Chromosome 6

by Robin Cook

  “Jeez, you give a guy an inch and he wants a mile,” Ted complained. “We just got the blood, for chrissake. You’ll have to wait on the results. After all, we turned the lab upside down to get what you got so quickly. Besides I’m more interested in this DQ alpha situation compared to the polymarker results. Something doesn’t jibe.”

  “Well, don’t lose any sleep over it,” Jack said. He stood up and gave Ted back all the material Ted had dumped in his lap. “I appreciate what you’ve done. Thanks! It’s the information I needed. And when the mitochondrial results are back, give me a call.”

  Jack was elated by Ted’s results, and he wasn’t worried about the mitochondrial study. With the correlation of the X rays, he was already confident the floater and Franconi were one and the same.

  Jack got on the elevator. Now that he’d documented that it had been a transplant, he was counting on Bart Arnold to come up with the answers to solve the rest of the mystery. As he descended, Jack found himself wondering about Ted’s emotional reaction to the DQ alpha results. Jack was aware that Ted didn’t get excited about too many things. Consequently, it had to be significant. Unfortunately, Jack didn’t know enough about the test to have much of an opinion. He vowed that when he had the chance he’d read up on it.

  Jack’s elation was short-lived; it faded the moment he walked into Bart’s office. The forensic investigator was on the phone, but he shook his head the moment he caught sight of Jack. Jack interpreted the gesture as bad news. He sat down to wait.

  “No luck?” Jack asked as soon as Bart disconnected.

  “I’m afraid not,” Bart said. “I really expected UNOS to come through, and when they said that they had not provided a liver for Carlo Franconi and that he’d not even been on their waiting list, I knew the chances of tracing where he’d gotten the liver fell precipitously. Just now I was on the phone with Columbia-Presbyterian, and it wasn’t done there. So I’ve heard from just about every center doing liver transplants, and no one takes credit for Carlo Franconi.”

  “This is crazy,” Jack said. He told Bart that Ted’s findings confirmed that Franconi had had a transplant.

  “I don’t know what to say,” Bart commented.

  “If someone didn’t get their transplant in North America or Europe, where could it have taken place?” Jack asked.

  Bart shrugged. “There are a few other possibilities. Australia, South Africa, even a couple of places in South America, but having talked to my contact at UNOS, I don’t think any of them are likely.”

  “No kidding?” Jack said. He was not hearing what he wanted to hear.

  “It’s a mystery,” Bart commented.

  “Nothing about this case is easy,” Jack complained as he got to his feet.

  “I’ll keep at it,” Bart offered.

  “I’d appreciate it,” Jack said.

  Jack wandered out of the forensic area, feeling mildly depressed. He had the uncomfortable sensation that he was missing some major fact, but he had no idea what it could be or how to go about finding out what it was.

  In the ID room he got himself another cup of coffee, which was more like sludge than a beverage by that time of the day. With cup in hand, he climbed the stairs to the lab.

  “I ran your samples,” John DeVries said. “They were negative for both cyclosporin A and FK506.”

  Jack was astounded. All he could do was stare at the pale, gaunt face of the laboratory director. Jack didn’t know what was more surprising: the fact that John had already run the samples or that the results were negative.

  “You must be joking,” Jack managed to say.

  “Hardly,” John said. “It’s not my style.”

  “But the patient had to be on immunosuppressants,” Jack said. “He’d had a recent liver transplant. Is it possible you got a false negative?”

  “We run controls as standard procedure,” John said.

  “I expected one or the other drug to be present,” Jack said.

  “I’m sorry that we don’t gear our results to your expectations,” John said sourly. “If you’ll excuse me, I have work to do.”

  Jack watched the laboratory director walk over to an instrument and make some adjustments. Then Jack turned and made his way out of the lab. Now he was more depressed. Ted Lynch’s DNA results and John DeVries’s drug assays were contradictory. If there’d been a transplant, Franconi had to be on either cyclosporin A or FK506. That was standard medical procedure.

  Getting off the elevator on the fifth floor, he walked down to histology while trying to come up with some rational explanation for the facts he’d been given. Nothing came to mind.

  “Well, if it isn’t the good doctor yet again,” Maureen O’Conner said in her Irish brogue. “What is it? You only have one case? Is that why you are dogging us so?”

  “I only have one that is driving me bananas,” Jack said. “What’s the story with the slides?”

  “There’s a few that are ready,” Maureen said. “Do you want to take them or wait for the whole batch?”

  “I’ll take what I can get,” Jack said.

  Maureen’s nimble fingers picked out a sampling of the sections that were dry and placed them in a microscopic slide holder. She handed the tray to Jack.

  “Are there liver sections among these?” Jack asked hopefully.

  “I believe so,” Maureen said. “One or two. The rest you’ll have later.”

  Jack nodded and walked out. A few doors down the hall, he entered his office. Chet looked up from his work and smiled.

  “Hey, sport, how’s it going?” Chet said.

  “Not so good,” Jack said. He sat down and turned on his microscope light.

  “Problems with the Franconi case?” Chet asked.

  Jack nodded. He began to hunt through the slides for liver sections. He only found one. “Everything about it is like squeezing water from a rock.”

  “Listen, I’m glad you came back,” Chet said. “I’m expecting a call from a doctor in North Carolina. I just want to find out if a patient had heart trouble. I have to duck out to get passport photos taken for my upcoming trip to India. Would you take the call for me?”

  “Sure,” Jack said. “What’s the patient’s name?”

  “Clarence Potemkin,” Chet said. “The folder is right here on my desk.”

  “Fine,” Jack said, while slipping the sole liver section onto his microscope’s stage. He ignored Chet as Chet got his coat from behind the door and left. Jack ran the microscopic objective down to the slide and was about to peer into the eyepieces, when he paused. Chet’s errand had started him thinking about international travel. If Franconi had gotten his transplant out of the country, which seemed increasingly probable, there might be a way to find out where he’d been.

  Jack picked up his phone and called police headquarters. He asked for Lieutenant Detective Lou Soldano. He expected to have to leave a message and was pleasantly surprised to get the man himself.

  “Hey, I’m glad you called,” Lou said. “Remember what I told you this morning about the tip it was the Lucia people who stole Franconi’s remains from the morgue? We just got confirmation from another source. I thought you might like to know.”

  “Interesting,” Jack said. “Now I have a question for you.”

  “Shoot,” Lou said.

  Jack outlined the reasons for his belief that Carlo Franconi might have traveled abroad for his liver transplant. He added that according to the man’s mother, he’d taken a trip to a supposed spa four to six weeks previously.

  “What I want to know is, is there a way to find out by talking to Customs if Franconi left the country recently, and if so, where did he go?”

  “Either Customs or the Immigration and Naturalization,” Lou said. “Your best bet would be Immigration unless, of course, he brought back so much stuff he had to pay duty. Besides, I have a friend in Immigration. That way I can get the information much faster than going through the usual bureaucratic channels. Want me to check?”

>   “I’d love it,” Jack said. “This case is bugging the hell out of me.”

  “My pleasure,” Lou said. “As I said this morning, I owe you.”

  Jack hung up the phone with a tiny glimmer of hope that he’d thought of a new angle. Feeling a bit more optimistic, he leaned forward, looked into his microscope, and began to focus.

  Laurie’s day had not gone anything like she’d anticipated. She’d planned on doing only one autopsy but ended up doing two. And then George Fontworth ran into trouble with his multiple gunshot wound case, and Laurie volunteered to help him. Even with no lunch, Laurie didn’t get out of the pit until three.

  After changing into her street clothes, Laurie was on her way up to her office when she caught sight of Marvin in the mortuary office. He’d just come on duty and was busy putting the office in order after the tumult of a normal day. Laurie made a detour and stuck her head in the door.

  “We found Franconi’s X rays,” she said. “And it turned out that floater that came in the other night was our missing man.”

  “I saw it in the paper,” Marvin said. “Far out.”

  “The X rays made the identification,” Laurie said. “So I’m extra glad you took them.”

  “It’s my job,” Marvin said.

  “I wanted to apologize again for suggesting you didn’t take them,” Laurie said.

  “No problem,” Marvin said.

  Laurie got about four steps away, when she turned around and returned to the mortuary office. This time she entered and closed the door behind her.

  Marvin looked at her questioningly.

  “Would you mind if I asked you a question just between you and me?” Laurie asked.

  “I guess not,” Marvin said warily.

  “Obviously, I’ve been interested in how Franconi’s body was stolen from here,” Laurie said. “That’s why I talked to you the afternoon before last. Remember?”

  “Of course,” Marvin said.

  “I also came in that night and talked with Mike Passano,” Laurie said.

  “So I heard,” Marvin said.

  “I bet you did,” Laurie said. “But believe me I wasn’t accusing Mike of anything.”

  “I hear you,” Marvin said. “He can be sensitive now and then.”

  “I can’t figure out how the body was stolen,” Laurie said. “Between Mike and security, there was always someone here.”

  Marvin shrugged. “I don’t know, either,” he said. “Believe me.”

  “I understand,” Laurie said. “I’m sure you would have said something to me if you had any suspicions. But that’s not what I wanted to ask. My feeling at this point is that there had to be some help from inside. Is there any employee here at the morgue that you think might have been involved in this somehow? That’s my question.”

  Marvin thought for a minute and then shook his head. “I don’t think so.”

  “It had to have happened on Mike’s shift,” Laurie said. “The two drivers, Pete and Jeff, do you know them very well?”

  “Nope,” Marvin said. “I mean, I’ve seen them around and even talked with them a few times, but since we’re on different shifts, we don’t have a lot of contact.”

  “But you don’t have any reason to suspect them?”

  “Nope, no more than anybody else,” Marvin said.

  “Thanks,” Laurie said. “I hope my question didn’t make you feel uncomfortable.”

  “No problem,” Marvin said.

  Laurie thought for a minute, while she absently chewed on her lower lip. She knew she was missing something. “I have an idea,” she said suddenly. “Maybe you should describe to me the exact sequence you go through when a body leaves here.”

  “You mean everything that happens?” Marvin said.

  “Please,” Laurie said. “I mean, I have a general idea, but I don’t know the specifics.”

  “Where do you want me to start?” Marvin asked.

  “Right from the beginning,” Laurie said. “Right from the moment you get the call from the funeral home.”

  “Okay,” Marvin said. “The call comes in, and they say they’re from so-and-so funeral home and they want to do a pickup. So they give me the name and the accession number.”

  “That’s it?” Laurie asked. “Then you hang up.”

  “No,” Marvin said. “I put them on hold while I enter the accession number into the computer. I gotta make sure the body has been released by you guys and also find out where it is.”

  “So then you go back to the phone and say what?”

  “I say it’s okay,” Marvin said. “I tell them I’ll have the body ready. I guess I usually ask when they think they’ll be here. I mean, no sense rushing around if they’re not going to be here for two hours or something.”

  “Then what?” Laurie said.

  “I get the body and check the accession number,” Marvin said. “Then I put it in the front of the walk-in cooler. We always put them in the same place. In fact, we line them up in the order we expect them to go out. It makes it easier for the drivers.”

  “And then what happens?” Laurie asked.

  “Then they come,” Marvin said with another shrug.

  “And what happens when they arrive?” Laurie asked.

  “They come in here and we fill out a receipt,” Marvin said. “It’s all got to be documented. I mean they have to sign to indicate they have accepted custody.”

  “Okay,” Laurie said. “And then you go back and get the body?”

  “Yeah, or one of them gets it,” Marvin said. “All of them have been in and out of here a million times.”

  “Is there any final check?” Laurie asked.

  “You bet,” Marvin said. “We always check the accession number one more time before they wheel the body out of here. We have to indicate that being done on the documents. It would be embarrassing if the drivers got back to the home and realized they had the wrong corpse.”

  “Sounds like a good system,” Laurie said, and she meant it. With so many checks it would be hard to subvert such a procedure.

  “It’s been working for decades without a screwup,” Marvin said. “Of course, the computer helps. Before that, all they had was the logbook.”

  “Thanks, Marvin,” Laurie said.

  “Hey, no problem, Doc,” Marvin said.

  Laurie left the mortuary office. Before going up to her own she stopped off on the second floor to get a snack out of the vending machines in the lunch room. Reasonably fortified, she went up to the fifth floor. Seeing Jack’s office door ajar, she walked over and peeked in. Jack was at his microscope.

  “Something interesting?” she asked.

  Jack looked up and smiled. “Very,” he said. “Want to take a look?”

  Laurie glanced into the eyepieces as Jack leaned to the side. “It looks like a tiny granuloma in a liver,” she said.

  “That’s right,” Jack said. “It’s from one of those tiny pieces I was able to find of Franconi’s liver.”

  “Hmmm,” Laurie commented, continuing to look into the microscope. “That’s weird they would have used an infected liver for a transplant. You’d think they would have screened the donor better. Are there a lot of these tiny granulomas?”

  “Maureen has only given me one slide of the liver so far,” Jack said. “And that’s the only granuloma I found, so my guess would be that there aren’t a lot. But I did see one on the frozen section. Also on the frozen section were tiny collapsed cysts on the surface of the liver which would have been visible to the naked eye. The transplant team must have known and didn’t care.”

  “At least there’s no general inflammation,” Laurie said. “So the transplant was being tolerated pretty well.”

  “Extremely well,” Jack said. “Too well, but that’s another issue. What do you think that is under the pointer?”

  Laurie played with the focus so that she could visually move up and down in the section. There were a few curious flecks of basophilic material. “I don’t know. I ca
n’t even be sure it’s not artifact.”

  “Don’t know, either,” Jack said. “Unless it’s what stimulated the granuloma.”

  “That’s a thought,” Laurie said. She straightened up. “What did you mean by the liver being tolerated too well?”

  “The lab reported that Franconi had not been taking any immunosuppressant drugs,” Jack said. “That seems highly improbable since there is no general inflammation.”

  “Are we sure it was a transplant?” Laurie asked.

  “Absolutely,” Jack said. He summarized what Ted Lynch had reported to him.

  Laurie was as puzzled as Jack. “Except for identical twins I can’t imagine two people’s DQ alpha sequences being exactly the same,” she said.

  “It sounds like you know more about it than I do,” Jack said. “Until a couple of days ago, I’d never even heard of DQ alpha.”

  “Have you made any headway as to where Franconi could have had this transplant?” Laurie asked.

  “I wish,” Jack said. He then told Laurie about Bart’s vain efforts. Jack explained that he himself had spent a good portion of the previous night calling centers all over Europe.

  “Good Lord!” Laurie remarked.

  “I’ve even enlisted Lou’s help,” Jack said. “I found out from Franconi’s mother that he’d gone off to what she thought was a spa and came home a new man. I’m thinking that’s when he might have gotten the transplant. Unfortunately, she has no idea where he went. Lou’s checking Immigration to see if he’d gone out of the country.”

  “If anyone can find out, Lou can,” Laurie said.

  “By the way,” Jack said, assuming a teasingly superior air, “Lou ’fessed up that he was the source of the leak about Franconi to the newspapers.”

  “I don’t believe it,” Laurie said.

  “I got it from the horse’s mouth,” Jack said. “So I expect an abject apology.”

  “You’ve got it,” Laurie said. “I’m amazed. Did he give any reason?”

  “He said they wanted to release the information right away to see if it would smoke out any more tips from informers. He said it worked to an extent. They got a tip which was later confirmed that Franconi’s body had been taken under orders from the Lucia crime family.”