Terminally Ill

by Melissa Yi

I tried not to stare at the petechiae that I could see even from the foot of the bed. “No, I’m afraid not. We could ask, but as I said, bruising in the eyes is fairly common. So you would have to file a request for an autopsy, and you might have to pay for it.”

  She clicked her teeth together. “How much will it cost?”

  “I don’t know.”

  “More than a few thousand dollars?”

  I shook my head. “I’ve never asked for an autopsy before, but I’m guessing they’d charge less than that.” I think routine surgeries on most live people don’t cost more than a few thousand dollars, but maybe I just have a skewed Canadian view of how cheap things should be.

  “A few thousand dollars, I have,” she said. “If I have to go private, I will.”

  “I’ll look into it.” As part of my orientation in July, the pathologist came to speak to our group. He emphasized that we need to do more autopsies, that just because we have CT scans and, in other hospitals, MRI’s, we can’t image everything. You still need a qualified pathologist to look at the patient and determine cause of death. An MRI won’t tell you if a hair belongs to someone else. “But we also need to talk to the police, because they’re the ones who will collect evidence.”

  “Who are you going to call first?”

  “I don’t know.” I stopped to think about it. It seemed to be a chicken and egg problem. The police would have to collect evidence before more people came in the room. Already, Mrs. Bérubé, Dr. Huot, Karen and I had trampled throughout, and the coroner or funeral home people would only make it worse. On the other hand, I worked for St. Joe’s, and if I pissed off the pathologist by bringing the police in first, I’d pay for it. “I’ll call both of them, one right after the other, and see what they say, and who’s the fastest to respond. But we won’t want him moved, or having too many visitors, before they come.”

  She raised her chin. “I know. They’ll just have to see him at the funeral home, when he’s all cleaned up.”

  She was one tough cookie. I remembered Mrs. Lee, from my last case, who was visiting her sister in Toronto this week but otherwise would’ve been chock-full of advice for me. I’ve got advice, too. Don’t mess with 21st century old ladies. They will fuck you up.

  I tapped my piece of paper. “Okay. After the police and coroner, I’ll try and figure out when the lunch trays were delivered. I can ask the staff, and the other patients, even if the kitchen doesn’t remember. I’ll also talk to Karen, his nurse who helped him into bed. We’ll narrow down exactly when he passed away, and who might have been around while you were gone.”

  Mrs. Bérubé brightened. “I know they have security cameras at the main entrance.”

  “Yes, and security guards at the front entrance, and two more guards beside the emergency room.” It would take a lot for them to remember every single person who passed through, and now that the weather had turned cold, people had started wearing hats and scarves and long-sleeved coats. But that was true, video could help us ID someone. They wouldn’t turn the video over to me, though. The police would have to be sufficiently interested. “But is there any other reason, besides his eyes, that you suspect foul play, Mrs. Bérubé?”

  She set her lips and shook her head. “I have a feeling about this.” Before I could say anything, she held up her hand. “I know you want evidence, and you’re a doctor and a woman of science, Hope. But I know my husband. This wasn’t his time.”

  Inside, I squirmed. I tried to keep my voice calm. “Mrs. Bérubé, I don’t think the police would understand. They’re looking for means, motive, and opportunity.”

  She looked at me with a trace of humour curling her lips. “I don’t think you understand either, Hope. Nevertheless, I understand your point. I will try to stick to means, motive, and opportunity with the police.”

  I breathed a sigh of relief to myself. Otherwise, the police would probably just write her off as a crazy lady and we’d never get any evidence collected. “So, speaking of that, I know this sounds strange, but did your husband have any enemies?”

  “Several, but one good thing about getting older is that your enemies might pass away before you do, which is what happened in George’s case.” Her eyes gleamed with suppressed laughter before her amusement winked away again.

  I spoke quickly, before she could start to cry. “Uh, were there grudges that they might have passed on to their kids, who could have come after your husband?” I sounded silly to my own ears.

  She laughed. “No, I don’t think so. One was a man who accused George of cheating at poker. They didn’t speak for almost twenty years. He died just three months ago. George still couldn’t stand the man. He used to check the obituaries just to see if he’d croaked, and the day he did, George poured himself a whisky. George also hated the Japanese, because of the war, you know—” She cast me an apologetic glance, but I shrugged. It’s unfair that a lot of Canadians hate “Japs” and placed Canadians of Japanese ancestry in internment camps while hugging their German neighbours, when we all know who started World War II. On the other hand, the same people don’t realize that Chinese populace suffered even more at the hands of the Japanese (rape of Nanking, anyone?). I had a friend whose grandmother still won’t buy anything made in Japan.

  Still, it seemed extremely unlikely that someone had held a grudge for over sixty years and murdered Mr. Bérubé in his sleep. Like I said, we should be looking for horses, not zebras. “I suppose you could give any enemies’ names to the police, but we’d probably be better off thinking of who had the opportunity to enter his room at all. The police could go through the hospital cameras, but it’s labour-intensive to have an officer go through every hour.”

  She shook her head. “If they just checked the videos from 8 a.m. to 2 p.m.—”

  “Even so. They’d probably start at 6 a.m., since a lot of shifts start at 6:00 or 7:00. I don’t know if they could spare the personnel to do it, especially on our say-so. I think they’d wait for any evidence from the autopsy before they started combing through evidence like that. But let me call them and find out.’

  She gestured that I should use the hospital phone on the bedside table.

  I shook my head. “I’d better use the nursing station phone, just in case the police decide to look for fingerprints. I’ve never touched your phone before, and I probably shouldn’t now.”

  She cocked her finger at me. “Good idea, Dr. Sze. Good thinking.”

  I felt bad, like I was giving an old lady false hope, but I sat down at the nursing station and called locating, a.k.a. our hospital operator. “Hello, this is Dr. Sze.” I’ve learned to use my title, for what it’s worth. “I’d like to speak to the pathologist on call about an autopsy.”

  “The pathologist?”

  “Yes. The pathology department.”

  “One moment, please.”

  I drummed my fingers and listened to a loop of unfamiliar piano music that tinkled pleasantly enough, but only lasted five seconds before restarting at the beginning, so after twenty seconds, I’d already begun holding the receiver at a safe distance from my ear. Then the phone started ringing, only to end up at a recording of a woman reciting in French and then in English, “You have reached the pathology department of St. Joseph’s hospital. Our phones are answered between 8 a.m. and 4 p.m., except between 12 p.m. and 1 p.m. We are not able to take your call right now. Please leave a message and we will answer you as soon as possible.”

  I left a message, but I called locating again. “Is there a pathologist on call? Not the pathology department, but the pathologist himself or herself?”

  “I gave you the pathology extension.”

  “I don’t want the extension, I want the pathologist on call. The doctor who does the autopsies.”

  She sighed. “One moment, please.”

  This time, I listened to the piano for a solid two minutes while I brought up Inspecteur J. Rivera’s number on my phone. It’s one of the few I bothered to program into my cheap-o pay-as-you-go phone
, and the one number I call regularly even though I know he’ll hate to hear from me.

  Just as I’d given up, a man’s voice came roughly down the line. “Yeah.”

  “Hi. My name is Dr. Hope Sze. Is this the pathologist on call?”

  “Yeah.” He didn’t bother giving his name.

  “Great. One of my patient’s family members is requesting an autopsy.”

  “Good. Fill out the form. They’ll send the body down.”

  “Just a second. It’s kind of a special case. The widow thinks the patient was suffocated because the patient has a lot of petechiae in his sclera. That’s why she wants an autopsy, and to have the police involved. I’m not sure what the procedure is, if they have to come and inspect the scene before they send the body down to you, but I wanted to give you a head’s up about what the family member’s expectations are.”

  He sighed, a long sigh that gusted into my ear. “Hang on. You think this is a criminal case?”

  “The patient’s widow is very concerned.”

  “What did you say your name was again?”

  “Dr. Hope Sze. I’m a first year resident—”

  “I know who you are.” He paused, but he didn’t bother adding the detective doctor line. “You have to call the coroner. They’ve got their own forensic pathologist. You’ll have to talk to them.”

  “Oh.” That made total sense. “Well, thank you.”

  “Yeah.” He hung up.

  Holy cow. They say pathologists aren’t necessarily good at chat, since they work with dead people all the time, but one of my small groups/problem-based learning teachers was a pathologist who was extremely sweet. This guy fit the oddball stereotype, though. I still didn’t know his name.

  One of the nurses was watching me, and even the singing cleaner had stopped to listen. When the cleaner noticed me noticing her, she lowered her head and pushed her cart away, but the nurse moved closer. Her name tag said Toni, and I’d seen her around a few times. She liked to wear bright yellow scrubs, she talked about running and weight-training all the time—I hope I’m that energetic when I’m forty-something. Anyway, Toni said, “What’s that all about?”

  “Oh…” Maybe I should have made my calls from the family room, but what if a family member walked in? That would be even worse. “I’m trying to get an autopsy on Mr. Bérubé. His wife wants one.”

  “You think he was murdered?”

  “She wants me to look into it, and Dr. Huot said I should. So. I’ll just call the coroner now, but maybe I could ask you and Karen some questions afterward?”

  “Suuuuuure.” She grinned at me, and I realized that she was probably bored on palliative care. I smiled back and called locating again. “I’ll page the coroner for you,” she said, and hung up.

  Finger-twiddling time. I turned to Toni. “Were you working before noon?”

  She nodded. “I’m doing the 12 to 8 shift.”

  “What time were the lunch trays delivered?”

  “I’m not sure. I was doing my meds, so I was up and down the hall the whole time. Definitely before 1 p.m., but you want an exact time, right?”

  I nodded.

  She raised her voice at the unit clerk. “Ricky. Hey, Ricky.”

  Ricky glanced up from her desk. She was in the middle of taking a chart apart.

  Toni said, “What time did they deliver the lunch trays?”

  “They came over from the oncology ward at 12:30.”

  “When do you think they did Mr. Bérubé’s room?”

  Ricky shrugged. “I didn’t keep track, but they brought the tray rack to the elevators before I went for my break at 12:50.”

  That was a twenty minute window. Mr. Bérubé should have been alive at 12:50, then, because surely the orderly would have noticed if the patient was deceased when he or she dropped off a tray.

  On the other hand, if you had to deliver six lunch trays and get to another floor, maybe you wouldn’t pay too close attention to whether the patient was asleep or deceased. It would depend on the orderly. “Do you know who delivered the trays?”

  Ricky nodded. “Bobby was sick, so they had that other guy in. Lloyd.”

  Toni snapped her fingers. “Oh, yeah. The big guy.”

  “That’s the one.”

  I hadn’t noticed a Lloyd, big or otherwise. The names and faces just kind of swam by me. I realized once again that while I was focused on medicine, making a good impression on the staff, with the occasional foray into Tucker or Ryan-land, but there was a whole other world going on at St. Joe’s. “I should ask Lloyd himself. Do you know how to get ahold of him?”

  Ricky stared at me over the rims of her glasses like I was a bug she hadn’t decided whether or not she wanted to squish. “You could try through locating.”

  Yes. Because that worked so well. Even the coroner didn’t bother to call back. I wondered if I should call the police directly, but they already thought I was full of it. I could put Mrs. Bérubé on the line, but I was trying to spare her any grief or humiliation in the wake of her grieving.

  Just as I thought my dastardly thoughts, the phone rang, so I picked it up. “Hello, this is Dr. Sze.”

  “This is Dr. Lapierre, calling for Dr….Zee?”

  “That’s me, Dr. Hope Sze. I’m calling because one of my patients passed away. His widow is requesting an autopsy because she considers it a suspicious death.”

  “Could you explain the circumstances?”

  I did, as best I could. “I realize that petechiae don’t prove death by suffocation, by any means, but I know that Mrs. Bérubé is very concerned.”

  He sighed. “Dr. Sze, we are simply unable to perform all autopsies because the patient’s family demand it.”

  “Yes, I know that.” I hesitated. “She is very determined. She is willing to pay for it herself, provided the costs are not exorbitant.”

  He sniffed. “It is not simply a matter of cost, but a matter of resources. A man who is receiving palliative care, for lung cancer, whose his wife can’t accept it and requests a criminal autopsy...unless you have concrete evidence, of course...”

  My turn to sigh. “Dr. Lapierre, I know this is highly unusual. When I was doing my emergency rotation, one of the doctors tried to get a post-mortem on a 80-year-old who arrived in asystole and had no known history of heart disease. It was refused. But I also know that Mrs. Bérubé will not be satisfied if you tell her no. I hate to say this, but if we refuse, she will try to get one privately, and if they find anything, she might bring legal action against the hospital or the coroner’s office for refusing to do an autopsy in the first place.”

  “Lawsuits are quite unusual in Quebec,” he said, after a pause.

  “Yes, but not unheard of.” I knew that Quebecers were less likely to sue. My CMPA (medical malpractice) premiums were lower in Quebec, which was the only bonus I could think of, since the province paid residents less, taxed us more, and forced us to pay tuition for the privilege. “Wasn’t there a case of a man suing because the pathology department retained part of his son’s brain for research purposes, even though they had promised to return his body intact for the funeral?”

  Dr. Lapierre said, “I don’t like this turn of conversation.”

  My heart beat hard. “Neither do I, Dr. Lapierre. It’s very unfortunate. I could have the patient talk to your herself, if you like.”

  “That won’t be necessary. I will review the case myself and make a decision.”

  “Thank you, Dr. Lapierre.” I know when to kiss ass and leave well enough alone. Sometimes.

  I waved my thanks to Toni and Ricky and went to give Mrs. Bérubé the possibly good news.

  Chapter 23

  Since Dr. Huot had given me a free pass to do some research, and Mrs. Bérubé was busy grieving and organizing family members, I headed to the library and dug up an article called “Asphyxial Deaths and Petechia: a Review” from the Journal of Forensic Science. It was from the year 2000, but luckily, things didn’t change much in the lovel
y world of people killing each other. In scanning the introduction, I discovered that these petechiae had first been described by Tardieu et al in 1855. Wow. Plus ça change.

  My pager’s beeps cut through the library’s silence. The number wasn’t the palliative care ward—it looked like some other hospital extension. Was the coroner trying to contact me again? I dialed it right away.

  “Whatcha doin’ there, Willis?” asked Tucker.

  I sighed. Trust Tucker to come up with a pop culture reference older than my article. But I was glad to hear from him, at long last. “I’m doing research.”

  “You are? On what, pray tell?”

  I whispered, “One of my palliative patients died, and his widow wants me to find who killed him.”

  He said, at normal volume, “This sounds like a massive joke.”

  “No one’s laughing.” I did my best to explain the case without using any names, and at low volume. The library seemed pretty deserted, but you never knew who could be tucked away in a study carrel, and since this phone was attached to the wall near the entrance, I couldn’t exactly insert myself behind a bookshelf for some privacy.

  “Are you serious?” Tucker burst out.

  That stung. “Of course I’m serious. And I’m going to help Elvis, too. Now that Dr. Huot has given me a bit of time to work—”

  “Why is she doing this?”

  “I don’t know. I think she’s a bit of a fan.” I laughed, which echoed oddly in the nearly-empty library.

  “That doesn’t make any sense. You could lose your palliative care rotation if you don’t learn enough.”

  “She’s already taught me about morphine equivalents and more about laxatives. The rest is mostly interpersonal stuff, right? And that’s what I’m doing.”

  “I’m serious, Hope. And I agree with the coroner. The whole thing about petechiae is very wishy-washy. Correlation does not prove causation.”

  “I know that!” I sputtered. It was one of my pet phrases, too. Just because two things were associated didn’t mean that one caused the other, i.e. just because I stepped on an spider didn’t mean it would rain, just like rain didn’t make me step on an spider; spider-killing and rain could just happen around the same time without any link between them.