Робин Кук: Intervention

“I’m afraid so, sport,” Jack said. “Vacation is over. You and I are going to get back down to work. It’s my New Year’s resolution.”

“But it’s not New Year’s for another month,” Vinnie complained.

“Tough,” Jack responded. He reached out and pushed the chart of the twenty-seven-year-old woman in Vinnie’s direction. “Let’s start with Keara Abelard.”

“Not so fast, supersleuth,” Vinnie protested, using his old nickname for Jack. He made a production of inspecting his watch as if he were about to refuse Jack’s order. “I might be able to accommodate you in, say, ten minutes, after I make the house coffee.” He smiled. Feigning the opposite, he’d actually missed his special relationship with Jack based on their early starts.

“It’s a deal,” Jack said. After a quick high-five with Vinnie, he went back to the stack of charts.

“Since you stopped coming in early when your son was born, I thought it was a permanent schedule change,” Vinnie said as he loaded the pot with fresh coffee, whose aroma quickly permeated the room.

“It was just a temporary slowdown,” Jack said. Although most everyone at the OCME knew about his child’s birth, no one, as far as Jack knew, was aware of the infant’s illness. Jack and Laurie were both intensely private people.

“How do you know Dr. Besserman won’t want this Keara Abelard for himself?”

“Is that the ME who’s on this week and supposed to be here already?”

“None other,” Vinnie said.

“I don’t think he’ll be too upset,” Jack said, with his usual sarcasm. He knew full well that Besserman, one of the most senior MEs, would just as soon pass on all autopsies at this stage of his career. Nonetheless, Jack scribbled a quick note to Arnold, telling him he’d taken the Abelard case but would be happy to do another couple of cases if need be. He put the Post-it on top of the pile of records and scraped his chair back.

In less than twenty minutes Jack and Vinnie were down in the autopsy room, which had been renovated to a degree during the previous year. Gone were the old soapstone sinks. In their place were modern composite ones. Gone also were the giant glass-fronted cabinets with the collections of medieval-appearing autopsy tools. In their place were nondescript Formica ensembles with solid doors and significantly more space.

“Let’s do it!” Jack said. While he’d filled out the initial paperwork, not only had Vinnie gotten the body on the table and the X-rays on the view box, he’d also gotten all the supplies laid out, including the instruments he thought Jack was likely to want: specimen bottles, preservatives, labels, syringes, and evidence custody tags, in case Jack happened to detect an element of criminality.

“So, what are you looking for?” Vinnie asked, as Jack went through his exhaustive external examination. He ranged over the whole body but devoted particular attention to the head.

“Signs of trauma, for one thing,” Jack said. “That would be my number-one guess at this point. Of course, it could have been an aneurysm as well. She apparently became quickly disoriented and spastic, which led to coma and death.” Jack glanced into both external ear canals. He then used an ophthalmoscope to look at eye grounds. “Reputedly, she’d been out having cocktails with friends — nonalcoholic, according to history, and no drugs.”

“Could she have been poisoned?”

Jack straightened up and looked across the body at Vinnie. “That’s a strange suggestion at this point. What made you think of that?”

“There was a poisoning on a TV show last night.”

Jack laughed behind his mask. “That’s an interesting source for differential diagnosis. I’m guessing that’s not too likely, but we’ll still need to do a toxicology screen. We’ll also make sure she’s not pregnant.”

“Good point about the pregnancy idea. That was what happened in the show last night. The boyfriend wanted to get rid of the baby and the mom at the same time.” Jack didn’t respond. Instead, he began carrying out a painstaking examination of Keara’s scalp. Her thick, shoulder-length hair made progress slow.

“There’s no way this case could be infectious, could it?” Vinnie asked. He had never liked germs. In fact, he hated them. Whether involving bacteria, viruses, or “anything in between,” as he called some of the other infectious agents, he’d typically avoided contact as best he could, at least until Jack arrived. Since then, because of the number of infectious cases Jack had done, he’d become inured to his phobia. That morning he and Jack were wearing only Tyvek suits, regular medical masks, surgeon’s caps, and curved plastic face guards over their clothes. For a few years the front office had dictated full barrier protection on all cases with what were called “moon suits,” but that was no longer the situation, and now each medical examiner could wear whatever he or she wanted provided it was appropriate. Same held for the mortuary techs.

“There’s even less chance of it being infectious than it being poisoning,” Jack said.

Finishing with the head, Jack carefully examined the neck. When that was completed, he was reasonably certain there was no sign of trauma, as the external exam had been entirely normal. Jack had no more idea of what killed the young woman than he had when they’d started, and feeling less patient than usual, he was briefly and irrationally irritated at the patient for withholding her secrets.

After taking ocular fluid, urine, and blood for toxicology and checking out the X-rays on the chance they might provide a clue about the cause of death, Jack started the internal part of the autopsy. He used the typical Y-shaped incision from the points of the shoulders down to the pubis, then, with Vinnie’s help, removed the organs and examined each in turn.

“While you rinse out the intestine, I’m going to make sure there was no venous thrombosis in the deep leg veins,” Jack said, wanting to cover all the bases. Increasingly curious about the cause of death, he was now all business and trying to think out of the box. There was none of his signature black humor or teasing of Vinnie.

By the time Vinnie returned with the clean intestine, Jack was able to inform him that in addition to the other negatives there’d been no clotting problems with possible emboli to the brain. The cause of death of Keara Abelard was still a total mystery, whereas with most cases at that point there would have been a good idea.

After the abdominal and chest portions of the postmortem were completed, Jack returned his interest to the patient’s head. “This has got to be pay dirt!” he said, as he stepped back to give Vinnie room to use the bone saw to cut off the skullcap.

While Vinnie was busy sawing, several of the other day mortuary techs appeared and prepared to assist their assigned medical examiners. Jack didn’t even notice them. As Vinnie continued cutting with the noisy bone saw, Jack began to feel uncomfortable. With no theories as to the cause of death other than a burst aneurysm, which he doubted, he had the sense he was missing something, something important, perhaps even making a mistake.

The moment Vinnie put the calvarium aside and then freed up and lifted out the glistening, furrowed brain, Jack leaned forward and his heart skipped a beat. There was dark blood in the posterior fossa at the very back of the head, and enough such that it was spilling out onto the stainless-steel autopsy table.

“Damn!” Jack snapped with obvious regret while pounding his gloved hand on the corner of the table.

“What’s the matter?” Vinnie asked.

“I made a mistake!” Jack said angrily.

Taking a step down alongside the body, Jack peered into the depths of the chest cavity and up toward the head, lifting the anterior wall of the chest. “We’ve got to do an arteriogram X-ray of the vasculature to the brain,” Jack said out loud, more to himself than to Vinnie. He was clearly disappointed with himself.