Critical (41 page)

"There's a couple in here which I think will be a challenge," Riva said.

"That sounds good," Jack said. "How many can I expect?"

"At least three," Riva said. "I've got two people who've requested

paper days, so the rest of us will have to pick up the slack." Paper days were days that medical examiners did not do autopsies but rather concentrated on getting all the information needed to finish their pending cases and finalize the death certificates.

"Jack, I'm afraid you have to look at this," Laurie said. She'd gone through the MRSA case that Riva had given her.

Jack rolled his eyes. It wasn't difficult for him to guess that Laurie was about to mount one more effort to get him to change his mind.

"This case is a repeat of David Jeffries's," Laurie began. "She also had been operated on at an Angels Healthcare hospital, only to suffer a fulminant MRSA infection, for which she was shipped off to the University Hospital in hope of saving her."

"Thank the good Lord it wasn't at the orthopedic hospital," Jack said.

"Jack, be serious!" Laurie complained. "This is the second astoundingly fulminant staph infection in as many days. You must rethink your decision. The vast majority of MRSA infections don't kill their victims, and surely not within hours of the initial symptoms. These are very unusual in all regards. Why can't you see this?"

"I do see it. It is a mystery and I'm supportive of your efforts to figure it out. As for me, I've put myself in Dr. Wendell Anderson's very capable hands. If he's confident, I'm confident. If you can come up with something specific why I am specifically at risk, I'll consider it more seriously, but otherwise my mind is made up. I've even been tested for MRSA, and I don't have it. Dr. Anderson has not had a case. In short, I'm going to have my surgery tomorrow, and that's it." Jack stopped and took several breaths. He'd worked himself up during his monologue. He and Laurie locked eyes for a beat, then he said, "Now I'm going down and do my first case. Okay?"

Laurie nodded. The melancholy she'd experienced on awakening drifted back. She felt tears bubble up from somewhere behind her eyes, but she fought them off. "Okay," she said, with a slightly hesitant voice. "I'll see you in the pit."

"I'll see you in the pit," Jack echoed, and walked from the room.

Riva and Laurie stared at each other, with Laurie wanting support and Riva wanting to give it.

"The trouble with men," Riva pontificated, "is that they are men, and they don't think like we do. The irony is that they accuse us of emotionalism, whereas they are equally capable. He'd made an emotional decision to have the surgery and, at this point, he's incapable of rationality."

Laurie smiled in spite of herself. "Thank you," she said. "I needed that."

"Interesting that he did offer you an out," Riva said. "And I can be the witness. He said if you could come up with something that could specifically put him at risk, he'd be amenable to hear it. Of course, he didn't offer to change his mind, but he might. What you need to do is find out the how and the why of these infections. I know it is a tall order in less than twenty-four hours, but from your past record, if anybody could do it, you can."

Laurie nodded agreement, not the part about her being the most capable of the challenge but rather the idea of her possibly changing Jack's mind by her solving the apparent mystery. Suddenly, Laurie stood up and headed out of the room. Her melancholy had been overwhelmed by a surge of adrenaline. She was committed to the puzzle, no matter how unlikely the success, and undaunted by the seemingly impossible time constraint.

"I'm afraid I will have to assign you a few other cases," Riva called after her.

Laurie waved to indicate she'd heard.

"Do you want the case files now or later?" Riva yelled.

Laurie stopped and hurried back to Riva.

"They should be both interesting and quick," Riva said, while handing over the two envelopes. "Both are young, seemingly healthy people in their early thirties, so the posts will be quick and you can get back to your MRSA mystery."

"What's the presumed cause of death?"

"There isn't any. One died at the dentist's office after getting injected with a local anesthetic. I know it sounds like a drug reaction, but there were no symptoms of anaphylaxis. The other collapsed at a health club while riding a stationary bike."

"I'm here!" a voice called out. "The day can now officially begin."

Both Laurie and Riva looked up as Chet bounded into the room. He swirled his jacket over his head like a lariat and let it fly into one of the vinyl club chairs.

"Where is everyone?" he asked, looking confused. He'd expected to see Jack.

"Jack and Vinnie are already downstairs," Laurie said. "You're even more chipper than yesterday, and almost on time two days in a row. What gives? Don't tell me you scored a dinner date with your new woman friend."

Chet stood up straight, flashed a Boy Scout signal with his raised right hand, and clicked his heels. "Scouts never lie. I did indeed, and I'm happy to report she was more intriguing and beautiful than I had remembered. I actually enjoyed talking with her."

"Listen to this, Riva! We are witnessing the possible stirring of maturity in this heretofore juvenile. He was content merely to learn about another human, female being."

"Now, I wouldn't go that far," Chet said. "I was still plotting to get her back to my apartment or me over to hers, but she cut me off with just dinner."

"Darn," Laurie said, snapping her fingers in sham disappointment.

"I have to thank you for your advice, Laurie. I'm sure the date wouldn't have happened had it not been for your encouragement and advice."

"You're very welcome," Laurie said. She turned to Riva. "Thanks for these cases. They're perfect." Laurie started once again to leave.

"She took me completely by surprise," Chet continued, forcing Laurie to hold up. "She's a doctor; she's boarded in internal medicine. On top of that, she's CEO of what has to be a multimillion-dollar company that builds and runs specialty hospitals. I mean she is one impressive lady."

Laurie experienced an unpleasant visceral contraction accompanied by a sensation akin to dizziness which resolved as quickly as it had appeared. She cleared her throat before asking, "Is her name by any chance Angela Dawson?"

"It is!" Chet exclaimed. "Do you know her?"

"Vaguely," Laurie said with surprise. "I have met her, and unfortunately I have to say I wasn't as impressed as you are."

"Why not?"

"I'm afraid I don't have time to explain now, but let me just say that I sensed her priorities as a businesswoman were trumping those of a physician."

Laurie knew Chet would undoubtedly have more questions, but she had to move on. Despite his protests, she excused herself. Walking quickly through communications, where notification of all the deaths of the city were received, she began to plan her day.

With as little time as she had before Jack went under the knife, she would need to be efficient. The first stop was the forensic investigator's office. Janice Jaeger had done the site visit on the new MRSA case, and Laurie wanted to question her. More than once, Laurie had learned something important from Janice's wealth of experience that had not gotten into the report. Forensic investigators were tasked to include only facts, not impressions.

Laurie found Janice finishing up after a long night. She was the sole PA officially working from eleven to seven but rarely left before eight. She was aided, if need be, by forensic pathology residents who rotated night call. If even more backup was needed or the case was particularly challenging, one of the medical examiners was also available.

"Did I miss something?" Janice asked, as Laurie came up to her desk. Laurie got along famously with all the PA's but particularly with Janice, who appreciated Laurie's recognition of her work. More than any of the MEs, Laurie was constantly coming to her and asking questions and valuing her opinion.

"I'm about to do Ramona Torres," Laurie said. "I gathered from your note you made a site visit to the University Hospital."

"I did indeed."

"Did you sense anything about the case that you thought was interesting or unique but not appropriate for your report?"

Janice smiled. Laurie was always asking her probing questions "I did, actually," Janice said. "I got the feeling the doctors were upset that they weren't getting the Angels Healthcare septic patients soon enough to make a difference concerning survival."

"Did you make a visit to the Angels Healthcare Cosmetic Surgery and Eye Hospital?"

"No, I did not," Janice said. "Not in this case. Do you think I should have?"

"I can't say," Laurie admitted. "But you have visited Angels Healthcare hospitals in conjunction with other MRSA cases."

"Absolutely" Janice said. "On a number of occasions."

"I've read several of your reports. What's your general feeling about the hospitals and these recurrent MRSA cases?"

Janice smiled again. "Do you want the truth?"

"Of course! I wouldn't be asking if I didn't."

"I don't know how to explain it, but I feel like something strange is going on. I mean, it's nothing I can write in my report, but they keep having these infections and yet keep doing the surgery. Whenever I ask any type of question in this regard, they say that they are doing everything they possibly can. Meanwhile, people are dying."

"I've had the same response," Laurie admitted. "Thanks for your opinion. Is Cheryl around?"

"She's out on a call. Bart Arnold is around. Do you want to speak with him?" Bart Arnold was the chief of forensic investigation and ran the department.

"No. Just leave a message that I need the hospital record for Ramona Torres. They can e-mail it to me like they did with the others."

"Not a problem."

Laurie rushed all the way to the front elevators to save time: Not only were they faster, there were more of them. She bounded into her office, laid the three case files on her desk, and hung up her coat. Snatching up the phone, she called down to the mortuary office and asked for Marvin. When she got him on the line, she asked him if he would work with her again that day. She said she wanted to be expeditious. He agreed with his usual cheerful readiness. Laurie gave him Ramona Torres's accession number, said she wanted to do her first, and then rang off.

She looked at the clock. One of the first things she wanted to do that day was call the CDC, but fearing they might not be functioning as early as it was, she turned her attention to reviewing the day's autopsy cases. That required rereading the case file of Ramona Torres. After doing so, she felt confident the post would be similar to David Jeffries's. Putting that one aside, she picked up the first of the two sudden-death cases and pulled out the PA's report.

The patient's name was Alexandra Zuben, age twenty-nine. She had visited the dentist for a root canal and had received the local anesthesia as Riva had described. At the very outset of the procedure, the patient suddenly had fallen unconscious. After she had been placed in a head-down position, she'd revived and insisted the procedure continue. A few minutes later, the same situation had developed, although on this occasion she did not revive, 911 had been called, and the patient had been rushed to the hospital, where she was found to have an arrhythmia, a markedly elevated blood pressure, and little or no respiratory efforts. She'd been put on a ventilator, but despite aggressive therapy, she had progressed to a cardiac arrest that could not be reversed. The emergency-room diagnosis had been recorded as respiratory failure compounded with cardiac failure secondary to severe allergic reaction and anaphylaxis to Novocain. The PAs concluded with the fact that a family member had said that the patient was remarkably healthy but had had, on occasion, several syncopal attacks involving palpitations, flushing, and heavy perspiration.

Laurie slipped the PA's report back into its folder. Her initial impression was that the emergency-room diagnosis was in error, and she had a reasonable idea of what she would find on the autopsy. Of particular note, she was reasonably certain she would not need any special equipment for the post.

Next, Laurie took out the PA's report on her third case. It was very short. It merely said that Ronald Carpentu had been on a semirecumbent stationary bike, which he used most every day, and had suddenly collapsed. Immediate CPR had been given by the health club's personnel but without success, 911 had been called, and the CPR was continued en route to the emergency room. On arrival, the patient was declared dead with the diagnosis of a severe heart attack.

Laurie replaced the PA's report. On this third case, she was quite certain the emergency-room diagnosis would prove to be correct, but there was still the question of why. Laurie guessed atheromatous heart disease. Again, she would not need any specialized equipment.

Picking up the phone, she called down to the autopsy room. It rang six times, causing Laurie to drum her fingers on her desk. While she waited, she thought about the weird coincidence of her giving Chet advice about dating Angela Dawson, of all people.

"Hello," a voice said, sounding more like "Yellow."

Laurie asked for Marvin, and after only a few seconds, he came on the line. "Are we ready?" Laurie asked.