by Ray Flynt
TRANSPLANTED
DEATH
A Brad Frame Mystery
Ray Flynt
DEDICATION
For Charles and Mae Clark
Chapter One
2:00 p.m., Wednesday, January 10th
“You’re just in time for the autopsy,” Dr. Alan Fenimore announced.
No hello. No handshake. Alan hadn’t mentioned a death when he’d called, and Brad Frame wondered what other details he had neglected to tell him.
“It’s nasty out there,” Brad said, as he shook the snow from his overcoat.
The medical director of Philadelphia’s Strickland Memorial Hospital grunted, seemingly oblivious to the storm that churned just outside the lobby windows. He turned and headed down the tiled hospital corridor, which a tireless custodian had waxed and buffed to a high sheen.
Brad slipped off his fur-lined gloves, removed his wool overcoat and folded it over his arm. The doctor stopped and stared back at him impatiently, and Brad realized Alan hadn’t changed much since the days when they played tennis doubles at Princeton. Alan Fenimore always wore his drive and ambition close to his skin, with achievements to match—team captain, married to the prettiest Phi Beta Kappa on campus, and heart surgeon at the age of twenty-nine.
“Thanks for coming,” he said, and motioned for Brad to follow.
Brad kept pace a few steps behind Fenimore’s determined gait as they passed coffee and gift shops on the right. The two of them had often been mistaken for brothers on the tennis court with their tall lean bodies, straight shoulders, and dark brown hair, but now Brad observed stooped shoulders and a bald spot encircling the back of his friend’s head. Brad was grateful he still had a thick head of hair.
At the end of the hall, Dr. Fenimore turned left into an elevator lobby with two sets of doors. He punched the down button, and the men faced each other as they waited.
“What’s going on, Alan?” Brad asked. “I got here as soon as I could.”
“I appreciate it. We’ve got, ah … a situation with one of our transplant patients.”
Situation? Don’t call in a private detective, even one who is an old friend, and lay out facts in such a vague way.
An elderly couple with a teenager in tow joined them in the small elevator lobby. Dr. Fenimore stopped talking, cocked his head in their direction, and mouthed later.
Brad watched as the doctor once more jammed his finger into the down button, hard enough to make his hand quiver.
“Relax, Alan.”
A young couple arrived at the elevator, and Dr. Fenimore drew alarmed glances as he pounded the elevator’s call button with the side of his fist.
An up elevator arrived and everyone else hustled onto it. Next to him, Brad heard Alan emit a peevish groan.
Brad put his hand on Alan’s shoulder and quietly said, “I’m sorry I haven’t visited you since the funeral. Beth and I were very busy over the Christmas holidays, and time got away from me.” Brad knew it was a lame excuse. He hadn’t expected to find his friend in quite this state; not that one could shrug off the death of a spouse. He felt remorse that he had not done more for Alan when Marie died. After all, he knew first-hand how life could fall apart after a death in the family.
Brad added, “I’m sure you’ve had a tough time.” His words felt like a cop-out.
Alan blinked. “It’s okay,” he said, unconvincingly, as he rocked on his heels. “Marie’s sister and her family spent a week with me after Christmas, and I’ve been keeping busy here. Ken stops out once a week.”
“That’s good.” It had been years since Brad had seen their son, then a pimply-faced teen.
Alan ground his hands together. “Let’s use the stairs.” He bolted to the right and Brad kept pace as the doctor pulled open the door to the stairwell and raced downstairs.
At the first landing, Brad grabbed his friend by the arm. “Alan, stop. I’ve never seen you this uptight. What’s going on?”
Alan glared back at him. Brad released him and then at the spot where Brad had held his arm the doctor straightened the sleeve on his white lab coat.
“At approximately eleven o’clock this morning I got called to 7-North, one of our transplant units.” The doctor’s words echoed in the beige concrete block stairwell, and he lowered his voice to a whisper. “Dr. Wu, the head of the surgical team, told me that Michael Severns had been making an excellent recovery from a kidney transplant, but at 10 a.m. the duty nurse found him unconscious. Their attempts to revive him failed.”
“When was his surgery?” Brad asked.
“Two days ago,” Alan replied. “Actually, almost three days. It began late Sunday and ended early Monday morning. Dr. Wu, who just recently joined our staff from the Mayo Clinic, was troubled by his patient’s sudden death. Then the duty nurse informed him that a heart-lung transplant patient had died earlier this morning on 7-North. That alarmed Dr. Wu and he contacted Dr. Peterson, who notified me.”
“Who’s Dr. Peterson?” Brad asked.
“Our chief transplant surgeon. He performed the heart-lung transplant. He’d been notified of his patient’s death early this morning. However, while any death is…” Alan paused, appearing to search for the right word. “…disturbing, Jack wasn’t unduly alarmed because he described the man as being ‘at death’s door’ before the complicated heart-lung transplant, which carries more than double the risk.”
Brad thought he’d come for an hour or two of consultation with a college buddy, but now a more complex investigation seemed likely. If foul play was involved, the police would have to be called. Brad also wondered if he should alert Sharon, his associate in his private detective practice.
“That’s when you ordered the autopsies?” Brad asked, deciding to hold Sharon off for now.
“I ordered the post for Mr. Severns, but Mr. Esposito’s body had already been released to the mortuary. My office is trying to get his body back so we can do an autopsy. I understand we’ve contacted the funeral home, but had to leave a message with their answering service. I’m hoping we can have the body back here by the time Jamal finishes the autopsy on Mr. Severns.”
“Have you contacted the police?” Brad asked.
Alan frowned. “No. I contacted you. Until we get autopsy results, I’m only going on supposition. I’m reluctant to call the police until we have more information.”
Brad digested the scenario: two deaths, one potentially suspicious, and thought about giving a heads-up to his friend and business partner, Nick Argostino of the Philadelphia Police Department. He studied Alan’s face. He hadn’t seen Alan since Marie’s funeral six weeks earlier when Brad had served as a pallbearer. The corners of Alan’s mouth were turned down, and a bowl of oatmeal had more color than his cheeks. His glasses, on a man renowned for his fastidious nature, were smudged.
When they attended Princeton, Brad dated Marie’s roommate, and when Marie requested an introduction to his “handsome tennis partner” Brad arranged a double-date. Alan and Marie always claimed they fell in love that night.
But it was evident that Marie’s tragic accident had taken its toll on Alan. Brad had endured his own share of tragedy, and he worried that more deaths and autopsies wouldn’t do anything to advance his old friend’s healing process.
“Can we continue?” Alan pointed down the stairs.
Brad nodded.
On the ground level, they emerged through a set of double fire doors and stood in front of a security station with a sign marked RESTRICTED AREA.
The doctor flashed his badge, which hung around his neck on a lanyard, to the uniformed security guard, and announced, “He’s with me.”
“You’re gonna have to sign him in,” the guard said.
Dr. Fenimore scowled and thr
ew his hands up in the air.
“While you register me, I’m going to call my associate and ask her to join us,” Brad said. From what he saw, Alan’s erratic actions would only serve as a distraction to the investigation. Sharon would be an asset, and the two could manage him better than one.
Alan grunted his consent, and Brad pulled out his smart phone, called Sharon Porter and asked her to meet him at Strickland Memorial Hospital.
“Are you nuts?” Sharon sounded stunned. “Have you looked outside lately? It’s coming down at about four inches an hour.” Brad smiled at her tendency toward hyperbole. “And two of my tires are almost bald.”
“Catch a cab. I need you here.”
She sighed theatrically. “Okay…” After a pause, she added, “I’ll get there as soon as I can.
“Add Sharon Porter’s name,” Brad told the security guard. “She should be here within an hour.”
“She’ll need photo ID,” the guard advised.
“She’ll have it.”
Brad affixed his visitor’s badge to his shirt, and moments later he and Alan entered a door marked A-10.
“We’re finally here, Jamal,” Alan announced.
A man clad in green scrubs turned to greet them. He had caramel-colored skin, a shiny bald head and wore a goatee. A diamond stud glinted in his ear. Brad judged him to be about thirty-five. Beyond him, lying on a metal table was a body covered with a sheet.
“Jamal Dubei meet Brad Frame. Dr. Dubei is our resident pathologist,” Alan said, adding, “He’s also an Assistant Medical Examiner for the City of Philadelphia.”
His ME position will expedite contacts with the police, Brad thought, in the event of foul play.
“Call me Jamal. It’s good to meet you,” the pathologist said. “There’s a closet over there.” He pointed. “I was just about to get started with the autopsy.”
Brad hung up his coat and took in the surroundings. He’d attended autopsies before and the smell was always the same—antiseptic with a rank twist of human decay. This room seemed brighter, more bathed in fluorescent light, than others he remembered, perhaps because of the white ceramic-tiled walls.
“You’ll need to wear these.” Dr. Dubei handed him a paper hat and green gown to slip over his street clothes, as well as a facemask and a plastic face shield.
Brad suited up, and smiled as he caught a glimpse of himself in the mirror on the opposite wall. The image resembled a Martian who’d just stepped off a space ship.
Dr. Dubei cleared his throat. “Are we ready to start?”
“Yes, let’s go,” Fenimore replied.
The room felt cold. Dr. Dubei switched on an overhead examination light, and the bright light bounced off the white sheet covering the body, making the room glow. Dubei tapped twice on a rear door to the room, and seconds later a young woman entered carrying a tray of medical instruments. She wore a facemask that concealed much of her porcelain complexion. She had long straight black hair and gray eyes, and looked Vietnamese. Dr. Dubei made no introduction, and referred to her only as Kim. She was already suited up, and began removing the sheet draping the man’s body. She uncovered the man’s head and then folded the cloth back to the shaved pubic area. Brad saw that whatever body hair he might have had would have been shaved before his surgery. He also noticed a fresh surgical scar on the lower right side of the man’s abdomen—complete with staples still in place. The man appeared younger than Brad expected—late 30’s or early 40’s he judged—and quite skinny. His face and chest had a waxy pallor, while the skin on the underside of the corpse had a burgundy hue.
Brad watched as the pathologist slipped on a rubber apron, then attached a small microphone to the neckline on his scrubs. He consulted a chart and began dictating. “This is Dr. Jamal Dubei conducting the post-mortem examination of Michael R. Severns of Cherry Hill, New Jersey, DOB April 14, 1972. Mr. Severns is five foot six inches tall and weighs 115 lbs.”
Dr. Dubei recorded the date and the names of all in attendance, and Brad learned that his assistant’s last name was Coulter—Kim Coulter.
The pathologist carefully examined the body. Brad watched as he pushed on skin, lifted limbs, checked under the subject’s closed eyelids and tried to manipulate the man’s jaw, as his mouth gaped open. “There is evidence of the onset of rigor mortis,” he said for the benefit of the recorder. Dubei gave careful attention to marks on the inside of the man’s left arm, and what looked like an enlarged blood vessel snaking down his forearm. “There is a fistula, recently used for dialysis treatment. The record indicates the patient was on hemodialysis for approximately three years before receiving a kidney transplant two days ago.”
Alan Fenimore spoke, “A dialysis patient routinely undergoes a surgical procedure—”
Dr. Dubei reached over and turned off his recording system before snapping, “Please Doctor, this is voice activated.” He pointed to the microphone that hung around his neck. “To avoid unnecessary banter on the recording, please save your explanations for later.”
Alan huffed and glared at the pathologist. “As I was saying, Brad, there’s a routine operation for dialysis patients involving the joining of an artery with a vein to provide a larger vessel to accommodate the needles used during the dialysis procedure. It’s called a fistula—some people call it a shunt—and in this man’s case, as you can see, it is well-worn with needle tracks. You may continue your examination, Doctor.”
It was uncomfortably quiet in the room, as the two doctors stared each other down. Alan’s edginess had ventured into the autopsy suite.
“I won’t tolerate another interruption,” Dr. Dubei finally said.
“I’m sorry, Jamal.” Alan said Dubei’s first name with a patronizing tone and Brad recalled a high school chemistry teacher who used to drive him crazy with similar condescension. “Mr. Frame is here for a reason.”
The pathologist looked at Brad. “I don’t mean any disrespect to you Mr. Frame.” Turning toward Dr. Fenimore, he said, “I’m warning you, Alan, I will report you if you continue to interfere.”
Alan bowed and waved his hand.
Brad divided his attention between watching the autopsy and observing Alan, who stood with his hands clenched and a vein pulsed at this forehead. If he doesn’t calm down, he’ll have a stroke.
Carefully keeping the man’s genitals covered, Dr. Dubei re-draped the body to examine his legs. The pathologist turned his attention to the IV line still lodged in the patient’s hand, and unfurled a length of plastic tubing wrapped around his arm.
Alan’s phone buzzed, which drew a stare from Dr. Dubei. Alan held the phone at arm’s length and studied what appeared to be a text message. He whispered to Brad, “I’ll be right back.”
Alan slipped off the autopsy gown and mask, and disappeared out the door.
After Alan’s departure Dr. Dubei seemed to relax, and engaged in friendly banter with his assistant.
After extracting the needle from Michael Severn’s arm, Dubei used a magnifying glass to examine every inch of the plastic tubing. Finally, he pulled and probed the skin around the area where the needle had been inserted.
The pathologist reached for a scalpel. Brad watched as he drew the knife across the skin from each shoulder to the middle of the dead man’s chest and then all the way down to the pubic bone in the classic Y incision. After cutting through the ribs, Dubei spent the next ten or fifteen minutes removing organs and weighing them. Human odors overtook antiseptic ones, at least in the race to Brad’s nostrils. The smell reminded him of an overused public restroom with several backed-up toilets. Dubei turned on a wall-mounted TV monitor and then aimed a camera at various organs recording a digital image. He watched the monitor until he got just the picture he wanted, and then recorded it. On the television screen, Severns’ organs looked three times their normal size and bold in color. “His heart weighs thirteen ounces,” Dr. Dubei dictated. “The arteries to the heart show no evidence of significant plaque.
“The subjec
t’s lungs are filled with fluid.” Dubei aimed the camera for a close-up of the lungs. “This is indicative of cardiac arrest.” Brad thought the lung tissue looked like a frothy deep-red sponge. “Arterial connections and urethra links to the bladder appear normal,” he continued, “with no evidence of post-surgical rupture. I’m now removing the graft kidney from the lower right abdominal cavity. The organ weighs six ounces.”
“Why is the kidney placed in the abdomen?” Brad asked. “I thought kidneys were in the lower back.”
“They are, but unless tumors are present there is no reason to remove an existing kidney—even if it no longer functions.” The doctor deposited the kidney into a jar. “Also, there is less muscle tissue to cut through in the lower abdomen ensuring a quicker surgical recovery.”
It wasn’t until afterward Brad noted that Dr. Dubei did not take umbrage to his interruption as he had earlier with Alan.
The detailed examination continued, and Brad noticed that in addition to the recording, Dubei would occasionally stop to write a note in a file on the counter. The door to the autopsy suite opened and Alan Fenimore entered, which drew another glare from Dr. Dubei. Those two men do not like each other.
Alan donned the protective clothing, and leaning toward Brad, he muttered, “Bureaucrats.”
The room fell silent, and Brad could feel the emotional chill between the two doctors. Brad made a mental note to ask Alan about the origin of the animus between him and Dr. Dubei.
The silence ended a few minutes later as the pathologist picked up a Stryker saw and tested its operation. Brad winced, since the least tolerable part of the autopsy—removal of the brain—was about to begin.
As Dubei placed the man’s brain on the scale to weigh it, Dr. Fenimore’s cell went off. Alan answered, and Brad waited for more verbal fireworks.
“Hello,” Alan said. “…Hello. I can’t hear you.”
Dubei scowled. Alan gave an exaggerated what-can-I-do shrug. Looking at the digital display on the cell, Alan announced, “This is an inside call.” He pointed at the phone on the wall. “May I?”