Genesis

Chapter 4

May 8th

2:35 P.M.

It was a beautiful spring day with a startlingly blue sky as Laurie walked along First Avenue, heading back to the OCME from the NYU Medical Center complex. Normally she would have enjoyed the short walk just to be outside for a brief time. Unfortunately, on this particular day she was oblivious to her surroundings, her mind in overdrive. The previous three hours had been totally unsettling. Up until then the day had been going well, including her presentation at the City Council’s Health Committee meeting. She had been able to overwhelm them with actual statistics showing how the turnaround time for bodies at the OCME had significantly improved under her watch despite rumors to the contrary. As for the regrettable mix-up of the two Henry Norton bodies, Laurie had been able to say that the OCME IT department had already made changes to the computerized case management system to make such problems much less likely to occur in the future. The only complaint Laurie was not able to completely quash was the concern about closing the morgues in Staten Island and the Bronx. The fact that significant money was being saved and the quality of the forensics had actually improved fell on deaf ears with the City Council member from the Bronx who sat on the Health Committee. This individual took the closing personally, as if the Bronx was somehow being denied appropriate service, which clearly wasn’t the case.

When she had returned to the OCME, her meeting to consider raising the salaries of the medical-legal investigators also went well. Everyone unanimously agreed a significant salary increase was absolutely necessary for recruitment purposes. To fill vacancies, the OCME had to be competitive with the salaries that certified physician assistants and paramedics could get on the outside. So, when she had rushed over to the NYU Medical Center for her annual breast-cancer screening, she was feeling smug enough to assume the rest of the day would be smooth sailing as well. Unfortunately, that turned out to be disturbingly not the case.

The worst part of the screening from Laurie’s perspective was the mammogram. Each year she wondered if she was being injured in the mildly painful process of having her breasts forcibly squeezed between two firm, unforgiving surfaces, and today was no exception. The experience was as uncomfortable as usual, but at least when the ordeal was over, there wasn’t any bad news.

As chief medical examiner, Laurie held a position of Associate Professor of Pathology at NYU Medical School and Head of the NYU Department of Forensic Pathology. Consequently, she was recognized as a VIP and treated as such, meaning the Radiology Department was aware of her presence. Today, like her previous sessions, one of the ranking radiologists was present to read the digital images as they were produced. He even went over them with Laurie, who was rather adept at reading them herself.

The next part of the screening process was the MRI, which she found to be much easier than the mammogram because she wasn’t claustrophobic and didn’t mind lying prone within the narrow tube-like opening in the massive machine. Usually she was even able to relax during the procedure, and today was no exception.

It was after the test that her day had gone drastically south. Another ranking radiologist came in and looked at the slices. Unfortunately, the MRI picked up a problematic lesion that the screening mammogram missed, requiring a second diagnostic mammogram that was even more uncomfortable. This test, too, confirmed a disturbing abnormality, meaning the MRI finding was not artifact.

Laurie entered the OCME building in a kind of daze as her mind struggled to put in perspective what she had just learned over in the NYU Medical Center, and its implications. Marlene Wilson buzzed her into the building. She could tell the woman wanted to chat, but Laurie was in no mood for small talk. Instead she made a beeline into the head office area. She even passed Cheryl Sanford without stopping, which was certainly abnormal as Laurie was a gregarious person sensitive to other people’s feelings.

Once inside her office, she hung up her coat before sitting down at her desk. With unseeing eyes, she merely stared ahead. The problem was simple. She didn’t have the time to have a medical issue foisted on her, especially one of this type of potential consequence. She had a thousand employees at the OCME to worry about, and two children, one with a diagnosis of autism and the other with a newly announced potential behavioral problem at school.

A furtive knock followed by her door opening brought Laurie’s attention back to the present. Cheryl was standing in the doorway, note in hand.

“Are you okay?” Cheryl asked, clearly concerned.

“I’ve been better,” Laurie said. She didn’t elaborate.

“Is there anything I can do?”

“Not at the moment,” Laurie said. “I need some time by myself.”

“I understand,” Cheryl said. “Detective Lou Soldano called. He asked you to call him back as soon as you can. He said he tried to call Dr. Stapleton, but he was in the morgue. The detective seemed upset.” Cheryl stepped over to Laurie’s desk and put a yellow Post-it Note on the corner. She then quietly left.

Laurie pulled the note up off the desk and looked at the number. She could tell it was Lou’s mobile, which meant he was out on a case, possibly at a scene. As he was a dear friend and an extraordinarily committed Homicide detective who truly valued the contribution of forensic pathology, Laurie felt an irresistible urge to call him back despite her mental turmoil. Since there was a chance the call might have a personal aspect, she used her mobile. Lou answered immediately.

“Thanks for calling, Laur,” he said straight off. Laur was a name one of Lou’s children gave her way back when Lou and Laurie had first met. “I’m over here at the Manhattan General ED with one of my detectives who managed to get himself shot. It’s not a life-threatening injury but bad enough. By accident I happened to become aware of one of those cases that makes you sick.”

“Can you give me a bit more background?” she asked. There was little or no inflection in her voice, and she hoped Lou wouldn’t notice or question. She was trying her best under the circumstances to sound normal.

“Sure,” Lou said. “It’s a two-and-a-half-year-old Latina girl named Camila Ruiz, who supposedly fell into a hot tub and scalded herself. It reminded me of a case I had years ago, which I hope doesn’t repeat itself, because it gave me nightmares for years.”

“Is this child dead?”

“I wouldn’t be calling you guys if she wasn’t. I was hoping that Jack could look into it. I mean, this should be a medical examiner case, right?”

“Certainly, as an accident it’s a medical examiner case.”

“All right, that’s good to hear,” he said. “The kid was brought in by the mom’s boyfriend, which is exactly what happened in the case I mentioned years ago. It turned out in that case it was no fucking accident. Pardon my French. Anyway, this case needs a good look as it’s keying off my sixth sense that all is not right in never-never land.”

“I’ll let Jack know,” Laurie said. After a few more pleasantries, she disconnected. Then she called Bart Arnold to make sure Camila Ruiz would be posted and asked him to let Jack know when the child arrived.

With that small, sad dose of reality, she felt a bit less paralyzed and began to make some preliminary plans with how she would emotionally adjust to the positive breast-cancer screening result. Obviously, a positive screen didn’t necessarily mean she had breast cancer. It just meant that something had to be done to determine whether she did, and as far as she was concerned, it needed to be done immediately, the sooner, the better. But she didn’t get far with this line of thinking. Within minutes there was another quiet knock on her office door, followed by Cheryl reappearing. Cheryl never liked using the intercom.

“I hate to bother you again, Dr. Montgomery,” she said. “But Dr. Carl Henderson is on line one, and he says it’s urgent.”

“Okay, thanks,” Laurie said. Reluctantly she recognized that dealing with the emotions of her positive cancer screening would have to wait. Being chief medical examiner was far too demanding. As she picked up the phone, she felt mildly irritated that Chet must have taken it upon himself to speak with the chief of the NYU Department of Pathology about Dr. Aria Nichols even though Laurie had told Chet that she preferred to speak with the resident before speaking with her boss. Although Laurie had met Carl Henderson at several NYU functions, she had never spoken with him on the phone. He was relatively new to the NYU Medical School community, having been recruited from the University of Pittsburgh just two years earlier. She remembered he was a tall, slender, worldly-appearing man who dressed particularly nattily, in contrast with so many of the other male pathologists that Laurie knew.

“Dr. Montgomery,” she said into the phone in lieu of saying hello. As she had done with Detective Soldano, she struggled to sound normal.

“Thanks for taking my call,” Carl said with a certain urgency. He had a deep, commanding baritone voice. “I needed to talk to you about a developing problem. One of our own, a pediatric social worker named Kera Jacobsen, has apparently overdosed and will be coming into the OCME shortly if she is not already there.”

“I’m sorry to hear that,” Laurie said. Opioid overdose deaths were disturbingly common in NYC, occurring at a rate of one every six hours on average.

“As you know, the NYU medical community has been making a big effort to do something about this terrible, ongoing tragedy in our neighborhood and city,” Carl said. “Having one of our own succumb is hardly an appropriate advertisement for our efforts. As I’m sure you are aware, we have been spending considerable resources polishing our image in the city, as has Columbia-Cornell. It’s a dog-eat-dog world in medical academe.”

“I’m well aware of the competitive hospital environment,” Laurie said, wondering where this surprising conversation was going. She thought for sure it would be about Aria Nichols, not an overdose victim.

“I just got off the phone with our hospital president, Vernon Pierce,” Carl continued. “He thought that it would be a proper gesture to handle any autopsy that might need to be done here in-house rather than at the OCME. The idea would be to sort of bring her home since she is part of our community. I thought the idea has some merit even if it is a little unusual. I offered to do it myself in our autopsy theater in the Bellevue Hospital, which the president thought would be appropriate.”

“This is a rather strange request,” she said. She tried to keep her voice neutral, but she was shocked at the suggestion as it was unprecedented as far as she knew. The NYC OCME did not outsource its mandated autopsies, which an overdose was.

“I know it’s unusual,” he continued, “but Mr. Pierce also thought this might be a way of preventing the episode from possibly appearing in the tabloids. On occasion in the past the tabloids have seemed to have an inside source as to what’s going on in the OCME.”

“I’m sorry, Dr. Henderson, but we are required by law to do the autopsy, and it will be done here.” She was aware there had been rare OCME leaks, as it was difficult to prevent them with as many employees as they had, but they certainly weren’t a justification for having an autopsy done elsewhere. She had tried to think of a diplomatic way to make this point clear, but nothing had come to mind. Instead she thought it best to be blunt.

“I see,” Carl said. By the tone of his voice it was apparent he was disappointed.

“But there is a way we could perhaps partially satisfy your president,” she added as a sudden idea occurred to her in an attempt to appease NYU’s fears. “We could have one of your pathology residents who is currently rotating through the OCME assist on the case. And I could make it a point to be involved personally. This would keep it in the family, because, as you know, I am officially part of the NYU family.”

“That’s a creative suggestion and very nice of you, Dr. Montgomery,” he said. “I’m sure Mr. Pierce would be pleased, especially if we can keep your in-house gossip to a minimum and, more important still, keep it out of the papers. Do you know offhand the name of our resident?”

“I do,” she said. “Dr. Aria Nichols. By coincidence I was scheduled to work with her this afternoon. What I can do is arrange for us to do the case together. What was the name of the victim?”

“Kera Jacobsen,” Carl said.

Laurie wrote the name down on the Post-it Note alongside Lou Soldano’s number. As she was doing so, she heard another knock on her office door. She looked up, expecting to see Cheryl, but instead it was Jack, dressed in scrubs. Laurie pointed to the phone pressed against her ear. He nodded, closed the door behind him, and went to the couch, where he sprawled out. He looked annoyed. Still, she was glad to see him to share the bad news about the MRI and mammogram.

“Okay,” Laurie said into the phone as she struggled with herself, trying to decide if she should bring up Dr. Nichols’s less than exemplary professional behavior during her OCME rotation.

“I’d personally like to know if anything abnormal is found on the autopsy,” Carl said. “And to emphasize, I’m sure Vernon Pierce will be pleased that it’s being kept quiet, particularly in regard to the media.”

“With as many overdose cases as we handle, I can’t imagine there would be any particular media interest,” Laurie said. “But I will let our public relations department know of your president’s wishes. Of course, Kera Jacobsen’s family will have the last word. As for anything out of the ordinary I might find during the case, I will personally let you know.”

“That would be terrific. I appreciate your help, Doctor,” Carl said sincerely. “Let me give you my mobile number so you have it if you need to get in touch with me after hours.”

Laurie dutifully wrote down the number although she doubted she would need it.

“Again, I appreciate your cooperation and understanding,” Carl said. “If I can be of any help to you in the future, please let me know.”

Laurie kept the receiver in her hand even after she’d disconnected the call. Ultimately, she had decided not to say anything about Aria Nichols’s odd behavior as it would complicate an already mildly complicated situation. Instead she turned to face Jack. “You won’t believe the call I just had.”

“Who was it?”

“I’ll tell you in a minute,” she said as she placed a call to Bart Arnold, the head of the Medical Legal Investigator Department. The MLIs were the physician assistants or paramedics who did all the investigative work for every death in New York City, which was a lot of effort, considering that between a hundred and a hundred and fifty people died in the city every day. Of those, about ten percent were judged by the MLIs as needing to be brought to the OCME for further review, and of that ten percent a bit more than half ended up being autopsied.

“Has a Kera Jacobsen been brought in yet?” Laurie asked when she had Bart on the line.

“Let me check,” Bart said. She could hear the click of his keyboard. “Yes,” he said after a pause. “She arrived just after noon.”

“Anything abnormal in the MLI’s report?” Laurie said.

“Nothing noteworthy,” he said after another pause. “Seems a straightforward opioid overdose. Death must have been rapid because the syringe was left in the vein.”

After thanking Bart, Laurie put in a call to Chet McGovern.

“What’s going on?” Jack questioned impatiently. He was still reclined on the couch but careful to keep his shoes from touching the upholstery. He’d made that mistake in the past.

She held up her hand, mouthed that she had one more call to make, and motioned for Jack to be quiet. As soon as she had Chet on the line she said, “Have you spoken with Dr. Nichols about working with me this afternoon?”

“I certainly did,” Chet said. “And I made sure she understood it is a command performance. And I found an interesting teaching case for you two, which will demonstrate the value of forensics and possibly pique her interest.”

“I appreciate your efforts,” Laurie said. “But there’s another case I want to do with Dr. Nichols instead of the one you picked out. I’m sorry for the change. The name is Kera Jacobsen. Your case is most likely a better teaching case, since Jacobsen is apparently a routine overdose. Nonetheless, we’re going to do this one.”

“Okay, fine by me,” Chet said agreeably. “Do you want me to get it all prepared?”

“I’d appreciate it,” she said. “And see if Marvin Fletcher is available?” Back when Laurie did almost daily autopsies before becoming chief, she liked to work with Marvin for a variety of reasons, mainly because she thought he was possibly the best mortuary tech at the OCME and a pleasure to work with. And today, not knowing what to expect from Aria Nichols, she preferred that the general logistics went smoothly. She knew Marvin would guarantee that.

“What kind of time frame are we looking at?” Chet asked.

“An hour from now should work for me,” she said, glancing at the clock on her desk. “Are you expecting any difficulty locating Dr. Nichols?”

“We’ll see,” he said. “She said she would be in the library, but I do have her number just in case she’s left the building. I offered to have her come up here to my office and go over histology slides with me, but she blew me off big-time.”

“What exactly did she say?” Laurie couldn’t help but remember the woman’s mildly bawdy response to Chet’s having caught her over at the Tisch Hospital when she was supposed to be in the OCME.

“Do you really want to know?”

“Try me,” Laurie said.

“She told me that she would prefer to be run over by a herd of buffalo in heat,” Chet said with obvious disgust.

“Sounds like a charmer,” she said, smiling in spite of herself. Once again, the idea of Jack’s being right about Chet initially trying to make time with the woman went through her mind. Particularly in the current social environment, any suggestion of sexual harassment of any form often evoked a significant response. Laurie told herself to keep an open mind when it came to Aria Nichols.

“If you have trouble finding her, let me know immediately,” Laurie said. “Otherwise, I’ll expect to see her down in the autopsy theater within the hour.”

“You are going to do an autopsy on an overdose?” Jack asked with disbelief as she hung up the phone. “I thought you’d decided not to do autopsies on general principle. And why an overdose?”

“This is a unique situation,” Laurie said. “I don’t have time to explain completely, but it is going to be with the problematic resident I mentioned to you this morning. I’d arranged it with Chet before I went down to City Hall, but then there’s been a new development. When you first came in here, I was talking with Dr. Carl Henderson.”

“The chief of NYU Department of Pathology?” Jack asked.

“None other,” Laurie said.

“I’ve never met the man,” he said. “Wait! I take that back. I have met him briefly. A tall, good-looking guy, for a pathologist, with a sense of humor to boot, which is why I remembered him.”

“I’ve only met him on a few occasions,” Laurie said. “He’s relatively new.”

“What does your conversation with Carl Henderson have to do with the overdose case you’re doing with the resident? With as many overdoses as we process, it doesn’t sound so exciting to me.”

“The case itself most likely won’t be exciting or challenging,” she said. “There’s a political angle that’s developed, which is why Carl was calling. But the main reason for my doing it is an opportunity for me to get a feel for this problematic NYU pathology resident. Still, I’m looking forward to it. I know that sounds pathetic, but I do truly miss doing autopsies. But we are not going to advertise that I’m doing it. Okay? I’m going to tell anyone I run into down in the pit to keep it under wraps. Hopefully, because of the time there shouldn’t be too many people down there.”

“Okay, fine by me,” Jack said, pretending to zip his lips closed.

“Oh, by the way,” she said. “I spoke to Lou briefly a few minutes ago. He wants you to give him a call about a case. Do you need his number?” Laurie held up the Post-it Note.

“No, I’ve got it,” he said.

“Now tell me what happened at the Brooks School,” Laurie said. “You did go, didn’t you?”

“Of course I went,” Jack snapped. He sat up and put his feet on the floor. “And it turned out to be a disaster like I feared. I’m sorry, but I didn’t make us any friends at the school. I tried to just listen as you said, but they were telling me such nonsense, I couldn’t restrain myself from letting them know exactly how wrong I felt they were. I even accused them of colluding with the goddamn pharmaceutical industry. That was right after Miss Rossi actually said that she felt strongly JJ needed Adderall. That’s when I flipped out.”

“Oh, God,” Laurie said with frustration. With her elbows on her desk, she closed her eyes and rubbed her temples firmly while her mind did somersaults, trying to think of what they would do if JJ was asked to leave the school. She also realized as much as she wanted to share what she had learned over at NYU Radiology, it would have to wait as it would surely provoke a serious discussion. After a deep breath she said, “Maybe you better tell me exactly what happened, provided you can do it in fifteen minutes. I’ve got to get downstairs and get into some scrubs.”