Robin Cook - Foreign Body

“I’m not telling you bastards shit,” Jennifer said. “If you know what’s good for you, you’ll let me go now.”

Cal looked at Durell. “I think she’s just going to have to think about her situation before she’s going to be cooperative. And I need to get some ice on my shoulder.”

“I think you’re right,” Durell said, regaining his feet. “And I’m getting an egg on my head, so ice would be mighty helpful.”

“We’ll be back,” Cal said to Jennifer. With his right hand trying to immobilize his left shoulder, he, too, got to his feet. He winced.

Jennifer didn’t speak as they limped to the door. Nor did she try anything with Durell still clutching the chair leg.

After Cal locked the upstairs outside door, Durell questioned if being nice to her was the right tactic.

“You’re right,” Cal said. Going inside the garage’s first bay, he opened the circuit-breaker box. It took a bit of a search to find the circuits for the basement, but once he found them, he unscrewed the fuses.

“A little darkness should help,” Cal said.

Later, as the two wounded men were crossing the lawn to the bungalow, Cal spoke up: “I told you she was a tigress.”

“You did!” Durell agreed. “She took me totally by surprise. I thought she’d be shitting in her pants. By the way, what the hell is the Stockholm syndrome?”

“No idea whatsoever,” Cal said. “What do you think the chances are that she’s going to talk to us? I’m not as confident as I was initially.”

“If I had to guess, I suppose I’d have to say I’m not confident at all.”

“We might have to talk Veena into coming to the rescue again,” Cal said. “She’s already spoken with her.”

“That’s an idea. She could be the good cop while you and I are the bad cops, you know what I’m saying?”

“I know exactly what you are saying,” Cal responded. “And I think it’s a terrific idea.”

October 19, 2007

Friday, 11:35 a.m.

New Delhi, India

“These are better facilities than we have in New York City,” Laurie said, letting her eyes roam around the autopsy room at the private Gangamurthy Medical College. “Our autopsy room is over half a century old. It looks like a movie set for an old horror film by comparison.”

Laurie, Jack, Neil, Arun, and Dr. Singh were standing in the postmortem room of the pathology department of the medical school. Everything was new and the very latest. Its hospital, the Gangamurthy Medical Center, was a big player in the medical tourism industry, particularly with cardiac problems and particularly for patients from Dubai and other cities in the Middle East. An extremely grateful Mr. Gangamurthy from Dubai was the major donor, to the tune of one hundred million dollars.

“Unfortunately, I have a lecture in just a few minutes, and I am going to have to leave you people,” Dr. Vijay Singh said. He was a lightly complected man of sizable girth. He was wearing a Western jacket and tie, but a voluminous wattle obscured his necktie’s knot. “But I believe we have arranged for everything you might need. My digital camera is on the counter. We even have frozen sections available, as we provide them for the hospital. Jeet, my assistant, will be available if you need anything specific. Arun knows how to contact him, and he’ll come right in.”

Arun pressed his hands together, bowed, and said, “Namasté.”

“I will be off, then,” Vijay said. “Enjoy yourselves.”

“I’m feeling a little guilty,” Jack said, the moment Vijay departed. “Don’t you think we should have told him we stole this body and have no official permission to autopsy it?”

“No, because it would have made his decision more difficult,” Arun said. “This way he has no responsibility. He can claim he didn’t know, which is true. The more important thing is just to get it done without delay.”

“Okay, let’s do it,” Laurie said. She and Jack had donned appropriate suits and gloves. Arun and Neil had just put on gowns. Knowing Maria’s history, no one chose to wear isolation hoods.

“You or I?” Jack said, as he gestured toward Maria’s naked corpse laid out on the only autopsy table.

“I’ll do it,” Laurie said. She took the scalpel and began making the traditional Y-shaped autopsy incision.

“Alright. Let’s go over this again,” Arun said. “I’m really interested. You said you were considering poisoning.”

“We are,” Jack admitted. “Because of time constraints we are approaching this case differently than usual. We are starting with a hypothesis and trying to prove if it is right or wrong. Normally, when we do an autopsy we try to keep an open mind so as not to miss anything. Here we are going to see if there is anything specifically confirming poisoning while we confirm or rule out the provisional diagnosis of a heart attack.”

“We even have an idea about the specific agent,” Laurie said, straightening up from having made the initial incision. She then exchanged the scalpel for the hefty bone clippers.

“Really!” both Arun and Neil voiced simultaneously.

“We do,” Jack agreed, as Laurie clipped through the ribs. “First of all, we suspect a healthcare person to be the perpetrator. Having the deaths occur at more than one hospital, we expect it to be a doctor. Since we suspect a doctor, we have to think about drugs since doctors have access to drugs and all three patients had keep-open IVs running. Considering the history of cyanosis, particularly cyanosis that rapidly cleared on the third case during resuscitation, we have to think of curare-like substances used in anesthesia for muscle paralysis.”

Laurie finished with the bone clippers and removed the sternum with Jack’s help.

“Let’s go right for the heart,” Laurie said. “If there’s evidence of a major heart attack, we might have to completely revise our thoughts.”

“I agree,” Jack said.

“There’s quite a number of drugs that cause respiratory paralysis,” Neil said. “Do you favor some over others?”

Laurie and Jack worked rapidly, each anticipating the other’s movements. Jack reached for a pan on a side table, and the en bloc dissection of the heart and lungs sloshed into it.

“We do have one drug that we are going to test for specifically,” Jack said to Neil, while he watched Laurie free up the heart. “Again, thanks to the resuscitation effort on the third case, where they encountered hyperpyrexia and surprisingly elevated potassium, we’re going to concentrate our efforts on succinylcholine, which is known to cause both on occasion. At this moment, unless we find something very unexpected, that is the most promising agent.”

“My gosh,” Arun said. “This is fascinating.”

“There’s no heart disease here at all,” Laurie remarked. She’d made a series of slices into the cardiac muscle and along the tracks of the major coronary vessels. “Specifically, there’s no obstructive disease.”

The other three looked over her shoulder. “There is a sprinkling of hemorrhages on the pericardium,” Jack said. “That’s not pathognomonic of succinylcholine poisoning, but it’s consistent.”

“There are some on the pleural surfaces of the lungs as well,” Laurie said.

“Arun, could you take some photos of this with Vijay’s camera?” Jack asked.

“I certainly can.”

After the photos were taken, Laurie prepared to take the samples for toxicology. Using separate syringes, she wanted urine, blood, bile, and cerebrospinal fluid.

“There are two other reasons we’re thinking succinylcholine,” Jack said. “Succinylcholine makes the most sense from a purely diabolical point of view. If the perpetrator is a doctor, as we suspect, he or she would want to use the agent least capable of being detected, and succinylcholine certainly fits the bill. First of all, succinylcholine was probably used during the patients’ anesthesia, so even if succinylcholine happened to be found by the likes of us, its presence could be explained. And second, the body deals with succinylcholine very rapidly, which is why in an overdose situation, all you have to do is breathe for the patient for a short time and there’s a happy ending.”