Genesis

Chapter 10

May 8th

6:42 P.M.

Aria walked north along the east side of First Avenue, passing the famed and busy Bellevue Hospital on her right. Although it was almost seven P.M., sunset wouldn’t come for an hour or so. Despite wearing only a cotton blouse, her favorite pair of jeans, and her resident jacket, Aria wasn’t cold in the slightest although she knew things would change after the sun went down. Overhead, the sky was shockingly clear with only a few puffy clouds. To her right, the tops of the tall buildings were bathed in a golden glow of late-afternoon sun.

As soon as she had exited the OCME high-rise, Aria had placed the call to Dr. Henderson as he had requested in his text. As she did so, she had felt her pulse mildly quicken. It was rarely a good sign to be contacted by the front office, particularly after hours. Adding to her unease, she’d never had any dealings with the head of Pathology despite lots of dicey run-ins with the director of the pathology residency program, Dr. Gerald Zubin. Aria was well aware she was not considered a team player and accordingly had been continually balanced on a knife edge from the first days of her residency. Right out of the gate she’d bucked the system by refusing to do tasks dictated mostly by men and only because that was the way it had always been done. Her argument was that rules had to make sense. Even more disruptive, she’d made it a point to do as little scut work as possible, particularly during that first year of residency, when a lot of nonsense trickled down to those on the lower rungs of the totem pole as a kind of hazing. Yet through it all, here she was, poised to make it to her final year of residency in a little more than a month, provided the chief of the Pathology Department hadn’t been looking for her to try and suggest otherwise. Still, she was confident she could handle just about anything at this point, since she had proved she was significantly smarter than most of the male authority figures occupying the front office.

Although she’d been a tad anxious when the chief of the department had answered the call, the anxiety had quickly evaporated as his tone was congenial from the get-go and the conversation turned out to be remarkably benign. Instead of him being pissed that she’d violated some old, senseless rule or tradition of academic medicine like not taking the Forensic Pathology rotation seriously, he’d been surprisingly gracious, even indulging in a little small talk about how nice the weather was before getting to the reason for the call. “I would very much like to talk with you, preferably right now if you are available,” he’d said. Asking to see her right away was mildly ominous, but his tone wasn’t accusatory and in truth she was more curious than concerned.

As she passed the old, squat, and crumbling OCME Forensic Pathology building on the corner of 30th Street, she thought about the conversation she’d just had with David Goldberg. She’d not learned much, but what she had learned supported her intuition that the unknown father certainly needed to be found to learn of his possible role in the fatal dose of illicit drugs. She had almost laughed that afternoon at Dr. Montgomery’s flowery paean of forensic pathology as “listening to the dead tell their stories.” It was so hokey. Yet now, Aria had to admit that Kera Jacobsen seemed to be communicating with her on some level via the mother’s describing Kera as being recently “down,” and through the neighbor who said that Kera had been having late-night visitors once or twice a week. All this meant there was covert sex going on, meaning one of the couple or both didn’t want their liaison to be public knowledge, which was mildly suspicious in and of itself, and that the potential arrival of a little one didn’t bring joy to one or both of the participants. From Aria’s experience, it had to be the mysterious father who was less than enthused, ergo the tragic outcome.

Just beyond the OCME building loomed the multi-block New York University Medical Center. Cars were backed up while attempting to get into the parking garage. Aria had to squeeze through the waiting autos to continue north until she could enter the building that housed the Department of Pathology. Although she’d never been in Dr. Henderson’s office, she was familiar with its location since it was down the hall from the director of the pathology residency program’s office, where she’d been called on the carpet on far too many occasions.

As soon as she stepped off the elevator, it was apparent that most everyone in the department had left for the day. The only people present were two of the medical center’s janitors busily vacuuming the wall-to-wall carpeting and who ignored her as she passed. Dr. Henderson’s private, corner office was down at the far end. The door to the inner office was open. Aria walked in without bothering to announce herself. Rules of etiquette and kowtowing to supposed superiors were not of her concern. Thanks to her fashionable spring-inspired pink leather sneakers, she didn’t make a sound.

Pausing just inside the door with the realization she’d not been seen, Aria took the time to glance around at the office’s interior. It didn’t give her a good feeling as it reminded her of her father’s home office in their Greenwich, Connecticut, mansion overlooking the Long Island Sound. For her the décor had the same hackneyed male ambiance, with its dark wood, lots of books supposedly attesting to intellectual and cultural prowess, and framed photos of the occupant indulging in various sports or posing with celebrities. There was even a signed football in a plexiglass case to complete the similarities.

Still unnoticed, Aria directed her attention to the chief’s profile. He was sitting at his desk staring intently at his monitor, which was angled away such that she could see the screen. Although she had never spoken to the man in person, she’d seen him at a multitude of departmental functions. As a resident she was required to attend a bewildering number of conferences, seminars, case presentations, and meetings of all types, and the chief came to a fair number of them, often eloquently introducing the various speakers, especially the famous doctors or researchers from particularly prestigious institutions. He was always dressed in a long, shockingly white and highly starched doctor’s coat over a wrinkle-free white shirt with a carefully knotted, brightly colored — but usually pink — tie. As a mild clotheshorse herself, Aria appreciated this aspect of the man’s persona. At the same time, she couldn’t help but see him as the entitled, chauvinistic male authority figure that he undoubtedly was, and for that Aria was on guard despite his graciousness on the phone.

Moving closer, she was a bit surprised she’d not been seen or even heard. She imagined it had something to do with the hypnotic sound of the vacuum cleaners drifting in through the open door, progressively getting louder, suggesting the janitors were approaching this end of the floor.

Reaching the desk and still undiscovered, she was suddenly seized by a mildly devilish way of making her presence known. With the flat of her palm, she reached out and slapped the surface of the desk several times in a row. The result was almost as comical as it was predictable. The man leaped to his feet with such suddenness that his desk chair tipped over backward. Aria did all she could do to keep from smiling.

“My God,” Carl said while pressing his palm against his chest. “You scared the daylights out of me.”

“I’m so sorry, Dr. Henderson. I called out several times but couldn’t get your attention,” she lied, while laughing inwardly.

Carl righted his chair. For a moment he seemed mildly addled and stared at her as if trying to recover. Aria noticed he somehow managed to look as fresh as if he’d just put on his shirt and tied his tie. She also noticed he wore cuff links, which was not common for a doctor in her professional experience.

“Ummm, let’s see! Can I get you something? Coffee? A soft drink?”

“I’m fine,” Aria said. “Actually, Dr. Henderson, I’m a little busy. On the phone you suggested there was something you wanted to talk to me about immediately. Maybe you could just tell me what it is, so we can both go about our business.”

“Of course. But please, call me Carl.”

“If you’d like,” she said, but her guard went up a notch with the implied and questionable familiarity.

“I would like,” he said, regaining his usual poise. “I’m sorry that you and I have never met on a personal basis and hope that can be changed in the near future. I’ve tried to make it a point to personally meet everyone who is part of our Pathology team over these past two years. To that end, my wife, Tamara, and I have been inviting the staff over to our home in New Jersey for dinner, and we’re just now getting to do the same with the residents.” He smiled. “Do you mind if I call you Aria?”

“I suppose not,” Aria said. She couldn’t think of anything she’d like less than to go to the Henderson manse for dinner. She hoped the reason for this impromptu meeting wasn’t merely to extend a dinner invitation.

“How about we sit over on the couch,” Carl said, pointing across the room to a dark, tufted leather sofa, similar to what Aria’s father also had in his study.

“I suppose,” she said, even though she wasn’t wild about the idea as it added to her unease.

Carl came around his desk, stepped over to the sofa, and gestured for her to sit. As soon as she had, he joined her. She purposefully sat at the very right end of the sofa next to a side table. On the table was a small Eskimo statue carved in black stone. It gave her peace of mind to have a heavy, blunt object within reach if she needed it.

“I have heard quite a bit about you from Dr. Zubin,” Carl said as he crossed his legs and folded his arms across his chest.

“Don’t believe everything you hear,” Aria said.

“The part I want to believe is about your exceptional forte with surgical pathology.”

“That’s my major interest,” she said. “But could you get to the point here? As I said, I’m busy.”

“Yes, of course,” he said. “First, I’d like to be perfectly open with you.”

“That’s a start,” Aria said. Now that she was sitting reasonably close to the man, she realized that his projected persona reminded her of her father. It had nothing to do with the similarities of the respective offices nor their personal appearances, but rather it was a sense of male cockiness that she despised. The self-satisfied way he had his arms folded was exactly a posture her father would often assume before giving her unwanted advice, and it rubbed Aria the wrong way. She had to resist standing up and walking out.

“First, I want you to know I spoke with Dr. Montgomery twice today. On one of the calls, I’m sorry to say, she implied that your attitude and performance at the OCME had not been up to standard. Are you surprised to hear that?”

“Not at all,” Aria said. “I was open with her. I told her I felt I was wasting my time at the OCME. Forensic Pathology should be an elective, not a requirement. In just a few days over there, I believed I had gotten all that I wanted or needed, so I chose to come back over here in the afternoons to go over the day’s surgical pathology cases. The OCME’s director of education had the nerve to follow me back here one day and bawl me out, the creep.”

“That’s unfortunate,” Carl said. “But Dr. Montgomery also had some good things to say. She told me that she did a case with you this afternoon and was extremely complimentary about how you handled it.”

“It wasn’t difficult,” Aria said. “And in my experience, forensic autopsies are a hell of a lot easier than clinical autopsies. But then again, I haven’t done any gunshot wounds yet, which I’m told can be a bear.”

“She also mentioned that there was a surprise finding,” Carl said. “The patient was about ten weeks pregnant.”

“That’s correct,” she said. The sound of the vacuum cleaners through the open door reached a crescendo and then began to fall off.

“Dr. Montgomery also said that this finding seems to have turned your attitude about forensics around a hundred and eighty degrees. She told me that you are seriously committed to look into it almost on an emotional level.”

“She said that? ‘On an emotional level’?”

“Yes, she did,” Carl said. “And this is why I felt I needed to talk with you. The president and CEO of the hospital, Vernon Pierce, and I are concerned about this case, as is the dean. You do know that the patient, Kera Jacobsen, was part of our NYU Medical Center family?”

“Yes, I’m aware,” Aria said.

“And I assume you are aware that our community has made a big commitment to doing whatever we can to stop this opioid overdose scourge.”

“I suppose,” she said. From her perspective it was more lip service than commitment.

“Even before knowing about the pregnancy, we were concerned enough to offer to do the autopsy here in our theater to make sure that it doesn’t become fodder for the city’s tabloids. As you undoubtedly know, they love this kind of lurid stuff because it sells papers and encourages conspiracy theories in an age when conspiracy theories are in vogue. If this story does come out in the tabloids, it could put the medical center in a very bad light and negate advertising efforts we’ve been making over the last couple of years. Are you aware that on occasion privileged information has leaked out of the OCME?”

“I suppose,” Aria repeated yet again. She’d gotten the message that NYU was concerned about publicity and wondered why Carl was beating a dead horse. It wasn’t rocket science.

“What is it about this case that has caught your interest? I mean, I’m glad you’re suddenly taking advantage of the fabulous experience the NYC OCME affords our residents, but why has it been this case particularly? Vernon Pierce asked me to ask you. He’s even more afraid this unfortunate overdose of one of our own will turn into a publicity nightmare than I.”

She started to respond, but he interrupted her by saying: “I should warn you that Mr. Pierce might be contacting you directly, so you should be prepared. Have you ever met him?”

“No, I haven’t,” Aria said. Nor did she want to, but it certainly begged the question of why the hospital president would be so concerned about the passing of one social worker out of the thousands of people who worked in the medical center.

“Well, he might call. He even went so far as to ask me for your number. As you can imagine, he’s also taken an interest in this social worker’s death for obvious reasons,” Carl said. “Sorry to interrupt earlier! What were you about to say?”

“Regardless of possible publicity implications, I think the father has to be found,” Aria said with rising anger. “The goal of forensics is to determine the manner and cause of death. Because of the opioid crisis, it’s natural to think that the cause of Kera’s death was a drug overdose, particularly an overdose of fentanyl. And fentanyl was already found on a rapid test of the drugs found at the scene. Yet there was little or no pulmonary edema at autopsy, which is, as I understand it, always found with a fentanyl overdose. There was also no scarring on Kera’s arms that would indicate a long-term drug problem. In fact, before we stumbled onto the fetus, I was thinking of a channelopathy as the cause of death, even if it wasn’t related to fentanyl. I mean, is there an association with fentanyl and exacerbation of a channelopathy?”

“I have no idea,” he said. “I’m not sure if anyone would know the answer to that.”

“So, the cause of death in my mind is up in the air,” she said. “And now let’s think about the manner of death. Obviously, there’s a knee-jerk reaction to calling an opioid death accidental. Most drug users don’t want to kill themselves, which is why overdoses are labeled accidental. But with Kera I’m not so sure I’m willing to jump on the accidental bandwagon. Here was an unmarried, educated woman having a covert love affair. Why the need for the big secrecy? In all likelihood it was the father who insisted on keeping the relationship hushed up. It just stands to reason. If that is the case, and I believe it is, why wasn’t Kera’s body found earlier than it was? To me, that’s not a rhetorical question. Why didn’t the boyfriend find the body instead of letting it rot for two or three days?”

“Are you asking me?” Carl questioned. He was clearly impressed with her line of reasoning. After being at the OCME for just over a week she was sounding like an experienced forensic pathologist.

“What I’m doing is asking myself,” Aria said. “How was this unknown boyfriend involved in this drug overdose? Did he supply the drugs? Did he participate in some way? I think these are reasonable questions because maybe Kera’s death wasn’t accidental. Hell, it could have been homicide.”

“You’ve convinced me,” Carl said without hesitation. “Wow! It sounds to me that you are getting a lot more out of your forensic rotation than most pathology residents, myself included. Now you have me personally engrossed in the case, whereas before I just wanted it to go away. However, it also makes it even more imperative for you to keep it all close to your chest and tell no one of your suspicions and progress except, of course, Dr. Montgomery. She told me on the phone that she asked you to keep her informed of what you’re up to. I’d like you to do the same for me since I’ll need to keep Vernon Pierce up to speed. If your worst fears are realized, this case could be a true publicity nightmare for the medical center, and I’d like to be able to brief the head of our publicity department as well as the president before the press gets wind of it. If it turns out this overdose wasn’t accidental, there is no way to keep the press from becoming involved.”

“That’s probably true,” Aria said.

“So, your current goal is to try to find the father.”

“Yes,” she said.

“How are you going to do that?”

“I’m going to start by talking to the coworker who found the body.”

“Who was that?” he asked.

“A social worker named Madison Bryant. The medical-legal investigator on the case said that she and Kera Jacobsen were close friends. My hope is that she’ll know something that could be key.”

“When do you intend to talk to her?”

“Whenever works,” she said. “I’ll see if she’s available tomorrow. If not, then the next day.” She shrugged.

“I’m glad you are involved in this case, Dr. Nichols,” Carl said. “Good luck!”

“Okay,” Aria said. She stood. “I’ll be happy to keep you and Dr. Montgomery informed of any progress. And I understand the publicity issue.”

“And I’ll try to find out if anything is known about any association between cardiac channelopathies and fentanyl,” Carl said. He got to his feet as well. “If I do, I’ll let you know right away.”

“Whatever,” she said. “I’ll be in touch.”

“And I’ll be looking forward to hearing from you,” Carl said.

She hustled down the center of the empty office. The janitors had departed and most of the lights had been switched off. As she waited at the elevators appreciating the silence, she thought back over the short meeting with Dr. Henderson and tried to get past her reflexive dislike of male authority figures. Although a tad weird, the tête-à-tête hadn’t been all that unpleasant. To her the most unusual bit of information was the surprising interest of the medical center’s CEO, Vernon Pierce. Then she remembered telling Dr. Henderson that she wanted to start trying to find Kera’s lover by talking with Madison Bryant tomorrow, yet the more she thought about that idea, the less possible she thought it might be. As a hospital social worker, Madison Bryant most likely would be booked the whole day. Although it was late, Aria suddenly thought it reasonable to give the woman a try and see if she might be available that evening. After fumbling in both side pockets of her white coat, she got out the index card from David Goldberg. Then she took out her phone and punched in Madison Bryant’s number, hoping the woman would be available.