Night Shift

Chapter 2

Tuesday, December 7, 7:10 a.m.

“Good morning, Jennifer,” Jack said with more alacrity than he felt. In contrast to some of the other forty-one medical examiners, Jack did not make it a habit to project his inner mindset and mood to others, mainly because he was a private person. Dr. Jennifer Hernandez was one of the relatively new medical examiners on staff, and it was currently her turn to be on call for the week, meaning if one of the medical examiners was needed during the night to back up the forensic pathology fellow, she was the designee. It was also her role to come in early, go over the cases that had come in during the night, confirm the need for each to be autopsied, and then divide them up between the medical examiners. “Anything particularly interesting today?” Jack added as he approached the desk where Jennifer was sitting. He tried to act casual.

“I just got here two minutes before you,” Jennifer said. “I haven’t even started looking at them.” In front of her was a modest stack of folders containing the workups done by the medical legal investigators, or MLIs, highly trained physician assistants who went out into the field, if necessary, to investigate all deaths thought to be possible medical examiner cases. The police and hospital supervisory personnel were all highly cognizant of which deaths were required to be reported to the OCME by law and which weren’t. Although the previous day’s haul was extensive since it included the entire weekend, today’s cases were modest in number. Jack estimated no more than about twenty.

“Did you get any calls during the night from the pathology fellow or the MLIs for any problems?” Jack asked, trying not to sound too eager. Cases where the on-call ME participated were invariably more challenging and interesting.

“I didn’t,” Jennifer said. “I gather it was a fairly quiet night. Mostly overdoses.”

Jack inwardly groaned. He wasn’t surprised. They were seeing on average five overdose deaths a day, which were more depressing than intellectually stimulating. There was no forensic mystery involved, only the social question of what was happening to society to foment such an ongoing tragedy, above and beyond the appearance of fentanyl in the drug world. “Do you mind if I take a look?” Jack asked. He was sensitive to not be too pushy with his seniority.

Jennifer laughed. “Be my guest,” she said, gesturing to the stack of folders. It was common knowledge among the MEs that Jack often arrived early to cherry-pick cases to find the most challenging. No one denied him because everyone knew he was the kind of workaholic who always took more than his share of cases, even the routine ones. Jack was the opposite of a slacker, especially when he was stressed out like he was at the moment.

“Oh, no!” a voice cried. Both Jack’s and Jennifer’s head bobbed up as Vinnie Amendola breezed into the room with his ever-present New York Post tucked under his arm. He was a slight, dark-haired, and unshaven man who was dressed in a hooded sweatshirt and baggy sweatpants, looking slouchy despite being the most senior mortuary technician at the OCME. In contrast to his appearance, he was impressively knowledgeable about forensics. Having worked closely with Jack for many years, they were a well-oiled team. “God! I hate to see Dr. Stapleton here this early,” he moaned, rolling his eyes skyward while slapping his paper down onto the side table between two upholstered easy chairs as if angry. “Damn it all! It means I’m going to be stuck in the pit all day listening to his bullcrap. What could I have done to deserve this?” The pit was the nickname for the autopsy room among all the mortuary techs.

“I hope you didn’t get all dressed up for us,” Jack quipped. Lots of sarcastic barbs was the bulk of their normal verbal interaction.

“Let me guess,” Vinnie said as he collapsed into one of the chairs. “Problems on the home front? In-law difficulties? Am I getting close?”

Jack grimaced. Vinnie knew him much too well. “Things could be better,” Jack admitted without elaborating. “What I need is a challenging case.”

Vinnie immediately got the message and didn’t tease further. Instead, he changed his tone and said, “Okay! Anything promising?”

“I haven’t yet had a chance to look,” Jack responded. “How about getting the communal coffee ready?” Making coffee in the morning was one of Vinnie’s self-imposed jobs, as he was usually one of the first people on the day shift to arrive.

“All right, already!” he said, pretending to be irritated.

Jack redirected his attention to the stack of folders, hoping to hit pay dirt, but his optimism quickly dimmed. As Jennifer had warned, the first three were run-of-the-mill overdoses. Although he was certainly aware each was its own personal tragedy, particularly the third case, which involved a fifteen-year-old boy, none of them would be enough to dominate his mind at least for a few days or even for a week, which was what he was hoping to find. But then, like an unexpected slap in the face, the name on the fourth folder jolted him. It was Susan Passero, the name of Laurie’s oldest and closest friend, who also served as her general medical practitioner. Jack also knew her, and he certainly respected her as a first-rate internist as well as personable, socially committed, and a dutiful mother. Although Laurie usually saw Susan solo, mostly for lunch at least once a month, Jack and her husband, Abraham, known as Abby, had on occasion had been included with the women for dinner or to attend some sort of cultural event.

With his pulse quickening, he emptied the folder and hurriedly searched through the contents for the MLI’s investigative workup. As he did so, he hoped that the body downstairs in the cooler would turn out to be a different Susan Passero. As he snapped up the workup, Jack’s worst fears were realized when he read that the deceased was a physician on the staff of the Manhattan Memorial Hospital who had died suddenly in apparent good health, which was the reason it was deemed a medical examiner case.

Jack sighed loudly and involuntarily stared off into the middle distance, already worried about having to call Laurie and give her this disturbing and shocking news. With all the stresses and strains that were happening at home and those associated with her relatively new role as the chief medical examiner — running the largest ME office in the country, with more than six hundred employees and a yearly budget of $75 million — this added emotional burden was potentially going to be horrendous.

“Something wrong?” Jennifer asked, sensing Jack’s reaction.

“I should say,” he answered. He glanced at Jennifer, who knew Laurie well. Jennifer was the daughter of Laurie’s late nanny, and Laurie was largely responsible for Jennifer’s career choice as a physician and a forensic pathologist. Jack held up the MLI report. “I’m afraid this autopsy case is one of Laurie’s closest friends.”

“Good lord,” Jennifer said. “What happened?”

He went back and read more of the workup. “She apparently died in her car in the MMH’s garage. She was found slumped over the steering wheel by a nursing supervisor named Ronald Cavanaugh, who was coming on shift. He described finding no pulse, and with the help of another arriving nurse alerted the ED while starting CPR.”

“Cardiac, probably,” Jennifer said.

“That’s what the ED physician ultimately thought,” he said. He looked back at Jennifer and shook his head. “Wow! What a tragedy! This is going to be one hell of a blow for Laurie. Besides being a friend, the woman was a committed doctor, a doctor’s doctor, as I’m sure Laurie would agree.”

“Who was the MLI?” Jennifer asked.

“Kevin Strauss,” Jack said as he went back to reading.

“He’s good.”

“I agree,” he mumbled.

“If you are going to have a heart attack, I guess a hospital is a good place to have it,” Vinnie said as he was making the coffee.

“But not in your car in the garage,” Jack said.

“Did the ED send a resuscitation team?” Vinnie asked.

“Within minutes,” Jack said. “Apparently they made a lot of effort because the nursing supervisor and the other nurse said that the patient initially showed some signs of improvement when they started CPR.”

“Did they ever get a pulse?” Jennifer asked.

“No, no pulse was obtained either in the garage or in the ED where she was moved while the CPR was continued.”

“I wonder what they thought were signs of improvement.”

“It doesn’t say,” Jack said.

“Any history of cardiac issues?”

“Apparently not,” he said. “What she did have is type 1 diabetes, which I didn’t know, and I don’t believe Laurie knew, either, which is surprising for as long as she and Sue knew each other.”

“Well, sudden cardiac death is certainly not unknown with type 1 insulin-dependent diabetes,” Jennifer said. “And I actually did hear about this case last night.”

“How did that come about?” Jack asked, looking up from his reading.

“One of the ID team called me with a problem,” Jennifer said. “The husband of the patient was the one who came in to make the ID, and he was understandably very upset and let it be known that he was firmly against an autopsy. He demanded the body be released immediately to his designated funeral home. I ended up talking to him and tried to calm him down. When he would finally listen, I explained to him that it was not possible for the body to be released because his wife had died suddenly, in apparent good health, and that we were required by law to determine the cause and manner of death. I made sure he understood that an autopsy was needed.”

“I find all this really surprising. Was the name of the husband Abraham Ahmed?” For a few seconds, he entertained the idea that maybe this case involved a different Susan Passero, but the idea was dispelled when Jennifer confirmed the husband’s name.

“Good grief,” Jack said. “I’m shocked. Did he offer a reason for not wanting an autopsy?”

“Yes. He said he was Muslim and that he didn’t want to delay burial.”

“My word! You live and learn. I’ve spent some social time with the man and had no idea Abby, as he likes to be called, is Muslim. What did you tell him?”

“I told him most likely an autopsy would have to be done, but I assured him it would be done quickly and with full respect for the body. Because of a previous case I read up on Islamic attitudes and sensitivities toward autopsies. I knew that in this day and age, it is not as clear cut as he was suggesting. I read it’s not mentioned in the Koran.”

“Was he satisfied?”

“Not particularly,” Jennifer admitted. “He was obviously put out about the situation. I encouraged him to call back this morning, saying he could talk to whoever does the case.”

“Have you decided who you will assign it to?”

“I was thinking I would do it myself,” she said. “For one thing, it’s my understanding that Muslims prefer the same gender do the autopsy as the deceased, and since I’ve already spoken to the husband, it makes sense.”

“Oh, boy,” Jack commented vaguely with a shake of his head while nervously running a hand through his modified Caesar cut. It was turning out to be a much worse day than he’d bargained for. “Well, I think I’d better call Laurie right away to get her in the loop, but I’m not looking forward to it. She’s going to be one unhappy lady, and because of a few other issues on the home front, as Vinnie correctly suspected, I hate to be the messenger.”

“Sorry to hear. Would you like me to do it?” Jennifer graciously offered.

“Thank you, but no,” he said. “It’s nice of you to offer, but I’ve got to step up to the plate. I kinda immaturely bailed out this morning and need to face the music.” Jack never minded mixing his metaphors.

Jennifer picked up the phone that was on the opposite end of the desk and moved it over in front of him. Jack waved it off, saying he’d use his mobile but wanted to wait until he reread Kevin Strauss’s investigative report more carefully. He knew Laurie would have all sorts of questions, which he wanted to be able to answer.

“Want some fresh coffee for fortification?” Vinnie called out without a hint of sarcasm from where he was standing by the coffee maker.

“Please,” Jack responded as he began rereading and committing to memory Sue’s most recent blood chemistries, particularly her glucose and cholesterol levels. As he went through the whole report, it was obvious that Kevin had had an opportunity to go over Sue’s entire digital health record, which included being diagnosed with type 1 diabetes as a child. What Jack was most interested in determining was if there had been any history of cardiac issues whatsoever. There had been none, though, and a relatively recent routine ECG had been entirely normal.

“As per usual, the MLI did a bang-up job,” Jack commented to no one in particular when he finished. He then pulled his mobile out of his jacket pocket and retreated to one of the upholstered easy chairs. Vinnie brought over a steaming mug of coffee and set it on the side table. Jack acknowledged the gesture with a nod as he pulled up Laurie’s mobile number on his phone’s screen and then, after a sip of his coffee, tapped the screen gently to put the call through.