Foreign Body

Chapter 19

October 17, 2007

Wednesday, 6:15 a.m.

New York, USA

Before ever opening his eyes, Dr. Jack Stapleton heard a sound that was foreign to his ears. It was a distant hushed roar, the likes of which he found hard to describe. For a moment he tried to think what could be making it. Since their 106th Street Manhattan brownstone, which was actually brick, had been renovated only two years ago, he thought it could have been a sound that was normal to the newly configured house but that he’d just never appreciated. Yet on further thought it was too loud for that. Trying harder to characterize it, he suddenly thought of a waterfall.

Jack’s eyes blinked open. Sweeping his hand under the covers on his wife’s side of the bed and not encountering her sleeping form, he knew what the sound was: It was the shower. Laurie was already up, an unheard-of phenomenon. Laurie was a dyed-in-the-wool night owl and often had to be dragged kicking and screaming from her bed in order for her to get to the OCME, also known as the Office of the Chief Medical Examiner, at some reasonable time. As for himself, Jack liked to arrive early, before everyone else, to give him the opportunity to cherry-pick the good cases.

Mystified, Jack tossed back the covers, and completely naked, which was the way he liked to sleep, he padded into the steamy bathroom. Laurie was practically invisible within the shower stall. Jack cracked the door.

“Hey in there,” Jack called out over the sound of the water.

With suds in her hair, Laurie leaned out of the spray. “Good morning, sleepyhead,” she said. “It’s about time you woke up. It’s going to be a busy day.”

“What are you talking about?”

“The India trip!” Laurie said. She leaned her head back into the torrent and vigorously rinsed her hair.

Jack leaped back to avoid being splashed and let the shower door close. It all came back to him in a rush. He’d vaguely remembered snatches of the conversation in the middle of the night when he’d first awakened, but he’d thought it all had been a nightmare.

Jack had not seen Laurie so motivated since she and her mom had teamed up for planning their wedding. A little later Jack learned that Laurie had stayed up and essentially made all the travel and lodging arrangements, pending Calvin’s permission for the two of them to take a week off. They were to leave that evening, change planes in Paris, and arrive in New Delhi late the following night. As far as the hotel was concerned, they were booked in the same place Jennifer Hernandez was staying.

By seven a.m. Jack found himself staring into the lens of a digital camera in a shop on Columbus Avenue. When the flash went off, he jumped. A few minutes later he and Laurie were back on the street.

“Let me see your photo!” Laurie said, and giggled when she looked at it. Jack grabbed it back, miffed that she was making fun of it. “Want to see mine?” Laurie asked, but she extended it to Jack before he had a chance to respond. As he’d expected, hers looked better than his, with the flash catching the auburn highlights in her brunette hair as if the clerk was a professional photographer. The biggest difference was the eyes. Whereas Jack’s light brown, deeply set eyes looked like he was hungover, Laurie’s blue-green eyes were bright and sparkly.

When they got to the OCME at seven-thirty, Laurie thought things looked auspicious. She imagined that if it had been a particularly busy day, Calvin would be less inclined psychologically to let them both take a week. But it was not busy, at least not yet. When she and Jack walked into the ID office, where the day began for all the medical examiners, the medical examiner in charge of reviewing the cases that had come in during the night, Dr. Paul Plodget, was sitting at the ID desk reading The New York Times. In front of him was an unusually small stack of folders that had already been reviewed. Next to him in one of the brown vinyl club chairs sat Vinnie Amendola, one of the mortuary techs whose job it was to come in early to help with the transition from the night techs. He also made the communal coffee. At the moment he was reading the New York Post.

“A light day today?” Laurie questioned to be certain.

“One of the lightest,” Paul said, without appearing from behind his newspaper.

“Any interesting cases?” Jack asked as he started rummaging through the short stack.

“Depends on who’s asking,” Paul said. “There’s one suicide that’s going to be a problem. Maybe you saw the parents. They were parked out in the ID room earlier. They are part of a prominent, well-connected Jewish family. To put it bluntly, they don’t want an autopsy, and they are pretty adamant.” Paul glanced around the edge of his paper at Jack to make sure he’d heard.

“Does the case really need an autopsy?” Jack asked. By law, suicides demanded autopsies, but the OCME tried to be sensitive to families, especially when religion was involved.

Paul shrugged. “I’d say yes, so there needs to be some finesse involved.”

“That leaves out Dr. Stapleton,” Vinnie commented.

Jack roughly flicked the back of Vinnie’s paper with his fingernails, causing the man to jump. “With that kind of recommendation, mind if I take the case?” Jack asked Paul.

“Be my guest,” Paul said.

“Has Calvin arrived yet?” Laurie asked.

Paul lowered his paper so he could look at Laurie with an exaggerated questioning expression that said, Are you crazy?

“Jack and I are possibly having to take some emergency leave starting later today,” Laurie said to Paul. “If it’s not a problem, which it doesn’t look like it will be, I’d like to take a paper day to sign out any and all cases I can.”

“Shouldn’t be a problem,” Paul agreed.

“I’m heading out to talk with these parents,” Jack said to anybody and everybody while holding the case file aloft.

Laurie grabbed his arm. “I’m going to wait for Calvin. I want a yes or a no as early as possible. If it’s yes, I’ll pop down to the pit before heading out to get our visas.”

“Okay,” Jack said, but it was apparent he was already preoccupied by the purported case.

After a quick detour out to Marlene at reception to ask to be informed the minute Calvin arrived, Laurie took the elevator up to her fifth-floor office. Sitting down, she dove into the stack of cases she had pending. But she didn’t get far. It was only twenty-two minutes later that Marlene informed her that Calvin had just come in through the front door, much earlier than usual.

The deputy chief medical examiner’s office was sited next to the chief’s much larger one near the building’s front entrance. At that time, prior to eight, the secretaries had yet to arrive, and Laurie had to announce herself.

“Come on in!” Calvin said when he saw Laurie at his door. “Whatever is on your mind, make it fast. I’m due down at City Hall.” Calvin was an enormous African-American who could have played in the NFL had he not been quite so interested in studying medicine when he graduated from college. With his ability to intimidate combined with a stormy temperament and streak of perfectionism, he was a very effective administrator. Despite the OCME being a city agency, things got done and got done efficiently under Calvin Washington, M.D.

“Sorry to bother you so early in the day,” Laurie began, “but I’m afraid Jack and I have a kind of emergency.”

“Uh-oh,” Calvin intoned, as he gathered the material he needed to take to the mayor’s office. “Why do I get the feeling I might have to do without my two most productive pathologists. Okay, give me the short version of the problem!”

Laurie cleared her throat. “Do you remember that young girl, Jennifer Hernandez, whom I invited here fourteen years ago?”

“How can I forget. I was totally against it, and somehow I let you talk me into it. Then it turned out to be one of the best things this office has ever done. Has it been fourteen years? Good lord!”

“It has been that long. In fact, Jennifer is graduating this coming spring from UCLA Medical School.”

“That’s terrific. I loved that kid.”

“She sends her regards.”

“Likewise,” Calvin said. “Laurie, you have to pick up the pace. I’ve got to be out that door five minutes ago.”

Laurie told the story of Maria Hernandez’s death and Jennifer’s difficulty trying to deal with the body. She also told Calvin how Maria had been like a mother, not only to Jennifer but to herself as well from infancy to early teens, and concluded by saying that she and Jack wanted to go to India and needed a week to do so.

“My condolences,” Calvin said. “I certainly can understand your wish to show your respects, but I’m not sure I understand why Jack has to go. To lose both of you at the same time puts us under a degree of strain unless we have significant warning.”

“The reason Jack has to go is actually unrelated to the Hernandez death,” Laurie explained. “Jack and I have been undergoing infertility treatment for about eight months. Currently, I’m in a cycle where I have been injecting myself with high levels of hormones, and within days I’ll be giving myself the follicle-releasing shot. At that point—”

“Okay, okay!” Calvin exclaimed, stopping Laurie in midsentence. “I get it. Fine! You guys take your week. We’ll manage.” Calvin picked up his briefcase.

“Thank you, Dr. Washington,” Laurie said. She felt a shiver of excitement. The trip was really going to happen. She followed the deputy chief out of his office.

“Give me a call when you’ll be returning to work,” Calvin called over his shoulder on his way to the front door.

“Will do,” Laurie called back, as she headed for the elevators.

“One more thing,” Calvin called, halfway out the door, keeping it open with his butt. “Give me a souvenir; get pregnant.” With that he left, and the door swung shut.

Like the arrival of a sudden summer storm, a cloud swept over Laurie’s nascent excitement. Calvin’s last comment infuriated her. Turning back to the elevator, she let loose a barrage of expletives. With all the pressure she’d been putting on herself to get pregnant and the despondency it engendered, she didn’t need more. For her, Calvin’s weighing in on the issue was akin to sexual discrimination. After all, he wasn’t about to put equivalent pressures on Jack.

Inside the elevator, she slammed the fifth-floor button with the heel of her fist. She could not believe how insensitive men could be. It was inexcusable.

Then, almost as soon as the fury had arrived, it dissipated. Sudden clairvoyance made Laurie know it was the hormones at work again, similar to her response last night with Jack and in the grocery store with the elderly woman. What surprised and embarrassed her was the speed with which such episodes took place. There wasn’t time to be rational.

Once back in her office and feeling more in control of her emotions, Laurie put in a call to her friend Shirley Schoener. She knew it was a good time, because Shirley set aside eight to nine as the time to be available for phone and e-mail communication with her infertility patients. She answered immediately.

Knowing other patients would be calling, Laurie got right down to business, telling Shirley that she and Jack were leaving for India that evening and why.

“I’m jealous,” Shirley responded. “You are going to find it so... interesting.”

“That’s how someone would describe something he or she didn’t like but felt the need to be diplomatic about,” Laurie responded.

“It’s just that it is difficult to characterize your response to India,” Shirley explained. “The country evokes such a wide range of emotions; it makes simple, generic descriptions useless. But I loved it!”

“We’re not going to have time to really see India,” Laurie said. “It’s going to be in and out, I’m afraid.”

“It doesn’t matter. India is so full of contradictions all over that you’ll sense what I’m talking about irrespective of how long you are there and no matter whether you go to Delhi, Mumbai, or Kolkata. It’s so complex. I was there a year ago for a medical conference, and I just haven’t been the same since. There’s sublime beauty and urban ugliness all mixed together. There’s extreme wealth and the most wrenching poverty you can imagine. I tell you, it takes your breath away. It’s impossible not to be affected by it.”

“Well, we’ll certainly keep our eyes open, but we’re going to be there to deal with Maria Hernandez’s death. But we have to deal with my cycle as well.”

“My goodness,” Shirley exclaimed. “In my enthusiasm about India, I momentarily forgot about that. I feel so positive about this cycle; I don’t want you to go away. I won’t be able to take any credit for when you get pregnant, which I think you are going to do.”

“Now, don’t you put any extra pressure on me,” Laurie said with a chuckle. She related her recent reaction to Calvin’s innocent comment.

“And you were the woman who doubted you’d have a problem with hormones!” Shirley laughed.

“Don’t remind me. But I really didn’t think I would. PMS was never the bother that it is with some of the people I know.”

“So we are going to need you to be seen by someone in New Delhi the first full day after you arrive. We don’t want to take any risk of hyperstimulation.”

“That’s the reason I’m calling. Do you know anyone in New Delhi you could recommend?”

“Lots,” Shirley responded. “Thanks to my having been there for that meeting, I’m in contact with a number. Indian medicine is quite advanced, more than most people realize. I know at least a half-dozen docs I’d feel comfortable recommending for you to see. Any specific requirements, like male or female, or any particular location in the city?”

“What might be handy is if any of those you recommend are associated with the Queen Victoria Hospital,” Laurie said. “It might be helpful to know someone on the staff when we’re dealing with the administration.”

“I couldn’t agree more. I tell you what. I’ll make some calls right now. It’s around quarter-to-six in the evening in Delhi, which is a perfect time. I could e-mail, too, but I think telephoning and talking directly will be better, and I don’t seem to have any incoming calls.”

“Thanks, Shirley,” Laurie said. “I’m certainly going to owe you for all this, but I don’t know how I’m going to repay. I seriously doubt you want any in-kind professional services.”

“Don’t even joke like that,” Shirley said. “I’m too superstitious.”

Disconnecting, Laurie reflexively checked her watch. The Indian visa place didn’t open until nine, so she had some time. The first thing she did was call up the airlines and use her credit card to pay for the tickets she had reserved. Next she called Jennifer. The phone rang four or five times, and when it was finally answered, Laurie expected voicemail. It was Jennifer, who sounded out of breath.

Laurie identified herself and then asked if she were calling at a bad time, because she could easily call back.

“No, this is fine,” Jennifer said, breathing deeply. “I’m having dinner in a fancy Chinese restaurant here in the hotel, and when the phone rang, I ran out here to the lobby to answer it. Guess who I’m having dinner with?”

“I couldn’t begin to guess.”

“A Mrs. Benfatti. She’s the wife of the man who died at the Queen Victoria last night.”

“That’s a coincidence.”

“Not really. I looked her up and we had lunch. I have to say his death has some strange parallels with Granny’s.”

“Really?” Laurie questioned. She wondered if they were real parallels or imagined.

“Gosh, here I am blabbing away, and you called me. Please tell me you are coming to India.”

“We are indeed coming to India,” Laurie said, the excitement showing in her voice.

“Terrific!” Jennifer cheered. “I’m so pleased, you have no idea. Tell Dr. Washington thank you, thank you, thank you.”

“He did send you his regards,” Laurie said. “Have there been any big changes in the situation there?”

“Not really. They are still trying to push me to give them the green light. I did tell them that you guys were coming and will be there Friday morning sometime.”

“Did you mention that we happen to be forensic pathologists?”

“Oh, yeah, most definitely.”

“And their response?”

“Another lecture that there will be no autopsy. They are very adamant.”

“We’ll see,” Laurie said.

“I made it a point to talk with the nurse who took care of Granny. She’s this beauty queen you won’t believe with a figure to die for.”

“Coming from you, that’s quite a compliment.”

“I’m not in her league. She’s the kind of woman who probably can eat anything, and she just looks better and better. She’s also really nice. At first when I met her she acted weird.”

“How so?”

“Shy or embarrassed, I couldn’t tell which. It turns out she was afraid I would be angry at her.”

“Why would you be angry?”

“That’s what I asked her. You know what it turned out to be? Granny was the first patient she has lost since she’d graduated from nursing school. Isn’t that touching?”

“Did you learn anything about your grandmother from her?” Laurie asked. She didn’t comment on Jennifer’s rhetorical question. At first blush, Laurie didn’t understand how Maria being the nurse’s first nursing death meshed with the nurse’s being worried Jennifer might be mad at her. Laurie assumed it had to be a cultural thing.

“Not really,” Jennifer said, but then corrected herself. “Except she said Granny was cyanotic when she was found.”

“True cyanosis?” Laurie questioned.

“That’s what she said, and I asked her specifically. But she was relating this secondhand. Granny didn’t die on her shift but on the evening shift. She had learned it from the nurse who had come upon Granny after Granny had already died.”

“Maybe you’d better not play medical investigation,” Laurie suggested. “You might ruffle too many feathers.”

“You’re probably right,” Jennifer agreed, “and especially not with you guys coming. What are your flight details?”

Laurie gave the flight numbers and the expected arrival time. “Now, you don’t have to come to the airport like you suggested,” Laurie said. “We can just jump in a taxi.”

“I want to come. I’ll take a hotel car. I mean, my expenses are being covered.”

Under those circumstances, Laurie agreed for Jennifer to come out to fetch them when they arrived. “Now I better let you get back to your dinner and your dinner companion.”

“Speaking of Mrs. Benfatti, I offered that you would look into the situation with her husband. I hope you don’t mind. There are parallels, as I’ve said.”

“We’ll look first at the parallels and then decide,” Laurie said.

“One more thing,” Jennifer said. “I went to the U.S. embassy this afternoon and spoke to a very nice consular officer who was very helpful.”

“Did you learn anything?”

“It turns out that the case manager at the Queen Victoria was giving me the true story about bringing bodies back to the States. You have to jump though a lot of bureaucratic hoops, and it is expensive. So I’m leaning in the direction of cremation.”

“We’ll discuss it more when I get there,” Laurie said. “Now get back to your dinner.”

“Aye-aye, sir. See you tomorrow night,” Jennifer said gaily.

Laurie replaced the receiver. For a moment she kept her hand on it, thinking about a heart attack and general cyanosis. When the heart fails, the pumping action stops, and you don’t get general cyanosis. Cyanosis generally comes from the lungs failing and the pumping continuing.

The phone under Laurie’s hand rang harshly, causing her to start. With her pulse racing, she snapped the receiver back up and blurted a hurried hello.

“I am looking for Dr. Laurie Montgomery,” a pleasant voice said.

“This is she,” Laurie answered with curiosity.

“My name is Dr. Arun Ram. I just spoke with Dr. Shirley Schoener. She said you were imminently coming to New Delhi and are in the middle of an infertility cycle using hormones. She said you will need to have the size of your follicles followed and your estradiol blood levels checked.”

“That’s true. Thank you for calling. I expected to hear back from Dr. Schoener with some numbers so I would have to make the calls.”

“It is no bother. It was my suggestion, since Dr. Schoener said she had been just speaking with you. I wanted to let you know I would be honored to be of assistance. Dr. Schoener told me a little about you, and I am very impressed. There was a time in my early training when I aspired to become a forensic pathologist from watching American TV shows. Unfortunately, I became disenchanted. The facilities in this country are very bad because of our infamous bureaucracy.”

“That’s too bad. We need good people in the specialty, and India would be well served if the facilities and the field were improved.”

“Dr. Schoener had first called a colleague of mine, Dr. Daya Mishra, who is obviously a woman, if you would prefer. But Dr. Schoener said you were interested in someone with admitting privileges at the Queen Victoria Hospital, so Dr. Mishra recommended me.”

“I would be very grateful if you would see me. My husband and I have other business at the Queen Victoria Hospital, so it will be convenient.”

“When are you coming exactly?”

“We are leaving this evening from New York and scheduled to arrive in Delhi late Thursday night, October nineteenth, at twenty-two-fifty.”

“Where are you in this current infertility cycle?”

“Day seven, but more important, on Monday, Dr. Schoener estimated five days before the trigger shot should be given.”

“So the last time you were seen was Monday, and everything was fine.”

“Everything was fine.”

“Then I believe I need to see you Friday morning. What time would you prefer? Anytime is good since Friday is a research day and my calendar is clear.”

“I don’t know,” Laurie said. “How about eight a.m.”

“Eight a.m. it is,” Dr. Arun Ram said.

After terminating the call with Dr. Ram, Laurie called Shirley back and thanked her for the referral.

“You’ll like him,” Shirley said. “He’s very smart, has a great sense of humor and good stats.”

“One can’t ask for much more than that,” Laurie said before ringing off.

With all the calls out of the way, Laurie glanced briefly at her watch. It was time to head over to the company to which India had outsourced its visa service. She got out her and Jack’s passports from her briefcase and wedded them with the photos they’d had taken that morning.

With the passports and photos tucked into her shoulder bag along with her mobile phone, Laurie stepped back out of her office and headed for the elevators. When she heard the elevator door open ahead, she quickened her step to catch it and bumped head-on into her officemate, Dr. Riva Mehta, exiting. Each apologized. Laurie actually laughed.

“My, you are in a good mood,” Riva commented.

“I guess I am,” Laurie responded cheerily.

“Don’t tell me you are pregnant,” Riva said. Not only were Riva and Laurie officemates, they were also confidantes. Riva was the only person other than Shirley with whom she had shared all the stresses of the infertility treatment.

“I wish,” Laurie said. “No, Jack and I are making an emergency trip to India.” Laurie struggled with the elevator door that desperately wanted to close.

“That’s terrific,” Riva said. “Where in India?” Riva and her parents had emigrated to the United States when she was eleven.

“New Delhi,” Laurie said. “Actually, I’m on my way over to get our Indian visas. I’ll be back in a half-hour or so. I’d love to talk to you about it and maybe get some tips.”

“By all means,” Riva said with a wave.

Laurie ducked into the elevator car and let the insistent door close. As she descended, she thought about Riva’s comment regarding her mood and realized that she was truly on a high, magnified by the low she’d been on over the last two to three months. Vaguely, she hoped that the strain of infertility wasn’t making her bipolar.

Getting off at the basement level, Laurie hurried down to the autopsy room. Knowing she was going to be in there for only a few moments, she grabbed just a gown and a hat, and pushed in through the main double doors. Although it was almost eight-forty-five, Jack and Vinnie were the sole team working. Several other mortuary techs were preparing cases and putting out bodies, but the associated docs had yet to appear. Jack and Vinnie were well along. The body they were working on already had the large Y incision over the chest and abdomen sutured. At the moment, the individual’s skull cap was off and they were working on the brain.

“How’s it going?” Laurie asked, coming up alongside Jack.

“We’re having a ball as usual,” Jack responded, straightening up and stretching.

“A typical gunshot suicide?” Laurie asked.

Jack let out a short laugh. “Hardly. At this point, it’s pretty clear it was homicide.”

“Really?” Laurie questioned. “How so?”

Jack reached over to the corpse and grabbed the reflected and inverted scalp and pulled it from covering the face back into its original position. High on the side of the head and in the center of a shaved area was a sharply defined circular deep-red entrance wound surrounded by a number of two-to-three-inch black speckles.

“My word,” Laurie exclaimed. “You are right. This is not suicide.”

“And that is not all,” Jack said. “The path of the bullet is steeply downward such that it ended up in the subcutaneous tissues of the neck.”

“How can you guys read so much into this?” Vinnie asked.

“It’s easy,” Laurie said. “When someone shoots themselves, they almost always place the barrel against the skin. What happens then is the explosive gases go into the wound along with the bullet. The resultant entrance wound becomes raggedly stellate as the skin blows away from the skull and tears.”

“And you see this stippling?” Jack said, pointing with the handle of a scalpel to the ring of black spots around the wound. “That’s all gunpowder residue. In a suicide, all that goes into the wound.” Then, turning back to Laurie, he asked, “How far away do you think the barrel was when the gun was fired?”

Laurie shrugged. “Maybe fifteen to twenty inches.”

“That’s exactly my thought,” Jack agreed. “And I think our victim was lying down when it happened.”

“You’d better let the boss know as soon as possible,” Laurie advised. “This is the kind of case that invariably has political fallout.”

“That’s my plan,” Jack said. “It’s amazing, isn’t it, how many cases we see where the manner of death is different after the autopsy than what it was thought to be before.”

“It’s what makes our job so important,” Laurie said.

“Hey!” Jack voiced. “Did you get to see Calvin yet?”

“Oh, yeah!” Laurie said remembering her mission. “That’s why I popped down here. I’m on my way to Travisa to get our Indian visas. Calvin has given us the green light for a week.”

“Damn,” Jack said, but then he laughed before Laurie could get miffed.