Marker

seven

WITH A MIGHTY YAWN THAT brought tears to her eyes, Laurie put down her pencil, stretched, and then viewed her handiwork. She had created a matrix on a piece of graph paper that had the names of the four patients of her supposed series on the left-hand side of the page. Running along the top of the page and creating columns were all parameters of the cases that she thought might be important, including: the age of the patient, the sex of the patient, the type of surgery involved, the name of the surgeon, the anesthesiologist and anesthetic agent used, the sedative and pain medication employed, where in the hospital the patient was boarded, how the patient was discovered and by whom, the time the patient was discovered, who did the autopsy, any potentially relevant pathology, and the toxicology results.

Currently, Laurie had preliminary entries in all the boxes of her matrix, except for the names of the surgeons and anesthesiologists, the type of anesthetic and drugs used, the toxicology results on the two cases she had posted, and any possible relevant pathology on Darlene Morgan. To fill in the empty boxes, she needed the hospital charts and the continued cooperation of Peter and Maureen. In the toxicology boxes of the two cases posted by Kevin and George, Laurie had written: negative screen, further testing pending.

One piece of information that the matrix had already brought to her attention, which she thought important and mildly damning for her theory of a serial killer, was that the cases were not on the same ward. Two of the patients had been on the general surgical floor, while the other two had been on the orthopedic and neurosurgical floor. Since none of the patients had had neurosurgery and since one of the orthopedic cases had been on general surgery, Laurie had already called the Manhattan General admitting office for an explanation. The explanation turned out to be simple: Because the hospital operated at near capacity, beds frequently had to be allocated irrespective of the type of surgery.

From the moment Laurie had left Jack in the ID room, she had been a human dynamo in regard to investigating the four patients. Her motivation was twofold. There was the continued need for a diversion to keep from obsessing about her own problems, as Jack had surmised. That hadn't changed. What had changed was a strong desire to vindicate her intuitive belief that these cases did not represent a coincidence. Jack's blithe dismissal of the idea had been both belittling and galling.

First, she had gone up to histology to see Maureen, who'd been happy to present her with a tray of McGillan's HE-stained microscopic sections in less than twenty-four hours. With the burden of processing eight thousand autopsies a year, overnight histology-slide service was unheard-of. Laurie had thanked her profusely for her efforts and had immediately taken the slides back to her office to study them painstakingly. As she had suspected, she found no pathology in general, and specifically, she found the heart entirely normal. There were no signs of active or healed inflammation of the cardiac muscle or the coronary vessels, and she saw no abnormalities of the valves or conduction system.

Next, she had gone down to the fourth-floor toxicology lab, where she'd run into a minor setback by bumping into John DeVries. Thanks to the bad blood between them and John's territoriality, he'd demanded to know what she was doing wandering around in his laboratory. Not wishing to get Peter in trouble with his boss, Laurie had to be creative. She happened to have been standing next to the mass spectrometer, so she said she had never completely understood mass spectrometry and was hoping to learn something about it. Mollified to a degree, John had provided her with some printed literature before excusing himself to go down to the serology lab.

Laurie had found Peter in his windowless, Lilliputian office, and his eyes lit up when he saw her. Although Laurie didn't remember Peter from their life prior to the OCME, Peter remembered her when they both had attended Wesleyan University in the early eighties. He had been two years behind her.

"I ran a toxicology screen on McGillan," Peter had said. "I didn't find anything, but I have to warn you that sometimes compounds can hide out in the peaks and valleys on the readout, particularly when the concentration is very low. It would be a big help if you gave me more of a hint of what you are looking for."

"Fair enough," Laurie had said. "Since the autopsies on these patients suggested they suffered a very rapid demise, their hearts had to suddenly stop pumping blood. I mean, one minute everything was fine, and the next minute there was no circulation. That means we have to eliminate cardiac toxins like cocaine and digitalis, and any other drugs that can cause changes in the heart rate, either by affecting the center that initiates the beat or the conduction system that spreads the impulse around the heart. On top of that, we even have to rule out all the drugs that are used to treat abnormal cardiac rhythms."

"Wow! That's a rather big list," Peter had commented. "The cocaine and the digitalis I would have seen, because I know where to look on the readout, and they'd have to be big doses to do what you are talking about. The others, I don't know, but I'll look into it."

At that point, Laurie had asked about Solomon Moskowitz and Antonio Nogueira, whose autopsies had been done several weeks earlier. She told Peter that the cases mirrored McGillan's. Using his keypad in front of his monitor and his password, Peter accessed the laboratory database. Both toxicology screens had been normal, but he offered to run them again now that he had a ballpark idea of what she was looking for.

"One other thing," Laurie had said when she was about to leave. "I did another case this morning whose samples should be on the way up. Again, it was strikingly similar to the others, which tells me there's something weird going on over at the Manhattan General. Since I can't find any pathology, I'm afraid the major burden is going to be on your shoulders to find out what it is."

Peter had said he'd do his best.

After her visit to toxicology, Laurie had gone up to George's office to get a look at Antonio Nogueira's folder. George had surprised her by having copies of the salient portions waiting for her. Kevin had not been so accommodating, but he didn't mind if Laurie made copies. Taking the material back to her office, Laurie had gone over it in detail, filling in her matrix as she went along.

Taking the sheet containing the matrix and twisting around in her chair, Laurie waited for Riva to hang up on a call she was on with a local doctor about her hit-and-run case that morning.

"Check this out!" Laurie said, extending the graph paper to her officemate as she hung up the receiver.

Riva took the sheet and studied it, then looked over at Laurie. "You're being very industrious. This is a great way to organize this information."

"I'm fascinated by this puzzle," Laurie admitted. "I'm also intent on figuring it out."

"I suppose this is why you were pleased when you found no pathology on Morgan, meaning you had yet another case."

"Precisely!"

"So what is your thinking at this point?" Riva asked. "With all this effort, you must have a better idea."

"I think I do. It's become pretty clear to me that the mechanism of death was ventricular fibrillation for all four. The cause is another matter, as is the manner."

"I'm listening."

"Are you sure you want to hear? I mentioned my ideas to Jack, and he was irritatingly dismissive."

"Try me!"

"All right! In a nutshell, since I've decided that the mechanism of death was ventricular fibrillation or cardiac standstill, and since the hearts have been structurally normal, the cause of death has to be some arrhythmia-producing drug."

"That seems pretty reasonable," Riva said. "Now what about the manner of death?"

"This is the most interesting part," Laurie said. She leaned forward and lowered her voice as if she were afraid someone might hear. "I'm thinking the manner of death is homicide! In other words, I think I have stumbled onto the handiwork of a clever serial killer in the Manhattan General."

Riva started to say something, but Laurie held up her hand and moderated her voice. "As soon as I get the hospital charts, I'll be able to fill in the rest of my matrix that will include the preop drugs, the anesthetic agent, as well as the postoperative medication. We'll talk again and see what your response is. Personally, I don't think the extra information is going to make any difference. The occurrence of four cases of fatal ventricular fibrillation unresponsive to resuscitation in young, healthy people undergoing elective surgery in the same hospital using customary protocols within a couple of weeks is too much of a coincidence."

"It is a very busy hospital, Laurie!" Riva said, simply not wanting to argue.

Laurie breathed out forcibly. In her sensitized state, she interpreted Riva's tone as condescending and not all that different from Jack's. Laurie reached out and snatched her matrix from Riva's hand.

"It's just my opinion," Riva said, sensing Laurie's reaction.

"You're entitled to your opinion," Laurie said, swinging back around to face her desk.

"I don't mean to irritate you," Riva said to Laurie's back.

"It's not your problem," Laurie said without looking back. "I'm a bit thin-skinned these days." She turned around again and faced Riva. "But let me tell you this: What made those previous incidences involving serial killers in healthcare facilities go on for so long was a low index of suspicion."

"I think you are right," Riva said. She smiled, but Laurie did not return the peace gesture. Instead, she spun back around and picked up the phone. She might have found it aggravating to share her ideas with Jack and Riva, but the process of vocalizing them had put everything more in focus and had served to make her even more confident that she was correct. Her friends' objections had done nothing to shake her beliefs. She was now even more committed to her serial-killer scenario. As such, she realized that even if it were premature in the sense of having no definitive proof, it was incumbent on her to see that someone over at the Manhattan General was informed. Unfortunately, from bitter experience she knew that such a decision was not hers to make. It had to come from administration and go through public relations. Consequently, she dialed Calvin's extension and asked Connie Egan, Calvin's secretary, for a moment of Calvin's time.

"The deputy chief is due to leave for an Advisory Board luncheon in a few minutes," Connie said. "If you want to try to catch him, I'd advise you to come down immediately. Otherwise, you'll be looking at sometime after four, and even that is dependent on his getting back here, and there's no guarantee of that."

"I'll be right down," Laurie said. She hung up and got to her feet.

"Good luck," Riva said, overhearing the conversation.

"Thanks," Laurie responded without a lot of sincerity. She picked up her matrix.

"Don't be disappointed if Calvin is even more dubious than I," Riva called after her. "And he might bite your head off with such a suggestion of criminality. Remember, he has a soft spot for the Manhattan General, since he trained over there as a medical student and resident in its former life as a major university-affiliated teaching hospital."

"I'll keep that in mind," Laurie yelled back. She felt a little guilty about her behavior toward Riva. Being in such a bad mood was out of character for Laurie, but she couldn't help herself.

For fear of missing Calvin, she wasted no time. She took the front elevators and in less than five minutes, she was walking into the administration area. A number of people were seated on a long couch, waiting to see the chief, whose office door was closed and guarded by his secretary, Gloria Sanford. Laurie could remember a few times sitting there herself, waiting to be bawled out for doing something she was now avoiding by going to see Calvin. Laurie had been a good deal more headstrong, as well as apolitical, when she had first started at the OCME.

"You can go right in," Connie said as Laurie approached her desk. Calvin's door was ajar. He was on the phone with his legs perched on the corner of his desk. As Laurie came in, he motioned with his free hand for her to take one of the two chairs facing him. Laurie's eyes glanced around the familiar room. It was less than half the size of Bingham's and didn't connect with the conference room. Still, it was mammoth when compared to the space Laurie had to share with Riva. The walls were covered with the usual array of diplomas and awards and pictures with major city politicians.

Calvin concluded his conversation, which Laurie could tell dealt with the agenda of the up-and-coming Advisory Board luncheon. The Advisory Board had been set up by the mayor almost twenty years ago, to make the OCME less beholden to both the executive branch and law enforcement.

Calvin let his heavy legs plop down on the floor. He peered at Laurie through his newly acquired, rimless progressive lenses. Laurie felt herself tense. Thanks to a lingering, mild problem with male authority figures from an early age, Calvin had always intimidated Laurie, even more than the chief. It was a combination of his imposing physical presence; his unwavering cold, black eyes; his legendary stormy temperament; and his occasional chauvinism. At the same time, she knew him to be capable of warmth and gentlemanly behavior. What worried her at any given encounter was which side would be dominant.

"What can I do for you?" Calvin began. "Unfortunately, we have to make this short."

"It won't take but a moment," Laurie assured him. She handed over the matrix she had prepared. Then she quickly summarized the history of the four cases as they had unfolded, followed by her ideas concerning the possible mechanism, cause, and manner of death. It took only a few minutes, and when she was done, she fell silent.

Calvin was still studying the matrix. Finally, he looked up. His eyebrows were arched. Settling back into his seat, which complained with a squeak, he arched his index fingers with his elbows on the desk, and shook his head slowly. His expression was of confusion. "I guess my first question has to be why you are telling all this to me at this early stage? None of these cases has been signed out yet."

"Purely because I thought you might want to warn someone over at the Manhattan General what our thinking was, to raise the index of suspicion."

"Correction!" Calvin boomed. He took a fleeting glance at his watch, which wasn't lost on Laurie. "I would be warning them what your thinking was, not mine. Laurie, I'm surprised at you. You're using grossly inadequate data here to make a premature and ridiculous leap." He slapped the matrix with the back of his free hand. "You're suggesting that I communicate pure speculation, which could be extraordinarily detrimental to the Manhattan General Hospital if it got out into the wrong hands, something that happens all too frequently. It could even cause a panic. We deal in facts here at the OCME, not fanciful supposition. Hell, we could lose all credibility!"

"I have a strong intuition about this," Laurie countered.

Calvin slammed his sizable palm down onto the surface of his desk. A few papers went wafting off. "I have zero patience with female intuition, if that's what this is boiling down to. What do you think this is, a sewing club? We're a scientific organization; we deal in facts, not hunches and guesswork."

"But we're talking about four essentially unexplained cases within a two-week period," Laurie said while inwardly groaning. It seemed that she had awakened Calvin's dormant chauvinism.

"Yeah, but they do thousands of cases over at the Manhattan General. Thousands! I happen to know they have a low death rate, well below the bellwether three percent. How do I know? I serve on the board. Come back with some facts from toxicology or infallible evidence of low-voltage electrocution and I'll listen to you, not some cockamamie story of serial killer on the loose with no facts to back it up."

"They were not electrocuted," Laurie said. At one point, she had briefly considered the idea, since standard 110 voltage was capable of causing ventricular fibrillation. But she'd dismissed the idea because patients weren't routinely subjected to power sources. Maybe one could have been exposed to an aberrant piece of equipment, but surely not four, particularly since none had been monitored.

"I'm just trying to make a point," Calvin yelled. He stood up abruptly, causing his desk chair to roll back on its casters and strike the wall. He handed Laurie her paper. "Go back and get some facts if you are so motivated! I don't have time for this foolery. I've got to go to a meeting where we deal with real problems."

Embarrassed at being chastised like a schoolgirl, Laurie fled the administration area. Calvin's office door had been open during the exchange, and the people waiting to see Bingham watched her departure with expressionless faces. She couldn't imagine what they thought about what they had heard. She was relieved to catch an empty elevator to pull herself together. As she had said to Riva, she knew she was thin-skinned at the moment, and under normal circumstances, she probably could have brushed off Calvin's crusty response to her concerns. Yet combining Calvin's reaction with Jack and Riva's, she felt like a modern-day Cassandra. She couldn't believe that people whom she respected could not see what was so clear to her.

Back in her office, she threw herself into her chair and for a moment buried her head in her hands. She was stymied. She needed further information but was paralyzed by having to wait for the charts to come over from the Manhattan General through the usual channels. There was no way she could speed up the system. Other than that, she had to wait for Peter to work his magic with the gas chromatography and mass spectrograph. Short of getting yet another similar case the following day, which she was not wishing for, there was nothing to be done.

"I have to assume your meeting with Calvin was not as auspicious as you hoped," Riva said.

Laurie didn't respond. She was feeling even more temperamental than earlier. From when she was a little girl, she'd always sought approval from authority figures, and when she didn't get it, she felt terrible. Calvin's reaction was a case in point, making her feel that all the disparate segments of her life were unraveling. First was the situation with Jack, next her mother and the BRCAl problem, and now it seemed that even her job was in disarray. On top of it all, she felt physically exhausted from insufficient sleep two nights in a row.

Laurie sighed. She had to pull herself together. Thinking about the BRCAl problem reminded her that she had agreed with Jack to have herself tested for the marker by calling her old college roommate, Sue Passero. At the time, Laurie had not been completely forthright, since she actually hadn't entirely decided to do it, so her acquiescence was more to assuage his unexpected insistence than a real decision. Yet suddenly, she saw the idea in a new light, since getting away from the OCME, even for just a couple of hours, sounded like a good idea. The thought also occurred to her that she could kill two birds with one stone. Knowing Sue as well as she did, Laurie was confident that while getting tested, she could pass along her concerns about the possibility of a serial killer that would give the hospital a reason to be vigilant without the need to cite herself or the OCME as the source.

Laurie got out her address book for Sue's office number and made the call. They had been close in college and in medical school, and having ended up practicing in the same city, they got together every month or so for a dinner. They always vowed to see each other more often, but somehow it never happened.

Laurie got one of the clinic secretaries where Sue worked and asked for Sue. Laurie's intention was just to leave a message for Sue to call back at a convenient time, but when the secretary asked who was calling and Laurie said "Dr. Montgomery," the secretary went off the line before Laurie could explain. The next thing she knew, she was talking with her friend.

"This is a nice surprise," Sue said cheerfully. "What's up?"

"Do you have a minute to talk?"

"A minute, what's on your mind?"

Laurie said she needed to be tested for BRCA1 for reasons that she would explain later. She also mentioned that she had been switched to AmeriCare but had not yet made arrangements for a primary-care doctor.

"No problem. Come over anytime. I can set you up with a script and send you down to the lab."

"How about today?"

"Today is fine. Come on over! Have you had lunch?"

"I haven't." Laurie smiled. It was going to be three birds with one stone!

"Well, get your rear end over here, girl! The cafeteria food is not something to write home about, but the company will be good."

Laurie hung up and got her coat from behind the door.

"I think you are doing the right thing about being tested," Riva said.

"Thank you," Laurie responded. She looked at her desk to be sure she wasn't forgetting something.

"I hope you're not cross with me," Riva said.

"Of course not," Laurie responded. She gave Riva's shoulder a reassuring squeeze. "As I said earlier, I know I'm oversensitive these days, and everything is bothering me more than it should. Be that as it may, and I know you're not my secretary, but I'd appreciate it if you would once again take messages, especially from Maureen or Peter. I'll make it up to you."

"Don't be silly. I'll be happy to answer your phone. Are you going to be back this afternoon?"

"Absolutely. It's going to be a quick lunch and a simple blood test, although I might stop and say hello to my mother as well. Anyway, I'll have my cell if you need to call."

Riva waved and went back to her work.

Laurie walked out the OCME entrance on First Avenue. There was a bite to the air. The temperature had dropped as the day progressed, so it was colder than when she'd walked to work that morning. As she descended the front steps toward the curb, she got her zipper started and pulled it up to her chin. Standing on the curb, she was shivering slightly as she raised her hand to hail a cab.

The ride to Manhattan General was a little longer than the ride she'd taken the previous day to University Hospital. Both institutions were on the Upper East Side and approximately equal distance to the north from OCME, but the General was farther west, sprawled along Central Park. It took up more than an entire city block, with several pedestrian walkways spanning the surrounding streets to connect with outlying buildings. The complex had been constructed of gray stone in fits and starts during the course of almost a century, so the various wings were of slightly different architectural design. The newest wing with the most modern silhouette and named for the benefactor, Samuel B. Goldblatt, stuck off the back of the main structure at right angles. It was the VIP wing, the equivalent of where Laurie's mother had been roomed over at the University Hospital.

Having been to the Manhattan General on a number of occasions, including visiting Sue, Laurie knew where she was going, which was helpful, since the hospital was always mobbed. She headed directly to the Kaufman outpatient building. Once inside, she walked down to the internal medicine section and inquired after her friend at the main check-in desk. When Laurie mentioned her own name, the secretary handed her an envelope. Inside was a completed script for a screen for the BRCA1 marker, as well as a note from Sue. The note told her where the genetics lab was located in the central building on the second floor. There were also instructions for Laurie to go first to admitting. As a new AmeriCare subscriber, she had to get a hospital card. The final line in the note said that Laurie should go directly to the cafeteria when she was finished, and that Sue would meet her there.

Obtaining the hospital card took more time than the blood test. She had to wait in line to see one of the customer-service representatives. Still, it took only fifteen minutes, and she was soon on her way up to the laboratory on the second floor. Sue's directions were clear, and Laurie found the genetics diagnostics lab without difficulty. Inside, it was surprisingly serene in comparison to the rest of the hospital. Canned classical music issued from wall speakers. Framed prints of Monet's "Water Lilies" from the Museum of Modern Art lined the walls. No patients were in the ' waiting room when Laurie handed over Sue's script to the receptionist. It was apparent that walk-in genetic testing was in its infancy, but Laurie knew it would soon be changing, and with it, medicine in general.

Sitting in the waiting area, Laurie was again forced to confront the reality of what might be lurking deep within the core of her being. It was a disturbing revelation to think she was possibly carrying an instrument of her own death in the form of a mutated gene. It was a kind of unconscious suicide or built-in self-destructive device, which was certainly the reason she'd been actively avoiding thinking about it. Would she be positive or negative? She didn't know, and being in the hospital made her feel like a gambler, something she was never comfortable with. Had Jack not insisted, she most likely would have put off doing the test indefinitely. But now that she was there, she would have the blood drawn, and then she would forget about it, a trait Laurie shared with her mother.

After the blood was drawn, a deceptively simple procedure, Laurie returned to the first floor and waited in line at the main information desk. She had no idea where the cafeteria was located in the extensive complex. When it was her turn, the pink-smocked volunteer asked Laurie if she wanted the main cafeteria or the staff cafeteria. Momentarily indecisive, Laurie said the staff cafeteria and was given directions.

The directions were complicated but made easier by the volunteer's last suggestion-namely, to follow a purple line on the floor. After a five-minute walk, Laurie found herself in the staff cafeteria. Since it was quarter past twelve, the place was bustling. Laurie had no idea the staff of the Manhattan General was as large as it was, especially considering that the crowd represented only a portion of one shift out of three.

Laurie looked around at the teeming faces both sitting at tables and waiting in the steam-table line. The babble of reverberating conversation reminded her of the noise of a wetland sanctuary on a late summer night. With such a crowd, Laurie couldn't help but be immediately pessimistic about hooking up with Sue. The plan smacked of trying to meet a friend in Times Square on New Year's Eve.

Just when Laurie was about to head over to the cashiers to ask for a house phone to page her friend, a hand tapped her on the shoulder. To Laurie's delight, it was Sue, who enveloped her in a big hug. Sue was a big-boned, athletic woman of color who had excelled at college soccer and softball. Laurie felt tiny in her embrace. As usual, Sue looked fetching. In contrast to most of her colleagues, she was dressed in a stylish and flattering silk dress overlaid with a highly starched white coat. Similar to Laurie, she liked to indulge her feminine side with her attire.

"I hope you didn't bring your appetite," Sue teased while gesturing toward the steam-table line. "But joking aside, the food's not that bad."

As they descended the steam-table line and chose their food, they maintained a superficial banter about their respective professional roles. While waiting in the cashiers' line, Laurie asked about Sue's two children. Sue had gotten married just after medical school and had a boy, fifteen, and a girl, twelve. Laurie couldn't help but be jealous.

"Except for the agony of adolescence, everything is hunky-dory," Sue said. "What about you and Jack? Any light at the end of the tunnel? Seems to me you've got to get a move on, girl! I happen to know you are sneaking up to the big forty-three in a few days, since I'm close behind."

Laurie felt her face flush, along with a twinge of irritation that she was incapable of hiding anything. She could tell that Sue had caught the reaction, and since she and Sue had been friends for al- most twenty-six years, she had confided in her about her desire for children and the situation with Jack, particularly over the last two years. Laurie was not going to be able to get away with platitudes.

"Jack and I are history," Laurie said, deciding to be more forthright than she actually felt, "at least intimacy-wise."

"Oh, no! What's wrong with that boy?"

Laurie wrinkled her forehead and shrugged to say she had no idea. She didn't want to get into a long, drawn-out emotional conversation in her current state.

"Well, you know something… good riddance. You've been more than patient with that indecisive nincompoop. You should get a medal, because he ain't going to change."

Laurie nodded and had to restrain herself from defending Jack, even though what Sue was saying was true.

Sue wouldn't let Laurie pay for her lunch and insisted on putting the charges on her house account. With their trays in hand, they managed to get a table for two by the window. The view was of an inner courtyard with an empty fountain. In the summer, it was lush with flowers, water gushing from the fountain's multiple tiers.

They talked casually for a few more minutes about the situation with Jack, with Sue doing most of the talking. She then insisted that she would find someone more suitable for Laurie, and Laurie teased her by daring her to try. The conversation then switched to why Laurie had to have the BRCA1 screen. Laurie told the story about her mother and the fact that as usual, her mother had hidden the information from her. Sue's only comment was that she would arrange an appointment for Laurie with a top-notch oncologist if the test came back positive.

"What about a primary-care physician?" Sue asked after a short pause. "Now that you are officially a subscriber, you're going to need one."

"How about you?" Laurie suggested. "Are you taking new patients?"

"I'd be honored," Sue replied. "But are you sure you would be comfortable with me as your doc?"

"Absolutely," Laurie said. "I'll also have to switch my gyno."

"I can help you with that as well," Sue said. "We've got some terrific people on staff, including the woman I use my myself. She's quick, gentle, and knows her stuff."

"Sounds like a good recommendation. But there's no rush; I'm not due for a yearly checkup for another six months."

"That might be true, but I think we should get it in the works. The woman I'm thinking of is awfully popular. For all I know, she has a six-month wait for a first appointment. She's that good."

"Then by all means," Laurie said.

For a few minutes, they both concentrated on eating. It was Laurie who broke the silence. "There's something else important that I wanted to talk to you about."

"Oh?" Sue commented. She put down her teacup. "Fire away!"

"I wanted to talk to you about SADS."

Sue's face screwed up into an expression of complete confusion. "What the hell is SADS?"

Laurie laughed. "I just made it up this second. You've heard of SIDS, sudden infant death syndrome."

"Of course! Who hasn't?"

"Well, I've coined SADS for sudden adult death syndrome, which is a good name for a problem that's been occurring over here at the Manhattan General."

"Oh?" Sue questioned. "I think you'd better explain."

Laurie leaned forward. "Before I do, I have to say that it has to be in strictest confidence that the information I'm about to tell you came from me. I had suggested to our deputy chief that some- one over here at the Manhattan General should be warned, but he blew his top, contending that it was all mere speculation with no proof, and as such, might hurt the hospital's reputation. Yet I feel like the researcher caught in the bind of conducting a double-blind study on a life-saving procedure, which has quickly suggested its worth. Even though I'd be destroying the integrity of the study, which might keep the FDA from approving the treatment, I've got to leak the results so the people getting the placebo can be saved."

Laurie leaned back and laughed at herself. "Wow! Am I getting melodramatic or what? But it is true that I have no specific proof concerning what I'm about to tell you, mainly because I haven't finished investigating the cases. I don't even have copies of their hospital charts yet. I just feel it strongly, and someone has to know sooner rather than later. Anyway, this kind of medical politics drives me up the wall. It's the one bad thing about my job."

"Now you've got my curiosity up. Way up! Come on! Spill the beans!"

Leaning forward again and lowering her voice, Laurie proceeded to tell the story in the chronology it had unfolded by starting with McGillan, then adding the two cases posted by Kevin and George, and ending with her case that morning. She talked about the ventricular fibrillation and the fact that the autopsies had been completely clean. She then told Sue that she felt that with no pathology on gross or microscopically, the chances of four cases happening by chance was about the same as the sun not coming up the following morning.

"What exactly are you saying?" Sue questioned dubiously.

"Well…" Laurie said with hesitation. Knowing Sue as well as she did, she was aware that what she was about to say was the figurative equivalent of slapping her friend in the face. "Although I suppose there is still a minuscule chance the cause of these deaths was accidental in the form of a late anesthetic complication or maybe an unexpected side effect of a drug, I sincerely doubt it. And when I say minuscule, I mean infinitesimally small, because our toxicology screens have so far been negative. Anyway, the bottom line is this: I'm concerned about the possibility that these deaths are homicides."

For a few minutes, neither Laurie nor Sue said a word. Laurie was content to let the information sink into Sue's brain. She knew Sue was enormously quick-witted and patriotic about the Manhattan General. She'd done all her residency training within its walls.

Sue eventually cleared her throat. It was obvious that what Laurie had said had troubled her greatly. "Let me get this straight. You think we have some kind of a grim reaper wandering around our wards at night?"

"In a way, yes. At least, that's my worry. Before you dismiss the idea out of hand, just call to mind those cases in the news over the last couple of years, where deranged healthcare workers were dispatching patients under their care. You remember them, don't you?"

"Of course I remember them," Sue said, seemingly taking offense at the comparison. She sat up straighter in her chair. "But we're not out in the boonies here or operating a fly-by-night nursing home. This is a major medical center with layers of oversight. And these patients you've been describing weren't bed-ridden or at death's door."

Laurie shrugged. "It's hard to argue with the facts that we have namely, no explanation for four deaths. And as I remember it, at least some of the institutions involved in those serial-murder cases were highly regarded. The double tragedy is that they went on for so long."

Sue took a deep breath and let her eyes wander around the room blankly.

"Sue, I'm not expecting you to do anything about this personally," Laurie said. "Nor should you feel defensive about the Manhattan General. I know it is a fine institution, and I'm certainly not trying to sully its reputation. What I was hoping is that you would know whom you or I should inform to try to keep it from happening in the future. Seriously, I'll be happy to tell this individual exactly what I told you, provided my identity can stay out of the picture, at least until the OCME officially gets involved."

Sue visibly relaxed. She gave a quick, mirthless laugh. "Sorry! I guess I take any criticism of the place to heart. Silly me!"

"Do you know someone like I described: someone on a clinical administrative level? Or what about the head of anesthesia? Maybe I should talk to him."

"No, no, no!" Sue repeated for emphasis. "Ronald Havermeyer has an ego as big as a tectonic plate, with the usual associated volcanic eruptions. He should have been a surgeon. Don't talk to him! He'd definitely take it personally and want to take revenge on the messenger. I know because I've sat with him on several hospital committees."

"What about the hospital president? What's his name again?"

"Charles Kelly. But he'd be as bad as Havermeyer, and maybe worse. He's not even a doctor, and he clearly thinks of this whole operation as a business. There's no way in hell he'd be sensitive to your situation, and he'd be looking for a scapegoat immediately. No, it has to be someone with a bit of finesse. Maybe a member of the mortality/morbidity committee."

"Why do you say that?"

"Simply because dealing with something like this is their mandate, and they meet once a week to keep tabs on what is going on."

"Who serves on it?"

"I served on it for six months. Someone from the clinical side serves on a rotating basis. The permanent members are the risk management officer, the quality-control chief, the chief counsel for the hospital, the president of the hospital, the nursing supervisor, and the chief of the medical staff. Wait a second!"

Sue lunged across the table and grasped Laurie's forearm so quickly that Laurie jumped. Laurie's eyes darted around the room, as if she expected an imminent physical threat.

"The chief of the medical staff!" Sue repeated with enthusiasm. She let go of Laurie's arm and gestured widely with her hands. "Why didn't I think of him before? Oh my gosh, he's perfect!"

"How so?" Laurie questioned, having recovered from her momentary fright.

It was now Sue's turn to lean forward and lower her voice in a conspiratorial tone. "He's in his late forties, single, and he's a doll. He's only been here for three or four months. All the single nurses are gaga over him, and if I weren't happily and irrevocably married, I would be, too. He's tall and lean and has this smile that melts ice. He does have a rather big snout, but you don't even notice it. Best of all, he's got an IQ in the stratosphere and a personality to go with it."

Laurie couldn't help but wryly smile. "He sounds charming, but that's not what I'm looking for. I need someone in a position of power who can be discreet. It's that simple."

"I told you, he's the chief of the medical staff. What more power can you ask for? And as far as being discreet is concerned, he's the definition of the word. I tell you, you have to pry personal information out of him with a crowbar. It took me a quarter of an hour at the Christmas party just to find out that before coming here, he'd been with Médecins Sans Frontières, which took him all over the world. I had to bite my tongue when Gloria Perkins, the head nurse in the OR, butted in and asked him to dance."

"Sue, I think you are telling me more than you need to. I don't need to know the guy's history. All I want to know is if you're reasonably confident he'll listen to what I have to say, act on it, and leave my name out of it until there's official word from the OCME. Is that your take?"

"I told you he's the picture of discretion. And personally, I think you two will hit it off famously. And all I ask in return is that you name your firstborn after me. I'm joking, of course. Now, let's see if he's here." Sue pushed back her chair, stood up, and started scanning the crowd.

Aghast at suddenly comprehending Sue's romantic intentions, Laurie reached out and tugged insistently on her white coat. "Hold on! This is not the time or place to try to fix me up."

"Hush, girl!" Sue said, batting Laurie's hand away while continuing to search the room. "You dared me to find somebody suitable, and this dude fills the bill. Now, where in tarnation is he? He's always here with women around him like he's dressed in flypaper. Ah, there he is, and no wonder I couldn't see him. He's holding court at the far table."

Without a second's hesitation, and oblivious to Laurie's appeals to the contrary, Sue strode off. Laurie watched her wend her way among the crowded tables. Almost fifty feet away she tapped a medium-brown-haired man on the shoulder. He stood up, and being a head taller than Sue, Laurie guessed he was close to Jack's height. For a moment Sue talked with him, utilizing lavish hand gestures capped off with her finger pointing in Laurie's direction. Laurie felt herself blush, and she looked down at her tray. The last time she had experienced this kind of social humiliation was in middle school, and although that episode turned out reasonably well, she didn't feel confident now.

The next few minutes crawled by. Laurie redirected her eyes out the window at the empty fountain, wondering if she should flee. The next thing she knew, Sue was tapping her shoulder and calling her name. With a sense of resignation, Laurie turned and found herself looking up into the rugged, smiling face of an attractive and vigorous-appearing man standing next to her friend. He could have been a sailor or someone who had spent a good deal of time in the sun. He was carefully groomed, dressed in a dark blue suit with a white shirt and colorful tie. Over his clothes, he had on a clean, highly starched white coat similar to Sue's. All in all, he exuded an urbane, refined, even elegant aura that stood out markedly from the other mostly frumpy doctors. As far as the nose was considered, Laurie felt it fit in just fine.

"I want you to meet Dr. Roger Rousseau," Sue said. Her hand gripped his shoulder.

Laurie scrambled to her feet and shook the hand that was extended toward her. It was warm and forceful. Looking into his eyes she was surprised to find them a pale blue. After stumbling over saying she was glad to meet him, Laurie winced internally. She felt like she was acting as she had back in middle school, during that previous awkward introduction.

"Please call me Roger," the man said warmly.

"And me Laurie," Laurie added, regaining her composure. She noticed the man's smile that Sue had described and found it appealing.

"Sue mentioned that you had some confidential information that you were willing to share with me."

"I do," Laurie said simply. "I assume she also mentioned it has to stay anonymous. A leak could put my job in jeopardy. Unfortunately, I've had some bad experiences in the past."

"I have no problem with your need for secrecy. I give you my word." He glanced around the busy cafeteria. "This isn't the best place for a confidential conversation. May I invite you up to my modest but at least private office? We won't have to shout, and we surely won't be overheard."

"That would be fine," Laurie said. She glanced at Sue, who winked, smirked, and waved good-bye all at the same time. When Laurie started to pick up her tray Sue motioned for her to leave it, saying she'd take care of it.

Laurie followed Roger as he threaded his way out through the cafeteria entrance, which was now even more crowded than when Laurie first arrived. Just beyond the throng, Roger stopped and waited for Laurie to catch up. "It's only one flight up. I usually take the stairs. Do you mind?"

"Heavens, no," Laurie said. She was surprised he'd even thought to ask.

"Sue told me you were part of the Médecins Sans Frontières," Laurie said as they climbed.

"I was indeed," Roger said. "For about twenty years."

"I'm impressed," Laurie said, knowing something of the good works carried out by the organization, for which it had received a Nobel Prize. Out of the corner of her eye, she noticed that Roger was taking the stairs by twos. "How did you happen to join that organization?"

"When I finished my residency in infectious diseases in the mid-eighties, I was looking for some adventure. I was also an idealistic, far-left liberal who wanted to change the world. It seemed like a good fit."

"Did you find adventure?"

"Most assuredly, as well as training in hospital administration. But I found some disillusionment as well. The need for even the most basic medical care in so much of the world is staggering. But don't get me started."

"Where were you located?"

"The South Pacific first, then Asia, and finally Africa. I made sure I made the rounds."

Laurie remembered her trip to West Africa with Jack and tried to imagine what it would be like to work there. Before she could mention her experience, Roger sprinted ahead and opened the door at the top of the stairs.

"What made you leave the organization?" Laurie asked as they descended the busy main corridor en route to the administration area. As Roger was a relatively new employee she was impressed by how many people greeted him by name as they passed.

"Partly the disillusionment of not being able to change the world, and partly because I felt the need to come home and settle down and have a family. I'd always seen myself as a family man, but it wasn't going to happen in Chad or Outer Mongolia."

"That's romantic," Laurie said. "So love brought you back from the wilds of Africa."

"Not quite," Roger said as he held open the door that lead into the carpeted, peaceful realm of the administrative offices. "There was no one here waiting for me. I'm like a migratory bird instinctively flying back to the nesting site where I began as a chick, hoping to find a mate." He laughed as he waved to the secretaries who were not at lunch.

"So you're from New York," Laurie commented.

" Queens, to be exact."

"Where did you go to medical school?"

"Columbia College of Physicians and Surgeons," Roger said.

"Really! What a coincidence! So did I. What year did you graduate?"

"Nineteen eighty-one."

"I was eighty-six. Did you happen to know a Jack Stapleton in your class?"

"I did. He was one of the best basketball players in Bard Hall. Do you know him?"

"I do," Laurie said without elaborating. She felt strangely uncomfortable, like she was cheating on her relationship with Jack just by bringing up his name. "He's a colleague of mine over at the OCME," she added lamely.

They entered Roger's office, which was, as he had said, modest. It was situated on the inside area of the administration wing and accordingly had no windows. Instead, the walls were covered with framed photos of numerous places around the world where he had worked. There was a number of himself with either local dignitaries or patients. Laurie couldn't help but notice that in all of them, Roger was smiling as if each photo had recorded a celebratory event. It was particularly noticeable, since the other people were expressionless or actually frowning.

"Please, sit down!" Roger suggested. He angled a small straight-back chair toward the desk. After closing the door to the hall, Roger sat at the desk, leaned back, and folded his arms. "Now then, tell me what's on your mind."

Laurie again emphasized the need to keep her name out of the situation, and Roger assured her that she had nothing to fear. Reasonably confident, Laurie told the story as she had told it to Sue. This time, she used the term "serial killer." When she was finished she reached over and put a three-by-five index card with the four names directly in front of him.

Roger had been silent throughout Laurie's monologue, staring at her with increasing intensity. "I can't believe you are telling me this," he said finally. "And I am enormously appreciative of your making this effort."

"My conscience dictated that someone should know," Laurie explained. "Perhaps after I get copies of the charts or if toxicology comes up with something surprising, I'll have to eat my words. That would be fine, and no one would be happier than I. But until then, I'm worried something weird is going on."

"The reason I'm so surprised and appreciative is because I have been the scorned gadfly here like you have been over at the OCME, and for the same reasons. I've brought up each of these cases at the morbidity/mortality meeting. In fact, the last time was this morning with Darlene Morgan. And every time, I've been met with denial, even anger, particularly from the president himself. Of course, I haven't had the added benefit of the autopsy results, since we haven't gotten them yet."

"None of the cases have been signed out," Laurie explained.

"Whatever," Roger said. "These cases had me worried right from the first one, Mr. Moskowitz. But the president has put a gag order on our even discussing them, lest something leak out to the media and put the efficacy of our CPR program in question. The on-call docs were unable to get even a rudimentary heartbeat going on any of these cases."

"Has there been any investigation of any sort?"

"Nothing, which flies in the face of my strenuous recommendations. I mean, I've personally looked into it to a degree, but my hands are tied. The problem is, our mortality is very low, below two-point-two percent. The President said we'd do something when it gets to three percent, the usual level of concern. The rest of the committee agrees, particularly the quality-control person, the risk-management person, and the damn lawyer. They are all convinced beyond a shadow of doubt these episodes are merely unfortunate and unavoidable complications in the inherently risky environment of a tertiary-care center. In other words, they are within statistical predictions. But I don't buy it. For me, they're sticking their heads in the sand."

"When you looked into it, did you find anything at all?"

"I didn't. The patients have been on different floors, with different staff, and different doctors. But I haven't given up."

"Good!" Laurie said. "I'm glad you are on top of it, and I'm glad to have had a chance to satisfy my conscience." She stood up, but the second she did, she wished she hadn't, yet she couldn't sit back down for fear of embarrassing herself. The problem was Jack. In fact, lately it seemed that the problem was always Jack. She had enjoyed talking with this man and the feeling made her uncomfortable. "Well, thanks for listening to me," she added, extending her hand toward Roger in an attempt to regain a modicum of control. "It has been nice meeting you. As I mentioned, I'll be getting copies of the charts, and I have our best toxicologist working on it. I'll let you know if anything comes up."

"I'd appreciate it," Roger said, shaking her hand but then holding on to it. "Now, may I ask a few questions?"

"Of course," Laurie said.

"Would you mind sitting back down?" Roger asked. He let go of Laurie's hand and gestured toward the chair Laurie had just vacated. "I prefer you sitting, so I don't have to worry you'll flee out the door."

Somewhat confused by Roger's last comment and why he might believe she'd want to flee, Laurie sat back down.

"I have to confess that I have an ulterior motive in being uncharacteristically glib about answering personal questions. If you would indulge me, I'd like to ask you a few personal questions, since Sue made it a point to tell me that you were single and unattached. Is any or all of that correct?"

Laurie immediately felt dampness in the palms of her hands. Was she unattached? Being put on the spot by an attractive, interesting man who was expecting an answer made her pulse race. She didn't know what to say.

Roger leaned forward and dipped his head to try to look Laurie in the eyes. Her eyes had lowered in response to her emotional confusion.

"I apologize if I am upsetting you," Roger said.

Laurie straightened up, took a deep breath, and smiled wanly. "You're not upsetting me," she lied. "I just didn't expect to be asked that kind of question, especially on this potentially kamikaze career-wise mission of mine over here to the Manhattan General."

"Then an answer would be nice," Roger persisted.

Laurie smiled again, mostly at herself. She was again acting like a teenager. "I am single and mostly unattached."

" 'Mostly' is an interesting choice for an adverb, but I'll accept it on face value, since we all live in a social web of sorts. Do you live in the city?"

An embarrassing snapshot of her tiny apartment with its seedy entrance flashed through Laurie's mind. "Yes, I have a flat downtown." Then, to make it sound better than it was, she added, "Not too far from Gramercy Park."

"Sounds good."

"How about yourself?"

"I've only been back for a little over three months, so I wasn't sure where the best place was to live currently in the city. I took a year's lease on an apartment on the Upper West Side – Seventieth Street, to be exact. I like it. It's close to that new Sports L.A. club, the museum, and Lincoln Center, plus I have the park at my fingertips."

"Sounds good," Laurie said. She and Jack had frequented restaurants in that area over the last several years.

"My next question is whether you'd care to have dinner with me tonight."

Laurie smiled inwardly as the aphorism "Be careful what you wish for, since it may come true" occurred to her. Over the last number of years with Jack, she'd progressively come to realize how much she appreciated decisiveness in her significant other, something Jack lacked in his personal life. Roger, on the other hand, seemed to be the opposite. Even during this brief encounter, she sensed his personality embodied the term.

"It doesn't have to be a late night," Roger added when Laurie hesitated. "It can be a restaurant of your choosing right around where you live."

"How about on the weekend?" Laurie suggested. "I happen to be free."

"That could be held out as a bonus if you enjoy yourself tonight," Roger said zealously, taking Laurie's suggestion as an auspicious response. "I'm afraid I must insist on tonight, provided, of course, you are free. That gives you an easy out, since you can always say you are busy. But I hope you don't. I have to admit right up front I have not been bowled over by interesting, accomplished women in this town, and I have had my antennae fully extended."

Laurie was flattered with Roger's insistence, especially compared to Jack's indecisiveness, and having been introduced to him by Sue, Laurie felt there was no reason why she shouldn't accept. She had been looking for a diversion, and this was the healthiest. "Okay," she said. "We have a date!"

"Great! Where? Or would you prefer I pick?"

"How about a restaurant in SoHo called Fiamma," Laurie suggested. She wanted to steer clear of any of the places she and Jack had frequented, even if there was a low probability of running into him. "I'll call and make a reservation at seven."

"Sounds good. Should I pick you up at your apartment?"

"Let's meet at the restaurant," Laurie said, as a sudden brief image of Mrs. Engler's bloodshot eye peering out from behind her door popped into her head. She did not want to subject Roger to that. Not at this stage.

Fifteen minutes later, Laurie walked out of the Manhattan General Hospital with a definite spring to her step. She was both surprised and thrilled at what felt like an adolescent infatuation. It was a type of excitement she'd not experienced since being in the ninth grade at the Langley School for Girls. She knew from experience that the feelings were premature and that they probably wouldn't stand the test of time, but she didn't care. She was going to enjoy the euphoria while it lasted. She deserved it.

Standing at the curb, she looked at her watch. With time to spare and with the University Hospital in proximity she decided to head over and pay a quick visit to her mother before returning to the OCME.