He redirected the light straight down on the table. The corpse had pincushion arms—typical for a hospital death. Dvorak counted four different puncture sites on the left upper extremity, five on the right. There was also a needle puncture wound in the right groin—probably from an arterial blood gas draw. This patient had not gone peacefully into that good night.
He picked up the scalpel and made his Y incision. Lifting the sternum in one piece, he exposed both the chest and abdominal cavities to view.
The organs looked unremarkable.
He began to remove them, dictating his findings as he worked.
“This is the body of a well-nourished white male, age eighty-two . . .” He paused. That age couldn’t be right. He flipped to the front of the chart and checked the birth date. The age was correct.
“I would’ve guessed sixty-five,” said Lisa.
“It says here, eighty-two.”
“Could that be a mistake?”
Dvorak studied the corpse’s face. The variability of aging was a matter of both genetics and lifestyle. He had seen eighty-year-old women who could pass for sixty. He had also seen a thirty-five-year-old alcoholic who’d appeared ancient. Perhaps Angus Parmenter was merely the beneficiary of youthful genes.
“I’ll confirm the age later,” he said, and continued dictating. “Decedent expired today at five-fifty-eight in Springer Hospital, Newton, Massachusetts, where he was admitted as a patient seven days ago.” Once again, he picked up the scalpel.
Dvorak had gone through these motions so many times before that much of it was automatic for him. He severed the esophagus and trachea, as well as the great vessels, and removed the heart and lungs. Lisa slid them onto the scale and called out the weights, then placed the heart on the cutting board. Dvorak sliced along the coronary vessels.
“I don’t think we have an MI,” he said. “Coronaries look pretty clean.”
He resected the spleen, then the small intestine. The seemingly endless coils of bowel felt chill and slippery. The stomach, pancreas, and liver were resected in one block. He saw no signs of peritonitis, nor did he detect the odor of anaerobic bacteria. The joys of working on a fresh corpse. No foul smells, only the butcher-shop scent of blood.
On the cutting board, he sliced open the stomach and found it was empty.
“Hospital food must’ve sucked,” said Lisa.
“He wasn’t able to eat, according to the record.”
So far, Dvorak had seen nothing on gross inspection that would point to the cause of death.
He circled around to the cadaver’s head, made his incision, then folded the scalp forward over the face like a rubber mask. Lisa had the Stryker saw ready. Neither of them spoke as the saw whined, opening up the skull.
Dvorak lifted off the cap of bone. The brain looked like a mass of gray worms under its delicate covering of meningeal membrane. The meninges did not appear in any way unusual, which argued against infection. Neither did Dvorak see any signs of epidural bleeding.
The brain would have to be removed for closer inspection. He picked up the scalpel and worked quickly, severing optic nerves and blood vessels. As he reached deeper, to free the brain from the spinal cord, he felt a sharp bite of pain.
At once he withdrew his hand and stared at the cut glove. “Shit,” he muttered and crossed to the sink.
“What happened?” said Lisa.
“Cut myself.”
“Are you bleeding?”
Dvorak ripped off the gloves and examined his left middle finger. A fine line of blood welled up along the razor-thin laceration. “Scalpel went right through both gloves. Shit, shit, shit.” He grabbed a bottle of Betadine from the counter and squirted a stream of disinfectant on his finger. “Die, buggers.”
“He’s HIV negative, right?”
“Yeah. Lucky for me,” he said, blotting his finger dry. “That shouldn’t have happened. I just got careless.” Angry at himself now, he regloved and went back to the cadaver. The brain had already been severed of all its connections. Gingerly he scooped it up in both hands, swished it in saline to wash off the blood, and lay the dripping organ on the cutting board. He gave the organ a visual inspection, turning it to examine all the surfaces. The lobes appeared normal, without any masses. He slid the brain into a bucket of Formalin, where it would fix for a week before it was ready to be sliced and mounted on slides. The answers would most likely be found under the microscope.
“Dr. Dvorak?” It was his secretary, Stella, speaking over the intercom.
“Yes?”
“There’s a Dr. Carl Wallenberg on the line.”
“I’ll call him back. I’m in the middle of an autopsy.”
“Actually, that’s why he insists on talking to you now. He wants the autopsy stopped.”
Dvorak straightened. “Why?”
“Maybe you should talk to him yourself.”
“Guess I have to take this call,” he muttered to Lisa, stripping off his gloves and apron. “Go ahead with the muscle biopsies and liver sections.”
“Shouldn’t I wait until you talk to him?”
“We’ve gone this far. Let’s finish the tissue sections.”
He went to his office to take the call. Even with the door shut, the room was pervaded by the odor of Formalin, carried in on his clothes, his hands. He himself smelled like some preserved specimen, hidden away in this windowless office.
A man in a jar, trapped.
He picked up the phone. “Dr. Wallenberg? This is Dr. Dvorak.”
“I believe there’s been a misunderstanding. Mr. Parmenter was my patient, and I’m at a complete loss as to why you’re performing an autopsy.”
“It was requested by one of the doctors at Springer Hospital.”
“You mean Dr. Harper?” The sound that came through the line was clearly a snort of disgust. “She wasn’t involved with the patient’s care. She had no authority to call you.”
“According to the record, she did see the patient in the ER.”
“That was a week ago. Since then, the patient has been under my care, as well as the care of several subspecialists. None of us felt an autopsy was necessary. And we certainly didn’t think it was a case for the medical examiner.”
“She led me to believe this was a public health issue.”
Again, that snort of disgust. “Dr. Harper’s not exactly a reliable source of information. Maybe you haven’t heard. Springer Hospital has her under investigation for mistakes she’s made in the ER, serious mistakes. She may soon be out of a job, and I wouldn’t trust her opinion on anything. Dr. Dvorak, this is a chain-of-command issue. I’m the attending physician, and I’m telling you an autopsy is a waste of your time. And a waste of my taxes.”
Dvorak stifled a groan. I don’t want to be dealing with this. I’m a pathologist. I’d rather work with dead bodies than live egos.
“Also,” said Wallenberg, “there’s the family. The daughter would be very upset about her father being mutilated. She may even consider legal action.”
Slowly Dvorak straightened, his head coming up in puzzlement. “But Dr. Wallenberg, I’ve spoken to the daughter.”
“What?”
“This morning. Mrs. Lacy called to discuss the autopsy. I explained the reasons for it, and she seemed to understand. She didn’t argue against it.”
There was silence on the line. “She must have changed her mind since I spoke to her,” said Wallenberg.
“I guess so. At any rate, the autopsy has been done.”
“Already?”
“It’s been a relatively quiet morning here.”
Again there was a pause. When Wallenberg spoke again, his voice was oddly subdued. “The body—it will be returned, complete, to the family?”
“Yes. With all the organs.”
Wallenberg cleared his throat. “I suppose that will satisfy them.”
Interesting, thought Dvorak as he hung up. He never asked what I found on autopsy.
He replayed the conversa
tion in his head. Had he simply been sucked into the petty politics of a suburban hospital? Wallenberg had characterized Dr. Harper as a marginal physician, a woman under scrutiny, perhaps a woman at odds with her colleagues. Was her request for an autopsy merely an attempt to embarrass another physician on the staff?
This morning, he should have exercised a little Machiavellian reasoning, should have sought out her real agenda. But Dvorak’s logic tended toward the concrete. He gathered information from what he could see and touch and smell. A cadaver’s secrets are easily laid bare with a knife; human motives remained a mystery to him.
The intercom buzzed. “Dr. Dvorak?” said Stella. “Dr. Toby Harper’s on the line. Want me to put her through?”
Dvorak thought it over and decided he was in no mood to talk to a woman who’d already ruined his day. “No,” he said.
“What shall I tell her?”
“I’ve gone home for the day.”
“Well, if that’s what you really want. . .”
“Stella?”
“Yes?”
“If she calls back again, give her the same answer. I’m not available.”
He hung up and returned to the morgue.
Lisa was bent over the cutting board, her scalpel slicing off a section of liver. She looked up as he walked in. “Well?” she asked. “Do we finish the biopsies?”
“Finish them. Then return the organs to the cavity. The family wants it all back.”
She made another cut, then paused. “What about the brain? It still needs to be fixed for another week.”
He looked at the bucket where Angus Parmenter’s brain lay in its bath of Formalin. Then he looked down at his bandaged finger and thought of how the scalpel had sliced through two gloves and into his own flesh.
He said, “We’ll keep it. I’ll just replace the skull cap and sew the scalp shut.” He pulled on a fresh pair of gloves and reached into a drawer for a needle and suture. “They’ll never know it’s missing.”
Toby hung up the telephone in frustration. Had the autopsy been completed or hadn’t it? For two days she’d been trying to get through to Daniel Dvorak, but each time his secretary had told her he was not available, and her tone of voice had made it clear that Toby’s calls were not welcome.
The oven alarm buzzed. Toby turned off the gas and removed the casserole dish. She was copping out tonight— lasagna from the frozen food section, and a sadly wilted salad. She’d had no chance to shop for groceries and there was no milk left, so she poured two glasses of water and set them on the kitchen table. Her whole life, it seemed, had been reduced to a mad scramble for shortcuts. Frozen dinners and dishes stacked in the sink and wrinkled blouses pulled straight from the dryer. She wondered if her profound weariness was due to some incubating flu virus, or if it was mental exhaustion that was dragging her down. She opened the kitchen door and called out:
“Mom, dinner’s ready! Come in and eat.”
Ellen emerged from behind a clump of bee balm and obediently shuffled into the kitchen. Toby washed her mother’s hands at the sink and sat her down at the table. She tied a napkin around Ellen’s neck and slid the plate of lasagna in front of her. She cut the lasagna into bite-size pieces. She did this to the salad as well. She placed a fork in Ellen’s hand.
Ellen did not eat but sat waiting and watching her daughter.
Toby sat down with her own plate of food and took a few bites of lasagna. She noticed Ellen wasn’t eating. “It’s your dinner, Mom. Put it in your mouth.”
Ellen slid the empty fork into her mouth and tasted it with great concentration.
“Here. Let me help you.” Toby glided Ellen’s fork to the plate, scooped up a lasagna noodle, and raised it to Ellen’s mouth.
“Pretty good,” said Ellen.
“Now take another bite. Go on, Mom.”
Ellen looked up as the doorbell rang.
“That must be Bryan already,” said Toby, rising from the table. “You keep eating now. Don’t wait for me.”
She left her mother in the kitchen and went to answer the front door. “You’re early.”
“I thought I’d help out with dinner,” Bryan said as he came into the house. He held out a paper bag. “Ice cream. Your mama does like her strawberry ice cream.”
As she took the bag, she noticed Bryan wasn’t looking at her; in fact he seemed to be avoiding her gaze, turning his back to her as he removed his jacket and hung it up in the closet. Even when he turned to face her, his eyes were focused elsewhere. “So how’re we doing with dinner?” he asked.
“I just sat her down at the table. We’re having a little trouble eating today.”
“Again?”
“She didn’t touch the sandwich I left her. And she looks at the lasagna like it’s something from outer space.”
“Oh. I can take care of that—”
From the kitchen came a loud crash followed by the clatter of broken china skittering across the floor.
“Oh my God,” said Toby as she ran into the kitchen.
A bewildered Ellen stood staring down at the broken casserole dish. Lasagna had splattered all over the floor and against one wall in a shocking spray of cheese and tomato sauce.
“Mom, what are you doing?” yelled Toby.
Ellen shook her head and mumbled: “Hot. Didn’t know it was hot.”
“Christ, look at this mess! All this cheese . . .” Toby grabbed the trash can. In rage and frustration she dragged it across the floor to the broken dish. As she knelt down to clean up the ruined meal she realized she was dangerously close to tears. I’m losing it. Everything in my life is so fucking screwed up. I can’t deal with this, too. I just can’t.
“Come on, Ellen sweetie,” she heard Bryan say. “Let’s have a look at those hands. Oh dear, you’re going to need some cold water on that. No no, don’t pull away, sweetheart. Let me make them feel better. That’s nasty, isn’t it?”
Toby looked up. “What is it?”
“Your mama burned her hands.”
“Ouch, ouch, ouch!” Ellen squealed.
Bryan led Ellen to the sink and ran cold water over her hands. “Isn’t that better? Now, we’re going to have ice cream after this and that’ll make you feel even better. I brought strawberry. Yum yum.”
“Yum,” murmured Ellen.
Cheeks flushing with shame, Toby watched as Bryan tenderly dabbed Ellen’s hands with a towel. Toby hadn’t even noticed her mother was hurt. In silence she resumed picking up the pieces of crockery and the lumps of congealing cheese. She sponged up the sauce and wiped down the wall. Then she sat down at the table and watched Bryan coax Ellen into eating the ice cream. His patience, his gentle wheedling, made Toby feel more guilty. It was Bryan who had noticed Ellen’s burned hands, Bryan who’d seen to her needs; Toby had seen only the broken dish and the mess on the floor.
Now it was already six-fifteen, time for Toby to get ready for work.
She didn’t have the energy to rise from the table. She sat with her hand against her forehead, delaying just a little while longer.
“I have something to tell you,” said Bryan. He put down the spoon and gently wiped Ellen’s mouth with a napkin. Then he met Toby’s gaze. “I’m really sorry about this. It wasn’t an easy decision but . . .” He placed the napkin carefully on the table. “I’ve been offered another position. It’s something I can’t pass up. Something I’ve wanted to do for so long. I wasn’t looking for another job—it just sort of happened.”
“What happened?”
“I got a call from Twin Pines nursing home, out in Wellesley. They’re looking for someone to start up a new recreational art therapy program. Toby, they made me an offer. I couldn’t turn it down.”
“You didn’t say a word about this to me.”
“I only got the call yesterday. I had the interview this morning.”
“And you took the job, just like that? Without even talking to me?”
“I had to make a decision on the spot. Toby, it’s a nine
-to-five job. It means I can rejoin the rest of the human race.”
“How much are they offering you? I’ll pay you more.”
“I’ve already accepted.”
“How much?”
He cleared his throat. “It’s not the money. I don’t want you to think that’s the reason. It’s . . . everything combined.”
Slowly she sank back. “So I can’t make you a better offer.”
“No.” He looked down at the table. “They want me to start as soon as possible.”
“What about my mother? What if I can’t find anyone to watch her?”
“I’m sure you will.”
“Exactly how much time do I have to find someone?”
“Two weeks.”
“Two weeks? Do you think I can pull someone out of thin air? It took me months to find you.”
“Yes, I know, but—”
“What the hell am I supposed to do?” The desperation in her voice seemed to hang like an ugly pall between them.
Slowly he looked up at her, his gaze unexpectedly detached. “I like Ellen. You know that. And I’ve always given her the best care I could. But Toby, she’s not my mother. She’s yours.”
The simple truth of that statement silenced any response she could have made. Yes, she is my mother. My responsibility.
She looked at Ellen and saw that her mother was paying attention to none of this. Ellen had picked up a napkin and was folding it over and over, her forehead wrinkled in concentration.
Toby said, “Do you know anyone who might want the job?”
“I can get you some names,” he said. “I know a few people who might be interested.”
“I would appreciate it.”
They looked at each other across the table, not as employer and employee this time, but as friends. “Thank you, Bryan,” she said. “For all you’ve done for us.”
Life Support Page 13
