Marker

by Robin Cook

  “I hope I’m not interrupting anything,” a voice said.

  Laurie turned around. Jack was standing in the doorway. Instead of his usual mildly sardonic expression, his face reflected concern.

  “You look awfully busy,” he added.

  “It’s best I stay busy,” Laurie responded. She reached over for Riva’s chair and pulled it over next to her desk. “I’m glad to see you. Come on in and sit down.”

  Jack lowered himself into the seat and scanned Laurie’s desk. “What are you doing?”

  “I wanted to make certain the Queens cases were the equivalent of those at the General. They are, to a surprising degree. I also found something curious. Are you acquainted with a blood test called MASNP? I assume it is an acronym, but I’ve never heard of it.”

  “Me neither,” Jack said. “Where did you see it?”

  “It’s part of the standardized preoperative orders in all these cases,” Laurie said. She picked up a chart at random and showed the order form to Jack. “It’s in every chart. I guess it’s part of AmeriCare’s established routine, at least at these two hospitals.”

  “Interesting,” Jack commented. He shook his head. “Did you look in the back to see what kind of units the results are recorded in? That might be a clue.”

  “I tried that, but I couldn’t find any results.”

  “Not in any one of the charts?”

  “Nope. Not one!”

  “Well, I’m sure we can clear that up on Monday by asking one of the forensic investigators to look into it.”

  “Good suggestion,” Laurie said. She made herself another Post-it note. “There is something else curious about all these victims. Without exception, every one of them is a relatively new subscriber to AmeriCare, having joined the plan within the last year.”

  “Now that’s a cheery thought, considering that’s what we are.”

  Laurie gave a half laugh. “I hadn’t thought of that.”

  “The plan is growing so fast, I imagine a fair percentage of subscribers falls into that group.”

  “True, but it still seems odd to me.”

  “Anything else of note?” Jack asked.

  Laurie glanced around at the charts scattered across her desk. “There is one other thing.” She picked up Sobczyk’s chart with the short run of EKG recording folded out, and handed it to Jack. “Does this tracing ring any bells with you? It was taken by the resuscitation team the moment they got to the patient and just before the patient flatlined.”

  Jack glanced at the squiggles, too embarrassed to admit he’d never been much good at EKG interpretation in even the best of circumstances. He had decided early in medical school that he was going into ophthalmology, and he didn’t pay too much attention to skills that he wasn’t going to need.

  With a shake of his head, Jack handed the chart back to Laurie. “If I was forced to say something, I’d say that it looks to me as if the conduction system of the heart is failing, but that’s obvious with the way the complexes are spread out. But you shouldn’t be asking me. My advice would be to show it to a cardiologist.”

  “That’s my plan,” Laurie said, taking the chart back and putting it with the others.

  “What about Roger’s lists?” Jack asked. “Have you had time to go over them?”

  “Not yet. I had to do the police custody case first, so I’ve only been here for half an hour or so. I’ll spend some time with the lists when I finish the charts. It’s with the charts that I feel I can make the biggest contribution. There’s got to be some piece of the pie I’m not seeing.”

  “You don’t think it’s random?”

  “No. There’s something that links these patients together, beyond what we already know.”

  “I’m not so sure. I think the cases are opportunistic with the victims being at the wrong place at the wrong time.”

  “Did you guys have any luck with Najah?”

  “Yes and no,” Jack said. “They picked him up all right, but he’s not cooperating. He claims he’s being discriminated against and victimized by racial profiling. They’ve got him in custody, but he won’t talk. He’s insisting on waiting for his attorney, who’ll be up from Florida tomorrow for the arraignment.”

  “And the gun?”

  “It’s been sent to ballistics. But results won’t be available for a while. In the meantime, I’m sure he’ll be given bail.”

  “What’s Lou’s take on whether he’s the man?”

  “He’s optimistic, especially given his behavior. Lou says if someone is innocent, they’re happy to cooperate. Of course, Lou is only concentrating on who shot the nurse and Rousseau. He’s not thinking about your series.”

  “What about you?”

  “As I said, I like the idea he’s an anesthesiologist. Given his training, he could be knocking these patients off in a way that would be hard for us to figure out. As for him shooting the nurse and Rousseau, that’s equally circumstantial, since it’s based merely on knowing he owned a nine-millimeter handgun. The problem is that there are a lot of those weapons out there.”

  “You don’t think that whoever is killing the patients killed the nurse and Roger?”

  “I’m not sure.”

  “I am,” Laurie said. “It stands to reason. The nurse probably saw something suspicious. Her death occurred the morning after there were two additions to my series. As for Roger, he’d gone up in the hospital specifically to talk to people he thought were potential suspects. He could have confronted Najah. Maybe he even saw him in Pruit’s room.”

  “Very good points,” Jack conceded.

  “I’m glad they arrested Najah,” Laurie said. “If he’s the one, he’ll think twice about any more shenanigans while Lou is breathing down his neck, which means I’m going to sleep a little better tonight. In the meantime, I’m going to go over Roger’s lists very carefully, in case he doesn’t pan out.”

  Jack nodded several times that he agreed with Laurie’s plan. There was a brief pause until Jack said, “I know it’s a bit off-topic, but can we pick up where we left off last night?”

  Laurie eyed Jack warily. As they had been talking, she’d noticed that his typical sardonic expression had gradually reappeared, which she couldn’t help but feel was a bad sign now that he was suggesting turning the conversation to personal issues. Deep down, a combination of frustration and irritation begin to brew. With everything else going on, from guilt about Roger’s death to the pressure in her lower abdomen, she was uninterested in weathering any more disappointment.

  “What’s the matter?” Jack asked, in response to Laurie’s silence. Misinterpreting her hesitancy, he raised his eyebrows questioningly and superciliously added, “Is this still not the time or the place?”

  “You got that right!” Laurie blurted, struggling for control in the face of Jack’s tone. “The city morgue is hardly the place to discuss starting a family. And furthermore, to be honest with you, I suddenly realize I’m finished discussing it. The facts are pretty damn plain. I’ve made it clear how I feel, up to and including the new development of my pregnancy. What I don’t know is how you feel, and I’ve got to know whether you’re interested and capable of abandoning your self-absorbed grieving role. If that is what you want to tell me, then fine! Tell me! I’m sick and tired of discussing it, and I’m sick and tired of waiting for you to make up your mind.”

  “I can see this is definitely not the time or the place,” Jack said with equal irritation. He stood up. “I think I’ll wait until a more opportune circumstance.”

  “You do that,” Laurie snapped.

  “We’ll be in touch,” Jack said before walking out the door.

  Laurie turned to her desk, cradled her head in her hands, and sighed. For a brief second she considered running after Jack, but even if she did, she wouldn’t know what to say when she caught him. It was obvious he wasn’t about to tell her what she wanted to hear. At the same time, Laurie questioned if she was being too pushy and demanding, especially since she’
d not told him about her latest symptoms and the fear that she had yet to voice even to herself: the fear of a miscarriage, which would change everything all over again.

  It was a little after four in the afternoon when David Rosenkrantz turned his car into the parking lot of the small commercial building where Robert Hawthorne had his office. In its previous life, the building had been a warehouse, but like much of the renovation in downtown St. Louis, it had been recycled. It now had an upscale restaurant on the first floor and boutique offices on the second. When Robert Hawthorne—or Mr. Bob, as he was known to his operatives—came to town, first to found a company called Adverse Outcomes and subsequently to set up Operation Winnow, he had found the space and thought it convenient, since it was close to the law offices of Davidson and Faber. David didn’t know what the relationship was with the law firm, and he knew he wasn’t supposed to ask. What he did know was that Robert was called over there on a fairly regular basis.

  It wasn’t often that David was in town, since it was his job to travel around to the various cities and check in on the field operatives and deal with them as necessary. This was not an easy job, considering the oddball characters they had functioning as independent contractors. At first David just put out fires, but now that he’d worked for Robert for more than five years, he’d been entrusted with recruitment as well. The recruitment was more fun and challenging. Robert would come up with the names from an old Army buddy who still worked in the Pentagon. They were mostly people who had worked in some sort of medical capacity in the military and who had been discharged less than honorably. David hadn’t been in the military himself but could appreciate how the experience could affect people who were trying to return to civilian life, especially those who had seen any sort of combat. With Iraq grinding on, they had plenty of potential recruits. Of course, they also looked for people fired from civilian hospitals. Most of those tips came from people who were already embedded.

  The door to the office was unmarked. David rapped on it with his knuckle in case Yvonne, the secretary, who was also Robert’s live-in girlfriend, was in the back office. It wasn’t a big operation. Robert, Yvonne, and David were the only employees, and for quite a few years, it had been just Robert and Yvonne.

  There was a loud click of the locking mechanism as big-busted Yvonne opened the door. With her syrupy, southern-accented voice, she coquettishly invited David to step inside. Her syntax was interspersed with a lot of “honeys” and “dears,” but David wasn’t fooled. Despite the bleach-blond hair and the floozy affectations like spike heels and a short skirt, he knew that she worked out regularly with Robert and was proficient in tae kwon do. David felt sorry for anyone who might mistakenly decide after a few drinks to take advantage of her flirtatious behavior.

  The office was simple. There were two desks, one in the front room and one in Robert’s inner office, two computers, a couple of small tables, a few chairs, a file cabinet, and two couches. It was all rented.

  “The ugly old boss is in the back room, honey,” Yvonne whispered. “Now don’t you go off and upset him, you hear?”

  David had no intention of upsetting Robert. He knew something was up when Robert called him in. David had arrived back in town the night before, after a number of days on the West Coast, and was supposed to be enjoying some downtime.

  “Sit down!” Robert said when David entered. Robert was at his desk with his legs crossed and his feet perched on the corner, hands behind his head. His Brioni jacket was tossed over the arm of the couch.

  “You want any coffee, dear?” Yvonne questioned. There was an Italian espresso machine on the table in the front room.

  David smiled and thanked Yvonne but declined. He looked at Robert, who had his lips pressed together in an expression of frustration. “I got some bad news a little while ago,” Robert said. “It seems that our little Hungarian number in the Big Apple just can’t control herself.”

  “Another shooting?” David asked.

  “I’m afraid so,” Robert said. “This time, it was one of the doctor administrators. The woman is a menace. She’s good, but she’s jeopardizing the whole operation.”

  “Are you sure she did it?”

  “A hundred percent sure? No! Ninety-nine percent sure? Absolutely. Shootings follow her around like flies on a hunk of smelly cheese. Obviously, this kind of thing can’t go on, so I’m afraid your little vacation has to be put on hold. Yvonne got you a reservation on a flight that gets in around ten-thirty.”

  “It’s short notice. What about a gun?”

  “Yvonne’s taken care of that as well. You’ll just have to make a detour on your way into the city.”

  “I don’t remember her address.”

  “Yvonne’s got that, too. Don’t worry, we’ve thought of everything.”

  David got to his feet.

  “You don’t mind, do you?” Robert asked.

  “No, I don’t mind. I knew it was going to happen sooner or later.”

  “Yeah, I guess I did, too.”

  Outside of Laurie’s rather dirty office window the gray day had faded into night as she’d pored over the charts yet another time, hoping to find some hidden piece of critical information. As had been the case on her previous readings, nothing jumped out at her. She had her Post-it notes to show the short strip of EKG to a cardiologist and to get the forensic investigators to clarify the nature of the MASNP test. Other than that, she didn’t know what else to do.

  She’d also carefully reviewed all of Roger’s suspect lists, ranking them in order of their potential relevance. She still thought Najah was the most intriguing and most likely suspect, but the other seven individuals from various hospital departments who worked the night shift and who had transferred from St. Francis to the General around the critical time were almost equally interesting, especially since the entire group had easy access to the patient floors. The next list featured eight physicians whose hospital privileges had been canceled during the immediately preceding six-month period. She’d like to find out if possible what each one had done to warrant the disciplinary action.

  Between studying Roger’s lists and going over the charts for the final time, Laurie had thought about calling Jack. Although she felt her reaction to him earlier was understandable under the circumstances, she regretted it. She’d been far too precipitous and bitter, and she should have at least given him a chance to speak his mind, even if she suspected he was not going to say what she wanted to hear. At the same time, what she had said to him was unfortunately all too true. She was tired of his indecisiveness, which was the reason she’d moved out of his apartment when she had. Ultimately, Laurie decided not to call. It would have been like throwing salt on a wound. Instead, she decided to wait until morning, and if he hadn’t called by then, she would call him.

  Laurie stacked the hospital charts into two neat piles. Next to them, she put the notepad with her own list of how all the cases resembled one another. She put the CD with the digital records on top of the pad. She looked at her watch. It was quarter to seven, which she thought would be a good time to head back to her apartment. She would make herself a light supper before bed. Whether she would be able to sleep was another issue entirely. She hadn’t wanted to go home earlier, for fear of becoming depressed. It had been better to stay busy all afternoon to keep from thinking about Roger’s death, Jack’s aggravating behavior, and her own looming problems.

  Pushing back from the desk, Laurie was about to get up when she looked back at the CD. Suddenly, the idea occurred to her to look and see if there was a difference between the digital record and the hard-copy hospital chart—specifically, in respect to the unknown blood test. Maybe she could find a result, and if so, maybe she could figure out what the test was.

  Pulling herself back to the desk, Laurie booted up her computer and inserted the CD, scrolling through the pages until she arbitrarily found herself at Stephen Lewis’s laboratory values. The print was very small, and Laurie used her finger to run down the
column on the left side of the page. Near the bottom, she found MASNP. Running her finger horizontally, she saw the result. It was “positive MEF2A.”

  Laurie absentmindedly scratched her scalp as she stared at the recorded result. There was no explanation. MEF2A didn’t make any more sense to her than MASNP. It was like looking up the definition of an unknown word and finding an unknown synonym. Laurie took another Post-it from the dispenser and wrote down the result, followed by a question mark. In order to put the new Post-it with the others, which she had stuck to the wall behind her desk, she scooted her chair back and half stood, leaning forward with her hand outstretched.

  A muffled cry of pain escaped from Laurie’s lips. Instead of pasting the Post-it to the wall, both her hands went down on the surface of her desk to support her weight. She’d gotten a sudden, strong cramp in her lower abdomen, and for a few seconds, she held her position as well as her breath. Thankfully, the pain began to lessen, and Laurie slowly let herself sink back into her chair. She held herself stiffly, lest she aggravate whatever was going on inside her body.

  A continuous low-grade discomfort had persisted in Laurie’s abdomen following the autopsy on the police custody case. It had waxed and waned to a degree, but it had never entirely gone away. She had characterized it more as pressure than pain until she’d tried to place the new Post-it with the others.

  Once the pain had lessened to the point that Laurie could breathe normally, she allowed herself to adjust her weight in her chair by sitting up straighter. Thankfully, what had now become an ache stayed at the same tolerable level. Perspiration had appeared on her forehead, and she wiped it off with the back of her hand. She knew she was anxious, but she was surprised that she was anxious enough to perspire so freely. She wondered if she could have a fever, but didn’t think so. Gingerly, she palpated her abdomen with a single finger. In contrast to previous occasions, there was now an area of definite tenderness, which seemed ominous to her. As she had noted earlier, it was exactly the location where the pain of appendicitis occurred.