Genesis

Chapter 11

May 8th

7:23 P.M.

When Laurie slid out of the back of the Uber in front of their house on 106th Street, she felt more tired mentally and physically than she could ever remember. So far it had been a fourteen-hour day without a lunch break. The only time she had slowed down was during the MRI, when she had to lie still for an hour. And the day wasn’t over yet. She still had to talk with Jack about two things in particular, as decisions had to be made. The most troubling from her perspective was the disastrous positive breast-cancer screening result. She had been tempted to at least broach the issue with him when he’d popped into her office while she’d been on the phone with the chief of Pathology, but she didn’t, thinking there wasn’t enough time to do it justice. Besides, her mind was in total turmoil, with lots of denial about the situation. The other issue she had to bring up before passing out from exhaustion was the need to get the whole story of his apparently disastrous visit to the Brooks School that morning. In retrospect, she wondered what she had been thinking by asking him to go in her stead. Jack had a lot of good qualities, but discretion and impulse control weren’t among them when it came to a medical issue he cared about. She knew full well that the current indiscriminate prescribing of Adderall was a hot-button issue for him, right up there with vaccination conspiracists. He’d done multiple autopsies on kids who had died because of both problems.

Pausing on the top step of the granite stoop, Laurie turned around to look across the street. From that vantage point she had a good view of the outdoor basketball court that was part of the small neighborhood park that also had a few swing sets, sandboxes, and wrought iron park benches. At that hour the sun, which had yet to set, had disappeared behind the buildings to cause dark shadows, and the LED lighting that Jack had paid to have installed over the court was on. From where she was standing, she could see a game was in progress with the shirts and skins alternately sweeping up and down the court, running from one basket to the other. Although she couldn’t be certain from that distance, she thought she could pick out Jack, who was one of the players not wearing a shirt despite the temperature being somewhere in the fifties.

Laurie shrugged. Jack’s continued playing of street basketball was a passion of his that she didn’t share. She just hoped to heaven that he’d eventually see the light and recognize it wasn’t worth the risk of serious physical injury, which he’d already experienced, requiring knee surgery. With a sigh, she pushed through the front door of their building and began the three flights up to their apartment. The higher she went, the heavier her legs and her soft-sided briefcase felt. It almost seemed as if the stairs were longer and steeper than usual. She hadn’t expected to get home so late, but such was the burden of being the chief of the NYC OCME. That evening, just when she thought she’d wrapped up the calls she had to return after doing the autopsy with Aria Nichols, she’d been informed that one of the new Sprinter Medical Examiner Transport Team vans had been in a serious accident while bringing a corpse back to the morgue. Immediately she’d had to coordinate with Mortuary/Transportation, Legal, Human Resources, and the NYPD. Luckily the OCME drivers were wearing their seat belts, and although hospitalized, were doing well. The same could not be said about the vehicle, and it was lucky that the sole passenger was already dead.

After hanging up her spring jacket in the front hall closet and putting on her slippers, Laurie climbed the flight of stairs leading to the fifth floor. Progressively the family room and the kitchen came into view. It was a peaceful scene with JJ at the table in front of his laptop and Caitlin, their nanny, busy in the kitchen. Every single day Laurie thanked her lucky stars that they had stumbled across Caitlin O’Connell. Without her, life wouldn’t have been the same, particularly after Emma’s autism diagnosis. There was no way that Laurie could have continued her role as chief medical examiner if it hadn’t been for the multitalented Irishwoman.

As Laurie reached the top of the stairs, she could now see and hear that the TV was tuned with low volume to the local PBS station, most likely for Caitlin’s benefit. She now could also appreciate that the couch was empty. Laurie’s eyes swept the rest of the room. Emma was nowhere to be seen and most likely already in bed, pulling on Laurie’s heartstrings. Instantly her self-critical mind questioned what kind of mother she was, leaving in the morning before her child was awake and returning when she was already in bed. Laurie knew other women, even those with neurotypical children, struggled with this same issue as it was one of the female burdens in modern society. That recognition didn’t make it any easier.

“Hello, everyone,” she said with more cheer than she felt. She couldn’t help but again find fault with Jack out on the playground, putting himself at risk rather than spending time with his children.

“Hello, Laurie,” Caitlin called out in her sweet-sounding Irish brogue. “How was your day?”

“It was interesting,” Laurie said in an attempt to be truthful. “Is Emma already in bed?”

“She is indeed,” Caitlin said. “Poor thing was exhausted after having to deal with three therapists and Dorothy.”

“How did things go today?” Laurie asked. Her mother, Dorothy, in conjunction with the pediatrician and a psychiatrist with a particular interest in the autism spectrum, had employed a board-certified behavior analyst organization that was handling Emma’s case.

“I think it went very well,” Caitlin said. “Emma happened to have short sessions of behavioral therapy, speech therapy, and physical therapy all in the same day, and she handled it like a champ. Everyone agreed she’s definitely making progress.”

“Terrific,” Laurie said. She was relieved that Emma was responding to the therapies but couldn’t help but feel a little guilty that her progress came about because they as a family had the resources to deal with such an issue. The fact that the United States, supposedly the richest country in the world, made money the deciding factor in health care was a moral and ethical travesty from Laurie’s perspective.

“Want some dinner?” Caitlin called out as Laurie put her briefcase on the dining room table. JJ hadn’t even looked up from his laptop.

“I’ll make some pasta and a salad in a little while,” Laurie said. Such was the usual weekday routine. Whenever Laurie got home, after interacting with the children, she would make some food for Jack and herself. Sometimes Jack helped, but not all the time, and even less when the weather was good like it was now.

Laurie took the seat next to JJ. She could see he was playing Minecraft, his favorite pastime. She watched for a while and, as usual, was impressed with his concentration and his hand-eye coordination. He was building a virtual castle-like structure with blistering speed.

“Aren’t you going to say hello to your mother?” Laurie said at length.

“Hi, Mom,” he said without taking his eyes off the screen or his hands from the keyboard.

“I assume you already did your homework?”

“Yeah, it was easy,” JJ said.

“Maybe you could stop for a minute,” Laurie said. “I want to ask you a question.”

He rolled his eyes, but he did turn away from his computer to look at her. It was obvious he didn’t care for the interruption.

“Your dad stopped into your school this morning,” Laurie said. “Did you know that?”

“Yeah, I saw him.”

“Before or after he spoke with Miss Rossi?”

“Both.”

“Did you talk to him on either occasion?”

“No, we were playing kickball. Besides, he looked mad after he talked to Miss Rossi. His face was all red when he came out and got on his bike. Still, he waved at me, and I waved back.”

Uh-oh, Laurie thought. For JJ to notice Jack was angry was saying something serious. Instead she asked: “How did you do today in school?”

“Fine,” JJ said.

“Any fights out on the playground?” she asked. Aggression was the main complaint the school had communicated, although they were also concerned about JJ’s talking in class, his not following directions, his lack of impulse control, and other symptoms typical of hyperactivity.

“No, no fights,” he said.

“You do know that Miss Rossi is concerned about your behavior.”

“Yeah, I know,” JJ said. “She said if I didn’t get better, I might have to go to another school.”

Good Lord. That was the first she’d heard of a possible expulsion, which raised the stakes. With everything else going on, she couldn’t imagine having to look for a new school for JJ. Instead of responding directly, she asked him if he had any idea why he was fighting and why he was talking so much during class.

“It’s Barry Levers’s fault,” JJ said with conviction. “And people talk to me first.”

“Okay, okay,” Laurie said. The little she knew about child psychology told her that it was almost a certainty that a boy JJ’s age would externalize responsibility as a matter of course. Instead of continuing what would have been a pointless conversation, she asked him if he might show her what he had been building that evening.

“Yeah, sure!” JJ said with great alacrity.

After about a half hour of watching him and Minecraft to the point of feeling a little dizzy on top of her exhaustion, she thanked her son, told him she was really impressed with what he had built, and got up from the dining room table. Climbing the stairs up to the top floor, she went into Emma’s room to look in at her daughter. She appeared just as angelic as she had that morning.

Returning to the kitchen, Laurie set out to clean and prepare salad makings and throw together a simple pasta dish. JJ was still at his computer. Caitlin had retired to her own room down on the fourth floor, as was her habit once Emma was asleep. Laurie was about to put the pasta into the boiling water when she heard the apartment door close. Jack bounded up the stairs a moment later. He was in his shorts and T-shirt and his light-brown hair, tinged with a touch of gray over his ears, was plastered to his forehead. There were circles of sweat under both arms. He was in a great mood.

“Greetings to all,” he said gaily. He tousled JJ’s hair, causing him to duck out of his reach without interrupting his play. Jack approached Laurie, but she held up the spoon she was using to stir the pasta to keep him at arm’s length.

“You need to shower,” Laurie pretended to scold. She didn’t have to pretend too hard, given that she was still irked about the time he spent on the court.

“I believe you’re right,” he responded good-naturedly. “It was a great game tonight. My shots were falling like there was no tomorrow. I couldn’t miss.”

“I’m happy for you,” she said without trying to keep the irony from her voice. “I’ll have dinner on the table in fifteen, so make tracks.”

It was more like twenty minutes later that the food was ready. Jack had shown up dressed in his normal evening apparel, which consisted of a clean T-shirt and sweatpants. JJ had fled upstairs to his own room to avoid being bothered.

“So, let’s hear about Chet’s girlfriend resident,” Jack said as he helped himself to the pasta.

“I have a couple of things to talk about that take precedent,” Laurie said. “First we have to decide what to do about JJ. I feel strongly that we should go ahead and have him professionally evaluated. Not only is it a reasonable idea, but I don’t think we have a lot of choice.” She went on to tell him what JJ had told her the teacher had said to him after Jack’s visit about possibly having to go to another school.

“So, my mini-tantrum supposedly gave Miss Rossi an understanding of why JJ gets into fights on the playground: a chip off the old block.”

“I can’t imagine that JJ would make something like that up,” Laurie said. “You must have really mouthed off.”

“I suppose I did,” he said. “The whole issue irks me to death. He’s just being a normal boy. Hell, I was probably worse if I remember correctly. Boys are competitive with each other. Little scuffles are the norm. I tell you, our child is not going to take Adderall or anything similar. No way.”

“But the school is not insisting he take meds,” Laurie said. “They just want us to agree to have him professionally evaluated, which I don’t have any problem with. Times have changed since you were a kid. Same with me. And having him evaluated is not necessarily going to mean meds are prescribed. We’re the parents. It’s up to us if drugs are to be used.”

“It’s the first step in the process,” Jack said, but with somewhat less emotion. “The pharmaceutical industry has cleverly hoodwinked an entire generation of people to believe boys need medication so that they can sit still like girls. Just having him evaluated means that we’re admitting we think something is wrong with him.”

“I disagree,” she said. “I’m sorry, but you are being ridiculous. You’re starting to sound like one of those conspiracists that you’re always railing against. The better we understand him, the better able we’ll be to make informed decisions. JJ’s school handles conflict very differently than when you and I were in elementary school. And your experience isn’t as relevant as you might think. I’m concerned about his impulse control, and I’d like to learn more about it if we can.”

“So, you really think I’m off base here?” he said.

“Yes, I do,” Laurie said. “We will be having him evaluated to see if a professionally trained person thinks he has an issue that can be addressed in any one of a number of ways. We are not agreeing to drugs. Not by a long shot. I don’t think we have much choice. I’m afraid if we refuse, which I don’t want to do, JJ might be asked to leave the school, and unless you want to find another school for him on your own, we have to respect their concerns.”

“Okay,” Jack said, throwing his hands into the air in surrender. “You win. But I have one stipulation. I want the psychiatrist or psychologist who does the evaluating to be a male.”

“That’s rather sexist,” she said.

“Maybe yes, maybe no,” he said. “It will just make me feel a bit better that the analyst can understand my point of view. Humor me!”

“All right, fine,” Laurie said. She was certain that there were plenty of equally qualified men and women in the field, but if a male therapist made Jack feel better, she was for it.

“Okay, now let’s hear about this resident. What’s her name? Nichols?”

“Yes, that’s her family name,” Laurie said. “Her whole name is Dr. Aria Nichols. But first there’s something else we have to discuss. You never asked me about my breast screening today.”

“You’re right,” Jack said. His face fell, and he guiltily put down his fork, giving his full attention to Laurie. “I’m sorry. The visit to the Brooks School this morning got me all out of whack right out of the gate. I’ve been struggling to get back to some kind of equilibrium all day. Lou’s case of the scalded child added to my general muddle. So, what happened at your screening? Or shouldn’t I ask?”

“The news wasn’t good,” Laurie said. She could feel her anxiety ratchet up as the denial she’d been nurturing all day began to crumble. She was able to appreciate Jack’s feeling out of sorts, since she’d been struggling to maintain her own equilibrium since she’d had the MRI. Even now, it took her a moment to pull herself together. “Initially the mammogram was fine, but then something was found on the MRI. When they repeated the mammogram and did a diagnostic study in contrast to a screening test, they could see the questionable mass on the X-ray as well. It’s a little more than a centimeter, but it is a definite abnormality that has to be evaluated. It’s especially important to be looked into because of my status with the BRCA1 gene and since both my mother and grandmother have had breast cancer.”

“I’m so sorry,” Jack said with obvious alarm. “Oh my gosh! That’s awful and frightening news for you to have to bear. And I sincerely apologize again for forgetting you were having your screening today. There is no excuse, although maybe I’m guilty of a bit of denial.”

“It’s okay,” Laurie said. “I had to process the news myself, so I probably wouldn’t have wanted to talk about it much. At least we’re home now and can think about it relatively rationally. At least I hope so. One of the problems is that it seems so very inconvenient with everything else that is going on with Emma and now this issue with JJ.”

“This is super-important no matter what else is happening,” he said. “Are there any plans in place for the next step?”

“It’s the benefit of being a medical VIP,” she said. “The studies have already been looked at by a coterie of radiological higher-ups who all concur the lump is suspicious even though the fact that I have dense breast tissue makes the interpretation more difficult.”

“So, it will need to be biopsied,” Jack said. “Have you spoken to anyone about it?”

“Absolutely,” Laurie said. “They wouldn’t let me leave until I had spoken with both a surgeon and an oncologist, both of whom specialize in breast cancer.”

“Oh, good Lord,” Jack said. For a moment he stared off with unseeing eyes. Ever since his first family had died in a small plane crash after visiting him in Chicago when he was retraining in forensic pathology, he worried that he was somehow a jinx for anyone he loved. The horrid notion had been underscored by JJ’s being diagnosed with neuroblastoma as an infant. Then the superstitious fear had come roaring back when Emma started to retrogress and was diagnosed to have autism. Now, it was again returning big-time with the threat of Laurie’s having breast cancer.

“Jack, did you hear what I said?” Laurie had reached out to grasp his forearm and give it a squeeze.

“No, sorry,” he replied. He refocused his eyes on her, realizing he hadn’t heard what she had just added.

“I said that both the surgeon and the oncologist want to schedule a biopsy.”

“Yes, of course,” Jack said. He shook his head and breathed out through puffed cheeks, sounding like a tire deflating.

“I didn’t want to schedule anything until I spoke with you,” Laurie continued. “What has to be decided in advance is what should be done if surgical pathology determines it is cancer. At that point it can’t be a discussion because I’ll be under anesthesia. Of course, if it is cancer, the cell type has to be considered to some degree, as does whether there is any spread to the lymph nodes. But complicating all that is that I have the mutation in my BRCA1 gene. Should I just schedule a mastectomy rather than a biopsy?”

“God,” Jack murmured while he cradled his head in his hands for a moment, massaging his temples. When he looked up at Laurie, he added: “I’m sorry, but I’m having trouble processing all this.”

“The oncologist and the surgeon both suggested I just have the mastectomy,” Laurie went on, ignoring Jack’s admission. “But I just don’t know how I feel. I know what Angelina Jolie would say: Go for it. But it seems so drastic to me. And then there’s the issue about my ovaries. Should I have them removed at the same time because of the danger of ovarian cancer from the same mutation?”

“Honestly, these are questions that only you can answer,” he said as he began to get hold of himself. “We had all these discussions back when we first learned you carried the mutation. You were pretty adamant then about avoiding disfiguring surgery.”

“That was then, and this is now,” she said. “I’m a bit older and we have two children, which we didn’t have then. I’m certainly more amenable to the idea now, not that I like it. But do you have a feeling one way or the other?”

“You are a lot more important to me and to our children than your God-given breasts and ovaries,” Jack said. “Obviously I’ll be ruminating about all this, but if you asked for my opinion right this minute, I’d say go for it. Have the mastectomy and the oophorectomy, and if surgical pathology says there’s no cancer in your breast lump then the reconstruction is easier. If it is positive, then the reconstruction is a little more difficult.”

“You think I should go ahead and have both breasts removed?” The idea was still an anathema to Laurie.

“I do,” Jack said. “That’s if you forced me to give my opinion right now. Maybe tomorrow I’ll feel differently, but I don’t think so.”

“As the person in the center of all this, I can tell you one thing that I am absolutely sure of...” she said, fighting back tears, “and that is that I don’t want to put this off. If I have a cancer smoldering in my breast, I want it out today, not tomorrow.”

“I can appreciate that,” he said. “I’m sure I would feel the same. I think everybody would feel the same. It’s like walking around thinking you have a time bomb ticking away inside your body, ready to explode at any moment.”

“Exactly,” Laurie said. She closed her eyes tightly and breathed deeply. After getting reasonable control of herself, she added: “Well, I’m glad I brought it up, as hard as it was. Yet just talking about it is helpful. It’s been in the back of my mind since the MRI.”

“I can only imagine,” Jack said. “I can’t believe you managed to work all afternoon with that on your mind. How could you concentrate on anything? And how the hell were you able to do that overdose autopsy with Miss Congeniality?”

“Your sarcasm is on the money,” she said, managing a mirthless laugh. “It wasn’t easy. Dr. Aria Nichols might be the most unappealing resident who has ever rotated through the OCME. At least in my experience.”

“I’m amazed,” he said, latching on to the change of subject. “That means her behavior, at least to Chet, wasn’t just predicated on his making a pass at her.”

“I don’t think so,” Laurie said. “But there is still room for doubt. According to her, Chet floated the idea that they have a drink sometime when he first met her in his capacity as the director of education at the OCME.”

“There you go,” Jack said. “So, I wasn’t totally off base.”

“Maybe not,” Laurie said. “And I’m afraid I will have to say something to Chet about making sure his off-hours persona isn’t brought in-house. But getting back to Miss Congeniality, she’s a strange bird who might even be sociopathic to some degree. She doesn’t seem to have much empathy or care what other people think of her. She said her father was sociopathic. Do you recall if that has a hereditary aspect?”

“Not offhand,” Jack said. “So, she’s that bad?”

“I believe she is,” Laurie said. “Knowing your sensitivities, you’d be appalled at her vulgar language. In her defense, according to her, she had a difficult childhood and was abused physically by her true father, who committed suicide when she was a young teen, and then abused sexually by her new stepfather.”

“My word,” he said. “You learned all this doing an autopsy with her?”

“She’s remarkably up front,” she said. “But who’s to know where the truth is. According to Chet she openly lied to him.”

“She certainly wasn’t very gracious to me when I introduced myself down in the pit.”

“I wouldn’t take it personally,” Laurie said. “She doesn’t like men in general and said as much.”

“Good grief,” Jack remarked. “She’d better stay clear of me and my openness.”

Laurie laughed in spite of herself. “You are so right. You and she would get along like oil and water. But to give her some credit, she is smart, and Dr. Henderson mentioned she has a gift for surgical pathology. She’s only been here at the OCME a little more than a week and has picked up a rather amazing amount of forensic knowledge from just observing a handful of autopsies. On top of that, she’s a talented prosector. I was impressed with her professional capabilities.”

“What about you? Did you enjoy doing the autopsy even if you found working with Dr. Nichols trying? I know how much you’ve been missing the nuts and bolts of forensics.”

“Very much so,” she said.

“When I was in your office and asked you why you were doing an autopsy when you had made the general decision not to do them, you said you were doing it to evaluate Dr. Nichols but also for political reasons. What did you mean by that?”

“I was doing the autopsy to evaluate the resident,” Laurie said. “But the particular case I was doing as a compromise for NYU.”

“What do you mean?” He picked up his fork and tried a bite of the pasta.

She explained as briefly as possible the circumstances surrounding Kera Jacobsen’s overdose and Dr. Henderson’s and the medical center’s CEO’s subsequent concerns about the media getting wind of the autopsy. Jack whistled.

“Well, I hope you don’t get inundated with requests to do autopsies because you agreed to do this one,” Jack said.

“I hope so, too,” Laurie said. “Not too many people here in the OCME know I did it. With most everyone upstairs in the afternoon conference, I thought I could sneak it in. I told Marvin and Vinnie to keep it to themselves.”

“Good try, but something like this is not going to remain a secret,” he said. “But, be that as it may, was the case successful in accomplishing what you wanted?”

“Very much so,” she said. “First of all, I enjoyed it. Just getting away from all the headaches of being chief of the OCME for an hour was a professional delight. Second of all, it turned out to be a much better case than I expected for changing Miss Congeniality’s appreciation of forensics. It wasn’t such a garden-variety overdose case. Although there was a positive rapid test for fentanyl on the fluid in the syringe, there was little pulmonary edema and no cerebral edema. And there was a surprise finding: the patient was pregnant. About ten weeks, from the looks of it.”

“Why would a pregnancy have that kind of an effect on our sociopath?”

“It has to do with her mistrust of men,” Laurie said. “Since the patient wasn’t found for several days and wasn’t discovered by the father of the child, she’s convinced the father had something to do with the drugs.”

“That’s quite an assumption,” Jack said.

“I felt the same,” she said. “But I could tell she was truly interested in investigating the case further to make sure of the manner of death. Before the autopsy, she told me that she thought forensics was a waste of her time. Now she’s truly motivated. Who knows, maybe I’ve been responsible for a new convert to forensic pathology.”

“God forbid with her personality,” Jack said. “Would you have her here as a fellow?”

“Not on your life,” Laurie said with a laugh. “She told me she hates patients, which was the reason she went into pathology: to avoid them. Little does she know how often we have to deal with bereaved families. They are our patients, not the corpses. She’d make a terrible forensic pathologist.”

“How is she going to investigate the case?” Jack asked.

“I’m assuming she would do it just the same as you or I,” Laurie said. “She’ll talk to all the people involved, like the woman who found the body, probably the patrolmen who answered the nine-one-one call, maybe the neighbors, and maybe other friends she can find. It will be interesting if she finds the father to get his side of the story. Then when toxicology is back, we’ll know a bit more about the cause of death and that can be added in to the equation. My hunch is that the fentanyl level is going to be really high to explain the lack of pulmonary edema. Kera Jacobsen didn’t suffer with a progressive suppression of her breathing like usual. She died very rapidly.”

“That’s enough about this sociopathic resident,” he said. He pushed away his bowl of pasta. “I’m sorry, but I’m not hungry after hearing about what happened today at your screening. I think you should seriously consider the definitive solution. I feel even stronger than I did ten minutes ago.”

“I appreciate your thoughts,” Laurie said. “I’ll sleep on it.” Although she was generally a night person who normally got a second wind sometime during the evening, tonight was different. Just mentioning the word sleep made her feel like she might have trouble getting up to the bedroom. She pushed back from the table and stood up on mildly wobbly legs. “I’m not even sure I’ll be able to stay awake to take a bath.”

“You go ahead,” Jack said as he, too, stood. “I’ll clean up here and see you upstairs. But first I need a hug.”

She welcomed him wrapping his arms around her. After giving her a gentle kiss, he leaned back, still holding her tight. “You are the most important thing in my life. I want you to know that.”

“Thank you,” Laurie said. “This isn’t easy for me, but I’m glad we have each other.”