Genesis

Chapter 27

May 10th

6:45 A.M.

The weather was perfect and at least for a few minutes Jack wasn’t thinking and wasn’t worrying, he was just enjoying himself as the wind whistled through his bicycle helmet. He was on the West Drive in Central Park heading south, perched on top of his relatively new Trek road bike, and pedaling to beat the band. When he’d just joined the roadway up near 106th Street, he’d happened upon a group of serious, significantly younger bikers all decked out in expensive biking finery and riding custom-made bikes from Italy or France. He loved to ride with these guys because they took themselves inordinately seriously and looked down on his wearing a corduroy jacket, jeans, a chambray shirt, and a knit tie. He got a kick out of not only keeping up with them, but challenging them, particularly on the uphill sections. Because of his pickup basketball, Jack was in superb cardiovascular shape.

He had not slept that well, which seemed mildly ironic because Laurie had. Now that she’d made up her mind about her surgery, she could relax, while the immediacy of it had the opposite effect on Jack. This morning had been his turn to wake up early and wander around the apartment, stealing long looks at his sleeping children. As he had said to Laurie the previous day, he wished it was he who was having the surgery. If that had been the case, there was no doubt in his mind that he would have been fast asleep at that point, waiting for the alarm and not being tortured by dark thoughts concerning Laurie’s well-being.

At the southeast corner of the park, Jack bid farewell to his fellow riders with a nod of his head as he peeled off, going south on East Drive while they went north. When he got to the Grand Army Plaza, he headed south on Fifth Avenue. It was his normal route, which he followed without giving it much thought. At that time in the morning the traffic was light. Although not that many years ago he used to challenge taxis on his morning commute, he didn’t do that anymore. In that regard he’d become relatively conservative now that he had family obligations.

Eventually he traveled east over to Second Avenue. This was the only portion of the bike ride that he varied on a whim from day to day. On this particular morning he took 54th Street. As per usual, he looked forward to getting to the OCME. Work was one of the ways that Jack dealt with his submerged anxieties, and whenever something was bothering him, he invariably worked harder. Yesterday he’d done four autopsies and the day before, five, such that cases were piling up on his desk, crying out to be completed. In contrast to most of the other medical examiners, he preferred to be in the pit actually doing the autopsies rather than the more sedentary aspect of sitting at his desk collating all the material to complete the death certificate. At least that was his preference unless there was a particularly challenging conundrum. Jack loved to do field work even though he was supposed to leave that aspect up to the medical-legal investigators. The problem was that Jack was trained at a forensic program that encouraged the medical examiners to go out in the field when it would be helpful, and from day one at the NYC OCME he’d strained at the limitations.

On reaching Second Avenue, he turned south. Here the traffic was significantly lighter than usual, which gave him a chance to think. After his run out on the neighborhood basketball court last night, where he didn’t play up to his expectations with everything on his mind, he’d had another talk with Laurie about Dr. Nichols. Laurie had told him that although she didn’t mind continuing to collaborate with her regarding the autopsy she’d done with her, she didn’t have the time or energy to deal with the problem her general performance created. She said she was going to tell Chet that it was up to him but wanted to encourage Jack to lend a hand without making the situation worse. Jack had promised he’d do so, which was going to require him to be more accommodating than usual.

As was his customary habit, he rode his bike down 30th Street alongside the OCME building and entered at the loading dock. Hefting his bike onto his shoulder, he brought it inside and locked it in its usual location not far from the autopsy room. From there he went up to the ID area on the ground floor, where the day started for all the medical examiners. Since it was only 7:15 there were only two people in the room, Dr. Jennifer Hernandez and Vinnie Amendola. Jennifer was there because it was her week as a junior ME to be the on-call ME, one of whose jobs was to go over the cases that had come in overnight, decide which of them should be autopsied, and to divvy them up to the various MEs. Vinnie, one of the more senior mortuary technicians, was there to make sure the transition from the night shift to the day shift proceeded without a hitch and, maybe more important for the OCME community, to make the coffee in the communal coffee pot.

As Jack passed Vinnie, he swatted the newspaper Vinnie was holding up in front of his face, totally engrossed in the sports pages. Vinnie didn’t respond overtly because Jack did it every day. When he first started doing it years ago, Vinnie used to visibly jump and complain. But after so many repeats, he took the harassment in stride in the vain hope Jack would tire of it.

Approaching the desk where Jennifer was sitting, Jack said, “What kind of night was it? Are people still dying to get in here?”

“Very funny,” Jennifer said. “It was a relatively busy night.” Jack was known for his black humor, which some people thought was clever, others less so.

“Any intriguing cases?” Jack asked. It was his modus operandi to cherry-pick cases according to his interests, which was why he made it a point to arrive before anyone else other than the ME on call. Most of the other medical examiners tolerated this behavior because everyone knew that he did more cases than anyone else, a lot more.

“Quite a number of interesting cases,” Jennifer said. “Especially if you find getting run over by a subway train interesting.”

“Was it accidental or suicide?” Jack questioned. In general, he didn’t find such cases particularly interesting since the OCME saw about thirty of them a year. When a person got hit by a train there wasn’t a lot of question what killed the individual. Jack liked mysteries and challenges.

“Neither,” Jennifer said. “It’s possibly a little complicated, or so the MLI thought, and the MLI was Bart Arnold.”

“Complicated how?” he asked, immediately becoming interested.

“The subway part wasn’t accidental or suicide,” Jennifer said.

“You mean, someone pushed the victim in front of the train?” Jack asked. Unfortunately, that was becoming more common of late.

“Yes. According to Bart it was a homeless-appearing man who fled the scene,” Jennifer said. “The police are still going over the video feeds, and as of yet there are no suspects in custody. There’s also several eyewitnesses. But here’s the catch: There were almost twenty-four hours between the event and the death, with the patient having spent the time in the Bellevue ICU, where she had been conscious and oriented. She had survived getting run over by the train. The terminal event was a heart attack.”

“Hmm, the plot thickens,” Jack said. “I get your point. If a good defense attorney could convince a jury that the death was due to something that was done in the hospital to cause a heart attack, a suspect could potentially get off with a slap on the wrist.”

“That’s the fear,” Jennifer said.

“Let me take a look,” he said. He took the folder from her and quickly read through Bart Arnold’s investigative report of Madison Bryant. As the head of the MLI unit, combined with his years of experience, Bart’s work was always top notch. Besides describing the victim as an NYU hospital social worker, he had laid out the problem just as Jennifer had described. Prior to the final heart attack or ventricular fibrillation, there had been no history of heart disease, and there had been no symptoms or signs of impending heart trouble during the time she was in the emergency room or in the ICU.

“It’s got me hooked,” Jack said. “Mind if I take this one to start?”

“Be my guest,” Jennifer said. “How many more do you want? There are plenty to go around today.”

“As many as you need to give me,” Jack said with a smile. Normally he would go through the rest of the stack to see what else caught his eye, but he was adequately intrigued with the Madison Bryant case. For him it was a good way to start the day and get his mind off Laurie’s upcoming surgery and JJ’s imminent psychological evaluation, the two things that were weighing him down.

“There’s a case of a high school baseball player that looks interesting,” Jennifer said. “He got hit in the chest with a baseball.”

“That sounds good, too,” he said. “Put my name on it. I’d also like to ask you to do me a favor.”

“Of course,” she said.

“If and when the NYU pathology resident Dr. Nichols decides to show up, would you tell her she has been assigned to work with me once again?”

“Does Dr. McGovern know about this?” Jennifer asked.

“He does indeed,” Jack said. “We discussed it yesterday late afternoon.”

“I’ll be happy to tell her,” Jennifer said.

Jack walked over to the overstuffed easy chair where Vinnie was sprawled and this time snatched away the newspaper. Vinnie clawed after it but without bothering to sit up. This paper grab was also a daily pantomime. He and Vinnie had been working together for so long that teasing each other had become ritualized.

“We have work to do,” Jack said, keeping the paper just out of Vinnie’s reach for a few beats before giving it back.

“Why can’t you act like every other civilized medical examiner and start at eight or even nine?” Vinnie griped as usual.

“The early bird gets the worm,” Jack repeated for the thousandth time.

“I haven’t finished my coffee,” Vinnie said, pretending to go back to reading his sports page.

“Actually, I have a surprise for you,” Jack said, catching Vinnie off guard. This statement was not part of the usual script.

Vinnie lowered the paper and regarded him quizzically. “What kind of a surprise?”

“Remember the gracious debutante we had assist us yesterday on our first case?”

“You mean Dr. Nichols?”

“None other,” Jack said. “I’ve invited her for an encore.”

“Why?” Vinnie complained.

“It’s too long a story for your pea brain,” he said. “But I want you to be on good behavior for a change.” He then dropped Madison Bryant’s folder in Vinnie’s lap. “Let’s go, big guy.” He extended his hand and hoisted Vinnie to his feet.

In the elevator on the way down, Vinnie reiterated his question about why Jack was willing to work with Aria Nichols. “It doesn’t make sense after the way you carried on yesterday when she disappeared at the end of the gunshot case.”

“As I said, it’s a long story, but a condensed version is that she’s giving Dr. McGovern a hard time, and I offered to help.” Jack didn’t say anything about Laurie and her specifically asking him to lend a hand with Aria so that it was one problem she didn’t have to think about. He knew that Laurie had yet to announce that she would be having surgery except to the deputy chief, so the rest of the OCME was in the dark.

Working in tandem, which was the way they always handled the first case of the day, Jack helped Vinnie get Madison Bryant’s body put out on table #1 and the X-ray up on the screen. The endotracheal tube that had been inserted during the resuscitation attempt was still in place, which was standard procedure with such a case. Jack removed it after making sure it had been positioned properly.

“She looks pretty damn good for having been run over by a train,” Jack commented as he continued his external exam. He and Vinnie had noted the broken left humerus, the three broken ribs, and the linear skull fracture on the X-ray, as well as the missing left foot.

“We’ve seen worse with people falling off their front stoop,” Vinnie agreed.

“My sense is that she fell headfirst between the rails,” Jack said, examining the scalp laceration that had been sutured in the emergency room after the area had been shaved. “Had it not been for the foot getting caught, she might have been able to walk away.”

“I don’t know,” Vinnie questioned. “I kind of doubt it, considering that skull fracture.”

“You’re right,” Jack said. “I wasn’t being literal because she was probably knocked out cold. But she looks a hell of a lot better than my last subway victim, who appeared as if he’d been practically skinned alive.”

Using one of the digital cameras, Jack took photos of all the injuries. He also drew them on a schematic diagram and indicated their size and location by referencing various anatomical landmarks. As he was finishing taking urine and vitreal samples, he caught sight of Dr. Nichols pushing in through the swinging entrance doors. Jack was surprised. It was only 7:38, an hour earlier than yesterday. He watched her as she approached, noticing even from a distance that she had an aura of confidence, almost arrogance, as if she owned the place. Jack girded himself, sensing that the morning might be more difficult than he’d anticipated.

Without acknowledging either Jack or Vinnie, Aria marched up to the autopsy table, gloved hands and arms akimbo. She stared down at the cadaver. Jack and Vinnie exchanged a glance, during which Vinnie rolled his eyes.

“Holy fuck,” Aria said to no one in particular. Vinnie winced as if he’d been slapped, knowing what Jack’s response was going to be to her choice of words.

“Excuse me?” Jack blurted. He’d heard but wanted to pretend otherwise. He thought he’d prepared himself for this woman, but it was obvious he hadn’t. With great effort he controlled himself and merely said: “Dr. Nichols, such language offends me, and I have to ask you not to use it. I’m old-school, and I find it disrespectful to me, to this patient, and to the institution.”

“I know this woman,” she said, ignoring Jack’s comment. She was still staring at the body on the autopsy table and acting as if she were angry.

“Did you hear what I said?” Jack pressed.

“This is fucking unbelievable,” Aria said, seemingly hypnotized and angered by the sight of Madison Bryant’s body. “I know this woman. She was supposed to help me with the Jacobsen case I did two days ago, since she worked with her and was her goddamn best friend. I don’t believe this! First, she goes and gets herself hit by a train and now she fucking dies. What is this, a conspiracy?”

Jack felt his face suffuse with color as his blood pressure headed north. Not only was Aria’s language threatening to drive him up the wall, so was her total lack of empathy for this victim of a horrible crime and possibly a therapeutic complication. He was at a definite crossroads: Either he was going to bodily toss this antisocial woman out of the autopsy room, or he was going to have to accept that some of his old beliefs needed to be updated and modified with the times. In his mind he counted to ten as he reminded himself of his promise to Laurie not to make the Aria Nichols situation worse. Throwing her out of the autopsy room would definitely cross that line.

“Somebody must have screwed up over there in the Bellevue ICU big-time,” she continued. For the first time since she’d marched into the room, she looked Jack in the eyes. “I was over there yesterday and was told she was stable and doing well. How the fuck could she die? She was a healthy young woman as far as I know.”

“How she died is what we need to find out,” Jack managed. He had to restrain himself from dashing out of the autopsy room to find something to vent his anger on just to get himself under control.

“Where’s the goddamn folder?” Aria demanded, as if she were in charge, and seemingly totally oblivious of the effect she was having on Jack.

“It’s over on the countertop,” Vinnie said, pointing.

Aria strode over, flipped it open, and rummaged through the contents until she found Bart Arnold’s investigative report. She pulled it out and started reading. Meanwhile Jack and Vinnie exchanged another glance but didn’t speak. Vinnie could tell just by looking at Jack that he was struggling with his self-control, and Vinnie didn’t want to become the spark that ignited a conflagration.

“Ventricular fibrillation!” she called out when she finished reading. She replaced the investigative report in the file and came back to the table. Neither Jack nor Vinnie had moved.

“In my book, ventricular fibrillation is a diagnostic sign, not a diagnosis,” she added. For the first time her voice was calm and reflective, as if her anger had somehow evaporated after reading the MLI report.

“You’re right,” Jack managed to say. Somehow, he was finding the strength to avoid an explosive confrontation with this insensitive, self-centered woman. What helped was her sudden change of tone along with her avoidance of any further vulgarities, making him optimistically wonder if perhaps they had reached a secret bargain. Hoping to start a reasonable conversation, he said, “What are your thoughts about the causes of ventricular fibrillation?”

“Are you gearing up to provide me with another lecture?” Aria asked in a supercilious tone. “If you are, I’d prefer you don’t, if you don’t mind.”

“I’m just trying to understand your thinking before you begin doing the autopsy,” Jack said.

Aria eyed Jack with obvious surprise. “Are you suggesting that you want me to do the autopsy?” she asked hesitantly.

“That’s what I have in mind.” It had been a sudden decision when he remembered Laurie’s comment about the pathology resident’s rotation not being challenging enough. He also recalled Laurie’s compliments about Aria’s prosecting ability. Combining the two by giving her more responsibility had suddenly suggested itself as a way to deal with her aggravating antisocial eccentricities.

“Well, that’s a step in the right direction,” she said. “Okay, here’s what I think. In general, the causes of ventricular fibrillation are usually related to preexisting heart disease of some sort, like a previous heart attack or a congenital heart defect or the history of a channelopathy. Of course, cardiomyopathy could cause VF, too, as well as some drugs like cocaine or methamphetamine. The only other things I’d keep in mind are the possibility of electric shock from some malfunctioning hardware or electrolyte abnormalities with potassium, magnesium, or calcium.”

“Very well said,” he remarked with surprise. He was actually impressed and for a beat stared at her, thinking she was a piece of work yet clearly medically knowledgeable despite her behavioral issues. “With all that in mind, what might you be expecting to find on this case?”

“Statistically I’d put money on previous heart disease either acquired or congenital,” Aria said. “Probably the most important part of the forensic autopsy will involve the careful examination of the heart. But knowing she was on intravenous fluid in an ICU unit for almost twenty-four hours, I’d want to get electrolyte levels and a toxicology screen. And there is always the possibility of deep vein thrombosis and embolism, especially after the trauma she suffered.”

“Vinnie! Would you mind handing the lady a scalpel?” Jack said. “Time’s a-wastin’. Let’s get this show on the road!”