Marker

eleven

THE THURSDAY-AFTERNOON conference at the Office of the Chief Medical Examiner was a command performance, according to the dictates of the chief, Harold Bingham. Although he frequently did not attend himself, citing pressing administrative duties, everyone else under his command in the five boroughs of New York had to attend. The rule was strictly enforced by the deputy chief, Calvin Washington, unless prior dispensation had been granted, which required deathbed illness or the equivalent. Consequently, the forensic pathologists from the branch offices in Brooklyn, Queens, and Staten Island all had to make the weekly hajj to Mecca for the questionable enlightenment that the conferences offered. For those medical examiners assigned to the home office serving Manhattan and the Bronx, the onus was far less of an imposition, since all they had to do was take the elevator from the fifth floor down to the first.

Laurie generally found the conferences entertaining to a degree, particularly the informal social period prior to the meeting. It was during this time that the examiners traded war stories of the week's more intellectually challenging or plainly bizarre cases. Laurie rarely contributed to these "sidewalk" discussions but enjoyed listening. Unfortunately, enjoyment was not the situation on this particular Thursday. After learning that she was positive for the BRCA1 marker and then having the disturbing worry emerge in Roger's office, she felt shell-shocked, almost numb, and certainly didn't feel social in the slightest. Coming into the room, she didn't join the group around the coffee and donuts, but rather had taken a seat near the door to the hall in hopes of possibly slipping away at some convenient and unobtrusive time.

The conference room was of moderate size, and its decor had a particularly tired look that suggested it was much older than its purported forty-four years. To the left, where a door communicated directly into Bingham's office, stood a scarred and scratched lectern with its own little picture lamp that no longer worked and a goose-necked microphone that did. Arrayed in front of the podium were four rows of equally battered seats fixed to the floor and outfitted with hinged writing surfaces. The seats gave the room the appearance of a small lecture hall and allowed it to fulfill its major function: Bingham's news conferences. In the back of the room stood a library table that presently supported the refreshments, and around which were grouped the city's medical examiners: everyone except the two higher-ups and Jack. A babble of voices interspersed with laughter floated around the room.

Unlike Laurie, Jack did not like anything about the Thursday conferences. Jack had had a run-in with one of the medical examiners from the Brooklyn office over the sister of one of Jack's basketball buddies and refused to even socialize with the man. The same feelings were extended to the branch chief when he supported his underling in the dispute. Even though Jack denied that it was deliberate, he always arrived late, to Calvin's irritation.

The door to Bingham's office opened, and Calvin's massive body appeared. He was clutching a folder, which he opened on the lectern. His dark eyes scanned the room, briefly connecting with Laurie's before moving on. He was obviously taking attendance.

"All right!" Calvin bellowed when no one paid him any heed. Thanks to the microphone, his voice reverberated around the room like a kettledrum. "Let's get under way here."

Calvin kept his head bent down while he organized his papers on the lectern's slanted surface. The medical examiners quickly broke off from their conversations and filed into the rows of chairs to take their seats. Calvin began the meeting the way Bingham used to, back when the chief regularly attended. First, he launched into a summary of the previous week's statistics.

As Calvin's voice droned on, Laurie's mind wandered. Although she was usually good at slipping into her professional persona on command and leaving her personal problems for another time, she couldn't do it presently. Her new worry kept popping back unpleasantly into her consciousness, such that it even trumped the BRCA1 concern. The problem was that she had no idea what she would do if her fears were realized.

The hall door immediately to Laurie's left opened, and Jack walked in. Calvin stopped his presentation, glared at Jack, and said sarcastically, "I'm so glad you were able to grace us with your presence, Dr. Stapleton."

"I wouldn't miss it for the world," Jack answered, causing Laurie to wince. With her fear of authority figures, she couldn't understand how Jack could be so transparently brazen with Calvin. She thought it was a kind of masochism on Jack's part.

Jack looked down at Laurie with an exaggerated questioning expression. She was sitting in the seat he always preferred, and for the same reason Laurie had taken it. He gave her shoulder a squeeze before taking the aisle seat directly in front of her. With Jack's head in the line of her vision, she found it even harder to concentrate on what Calvin was saying. It was a visual reminder that, one way or the other, she was going to have to have a serious conversation with him.

After giving the statistics, Calvin launched into his usual discussion of cogent administrative issues that usually involved some decrease in city funding, and this week's conference was no different. Instead of listening, Laurie watched Jack. Although he had just sat down, his head started the telltale bobbing that suggested that he had already begun falling asleep, causing her to worry that Calvin was going to notice and fly into a rage. When authority figures got angry, even if it wasn't directed at her, it still made her feel uncomfortable.

Either Calvin didn't notice or he just elected to ignore the disrespect, because he concluded his remarks without making a scene and introduced the chief of the Brooklyn office, Dr. Jim Bennett.

Each one of the chiefs from the respective borough offices stood up to give their presentations. When Dick Katzenburg from Queens got behind the microphone and started speaking, Laurie had a flashback to her cocaine conspiracy twelve years earlier. It was at a Thursday-afternoon conference that she had the idea of discussing her overdoses with the group, and the ensuing discussion had been helpful, thanks to Dick. She wondered why the idea of doing the same with the Manhattan General cases hadn't occurred to her, and she thought about bringing it up. But then she changed her mind. She was too stressed-out to deal with the anxiety of talking in front of the group. But then she waffled again when she reminded herself that Calvin seemed to be in a reasonably tolerant mood.

At the end of Margaret Hauptman's presentation of the Staten Island statistics, Calvin reclaimed the podium and asked if anyone else wanted the microphone for any other business. It was a pro forma offer that was rarely accepted, since people were eager to leave. After a moment of painful indecision, Laurie tentatively raised her hand. Any chance of changing her mind was dashed when Calvin quickly but reluctantly recognized her. Jack twisted around in his seat in front of her and gave her an exasperated questioning expression that implied: Why are you extending this agony?

Laurie walked unsteadily up to the podium. She felt a jolt of adrenaline, since speaking in front of groups always intimidated her. As she adjusted the microphone, she berated herself for getting into such a situation. She certainly didn't need any more stress.

"First, let me apologize," Laurie began. "I hadn't prepared for this, but it just occurred to me that I would like to get some general response from everyone about a current series of mine."

Laurie looked down at Calvin and could tell that his eyes had narrowed. She sensed that he knew what was coming and didn't approve. She glanced back at Jack, and as soon as her eyes connected with his, he positioned his fingers like a gun and pretended to shoot himself in the head.

With such negative vibes, Laurie felt even more insecure. To collect her thoughts, she looked down at the lectern's defaced wooden surface with its myriad initials and doodles encased with ballpoint-pen marks. Vowing to avoid making eye contact with either Calvin or Jack, she raised her eyes and launched into a short description of her Sudden Adult Death Syndrome, or SADS, a term she admitted she'd coined when talking with a professional colleague five weeks ago, about four totally unexpected, hospital-based cardiac arrests that had resisted resuscitation. She said she now had six cases spanning a six-week period, all of which had similar demographics: young, healthy, and within twenty-four hours of elective surgery. She went on to say that there was no pathology on gross or microscopic, although on the last two cases, she had yet to do the microscopic, since they had been posted that very morning. She concluded by saying that despite toxicology failing to come up with any possible arrhythmic agent, she suspected that the manner of death in these cases was not natural or accidental.

Laurie let her voice trail off. Her mouth was bone-dry. She would have loved a drink of water, but she stayed where she was. The implication of her monologue was immediately clear to the group, and for a few seconds, silence reigned in the conference room. Then a hand shot up, and Laurie called on the individual.

"What about electrolytes: sodium, potassium, and particularly calcium?"

"The lab reported all electrolytes from all the usual sample sources to be entirely normal," Laurie responded. She then called on another person who raised his hand.

"Are the patients related in any way other than all being young, healthy, and having just had surgery?"

"Not that is apparent. I've made it a point to search for commonalities, but I haven't found any other than what I have mentioned. The cases involve mostly different doctors, different procedures, different anesthetic agents, and, for the most part, different medications, even for postoperative pain."

"Where have they occurred?"

"All six have been at the same hospital: the Manhattan General."

"Which has an extremely low death rate," Calvin snapped. He'd had enough. He stood up, approached the podium, and used his bulk to nudge Laurie aside. He bent the microphone up, and a harsh squeal emanated from the speakers as if in protest. "Calling these disparate cases at this stage 'a series' is misleading and prejudicial because, as Dr. Montgomery has admitted, they are not related. I've told Dr. Montgomery this before, and I'm telling her again. I'm also telling this august assemblage that this is an in-house discussion that doesn't leave this room. OCME is not going to tarnish the reputation of one of the city's premier tertiary-care centers with unsubstantiated innuendo."

"Six is rather a lot for a coincidence," Jack said. He had revived when Laurie got up to speak. Although he was not asleep, he was slouched back in his seat with his legs draped over the seat in front of him.

"Would you kindly show some respect, Dr. Stapleton," Calvin growled.

Jack put his feet down on the floor and sat up. "Four was borderline, but six is too many when they are all at the same hospital. Still, I'm going to vote for accidental. Something in the hospital is affecting these patients' conduction systems."

Dick Katzenburg raised his hand. Calvin motioned with his head for him to speak.

"My colleague at the Queens office just reminded me that we saw some similar cases," Dick said. "It's our recollection that the demographics were quite similar: all relatively young and supposedly healthy. The last case was at least a few months ago, and we haven't had one since."

"How many overall?" Laurie asked.

Dick leaned toward Bob Novak, his deputy, and listened for a moment, then straightened up. "We think it was also six. But it was spread over a period of several months with a number of examiners. Just when we began to be a bit curious about them, they stopped, and as a consequence, they have sort of dropped off our radar. It's my recollection that all were eventually signed out as natural, even though no significant pathology was found. I know for certain that toxicology was negative on all of them, because that would have certainly been brought to my attention."

"Were they postoperative?" Laurie asked. She was taken aback, excited, and pleased. It would be déjà vu if her series were to double from having brought up the issue at a Thursday conference. And if it did double, the profile of these cases would surely be even more of a mental diversion than it had been to date.

"I believe so," Dick said. "Sorry that I can't be more definitive."

"I understand," Laurie said. "Where did these deaths occur?"

"At Saint Francis Hospital."

"Ah, the plot thickens," Jack commented. "Isn't St. Francis another AmeriCare hospital?"

"Dr. Stapleton!" Calvin snapped. "Kindly maintain a modicum of decorum! Allow yourself to be recognized if you wish to contribute to the conversation."

"It is an AmeriCare institution," Dick said, turning toward Jack and ignoring Calvin.

"How soon can I get their names and accession numbers?" Laurie asked.

"I'll e-mail them to you as soon as I get back to the Queens office," Dick said. "Or we can just call my secretary. I think she could find the list."

"I'd like them as soon as possible," Laurie said. "I'd like to get their hospital charts, and the sooner I get the accession numbers to one of our investigators, the better."

"Fine by me," Dick said agreeably.

"Any other business?" Calvin asked. He scanned the group, then concluded the meeting. "See you all next Thursday."

As most of the medical examiners stood up, stretched, and recommenced their conversations that the meeting had cut short, Dick made his way over to Laurie. He had his cell phone pressed up against his ear and was describing the location of a folder in his desk. He motioned for Laurie to wait.

Glancing over at Jack, Laurie saw him immediately duck out of the conference room. She had hoped to talk with him, even if only briefly, and thank him for being ultimately supportive during her mini-presentation.

"Do you have something to write on?" Dick asked.

Laurie produced a pen and the back of an envelope. While Laurie kept her finger on the envelope to keep it steady on the writing surface of one of the chairs, Dick wrote down the names and the accession numbers. He thanked his secretary and rang off. "Well, there you have them," he said. "Let me know if I can be of assistance in any other way. I have to say, it does seem curious."

"I imagine I'll be able to access what I need from the data bank, but if I can't, I'll be in touch. Thanks, Dick! This is the second time you have helped me out. Do you remember those cocaine cases twelve years ago?"

"Now that you mention it, of course I remember, although it seems like it was in a different lifetime. At any rate, I'm glad to be of service."

"Dr. Montgomery!" Calvin called. "Can I speak to you for a moment?" Although his comment was presented as a request, it was more of a command.

Laurie gave Dick a parting wave and then stepped warily over to Calvin. "If these cases of Dick's turn out to resemble yours demographically, I want you to let me know. In the meantime, the proscription of talking about your supposed series with anyone outside of the OCME still holds. Am I clear on that? You and I have had disagreements about information leaks to the media in the past, and I don't want it to happen again."

"I understand," Laurie said nervously. "Don't worry! I learned my lesson, and I certainly would not go to the media. At the same time, I must admit I have been speaking with the chief of the medical staff over at the Manhattan General right from the beginning about the cases. He happens to be a friend."

"What's his name?"

"Dr. Roger Rousseau."

"Since he's on the staff, I suppose it's safe to assume he is aware of the sensitive nature of the issue."

"Most definitely."

"I suppose it's equally safe to assume he's not apt to go to the media."

"Hardly," Laurie said. She was feeling more confident. Calvin was definitely in a mild-mannered mood. "Yet Dr. Rousseau is rightfully concerned, and I believe he would want to hear if Dick's cases are indeed similar. It would give him the opportunity to talk with his counterpart at Saint Francis and make him feel he's not the only one with such a problem."

"Well, I don't see any harm in talking with him, provided you are clear the OCME officially does not currently agree with your assessment of the manner of death, and at the moment will back the Queens office's disposition."

"Certainly, and thank you," Laurie said. It was good to clear the air. She'd carried a twinge of guilt from having talked to Roger about the deaths when she'd first met him, despite Calvin's wishes.

Leaving the conference room, Laurie headed directly to the investigators' office. She was beginning to calm down from the anxiety of talking in front of the group and from having to confront Calvin. She felt even better when she found Cheryl Meyers at her desk, since her workday had officially ended an hour earlier. In Laurie's estimation, Cheryl was the most talented investigator at the OCME and just as hard a worker as Janice. Laurie had Cheryl copy the list of names and accession numbers Dick had provided, and Laurie asked her to put in a request for copies of the patients' charts from St. Francis Hospital.

"What about the autopsy folders and death certificates?" Cheryl asked.

As Laurie had told Dick, she said she'd first try to see what she could obtain from the computerized database. If she needed help for hard copies, Laurie said she'd get back to her.

Clutching her envelope and silently reading the names over and over, Laurie rode up in the elevator. Her intuition told her loudly and clearly that the demographics and details of this new list of victims was going to match her own. Her SADS series was now twelve people.

Once on the fifth floor, Laurie hesitated. It took her a moment to build up her confidence. She wanted to go down to Jack's office and talk to him, even if only briefly, about her disturbing, potential epiphany she had had in Rogers office. She thought it would assuage her anxieties to share them, but she didn't quite know what she wanted to say or even how to begin. Attempting to steel herself against all the uncertainties, she took a fortifying breath and started off.

The closer she got, the slower she walked. She hesitated again before stepping into view in the doorway, appalled at her indecision. She was becoming either a coward or hopelessly wishy-washy, or a mixture of both. Laurie looked back longingly over her shoulder at her own door some forty feet away and waffled.

Hearing a desk chair scrape back within the office in front of her, and sensing that Jack was coming out, Laurie almost fled in a panic. Fortunately, there wasn't enough time, and it wasn't even Jack. It was Chet who literally bumped into her in his haste.

"Oh, gosh, I'm sorry!" Chet offered as he grabbed Laurie by the shoulders to keep from bowling her over as the two stumbled back a step. He immediately let go of Laurie and bent down to pick up the jacket he'd dropped.

"It's quite all right," Laurie said. She recovered quickly, although her pulse was racing.

"I'm off to my body-sculpting class," Chet offered as an explanation. "Obviously, I'm late. And if you are looking for Jack, you missed him. He had some important basketball game at his neighborhood court and bolted out of here ten minutes ago."

"Oh, too bad," Laurie said. She was actually relieved. "No problem. I'll catch him in the morning."

Chet waved good-bye and ran down the corridor toward the elevator. Laurie walked toward her office. Suddenly, she was very tired. The day had taken its toll. She looked forward to getting back to her apartment and taking a hot bath.

As Laurie suspected, her office was empty. She sat down at her desk and typed in her password. For the next thirty minutes, she downloaded the records on the six cases from Queens. Although the forensic investigators' reports were not even close in quality to those done by Janice, there was enough information for Laurie to conclude that the cases were indeed similar to hers. The deaths were all in the early-morning hours between two and four, the ages ranged from twenty-six to forty-two, none of the patients had a history of cardiac problems, and all were within twenty-four hours of elective surgery.

When she was finished, Laurie reached for her phone and dialed Roger's number. She had promised to call, and this was as good a time as any, especially since she had something particular to say besides explaining her behavior in his office. As the call went through, she found herself hoping on this occasion to get his voice-mail to avoid having to resist being drawn into a conversation about things that she didn't want to discuss, but unfortunately, Roger answered on the second ring with his usual cheerful voice. When he realized it was Laurie, he became immediately solicitous.

"Are you all right?" he asked anxiously.

"I'm holding my own," Laurie answered. She wasn't going to lie. "I'm looking forward to getting back to my apartment. It hasn't been my idea of a great day. In the meantime, I've learned something within the hour that I think you will find interesting. During our Thursday-afternoon interdepartmental conference, it was brought to my attention that there had been six deaths at Saint Francis Hospital in Queens that so far sound strikingly similar to those at the Manhattan General."

"Really?" Roger questioned. He was both surprised and interested.

"I've downloaded their death certificates and investigative reports, and I've ordered copies of their hospital charts. Getting the charts will take a while, but in the interim, I'll get what I can over to you tomorrow. I assume you'll want to discuss this with the chief of the medical staff at Saint Francis."

"Most definitely, if only to commiserate with him." Switching gears, Roger added, "Now, let's talk about you. I have to say I've been worried sick since you mysteriously stopped in mid-sentence here in my office and then essentially walked out. What's going on in your mind?"

Laurie twisted the phone cord in her fingers while she tried to think of something appropriate to say. It was not her intent by any stretch of the imagination to cause Roger anxiety, but there was no way she wanted to discuss what was dominating her thoughts, especially when she didn't even know for certain that her worries were justified.

"Are you still there?" Roger questioned.

"I'm still here," Laurie assured him. "Roger, I'm all right. Truly! And as soon as I feel comfortable talking about what is on my mind, I promise I will do so. Can you accept that for the time being?"

"I suppose," Roger said without enthusiasm. "Is it about your being positive for the BRCA1 marker?"

"Indirectly, to some extent. But please, Roger, no more questions."

"Are you sure you don't want to get together tonight?"

"Not tonight. I'll call you in the morning. I promise."

"Okay, I'll be waiting to hear from you. But if you have a change of heart, I'll be home all evening."

Laurie hung up the phone, leaving her hand resting on the receiver. She felt guilty about causing Roger distress, but she was not about to talk to him about what was on her mind.

Pushing back from the desk and standing up, Laurie looked down at the stack of new material from the OCME database. She thought about taking the papers home with her and adding the names to her matrix, but then quickly dismissed the idea. She could deal with her burgeoning series the following day.

With her coat over her arm and her umbrella in one hand, Laurie turned off the light and locked her office door. Next stop was the drugstore, and after that, her apartment. As Laurie pushed the elevator's down button, she could almost feel the delicious sensation of slipping into an enveloping hot bath. For her, a bath was as much a therapeutic experience as it was an opportunity to get clean.