Robin Cook - Marker

Why does something like this always have to happen on a weekend? Laurie silently lamented. She'd like to ask Laura Riley the significance but was reluctant to call her on a Saturday. Laurie took a fresh piece of toilet tissue and again blotted herself. The blood didn't reappear, which provided a bit of consolation, yet combining the fact that there had been any blood with the right lower quadrant discomfort she'd been having lately seemed inauspicious at best.

Out at the sink, while she was washing her hands, Laurie looked at herself in the mirror. The last few nights of restless sleep had taken their toll. Although hardly in Janice's league, her eyes had dark circles and looked tired, and her face was drawn. She had a bad feeling that she might be facing yet another upheaval and prayed that if it were to happen, she'd find the emotional reserve to deal with it.

It didn't take laurie as long as she'd feared to get back to the OCME, but once again, the ride in the taxi markedly aggravated her abdominal distress. Marvin had been waiting for her, and she immediately posted the police custody case, which turned out to be therapeutic. By the time she finished the autopsy, the pain had vanished and in its stead was a vague sensation of pressure. As she changed out of her scrubs, she pressed the area with her fingers. In contrast to what had happened that morning, palpating the area made it feel worse. As confused as ever, she went into the toilet stall to see if she was spotting, but she wasn't.

Laurie went up to her office and stared at her phone. Once again, she thought about calling Laura Riley but had the same reluctance. She didn't even know the woman, and she hated to start out the relationship by bothering her on a weekend with a problem that could probably wait until Monday. After all, Laurie had been having the symptoms for a number of days. The sudden appearance of the few drops of blood was the only aspect that was truly different, and that seemingly had stopped.

Annoyed with herself for her indecisiveness, Laurie switched to thinking about calling Calvin. She could update him on Roger and give him a heads-up on the police custody case. She'd found extensive trauma to the prisoner's larynx, with the implication that excessive force had been used. Such cases were invariably politically challenging and Calvin would need to be apprised. Yet there was no apparent pressure from the media, and the toxicology had yet to be done. Laurie decided it could all wait until Monday unless Calvin took it upon himself to call.

Instead of making any phone calls, Laurie decided to spend some serious time with the charts from Queens and then Roger's lists. She felt she owed it to him, since he had, in a way, sadly given his life for the cause.

The first thing that she noticed was that the St. Francis charts were significantly different from the General's. Whereas the Manhattan General was a tertiary teaching hospital, St. Francis was a mere community institution. There were no interns or residents writing notes, so the charts were much skimpier. Even the attending doctor's notes and the nurses' notes were shorter, which made them much easier to go through.

As she expected from having read the forensic investigators' reports on each of the cases, the demographics matched those of the General. The victims were all relatively youthful, and had died within twenty-four hours of elective surgery. They were also all healthy, compounding the tragedy.

Laurie then remembered Roger saying that he'd discovered that the General cases were all relatively recent subscribers to AmeriCare. Turning to the biographical data section of the chart she was currently examining, Laurie saw that it was the same. She quickly checked the other five Queens charts. All of the patients had been AmeriCare subscribers for less than a year. Two of them had been subscribers for only two months.

Laurie pondered this curious fact and wondered if it was significant. She didn't know, but she took out a ruled pad of paper and wrote: all victims recent AmeriCare subscribers. Beneath that, she wrote: all victims within twenty-four hours of anesthesia; all victims on IV's; all victims young to middle-aged; all victims healthy.

Laurie looked at her list and tried to think of any other ways the victims had been related. Nothing came to mind, so she put the pad aside and went back to the charts. Although she knew the General cases had occurred in various parts of the hospital with many on the surgical floor, she didn't know about the Queens cases. Quickly, she determined that it was similar, with cases spread around the hospital.

Since the Queens charts were considerably thinner, Laurie was more tempted to look at every page, and with one chart, she found herself even reading the admission orders, which were standardized on a printed form. They described prepping the operative site, proscribing anything by mouth after midnight, and various routine laboratory studies. As Laurie's eyes ran down the list, she stopped on a test she didn't recognize. It was grouped with blood tests, so she assumed it was a blood test. It was called MASNP. She'd never heard of a test called MASNP. She wondered if NP stood for nuclear protein, but if it did, what did MAS stand for? She didn't know, but if she was right about the meaning of NP, then the test might be some kind of immunological screen.

Switching to the back of the chart where all the laboratory test results were appended, Laurie searched for the result. She didn't find it. Although she found all the other test results, there was no MASNP result.

With her curiosity piqued, Laurie looked in the other Queens charts. Each one had an order for an MASNP, but no result. It was exactly the same with the charts from General: Each chart had the order, but no results.

Laurie reached for her ruled pad and wrote: All victims had an MASNP ordered but no MASNP result; what's an MASNP?

Thinking about laboratory tests reminded Laurie of the short run of EKG in Sobczyk's chart taken by the resuscitation team. She shuffled through the charts until she found the right one. It was easy, since it still had her ruler sticking out. Laurie opened the chart, unfolded the segment, and reread the Post-it note she'd written to herself to show the segment to a cardiologist. Putting Sobczyk's chart aside but open to the EKG, she then checked to make sure none of the other charts had any EKG associated with the resuscitation attempts. She hadn't remembered seeing any, but she wanted to be certain.

"I hope I'm not interrupting anything," a voice said.

Laurie turned around. Jack was standing in the doorway. Instead of his usual mildly sardonic expression, his face reflected concern.

"You look awfully busy," he added.

"It's best I stay busy," Laurie responded. She reached over for Riva's chair and pulled it over next to her desk. "I'm glad to see you. Come on in and sit down."

Jack lowered himself into the seat and scanned Laurie's desk. "What are you doing?"

"I wanted to make certain the Queens cases were the equivalent of those at the General. They are, to a surprising degree. I also found something curious. Are you acquainted with a blood test called MASNP? I assume it is an acronym, but I've never heard of it."

"Me neither," Jack said. "Where did you see it?"

"It's part of the standardized preoperative orders in all these cases," Laurie said. She picked up a chart at random and showed the order form to Jack. "It's in every chart. I guess it's part of AmeriCare's established routine, at least at these two hospitals."

"Interesting," Jack commented. He shook his head. "Did you look in the back to see what kind of units the results are recorded in? That might be a clue."

"I tried that, but I couldn't find any results."