Marker

six

SHELLY, WATCH OUT!" LAURIE yelled. "Stop!" To her utter horror, her brother was running full tilt toward a stagnant lake, the shore of which was ringed with deadly mud capable of swallowing an elephant. She couldn't believe it. She'd warned him of the danger, but he wouldn't listen. "Shelly, stop!" she repeated as loud as she could.

Filled with the agonizing frustration of powerlessness in the face of imminent disaster, Laurie began running. Although she knew she would be helpless when Shelly blundered into the mud, she couldn't stand there and let the tragedy unfold without trying to do something. As she ran, she frantically looked for a long stick or a log that she could extend to her brother once he was caught in the muck, but the surrounding landscape was barren, with nothing but bare rock.

Then, suddenly, Shelly stopped about ten feet from the quicksand-like muddy border of the lake. He turned and faced Laurie. He was smiling in the same taunting fashion as he had when they were children.

Relieved, Laurie came to a halt. Panting, she didn't know if she should be thankful or angry. Then, before she could say anything, Shelly turned around again and recommenced his mad dash toward calamity.

"No!" Laurie shouted. But this time, Shelly reached the lake and ran out as far as he could go before his legs became hopelessly mired. Again, he looked back, only now his smile was gone. In its place was a look of terror. He reached toward Laurie, who'd run to the very edge of the dry land. Again, she looked for something to use to reach out to him, but there was nothing. Rapidly and relentlessly, her brother sank into the muck, with his pleading eyes riveted to Laurie's until they disappeared into the filth. All that was left was a hand vainly grasping at the air, but it, too, soon disappeared from view, swallowed by the enveloping mud.

"No! No! No!" Laurie shouted, but her voice was drowned out by a jarring jangle that pulled her from the depths of sleep. Quickly, she stretched out and quieted her ancient windup alarm clock. She flopped back onto the bed and stared up at the ceiling. She was perspiring and breathing heavily. It was an old nightmare that, mercifully, she'd not had for several years.

Laurie sat up and put her feet over the side of her bed. She felt terrible. The night before, she'd stayed up too late, compulsively cleaning her dirty apartment despite her exhaustion. She knew it had been a stupid thing to do, but it had been symbolically therapeutic. The literal and figurative cobwebs had to be cleaned.

She couldn't believe how much her life had changed in forty-eight hours. Although she was confident that her friendship with Jack would remain strong, her intimate relationship with him was probably over. She had to be realistic about her needs and his reality. On top of that were the concerns about her mother, as well as the worry about her own health.

Getting to her feet, Laurie went into her tiny bathroom and started her morning routine of showering, washing and drying her hair, and putting on the small amount of makeup she'd become accustomed to using. It was restricted to a touch of coral blush, a bit of eyeliner, and a natural-color lipstick. When she was finished, she looked at herself in the mirror. She wasn't pleased. She appeared tired and stressed, despite her attempts to hide it, and even with additional blush and a few dabs of concealer, she didn't look any better.

Laurie had always been a healthy person, and had taken health for granted except during a brush with bulimia in high school. Suddenly, the threat of carrying the marker for a BRCAl mutation changed that dramatically. It was a scary, disturbing idea that a genetic conspiracy might be covertly residing inside every one of her trillion cells. Although she had hoped the previous evening's research would have been reassuring, it hadn't been. She now knew a lot more about the BRCAl problem from an academic point of view; namely, that the normal gene functioned as a tumor-suppressor gene but that in its mutated form, it acted the opposite.

Unfortunately, bookish information was not a lot of help when she thought about the issue personally, particularly when she coupled what she had learned with her desire to have children. Prophylactically losing her breasts was bad enough, but losing her ovaries was much worse: It was castration. To her horror, she'd learned that if she had the marker for BRCAl, she not only had an increased chance of developing breast cancer before age eighty but also an increased chance of ovarian cancer! In other words, her biological clock was ticking even louder and faster than she had thought.

It was all very depressing, especially combined with her exhaustion from lack of sleep. The question was: Should she be tested for the BRCA marker? She didn't know. She certainly would not consent to having her ovaries removed, at least not until she had had a child. And her breasts? She didn't think she'd consent to that, either, so what would be the rationale for having the test? In her mind, such a quandary was the current problem with modern genetic testing: Either there was no cure for the illness in question, or the cure was too horrific.

After a quick breakfast of fruit and cereal, she got out of her apartment only fifteen minutes later than she would have liked. Mrs. Engler didn't disappoint her. She cracked open her door on cue and looked out at Laurie with her bloodshot eyes as Laurie repeatedly hit the elevator button in the hope of speeding it up. Laurie smiled and waved at the woman but got no response other than Mrs. Engler clicking the door shut.

The walk up First Avenue was uneventful. It had turned colder than it had been the previous few days, but Laurie didn't try to hail a cab. With her down coat zipped up to her neck, she was warm enough. She also enjoyed the distraction that the pulsating city provided. For her, New York had a dynamism like no other place on the planet, and her problems mercifully retreated into the recesses of her mind. In their place surfaced thoughts about the McGillan case and the hope that she would get slides from Maureen and a report from Peter. She also found herself wondering what kind of cases she'd get that day. She hoped they would be as absorbing and distracting as McGillan's.

Laurie entered the OCME through the front door. In contrast with the previous morning, the reception area was empty. The administration area to the left was also empty. She waved to Marlene Wilson, the receptionist, who was enjoying the solitude and leafing through the morning paper. She waved back with one hand while buzzing Laurie into the ID room with the other. Laurie slipped out of her coat as she walked into the office.

Two of the more senior medical examiners, Kevin Southgate and Arnold Besserman, were sitting in the two brown vinyl club chairs, deep in conversation. Both waved to Laurie without interrupting their dialogue. Laurie waved back. She noticed that Vinnie Amendola was not in his usual spot, hiding behind his newspaper. She approached the desk where Riva was busy reviewing the cases that had come in overnight. Riva looked up, peering at Laurie over the tops of her glasses. Riva smiled. "Did you get more sleep last night?" she asked.

"Not a lot more," Laurie confessed. "I was apartment cleaning until almost two."

"I've been there," Riva said with an understanding chuckle. "What happened at the hospital?"

Laurie told her about the visit and that her mother was doing fine. She talked briefly about her father but didn't mention the BRCA1 problem.

"Jack is already down in the pit," Riva said.

"I guessed as much when I noticed Vinnie wasn't here reading the sports page."

Riva shook her head. "Jack was already in here, rooting around in the cases, when I arrived before six-thirty. That's too early for him to be in here. It's pathetic. I told him to get a life."

Laurie laughed. "That must have gone over well."

"I also told him about your mom. I hope that was okay. He had asked where you had gone yesterday afternoon. Apparently he'd come by our office just after you'd left for the hospital and I had gone down to talk with Calvin."

"That's fine," Laurie said. "Now that I've been told, it's no secret."

"I hear you," Riva said. "I can't understand why your mother wouldn't want to confide in you. Anyway, Jack was taken aback; I could tell."

"Did he say anything in particular?"

"Not about your mom. He was quiet for a few minutes, which is not like Jack."

"What kind of case is he doing?" Laurie asked.

"An ugly one," Riva said. "He is amazing; I have to give him credit. The more difficult the case, whether emotionally or technically, the better he likes it. This one was particularly troubling from an emotional point of view. It was a four-month-old infant that had been abraded all over its little body, then brought into the ER, dead. The ER personnel were in an uproar of indignation, since the parents tried to say they had no idea what had happened. The police were called, and now the parents are in jail."

"Oh, God!" Laurie voiced with a shudder. Despite thirteen years as a medical examiner, she still had trouble doing children, especially infants and abuse cases.

"I was in a muddle when I read the investigative report," Riva admitted. "There was no question the child had to be posted, but there wasn't anyone I disliked enough to assign it to."

Laurie tried to laugh because she knew Riva was joking, but she only managed a smile. Riva liked everyone and vice versa. Laurie also knew that Riva would have taken the case herself, had Jack not volunteered.

"Before Jack went downstairs, he mentioned another case," Riva said as she searched through the files before holding one up. "He said he'd had his usual informal tete-a-tete with Janice on his way in, and that she had told him there'd been a case of another young adult at the Manhattan General strikingly similar to McGillan's. He said that you would probably want it, and that I should assign it to you. Are you interested?"

"Absolutely," Laurie said. Her brows knitted as she took the folder. She opened it and rifled through the pages to find the investigative report. The patient's name was Darlene Morgan, age thirty-six.

"She was the mother of an eight-year-old," Riva said. "What a tragedy for the child."

"My word," Laurie voiced as she skimmed the report. "It does sound similar-strikingly similar." She looked up. "Do you know if Janice is still here?"

"I haven't the faintest idea. She was when I passed the PA's office, but that was before six-thirty."

"I think I'll check," Laurie said. "Thanks for the case."

"My pleasure," Riva said, but she was talking to Laurie's back, because Laurie was already on her way.

Laurie moved quickly. Technically, Janice was off at seven, but she frequently stayed later. She was compulsive about her reports and often could be there as late as eight. It was seven-forty as Laurie passed through the clerical room. A minute later, she leaned into the investigator's doorway. Bart Arnold looked up from his desk. He was on the phone.

"Is Janice still here?" Laurie asked.

Bart hooked his thumb over his shoulder to point into the depths of the room. Janice's head popped out from around a monitor. She was sitting at the desk in the far corner.

Laurie walked in and grabbed a chair. She pulled it over to Janice's desk and sat down. She waited until Janice finished a strenuous yawn.

"Sorry," Janice said when she had recovered. She used a knuckle to wipe under her eyes; they were watering.

"You're entitled," Laurie said. "Was it a busy night?"

"Volume-wise it was the usual. Nothing like the night before, although there were a couple of heartbreakers. I don't know what's getting into me. I didn't used to be so sensitive. I hope it's not affecting my objectivity."

"I heard about the infant."

"Can you imagine? How can people be like that? It's beyond me. Maybe I'm getting too soft for this job."

"It's when you stop being affected by such cases that you have to worry."

"I suppose," Janice with an exhausted sigh. She straightened herself up in her chair as if pulling herself together. "Anyway, what can I do for you?"

"I've just scanned your report on Darlene Morgan. The case strikes me as being disturbingly similar to that of Sean McGillan."

"That's exactly what I told Dr. Stapleton when I ran into him this morning."

"Is there anything you can tell me that's not in here?" Laurie said, waving the report in the air. "Like any impressions you might have gotten while talking to the people involved, like the nurses or the doctors or even the family members. You know, a step beyond the facts. Something that you sensed intuitively."

Janice kept her brown eyes glued to Laurie's while she thought. After a minute, she shook her head slightly. "Not really. I know what you mean, kind of a subliminal impression. But nothing came to mind. It was just another hospital tragedy. An apparently healthy, young-to-middle-aged woman whose time was up." Janice shrugged. "When someone like that suddenly dies, it certainly makes you realize we are all living on the edge."

Laurie bit her lip while she struggled to think of what else she should ask. "You didn't talk to the surgeon, did you?"

"No, I didn't."

"Was it the same surgeon who operated on McGillan?"

"No, there were two different orthopedic guys involved, and my impression from the resident was that both are held in high regard."

"It seems that both patients died at about the same time in the morning. Did that seem strange to you?"

"Not really. In my experience, that two-to-four-A.M. time frame is quite popular for deaths to occur. It's my busiest time during my shift. A doctor one time suggested to me it had something to do with circadian hormone levels."

Laurie nodded. What Janice was saying was probably true.

"Dr. Stapleton told me that you did the post on Sean McGillan. Is the reason you are asking these questions because you didn't find much pathology?"

"I found none," Laurie admitted. "What about anesthesia? Any similarities there, like the same personnel or same agents?"

"I have to confess I didn't look into that. Should I have?"

Laurie shrugged. "Both were about eighteen hours postsurgery, so they would still have remnants of the anesthesia on board. I think we're going to have to look into everything, including all the medication they got and in what order and dosage. I asked Bart to get the McGillan chart. I'm going to need the Morgan chart also."

"I can put in the request before I go," Janice said.

Laurie stood up. "I appreciate it. I hope you don't think my coming in here is a negative reflection on your investigative report, because it is quite the contrary. Your reports are always first-rate."

Janice flushed. "Well, thank you. I try. I know how important it can be to have all the information, especially in mysterious cases like these four."

"Four?" Laurie questioned with surprise. "What do you mean 'four'?"

"As I recall, the week before last there were two others, both from the Manhattan General, that were similar from my end."

"How similar? Were they patients who were in their first day postoperative, like McGillan and Morgan?"

"That's my recollection. What I do remember for certain is that they were young and generally in good health, so that it was a big-time unpleasant surprise to everyone that they had cardiac arrests. I also remember both were found by the nurse's aide while doing routine postoperative temperatures and heart rates, which is how Darlene Morgan was found, suggesting they had to have suffered some kind of major medical catastrophe. I mean, there was no warning. At least with Sean McGillan, he'd had a chance to ring his call button. Also, just like with McGillan and Morgan, the resuscitation team had zero luck. I mean, they got nothing but a flat line."

"This could be very important," Laurie said, pleased that she had come to seek out Janice.

"Anyway," Janice said, "I was planning on pulling copies of the investigative reports, but I haven't had time yet."

"Were they orthopedic cases?"

"I don't remember exactly what kind of surgery they had, but it will be easy to find out. If I had to guess, I'd say they were both general surgery cases, not orthopedic. Would you like me to pull the investigative reports?"

"Don't bother. I'm certainly going to want to have the whole folders. Do you remember which doctor posted them?"

"I don't think I ever knew. I don't have much contact with the doctors, besides you and Dr. Stapleton."

"Do you remember what was the final, official cause of death?" Laurie asked.

"Sorry," Janice admitted. "I don't even know if they have been signed out yet. Sometimes I follow up on cases that interest me, but not on the two we're talking about. I have to admit that at the time, they seemed like a couple of pretty routine, unexpected major cardiac problems. I guess saying something is routine and unexpected is an oxymoron, so maybe routine is not the right word. I mean, people die in the hospital, as tragic as that may be, and a lot of times it's not from the problem that brought them into the hospital in the first place. It wasn't until this morning when I was writing up the Morgan case and thinking about the nurse's aide angle that I even remembered them."

"What were the names?" Laurie asked. She felt a shiver of excitement. This curious, unexpected yet potentially important snippet of information was exactly the reason she had wanted to talk with Janice. It made her feel more strongly that her medical-examiner colleagues who ignored the experience and expertise of the forensic investigators and the mortuary techs did so at their professional peril.

"Solomon Moskowitz and Antonio Nogueira. I wrote them down with their accession numbers." Janice handed the paper to Laurie.

Laurie took the paper and looked at the names. Whether she was actively seeking a major diversion from her own personal problems she didn't know. What she did know was that she had found one.

"Thanks, Janice," Laurie said sincerely. "I've got to hand it to you. Associating these cases might be important." One of the problems of there being eight medical examiners at the OCME is that such associations could slip through the cracks. There was a Thursday-afternoon conference where cases were vetted in an open forum, but it usually involved only the more academically interesting or even macabre ones.

"Don't mention it," Janice said. "It makes me feel good when I think I'm really part of the team and contributing."

"You most certainly are," Laurie responded. "Oh, and by the way, when you put in the request for Morgan's chart, will you also ask for Moskowitz's and Nogueira's as well?"

"I'll be happy to," Janice said. She made a notation on a Post-it and put the reminder on the side of her monitor.

With her brain in a twitter, Laurie hustled out of the forensic investigator's office and took the elevator up to the fifth floor. Concerns about BRCA1 and even Jack were pushed to the back of her mind. She couldn't take her eyes off the two names on the paper that Janice had given her. Going from one curious case to four was a huge leap. The question was simply whether these four cases were indeed related. For her, this was what being a medical examiner was all about. If the cases were related by a common drug or procedure, and if she could figure it out, then she would have the rewarding opportunity to prevent more deaths. Of course, such information would also tell her if the deaths were accidental or homicidal, and that thought gave Laurie a shiver.

Entering her office, Laurie quickly hung up her coat behind the door, then sat down at the computer. She typed in the accession numbers of the two cases, learning that neither had been signed out as of yet. Mildly disappointed, she did get the names of the two doctors who had done the autopsies: George Fontworth had posted Antonio Nogueira, and Kevin Southgate had posted Solomon Moskowitz. Having seen Southgate down in the ID office earlier, she picked up her phone and dialed his extension. She let it ring five times before hanging up.

Returning to the elevator, Laurie descended to the first floor and wended her way back to the ID room. She'd hoped Kevin would still be there, talking with Arnold, and she wasn't disappointed. She waited patiently for a break in their animated conversation. The two incessantly argued about politics: Kevin, the inveterate liberal Democrat, and Arnold, the equivalent conservative Republican. Both had been at the OCME for almost twenty years and had come to resemble each other. Both were overweight with ashen complexions and were haphazard about their hygiene and dress. In Laurie's mind, they were the stereotypical coroners in old Hollywood movies.

"Do you remember posting a Solomon Moskowitz about two weeks ago?" Laurie asked Kevin after apologizing for interrupting. As usual, he and Arnold seemed to be just shy of exchanging blows. They frustrated each other, since neither had a snowball's chance in hell of changing the other's entrenched opinions.

After joking that he couldn't remember the cases he did yesterday, Kevin's doughy face screwed up in thought. "You know, I think I remember a Moskowitz," he said. "Do you happen to know if it was a Manhattan General case?"

"That's what I was told."

"Then I remember it. The patient had an apparent cardiac arrest. If it's the one I'm thinking about, there wasn't much on the post. I don't believe I've signed it out yet. I imagine I'm waiting for the microscopic to come back."

Yeah, sure, Laurie thought to herself. Even in the busiest of times, it didn't take two weeks to get slides. But she wasn't surprised. Kevin and Arnold were notorious for failing to get their cases out on a timely basis. "Do you remember if the patient had had recent surgery?"

"Now you're pushing your luck. I tell you what, why don't you stop up to my office, and I'll let you go over the folder."

"Sounds like a good idea," Laurie responded. She was momentarily distracted by seeing George come in through the door to the ID room, removing his coat. Allowing Kevin and Arnold to get back to their bickering, Laurie joined George at the coffee machine.

George had been at the OCME for almost as long as Kevin and Arnold, but he hadn't picked up any of their personal habits. He appeared significantly more stylish, with pressed pants, a clean shirt, and a colorful tie, all of which were reasonably contemporary, which was how he liked to present himself. He also looked dramatically younger by avoiding the common middle-age weight gain. Although Laurie knew Jack did not hold George in high esteem professionally, she had always found him easy to work with.

"I heard your gunshot case yesterday had a surprising denouement," Laurie said.

"What an ordeal," George complained. "If Bingham ever offers to do another case with me, remind me to graciously refuse."

Laurie laughed and chatted about the case for a few minutes before switching to her real interest. As she'd spoken with Kevin concerning Moskowitz, she asked if George remembered doing Antonio Nogueira some two weeks earlier.

"Give me a hint," George responded.

"I'm guessing at the details, since I don't know them for certain," Laurie said, "but I believe he would have been relatively young, he would have been within twenty-four hours of having surgery at the Manhattan General, and he would have been suspected of having suffered some sort of cardiac catastrophe."

"Okay, I remember the case: a real teaser. I found zilch on the post and nothing to hang my hat on with the microscopic. The folder is up on my desk, waiting for toxicology possibly to come up with something. Otherwise, I'm going to be forced to sign it out as a spontaneous ventricular fibrillation or a massive heart attack that was so sudden and so global that there wasn't any time for pathology to develop. Of course, that means whatever caused it had to magically disappear. One way or the other, the heart stopped. I mean, it couldn't have been that his breathing stopped, because there was no cyanosis." He shrugged and gestured helplessly with his hands.

"So the microscopic didn't show much in the coronary vessels?"

"Minimal."

"And the heart muscle itself looked normal? I mean, like something capable of causing a sudden lethal arrhythmia. Was there any sign of inflammation?"

"Nope! It was completely normal."

"Do you mind if I look at the folder later this afternoon?" Laurie asked.

"Be my guest! Why the interest? How did you hear about it?"

"I heard about it from Janice," Laurie said. "I'm interested because I had a case surprisingly similar yesterday." Laurie felt mildly guilty about not mentioning the two other cases, but not guilty enough to bring them up. For one thing, her suspicion that they were connected in any way was purely speculative, and second, at this early stage she couldn't help but feel proprietary about what she was beginning to think might be some kind of series.

Leaving the ID office, Laurie descended a floor and sought out Marvin. She found him in the mortuary office. As she had hoped, he was already in his scrubs.

"Are you ready to rock and roll?" Laurie asked. She was eager to start.

"You're on, sister!" Marvin said as if it today was a rerun of the previous day.

Laurie gave him Darlene Morgan's accession number before going into the locker room to change into scrubs. She was excited. It was the first time in her career as a medical examiner that she hoped to find nothing on the autopsy, meaning Morgan would be like McGillan, Nogueira, and Moskowitz. The longer the series idea played out, the better the diversion it would be and the less apt she'd be to agonize over personal unpleasantries.

Leaving the locker room, she crossed over to the storage room and rescued her battery pack from the charger. Fifteen minutes later, she was in the moon suit and pushing into the pit from the anteroom where she'd gloved. There was only one case under way. She had no trouble distinguishing between Jack and Vinnie, since Vinnie was shorter and considerably slighter. Jack was peering through the viewfinder of a camera set on a tripod. Laurie tried not to look at the tiny, naked infant splayed out on the table. Laurie blinked by reflex when the camera's flash went off.

"Is that you, Laurie?" Jack called out. He had straightened up and turned in her direction in response to the sound of the door closing.

"It is," Laurie said. Not finding Marvin in the autopsy room, she twisted around to look through the wire-embedded glass in the door leading out to the corridor. Marvin was approaching with a gurney in tow. At the back, pushing, was another mortuary tech, Miguel Sanchez. Laurie guessed there had been a problem. Marvin was customarily super-efficient and invariably waiting for her.

"Come on over here!" Jack said with some excitement. "I have something to show you. This case is a corker."

"I'm sure it is," Laurie said. "But I think I'll let you tell me about it after the fact. You know that autopsies on children are not my cup of tea."

"I'm pretty certain this case is another one like those yesterday," Jack said. "I'm more than ninety percent sure the cause and manner of death are going to surprise everyone. I'm telling you, it's textbook!"

Despite her distaste for dealing with kids in the autopsy room, her professional curiosity urged her over to Jack's side. With some difficulty, she made herself look down at the hapless child. Just as Riva had described, the poor little girl appeared bruised, abraded, and burned over much of her tiny body, including her face. The awfulness of the image made Laurie sway slightly, as if dizzy. She spread her feet to stabilize herself. Behind her, she heard the door open, followed by the squeak of the wheels of an old gurney as it was pushed in.

"What if I told you the whole body X-ray of this infant was completely negative for fractures, old or new? Would that influence your thinking about this case?"

"Not particularly," Laurie said. She tried to look in at Jack's face, but it was difficult with the overhead lights reflecting off his plastic face mask. They hadn't seen each other or talked for almost twenty-four hours, and when they first met that morning, she had hoped for something other than a repeat of his playful professorial role.

"What if I told you that in addition to the X-ray being normal, the frenulum is intact?"

"It certainly wouldn't negate what I'm looking at," Laurie responded. Despite her repugnance, Laurie bent over and looked closely at the skin lesions, particularly where Jack had made a small incision through one of the abrasions. There had been no blood or edema. All at once, she knew now what Jack was implying when pointing out signs that suggested abuse was not at issue. "Vermin!" she said suddenly. She straightened up.

"Give this lady a prize!" Jack said like a carnival barker. "As expected, Dr. Montgomery has expertly corroborated my impression. Of course, Vinnie isn't convinced, so we have a five-dollar bet riding on finding nonspecific evidence of an asphyxial death when we do the internal part of the autopsy, and everybody knows what that would imply."

Laurie nodded. The chances were good that the child in front of her had died of sudden infant death syndrome, or SIDS, which shows signs of asphyxial death on autopsy. Although on first glance she had thought all the skin lesions had been inflicted prior to death, she now guessed they were most likely postmortem damage caused by a variety of vermin, such as ants, cockroaches, and possibly mice or rats. If this indeed proved to be the case, then the manner of death was not homicidal but accidental. Of course, that didn't lessen the tragedy of the young life lost, but it surely had very different implications.

"Well, I better get cracking here," Jack said as he detached the camera from the tripod. "This child was maimed by the circumstances of poverty, not abuse. I've got to get her parents out of jail. Keeping them there is like adding insult to injury."

Laurie made her way over to where Marvin was aligning the gurney next to one of the autopsy tables, trying not to dwell on her disappointment about Jack's blithe repartee and apparent mind-set. She also couldn't help but wonder if Jack's case was another preternatural hint to remind her that things were not always quite what they seemed at first glance.

"Did you have some trouble?" Laurie asked Marvin as the two techs moved the body onto the autopsy table. Marvin positioned the head on a wooden block.

"A slight hitch," Marvin admitted. "Mike Passano must have written down the wrong compartment number. But with Miguel's help, we found the body in short order. Any special requests for this case?"

"It should be straightforward," Laurie said as she checked the accession number and name. "In fact, I hope it turns out to be a mirror image to the first case we did yesterday." Marvin shot her a perplexed glance as she started the external exam.

Laurie's trained eye began recording her observations. The body was that of a Caucasian woman in her mid-thirties with brunette hair in a normal distribution who appeared to have been in good health, although slightly overweight, with extra adipose tissue across her abdomen and on the lateral aspect of her thighs. Her skin had the usual pallor of death and was lesion-free, save for a few innocuous nevi. There was no cyanosis. There was no evidence of recreational drug use. There were two freshly sutured incisions on the lateral surfaces of her left knee and no signs of inflammation or infection. A capped-off intravenous line ran into her left arm, with no extravasations of blood or fluid at the site. An endotracheal tube that was correctly positioned in her trachea protruded from her mouth.

So far, so good, Laurie said to herself, meaning the external exam was comparable with Sean McGillan Jr.'s. She took the scalpel offered by Marvin and began the internal portion. She worked quickly and intently. The activity in the rest of the room receded from her consciousness.

Forty-five minutes later, Laurie straightened up after tracing the veins in the legs up into the abdominal cavity. She had found no clots. Other than several insignificant uterine fibroids and a polyp in the large intestine, she had found no significant pathology and certainly nothing that would have explained the woman's demise. Exactly like McGillan, she would have to wait for the microscopic and the toxicological if she was going to find a cause of death.

"A clean case," Marvin commented. "Just like you wanted."

"Very curious," Laurie said. She felt vindicated. She looked around the room, which had practically filled during her intense concentration. The only table that wasn't in use was immediately adjacent to where Jack had been working. Apparently, he'd finished and left without so much as a word. Laurie wasn't surprised. It seemed consistent with his recent behavior.

At the table on the other side of hers, Laurie thought she recognized Riva's diminutive frame. When Marvin went out into the hall to get a gurney, Laurie stepped over to check. It was Riva.

"Interesting case?" Laurie asked.

Riva looked up. "Not particularly, from a professional point of view. It's just a hit-and-run on Park Avenue. She was a tourist from the Midwest, and she was holding on to her husband's hand when she was struck. He was only a step ahead of her. It always amazes me pedestrians aren't more careful in this city, considering how fast the traffic moves. How about your case?"

"Extremely interesting," Laurie said. "Almost no pathology whatsoever."

Riva looked at her officemate askance. "Interesting and no pathology? That doesn't sound like you."

"I'll explain later. Meanwhile, do I have another case?"

"Not today," Riva said. "I thought you could use a little down time."

"Hey, I'm okay. Really! I don't want any special treatment."

"Don't worry. It's a relatively light day. You've got a lot on your plate."

Laurie nodded. "Thanks, Riva," she said, although she would have preferred to keep busy.

"I'll see you upstairs."

Laurie returned to her table, and when Marvin came back with the gurney, she thanked him for his help and said that she was finished for the day. Ten minutes later, after the usual cleaning process, she hung up her moon suit and attached her battery to the charger. Planning on heading to histology and toxicology, she was surprised to see Jack blocking her exit from the storeroom.

"Can I buy you a cup of coffee?" he asked.

Laurie glanced up into his maple-syrup-colored eyes and tried to gauge his mood. She'd had quite enough of his lightheartedness; considering the circumstances, it was ultimately humiliating. Yet there was no impish smirk like he'd worn the previous afternoon when he'd appeared in her office doorway. His expression was serious, almost solemn, which she appreciated, since it was more apropos to what was going on between them.

"I'd like to talk," Jack added.

"I'd love a cup of coffee," Laurie responded. With some difficulty, she tried to reign in her expectations about what Jack had in mind. This seemed to be almost too-appropriate behavior for him.

"We could head up to the ID office or the lunchroom," Jack said. "It's your call."

The lunchroom was on the second floor. It was a loud room with an old-fashioned linoleum floor, bare concrete walls, and a bank of vending machines. At that time in the morning, it would be reasonably crowded with secretarial and custodial personnel on break.

"Let's try the ID office," Laurie suggested. "We should have the place to ourselves."

"I missed you last night," Jack said as they waited for the back elevator.

My word, Laurie thought. Despite her concerns, her hopes of having a significant conversation rose. It was not customary for Jack to admit to his feelings quite so directly. She looked up at his face to make sure he wasn't being sarcastic, but she couldn't tell for certain, since his face was averted. He was absorbed in watching the floor indicator above the elevator door. The numbers were decreasing with their typical agonizing slowness. The back elevator was used for freight and moved at a glacial pace.

The door opened, and they boarded the cab.

"I missed you, too," Laurie admitted. Concerned that she was allowing herself to be set up for a fall, she felt embarrassingly self-conscious and now avoided eye contact. From her perspective, they were both acting like a couple of preteens.

"I was a hopeless case on the basketball court," Jack said. "I couldn't do anything right."

"I'm sorry," Laurie said, but then immediately wanted to take it back. It sounded as though she was apologizing, when she was merely sympathizing.

"As I expected, the internal on my case was consistent with SIDS," Jack said to change the subject. It was obvious that he was equally uncomfortable.

"Really?" Laurie said.

"How was yours?" Jack asked as the elevator began its ascent. "When I bumped into Janice, she mentioned it seemed similar to your McGillan case, so I told Riva that you'd probably want it."

"I appreciate it," Laurie said. "I did want it. And you were right. It was exactly like McGillan to an uncomfortable degree."

"What do you mean 'uncomfortable'?" Jack asked.

"I'm beginning to think that your suggestion yesterday about forensics establishing a manner of death opposite to what was expected could be applicable. I'm thinking I might be dealing with homicide, sort of the Cromwell case in reverse. In other words, I might have stumbled onto the work of a serial killer. I can't help but think about some of those infamous health-institution serial murders, particularly the recent one over in New Jersey and Pennsylvania." Laurie did not have the same reservations about mentioning her suspicions to Jack as she had had with Fontworth.

"Whoa!" Jack said. "When I was talking about forensics providing some surprises, I was talking in general. I wasn't suggesting anything about your case."

"I thought you were," Laurie said.

Jack shook his head as the elevator door opened on the first floor. "Not at all. And I have to say that I think you're taking a quantum leap going from natural to homicide with the case you described to me. Why on Earth did it even occur to you?" He gestured for Laurie to exit ahead of him.

"Because I've now autopsied in successive days two relatively young, healthy people who have died suddenly, yet have no associated pathology. None!"

"Your case today didn't have any emboli or obvious cardiac abnormalities?"

"Absolutely none. It was clean! Well, there were a few uterine fibroids, but that was it. Like McGillan, she was within twenty-four hours postsurgery with general anesthesia. Like McGillan, she had been completely stable without complications, and then… bingo! She arrests and is totally unable to be resuscitated!" Laurie snapped her fingers for emphasis.

They passed through the communications room. The secretaries were bunched together and chatting. For the moment, the phone lines were quiet. After the mayhem of the morning commute, death generally took a breather in the city.

"Two cases don't make a series!" Jack asserted. He was dumbfounded by Laurie's suggestion of a serial killer.

"I think it is four cases, not two," Laurie said. "That's too many to be a coincidence." While they helped themselves to the communal coffee, Laurie described her conversations with Kevin and George. As she spoke, she and Jack sat down in the two brown vinyl club chairs that Kevin and Arnold had been in earlier.

"What about toxicology?" Jack questioned. "If there turns out to be no pathology on gross or histologically, then the answer is going to come from toxicology, whether there was hanky-panky going on or even if there wasn't."

"George said he's still waiting on toxicology for his case. Obviously, for mine I've got a wait. Be that as it may, we're dealing with a curious set of circumstances here."

Jack and Laurie sipped from their respective cups, eyeing each other over the brims. Both were aware of the other's current mindset in regard to Laurie's serial-killer theory. Laurie's expression was challenging, while Jack's reflected his feeling that she was out in left field.

"If you want my opinion," Jack said finally, "I think you're letting your imagination run wild. Maybe you're upset because of our problems, and you're looking for a diversion."

Laurie felt a wave of irritation spread through her. It came from a combination of Jack's being patronizing on the one hand and his being correct on the other. She averted her gaze and took a breath. "What is it you wanted to talk about? I'm sure it wasn't our respective cases."

"Riva told me about your mother yesterday," Jack said. "I was tempted to call last night to ask you about her and extend my sympathies, but under the circumstances, I thought it better to talk in person."

"Thank you for your concern. She's doing fine."

"I'm glad," Jack said. "Is it appropriate if I send some flowers?"

"That's completely up to you."

"Then I will." Jack said. He paused, fidgeted, and then said hesitantly, "I don't know if I should bring this up about your mother…"

Then don't, Laurie said to herself. She was disappointed. She had allowed herself to be set up after all. She didn't want to talk about her mother.

"… but I'm sure you are aware there is a hereditary aspect to breast cancer."

"I am," Laurie said. She looked at Jack with exasperation, wondering where he was going with this conversation.

"I don't know if your mother has been tested for the markers indicating BRCA gene mutations, but the results would have significance concerning treatment. More important for you, it would have significance concerning prevention. One way or the other, I think you should definitely be tested. I mean, I don't want to alarm you, but it would be prudent."

"My mother is positive for a BRCA mutation," Laurie admitted.

Some of her anger, although not her disappointment, abated when she realized that Jack was being solicitous about her health and not just her mother's.

"That's an even greater reason for you to be tested," Jack said. "Have you thought about it?"

"I've thought about it," Laurie admitted. "But I'm not convinced it would have much significance and may just add to my anxiety. I'm not about to have my breasts and ovaries removed."

"Mastectomy and oophorectomy are not the only preventive measures available," Jack said. "Last night, I went on the Internet and read up on all this."

Laurie found herself almost smiling. She wondered if she and Jack had visited the same websites.

"More frequent mammograms is another option," Jack added. "Eventually, you might even consider tamoxifen treatment. But that's down the road. Anyway, the bottom line is that it just makes sense. I mean, if this predictive information is available, you should do it. In fact, I would like to ask you to do it. No, I take that back. I would like to plead with you to do it… for me."

To Laurie's surprise, Jack leaned forward and gripped her forearm with unexpected strength to emphasize his commitment to the cause.

"You're really convinced?" Laurie questioned, marveling at the "for me" part.

"Absolutely! No question!" Jack responded. "Even if the only effect is to make you more prone to have regular checkups. That would be an enormously positive effect. Laurie, please!"

"Is it a blood test? I don't even know."

"Yes, it's a simple blood test. Do you have a primary-care physician over at the Manhattan General, where we are now obligated to go?"

"Not yet," Laurie admitted. "But I can call my old college chum, Sue Passero. She's on staff in internal medicine. I'm sure she could set me up."

"Perfect," Jack said. He rubbed his hands together. "Should I call to make sure you do it?"

Laurie laughed. "I'll do it."

"Today."

"All right, for goodness' sakes. I'll do it today."

"Thank you," Jack said. He released Laurie's arm that he'd been firmly clutching. "Now that we've got that settled, I want to ask about whether we can compromise about your moving out of my apartment."

For a moment, Laurie was nonplussed. Just when she thought Jack wasn't going to bring up their relationship, he did.

"As I said," he continued, "I missed you last night. Worst of all, my basketball game was a disaster. The defenses I had carefully erected against your absence had been undermined by a pregame run-in with a pair of your pantyhose."

"What pantyhose?" Laurie asked, raising her guard again. She purposefully didn't laugh at Jack's reversion to witty sarcasm. For her, there was nothing funny about suggesting that Jack's prowess on the basketball court was a determining factor in her moving back to his apartment.

"A pair you left in the bathroom. But don't worry, they're safely ensconced in the bureau."

"What do you mean by 'compromise'?" Laurie asked dubiously.

Jack fidgeted in his chair. It was apparent that he was uncomfortable with the question. Laurie let him take all the time he wanted. Finally, he made a gesture of confusion by hunching his shoulders and extending his free hand, palm up. "We'll agree to make sure we discuss the issues on a regular basis."

Laurie's heart sank. "That's no compromise," she said with a voice that reflected her discouragement. "Jack, we both know what the issues are. At this point, more talk is not going to solve anything. I know that sounds contrary to what I've usually said about the importance of communication. The fact of the matter is that I've been compromising from the beginning, and particularly over the last year. I think I understand where you are coming from, and I'm sympathetic, which is what has kept me in a circumstance that has not been satisfying my needs. It's really as simple as that. I believe we love each other, but we're at a crossroads. I'm not twenty-five anymore. I need a family; I need commitment. To use one of your expressions, the ball is in your court. It's your decision. Talk is superfluous at this point. I'm not going to try to convince you, which, at this stage, talk would begin to sound like. And one final point: I didn't leave in a moment of pique. It's been a long time coming."

For a few minutes, they merely stared at each other without moving. Finally, Laurie was the one who moved. She leaned forward and gave Jack's thigh a squeeze just above the knee. "This doesn't mean I don't want to talk in general," she said. "It doesn't mean we're not friends. It just means that unless we can truly compromise, I'll be better off staying at my apartment. And meanwhile, I'll get back to my diversion."

Laurie stood up, smiled down at Jack without rancor, and then walked back through the communications room en route to the elevator.