Night Shift

Chapter 13

Tuesday, December 7, 2:50 p.m.

Emerging from Laurie’s office, Jack practically bumped into George Fontworth, the deputy chief, who’d obviously been waiting for him to leave. They did a little dance to get around each other. To make matters worse, he was clutching a significant number of OCME brochures to his chest.

Jack stopped at Cheryl’s desk. She was speaking to someone on the phone but had anticipated his need of Abby’s mobile number and produced it without having to be asked. Jack took the slip of paper and mouthed a thank-you. Cheryl responded with another of her thumbs-up gestures without interrupting her conversation.

After making a detour to get a candy bar from one of the vending machines in the second-floor employee lunchroom, Jack went up to his office. There he took off his jacket and sat down at his desk, putting Abby’s phone number center stage. He stared at it for a time, wrestled with the idea of calling the man, but ultimately put it off. Instead, as he munched on the candy bar, he called University Hospital, where Laurie’s father had been one of the top-notch cardiac surgeons when he’d been alive. Once he got the operator, he identified himself as Dr. Stapleton and asked to speak to Dr. Camelia Gomez.

It took a long time to get the doctor on the line, as Jack had to go through several different clerks at different clinics, each time being put on a lengthy hold. He wasn’t surprised, as he was well aware that modern American medicine had devised multiple ways to shield doctors from contact with the outside world. As he waited, he tried to think of how he was going to proceed with the Passero case. He could see Laurie’s position as Sue’s dear friend and understand her wish to be as helpful to Abby as possible, and he respected it. He also recognized that Laurie was correct in that he had obtained samples of every tissue and fluid he could think of during the autopsy, making it difficult for him to imagine a circumstance that would necessitate a redo. Consequently, he decided to follow Laurie’s order and release the body. But the death certificate problem was another issue entirely. He had never signed one out as being indeterminate, and he wasn’t going to do it now, no matter what Laurie said. For him it was a matter of professional integrity.

Jack’s patience ultimately paid off and finally he got to speak with Dr. Gomez. After introducing himself, he told her that Dr. Susan Passero had died the previous evening.

“I’m so sorry to hear,” Dr. Gomez said. “That’s a shock. What happened?”

Jack said, “The cause of death is still pending, which is the reason I’m calling you. As medical examiners we have the right to subpoena her medical records if necessary.”

“Of course. I understand.”

“What we need to know is if she ever had had any cardiac issues or symptoms to your knowledge.”

“I don’t think so,” Dr. Gomez said. “But give me a moment to bring up her record in our system.”

“Certainly,” he said. He could hear a series of keystrokes during a brief pause.

“My memory was correct,” Dr. Gomez said. “There were no cardiac issues. She even had an entirely normal ECG recently. In our judgment, Dr. Passero was in fine cardiovascular health. She had absolutely no evidence of diabetic retinopathy, either. We checked that out by an ophthalmology consult and fluorescein study.”

“Thank you,” Jack said. “That’s very helpful.”

He disconnected and tossed his mobile phone to the side. He hadn’t even thought of asking about the status of her retina. With no retinopathy the chances of her having coronary artery disease were probably close to zero, meaning Histology wasn’t coming to the rescue in the search for a mechanism of death. So, only Toxicology and the DNA lab were left, and he wasn’t hopeful.

Without another convenient way to put off calling Abby, Jack grabbed his phone and lined up the slip of paper Cheryl had given him so he could read the number. He wasn’t looking forward to making the call for many reasons, but by far the biggest was that it reminded him of the worst call he’d ever gotten in his life. It had been a call from a small rural Illinois hospital informing him his wife and daughters had perished in a plane crash after visiting him in Chicago, where he was doing his second residency, this time in forensic pathology.

“Get a grip!” he snapped as the call went through. He almost hoped Abby wouldn’t answer, but he did and in a way Jack had not anticipated.

“Thanks for calling, Jack,” Abby said right off in a sad, hesitant voice without even saying hello, apparently having Jack’s mobile number in his phone. “I can imagine it’s difficult, probably reminding you when your first wife and children died.” Abby had a slight and refined English accent. Although he’d grown up in Egypt, he’d gone to boarding school in England before coming to the United States for college.

It took Jack a few beats to recover his thoughts. Here was a man undeniably suffering acutely, yet able to empathize with someone else and his experiences. Jack had shared the sad story of his former life one night with both Sue and Abby after several bottles of wine.

“I’m so sorry for Sue’s passing,” Jack managed.

“It was so unexpected,” Abby said, his voice cracking. “I still don’t completely believe it. She was so vital, so healthy, so much healthier than I. Why am I the one here and she’s gone? It doesn’t seem right.”

“I know how you feel,” he said, but then didn’t know what else to say. It was the first time in years that he was at a loss for words. A rush of guilt from having even briefly entertained the crazy idea of Abby involved in some wild insurance scam had him embarrassed and tongue-tied.

“Laurie said that you would be taking care of Sue for us,” Abby continued, seemingly unaware of Jack’s discomfort. “Thank you for doing that. I’m sure it’s not easy but it’s appreciated. She also said that you would be arranging to have the body released today, so we can have the burial. We appreciate that as well.”

Jack cleared his throat to speak yet his voice still came out in a higher key than usual. “Yes, I will make the arrangements. All you will need to do is select a funeral service and have them call here. They know the ropes.”

“I’ve already chosen a funeral home,” Abby said. “I’ll call them and let them know. Meanwhile, I hate to cut you off, but Nadia and Jamal just arrived, and as you can imagine, they are very upset. I need to spend time with them.”

“Of course,” Jack said, again surprised. The unexpected twists of the conversation were disconcerting. “But before you go, I did want to ask you a quick question. When I was talking with Virginia Davenport earlier today, she happened to mention that you had stopped by Sue’s office this morning. Was there some particular reason?”

“Purely for sentimental reasons,” Abby said. “Sue loved her work. She was so caught up in it. It was a way of saying goodbye.”

“Did you take anything?”

“No, but I know I’ll need to do that,” Abby said. “We’ll be in touch. And thank you again.”

It took Jack a moment to realize the call had been disconnected. Slowly he put the phone down. He’d expected Abby to have been particularly interested in the exact cause of Sue’s death, if only to justify the autopsy that had been done despite his objections. Yet the question hadn’t even come up, making him wonder yet again if an insurance scam wasn’t all that far out of the realm of possibility. But then he remembered the sound of Abby’s voice when he answered the call as well as the surprising empathy he voiced about Jack’s loss of his own wife.

Jack shook his head in frustration. He’d never been caught up in a forensic conundrum in which he was so emotionally involved. He’d wanted a puzzling case as a challenging distraction, but this wasn’t what he’d had in mind. Picking the phone up again, he called down to the mortuary office, looking for Vinnie. Marvin Fletcher answered and said he’d find Vinnie and have him call.

Putting his phone back down, he glanced at the imposing stack of autopsy folders next to his monitor and the equally towering group of histology slide trays next to his microscope. He knew he needed to deal with them, but at the moment he felt incapable. Instead, he had an idea, which required putting in a call to the MMH Internal Medicine Clinic in hopes of reconnecting with Virginia. Although it wasn’t she who answered the call initially, he got to speak with her quickly, much more quickly than he’d gotten to speak with Dr. Gomez.

“Sorry to bother you again, knowing how busy you are,” Jack said.

“It’s no bother,” Virginia said. “We’ve finally gotten a handle on the day, dealing with Dr. Passero’s absence. What can I do for you?”

“First I’d like to thank you for the help you have already given me,” Jack said.

“It was my pleasure.”

“I’ve been thinking about Dr. Passero’s committee work,” he said. “You mentioned she was really fixated on two goals: being a member of the Mortality and Morbidity Task Force and the hospital board.”

“Very much so. Particularly the task force.”

“Do you think she could have been depressed about it since you mentioned she found it frustrating?”

“Not at all. As I said, Sue was the opposite of a depressive type. I think the challenge was stimulating for her rather than vice versa.”

“I had planned on looking at the contents of the Mortality and Morbidity Committee file after what you had said. Unfortunately, I had to leave the hospital rather suddenly and get back here to my office.”

Jack paused for a moment to give Virginia a chance to respond, to see if his expulsion by Marsha Schechter was part and parcel of hospital gossip. When she didn’t react, he continued. “I’m thinking it might be helpful for me to glance through it. Would you be willing to leave the folder down at the information desk with my name on it? I could stop by on my way home this afternoon and pick it up. I could have it back tomorrow if necessary.”

“Certainly,” Virginia said without the slightest hesitation.

Encouraged by the woman’s response, he asked if she could also include the folder labeled hospital mortality articles of interest, and she agreed again without pause. Disconnecting, he felt pleased. He’d decided that getting an idea of Sue’s mindset might be helpful although he didn’t know exactly why.

Having made the call to Virginia and being reminded of the conversation that he’d had with her in Sue’s office, Jack turned on his monitor and googled death ratio. It was a term that had come up when Virginia mentioned Sue’s abiding interest in joining the hospital’s Mortality and Morbidity Task Force. He didn’t find much. Mostly the search turned up articles about mortality rate, a more general term. But then he came across a specific article about death ratio that had been put out by the Mayo Clinic.

Quickly scanning the piece, Jack learned that death ratio referred to a ratio of the number of hospital deaths divided by the expected number of hospital deaths. A value of one meant the hospital was doing as expected. A value of greater than one meant the hospital was not doing so well, and a value of less than one meant it was doing better than expected. When he finished reading, he noticed that there had been no explanation of how the denominator, the expected number of deaths, was determined, although he assumed it had something to do with the expected mortality of each individual illness.

The harsh jangle of Jack’s office phone interrupted him. It was Vinnie calling back. Jack told him to go ahead and make the arrangements for Sue Passero’s body to be released.

“Will do, Señor Commandant,” Vinnie teased. “But, let me ask you, are you sick?”

“I’m not sick,” he said. “Why do you ask?”

“Hey, it’s three o’clock, and you haven’t bugged me, texted me, or nothing for hours.” Vinnie laughed. “I thought for sure you had to be on death’s door.”

“Consider yourself lucky,” Jack said, and hung up the phone.

With Vinnie reminding him how late it was, Jack suddenly had an idea. Since he was still suffering from not knowing what he didn’t know, despite his visit to the MMH, and since he knew that the evening MLIs arrived at three, he thought it was an opportune time to chat with Kevin Strauss. Although he’d read Strauss’s excellent workup on Sue several times, he still thought it might be of interest to talk with the man directly on the outside chance there was something he’d not included, perhaps thinking it was not relevant. With that in mind, Jack snatched up the office phone once again and punched in the MLI office main number.