by Robin Cook
Roger pressed the elevator’s down button and hazarded a glance back toward the surgical nurses’ station. It was only for a split second, but he thought he caught a glimpse of Jazz eyeing him from around the edge of the door to the utility room. Roger wasn’t so sure, and as tired as he suddenly felt, it could have been his imagination. The woman made him uneasy. He hated the thought of being a patient under her care.
The elevator came, and he boarded. Just before the doors closed, he looked back at the utility-room doorway. For the second time, he didn’t know if it was his eyes or his brain that was tricking him, because he thought he saw her again.
He took the elevator down to the basement level, where he’d never been. In contrast with the rest of the hospital it was completely utilitarian. The walls were unadorned stained concrete, and myriad exposed pipes—some insulated, some not—ran along the ceiling. The lighting fixtures were simple porcelain sockets with wire cages. Just beyond the elevators, an old sign composed of peeling paint applied directly onto the concrete wall said “autopsy amphitheater,” accompanied by a large red arrow.
The route was labyrinthine, but by following the red arrows, Roger eventually arrived at a set of double leather doors with oval windows set at eye-level height. The glass was covered with a greasy film. Although Roger could tell a light was shining in the room beyond, he couldn’t make out any details. He pushed through, then propped the door open with an old brass doorstop.
Inside was an old-fashioned, semicircular two-story medical amphitheater, with rows of tiny seats that rose up on tiers into the shadows. Roger guessed it had been built a hundred years ago, when anatomy and pathology were kingpins in the academic medical curriculum. There was a lot of old, scraped, and pitted dark varnished wood, and the lighting came from a single, large, hooded lamp that hung on a long cord from the ceiling. The light was centered on an antiquated metal autopsy table that occupied the center of the pit. Against the back wall was a glass-fronted cabinet with a collection of stainless-steel autopsy tools. Roger wondered when they’d last been used. Outside the medical examiners’ office, few autopsies were now done, particularly in managed-care hospitals like the Manhattan General.
Standing within the pit, along with the autopsy table, there were several shrouded hospital gurneys, obviously supporting corpses. Roger started forward, not knowing which was Patricia Pruit. As he approached the first body, he questioned, as he’d done in the past, why Laurie had chosen forensic pathology as her career. It seemed so contrary to her vibrant personality. With a shrug, he grabbed the edge of the sheet and lifted.
Roger grimaced. He was looking at the remains of an individual who had been involved in some kind of accident. The man’s head was horribly distorted and crushed such that one eye was completely exposed. Roger replaced the sheet. His legs felt weak. As a medical student, he’d not liked pathology, particularly forensic pathology, and this victim reminded him of that fact in an uncomfortably brutal fashion.
Roger took a few breaths before stepping over to the second gurney. He reached for the edge of the sheet, but his hand didn’t make it. Instead, he was propelled forward off his feet, having been hit smack in the middle of his back with what felt like a two-by-four. He knew he was falling, and his arms reflexively flew out to cushion himself, but before he hit the tiled floor, the board hit him again, taking his breath away.
Roger collided with the floor and skidded forward on the glazed tile. His head thumped up against the wall that separated the pit from the tiers of seats. He tried to move, but blackness descended over him like a heavy, suffocating blanket.
seventeen
WHEN LAURIE’S ALARM SHATTERED the silence early Saturday morning, she felt about the same way she had Friday morning. Once again, she hadn’t slept well, and what sleep she did get was marred by anxious dreams.
The first thing she did after getting out of bed was repeat the pregnancy test with a new kit. As a doctor, she was well aware of the necessity to repeat tests to rule out false readings. When she returned to check the results, she was aware of a definite ambivalence. But again, it was clearly positive. There could be little doubt that she was pregnant.
Adding credence to the test results was the morning nausea, which seemed a little worse than it had been the previous days, but after eating some dry raisin bran, she felt better. The accompanying right lower quadrant discomfort was another thing. Luckily, it wasn’t anything like she’d experienced the prior evening on her way home from her rendezvous with Jack. Then it had been frank pain, strong enough to make her writhe. It had come on suddenly in the taxicab like severe intestinal cramps. For a few seconds, she thought she’d have to put in a call to Laura Riley, but then, as suddenly as it appeared, it vanished. As intense as it was, Laurie was convinced it was related to her digestive system. Its quality was much sharper than a menstrual cramp, which made her think it couldn’t have anything to do with her being pregnant. The only confusion was that in the mornings, it appeared along with the nausea, suggesting it was related.
Laurie put her empty cereal bowl down on the countertop. Concerned about the lingering discomfort, she gingerly pressed in on her abdomen in the general area of the pain with her index finger, trying to determine if there was any pinpoint pain. There wasn’t, and curiously enough, the palpation alone seemed to be beneficial. When Laurie took her hand away, the discomfort had vanished, suggesting to her once again that the problem was intestinal, perhaps gas.
Relieved that the sensation had vanished, Laurie quickly dressed. She was on call for the weekend, which meant that of all the medical examiners at the OCME, it was her turn to go in and see what kind of cases had arrived during the night. She knew that she would probably be doing a few autopsies, unless they all could be put off until Monday, which in her experience had never happened. There was a person on second call in case of a flood of urgent cases, but in Laurie’s experience that never happened, either.
The weather was typical for New York in March—drizzling and cold. Laurie huddled under her umbrella as she trudged north on First Avenue. She had briefly searched for a taxi, but whenever the weather turned sour, they were hard to find.
As she walked, Laurie thought more about her conversation with Jack. In hindsight, she realized how her emotions had understandably been careening from one extreme to another. Although she now felt self-conscious about her reaction to Jack asking who the father was, since it was, in the final analysis, a reasonable question, she gave herself credit in general for having admirably maintained her composure. Considering the stakes involved, it might have been one of the most important conversations in her life. All she could do now was pray Jack would respond as she hoped. Given Jack’s track record, she imagined the chances were only about fifty-fifty.
On the street outside the OCME were several TV media trucks, suggesting that something newsworthy had happened overnight, and Laurie’s guard went up. Dealing with the media was not her favorite part of being a medical examiner. She’d had some unfortunate experiences with journalists in the past, to the extent of putting her job in jeopardy.
For a moment, Laurie hesitated and debated if she should head around to the 30th Street morgue entrance. She glanced back at the TV trucks. There were only three, and their antennae were not extended, suggesting that they were not anticipating breaking news. Guessing that whatever had drawn them to the OCME was not front-page news, Laurie climbed the steps and entered. A dozen or so journalists and three cameramen were making themselves at home in the lobby.
Waving a greeting to Marlene, who came in for a few hours every Saturday morning, Laurie tried to walk across the lobby to be buzzed in. Almost immediately, a journalist who recognized her blocked her way by thrusting a microphone in her face. Several bright lights switched on, bathing the lobby in stark illumination as cameramen hoisted their equipment to their shoulders.
“Doctor, do you care to comment on the accident?” the journalist questioned. Others crowded around, extending their
own microphones. “In your opinion, was it a double suicide, or were the two boys pushed?”
Laurie shoved the microphone out of the way. “I have no idea what you are talking about, and any information coming from this office has to be cleared by the chief, the deputy chief, or the public relations office. You people know that.”
Laurie pushed her way toward the ID room while ignoring a welter of further questions. To her relief, Robert was visible through the central glass pane. With his help, she got inside and closed the door behind her with the journalists stranded out in the lobby.
“Thanks, Robert,” Laurie said, peeling off her coat.
“They’re like a bunch of wolves,” Robert responded.
“What’s this is all about?” Laurie asked.
“A couple of thirteen-year-old boys were run over by a subway train.”
Laurie winced. Such a scenario was going to be emotionally taxing for her, and she was surprised she’d not been called during the night. Luckily, the current batch of tour doctors was particularly competent, and they had significant experience under their belts to handle all but the most critical cases. The tour doctors were mostly senior pathology residents earning a bit of money by moonlighting.
“Have the IDs been done?”
“Yup! That was all taken care of during the night.”
Laurie was glad that was out of the way. For her, the ID process was especially trying with children, as it invariably meant dealing with the bereaved parents.
Laurie continued into the ID office, delighted to see Marvin’s weekend call coincided with hers. He’d already made the coffee and had laid out the folders of the cases that had come in, with one of them in front of him.
Laurie and Marvin exchanged greetings as she helped herself to a mug of coffee. “Looks like we’re going to be busy,” she said, eyeing the folders.
“I’m afraid so,” Marvin agreed. He tapped the folder in front of him with his knuckle. “We got another of these confusing postoperative cases from the General.”
“No kidding!”
“There’s a note from Janice on the front.”
Laurie read the note quickly. It outlined the details on Patricia Pruit, answering all the usual pertinent questions. Laurie sucked in a deep breath. Providing she found no significant cardiac pathology, her series was now up to fourteen, with eight at the Manhattan General alone. It couldn’t go on.
“Let’s do Pruit first,” Laurie said.
“Before the two boys?” Marvin questioned. “Did you see all the newspeople waiting out in the lobby?”
“I did, and they can wait some more,” Laurie said. She wanted to confirm as soon as possible that Pruit was part of her series and let Roger know. Something had to be done. They couldn’t stand on the sidelines any longer.
“Okay, I’ll go down and get set up.”
“Anything else of note?”
“Most seem routine to me. I think you’ll want to pass on the majority of them. My guess is that we are looking at doing four cases, but you may have other ideas.”
While Marvin went down to the autopsy room, Laurie went through all the folders. As she had anticipated, Marvin was right. They’d do the four cases and call it a day, unless anything of note came in while they were working. With that decided, Laurie went up to her office to stash her coat. She was glad she had, because sitting on her desk was a stack of hospital charts. To her amazement, the PAs had somehow managed the impressive feat of getting Lewis and Sobczyk’s charts from the Manhattan General and the six charts from St. Francis, all in record time.
The chart on the top of the pile was Rowena Sobczyk’s. Laurie flipped it open and shuffled through some of the pages, glancing at the OR notes and the anesthesia record. As with McGillin and Morgan, there was nothing out of the ordinary. She was about to put the chart down when a short strip of abnormal EKG flopped out. It was about two feet long, having been folded, accordion-style, into the chart with just the first six inches glued to the page.
Laurie opened the chart to the location. It was a note written by the resident in charge of the resuscitation attempt. Laurie quickly read it and found it unenlightening. She then extended the EKG tracing and studied it. The complexes were stretched out, suggesting that they represented ineffectual heartbeats, if they had been heartbeats at all. They could have been merely poorly coordinated cardiac electrical activity that didn’t cause any muscular contraction. As the sequence continued, the complexes became progressively more distorted, then rapidly flattened out to a straight line. On the border, scribbled in pencil, was the message: “Short EKG segment from the outset of the resuscitation attempt, after which no further electrical activity was obtained.”
She’d never had a strong background in reading EKGs, and this short segment didn’t suggest anything to her. Yet she couldn’t help but think it might be significant, since there had been no similar tracings on either McGillin or Morgan, who’d had no electrical activity on EKG whatsoever, and she thought she might show it to someone more knowledgeable than she. She marked the spot in the chart with her ruler, and even scribbled on a Post-it note to remind herself to show the tracing to a cardiologist.
Her phone rang, and the sound made her jump. She eyed it, hoping and wondering if it could be Jack. She put her hand on it and allowed it to ring again, feeling the vibration through her skin in a vain attempt to influence the identity of the caller. Her efforts notwithstanding, it was Marvin, and the message was simple: All was ready downstairs in the autopsy room.
Laurie returned Sobczyk’s chart to the top of the pile, with the ruler sticking out of the side. She was looking forward to going over them later that afternoon, particularly those from Queens, to make sure the cases mirrored those from the General. She then looked back at the phone, and for a brief moment contemplated calling Jack. In the process, she noticed the small light on the side of the phone indicating she had voicemail. Confused by who would have left her a voicemail during the night, she picked up the receiver again and checked her messages.
Laurie was surprised first by the time of the message and then by the sound of Roger’s voice. She was impressed that he had taken her suggestion so seriously that he’d been working nonstop until two o’clock in the morning. She was even more impressed that he had managed to come up with what he considered a list of suspects, including an anesthesiologist by the name of Najah who’d recently transferred from St. Francis to the Manhattan General. As she continued to listen to the message, she felt a definite sense of satisfaction and an eagerness to hear the details, although when was another matter. As she headed back toward the elevators to the basement, she wondered if and when Jack might call. You never knew with Jack.
As Laurie had anticipated, the post on Patricia Pruit was strikingly similar to the others in the series, with absolutely no pathology to account for her sudden demise. True to form, the operative site was without any excessive bleeding, without signs of infection, and there were no clots in the major vessels of the legs, abdomen, or chest. The heart, lungs, and brain were all entirely normal.
At the end of the procedure, Laurie helped Marvin move the corpse back onto a gurney.
“Which one of the kids do you want to do first?” Marvin asked as he unlocked the gurney’s wheels.
“It doesn’t matter,” Laurie said. She had opened the two folders on a neighboring autopsy table and was searching for the forensic investigator’s reports. Then, getting a second thoughts, she said, “In fact, why not put them both up at the same time.”
“Fine with me,” Marvin said agreeably. He pushed the gurney with Pruit’s corpse out through the main door.
A few years ago, Laurie would have taken the folders up to the lunchroom between cases, but now that she had on her moon suit, it was too much trouble, so she read the investigative reports standing up, with her ventilation fan as a backdrop. She could immediately see why some journalists would be interested. The tragic episode had the kind of lurid appeal that the tabloi
ds loved. The accident had happened at three o’clock in the morning at the 59th Street station. The uptown train had thundered in and run over the two kids.
Conflicting stories were the problem. The engineer claimed that the kids had waited until the last minute to jump, so there was nothing he could do. Such a scenario suggested a double suicide, but the engineer failed a Breathalyzer test, casting severe doubt on his reliability. The other story came from the conductor, who claimed he was between car one and car two, looking out at the station, as the train came in. He said he didn’t see any kids on the platform, and he passed the Breathalyzer test. The third story was from the agent in the token booth, who claimed that a suspicious man had gone through the turnstile right after the kids but disappeared.
The door to the hall burst open and Marvin pushed in another gurney. “This is not pretty,” he said.
“I can imagine,” Laurie said. She continued reading the investigative reports. No suicide notes were found, either on the platform or on the victims. Conversations with both sets of parents did not confirm any episodes of depression. In the words of one of the parents, the kids were “wild and full of the devil but would never kill themselves.”
“I’m going to get the other one,” Marvin called out.
Laurie waved over her shoulder as she continued to read. Once again, she was impressed with Janice’s work. How Janice could pack as much as she did into a single night, Laurie had no idea.
When Laurie was finished with her reading, she took out the sheets for the autopsy notes from the two folders and turned around to face the first of the two corpses. As she did so, Marvin came back in with the second one.
