Робин Кук - Genesis

“If half-siblings were found, the case would be solved as their father would be the person we are seeking. But I personally think the chances of that happening are statistically negligible. But let’s not get ahead of ourselves. Presently I’m hoping that GEDmatch will give us a number of new matches that we can use for triangulation.”

“I’ll be waiting for any news,” she said.

“I’m sure we’ll have information in the next few hours,” Vijay said. “Perhaps it would be best if you came by and we can show you what we have been able to do.”

“Why not?” Aria said. She was beginning to share Vijay’s optimism.

With Jack helping, Vinnie was able to get Madison Bryant’s cadaver back in the walk-in freezer, the table cleaned, specimens taken care of, and Jonathan Jefferson on the table. He also got all new specimen jars and clean instruments, while Jack quickly read the investigative report done by one of the evening shift’s MLIs, Steve Mariott. It was the story of a sixteen-year-old who’d been in Central Park playing baseball and hit in the chest by a pitch. CPR had been administered immediately by the coaches. When paramedics had arrived, ventricular fibrillation had been determined and defibrillation attempted without success. CPR was continued during the ambulance ride to the hospital, where defibrillation was attempted another eight times along with the administration of standard cardiac resuscitation drugs, all to no avail.

Taking a deep breath, Jack put the investigative report back in the autopsy folder. As a medical examiner he was accustomed to death to the point that for him it had become just another part of the cycle of life. But there were exceptions, and this case was one of them. Of course, it had a lot to do with the age of the victim. Jack always found dealing with children emotionally stressful, and the younger the child, the harder it was, like with the scalded infant two days ago. But this current victim, a mere teenager, likewise pulled hard on his heartstrings. It seemed so unreasonably cruel and senseless that such a child’s life could be so easily extinguished while in apparent good health, playing athletics. Thinking about the unfairness of it all made him feel embarrassed about his reaction earlier with Aria. In such a context it seemed so trivial that he cared about her use of vulgar language, lack of empathy, or refusal to lend a hand cleaning up after an autopsy. Certainly, it was his responsibility to act as the adult and control himself, especially since he had told Chet and Laurie he’d help out. After all, the only actual negative was that he hadn’t had the opportunity to go upstairs and find out about Laurie’s surgery.

“The X-ray is up on the view box,” Vinnie called out, interrupting Jack’s mild epiphany.

Jack walked over to it. As he imagined, the X-ray was completely normal, including the sternum, where he assumed the boy had been hit by the baseball. Sudden death, mostly involving completely healthy young boys playing sports, was not unheard of. It mostly involved baseball, although softball, hockey, karate, and lacrosse were adding to the toll of about ten kids a year in the US alone. It came from being struck in the chest at a very specific, short interval of time during the normal heartbeat to throw the entire cardiac conduction system out of whack, resulting in ventricular fibrillation.

As Jack was still struggling with his emotions, he became aware of a presence next to him, and when he turned to look, he was surprised that Aria had joined him in looking at the child’s X-ray. While he stared at her profile, she continued to study the film.

“What happened to the kid?” Aria asked. “I don’t see any broken bones.”

“My guess is that it is a case of commotio cordis,” Jack said. “He was hit with a baseball and went into ventricular fibrillation. Is commotio cordis something you are familiar with?”

“Only through reading,” Aria said. “And you?”

“Likewise,” Jack said. “Luckily, I’ve never personally had a case, but I know Dr. Montgomery had one her first year here. Emotionally she found it difficult to handle.” Jack felt a little silly calling his wife Dr. Montgomery, yet he thought it was appropriate under the circumstances.

“Will I find anything at autopsy?” she asked, finally breaking off looking at the X-ray to glance at Jack.

“Probably not,” Jack said. “But it is a diagnosis of exclusion. In that sense it will be like Madison Bryant.”

“Well, let’s get it over with,” Aria said. “I’ve got things to do. Am I still going to be the prosector?”

Jack continued to stare at Aria for a beat while she stared back with a slight smirk. Even though he’d promised himself he’d be the adult, she had already ruffled his feathers by suggesting she had more important things to do than the autopsy on a child who’d died before his life could really begin. It was she who broke off and walked back to the table with a spring to her step. There wasn’t the slightest hint she found the case emotionally upsetting.

Although Aria looked closely at the child’s chest and even palpated the boy’s breastbone, she could not find any evidence of the child’s being hit by a baseball. There was no bruising or abrasion whatsoever. Nor did she find anything on the rest of the external exam. Like with Madison Bryant, Aria was standing on the patient’s right side while Jack and Vinnie were on the opposite side.

“Scalpel,” she said, extending her hand toward Vinnie. Vinnie had the instrument tray next to him.

“What about examining the inside of the mouth just in case the boy choked on something?” Jack said, making an effort to make it sound like a suggestion and not a criticism.

Without responding verbally, Aria did search the mouth and palpate the throat. When she was finished, she then took the knife to start the case with the usual Y incision.

Like with Madison Bryant, Aria worked rapidly but skillfully. Jack helped when he could, especially when she was using the bone shears. When the heart was fully exposed yet still covered by the pericardium, Aria bent down to look closely.

“I don’t see any signs of trauma whatsoever,” she said as she straightened up.

“Nor do I,” Jack said, responding to the first words Aria had said since the case began. He had learned his lesson to stay quiet and not lecture.

“Okay,” she said more to herself than to Jack or Vinnie. Just as she’d done with Madison, she carefully opened the pericardium and then finally removed the heart entirely. Jack watched intently and was convinced that the heart was entirely normal, at least from the outside. Specifically, there were no signs of bruising. As Aria began opening the heart, Jack caught sight of Laurie coming into the autopsy room for her morning autopsy rounds. Jack was eager to talk with her but was hesitant to leave Aria with the most important part of the autopsy under way. Laurie started at table #8, which was closest to the door to the hallway.

“The interior of the heart is normal,” Aria announced to no one in particular. Jack had been watching over her shoulder. “That leaves coronary vascular abnormalities as the only other possibility.”

“I agree,” Jack said. “The coronary arteries have to be exposed.”

Aria put down the butcher knife she’d been using and picked up more delicate dissecting instruments and began tracing out the coronary system. Jack watched for ten minutes or so to make sure there wasn’t obvious pathology, which there wasn’t, and to make sure she was following the normal protocol. When he was sure things were copacetic, he elected to leave her under Vinnie’s capable supervision and have a few words with Laurie. A moment later he caught up with her as she was moving from table #4 to #3.