by Judith Lucci
The NOLA Coroner's Office had been under considerable strain lately due to bad publicity in the media. The Times Picayune had run a whole series of articles about screw-ups at the Coroner's office. The stories had focused on staff losing DNA evidence, filing incomplete reports, and misinterpreting autopsy findings that had never existed. Worst of all, the office had been accused of selling body parts. It was rumored the coroner had made thousands of dollars selling livers, corneas, and bone marrow. These accusations were providing a field day for defense lawyers. Jack clenched his jaw and gritted his teeth just thinking about it. Damn the liberal press!
The Coroner's office employees, like most state offices in the many parts of the nation, were underpaid, understaffed, and under appreciated by most people who crossed their thresholds. The NOLA staff was demoralized and the office had experienced lots of turnover when, in fact, it was also home to some really fantastic forensic pathologists, dentists, and physicians. They were probably some of the best in the country, although you can bet the Times Picayune hadn't reported that little detail. He cursed the newspapers again under his breath.
The autopsy room was busy. Three physicians were autopsying recent victims, but he didn't see his favorite medical examiner. Nor did he find his two stiffs from this morning – at least, he didn’t think he did, since the victims on the tables all looked pretty old.
"Yo, Fred," he hailed a morgue tech, "You seen Dr. Jeanfreau?"
"Yeah, she's in her office. Straight back, Commander," Fred gestured, giving the Commander a big grin. Fred was a favorite of Jack Françoise because he always knew what was going on, never played dumb, and wasn't lazy, all traits which put Fred on his way to meeting most of Jack's criteria for earning praise.
"Thanks, man," Jack said, starting back down the hall, noticing the decrepit condition of the offices. Unlike the bright autopsy room, the temporary offices of the Coroner were pretty shabby. Jack eyed the faded, dirty carpet as he wandered down the hall towards Maddy's office. He wondered when they were moving into their new building, although he hated the thought of them leaving his police district. It had been convenient having them so close. Now he'd probably have to hit I-10 to get there. What a pain. Traffic was always bad going out of New Orleans. As a matter of fact, traffic in New Orleans was always awful and he didn't know all of the illegal parking spots in that part of town.
Maddy's door was partially open. Since she wasn't dictating, Jack decided to knock and interrupt her.
"Yo, Maddy, you rang?"
Dr. Madeline Jeanfreau, Assistant Medical Examiner, stood and walked around her desk to greet Jack. She was a tiny woman. Even with high heels, she was only a little over five feet tall. She hugged Jack and kissed him on the cheek. Jack returned the hug.
"What the hell, Commander? You get promoted, have a party, and don't even invite your favorite M.E.? How do you expect to keep getting special treatment from me or my office?" the diminutive Dr. Jeanfreau queried, as she smiled and shook her short, highlighted hair.
"That wasn't a party; it was just a bureaucratic BS hour. I didn't want to go and you would have hated it. Think of whom you would have had to hobnob with for an hour, all the while getting nothing but punch and cookies. It was grueling."
"Well, you owe me lunch then and it's going to cost you a bunch ... and drinks as well," Maddy insisted, giving Jack a grin. “Soon! I want my lunch soon."
"Anytime, Maddy. You're the busy one. You know I just sit around and eat chocolate éclairs all day,” Jack commented sarcastically. "What's up? Jason said you wanted to see me."
"Yeah, about those two dead kids that came in a couple of hours ago. Have you got any ID or information on them?"
"No, nothing yet. I just talked to Bridges, the detective who caught the case. We're still looking for witnesses. There was no ID found with the bodies. The detective said they looked Goth and were tatted up. Not much blood at the scene, though probably enough for DNA. Why?"
Maddy shook her head and said, "It's pretty strange. We haven't finished the autopsies yet, but we started collecting body fluids when they first came in, before we put them in the chiller."
"Yeah, so? That's pretty normal, right?"
"Yes, it is," Maddy replied, looking straight at Jack. "Problem is, they didn't have any."
"Didn't have any what? Maddy, I am not getting this. What are you telling me? The stiffs didn't have any fluids?"
"That's right, Jack. They didn't have any blood. It's likely the C.O.D. will be death by exsanguination." Maddy stared at Jack.
Jack's shoulders slumped and stared back at his friend. He felt the fear crawling out of his pores. Maybe not fear, just uncertainty perhaps? What The Fuck! Not again! Please, not again, he thought to himself. Their eyes locked, each reading the meaning on the other’s face.
Maddy finally broke the silence. "Yeah, Jack. Here we go again. Just like 2009, 1984, and 1933.”
Jack was suddenly overcome with fatigue. He shook his head. The day really wasn't getting better after all. "Well, keep me in the loop. Hopefully, these are the only two. We'll know more when we ID them." His voice sounded worn and tired.
"If you ever do ID them," Maddy replied. "Remember, we never had an ID for the case in 2009. I'll handle the autopsies personally. There could be another cause of death, but it’s unlikely with the two of them and the fact that they were young and healthy."
"Yeah, I know," Jack replied, while checking a text message that had just come in. "I've got to go. I just got a 911 from CCMC. I hope there’s nothing major gone wrong over there." He groaned, hugged Maddy, and left her office. But, he knew better. He knew something bad had happened. Whenever he got called to Crescent City Medical Center, it was always something bad.
"Oh, Jack," Maddy called after him, "the vics had a receipt on them for $116. From Howl.”
Jack turned around, looked at her, and shook his head. "Great, this day just keeps getting better," he said sarcastically.
Chapter 4
It was a little after midnight and Angela Richelieu was just finishing her nursing shift report when the red light went on in the corner of the nursing station at Crescent City Psychiatric Pavilion, signaling an All Staff Alert. "Damn!" she muttered under her breath. Flashing red meant all hell had broken out somewhere on the unit. Sadly, she knew what that meant for her and picking her daughter up on time. Her shift had ended at 11, but paperwork had taken her an hour after that. Now who knew when she would get out of there?
Cursing under her breath, she unlocked a small metal cabinet and took out a syringe filled with Vitamin G. She laughed a bit as she thought about the Vitamin G – a nickname for Geodon. A powerful anti-psychotic agent, it could settle down a horse almost immediately. G for goodnight! She placed the syringe in the pocket of her blue uniform top and cautiously opened the security door that led onto the Psych unit. Never knew who was hanging around, just waiting to get into the office.
The coast was clear and Angela saw everybody heading towards the east corridor. She heard an angry "Get the hell off of me! I'm a policeman!" coming from that hallway. Big Jim! she thought to herself.
She was surprised and not surprised at the same time. James McMurdie, the former NOPD cop, had been a model patient up until now, so she was surprised that he was involved. She was not surprised because she had almost seen something coming earlier in the evening.
It had been a great shift on the unit until that new administrator, Lester What's-his-name, had shown up. He wasn't even a real employee. Don Montgomery, the CEO, had contracted with him to run the Psych Pavilion. Lester was weird, just as weird as some of the patients. The patients had been quiet until he came onto the unit. Once the patients saw him, a sort of agitation had set in like a wolf walking into a field of tasty sheep.
Plus, he was creepy. Angie shook off a chill when she thought about the way he'd looked at her. He was gross and struck her as a real letch. He'd stayed most of the evening on the unit. He was working in his office between the genera
l psych and the prison units when he wasn't on the units talking with the patients. She remembered the other nurses saying how inappropriate it was that he talked so much with the patients. He’d spent a lot of time talking with Jim in the day room. A lot of time.
Angela hurried past the shuffling patients and when she turned the corner and looked down the corridor, she saw a sight that was both tragic and comical. Jason, the lone security guard, whose best asset was his enormous weight, was lying on top of Jim in the hallway. Ben, the orderly, had control of Jim's right arm and Amy, a petite Asian-American patient care assistant, was trying to control his left arm. Amy was wrapped around the arm like a python while he threw her up and down as if she were weightless and he tireless. Amy grunted each time Jim slammed her onto the dirty green tile floor.
Ben looked up as Angela ran down the hallway. "Hurry up! He's beating the hell out of Amy!"
Angela looked to Jim's left arm where Amy was clinging like a tired squirrel to a tree trunk, and saw that Jim's sleeve had ripped at the shoulder, exposing his taut deltoid muscle. Without hesitating, she sat down on top of Amy. Mercifully, their combined weight kept the flailing left arm pinned to the floor as Angela plunged the needle into the deltoid muscle and pushed the Vitamin G into Jim's body. She withdrew the needle and waited.
As she sat perched on the softening arm, Angela thought about what a joke the Psychiatric Pavilion was. The "Pavilion" was really an old three-story storage warehouse that CCMC had hastily renovated into three psychiatric units about eight years ago when psychiatric and substance abuse services had actually been moneymakers for the hospital. Now they weren't and the building had been sadly neglected. It was beginning to have the look of a "blighted" building that Angie remembered from her Community Health class at LSU where she had recently received her Bachelor's degree in Nursing. Fat lot of good that did me, she mused.
But Angie knew in her heart that her degree did matter. She chose to work at the Pavilion where the salary was at least 50% more than the medical units because the patients were so sick, scary, and dangerous. The Pavilion was actually three nursing units. Pavilion I was now the Prison Unit and housed some of the most dangerous, criminally insane inmates from the Deep South. Pavilion II was now general psychiatry where chronically psychotic patients were committed by temporary detaining orders. They were kept there 'until they promised not to try to kill themselves or others again'. Angie thought it was criminal that these sick patients were generally discharged in two days. Jim was one of the exceptions. Pavilion III was the substance abuse unit where patients were detoxed and 'cured' in three days, and then discharged. The absolute worst was the CCMC Pavilion management. Don Montgomery, the CEO of CCMC, had contracted with the state hospital over in Mandeville to take their forensic psychiatric patients several years ago when a public outrage from the good citizens of Mandeville had succeeded and the hospital closed. Even though CCMC received a premium for housing and caring for the forensic patients, none of the money went back into the safety and security of staff and patients at CCMC. Angie shuddered and felt a chill when she thought about the patients she'd worked with over the past year. Some of them had nearly frightened her to death. She had thought Jim was one of the safe ones – until now.
While plunging the needle into Jim's shoulder, she had made the mistake of looking into his eyes. The eyes were there, but Jim wasn't. It was as if he were somewhere else. He hadn't recognized her. Recognition was the basis of human interaction, and is what separated friend from foe. Those empty eyes terrified her!
"What set him off tonight?" Angela asked Ben as she came back to the present. "He was one of the good ones – I thought."
"Louis and Jim were playing Battleship in the day room. Louis won and Jim said he was cheating. It was so strange. Normally Jim didn't care if he won or lost. Not this time. Next thing, Jim said Louis was sleeping with his wife. Crazy! Louis hasn't had a hard on in ten years. Next thing, Jim lunged at Louis and missed and Louis ran into the hallway yelling. Jim followed with murder in his eyes. Louis ducked under Jason's arm and Jim ran smack into that arm. Knocked him down and Jason got on top of him. I came out of the day room and jumped on Jim's arm."
"Thanks, Louis. Many thanks to you, Jason. And Amy – what you did was above the call of duty. I think you're going to be pretty sore. If you need to call off for your next shift, I'll vouch for you," Angie said as she looked at the poor battered Asian-American woman.
"Thank you, Miss Angie," replied Amy in broken English.
"Okay, let's get a stretcher and get Jim into the seclusion room. I've got to go back to the office and write up the report for this incident." Angie got up and hurried back to the office, carrying the capped syringe with her to deposit in the Sharps Container.
Chapter 5
It was after two a.m. when Angela finally stood in front of the first of two locked metal exit doors. This one bore the scars of countless chair and table strikes. The institutional grey paint was scratched and the graffiti had not been washed off for a week. She fumbled with her keys, finally got the key in the lock, and urged the heavy tumbler to turn. "Damn," she cursed glancing at her watch and noting the time. She wished she had called the childcare center in the main hospital to tell them how late she would be picking up Jessica. Oh my God, I’m three hours late, she thought. They're going to kill me over there. She felt her pulse race with anxiety as she considered how upset her 16 month-old daughter was going to be when she woke her up to take her home.
I've got to get a new job, she thought. This psych unit is killing me. She closed the door and heard the reassuring click as it locked. She walked down the short hallway to the second locked door. This one only bore a couple scars, but they were deep. She didn't remember who it was or when, but one of the patients had followed a staff member through the first door with a broken off chair leg in hand. Most of the blows had landed on the unlucky staff member. A few had landed on the door. The door had survived – the staff member had not.
I never get off on time, she thought. She glanced behind her just once to make sure nobody was in there with her then she unlocked the second door. Once through that door, there was a long hallway, then an exit door with a push bar. The second door closed behind her and she made sure it was locked before she walked down the long hallway. Boy, it’s dark out there, she thought, peering through the glass windows of the hallway. Sensing freedom, she pushed on the bar to open the door to the outside. The elation was short-lived.
The heat smacked Angie in the face as she walked into the August night. The air was close and heavy. A crimson-tinged bolt of lightning highlighted the sky for an instant then things went dark again. Thunderstorms, she thought. “I've got to get home soon. Jessica is scared of thunderstorms and lightning and she will freak out if it happens in the car.” She walked quickly through the darkened path towards the parking lot. She looked around and told herself she was alone. It's pretty spooky out here, she thought. For a moment, she considered calling security and then she remembered that it would take at least thirty minutes for the guard to get over to the Pavilion. Besides, if he were busy, it could be twice that time.
With the cutbacks heralding the new health care act, there was only one security guard on the night shift now. There used to be three or more guards, even on weekends and now there was only one roaming guard and one – Jason – in the forensic psych unit where Angie worked. After all, it is New Orleans and even post Katrina, the crime rates were startling.
Angie continued to reflect on the Pavilion as she walked to her car. Now psychiatry was a money-loser, a liability to the bottom line – and CCMC, a world-class hospital, wasn't about to spend large sums of money to safeguard patients or staff. Managed care payment systems made it almost impossible for you to be crazy, have a breakdown, or recover from prescription or street drug abuse or alcohol. Reimbursement had all but disappeared and with health reform on the horizon, it would only get worse. The mental health system in the U.S. was sadly and severe
ly broken, irretrievably so, perhaps. In fact, with everyone getting care under the new reformed system, it was predicted that mental health care would increase steadily with shorter-term admissions.
Angie shook her head when she considered just how awful the mental health system was in the U.S. Depressed, deranged, and addicted psychiatric patients could no longer come in for a few weeks of therapy, get their meds regulated, have a few art classes, and play some board games to learn to control their anger. Why, just last week they had discharged a newly diagnosed Bipolar II female patient who had attempted suicide and been in a coma for 10 days with an aspiration pneumonia. She only stayed on the psych unit for two days, because the patient promised, "I'll never do it again. I don't know what came over me." Of course, her insurance didn't want to pay either but the hospital would have been ethically bound to keep her if she had asked to stay. In Angie's mind, that bordered on gross negligence. Suppose that woman went home and 'offed' herself with her small children in the home? Worse still, suppose in her psychosis, she killed herself and her family? It had happened before. What safeguards had been put in place? Oh, I forgot, Angie admonished herself. She had two days of counseling and three days of Lithium. At least that’s what the attending shrink had told Angie when she questioned the discharge. That should do it. Yeah, sure, Angie thought. She was disgusted with the entire U.S. mental health system. How in the world could anyone get better in only several days? These poor, mentally sick, often physically ill patients were discharged back on the streets of NOLA or even to their homes with no regulated medicines or skills to fight back against the demons that endlessly plagued their minds.
Her walk in the black night seemed endless. Even this late, the southern air was stifling and viscous. She was sweating, but she felt cold on the inside. Angie continued to think about the dangerous patient population at the Pavilion. Many of CCMC’s psychiatric admissions were initiated at the hands of the New Orleans Police and the local magistrate who had them committed after they had been picked up for a crime or some sort of outburst. Angie quivered again when she thought of some of the deeply psychotic patients trying to live on their own. They also had to medicate several of the most violent patients prior to bedtime. Angie had doled out six Thorazine Slurpees like they were health food drinks but even then the brutality was awful. She thought about it and then deliberately pushed it from her mind.
