Robin Cook - Marker

"I think I do. It's become pretty clear to me that the mechanism of death was ventricular fibrillation for all four. The cause is another matter, as is the manner."

"I'm listening."

"Are you sure you want to hear? I mentioned my ideas to Jack, and he was irritatingly dismissive."

"Try me!"

"All right! In a nutshell, since I've decided that the mechanism of death was ventricular fibrillation or cardiac standstill, and since the hearts have been structurally normal, the cause of death has to be some arrhythmia-producing drug."

"That seems pretty reasonable," Riva said. "Now what about the manner of death?"

"This is the most interesting part," Laurie said. She leaned forward and lowered her voice as if she were afraid someone might hear. "I'm thinking the manner of death is homicide! In other words, I think I have stumbled onto the handiwork of a clever serial killer in the Manhattan General."

Riva started to say something, but Laurie held up her hand and moderated her voice. "As soon as I get the hospital charts, I'll be able to fill in the rest of my matrix that will include the preop drugs, the anesthetic agent, as well as the postoperative medication. We'll talk again and see what your response is. Personally, I don't think the extra information is going to make any difference. The occurrence of four cases of fatal ventricular fibrillation unresponsive to resuscitation in young, healthy people undergoing elective surgery in the same hospital using customary protocols within a couple of weeks is too much of a coincidence."

"It is a very busy hospital, Laurie!" Riva said, simply not wanting to argue.

Laurie breathed out forcibly. In her sensitized state, she interpreted Riva's tone as condescending and not all that different from Jack's. Laurie reached out and snatched her matrix from Riva's hand.

"It's just my opinion," Riva said, sensing Laurie's reaction.

"You're entitled to your opinion," Laurie said, swinging back around to face her desk.

"I don't mean to irritate you," Riva said to Laurie's back.

"It's not your problem," Laurie said without looking back. "I'm a bit thin-skinned these days." She turned around again and faced Riva. "But let me tell you this: What made those previous incidences involving serial killers in healthcare facilities go on for so long was a low index of suspicion."

"I think you are right," Riva said. She smiled, but Laurie did not return the peace gesture. Instead, she spun back around and picked up the phone. She might have found it aggravating to share her ideas with Jack and Riva, but the process of vocalizing them had put everything more in focus and had served to make her even more confident that she was correct. Her friends' objections had done nothing to shake her beliefs. She was now even more committed to her serial-killer scenario. As such, she realized that even if it were premature in the sense of having no definitive proof, it was incumbent on her to see that someone over at the Manhattan General was informed. Unfortunately, from bitter experience she knew that such a decision was not hers to make. It had to come from administration and go through public relations. Consequently, she dialed Calvin's extension and asked Connie Egan, Calvin's secretary, for a moment of Calvin's time.

"The deputy chief is due to leave for an Advisory Board luncheon in a few minutes," Connie said. "If you want to try to catch him, I'd advise you to come down immediately. Otherwise, you'll be looking at sometime after four, and even that is dependent on his getting back here, and there's no guarantee of that."

"I'll be right down," Laurie said. She hung up and got to her feet.

"Good luck," Riva said, overhearing the conversation.

"Thanks," Laurie responded without a lot of sincerity. She picked up her matrix.

"Don't be disappointed if Calvin is even more dubious than I," Riva called after her. "And he might bite your head off with such a suggestion of criminality. Remember, he has a soft spot for the Manhattan General, since he trained over there as a medical student and resident in its former life as a major university-affiliated teaching hospital."

"I'll keep that in mind," Laurie yelled back. She felt a little guilty about her behavior toward Riva. Being in such a bad mood was out of character for Laurie, but she couldn't help herself.

For fear of missing Calvin, she wasted no time. She took the front elevators and in less than five minutes, she was walking into the administration area. A number of people were seated on a long couch, waiting to see the chief, whose office door was closed and guarded by his secretary, Gloria Sanford. Laurie could remember a few times sitting there herself, waiting to be bawled out for doing something she was now avoiding by going to see Calvin. Laurie had been a good deal more headstrong, as well as apolitical, when she had first started at the OCME.

"You can go right in," Connie said as Laurie approached her desk. Calvin's door was ajar. He was on the phone with his legs perched on the corner of his desk. As Laurie came in, he motioned with his free hand for her to take one of the two chairs facing him. Laurie's eyes glanced around the familiar room. It was less than half the size of Bingham's and didn't connect with the conference room. Still, it was mammoth when compared to the space Laurie had to share with Riva. The walls were covered with the usual array of diplomas and awards and pictures with major city politicians.

Calvin concluded his conversation, which Laurie could tell dealt with the agenda of the up-and-coming Advisory Board luncheon. The Advisory Board had been set up by the mayor almost twenty years ago, to make the OCME less beholden to both the executive branch and law enforcement.

Calvin let his heavy legs plop down on the floor. He peered at Laurie through his newly acquired, rimless progressive lenses. Laurie felt herself tense. Thanks to a lingering, mild problem with male authority figures from an early age, Calvin had always intimidated Laurie, even more than the chief. It was a combination of his imposing physical presence; his unwavering cold, black eyes; his legendary stormy temperament; and his occasional chauvinism. At the same time, she knew him to be capable of warmth and gentlemanly behavior. What worried her at any given encounter was which side would be dominant.

"What can I do for you?" Calvin began. "Unfortunately, we have to make this short."

"It won't take but a moment," Laurie assured him. She handed over the matrix she had prepared. Then she quickly summarized the history of the four cases as they had unfolded, followed by her ideas concerning the possible mechanism, cause, and manner of death. It took only a few minutes, and when she was done, she fell silent.

Calvin was still studying the matrix. Finally, he looked up. His eyebrows were arched. Settling back into his seat, which complained with a squeak, he arched his index fingers with his elbows on the desk, and shook his head slowly. His expression was of confusion. "I guess my first question has to be why you are telling all this to me at this early stage? None of these cases has been signed out yet."

"Purely because I thought you might want to warn someone over at the Manhattan General what our thinking was, to raise the index of suspicion."

"Correction!" Calvin boomed. He took a fleeting glance at his watch, which wasn't lost on Laurie. "I would be warning them what your thinking was, not mine. Laurie, I'm surprised at you. You're using grossly inadequate data here to make a premature and ridiculous leap." He slapped the matrix with the back of his free hand. "You're suggesting that I communicate pure speculation, which could be extraordinarily detrimental to the Manhattan General Hospital if it got out into the wrong hands, something that happens all too frequently. It could even cause a panic. We deal in facts here at the OCME, not fanciful supposition. Hell, we could lose all credibility!"