Night Shift

Chapter 5

Tuesday, December 7, 8:25 a.m.

Following Laurie’s visit into the autopsy room, Jack and Vinnie rapidly completed the autopsy on Sue Passero. As Jack had anticipated, there had been no stroke, since the brain was entirely normal, and he was again worrying about having to complete a death certificate with no obvious cause of death.

Just before they had opened the calvarium to examine the brain, a number of other mortuary techs showed up en masse and began to prepare the other tables for the morning cases. Marvin Fletcher, the mortuary tech whom Laurie favored when she did her weekly teaching case on Thursdays, was the only one who came over to Jack and Vinnie, questioning how they were almost finished with a case so early.

“It’s my burden,” Vinnie complained with a laugh. “Dr. Stapleton doesn’t have a life.”

“What’s more fun than an early-morning autopsy?” Jack questioned in response. Although it was probably impossible to keep a lid on Sue Passero’s identity from in-house chatter, Jack didn’t want to be the direct source.

When the case was finished and after Jack had helped Vinnie move the corpse onto a gurney, he ducked into the locker room to grab a white lab coat to put over his scrubs while Vinnie prepared for the suicide case. Aware that Laurie was desperate for all the details about Sue as soon as possible so that she could provide some answers to the family, Jack wanted to get the samples up to Toxicology and Histology, the two departments that worked the closest with the needs of completing the autopsy. As he knew from experience, the fastest way to get something done was to do it himself.

Clutching all the sample bottles to his chest, Jack first walked into Maureen O’Conner’s recently remodeled domain. As the Histology Department head, she now had a small private office, which was off the lab itself. From Jack’s first days as an NYC ME, he had made a distinct effort to befriend the red-faced Irishwoman with her broad smile and wonderful brogue. As was the situation with the current case, histology and toxicology often provided the critical information required to solve a difficult case, and the faster the microscopic slides were available, the sooner the case could be completed. All the other medical examiners were willing to wait patiently for their slides to be processed, but that had never been the circumstance with Jack, especially with time constraints. Luckily, befriending Maureen had been easy since she was a remarkably outgoing individual.

“Well, glory be!” Maureen said with her charming accent. “This is the earliest hour I have ever had the pleasure of a personal visit from the famous Dr. Stapleton. To what do we owe this distinct pleasure?”

“I can tell you, but with a condition,” Jack said.

“And what might that be?”

“You have to keep it under your hat.”

“My lips are sealed, and my curiosity is heightened. What’s up?”

“The case involves a very close personal friend of the chief’s,” he said, lowering his voice. “And she is eager to have any and all information for the family ASAP.”

“I’m sorry to hear that,” Maureen said, becoming serious. “What is it that you need?”

“Nothing out of the ordinary, other than sooner rather than later,” Jack said. “The friend was a doctor who died yesterday evening sitting in her car in her hospital’s garage. Because of the individual’s lifelong history of diabetes, it was assumed she’d suffered a cardiac issue. But I just found the heart to be grossly normal, and the coronaries looked remarkably clean. So I need to look at the microscopic sections of the coronary arteries and arterioles to see if they can tell us anything.” As he spoke, he separated out the histology sample bottles and arranged them in a line along the front of Maureen’s desk.

“We’ll get right on it,” Maureen said without hesitation.

“When the slides are ready, give a shout, and I’ll pop up here to get them,” Jack said.

“I will call you myself,” Maureen responded, as she leaned forward and began picking up the bottles. “I’ll try for late today but most likely it won’t be until tomorrow morning.”

“I appreciate your help,” Jack said.

Next he headed to the top floor, where John DeVries, chief of the Toxicology Department, had his new office. Toxicology used to be crammed into a tiny area of the fourth floor but had moved up to take over both the fifth and the sixth floors when most of the OCME team moved into the new high-rise quarters on 26th Street. Although the windows had not been upgraded and looked their more-than-a-half-century age, the rest of the laboratory looked sleek and modern and was certainly state of the art. John’s office, which used to be the size of a broom closet and perhaps had once been one, was now spacious and even had windows and a view. Along with the lab’s physical enhancements, John’s personality had undergone a considerable improvement. Previously prickly if not downright surly, John was now decidedly amiable, and to Jack the transition had been nothing short of miraculous. Since toxicology was as critical as histology for complicated forensic cases, Jack had tried to push John as much as he had pushed Maureen on multiple occasions, but instead of being helpful as Maureen was and willing to speed things up on critical cases, John had become progressively passive-aggressive or even outright aggressive. On several occasions Jack and John had nearly come to blows.

“Good morning, Dr. Stapleton,” John said cheerfully as Jack walked in through the open door to the man’s office.

“It’s Jack to you, Dr. DeVries,” Jack responded with a smile. John had a PhD in both chemistry and toxicology.

“Jack it is. What can we do for you today?”

He went through a similar explanation with John as he had with Maureen.

“And what are the results you are possibly looking for?” John asked, becoming serious.

“Well, you know better than I,” Jack said. “First we need to do a general drug screen. The only positive finding at autopsy was mild to possibly moderate pulmonary edema. The chances of it being any kind of drug overdose in my mind is zero, but I’ve been surprised in the past, and it should be ruled out.”

“Of course,” John responded. “That goes without saying. What else?”

“She was a type 1 diabetic, so we need to know as soon as possible and as much as possible about her level of glucose control, insulin levels, and whether any ketoacidosis or hyperglycemia was present when she had her terminal event.”

“Certainly,” John said agreeably. “You are giving us a vitreous sample?”

“Absolutely,” Jack said. He pointed to the specific sample bottle.

“Good,” John said. He quickly glanced through the other sample bottles, nodding as he did so. “What’s this?” he asked, picking up one merely labeled injection.

Jack bent over to take a look. “Ah, yes, thanks for pointing that one out. That’s an en bloc sample of skin and subcutaneous tissue from her last insulin injection site on her thigh. I didn’t know if it was something you ever look at in terms of assessing the amount of insulin.”

“It’s not usual in forensic cases. There are lots of studies on how various insulin preparations are absorbed in the subcutaneous space. Do you think it might have any particular significance in this case?”

“I can’t imagine,” Jack said. “But I’m finding this case troubling. I’m going to need a cause of death for the death certificate.”

“I’ll give it some thought,” John said.

On his way back down to the autopsy room, Jack stopped in his office and left the rest of the sample bottles. They were going to go down to 421, as the OCME high-rise was called. He personally wanted to give them to the DNA laboratory or Forensic Biology Department head, Naomi Grossman, and explain exactly why he wanted to have the lab search for the cardiac channelopathy mutations. Like with Maureen and John, Jack thought it was important to have a personal interaction with the department head. Otherwise, test results got put off, sometimes for weeks.

With all that accomplished, he was about to descend back down to the basement level where the autopsy room was located to get cracking on the supposed suicide case, but as his hand hovered over the basement button in the elevator, he changed his mind. Instead, he pushed the button for the first floor. He decided to stop briefly in Laurie’s office to see if she might be available for a quick chat. Vinnie’s comment about her not appreciating his salute was probably correct, and he thought maybe it would be wise to apologize again for leaving at the crack of dawn. There was no doubt he should have at least left a note.

Cheryl Stanford, an aging African American woman who could have retired years earlier and who had been the secretary for the former chief, Harold Bingham, had been kept on as Laurie’s secretary. Laurie had pleaded with her to do so, and she had graciously complied, significantly helping Laurie make the transition from medical examiner to chief. The process had not been easy for Laurie, as she had had no administrative training or experience and frankly had not been interested in being an administrator until the job was offered to her by the mayor. It wasn’t until all the medical examiners, including Jack, had talked her into it that she had been willing to accept.

As he entered the administration area near the front entrance of the building, Cheryl looked up. It was obvious she was on the phone and in the middle of a conversation, but the moment she saw Jack, she gave him a thumbs-up, meaning Laurie was currently available. He knocked before opening the inner door.

The décor of her office was the antithesis of the previous chief’s, as was her personality, considering he had been rheumy and grumpy. Although the physical space was identical, it was as if the room were on a different planet. Instead of being dark and forbidding, it was bright and cheerful. It even had colorful drapes and a couch upholstered in matching fabric. Instead of gilt-framed dark paintings of brooding, overweight men in dark suits, the walls were hung with lively Impressionist prints with narrow, blond wood frames.

“Well?” Laurie questioned. She was sitting behind the large, dark mahogany partners desk, which was the only remnant of the office’s previous occupant. Its size emphasized her svelte figure. Spread out in front of her were architectural drawings. “Was there any suggestion of a cerebral hemorrhage?”

“Nothing,” Jack said. “Except for the history of diabetes, she was the picture of health. I’ve rarely seen a cleaner autopsy.”

“Good grief!” Laurie complained, running her free hand nervously through her hair. “That’s distressing. What on earth am I going to tell Abby and the kids?”

“You’ll have to tell them that the cause of death is pending, dependent on what’s to be found on the histology sections and with the toxicology. At least the kids will understand.”

“Unfortunately, Abby already called,” she said. “I spoke to him briefly. Like last night, he was emphatic that he didn’t want an autopsy done, so I had to explain once more that we are required by law to determine the cause of death, which dictates an autopsy. But I told him that the autopsy was already nearly done and that he would get a call to let him know what was found. Most important, I told him that Sue’s body would be available later today to be picked up by a funeral service of his choosing.”

“Was he receptive?”

“Not really. He’s obviously and understandably beside himself. And then he surprised me by asking if the death certificate will be available when the body is released because he was going to need it ASAP.”

“That’s curious,” Jack said.

“My thoughts, too,” Laurie said. “So I asked him why he needed a death certificate ASAP.”

“And what was his response?”

“He said that the life insurance company will not release the funds until they have it in hand.”

For a few beats, they stared at each other. It was Jack who broke the silence. After clearing his throat, he questioned: “Could we be participating in a B movie here?”

Laurie nodded. “I have to confess the same thought went through my mind until I chided myself for even thinking such a thing. At the same time, I’ve known how strict a control Sue always maintained over her diabetes day in and day out. If anything, she was fanatical about it. Anyway, I mentioned to Abby that I didn’t know that Sue had life insurance. I told him that she and I had talked about life insurance when Nadia and Jamal had decided to go to medical school, but that she had decided against it. His response was to say that they had changed their mind a little over a year ago, considering the debt that they had accepted for the kids’ educations, which he said they had been in the process of paying off. He then reminded me that having been a stay-at-home dad and husband, he didn’t have a lot of current career options.”

“I don’t know what to say. It does potentially put a different spin on the case.”

She sighed. “Maybe, maybe not. One way or the other, it’s clear Abby is going to be pressuring us for the death certificate sooner rather than later, and I’m going to feel obligated to produce it.”

“That’s going to be a problem. Unless something definitive comes out of Histology, Toxicology, or Forensic Biology, I have no idea what I could put on a death certificate. I’ve never been comfortable with indeterminate. I consider it kind of a forensic cop-out.”

“The death certificate can always be amended when new information comes to light.”

“That’s not my style,” Jack said.

“Don’t let your imagination run wild,” Laurie said, showing a bit of emerging exasperation. “Listen, Sue and I were close and confided in each other. As far as I know, she and Abby got along just fine.”

“That may be, but peoples’ private life can be far different than what other people suspect. Plus, people evolve and change. Who knows the mindset of a stay-at-home dad after the kids have left the house, when a career has been abandoned, and aging begins to rear its ugly head.”

“Jack, please!” Laurie snapped. “You are jumping to conclusions. Cool it! Besides, you specifically said on the phone that the reason you slunk out of the apartment this morning was to come in here and find yourself a challenging case. Well, here it is! And you have to handle it because I can’t.” She gestured to the architectural drawings. “We need a new morgue, and the city council has balked on the funding. It’s become critical because the lease on this building from NYU Medical Center is running out, and we are going to be literally out in the cold with no autopsy suite. I’ve got a new mayor who is going to be inaugurated in a little more than a month, and I have to get him on board. What all this means is that you are going to have to carry the ball dealing with Abby by providing him with the death certificate he needs. Are we clear on this?”

He gritted his teeth, desperately trying to keep himself from provocatively saluting again. She was back to giving him orders, and although it was more appropriate in this instance, it still galled him. Yet instinctively he knew another salute would cause a scene, as he was aware of the pressure she was under. She’d been vainly struggling with the pressing need for a new morgue for more than a year, and with the city council dragging its feet, it truly was becoming critical.

“Well?” Laurie questioned impatiently when Jack demurred.

“I’ll work on it,” Jack said. “I’ll make sure the Forensic Biology lab looks into the channelopathy issue, as unlikely as it is, and I’ve already dropped off the samples to Maureen and John, asking them to fire their respective afterburners.”

“Thank you,” Laurie said with a sigh of relief. She smoothed out the drawings in front of her, clearly preparing to get back to trying to lower the estimated cost of the building without compromising its mission.

“But I’m not promising anything with the death certificate if nothing positive turns up,” Jack said as he headed for the door. “Without a discernable cause of death, I don’t have to tell you of all people that the manner of death is moot, and if it ain’t a natural death, like a heart attack, which we expected, that leaves only accidental, which isn’t likely; suicidal, which is less likely with no note or obvious method; and homicide. Obviously, the idea she died due to a therapeutic complication, the last manner of death, is a nonstarter, as she wasn’t being treated for anything other than her diabetes.”

“As I said, you wanted a challenge, so now you have it. Good luck, but get it done! To help you, I’ll give Abby a call back shortly because I said I would. I’ll tell him that the results of the autopsy are pending and that you will be giving him a call to convey them. I’ll also mention that you will be the one to provide the death certificate and will arrange for the body to be released to the funeral home.”

“Aye, aye!” he said, being careful to resist making a salute by keeping his hand tightly gripped on the doorknob. Then he left.