Robin Cook - Critical

"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.

"We've been ready for hours," Marvin joked.

Less than five minutes later, Laurie was suited up and staring down at Ramona's corpse. As with David Jeffries, an endotracheal tube and a number of intravenous lines were still in place. But the most striking thing was the extensive bruising over much of her body from the liposuction.

"You are motivated today," Marvin said, in a reference to how quickly Laurie had gotten down to the basement level, changed into her barrier protective gear, and come into the autopsy room. Besides her case, there was only one other under way, and that was the floater. Laurie hadn't even stopped to see how it was going.

"I want to be as efficient as I can," Laurie admitted. "I promise I won't leave you high and dry like I did yesterday. I apologize again. I got sidetracked and lost all idea of the time."

"No sweat," Marvin said, seemingly embarrassed that Laurie felt she needed to apologize.

Laurie palpated Ramona's skin and looked at it closely. It had a spongy feel, and there were multiple tiny abscesses such that Laurie felt that had she lived, she would probably have sloughed off a large part of her epidermis.

After taking a number of photographs, Laurie began the case. She worked quickly and silently. When Marvin asked questions, she answered as if preoccupied, and he soon stopped. Since they worked together so often, there was little need to talk.

As with David Jeffries, the most notable pathological finding, besides the extensive cellulitis, was in the lungs. Both were fluid-filled and contained innumerable small abscesses that would have coalesced into larger and larger ones had the patient lived. As with Jeffries, the necrosis was substantial.

When the final suture had been placed, closing the autopsy incision, Laurie stepped back from the table. She glanced around the room. Now, all eight tables were being utilized. Looking over near the door, she could see that Jack, Lou, and Vinnie were still involved with the floater.

"That was one of the fastest autopsies I've seen," Marvin commented, as he began to clean up.

"How soon can you have the next case?" Laurie asked.

"Fifteen minutes or so," Marvin said. "Do you have a preference as to which one of the two should be next?"

"It doesn't matter," Laurie said. "I wouldn't fault you if you don't believe me, but I'm going upstairs to make one phone call, and then I'll be back."

Marvin smiled.

Laurie stopped briefly at Jack's table and jokingly asked why he was taking so long. Jack was known to be one of the fastest prosectors.

"Because these two windbags talk like a couple of old ladies," Vinnie said disgustingly.

"We're being thorough," Jack said. "Even before the micro and the lab contribute, we know this young woman was raped rather brutally."

"Which raises the question," Lou said, "was it a rape followed by a homicide, or was it a homicide and an incidental rape?"