhile, do I have another case?”
“Not today,” Riva said. “I thought you could use a little down time.”
“Hey, I’m okay. Really! I don’t want any special treatment.”
“Don’t worry. It’s a relatively light day. You’ve got a lot on your plate.”
Laurie nodded. “Thanks, Riva,” she said, although she would have preferred to keep busy.
“I’ll see you upstairs.”
Laurie returned to her table, and when Marvin came back with the gurney, she thanked him for his help and said that she was finished for the day. Ten minutes later, after the usual cleaning process, she hung up her moon suit and attached her battery to the charger. Planning on heading to histology and toxicology, she was surprised to see Jack blocking her exit from the storeroom.
“Can I buy you a cup of coffee?” he asked.
Laurie glanced up into his maple-syrup-colored eyes and tried to gauge his mood. She’d had quite enough of his lightheartedness; considering the circumstances, it was ultimately humiliating. Yet there was no impish smirk like he’d worn the previous afternoon when he’d appeared in her office doorway. His expression was serious, almost solemn, which she appreciated, since it was more apropos to what was going on between them.
“I’d like to talk,” Jack added.
“I’d love a cup of coffee,” Laurie responded. With some difficulty, she tried to reign in her expectations about what Jack had in mind. This seemed to be almost too-appropriate behavior for him.
“We could head up to the ID office or the lunchroom,” Jack said. “It’s your call.”
The lunchroom was on the second floor. It was a loud room with an old-fashioned linoleum floor, bare concrete walls, and a bank of vending machines. At that time in the morning, it would be reasonably crowded with secretarial and custodial personnel on break.
“Let’s try the ID office,” Laurie suggested. “We should have the place to ourselves.”
“I missed you last night,” Jack said as they waited for the back elevator.
My word, Laurie thought. Despite her concerns, her hopes of having a significant conversation rose. It was not customary for Jack to admit to his feelings quite so directly. She looked up at his face to make sure he wasn’t being sarcastic, but she couldn’t tell for certain, since his face was averted. He was absorbed in watching the floor indicator above the elevator door. The numbers were decreasing with their typical agonizing slowness. The back elevator was used for freight and moved at a glacial pace.
The door opened, and they boarded the cab.
“I missed you, too,” Laurie admitted. Concerned that she was allowing herself to be set up for a fall, she felt embarrassingly self-conscious and now avoided eye contact. From her perspective, they were both acting like a couple of preteens.
“I was a hopeless case on the basketball court,” Jack said. “I couldn’t do anything right.”
“I’m sorry,” Laurie said, but then immediately wanted to take it back. It sounded as though she was apologizing, when she was merely sympathizing.
“As I expected, the internal on my case was consistent with SIDS,” Jack said to change the subject. It was obvious that he was equally uncomfortable.
“Really?” Laurie said.
“How was yours?” Jack asked as the elevator began its ascent. “When I bumped into Janice, she mentioned it seemed similar to your McGillan case, so I told Riva that you’d probably want it.”
“I appreciate it,” Laurie said. “I did want it. And you were right. It was exactly like McGillan to an uncomfortable degree.”
“What do you mean ‘uncomfortable’?” Jack asked.
“I’m beginning to think that your suggestion yesterday about forensics establishing a manner of death opposite to what was expected could be applicable. I’m thinking I might be dealing with homicide, sort of the Cromwell case in reverse. In other words, I might have stumbled onto the work of a serial killer. I can’t help but think about some of those infamous health-institution serial murders, particularly the recent one over in New Jersey and Pennsylvania.” Laurie did not have the same reservations about mentioning her suspicions to Jack as she had had with Fontworth.
“Whoa!” Jack said. “When I was talking about forensics providing some surprises, I was talking in general. I wasn’t suggesting anything about your case.”
“I thought you were,” Laurie said.
Jack shook his head as the elevator door opened on the first floor. “Not at all. And I have to say that I think you’re taking a quantum leap going from natural to homicide with the case you described to me. Why on Earth did it even occur to you?” He gestured for Laurie to exit ahead of him.
“Because I’ve now autopsied in successive days two relatively young, healthy people who have died suddenly, yet have no associated pathology. None!”
“Your case today didn’t have any emboli or obvious cardiac abnormalities?”
“Absolutely none. It was clean! Well, there were a few uterine fibroids, but that was it. Like McGillan, she was within twenty-four hours postsurgery with general anesthesia. Like McGillan, she had been completely stable without complications, and then . . . bingo! She arrests and is totally unable to be resuscitated!” Laurie snapped her fingers for emphasis.
They passed through the communications room. The secretaries were bunche
d together and chatting. For the moment, the phone lines were quiet. After the mayhem of the morning commute, death generally took a breather in the city.
“Two cases don’t make a series!” Jack asserted. He was dumbfounded by Laurie’s suggestion of a serial killer.
“I think it is four cases, not two,” Laurie said. “That’s too many to be a coincidence.” While they helped themselves to the communal coffee, Laurie described her conversations with Kevin and George. As she spoke, she and Jack sat down in the two brown vinyl club chairs that Kevin and Arnold had been in earlier.
“What about toxicology?” Jack questioned. “If there turns out to be no pathology on gross or histologically, then the answer is going to come from toxicology, whether there was hanky-panky going on or even if there wasn’t.”
“George said he’s still waiting on toxicology for his case. Obviously, for mine I’ve got a wait. Be that as it may, we’re dealing with a curious set of circumstances here.”
Jack and Laurie sipped from their respective cups, eyeing each other over the brims. Both were aware of the other’s current mind-set in regard to Laurie’s serial-killer theory. Laurie’s expression was challenging, while Jack’s reflected his feeling that she was out in left field.
“If you want my opinion,” Jack said finally, “I think you’re letting your imagination run wild. Maybe you’re upset because of our problems, and you’re looking for a diversion.”
Laurie felt a wave of irritation spread through her. It came from a combination of Jack’s being patronizing on the one hand and his being correct on the other. She averted her gaze and took a breath. “What is it you wanted to talk about? I’m sure it wasn’t our respective cases.”
“Riva told me about your mother yesterday,” Jack said. “I was tempted to call last night to ask you about her and extend my sympathies, but under the circumstances, I thought it better to talk in person.”
“Thank you for your concern. She’s doing fine.”