Intervention

15

10:06 A.M., FRIDAY, DECEMBER 5, 2008

NEW YORK CITY

Well, there’s no question what killed him,” Jack said. He had just sliced open the heart of a sixty-two-year-old African-American male named Leonard Harris. A large, sausage-shaped blood clot completely filled the right atrium.

“Did that clot come from the legs?” Vinnie asked.

“We’ll just have to check that out,” Jack answered.

The autopsy room was in full swing, with all eight tables in use. Jack and Vinnie were already deep into their third case, while most of the other MEs were still doing their first.

Jack’s first case had been a teenager shot in Central Park. There was a question of whether it was a suicide or a homicide. Unfortunately, there had been a mistake made by the OCME medicolegal investigator, George Sullivan, who had been bullied by the detective in charge to rush his investigation. The result was that he’d forgotten to bag the victim’s hands, possibly causing a loss of critical evidence. Since the victim was the son of a politically connected lawyer, Calvin had been called in, ordering Jack on the case.

Jack’s other two cases were a bit more straightforward, but just. The second case was a drug overdose of a college freshman. But the third case, the one he was on, presented a surprise challenge. Jack was confident the cause of death was a pulmonary embolism, but the manner of death was not necessarily natural.

“Vinnie, my friend, do you know—” Jack began as he sliced open the rest of the heart, looking for more blood clots, particularly at the tricuspid and pulmonary valves.

“No!” Vinnie interrupted, without even letting Jack finish his sentence. “When you start a question by being nice to me, I know you have something on your mind that I want no part of.”

“Am I that bad?” Jack asked, as he moved up to the bifurcation of the pulmonary artery looking for more clots.

“You’re wicked bad!” Vinnie declared.

“Sorry you feel that way,” Jack said. “But let me finish my sentence. Do you know what is particularly special about this case?”

Vinnie looked down at the large, dark clot and then over at the flayed-open corpse, trying to come up with something humorous. When he couldn’t, he fell back on the truth: “No!” he said.

“This case is a perfect example of just how important the medicolegal investigators are in forensic pathology. Because Janice asked all the right questions, this case will be viewed in a different light. I would have been certain it was a natural death, but because she asked the wife if he’d been taking any medication, she learned something the ER docs didn’t know: that he’d been taking an herbal remedy on his own, PC-SPES, made of Chinese herbs, which was supposed to be taken off the market but which is still available. Janice Googled the drug and learned that it was an FDA-unapproved medication that had often been contaminated with female hormones and was therefore associated with clotting problems and fatal pulmonary emboli.”

“So, the herbal remedy killed the man.”

“Possibly,” Jack said.

“Will you be able to prove it?”

“Perhaps. Let toxicology have a go at the samples we’ve taken and see if we can get some of the medication he’s been taking from the wife.”

“Hey, keep working!” Vinnie complained. Jack had stopped while he was talking.

“Do you take any herbal medicine, Vinnie?” Jack asked, going back to work.

“Sometimes. There’s a Chinese aphrodisiac called Tiger Stamina I use once in a while. And occasionally my acupuncturist gives me something for some minor complaints I have.”

Jack stopped working and stared at his favorite mortuary tech.

“What’s wrong? Why are you looking at me like that?”

“As the saying goes, I knew you were dumb, but I didn’t think you were stupid.”

“Why? What are you talking about?”

“I had no idea you were a user of alternative medicine. Why?”

Vinnie shrugged. “I guess because it’s natural.”

“Natural, my ass,” Jack said scornfully. “The worst poison known to man comes from a tree frog in South America. You cannot imagine how small an amount would be necessary to kill you, and it’s natural. Calling something natural is a meaningless marketing ploy.”

“All right, calm down! Maybe I like alternative medicine because it’s been in use for more than six thousand years. After all that time, they have to know what they’re doing.”

“You mean the wacky idea that somehow in the distant past people had more scientific wisdom than they do today? That’s both crazy and counterintuitive. Six thousand years ago people thought thunder was a bunch of gods moving around furniture.”

“All right,” Vinnie repeated, with a touch of irritation. “I like alternative medicine because it treats my whole body, not just my arm or spleen or whatever.”

“Ah!” Jack said, his voice rising and tinged with more scorn than when he spoke about the “natural” fable. “The holistic myth or the more-holistic-than-thou nonsense is just as crazy as everything else you’ve said. Regular medicine is a thousand times more holistic than alternative medicine. With conventional medicine, they’re even taking into account individual genetic profiles. How much more holistic can you be than that?”

“How about we get this autopsy over with,” Vinnie suggested. “And maybe you should stop yelling.”

Just as he had a few days ago in Ronald Newhouse’s office, Jack suddenly came to his senses. Again, he’d allowed his emotions to get the best of him. The room had gone silent, and everyone was staring at him. When he glanced down at his hands, he realized one hand was still grasping the heart and lungs he’d been examining while the other hand still held the butcher knife. As suddenly as the buzz of conversation stopped it now resumed.

“Wow!” Vinnie murmured. “You’re getting awfully touchy in your old age.”

“I’ve been looking into alternative medicine since our case of vertebral artery dissection on Monday, and I’ve become a touch emotional about what I’ve been learning.”

“A touch?” Vinnie questioned mockingly. “I’d say it’s over the top, but I tell you what I’ll do: I’ll give up on the acupuncture if it will make you feel better.”

“It would,” Jack said, “especially if you ditch the herbs as well.”

Vinnie leaned toward Jack and squinted. “Are you pulling my leg now or what?” He wasn’t certain.

“Half and half,” Jack said. “Meanwhile, let’s knock out this autopsy.”

They completed the pulmonary embolism case in near record time, too uncomfortable to talk. When they did finish, Jack said, “Sorry, my friend. I was definitely out of line.”

“You’re forgiven. To pay me back, you can promise me we won’t start autopsies until everyone else does.”

“Dreamer,” Jack said, snapping off his gloves and heading for the washroom.

Jack cleaned up and returned upstairs to his desk. Still feeling uncomfortable about his mini-blowup in the autopsy room, he closed his office door. For a while, at least, he didn’t want to see or talk to anyone. Forcing himself to work, he dictated all three autopsies he’d just completed so he was sure not to forget any of the details, using his scribbled notes to remind him of specific important points.

With the dictation out of the way, Jack looked at his crowded inbox, but, like many days of late, he couldn’t find the motivation to start. Instead, he opened up his center drawer and pulled out a large envelope where he’d been storing all his alternative-medicine data. As of that moment, he had a total of twelve cases from his colleagues. Keara Abelard made thirteen, and his herbal case that morning made a grand total of fourteen.

Jack should have been pleased with his progress, but he wasn’t. He’d come to the conclusion that the number of cases he was going to find, no matter what he did, was going to be seriously lower than the true number, for a complex of reasons. One problem was the lack of digitalization of the OCME records, meaning a search was not possible. Even if the records were digitalized, there would be no coding for alternative medicine in general, nor for specific types of alternative medicine in particular. On top of that, even if he was able to find VAD cases, there was no guarantee that the records would say anything about chiropractic, even if chiropractic therapy was involved in the cause of death.

In situations involving herbal medicine, the cases would be signed out as accidental poisoning, with the cause of death attributed to the specific poison involved. It would be the exception, not the rule, if herbal medicine was mentioned at all.

Although Jack thought his crusade of exposing the risks of chiropractic and other forms of alternative medicine was still a great idea and more than worth pursuing, his enthusiasm was being dampened by these tactical obstacles. Fourteen cases over some indeterminate period of time was not enough to attract the public’s attention. When he had started, he’d envisioned a grand exposé involving hundreds of cases capable of dominating the media for days. Jack could already assume that was not going to happen.

As Jack’s zeal for his crusade sagged, his problems at home only loomed larger. His out-of-control emotions, as the recent minor episode with Vinnie exemplified, were a clear sign he still lacked focus. For a few moments Jack debated whether he should stick with the alternative-medicine idea in hopes of solving the problems of researching it or whether he should switch and try to find something more engrossing.

The ring of the telephone startled him out of his reverie. He glared at the phone with a sudden flash of anger, suppressing an urge to rip the blasted cord out of the wall. He didn’t want to talk to anyone.

But what if it was Laurie? Perhaps there’d been a sudden change for the worse with JJ’s condition. Perhaps she was calling from Memorial’s emergency room. Jack snatched up the handset and barked, “Yes?”

“Hey, big guy,” Lou Soldano rumbled. “Am I catching you at a bad time? You sound harried.”

It took Jack a moment to reboot his brain. He’d been so certain it would be Laurie calling about some kind of disaster. “It’s okay,” he said, struggling to calm himself. “What’s up?”

Next to Laurie, Lieutenant Detective Lou Soldano was one of his favorite people. In many ways, Lou and Jack’s friendship had a curious twist. Before Jack had come on the scene, Lou and Laurie had dated for a time. Luckily for Jack, their relationship had changed from rocky romantic to pleasant platonic, and when Jack and Laurie began dating, Lou championed Jack on multiple occasions. At one particularly difficult juncture, it was Lou’s belief that Jack and Laurie were made for each other that probably saved the day.

“I wanted to give you some follow-up,” Lou said, “on that suicide gunshot case you called me about Tuesday. You know which case I’m talking about?”

“Of course. The woman’s name was Rebecca Parkman. That was the case that the husband was dead set — excuse my pun — against his wife having an autopsy, supposedly for religious reasons.”

“It appears he had other reasons, too,” Lou said.

“I’m not surprised. Although the entrance wound was somewhat stellate, it wasn’t stellate enough, which suggested it was not a contact wound. How far away did I guess the gun was when it was fired?”

“Two inches!”

“In my entire forensic career, I’ve never seen a suicide with a gunshot wound to the head that wasn’t a contact wound.”

“Well, with your suspicions we got a warrant and burst in on the guy. And guess what, he was entertaining this young chick. Can you imagine? Two days after his wife is supposed to have killed herself, he’s boffing this cheerleader type.”

“Did you find anything incriminating?”

“Oh, yeah!” Lou said with a confident chuckle. “In the dryer we found a recently washed shirt of his. Of course it looked clean, but the lab guys found some blood, which turned out to be the wife’s. I think that’s pretty damn incriminating. I have to give it to you guys at the OCME. Chalk up another victory for justice.” One of the things that had propelled Jack and Lou’s friendship was Lou’s high regard for forensic pathology and what it could do for law enforcement. Lou was a frequent visitor to the OCME, and a frequent observer of autopsies on criminal cases.

“Hey, how’s that new kid of yours?” Lou asked.

“It’s a struggle,” Jack said, without supplying any details. He hadn’t told Lou about JJ’s illness, nor did he want to. At the same time, he didn’t want to lie. Wasn’t life with an infant a struggle for everyone?

“Isn’t it, though?” Lou laughed. “Talk about changing one’s lifestyle. I remember with my two I didn’t sleep for months.”

“How are your children?” Jack asked.

“They aren’t kids anymore,” Lou said. “My baby girl’s twenty-eight, and my baby boy is twenty-six. I tell you, it goes by fast. But they’re fine. How’s Laur?” Laur was Lou’s nickname for Laurie.

“She’s fine,” Jack said, and before Lou could follow up, Jack added, “Lou, do you mind if I ask you a personal question?”

“Hell, no! What’s on your mind?”

“Do you use alternative medicine?”

“You mean like chiropractors and acupuncture and all that kind of shit?”

“Exactly! Or homeopathy or herbal medicine or even some of the more esoteric therapies involving buzzwords like energy fields, waves, magnetism, and resonance.”

“I have a chiropractor I go to once in a while to get adjusted, especially when I don’t get a lot of sleep. And I tried acupuncture to stop smoking. Somebody here at headquarters recommended it.”

“Did the acupuncture work?”

“Yeah, for a couple of weeks.”

“What if I told you alternative medicine isn’t risk-free? In fact, what if I told you cervical manipulation by chiropractors kills people every year? Would that influence you?”

“Really?” Lou questioned. “People die?”

“I just did a case Monday,” Jack said. “A twenty-seven-year-old female who died from having arteries torn in her neck. It was the first such case I’d seen, but I’ve looked into it over the last few days. I’m surprised at the number of cases I’ve found. It’s influenced my opinion of alternative medicine.”

“I never knew people died from chiropractic treatment,” Lou admitted. “How about acupuncture? Anyone die from that?”

“Yes. Laurie had such a case.”

“Jeez!” Lou remarked.

“What if I told you alternative medicine really doesn’t deliver the kind of health benefits it claims? That beyond providing a placebo effect, it doesn’t do much at all. You know what the placebo effect is, don’t you?”

“Yeah, that’s when you take some kind of medicine, like a sugar pill, that actually has no medicine in it, but you feel better.”

“Exactly. So, to reword what I’m saying, what if I told you alternative medicine doesn’t do anything other than provide a placebo effect, but in the process puts you at risk?”

Lou laughed. “Maybe I’ll just go out and buy me a bottle of sugar pills.”

“Lou, I’m being serious about this. I want to understand why you won’t question the rationale of going to a supposed health provider, paying good money, possibly putting yourself at risk of death, when I’m telling you all you’re getting is a placebo effect. Help me understand.”

“Maybe it’s because I can go and see this chiropractor guy.”

“I still don’t understand. What do you mean you go because you can go?”

“It’s harder than hell to get in to see my general practitioner. His office is like a fort with a couple of witches who act like they need to protect him from me, the grunt. And when I do get in to see him, he tells me to lose weight and stop smoking, as if that’s easy, and I’m in and out so fast that half the time I forget why I went in to see him in the first place. Then I call up the chiropractor, they take your call right away and are pleasant. If you want to speak to the chiropractor, you can. If it’s an emergency and you want to come in right away, you can. And when you do get into the office, there’s not the hour-long wait, and when you see the therapist, you don’t have the feeling he’s rushing you through an assembly line like a hunk of meat at a slaughterhouse.”

For a few moments there was a silence. As a benefit of controlling his own emotion to a reasonable degree, Jack could hear Lou’s breathing. The man was mildly vexed. Jack cleared his throat. “Thank you!” he said. “You’ve taught me something I needed to know.”

“You’re welcome,” Lou said with little sincerity.

“I said I have been looking into alternative medicine, and I’ve been mystified by the general public’s willingness to embrace it despite the fact it appears to me to be nearly worthless efficacy-wise, yet it costs the public billions upon billions of dollars a year. Herbal medicine alone, I found out, rakes in some thirty billion, which reminds me, do you take any herbal medicine?”

“Occasionally. When my weight spikes over two hundred pounds, I go on a weight-loss kick, which includes an herbal product called Lose It.”

“That’s not good,” Jack said. “As your friend, I’d advise you not to use it. Many herbal weight-loss products, especially those from China, are accidentally contaminated with lead salts or mercury salts, or both. On top of that, often the natural plant content has been known to be purposefully contaminated with dangerous pharmaceuticals to be assured that there will be some sort of a mild positive effect, meaning weight loss. My advice is to stay away from such remedies as much as possible.”

“You are such a wonderful bearer of good news today. I’m so glad I called.”

“I’m sorry,” Jack said. “But I’m pleased you’ve called. You have actually taught me something I needed to know, although probably something I didn’t want to know — namely, why the public is so willing to embrace alternative medicine and resistant to hear why they shouldn’t.”

“Now you have me curious,” Lou said. “What did I teach you?”

“You taught me that conventional medicine has a lot to learn from alternative medicine. The way you described your experiences with the two is truly telling. Alternative medicine has good customer relations with their patients, treating them like people, making the visit a positive social experience, even if there is no real curing going on. Conventional medicine, on the other hand, too often is the opposite, acting more as if they are doing you a favor. And worse still, if conventional medicine thinks they cannot help you, they ignore you; you’re out in the proverbial cold.” Jack couldn’t help but think that’s where he and Laurie were right now, treading water while they waited until JJ’s allergy to mouse protein went down, if it was going to go down. That was not a given.

“Why do you say you didn’t want to know that?” Lou asked.

Jack had to think for a moment, because the question had to do with his crusade, which had to do with JJ’s illness. Jack did not want to talk about JJ. “I didn’t want to know because learning that there is a legitimate reason for people to want to use alternative medicine means that my efforts to expose its limitations and even its risks will probably fall on deaf ears.”

“Sometimes I think you are the most irritatingly arcane person I know. But let me add another reason why people will fight you tooth and nail about alternative medicine: Alternative medicine doesn’t seem scary. If you say a handful of people die every year from going to an alternative-medicine therapist, they won’t blink an eye. Thousands upon thousands more people die who go only to conventional medical doctors than the people who go to a chiropractor. In fact, people who go to chiropractors want to believe in chiropractic specifically because they don’t want to go to conventional doctors, where they might get a diagnosis that will involve discomfort and pain and possibly death. At the chiropractor, that never happens. Everything is optimistic, every complaint can be treated, and it doesn’t hurt, and even if it is placebo, who cares?”

There was another period of silence until Jack said, “You’re right!”

“Thank you. Now let’s get back to our respective work, because we’re on city time. And one last thing, keep the forensic tips coming, because this last one on Sam Parkman was right on target.”

“But isn’t there going to be a problem with the Parkman case about the blood being circumstantial evidence? I mean, there’s no way to prove when the wife’s blood got on the shirt. The defense can argue it was a month ago or a year ago.”

“That’s not going to be a problem. The cheerleader girlfriend is singing at the top of her lungs, trying to avoid being considered an accomplice. The DA is very happy and considers the case a slam dunk.”

After Jack hung up the phone, he sat unmoving for a time. What little wind he’d had remaining in the sails of his alternative-medicine crusade was gone. Again, he felt discouraged. He took all his notes and dumped them back into the large envelope. Then, instead of returning it to his center drawer, he opened his bottom drawer containing the framed photo of Laurie and JJ, and tossed it in. He then kicked the drawer shut.

Prepared to get down to real work, Jack reached for his inbox with the intention of lifting out the material onto his blotter to begin to sort it. But his hand never made it. His phone’s jangle again pierced the room’s stillness. Sure it would be Lou with another thought about the alternative-medicine issue, Jack answered the phone as informally as he did earlier. But the caller wasn’t Lou. It was perhaps one of the last people in the world Jack expected to hear from.