Night Shift

Chapter 4

Tuesday, December 7, 7:55 a.m.

Now that the autopsy proper had started, Jack and Vinnie worked efficiently and silently. Since they could anticipate each other’s moves and instinctively knew what had to be done, there was little need for conversation. With the scalpel in hand, Jack made the usual Y-shaped incision, starting at the points of both shoulders, connecting over the sternum, and then running all the way down to the pubis. It was done in two rapid, decisive strokes. When Jack was finished freeing up the margins, Vinnie exchanged the scalpel for the bone shears, so Jack could cut through the ribs to free up and remove the sternum. With the body open like a book, exposing most of the major organs, Jack proceeded to take the usual fluid samples from the aorta, the gallbladder, the urinary bladder, and the eyes with a variety of syringes that Vinnie silently handed over.

“Okay,” he said, more to himself than to Vinnie, when all the toxicology samples had been obtained and he was looking down at the heart nestled between the lungs. “Let’s see what went wrong with the ticker.”

With forceps and scissors, Jack opened the pericardium. So far everything appeared entirely normal, yet he wasn’t surprised. Often fatal heart attacks, even massive ones, weren’t grossly visible, nor were sudden ruptures of heart valves until the organ was opened. Back to using the scalpel, he freed up the heart by cutting through all the attached great vessels and lifted it out of the chest cavity. Gingerly he placed it on a tray Vinnie presented. Stepping down to the foot of the autopsy table while carrying the tray, Jack used a combination of large dissecting scissors and a long-bladed knife to open all the chambers.

“Looks pretty damn normal,” Vinnie commented. He had joined Jack, watching intently.

“You got that right,” Jack agreed. “The pathology is going to be in the coronary vessels.” Meticulously he began tracing out the complicated arborization of the heart’s arteries using more delicate dissecting tools. He worked quickly but painstakingly, looking for the telltale signs of atherosclerosis or plaque lining the interior of the vessels, a condition frequently suffered by diabetics, which could cause the vessel to occlude suddenly, thereby denying a segment of the heart its needed oxygen and nutrients. When it happened, it was called a heart attack.

“My word!” Jack said with surprise as he continued working. “I don’t see any plaque whatsoever. The vessels look like those of a normal teenager.” In the recesses of his forensically oriented mind, faint alarm bells began to sound. With no cardiac pathology, the idea that Sue’s death was natural was being seriously called into question, thereby awakening the possibility of it being accidental or, worse still, homicidal.

“You said she was athletic,” Vinnie said.

“True enough. She was also chief of internal medicine at an academic medical center. She knew how to take care of diabetes and her general health, and she practiced what she preached.”

When Jack was finished with the dissection of the heart and Vinnie had bottled and labeled all the histology samples, Jack returned to his position on the right side of the patient. Moving on, he palpated the lungs before removing them. As he did so, he sensed they were a bit heavier than expected, which was confirmed when he weighed them. “Curious,” he mumbled.

“How much?” Vinnie asked.

“Two-point-four pounds,” Jack said.

Stepping back down to the foot of the autopsy table, Jack made use of the same tray he’d used to dissect the heart to make a series of slices into the lungs. “Mild pulmonary edema,” he commented as he looked more closely.

“Does that surprise you?” Vinnie asked.

“Not really,” Jack said. “It’s mild and nonspecific.”

“Does it make you more suspicious this could be a drug-related death?”

“Not really,” Jack said, but he wondered if Vinnie could be correct. Pulmonary edema of varying degrees was invariably present in the rash of drug overdose cases the OCME was being barraged with. Jack would have to wait in Sue Passero’s case, as ultimately toxicology would supply the answers if her passing was drug-related. Jack was still surprised and even troubled by not finding any visible pathology with the heart, which he had hoped he could offer Laurie, knowing how disappointed she was going to be if there wasn’t some specific explanation that she could provide for the family. Although there was a slight chance histology might come through showing significant microscopic pathology, Jack sincerely doubted it was going to happen, and even if it did, it would take days. Such a surprise had never happened to him, where he had not been able to anticipate what the microscope showed.

“Let’s move on,” Jack said, regaining his place at the table while taking another glance at the clock. The next organ system to be removed was the digestive system, and he began by opening the stomach, which was empty of food contents. As Jack was quickly palpating his way down the digestive system before removing it, he heard the door to the autopsy room bang open. Turning his head, he saw Laurie enter, pressing a face mask over her nose and mouth. In violation of her own rules of autopsy room apparel, she was dressed merely in a long lab coat over her colorful dress.

Laurie was hardly a fashionista or clotheshorse, but she had always made it a point to dress in a feminine style and made sure her voluminous, shoulder-length auburn hair was clean and pulled back out of the way. When she had just finished her forensic pathology training and started at the NYC OCME, women were a distinct minority in the field, and she felt obligated to proclaim her gender. Now that she was the first female chief medical examiner here, she felt a similar responsibility since she was paving the way for others.

As soon as he saw his wife enter, Jack pulled his hands out of Sue Passero’s abdomen and folded them over his gowned torso. He watched her approach and could tell her eyes were glued to the disturbing sight of her long-term friend flayed open on the autopsy table. Out of respect, he stayed silent, waiting for her to speak. Vinnie did the same.

After a pregnant pause, Laurie audibly took a deep breath through the mask she had clasped to her face and lifted her eyes up to meet Jack’s. “I thought I was prepared for this image, but I wasn’t,” she confessed. “Maybe I was secretly hoping there was some mistake of identification. Obviously there wasn’t. What a loss for everyone who knew her.”

“I agree,” he said soothingly. “She was a doctor’s doctor, the kind of doctor we all imagined before we went into medicine and learned that unfortunately not everyone in medicine joined the club for the right reasons. But, be that as it may, prepare yourself for a surprise. The heart is grossly entirely normal. More than normal. It’s like the heart of a youthful athlete. Not an ounce of atheromata visible, and I went through most of the coronary system, practically down to the capillaries.”

“None?” Laurie questioned. “Are you sure?”

“None,” Jack echoed. He pointed toward the dissected heart still on the tray at the foot of the table with both lungs. “Take a peek.”

“I believe you,” she added quickly. She didn’t want to have anything to do with the nitty-gritty of her friend’s autopsy. “That is surprising, since her death certainly had to be a cardiac issue. I suppose we should keep in mind a channelopathy with a fatal arrhythmia.”

“She had no cardiac history whatsoever,” Jack said. “Kevin Strauss, who’s thorough, as you know, was the MLI, and he obviously went through her entire computerized health record.”

“Well, a channelopathy is still possible,” Laurie said.

“A channelopathy is possible but certainly not likely with no cardiac history. We’ll have the DNA lab look for the usual markers, but it’s definitely a statistical long shot. We’ll also send all the usual samples up to Toxicology to have an idea of her glucose level and the like. She did have pulmonary edema. Not a lot, but a little with the lungs coming in at two-point-four pounds.”

“Sue always had her diabetes under control,” Laurie said. “She was obsessive-compulsive about her sugar levels. Pulmonary edema? You are not considering a drug overdose, are you?”

“Not particularly, but we have to touch all the bases, so we are sending all the usual samples up to John in Toxicology to see what he comes up with. And there is also the slight chance of a massive stroke, but I doubt it.”

“I doubt it, too, and Sue wasn’t taking drugs,” she said definitively. She took another sighing breath through her mask while hazarding a final glance at her friend’s corpse. “I was so hoping to have something concrete to offer as an explanation to Abby and the kids when I make my call.”

“Just like I’ll be wishing I had something definitive for the damn death certificate, which I’ll be responsible to fill out and sign. Without a clear-cut cause, I’m going to have trouble calling it a natural death.”

“I’m confident you’ll figure it out,” Laurie said. She started to leave but then turned back. “Thanks for doing the case and doing it quickly. I appreciate it. You are partially forgiven for leaving this morning without so much as a note. Don’t do it again.”

“Aye, aye, sir,” Jack said while saluting with his gloved hand.

Laurie eyed him and paused as if she was about to say something else, but she didn’t. Instead, without another word, she turned around and left. The swinging doors out into the hall squeaked as they closed behind her, and except for the water running along the autopsy table and making a sucking noise at the drain, a heavy silence reigned.

Vinnie eyed Jack, and Jack stared back at him. “I’m not sure the boss liked your salute,” Vinnie said at length.

“You are probably right,” Jack said with a shrug. “Sometimes, and maybe more often than not, I function by pure reflex without much thought for the consequences. On the spur of the moment, it seemed like the right thing to do in response to her order.”

“She is the chief,” Vinnie reminded him.

“She’s the chief here, but not necessarily at 42 West 106th Street,” Jack said. “At home, it’s supposed to be a bicameral government. Unfortunately, she’s starting to bring her work persona home and act as if she is in charge there, too.”

“I suppose it is rather unique to be married to the chief,” Vinnie said.

“Don’t get me started,” Jack said. “Instead, let’s finish this case, so we can move on to one with a bit of forensic challenge.”