by Robin Cook
After a few minutes of driving in total silence with even the men in the front seat not talking to each other, Jack thought he’d make an attempt at conversation. “Thanks for picking me up,” he said as a potential opener.
Since they were at that moment stopped at a traffic light, the driver was able to turn around. “You are very welcome,” he said. In contrast to the man in the passenger seat, he seemed to have no accent at all. He could have been an American, as far as Jack was concerned. But rather than initiating a conversation with Jack, the short exchange resulted in a seemingly heated discussion between the two men in what Jack thought might be Mandarin. It wasn’t until they were about to enter the Lincoln Tunnel that they reached an apparent resolution, as both men fell silent.
“Is there a problem?” Jack asked. He felt like the odd man out yet somehow responsible for what sounded like a disagreement.
“No problem,” the driver said, without any other explanation.
“Are you guys speaking Mandarin?” Jack asked out of curiosity.
“Yes,” the driver said simply.
Jack shrugged. He didn’t care one way or the other whether there was any talk. Instead of making an effort at chatting, he tried to think of how he was going to handle the visit to the Dover Valley Hospital with the invariable questions he’d face about his role in the snafu of the New York City shutdown. He knew they would have heard, as the news had undoubtedly gone around the world in seconds. But after thinking for just a few minutes, he decided he’d just have to wing it, mainly because he wasn’t sure if they knew about his recent administrative leave. He knew the chances were good that the media would learn of it if the mayor was in as desperate need of a scapegoat as Laurie had suggested.
The next topic was how he was going to handle himself after the autopsy. The question in his mind was how forceful he should be with whom. He had many questions that needed answers, like whether the Bannons had been paid for their son’s heart, or why Wei Zhao was the executor of Carol Stewart’s estate, and how she and the donor heart could have matching CODIS results. He also wondered how he might finagle another interaction with “the emperor,” Wei Zhao. Ultimately, Jack decided he really couldn’t plan and would need to improvise depending on what he learned, starting with the autopsy of Margaret Sorenson.
Forty-five minutes later the two silent, statue-like men drove Jack directly up to the front door of the Dover Valley Hospital. But then, even before the car came to a complete halt, the man in the passenger-side front seat erupted in a flurry of activity and leaped out to open the rear door for Jack.
“Thank you, gentlemen,” Jack said as he slid out of the Suburban. “It’s been a memorable conversation.”
Typical of the changeable weather in the Northeast, it had become a rather nice day with warm sun, in sharp contrast to what it was like when he and Laurie had gotten up that morning. As Jack walked toward the hospital’s entrance he noticed considerably more activity than there had been yesterday, with people coming and going. Even an ambulance arrived, and with its siren trailing off, it raced around to the ER entrance. Despite its futuristic architecture, it seemed like a normal, functioning community hospital.
Going through the revolving front door and expecting to have to head to the information desk, Jack was surprised to be immediately greeted by Harvey Lauder and Ted Markham. It was obvious that somehow they knew exactly when Jack would arrive. Seeing them together emphasized for Jack their differences. Although both were on the short side, with Harvey a bit shorter than Ted, they were opposite in body habitus; Harvey was stocky and phlegmatic, while Ted was slender and animated. Also, Harvey’s pug nose and thinning hair contrasted dramatically with Ted’s delicate features and his halo of dark curls.
“Welcome back,” Ted said. He shook Jack’s hand in an overly friendly fashion, gripping Jack’s forearm in the process. “I hope you make this a habit. We’re glad to see you again so soon. Thank you for coming.”
“It’s my pleasure,” Jack said. He then felt obligated to shake hands with Harvey as well. As he did so he wondered what they would say if they knew the true extent of how much he appreciated the invitation. He also wondered what they would say if they knew he’d just been put on unpaid administrative leave from the NYC OCME.
“What would you like to do?” Ted asked. “Harvey has the autopsy ready to go in our autopsy room in our morgue, but if you’d like to rest and perhaps have a coffee, that’s fine, too. It’s up to you.”
“I always think it best to get the work done first,” Jack said. He was amazed they said nothing about the New York City shutdown. Could they somehow have been so busy at work and preoccupied with their own issues that they hadn’t heard about it yet? Jack had no idea but wasn’t about to broach the issue.
“I couldn’t agree more about work before play,” Harvey said, speaking up for the first time.
The group set off toward the elevators. Jack took note that both men were dressed in scrubs with long white coats over them. He wasn’t surprised about Harvey, but he was about Ted. Somehow its casualness didn’t jibe with his intellectual internal-medicine persona. “I notice you are wearing scrubs,” Jack mentioned to Ted. “Does that mean you are going to participate in the autopsy?”
Ted laughed, more as an affectation than out of mirth. “I’m hardly going to participate,” he said. “I’m going to observe. Margaret was our program’s first heart transplant. We’re as devastated to lose her as we were Carol, maybe even a tad more so.”
Thanks to his high-energy state, Ted wasn’t satisfied just hitting the elevator button once. He had to hit it a half-dozen times and then scan the board to see where all the elevators were.
“I do have a question,” Jack said.
“Fire away,” Ted said.
“Did Margaret know Carol?” Jack asked. “Were they friendly?”
“They certainly knew each other,” Ted said. “They crossed paths here at the hospital on a few occasions. But as far as I know, that was about it.”
“We deduced from her tattoo that Carol was a lesbian,” Jack said. “Do you know if Margaret was as well?”
“I hardly think so,” Ted said. “She was married to a local boy. Why do you ask?”
The elevator arrived, and the passengers filed out. Ted gestured for Jack to enter.
“I wanted to know if there was any chance they might have been intimate with each other,” Jack said as he boarded.
“I can’t imagine,” Ted said. “Nor do I think it would matter.” He got on the elevator behind Jack, and Harvey followed him.
Jack did think it mattered, even though it seemed as if Ted was uncomfortable with the line of questioning, so Jack let the issue drop. If Carol had gotten the illness that killed her from the donor of the heart, which Jack thought possible, the only way Margaret could have gotten it was from Carol. When he’d first heard about Margaret, he thought maybe she’d gotten the virus from having had a transplant, but the more he thought about the idea, the less probable it seemed. The chances of another donor carrying the same unknown virus were extraordinarily slim. Although such a situation had happened with HIV and organ transplantation in the 1980s, that was when HIV was much more significantly widespread.
“Dr. Friedlander and Dr. Lin will be joining us for the autopsy,” Ted announced as the elevator descended.
“It’s going to be a regular party,” Jack said. It was one of his pet expressions.
“You do have a sense of humor,” Ted said. He laughed again, in the same manner as when Jack had asked if he was going to participate in the autopsy.
“It comes with the territory, right, Harvey?” Jack said.
“A lot of forensic pathologists use humor to deal with the reality they face on a daily basis,” Harvey said, essentially agreeing with Jack.
When they arrived at the morgue, Jack was blown away. Harvey had described it as
superb, but in Jack’s mind it was more than that. In comparison to what Jack was accustomed to at the NYC OCME, the autopsy room was akin to the difference between an operating room from the early twentieth century and a hybrid operating room of today. All the equipment was brand-new, including the latest stainless-steel autopsy table. The room itself was clad in a white composite material, including the ceiling. The floor was a white, spotted terrazzo that curved up at the edges to make cleaning easier. Jack could see that not only was standard X-ray available but also what was called 3-D virtual equipment.
“You weren’t kidding about the facility,” Jack said.
“Dr. Zhao allowed me to work with the architects,” Harvey said proudly. “I was able to make a few suggestions. It is capable of biosafety three if needed.”
“Impressive,” Jack said. “Out of curiosity, do you have any proprietary interest with the hospital?”
“Yes, of course,” Harvey said. “We all do. Dr. Zhao believes strongly that everyone feels part of the team. It’s a corporation, and we all have been given a little stock.”
“That’s right,” Ted chimed in.
“Interesting,” Jack said, falling back on his newly adapted favored retort. He wasn’t surprised. Wei had said as much yesterday.
“What level of personal safety would you feel comfortable with?” Harvey asked. “As I said, we can go all the way to biosafety three. But we believe that standard barrier precautions with face shields and latex gloves, not surgical gloves, et cetera, will be adequate.”
“I’m comfortable with that,” Jack said. He’d used a moon suit on the previous cases, but now that he was becoming progressively convinced a retrovirus like HIV was the culprit, he didn’t think it was necessary.
At that moment Dr. Stephen Friedlander and his apparent sidekick, Dr. Han Lin, appeared. They were both dressed similarly to Ted and Harvey, with the addition of surgical caps and with surgical masks hanging down from their necks. It was apparent they’d been in surgery.
“Thank you for coming out here again today,” Stephen said in his commanding voice. Han merely broadly smiled in apparent agreement. Stephen made a production out of shaking hands with Jack and didn’t immediately let go. “We are pleased you could make it. We were all sorry to hear about that huge screwup in New York this morning that you got caught up in.”
Jack inwardly cringed. Here it comes, he thought.
“That kind of ridiculousness is the reason I’m so happy to be out of there and here in the sticks,” Stephen continued, still clutching Jack’s hand. “We don’t have the layers of bureaucracy you people have to put up with. One thing it does show is that under certain circumstances there can be too much planning and training. Is that your take?”
“That and the dangers of a disgruntled employee,” Jack said. He started to relax. Stephen was immediately seeing Jack as the victim, not the cause, which was certainly how Jack viewed the event.
“Well, we’re glad you haven’t let the episode slow you down. We’re excited to have your help on our problem,” Stephen said. He let go of Jack’s hands before rubbing his own hands together in apparent anticipation of the upcoming autopsy. “Let me tell you exactly why we are thrilled you’re here. Since you had the opportunity to see Carol Stewart’s transplanted heart in situ, which we unfortunately were unable to do not being there with you, you’ll be able to give us valuable information. From a technical point of view, we are interested in comparing Carol’s heart with the transplanted heart in Margaret Sorenson, and you will be the only person who can do it from having seen both hearts in situ.”
“Are you thinking from a surgical point of view?” Jack asked. He remembered being impressed with what he had seen.
“I’m talking about the totality of the situation,” Stephen said. “The surgical technique being one of them, but also how the heart appears in its orientation in the chest and how the healing of the pericardium has progressed, along with the anastomoses with the great vessels. There were some technical differences in the two cases whose details I won’t bore you with, but the unfortunate fact that these two patients passed away within months of their procedures offers us a rare opportunity to analyze their progress and decide which was best, Carol’s or Margaret’s. We’d like to try to get something positive out of these two tragedies. Am I making sense here?”
“I think I might be able to reasonably compare them,” Jack said. In his mind’s eye, he tried to remember exactly what he’d seen and what he’d thought when he’d first opened Carol’s chest, and then later, when he’d removed the heart and lungs en bloc, and finally when he exposed the heart by cutting through the scarred pericardium. Most of it came back to him, so he thought he’d be able to make a comparison without too much trouble.
“All right, then,” Stephen said, clapping his hands. “Dr. Lauder will take you into the locker room to change into scrubs. We’ll meet you in the personal protective equipment room. Has Dr. Lauder asked you about your druthers regarding personal protection?”
“We went over that,” Harvey said. “He’s comfortable with standard precautions.”
“Excellent,” Stephen said. “So are we.”
The locker room was as posh as the autopsy room was up-to-date. Harvey gave Jack scrub pants and a shirt. Jack used one of the lockers for his clothes. As he was pulling on the shirt, Harvey returned and asked if there were any special tools he required.
“That I require?” Jack questioned. “I thought I was observing, not performing.”
“They want you to do the case,” Harvey said. “I’ll be assisting, if you need me. We’ll also have two mortuary technicians to help us. Are you okay with that?”
“No problem,” Jack said. Actually, he preferred to handle the case. Sometimes when he observed others, he got antsy that they were taking too long or being clumsy or, worse yet, incompetent. Jack’s prior life as an eye surgeon had honed his hand-eye coordination and made him efficient with his time. He had no idea of Harvey’s skill or lack thereof, but Jack had been mildly concerned Harvey might perform as haphazardly as he dressed. For Jack it was a comfort to know the scalpel and scissors and other instruments would be in his hands.
36
THURSDAY, 11:30 A.M.
As far as Jack was concerned, the Dover Valley Hospital autopsy room was not only a joy to look at, it was a pleasure to use. There was even classical music piped in quietly in the background, reminiscent of how Jack had liked to perform eye surgery in his former life. Having it during an autopsy was a first for Jack. He hadn’t even thought of piped music at the OCME, but now he considered making a suggestion to the design committee responsible for coming up with the plans for the new autopsy room.
There were seven people in the room, which included the two mortuary techs Harvey had mentioned and whom Jack had not formally met. Everyone was dressed in the same light green impervious gowns with full face shields. Jack was on the patient’s right, which was his choice, along with Stephen. Directly across from Jack was Harvey, along with Ted. Dr. Han Lin was standing at the head of the table. The two mortuary techs floated. Jack had the instrument tray brought over to his side, as he preferred to pick up instruments himself rather than having them handed to him by Harvey. It was his strong belief that handing off instruments was a source of accidents, which Jack made a point to avoid.
Once he’d finished the external exam with Beethoven’s Piano Concerto No. 3 playing almost subliminally in the background, Jack picked up the scalpel. After asking Stephen if it mattered to him if Jack cut through the woman’s well-healed thoracotomy scar, Jack carried out a modified Y autopsy incision just as he had done on Carol Stewart.
Jack worked quickly and efficiently. Although he knew everyone present was interested exclusively in the heart, he followed his usual routine and first did the abdomen. Jack never varied the order he followed in his autopsies, to make sure he never forgot any step.
He explained this to his audience, and they all said they understood. Stephen and Ted acted subdued as the case progressed, which was understandable, as autopsies were not part of their normal routine, and to the uninitiated they were brutal.
After checking the entire length of the digestive tract in situ, Jack removed the intestines and handed them off to one of the techs to wash out. He then inspected the rest of the abdominal contents. The only pathology he found were the signs of mild inflammation with extravasated blood in the gallbladder, spleen, and kidneys. He informed the group that Carol Stewart had the same findings, which he explained were later determined by microscopic section to have a mild amount of disseminated intravascular coagulation.
“Was it about the same amount of inflammation with Carol?” Ted asked, as Jack held up the cut surface of the kidney so it could be more clearly seen.
“I’d say nearly identical,” Jack said. “When I first saw it, I thought of hantavirus, as it’s a typical finding in those particular organs in fatal hantavirus pulmonary syndrome. But rapid tests for hantavirus were negative, as were tests for all the other respiratory viruses.”
“Can we move along here?” Stephen said. “Han and I have a case on a live person pending at noon.”
Jack didn’t respond. He was already working significantly faster than he knew most prosectors functioned. In his current sensitive state, he couldn’t help but be mildly annoyed at Stephen’s increasingly impatient and condescending air, which was becoming progressively apparent and which hadn’t been present yesterday.
Taking the heavy-duty wire cutters he’d requested at the outset of the case, Jack proceeded to cut through the wires holding Margaret’s sternum together. They made a distinctive metallic snap as each one was cut. Harvey then participated by pulling each wire out with a pair of pliers. When the last wire was cut, the sternum split apart with an audible pop.
Using a couple of towels against the jagged cut surfaces of the sternum, Jack yanked them apart with a decisive cracking noise, which he knew was the sound of breaking ribs. The thorax was now completely exposed and mostly filled by the pale, swollen lungs. Shielded by its scarred pericardial cover, the heart was not yet in view. Jack left the towels in place to avoid anyone cutting themselves on the sharp edges of bone.
