Intervention

3

6:05 A.M., MONDAY, DECEMBER 1, 2008

NEW YORK CITY

(1:05 P.M., CAIRO, EGYPT)

You’re a doctor?” the uniformed policeman questioned with exaggerated surprise. The policeman’s car was pulled to the curb behind them on the west side of Second Avenue as morning traffic streamed past on its way downtown. The cop’s partner was still sitting in the passenger seat, drinking coffee. Jack’s relatively new Trek bike was lying on its side on the pavement just in front of the cruiser. When Laurie had started her maternity leave, Jack had gone back to his old habit of commuting to the Office of the Chief Medical Examiner by bicycle.

Jack just nodded. Although he was calmer than he’d been, he was still irritated as hell at the taxi driver who’d cut him off by pulling across four lanes of traffic and stopping on a dime to pick up a fare. After managing to stop himself with just a minor jolt against the car’s rear bumper, Jack had dashed around to the driver’s side before the customer had gotten seated in the back. Jack had quickly inflicted several small but definite dents in the cabdriver’s side door with his heel in hopes of encouraging the driver to climb out of the car so that a proper discussion could ensue. Lucky for everyone, the incident was brought to a rapid close by the arrival of the police. Apparently, the cops had witnessed at least some of the confrontation.

“I think you could use some anger-management classes,” the policeman continued.

“I’ll take that under advisement,” Jack said sarcastically. He knew he was being provocative, but he couldn’t help himself. The policeman had dismissed the cabdriver without even checking his license. It was as if the cop thought the incident was Jack’s fault, since he was the one being detained.

“You’re on a bike, for crying out loud,” the cop complained. “What do you want to do, get yourself killed? If you are going to be crazy enough to ride a bike you have to expect the unexpected, particularly from cabbies.”

“I’ve always felt New York City taxis and I could share the road.”

With a final head shake and a roll of his eyes, the policeman handed back Jack’s driver’s license. “It’s your funeral,” he said, washing his hands of the affair.

Irritably, Jack picked up his bike, climbed on, started pumping, and rapidly pulled away from the police car even before the officer had climbed back into his cruiser. Soon the frenzy of the traffic, the icy wind, and the sustained exertion cooled his hot blood. Reaching the optimal speed of nearly twenty miles per hour, he was able to make the lights all the way to 42nd Street. As he waited for the green, panting for breath, he had to admit the policeman had been right. Hungry cabdrivers were always going to stop for a fare without regard for their surroundings. By failing to be a defensive rider, Jack was slipping into the patho logically destructive behavior that had put him at risk in the af termath of his wife and daughters’ deaths. Jack knew that he couldn’t afford such selfishness. Laurie and John Junior needed him. If the family was going to beat the neuroblastoma, they had to do it as a team.

Arriving at the Office of the Chief Medical Examiner at the corner of First Avenue and 30th Street, Jack crossed the wide avenue and made his way to the building’s driveway. Although the OCME building looked the same from First Avenue as it had when it was built in the sixties, changes had been made, particularly after 9/11. The old loading dock had been replaced by a larger parking area and a series of rollaway garage doors to accommodate the arrival of multiple vehicles with their corpses. Also gone was the herd of aged brown mortuary vans with HEALTH AND HOSPITAL CORP. stenciled on the sides parked helter-skelter all over 30th Street, replaced by an orderly fleet of new white vans. And instead of having to carry his bike into the morgue, Jack just rode it into one of the garages, where he could leave it safely in full view of a much better managed security office.

Inside the OCME were more changes. With the department’s importance highlighted after 9/11, it was rewarded by the legislature with more personnel, equipment, and space. A brand-new building had been built a few blocks down First Avenue to house the expanded department of forensic biology, including, in particular, the DNA laboratory. Though the OCME of New York City had once fallen on hard times because of budget cuts, losing its famed countrywide leadership in the field of forensics, those days were past.

Jack now had more than thirty medical examiner, or M.D. forensic pathologist, colleagues across the city. The number of non-M. D. forensic investigators in the Manhattan office had been increased, their titles changed. No longer referred to as physician’s assistants, they were now called medicolegal investigators, or MLIs. There were also eight new forensic anthropologists on staff, in addition to the forensic odontologists that Jack and the other MEs could tap for appropriate cases.

Jack had also personally benefited from all the growth and change. Along with the entire DNA and serology departments, other divisions including records, administration, legal, and human resources had moved to the new high-rise building, freeing space in the old building. All medical examiners now had their own, separate offices on the third floor. In addition to his desk, Jack now had his own lab bench, which meant he could leave out his microscope, slides, and paperwork without fear it would be disturbed.

Jack walked into the building, vowing to rise above his raw emotions and focus on his work. Feeling suddenly as if he were on a mission, he didn’t wait for the back elevator but took the stairs. He quickly traversed the new sudden infant death syndrome offices and cut through the old medical records room, which now housed the warren of new investigator cubbies. The graveyard shift of medicolegal investigators was finishing up reports for the seven-thirty shift change. Jack gave a cursory wave to Janice Jaeger, the night-shift investigator he’d known since he’d started work at OCME, and with whom he frequently partnered.

He tossed his jacket into an aged leather club chair when he reached the ID office, where all the medical examiners eventually started their day. Stacked on the solitary desk were the records of the cases that had come in during the night and that fell within OCME jurisdiction, according to the medicolegal investigation team. These cases represented those deaths that had occurred in any unusual or suspicious manner, including suicide, accident, criminal violence, or merely suddenly when the victim was in apparent good health.

Jack sat down at the desk and began going through the cases. He liked to pick out the more challenging ones because they gave him the opportunity to learn. That was what he most enjoyed about forensics. The other medical examiners tolerated this behavior because Jack also did the most cases of anyone.

The normal morning process involved the medical examiner on first call for the week to come in early, usually about seven or slightly before, and go through the cases to determine which ones definitely needed postmortems, then assign them out on an equitable basis. Even Jack had the duty about a dozen times a year, which he never minded since he was invariably there anyway.

Within a couple of minutes Jack found an apparent meningitis case of a teenage boy from a private school on the Upper East Side. Since Jack was generally known as the infectious-disease guru after having made several lucky diagnoses in the past, he read the record slowly and put it aside. He thought that case might be good for him, since many of his colleagues shunned infectious cases. He truly didn’t care.

Jack slowed down on his perusal of the next case as well. It was another relatively young individual, although this time it was a female. The victim was a twenty-seven-year-old woman who’d been brought into an emergency room with supposed rapid onset of confusion, spastic gait, and ultimately coma and death. There had been no fever or malaise, and according to her friends, she was an avid health enthusiast, shunning drugs and alcohol. Although her friends had been enjoying cocktails at the time of her collapse, they claimed the victim had consumed only soft drinks.

“Oh, shit!” a voice lamented, loud enough to snap Jack’s head up.

Standing in the opened doorway leading out into the empty ID room was Vinnie Amendola, one of the mortuary technicians, a newspaper under his arm. He was still holding on to the doorknob of the connecting door as if he might change his mind and flee. It was clear that the source of his outburst was Jack’s presence.

“What’s the matter?” Jack demanded, wondering if there was some emergency.

Vinnie didn’t answer. He glared at Jack for a beat before closing the door behind him. He stood in front of Jack’s desk, arms crossed. “Don’t freaking tell me you’re reverting to your old ways,” he said.

Jack could not suppress a smile. He’d suddenly realized the cause of Vinnie’s feigned anger. Prior to John Junior’s birth, when Jack would come to work early to cherry-pick the autopsy cases, he’d drag Vinnie down with him to the autopsy room to get a jump on the day. In addition to his regular mortuary-tech duties, Vinnie was responsible for coming in early to facilitate the transition from whatever the night techs were doing, although what he mostly did was make the communal coffee and then read the sports section of the Daily News.

Although Vinnie always complained about having to start autopsies earlier than the chief medical examiner decreed, he and Jack were a great team despite their merciless teasing of each other. Together they could frequently do one and a half or even two cases while others did just one.

“I’m afraid so, sport,” Jack said. “Vacation is over. You and I are going to get back down to work. It’s my New Year’s resolution.”

“But it’s not New Year’s for another month,” Vinnie complained.

“Tough,” Jack responded. He reached out and pushed the chart of the twenty-seven-year-old woman in Vinnie’s direction. “Let’s start with Keara Abelard.”

“Not so fast, supersleuth,” Vinnie protested, using his old nickname for Jack. He made a production of inspecting his watch as if he were about to refuse Jack’s order. “I might be able to accommodate you in, say, ten minutes, after I make the house coffee.” He smiled. Feigning the opposite, he’d actually missed his special relationship with Jack based on their early starts.

“It’s a deal,” Jack said. After a quick high-five with Vinnie, he went back to the stack of charts.

“Since you stopped coming in early when your son was born, I thought it was a permanent schedule change,” Vinnie said as he loaded the pot with fresh coffee, whose aroma quickly permeated the room.

“It was just a temporary slowdown,” Jack said. Although most everyone at the OCME knew about his child’s birth, no one, as far as Jack knew, was aware of the infant’s illness. Jack and Laurie were both intensely private people.

“How do you know Dr. Besserman won’t want this Keara Abelard for himself?”

“Is that the ME who’s on this week and supposed to be here already?”

“None other,” Vinnie said.

“I don’t think he’ll be too upset,” Jack said, with his usual sarcasm. He knew full well that Besserman, one of the most senior MEs, would just as soon pass on all autopsies at this stage of his career. Nonetheless, Jack scribbled a quick note to Arnold, telling him he’d taken the Abelard case but would be happy to do another couple of cases if need be. He put the Post-it on top of the pile of records and scraped his chair back.

In less than twenty minutes Jack and Vinnie were down in the autopsy room, which had been renovated to a degree during the previous year. Gone were the old soapstone sinks. In their place were modern composite ones. Gone also were the giant glass-fronted cabinets with the collections of medieval-appearing autopsy tools. In their place were nondescript Formica ensembles with solid doors and significantly more space.

“Let’s do it!” Jack said. While he’d filled out the initial paperwork, not only had Vinnie gotten the body on the table and the X-rays on the view box, he’d also gotten all the supplies laid out, including the instruments he thought Jack was likely to want: specimen bottles, preservatives, labels, syringes, and evidence custody tags, in case Jack happened to detect an element of criminality.

“So, what are you looking for?” Vinnie asked, as Jack went through his exhaustive external examination. He ranged over the whole body but devoted particular attention to the head.

“Signs of trauma, for one thing,” Jack said. “That would be my number-one guess at this point. Of course, it could have been an aneurysm as well. She apparently became quickly disoriented and spastic, which led to coma and death.” Jack glanced into both external ear canals. He then used an ophthalmoscope to look at eye grounds. “Reputedly, she’d been out having cocktails with friends — nonalcoholic, according to history, and no drugs.”

“Could she have been poisoned?”

Jack straightened up and looked across the body at Vinnie. “That’s a strange suggestion at this point. What made you think of that?”

“There was a poisoning on a TV show last night.”

Jack laughed behind his mask. “That’s an interesting source for differential diagnosis. I’m guessing that’s not too likely, but we’ll still need to do a toxicology screen. We’ll also make sure she’s not pregnant.”

“Good point about the pregnancy idea. That was what happened in the show last night. The boyfriend wanted to get rid of the baby and the mom at the same time.” Jack didn’t respond. Instead, he began carrying out a painstaking examination of Keara’s scalp. Her thick, shoulder-length hair made progress slow.

“There’s no way this case could be infectious, could it?” Vinnie asked. He had never liked germs. In fact, he hated them. Whether involving bacteria, viruses, or “anything in between,” as he called some of the other infectious agents, he’d typically avoided contact as best he could, at least until Jack arrived. Since then, because of the number of infectious cases Jack had done, he’d become inured to his phobia. That morning he and Jack were wearing only Tyvek suits, regular medical masks, surgeon’s caps, and curved plastic face guards over their clothes. For a few years the front office had dictated full barrier protection on all cases with what were called “moon suits,” but that was no longer the situation, and now each medical examiner could wear whatever he or she wanted provided it was appropriate. Same held for the mortuary techs.

“There’s even less chance of it being infectious than it being poisoning,” Jack said.

Finishing with the head, Jack carefully examined the neck. When that was completed, he was reasonably certain there was no sign of trauma, as the external exam had been entirely normal. Jack had no more idea of what killed the young woman than he had when they’d started, and feeling less patient than usual, he was briefly and irrationally irritated at the patient for withholding her secrets.

After taking ocular fluid, urine, and blood for toxicology and checking out the X-rays on the chance they might provide a clue about the cause of death, Jack started the internal part of the autopsy. He used the typical Y-shaped incision from the points of the shoulders down to the pubis, then, with Vinnie’s help, removed the organs and examined each in turn.

“While you rinse out the intestine, I’m going to make sure there was no venous thrombosis in the deep leg veins,” Jack said, wanting to cover all the bases. Increasingly curious about the cause of death, he was now all business and trying to think out of the box. There was none of his signature black humor or teasing of Vinnie.

By the time Vinnie returned with the clean intestine, Jack was able to inform him that in addition to the other negatives there’d been no clotting problems with possible emboli to the brain. The cause of death of Keara Abelard was still a total mystery, whereas with most cases at that point there would have been a good idea.

After the abdominal and chest portions of the postmortem were completed, Jack returned his interest to the patient’s head. “This has got to be pay dirt!” he said, as he stepped back to give Vinnie room to use the bone saw to cut off the skullcap.

While Vinnie was busy sawing, several of the other day mortuary techs appeared and prepared to assist their assigned medical examiners. Jack didn’t even notice them. As Vinnie continued cutting with the noisy bone saw, Jack began to feel uncomfortable. With no theories as to the cause of death other than a burst aneurysm, which he doubted, he had the sense he was missing something, something important, perhaps even making a mistake.

The moment Vinnie put the calvarium aside and then freed up and lifted out the glistening, furrowed brain, Jack leaned forward and his heart skipped a beat. There was dark blood in the posterior fossa at the very back of the head, and enough such that it was spilling out onto the stainless-steel autopsy table.

“Damn!” Jack snapped with obvious regret while pounding his gloved hand on the corner of the table.

“What’s the matter?” Vinnie asked.

“I made a mistake!” Jack said angrily.

Taking a step down alongside the body, Jack peered into the depths of the chest cavity and up toward the head, lifting the anterior wall of the chest. “We’ve got to do an arteriogram X-ray of the vasculature to the brain,” Jack said out loud, more to himself than to Vinnie. He was clearly disappointed with himself.

“You know I can’t put the brain back,” Vinnie said hesitantly, worried that Jack was blaming him for something.

“Of course I know that,” Jack said. “We can’t reverse what we’ve already done. I’m talking about an arteriogram of the vasculature leading to the brain, not of the brain itself. Just get some contrast dye and a big syringe!”