Mercy

CHAPTER 28

Lucy Abruzzo’s office was nothing special, just a concrete room with a couple of windows, a desk, and a small conference table set off to one corner. An oval-shaped area rug warmed the space somewhat, but it lacked a personal touch. Lucy’s diplomas used to take up floor space, but a custodian broke the glass on one, and by way of an apology, hung them all on her office wall. Her bookcase was filled with medical texts, though she had a shelf devoted to her favorite nonfiction books as well, which she lent out like a library.

Lucy was seated at her desk when Jordan Cobb knocked on her office door. He was dressed in his workday uniform, blue scrubs and canvas sneakers.

“Hi, Dr. Abruzzo,” Jordan said.

Lucy peered out from behind her computer monitor. “Ah, Jordan. Good. Come in.”

Lucy pushed the file she had been reading to the edge of her desk and absentmindedly left it splayed open. She got up from her chair and came around her desk to greet Jordan. He looked a little apprehensive; it was not every day the big boss asked to see him.

“Have a seat,” Lucy said, motioning to one of the chairs around the conference table.

Jordan did as he was told, his large frame barely fitting on the smallish seat. Lucy took a seat as well.

“Tell me something, Jordan. What is it you want to do with your life?”

Small talk was never Lucy’s strong suit. Jordan knew this, but even he was taken aback by her abruptness. He shifted uncomfortably in his chair.

“Excuse me?”

“The question isn’t all that vague, I think. What do you want to do with your life?”

“I’m doing it,” Jordan said, sounding more appreciative than defensive.

“You want to move dead people around, that’s the extent of your ambition?”

Jordan shrugged. “It’s honest work. And given my criminal record, my options are a little bit limited.”

“Oh, let’s forget about your criminal record for a moment, shall we? I knew all about it when I hired you. My question is, what else can you do?”

“What else?”

“Yeah, your other skills.”

“Um-I tutor in math.”

Lucy showed her surprise. “Really? I didn’t know you were mathematically inclined.”

“I understand it all right. Enough to tutor, you know? Taught it in prison.”

“I see. Well, the reason I’m asking all this is that we’re looking for a new lab assistant.”

Jordan’s face lit up. “Really? Like I could work with samples?”

“Oh, yes. The job involves processing specimens, preparation of tissue, bacterial cultures, staining for various smears, and of course preparation of human specimens for postmortem examinations.”

With the notable exception of Sam Talbot, to Lucy the dead were specimens and nothing more.

A big smile came to Jordan’s face, showing off teeth that would have benefited from braces if only he could have afforded them. “That would be… that would be incredible.”

Quick as that smile came, Jordan’s bright expression dimmed.

“What’s wrong?” Lucy said.

“All I have is a GED,” Jordan said. “You have to go through an accredited program to be certified as a lab assistant.”

Lucy gave a nod. “You’ve researched that, have you?”

“I just-I just know how things work, that’s all.”

“I see.”

Before Jordan could say anything more, Lucy glanced at her watch and appeared suddenly flustered.

“Oh, shoot. Jordan, look, can you wait here a moment? I have to go speak to a doc about a lab result, but I want to continue our conversation. I’ll be right back.”

The question was rhetorical. Of course Jordan would wait, but he nodded his agreement anyway. Lucy got up and left the room.

Jordan sat a while, but his eyes soon went to the folder splayed open on Lucy’s desk. Even from a distance he could tell it was a pathologist report. As Jordan moved closer, he could see it was from somebody suffering from chronic inflammatory bowel disease. IBD-a notoriously uncomfortable condition.

The report of the endoscopic biopsy specimen was written clearly and succinctly, to deliver information to a busy clinician. Even a diener could make sense of some of it. The second line of the pathologist report was almost always reserved for the presence or absence of dysplasia, a term used to refer to an abnormality or a growth anomaly. What patients wanted on that second line was “negative for dysplasia.” Second best would be “indefinite for dysplasia.” The third and final choice was “positive for dysplasia.” The dysplasia would be graded, high or low, and the lower the better. The more marked the cell change, the easier it was to make a diagnosis.

Jordan took a glance at the report and saw that this patient was negative for dysplasia. Good. Below that, though, was an image taken from the H &E stain, which was shorthand for a tissue section stained with hematoxylin and eosin. Jordan had worked pathology long enough for the nomenclature to become a fluent second language.

Jordan studied the image a moment, and felt his pulse tick up when he heard footsteps headed toward the office. He retook his seat just before Lucy reappeared. She looked a little frazzled as she hurriedly collected the patient file from her desk.

“Silly me,” Lucy said. “I went to give the doctor the pathology report, and what did I forget? The pathology report, of course. Can you wait another minute, Jordan? I just have to give the patient the good news.”

Lucy headed to the door, but Jordan looked at her uneasily. Lucy paused.

“Well, can you wait?”

“Um-um-”

“Yes or no? Not a hard question.”

“Um-”

“Jordan, is there something you want to say to me? The doctor is waiting. His patient will want to know that he’s cancer free.”

“Yeah-um-Dr. Abruzzo.”

Lucy set the folder down on her desk and crossed her arms. She gave Jordan a disapproving stare.

“Jordan, I’m in a hurry here. What is it?”

“Yeah, um-well-I was walking around the office, you know, waiting for you to come back and all, and well, I saw the file open on your desk.”

Lucy’s frown seemed to deepen. “Jordan, did you read a patient’s confidential file?” Her tone was serious.

“I didn’t mean nothing by it. Just caught my eye, is all.”

“Well, it’s my fault for leaving it out in plain sight, I suppose.”

Jordan shifted his weight from foot to foot, eyes to the floor. “Yeah, well, I just noticed that you wrote he was negative for dysplasia.”

Lucy glowered. “That’s none of your business. And do you even know what that means?”

Jordan shifted again. “Well, you know, you work here long enough, you pick up the lingo. But I was just wondering if maybe you were in a hurry or something and you wrote the wrong word.”

“Now why would you say that?”

Jordan gave this some thought. “Forget it.”

Lucy glared at him hard. “No. No, Jordan. I won’t just forget it. Why would you question me on this?”

“I don’t know.”

“Okay. Well, that was an odd little exchange we just had there. Wait right here. Let me deliver the good news and I’ll be right back.”

Lucy gathered up the folder. She made it to the door when Jordan called out her name. Her face almost a scowl, Lucy turned and shot Jordan an impatient glance.

“That patient is high-grade positive for dysplasia,” Jordan said in a breathless voice. “You tell him he’s clean and he’s gonna die.”

Lucy returned a quizzical look. “What are you saying?”

“I’m saying the picture of the stain shows an awful lot of cancer.”

“Are you suggesting that I’ve diagnosed this patient incorrectly?”

Lucy’s tone bordered on wrathful, as she got right up into Jordan’s face. It did not matter that Jordan towered over her and outweighed her by more than a hundred pounds; he still shrank back. His eyes blinked rapidly.

“The cells look messed up.”

“Messed up? Can you be a little bit more specific? I mean, you seem to absorb the language just fine.”

“No-it’s just messed up.”

“Tell me exactly how it’s messed up.”

Jordan stayed quiet.

“You saw something. You have a point to make. Now make it.”

“There’s variability in the size, shape, and staining of the cells.”

“Variability? You noticed that?”

“Yeah-the cells, they look, um…”

“Look like what, Jordan? Tell me, or I might have to find your replacement.”

“The nuclei in the luminal half of the cells are stratified and show pleomorphism. That means there’s a lot of distortion in the cells.”

Lucy exhaled a loud breath. “Well, now. That is quite a lot of our nomenclature you’ve absorbed.”

“Pleomorphism.” Jordan’s voice was barely audible. “That’s a characteristic of malignant neoplasms.”

Lucy stood with her arms akimbo. “I know what pleomorphism means,” she said through clenched teeth.

Jordan bowed his head. “I’m sorry, Dr. Abruzzo. I shouldn’t have said anything. I just-I just messed up, that’s all. I’ll wait right here while you deliver that report. But you shouldn’t do it. This guy has lots of cancer. That’s all I’m gonna say.”

“Funny, I thought I was the doctor and you were the diener.”

Lucy opened the report and studied it carefully. Instead of leaving, she took the top page of the report, and with a roguish expression ripped it in half.

“Well, lucky for us this patient doesn’t actually exist,” Lucy said with a smile.

Jordan was dumbfounded. “What?”

“I’ve noticed things around here. Relevant Web sites open to cases we happen to be reviewing, journal articles of certain importance left in the break room. But when you happened to stumble upon a mysterious lab report-one that seemed to have fallen out of the sky-and correctly diagnosed cobalt poisoning, well, let’s just say my suspicions were roused,” Lucy said. “But I couldn’t prove it. I looked, but whoever used our medical records system to run that lab was a shadow. Even the IT folks couldn’t find you.”

“I didn’t-I-”

“Jordan, please. I’m smart enough to know this fictional patient I baited you with was riddled with cancer. I’m also smart enough to know that you’re a hell of a lot more than a diener. What I don’t know, and what you’re going to tell me right now, is why you sent Brandon Stahl the EKG and echocardiogram of Donald Colchester.”