Robin Cook - Marker

Laurie let her voice trail off. Her mouth was bone-dry. She would have loved a drink of water, but she stayed where she was. The implication of her monologue was immediately clear to the group, and for a few seconds, silence reigned in the conference room. Then a hand shot up, and Laurie called on the individual.

"What about electrolytes: sodium, potassium, and particularly calcium?"

"The lab reported all electrolytes from all the usual sample sources to be entirely normal," Laurie responded. She then called on another person who raised his hand.

"Are the patients related in any way other than all being young, healthy, and having just had surgery?"

"Not that is apparent. I've made it a point to search for commonalities, but I haven't found any other than what I have mentioned. The cases involve mostly different doctors, different procedures, different anesthetic agents, and, for the most part, different medications, even for postoperative pain."

"Where have they occurred?"

"All six have been at the same hospital: the Manhattan General."

"Which has an extremely low death rate," Calvin snapped. He'd had enough. He stood up, approached the podium, and used his bulk to nudge Laurie aside. He bent the microphone up, and a harsh squeal emanated from the speakers as if in protest. "Calling these disparate cases at this stage 'a series' is misleading and prejudicial because, as Dr. Montgomery has admitted, they are not related. I've told Dr. Montgomery this before, and I'm telling her again. I'm also telling this august assemblage that this is an in-house discussion that doesn't leave this room. OCME is not going to tarnish the reputation of one of the city's premier tertiary-care centers with unsubstantiated innuendo."

"Six is rather a lot for a coincidence," Jack said. He had revived when Laurie got up to speak. Although he was not asleep, he was slouched back in his seat with his legs draped over the seat in front of him.

"Would you kindly show some respect, Dr. Stapleton," Calvin growled.

Jack put his feet down on the floor and sat up. "Four was borderline, but six is too many when they are all at the same hospital. Still, I'm going to vote for accidental. Something in the hospital is affecting these patients' conduction systems."

Dick Katzenburg raised his hand. Calvin motioned with his head for him to speak.

"My colleague at the Queens office just reminded me that we saw some similar cases," Dick said. "It's our recollection that the demographics were quite similar: all relatively young and supposedly healthy. The last case was at least a few months ago, and we haven't had one since."

"How many overall?" Laurie asked.

Dick leaned toward Bob Novak, his deputy, and listened for a moment, then straightened up. "We think it was also six. But it was spread over a period of several months with a number of examiners. Just when we began to be a bit curious about them, they stopped, and as a consequence, they have sort of dropped off our radar. It's my recollection that all were eventually signed out as natural, even though no significant pathology was found. I know for certain that toxicology was negative on all of them, because that would have certainly been brought to my attention."

"Were they postoperative?" Laurie asked. She was taken aback, excited, and pleased. It would be déjà vu if her series were to double from having brought up the issue at a Thursday conference. And if it did double, the profile of these cases would surely be even more of a mental diversion than it had been to date.

"I believe so," Dick said. "Sorry that I can't be more definitive."

"I understand," Laurie said. "Where did these deaths occur?"

"At Saint Francis Hospital."

"Ah, the plot thickens," Jack commented. "Isn't St. Francis another AmeriCare hospital?"

"Dr. Stapleton!" Calvin snapped. "Kindly maintain a modicum of decorum! Allow yourself to be recognized if you wish to contribute to the conversation."

"It is an AmeriCare institution," Dick said, turning toward Jack and ignoring Calvin.

"How soon can I get their names and accession numbers?" Laurie asked.

"I'll e-mail them to you as soon as I get back to the Queens office," Dick said. "Or we can just call my secretary. I think she could find the list."

"I'd like them as soon as possible," Laurie said. "I'd like to get their hospital charts, and the sooner I get the accession numbers to one of our investigators, the better."

"Fine by me," Dick said agreeably.

"Any other business?" Calvin asked. He scanned the group, then concluded the meeting. "See you all next Thursday."

As most of the medical examiners stood up, stretched, and recommenced their conversations that the meeting had cut short, Dick made his way over to Laurie. He had his cell phone pressed up against his ear and was describing the location of a folder in his desk. He motioned for Laurie to wait.

Glancing over at Jack, Laurie saw him immediately duck out of the conference room. She had hoped to talk with him, even if only briefly, and thank him for being ultimately supportive during her mini-presentation.

"Do you have something to write on?" Dick asked.

Laurie produced a pen and the back of an envelope. While Laurie kept her finger on the envelope to keep it steady on the writing surface of one of the chairs, Dick wrote down the names and the accession numbers. He thanked his secretary and rang off. "Well, there you have them," he said. "Let me know if I can be of assistance in any other way. I have to say, it does seem curious."

"I imagine I'll be able to access what I need from the data bank, but if I can't, I'll be in touch. Thanks, Dick! This is the second time you have helped me out. Do you remember those cocaine cases twelve years ago?"

"Now that you mention it, of course I remember, although it seems like it was in a different lifetime. At any rate, I'm glad to be of service."

"Dr. Montgomery!" Calvin called. "Can I speak to you for a moment?" Although his comment was presented as a request, it was more of a command.

Laurie gave Dick a parting wave and then stepped warily over to Calvin. "If these cases of Dick's turn out to resemble yours demographically, I want you to let me know. In the meantime, the proscription of talking about your supposed series with anyone outside of the OCME still holds. Am I clear on that? You and I have had disagreements about information leaks to the media in the past, and I don't want it to happen again."

"I understand," Laurie said nervously. "Don't worry! I learned my lesson, and I certainly would not go to the media. At the same time, I must admit I have been speaking with the chief of the medical staff over at the Manhattan General right from the beginning about the cases. He happens to be a friend."

"What's his name?"

"Dr. Roger Rousseau."

"Since he's on the staff, I suppose it's safe to assume he is aware of the sensitive nature of the issue."

"Most definitely."

"I suppose it's equally safe to assume he's not apt to go to the media."

"Hardly," Laurie said. She was feeling more confident. Calvin was definitely in a mild-mannered mood. "Yet Dr. Rousseau is rightfully concerned, and I believe he would want to hear if Dick's cases are indeed similar. It would give him the opportunity to talk with his counterpart at Saint Francis and make him feel he's not the only one with such a problem."

"Well, I don't see any harm in talking with him, provided you are clear the OCME officially does not currently agree with your assessment of the manner of death, and at the moment will back the Queens office's disposition."

"Certainly, and thank you," Laurie said. It was good to clear the air. She'd carried a twinge of guilt from having talked to Roger about the deaths when she'd first met him, despite Calvin's wishes.