Doctored Death

by P. D. Workman

  “Yeah. Great. Next time pick up your messages.”

  “Yes, sir.”

  He continued on to his office at a brisk pace. Kenzie moved more slowly to her own desk. She didn’t want to spill any more of the hot coffee or risk making any further mistakes by being in too much of a hurry and forgetting or misfiling something. If Dr. Wiltshire was getting harassed by higher-ups, Kenzie couldn’t afford to make any mistakes. He would want everything possible in front of him on his desk so that he could come up with required details in an instant. No matter how hard Wiltshire pushed, she needed to take her time and get everything assembled properly.

  Eventually, she was confident that she had caught all the required reports and materials, and she took the file in to Dr. Wiltshire. He looked at the folder impatiently. “Are your memos in there too?”

  “My memos?”

  “What you were working on yesterday. The previous deaths, your hypotheses...”

  “Uh...” Kenzie swallowed, hating to look stupid in front of her boss. “No. Sorry, I didn’t know you would want them, so I haven’t written everything up. I just have rough notes...”

  “Well, give me what you’ve got then.”

  “Okay. I’ll just be a minute.”

  Kenzie hurried back to her desk. There was no time to rewrite or type anything. Her notes and diagrams were a mess, never intended for anyone’s eyes but her own. She knew that she should be flattered that Wiltshire had asked for them. She hadn’t expected her half-baked ideas to be of any interest to him. Especially if he was getting pressure from higher up the food chain.

  As long as he wasn’t looking for someone else to blame. “My assistant is holding things up on a wild goose chase about a parasite or serial killer. Your guess is as good as mine as to which...”

  But he wouldn’t do that. He’d always been professional with her, honest and upfront, and he never dressed her down even when she probably deserved it. He treated her like she was already the assistant medical examiner that she wanted to be.

  23

  Kenzie ended up having to take a late lunch, the morning too hectic for her to leave her desk for long, and she did have to use the evil vending machine that Zachary had referred to, choosing a sad-looking sandwich that she thought might be turkey, and a small carton of milk. Neither was particularly appetizing, but she was famished despite her stock of snacks and had to get back to her desk quickly. There had been an unusual number of request forms to see to that morning.

  The phone was ringing when Kenzie got back to her desk and she barked her shins for a second time, even though this time the drawer wasn’t open. She saw before she picked it up that it was an internal call from Dr. Wiltshire.

  “Hello?”

  “Kenzie, could you join me on a call?”

  Kenzie froze, not sure what to do. “Uh... you want me to three-way someone for you, or...?”

  “Come into my office. We’ll take the call on the speakerphone.”

  “Okay. I’ll be right there. I just have to get someone to watch the desk.”

  There were a few people that Kenzie could call upon when she couldn’t be at her desk. She didn’t like to unless she was assisting in an autopsy. Everyone else had enough work to do without taking her responsibilities too. But she couldn’t just leave her station unmanned while she joined Dr. Wiltshire on whatever the call was. She called on Julie, a college student who bounced between departments as she was needed, to see if she could leave her duties in the forensic accounting department to help out.

  “Thank you!” Julie breathed. “I needed a break from filing. You wouldn’t believe the amount of paper this department produces. Paperless office? Remember that concept? Somebody got it backward. We aren’t going to be paper-free until we’re dead.”

  “Uh, have you seen my department?” Kenzie teased. “I’m sorry, but being dead just means more paperwork. Only the stiff is lucky enough not to have to fill it out himself.”

  Julie giggled. “I’ll be right down.”

  “Thanks. I appreciate it.”

  It was closer to fifteen minutes before Julie showed up at Kenzie’s desk. During that time, Kenzie was on pins and needles, worried that Dr. Wiltshire was going to call her again or to show up in person to find out why she hadn’t yet made it to his office for what was obviously a very important call.

  As long as that wasn’t code for him firing her. But she didn’t think she had done anything to warrant firing or even a reprimand. She had just missed a voicemail message. And she normally picked up voicemail several times a day. It was more efficient than stopping what she was doing every time she was notified that she had a message.

  She hurried to Wiltshire’s office, stomach full of butterflies, a pen and notepad in hand to be able to take down notes as required.

  “Ah, there you are.” Dr. Wiltshire looked up from his work and pushed his glasses up his nose. He looked at his watch. “That call should be coming through any time. Nothing to worry about,” he assured her with a grimace. “Just the governor’s office checking up on the investigation.” He rolled his eyes. “The governor’s. Like he has any say over how I run my morgue. Why would anyone go to him to move a medical examiner along?”

  Kenzie blinked, surprised. “Yeah. That’s kind of weird.”

  “People will use whatever kind of political pressure they can reach. If they have a friend in the governor’s office...” Wiltshire waved his hand like he was performing a magic spell. “You call the governor’s office.”

  “I guess so.” Kenzie was thinking of her father. A lobbyist often stationed at the statehouse, Walter Kirsch spent all day pressing the flesh and putting political pressure in the right places. Using personal relationships to get what he wanted was his bread and butter, and he was very good at it.

  She sat down in the guest chair in front of his desk and put her notepad down on the desk. Luckily, Wiltshire kept a pretty tidy desk—which Kenzie helped to keep clean—so they were not crowded. Otherwise, she would have had to balance her notebook on her lap.

  Dr. Wiltshire kept working on something on his computer while they waited. Kenzie looked around the room and looked at her phone a few times to try to appear occupied. Eventually, the phone began to ring. Dr. Wiltshire checked the screen, then answered it on speakerphone.

  “Dr. Wiltshire, Medical Examiner.”

  “Doctor,” a resonant voice boomed from the speaker. “Commissioner Toby Fletcher here. I’m glad I was able to get you. I hope I’m not taking you away from anything important?”

  “Well, if your intention is to move the Cartwright investigation forward, then it might be best not to interrupt the process.”

  The man on the other end of the line chuckled. “I understand you’ve already completed the autopsy, so I’m not sure what else you would have to do. The body should be able to be released at this point, shouldn’t it?”

  “Just because we have done a postmortem, that doesn’t mean that our investigation is complete or that we can release the body. There may still be some other tests that need to be done before we can make a determination. It isn’t like you see on TV, you know, where I have a wall of computers that spit out the answer to every question I might have or test I need to perform. Things take time, and as our investigation proceeds, the data we find may require additional tests that weren’t considered necessary in the beginning.”

  “Sounds like a lot of hot air to me. When will the body be released?”

  “I have my assistant, Dr. Kenzie Kirsch, with me, and we can go over some of the preliminary investigations we have done. I think you will see that we have been actively pursuing the case and have several viable avenues of investigation we need to follow before making a determination.”

  “Who?”

  Kenzie would have sunk down into the floor if she could have. She was a nobody. Of course, this politician from the Capitol didn’t have any idea who she was. And he didn’t care, either. The buck stopped at Dr. Wiltshire. He was the a
uthority in the case; the responsibility all landed on him.

  “Dr. Mackenzie Kirsch,” Wiltshire repeated slowly and clearly.

  “Kirsch. Any relation to Walter Kirsch?” Fletcher inquired.

  Dr. Wiltshire looked at Kenzie, waiting for her answer. Kenzie’s stomach muscles tightened and she found her breathing constricted. Her mouth was dry, but she hadn’t brought a bottle of water in with her. She licked her lips, feeling like the silence was drawing out much too long. Fletcher would think she was an idiot.

  “Walter is my father,” she confirmed finally.

  “Your father?” Fletcher laughed and swore jovially. “I probably bounced you on my knee when you were a little girl. Walter and I go way back. And how is Lisa these days? The two of them seem to get along pretty well for a divorced couple. Better than I get on with my ex-wives!”

  “Yes, Lisa is fine. She’s planning to be over your way for some masquerade fundraiser later this month.”

  “No kidding? I’ll have to make sure I go to that one. So, Walter’s little girl made it to the Medical Examiner’s Office. Good for you! Do you have any other siblings? I remember Lisa and Walter lost one years ago.”

  “That was Amanda. Yes. So it’s just me now.”

  “Ah, that’s too bad. But at least you get all of mom and dad’s attention, right?”

  Kenzie rolled her eyes and didn’t have an answer to this. She would much rather have had to split her time with a sibling. She would rather Amanda was still alive and demanding much of her parents’ attention. She had never been jealous of the time Walter and Lisa had spent with Amanda.

  “Can we focus on this case?” Wiltshire suggested, rescuing Kenzie. “As I’m sure you know, we’re quite busy here, so we should get to the matter at hand.”

  “Of course,” Fletcher agreed. “So what’s going on with this Cartwright fellow? He was old. He was in a nursing home. You basically just certify that it was natural causes, right?”

  “I’m sure it was,” Wiltshire assured him. “But natural causes is the manner of death. And we also need to determine the cause of death. What it was that actually killed him.”

  “He was old. It was old age. His heart gave out. It wasn’t exactly unexpected, was it?”

  “Are you a doctor now?” Wiltshire challenged.

  “You know I’m not saying that,” Fletcher protested. “I’m just saying, there’s no real mystery about it, is there? Nursing home death, it should be pretty quick to certify.”

  “In most cases, it is,” Wiltshire agreed. “But there is not a clear cause of death in this case, and we’re investigating it further. Sometimes when you open someone up... you find something unexpected. And you have to deal with that before you can move forward. Decide whether it is relevant, whether you have all the information you need about the circumstances leading up to death, and all that sort of thing. There are several complications in this case that have forced us to take a little longer with it than we normally would. That’s just the nature of the job.”

  “Unexpected? Like what?”

  Dr. Wiltshire sighed. He leaned forward, toward the phone. “You’re not a medical professional, so I really don’t know if it is helpful to discuss all of the details...”

  But he’d had a pretty good idea from the start that Fletcher or whoever called from the governor’s office was going to want details. That was why he had asked for Kenzie’s notes and for her presence on the call.

  “I have to have something to report to the governor.”

  “As you probably were told, Mr. Cartwright had a scalp laceration where he had fallen and hit his head. It was minor and didn’t appear to have anything to do with his death. But we didn’t find anything on the gross examination of the body that would indicate cause of death, and when we proceeded with the postmortem, his heart and lungs appeared to be in pretty good condition. The nursing home had reported that he had been in good health and I agree that appears to be the case.”

  “So maybe it was the conk on the head.”

  “That was our thinking as well. But when we examined the wound, there was no indication that it was serious. We did open up his skull to see if there was a bleed or swelling of the brain that might have resulted in his death. Closed head injuries don’t have outward indications.”

  “And...?”

  “That’s where the unexpected part comes in. We did not find any sign of a bleed, concussion, or stroke. We had slides prepared of the brain tissue as a routine measure, and that’s where we did find something surprising. Mr. Cartwright had extensive protein deposits in his brain tissue that would be expected to cause him problems.”

  “Protein deposits. What does that mean? What kind of problems?”

  “He had amyloid plaques, which are a key indicator of Alzheimer’s Disease.”

  “Ah. Well, like I said, he was old.”

  Kenzie wished he wouldn’t keep saying that. Eighty-seven was elderly, that was true, but if Fletcher was one of Walter’s contemporaries, then he wasn’t that much younger than Cartwright himself. He was likely in his seventies.

  “He was getting on in years,” Wiltshire agreed. “And Alzheimer’s Disease would not be unusual. Except that he didn’t have dementia symptoms. He was supervised, but he was in the independent living section of the nursing home. He was able to look after himself and only had minimal support from the staff.”

  “They must not have noticed.”

  “That’s one reason I had Kenzie out to the nursing home yesterday. To see if there was any possibility that the nursing home had missed symptoms or been negligent in their care of Mr. Cartwright. Maybe Kenzie could tell you a little bit about what she found there.”

  He nodded for Kenzie to step in. Kenzie swallowed and nodded back and tried to gather her thoughts.

  “The unit he was in is not equipped to handle someone with serious needs like advanced dementia. If his care was too difficult, then they would have transferred him to one of the other units, based on his symptoms and the kind of care that he needed.” Kenzie cleared her throat. “He did have some new symptoms cropping up in the week before he died. Issues with forgetting or disorientation. He had at least a couple of falls. He wasn’t eating. But all of that could just have been the temporary effects of a virus, too. They were starting to run some tests, but didn’t think it was serious enough to worry about. They figured it would just run its course and he would be fine again.”

  “Viruses can be pretty dangerous to the elderly.”

  “They can. But he didn’t have a lot of viral symptoms like you would expect. No vomiting or difficulty breathing. No rash. Just those very vague symptoms that people sometimes get before the actual virus symptoms show up.”

  “But say it was the flu or something like that. His body is fighting the virus and he’s just having bothersome symptoms. Maybe he doesn’t even realize he’s feeling sick because it’s causing tiredness and confusion. Then it really hits in the night. He spends a few hours throwing up, but doesn’t think he needs any help from the staff. Doesn’t realize that he’s gotten dehydrated, and...”

  Kenzie looked at Dr. Wiltshire.

  “Something like that is certainly possible,” Dr. Wiltshire agreed. “But it still doesn’t explain the signs of Alzheimer’s Disease in his brain. With everything that we know, he should have had advanced dementia symptoms. The question becomes, did he not have symptoms? Did he have them and they weren’t recognized? Is there something other than Alzheimer’s Disease that caused these plaques?”

  “But if it’s the flu that killed him, then you don’t need to worry about the plaques,” Fletcher said reasonably. “You just focus on what did kill him. Any other... anomalies... well, they don’t really matter, do they?”

  “We haven’t established that he had a stomach bug. We’ve sent in swabs for virology. He didn’t have vomit on his clothing. There wasn’t anything in his stomach, but the staff said he hadn’t been eating. He didn’t have an inflamed throat.”
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br />   “It could be a virus,” Fletcher said petulantly.

  “Yes, it could. But a virus doesn’t cause amyloid plaques.”

  Kenzie made a couple of notes on her notepad to follow up on. Fletcher was pushy, but hopefully, he was starting to get a better picture of what they were doing. And as Dr. Wiltshire had said, the governor’s office didn’t really have any say in how quickly he completed an autopsy. They could put on all the pressure they liked, that wasn’t going to move anything forward.

  “So what else causes amyloid plaques?” Fletcher asked.

  “We’ll do some more research into that. But it is a hallmark of Alzheimer’s Disease. I have heard of amyloid plaques sometimes showing up with Creutzfeldt-Jakob Disease.”

  “Mad cow?” Fletcher demanded. “Are you telling me that Cartwright might have had mad cow disease?” He swore.

  “No,” Dr. Wiltshire hurried to head Fletcher off before he could drop the phone and go tell everyone he knew that Cartwright had died of mad cow disease. “There are several kinds of Creutzfeldt-Jakob Disease. It can be inherited, sporadic, or it can be transmitted by eating contaminated meat. But we don’t know anything about whether Mr. Cartwright had any form of CJD. So don’t go spreading that around.”

  “Can’t you test for it? You are going to test for it, aren’t you?”

  “We’ll test,” Dr. Wiltshire assured him quickly. “Of course. And if he had CJD, that doesn’t mean that there is any problem with our food chain. Remember that it can lie dormant for years, even decades. Who knows when he might have been exposed if, in fact, he was? There are other prion diseases as well. Some of them are very rare and I would have to look up the symptoms to even know what to look for.”

  “If he had mad cow, what would that look like?” Fletcher demanded. “I mean, I know it’s not like rabies, he’s not running around trying to bite people or afraid of water. But what would his symptoms be?”

  “Dementia,” Dr. Wiltshire admitted. “Very much like Alzheimer’s Disease. The two can be easily mistaken for each other without testing. CJD is generally faster than Alzheimer’s Disease. It can take someone within a year of onset of symptoms.”