Crisis

22

The next few seconds were a blur for Jack. The instant he realized his brother-in-law was not breathing, he lunged forward with the intention of rounding the corner of the bed to get to Craig's side in the shortest possible time. There he would whip back the covers, rapidly evaluate the man's status, and begin CPR if it was appropriate.

The sudden sideward movement possibly saved Jack's life. In the next instant Jack realized that he was not alone in the room. There was another figure, clad in black, making him all but invisible, who streaked out of the open bathroom doorway. The individual was brandishing a large club that he swung in a wide arc at the spot where Jack's head had been.

Although the blow missed Jack's head, it did hit his left shoulder. Luckily, it was a glancing blow that did not impact with its full force. Still, it sent a shooting, searing pain into the core of Jack's body, weakening his knees in the process.

Jack was still clutching the flashlight, the beam of which raced haphazardly around the room as he scrambled past the end of the bed, avoiding going alongside it. He did not want to be trapped by the intruder. More by instinct than vision, he knew that another blow with the club was coming as the figure leapt at him in pursuit. Jack ducked down low to the floor and, believing offense the best defense, threw himself forward, meeting his attacker with the point of his right shoulder as if he intended to tackle him. Jack had the man around the upper thighs and with continued pumping of his legs strengthened by all his bicycle riding, he was able to drive the man backward before both fell to the floor.

In close proximity, Jack felt he had the advantage by using the foot-long, heavy Maglite as a weapon. The longer club, wielded by the attacker, was at a distinct disadvantage. Letting go of the man's thighs, Jack grabbed a handful of shirt and rapidly lifted the flashlight alongside his head with full intention of striking the man's forehead. But as he raised the flashlight, its beam had illuminated the man's face. Luckily, before Jack struck, his mind quickly fired the right neurons and recognized the man. It was Craig.

"Craig?" Jack shouted in disbelief. He swiftly brought the light down from its threatening position and shined it on Craig's face just to be certain.

"Jack?" Craig sputtered in return. He raised his free hand to shield his eyes from the blinding light.

"Good God!" Jack voiced. He let go of Craig's shirt, directed the flashlight away from Craig's face, and got to his feet.

Craig got to his feet as well. He went to a wall switch and turned on the light. "What the hell are you doing here, sneaking around in my house at whatever the hell time it is?" He looked over at the bedside clock. "Three thirty in the goddamn morning!"

"I can explain," Jack said. He winced at a stab of shoulder pain.

Tentatively, he touched the area, finding a point of tenderness at the juncture of his collarbone and shoulder.

"Good grief," Craig complained. He tossed what turned out to be a baseball bat onto the bed. He came over to Jack. "God, I'm sorry I freakin' hit you. I could have killed you. Are you all right?"

"I've had worse," Jack said. He glanced over at the bed. What he'd thought had been Craig was merely pillows and bedcovers. "Can I check it?" Craig asked solicitously.

"Sure, I guess."

Craig took hold of Jack's arm and gently put his hand on Jack's shoulder. He rotated Jack's arm in its shoulder socket, then raised it slowly. "Any pain?"

"A little, but the movement doesn't make it worse."

"I don't think anything is broken, but an X-ray wouldn't hurt. I could drive you over to the Newton Memorial if you'd like."

"I think I'll put some ice on it for now," Jack said.

"Good ideal Come on down to the kitchen. I'll put some ice in a Ziploc bag."

As they walked along the upper hallway, Craig said: "My heart is going a mile a minute. I thought you were one of these guys who'd broken in and manhandled my daughters, who was back to carry out his threat. I was ready to knock you into the next county."

"I suppose I thought you were one of those guys as well," Jack said. He noticed that Craig was wearing a dark-colored bathrobe and not the black ninja outfit Jack had creatively imagined. He also felt the gun in his jacket pocket knocking against him. He'd not thought of it in the fury of the moment, and it was a good thing.

Craig got Jack set up with an ice bag. Jack was sitting at one end of the couch, holding the cold pack against the point of his shoulder. Craig collapsed at the other end, holding a hand against his forehead.

"I'll get out of here so you can get back to sleep," Jack said. "But I owe you an explanation."

"I'm listening," Craig said. "Before I went to bed, I went downstairs to check the apartment. You'd pulled the linens off the bed. I certainly didn't expect you, and especially at this hour, and especially not sneaking around upstairs."

"I promised Alexis I'd check on you."

"Did you talk with her tonight?"

"I did, but not until quite late. Frankly, she's worried about your mixing alcohol and sleeping pills, and she should be worried. I've autopsied a few people, thanks to that combination."

"I don't need your advice."

"Fair enough," Jack said. "Nonetheless, she asked me to check on you. To be honest, I didn't think it was necessary. The reason I was seemingly sneaking was because I was afraid to wake you for fear you'd be angry I was there."

Craig took his hand away from his face and gazed at Jack. "You're right about that."

"I'm sorry if I offended you. I did it for Alexis. She was afraid you might be more upset than usual after what happened at the trial."

"At least you're honest," Craig said. "I suppose I should see it as a favor. It's just hard with what's going on. I'm being forced to see myself in an unflatteringly different light. I was a miserable, ridiculous, self-defeating witness today. When I think about it in retrospect, I'm embarrassed."

"How do you think the afternoon went with the defense experts?"

"It was reasonable. It was nice to hear some positive words for a change, but I don't think it was enough. Unless Randolph pulls off an Oscar-winning performance with his summation tomorrow, which I personally believe he's incapable of, I think the jury is going to find for that bastard, Jordan." Craig sighed despondently. He was staring at the blank TV screen.

"I had another reason for coming out here at this late hour," Jack said.

"Oh! And what was that?" Craig asked. He turned to look at Jack. His eyes were glazed, as if he was ready to cry but too embarrassed to do so. "You haven't told me about the autopsy. Did you do it?"

"I did," Jack said. He went on to tell Craig a truncated version of the day's events, starting with the exhumation and ending with the meeting with the toxicologist. He didn't tell Craig as much as he'd told Alexis, but the gist was the same.

As Jack spoke, Craig became progressively riveted, especially about the toxicologist and the possibility of the involvement of criminality. "If the toxicologist could find some drug or poison, it would be the end of this malpractice nonsense," Craig said. He sat up straighter.

"No doubt," Jack said. "But it is a very, very long shot, as I explained. Yet if Patience did not have a heart attack, it opens up the possibility of many more potential agents. The other reason I came out here tonight was to look at the box of bedside biomarker assay devices in your doctor's bag. Is there any reason you can think of that your result could have been a false positive?"

Craig raised his eyebrows for a moment while he mulled the question. "I can't think of any," he said at length. "I wish I could, but I can't."

"The lab supervisor at the hospital asked me if the one you used tested for both troponin I and myoglobin or just troponin I."

"It's the one with the myoglobin. I chose to stock that one for the reason the lab supervisor mentioned – namely, it gives a result in as little as two hours."

"Is there a shelf life for those devices?"

"Not that I know of."

"Then I guess we'll just have to limit the possible agents to those capable of causing a heart attack."

"What about digitalis?" Craig suggested.

"I thought of digitalis, for sure, and it was part of the screen. So digitalis was not involved."

"I wish I could help more," Craig said. "One of the worst parts of being sued is you feel so helpless."

"You could help if you could think of any cardiotoxic drugs Patience or Jordan might have had access to."

"She had quite a pharmacopoeia in her medicine cabinet, thanks to my absent partner, Ethan Cohen. But all those records were turned over in discovery."

"I've been through those," Jack said. He got to his feet. Relaxing for a few minutes seemed to make his legs feel heavy and sluggish. It was obvious he was going to need some coffee before the night was over. "I better get back and see if the toxicologist has had any luck, and you better get back to bed." He started for the door.

"Are you going to work all night?" Craig asked, accompanying Jack.

"It looks like that," Jack said. "After everything that's happened, I wish I could be certain of some positive result, but it's not looking likely."

"I don't know what to say other than thanks for all your effort."

"You're welcome," Jack said. "And it's been positive despite the problems I've caused and the whacks I've taken. It has been nice to hook back up with Alexis."

They reached the front door. Craig pointed down toward the study. "Should I run and grab my doctor's bag so you can look at the biomarker assay box? I'm sure it's the same box. After this fiasco, I'm not making many house calls."

Jack shook his head. "I'm good. You told me what I needed to know."

"Will we see you in court tomorrow?"

"I don't think so. I've got some pressing personal plans that are dictating I take the first shuttle back to the Big Apple. So let me say, good luck!"

Jack and Craig shook hands, having become, if not friends, a bit more knowledgeable and appreciative of each other.

THE RIDE BACK into the city a little after four a.m. was a mirror of the ride out. There was traffic on the Mass Pike but very little once in the city along Mass Ave. It took Jack less than twenty minutes to get all the way to the medical examiner's office. He parked right on the side of the building in a reserved space, but since he would be leaving at such an early hour, he didn't think it would matter.

Security recognized him and let him in. As he climbed the stairs, he looked at his watch. It was coming down to the wire. In less than two hours he'd be on the plane, taxiing away from the terminal.

Walking into the library, Jack did a double take. The place was in considerably greater disarray than when he had left. Latasha looked as if she were cramming to take her medical specialty boards. There were numerous large books that she'd gathered from around the office lying open on the tabletop. Jack recognized most. They included standard internal-medicine textbooks, physiology books, toxicology books, and pharmacology books. The case file material that Jack had organized was now randomly spread out, at least according to his eye.

"What the hell?" Jack questioned with a laugh.

Latasha's head popped up from an open textbook. "Welcome back, stranger!"

Jack flipped the covers back on a couple of the books he didn't recognize. After he saw the titles, he reopened the books to where Latasha had them. He took a seat opposite her.

"What happened to your shoulder?"

Jack was continuing to press the Ziploc bag against his bruise. By now the bag contained mostly water, but it was still cool enough to be of some benefit. He told her what had happened, and she was appropriately sympathetic for him and inappropriately critical of Craig.

"It wasn't his fault," Jack insisted. "I've been so consumed by this case for a variety of reasons that I never stopped to think of what a harebrained idea it was for me to go sneaking into his house. I mean, this is after someone else had broken into it and terrorized his kids to give him a message that they'd be back if I did an autopsy. And I just did the autopsy, for chrissake. What was I thinking?"

"But you were a houseguest. You'd think he'd make sure who he was hitting with a baseball bat."

"I wasn't a houseguest any longer. But let's drop it. Thank God no one got hurt any more than a shoulder contusion. At least I think it is just a contusion. I might have to get my clavicle x-rayed."

"Look on the positive side," Latasha said. "You certainly made sure he wasn't comatose, you know what I'm saying?"

Jack had to smile in spite of himself.

"What about the biomarker assay kit? Did you find out anything?"

"Nothing that raised the possibility he'd gotten a false positive. I think we have to assume it was a legitimate result."

"I suppose that's good," Latasha said. "It eliminates a lot of potential lethal agents." Her eyes swept over the books she had arranged around her.

"It looks like you've been busy."

"You have no idea. I got my second wind with the help of a few Diet Cokes. It's been like a great review course in toxicology. I haven't studied this stuff since forensic boards."

"What about Allan? Has he called you?"

"Several times, to be exact. But it's good. The more I hear his voice, the easier it is not to drag up old memories and get pissed."

"Has he had any luck?"

"Nope. Not at all. Apparently, he's trying to impress me, and you know something? He's not doing such a bad job. I mean, I knew he was smart and all back in college with his majoring in chem, math, and physics, but I didn't know he'd gone on to get a Ph.D. at MIT. I know that takes a few more brains than medical school, where perseverance is the major requirement."

"Did he say what kinds of things he's ruled out?"

"Most of the more common cardiotoxic agents that were not on the screen. He also explained to me some of the tricks he's using. The embalming chemicals are making it much harder with the tissue samples, like from the heart and liver, so he's concentrating on the fluids, where there's been less contamination."

"So what's with all these textbooks?"

"I started by reviewing cardiotoxic agents, a lot of which, I learned, could cause heart attacks or at least enough damage to the cardiac muscle so that clinically it would present as one even though there was no occlusion of cardiac vessels. I mean, that's what we've found from the autopsy. It's also what I found on the frozen sections we stained. I took a peek at a couple of the slides while you were gone. The capillaries look normal. I left the slide in the microscope in my office, if you'd like to take a peek."

"I'll take your word for it," Jack said. "I didn't expect we'd see anything as clear as the gross was."

"Now I've expanded from purely cardiotoxic agents to neurotoxic agents, since a lot of them do both. I tell you, it's fascinating stuff, especially how it dovetails with bioterrorism."

"Did you read the depositions?" Jack asked. He wanted to keep the conversation on track.

"Hey, you weren't gone that long. I think I've gotten a lot done. Give me a break!"

"We are running out of time. We have to stay focused."

"I'm focused, man," Latasha scoffed. "I'm not out driving around, learning something I essentially already knew, and getting beat on in the process."

Jack rubbed his face briskly with both hands in an attempt to dispel the cobwebs of fatigue that were interfering with his cognition and emotion. Being at all critical of Latasha was surely not his intent. "Where are those Diet Cokes? I could use a blast of caffeine."

Latasha pointed toward the door to the hall. "There's a vending machine in the lunchroom down on the left."

When the can of soda thudded down into the vending machine's opening, it was loud enough in the building's silence to make Jack jump. He was tired, but he was also tense, and he wasn't entirely sure why. It could have been because time was running out as far as the case was concerned, but it also could have been anxiety about returning to New York and all that it entailed. After flipping open the can of soda, Jack hesitated. Was caffeine advisable if he was already mildly uptight? Throwing caution to the wind, he downed the can, then burped. He rationalized that he needed his wits to be sharp, and for that, caffeine was what the doctor ordered.

Feeling a slight buzz since caffeine was not one of his vices, Jack reclaimed the seat across from Latasha and cherry-picked Craig's and Jordan's deposition transcripts from the debris around Latasha.

"I didn't read those depositions cover to cover," Latasha said. "But I did kinda breeze through them to make a list of Patience's symptoms."

"Really?" Jack questioned with interest. "That's what I was just about to do."

"I guessed as much, since that's what you suggested before your ill-fated drive out to the suburbs."

"Where is it?" Jack asked.

Latasha scrunched up her features in concentration while she riffled through some of the material in front of her. Eventually, she came up with a yellow legal pad. She handed it across to Jack.

Jack settled back in his chair. There was no order to the symptoms other than their being divided into two major groups: the morning of September eighth, and the late afternoon and early evening. The morning group included abdominal pain, increased productive cough, hot flashes, nasal congestion, insomnia, headache, flatulence, and general anxiety. The late afternoon/early evening group comprised chest pain, cyanosis, inability to talk, headache, difficulty walking, difficulty sitting up, numbness, a sensation of floating, nausea with a little vomiting, and generalized weakness.

"Is this all?" Jack asked, waving the pad in the air.

"You don't think that's enough? She sounds like most of my patients in third-year medical school."

"I just wanted to make sure it's all the symptoms mentioned in the depositions."

"It's all the ones I could find."

"Did you find any mention of diaphoresis?"

"No, I didn't, and I looked for it specifically."

"I did, too," Jack said. "Sweating is so typical of a heart attack, I couldn't believe it when I didn't see it on my first reading. I'm glad you didn't see it, either, because I thought maybe I'd just missed it."

Jack glanced back at the list. The trouble was that most of the entries had no modifiers, and the ones that did had modifiers that were too general and not descriptive enough. It was as if all the symptoms were equally important, which made it difficult to weigh each symptom's contribution to Patience's clinical state. Numbness, for instance, had little meaning without a description of location, extent, and duration, and whether it meant no feeling whatsoever or paresthesia, more commonly known as pins and needles. In such a circumstance, it was impossible for Jack to decide if the numbness was of neural or cardiovascular origin.

"You know what I find most interesting about this toxicology stuff?" Latasha said, looking up from a large textbook.

"No! What?" Jack said vaguely. He was preoccupied in deciding he would need to go back through the depositions himself and see what qualifiers existed for the symptoms mentioned.

"Reptiles," Latasha said. "It's a wonder how all their venoms evolved, and why there is such a difference in potency."

"It is curious," Jack said as he opened Jordan 's deposition and began rapidly flipping through the pages to get to the section involving the events of September eighth.

"There are a couple of snakes whose venom contains a powerful specific cardiotoxin capable of causing direct myocardial necrosis. Can you imagine what that would do to the level of cardiac biomarkers?"

"Really?" Jack questioned with sudden interest. "What kind of snakes?"

Latasha cleared a trench through the material on the desk, and, after turning the textbook around, she pushed it over in front of Jack. She used her index finger to point to the names of two types of snakes on a table comparing snake venom virulence. "The Mojave rattlesnake and the Southern Pacific rattlesnake."

Jack glanced at the table. The two snakes she pointed out were among the most poisonous of those listed. "Very interesting," Jack said. His interest faded as quickly as it had arisen. He pushed the book back. "However, we are not dealing with an envenomation. Patience wasn't bitten by a rattlesnake."

"I know," Latasha said, taking the book back. "I'm only reading about venom to get ideas for various classes of compounds to consider. I mean, we are looking for a cardiotoxin."

"Uh-huh," Jack said. He had already gone back to the deposition and found the part he was looking for. He began to read more closely.

"Actually, the most interesting venomous animals are a group of amphibians, of all things," Latasha said.

"Really," Jack said without actually hearing. He'd come across the mention of abdominal pain in the deposition. Jordan testified it was "lower" abdominal pain, more on the left than the right. Jack amended Latasha's entry on the yellow legal pad.

"It's the Colombian poison dart frogs that take the cake," Latasha said, flipping the pages in the textbook until she came to the right section.

"Really," Jack repeated. He skipped ahead in Jordan 's deposition until he got to where Jordan was talking about the evening symptoms. Jack was particularly looking for the section where Jordan talked about the numbness Patience had experienced.

"Their skin secretions contain some of the most toxic substances known to man," Latasha said. "And they have an immediate toxic affect on heart muscle. Are you familiar with batrachotoxin?"

"Vaguely," Jack said. He found the reference to numbness, and it was apparent from Jordan 's description that it was paresthesia, not the absence of feeling, and it involved her arms and legs. Jack wrote the information on the yellow pad.

"It is the worst toxin of all. When batrachotoxin comes in contact with heart muscle, it stops all activity immediately." Latasha snapped her fingers. "In vitro, one minute cardiac myocytes are pumping away, and the next instant, after exposure to a few molecules of batrachotoxin, they are completely stopped. Can you believe that?"

"It's hard to believe," Jack agreed. He found Jordan 's reference to floating and, interestingly, it was associated with the paresthesia and had nothing to do with being in liquid. It was a sensation of not being grounded and floating in air. Jack wrote the information on the yellow pad.

"The poison is a steroidal alkaloid rather than a polypeptide, for whatever that's worth. It's found in several frog species, but the one that has the highest concentration is called Phyllobates terribilis. It's aptly named, since one tiny frog has enough batrachotoxin to kill a hundred people. It's mind-boggling."

Jack found the section where Jordan discussed Patience's weakness, which, it turns out, didn't refer to a diminution of any particular muscle group. Rather, the weakness was a more global problem. It started with difficulty walking and progressed to difficulty sitting up in short order. Jack added the information to the yellow pad.

"There's something else you should know about batrachotoxin if you don't already. Its molecular mode of action is to depolarize electrical membranes like heart muscle and nerves. And do you know how it does it? It does it by affecting sodium transport, something you thought was esoterica. Remember?"

"What was that about sodium?" Jack asked as Latasha's comments penetrated his concentration. When Jack was thinking hard about something, he often could be oblivious to his surroundings, as Latasha had experienced.

"Batrachotoxin latches onto nerve and muscle cells and causes the sodium ion channels to lock in the open position, meaning the involved nerves and muscles stop functioning."

"Sodium," Jack repeated, as if in a daze.

"Yes," Latasha said. "Remember we were speaking…"

All of a sudden, Jack leaped to his feet and scrabbled madly through the litter spread around the table. "Where are those papers?" he demanded in a minor frenzy.

"What papers?" Latasha questioned. She had stopped speaking in mid-sentence and had leaned back in her chair, surprised by Jack's abrupt impetuosity. In his haste, he was knocking deposition transcripts off the table.

"You know!" he blurted, struggling to come up with the right word. "Those… those papers!"

"We've got a lot of papers here, big guy. God! How many Diet Cokes did you drink anyway?"

"Screw it!" Jack sputtered. He gave up on his search. Instead, he reached out toward Latasha. "Let me see that toxicology text!" He demanded rashly.

"Sure," Latasha said, mystified at his transformation. She watched as he riffled through the pages of the massive tome to get to the index. Once there, he hastily ran his fingers down the columns until he found what he was looking for. Then he went back to rapidly leafing through the book so fast that Latasha had a fear for its integrity. He found the correct page and was silent.

"Would it be asking too much for you to tell me what you are doing?" Latasha scoffed.

"I think I've had what you would call a eureka moment and I would call an epiphany," Jack muttered while continuing to read. "Yes!" he cried after a few moments, raising a triumphant fist in the air. He slammed the book closed and looked across the table at Latasha. "I have an idea of what to ask Allan to look for! It's weird, and if it is present, it might not fit all the facts as we know them, but it fits some of the most important ones, and it would prove Craig Bowman did not commit medical negligence."

"Like what?" Latasha demanded. She couldn't help but feel some irritation that Jack was being so coy. She was in no mood for games at almost five o'clock in the morning.

"Check out this strange symptom you wrote," Jack said. He reached over with the yellow pad and pointed to the notation "sensation of floating."

"Now, that's not your run-of-the-mill complaint of even the most dedicated hypochondriac. That suggests something truly weird was going on, and if Allan is able to find what I'm thinking, there would be the suggestion that Patience Stanhope was either a die-hard sushi fan or a crazed devotee of Haitian voodoo, but we're going to know differently."

"Jack!" Latasha said irritably. "I'm too tired for this kind of joking."

"I'm sorry" Jack said. "This apparent teasing is because I'm afraid I might be right. This is one of those situations, despite the effort involved, where I'd rather be wrong." He reached out for her. "Come on! I'll tell it to you straight while we hurry over to Allan's lab. This is going to go right down to the wire."