"Don't despair yet," Latasha said. "The ten dollars is still in the balance. There's no narrowing, but I don't see any atheromatous deposits, either."
"You're right. It's perfectly clean," Jack agreed. He couldn't quite believe it. The entire vessel was grossly normal.
Jack turned his attention to the left coronary artery and its branches. But after a few minutes of dissection it was apparent the left was the same as the right. It was devoid of plaque and stricture. He was mystified and chagrined. After all he'd been through, it seemed a personal affront that there was no apparent coronary abnormality, either developmental or degenerative.
"The pathology has to be on the inside of the heart," Latasha said. "Maybe we'll see some vegetations on the mitral or aortic valve that could have thrown off a shower of thrombi that then cleared."
Jack nodded, but he was mulling over the probability of sudden cardiac death from a heart attack with no coronary artery disease. He thought it was extremely small, certainly less than ten percent, but obviously possible, as evidenced by the case in front of him. One thing about forensic pathology that he could always count on was seeing and learning something new.
Latasha handed Jack a long-bladed knife, waking him from a mini trance. "Come on! Let's see the interior."
Jack opened each of the heart's four chambers and made serial slices through the muscular walls. He and Latasha inspected the valves, the septa between the right and left sides of the heart, and the cut surfaces of the muscles. They worked silently, checking each structure individually and methodically. When they were finished, their eyes met across the table.
"The bright side is that neither of us is out ten dollars," Jack said, trying to salvage humor from the situation. "The dark side is that Patience Stanhope is keeping her secrets to herself. She was reputed to be less than cooperative in life, and she's staying in character in death."
"After hearing the history, I'm shocked that this heart appears so normal," Latasha said. "I've never seen this. I guess the answers are going to have to wait for the microscope. Maybe there was some kind of capillary disease process that involved only the smallest vessels of the coronary system."
"I've never heard of such a thing."
"Neither have I," Latasha admitted. "But she died of a heart attack that had to have been massive. We have to see pathology other than a small, asymptomatic colon cancer. Wait a second! What's that eponymous syndrome where the coronary arteries go into spasm?" She motioned to Jack as if she were playing charades, wanting him to come up with the name.
"I honestly have no idea. Now, don't spout some trivia that's going to make me feel inadequate."
"Prinzmetal! That's it." Latasha said triumphantly. "Prinzmetal angina."
"Never heard of it," Jack admitted. "Now you're reminding me of my brother-in-law, who's the victim in this disaster. He'd know it for sure. Can the spasm cause massive heart attacks? That's the question."
"It can't be Prinzmetal," Latasha said suddenly with a wave of dismissal. "Even in that syndrome, the spasm is associated with some stenoses of the vessel nearby, meaning there would be visible pathology, which we don't see."
"I'm relieved," Jack said.
"We have to figure this out one way or the other."
"That's my intention, but not seeing any cardiac pathology has me fooled and even embarrassed, considering all the fuss I've caused to do this autopsy."
"I have an idea," Latasha said. "Let's take all the samples back to my office. We can examine the heart under the stereo dissecting microscope and even do some frozen sections of the heart tis-sue to look at capillaries. The rest of the specimens will have to be processed normally."
"Maybe we should just go have some dinner," Jack said, suddenly wanting to wash his hands of the whole affair.
"I'll pick up some pizza on the way back to the office. Come on! We'll make it a party. There's one hell of a mystery here. Let's see if we can't solve it. We can even get a toxicology screen tonight. I happen to know the night supervisor at the lab at the university. He and I were an item a while back. Things didn't work out, but we're still acquaintances."
Jack's ears pricked up. "Run that by me again!" he said with disbelief. "We could get a toxicology screen done tonight?" Back in New York at the OCME, Jack was lucky to get one in a week.
"The answer is yes, but we'll have to wait until after eleven, when Allan Smitham begins his shift."
"Who's Allan Smitham?" Jack asked. The possibility of an immediate toxicology screen opened up another whole dimension of inquiry.
"We met in college. We took a lot of chem and bio classes together. Then I went to med school and he went to grad school. Now we work a few blocks apart."
"What about your beauty rest?"
"I'll worry about that tomorrow night. You have me hooked on this case. We have to save your brother-in-law from the evil lawyers."
20
Alexis answered on the fourth ring. Jack had called her number and put his phone on speaker before placing it on the rent-a-car's front passenger seat. He was on his way from the Langley-Peerson Funeral Home to the Newton Memorial Hospital. He'd decided to make a short visit before the three-to-eleven shift left for the day in hopes of catching Matt Gilbert and Georgina O'Keefe. It had been an impulsive decision when he and Latasha left the funeral home after finishing up with the autopsy. She had said she was going to stop at her apartment briefly to feed the dog, drop off the fluid samples at the toxicology lab with a message for Allan to call as soon as he got in, and pick up a couple of pizzas at an all-night joint before meeting him in the parking lot of the medical examiner's office. She had given Jack the opportunity to tag along, but the window of opportunity had made him decide to stop at the hospital instead.
"I was hoping it was you," Alexis said when she heard Jack's voice.
"Can you hear me okay?" Jack asked. "We're on my speaker phone."
"I can hear you fine. Where are you?"
"I'm always asking myself that same question," Jack joked. His mood had flip-flopped from its nadir brought on by finding nothing relevant in Patience's autopsy to a near high. He had been energized by Latasha's enthusiasm and the prospect of getting the assistance of a toxicologist, and his mind had been picking up speed like an old-fashioned steam locomotive. Now ideas were flapping around inside his head like a flock of excited sparrows.
"You are in a rare mood. What's going on?"
"I'm in my rent-a-car on the way to the Newton Memorial."
"Are you all right?"
"I'm fine. I'm just going to duck in and ask a couple of questions to the ER people who handled Patience Stanhope."
"Did you do the exhumation and the autopsy?"
"I did."
"What did you find?"
"Other than a nonrelevant, from our perspective, cancer of the colon, I found nothing."
"Nothing?" Alexis questioned. The disappointment in her voice was apparent.
"I know what you are thinking, because I thought the same. I was depressed. But now I think it was an unexpected gift."
"How so?"
"If I'd found generic, garden-variety coronary disease, which is what I actually expected to find rather than something dramatic, which is what I'd hope to find, I would have left it at that. She had heart disease and had a heart attack. End of story. But the fact that she had no heart disease begs for an explanation. I mean, there is a slight chance that she had some fatal cardiac event that we're not going to be able to diagnose eight months after the fact, but now I believe the possibility is in our favor that there was something else involved, especially considering the resistance Fasano expressed about my doing the autopsy, and Franco trying to run me off the goddamn road, and, more significantly, the threat expressed to your children. How are they, by the way?"