Now, in the wake of Anna's call, I consider her urgent tone. It could be anything, even a professional problem. But I heard the strain of a personal lament. And what will I do if she has come to tell me that she cannot go on without reuniting? What if she feels as I have felt so long? The Dulcimer was the last of the places we met. Would she have chosen it if passion was not her purpose? I hover then, above myself, my soul looking down on my hungry heart. How can longing unfulfilled seem to be the only meaningful emotion in life? But it does. And I realize I will not say no to her, just as I could not say no when she turned her face to me on the sofa in my chambers. If she is willing to leap, I will follow her. I will leave behind what I've had. I stare at the pictures arrayed on my desk, of Nat at various ages, of Barbara, always beautiful. It's pointless to try to fathom the full consequences of what I'm about to do. They are so many and so varied that not even a Russian chess master or a computer would be able to play out every step. But I will do this. I will try to have at last the life I want. I will, finally, be brave.
CHAPTER 12
Tommy, October 27, 2008
Pathologists, toxicologists, the whole bunch weren't really wired like everybody else. But what would you expect when it was the dead who rocked their world? Tommy always figured part of the thrill for these guys was realizing the stiff was gone and they were still here. It was an idea, anyway.
The toxicologist who had come in with Brand looked okay. Nenny Strack. She was a little brown-eyed redhead, mid-thirties, attractive enough to be wearing a short skirt. She was over at the U Med School and worked for the county on a contract basis. Brand had gone directly to the police pathologist to get the work done quickly, and he in turn had leaned on American Medical Service, the Ohio outfit that was the reference laboratory for half of U.S. law enforcement. Tommy had feared these maneuvers would send up flares when the blood draws from Barbara's autopsy came back out of the coroner's refrigerator, but nobody noticed.
"So?" Molto asked the two of them.
"Long story or short?" Brand asked.
"Short to start," said Tommy, and Brand opened his hand to Strack. She had a file folder in her lap.
"The sampling of cardiac blood shows a toxic level of an antidepressant compound called phenelzine," she said.
Brand was looking down at his lap, maybe to keep from smiling. It was nothing to smile about, really.
"She didn't die of natural causes?" Tommy asked. He heard the shrill note in his own voice.
"Not to be difficult," said Dr. Strack, "but it's not my job to render an opinion on the cause of death. I can tell you that the symptoms reported-death by arrhythmia, with a possible hypertensive reaction-are classically associated with an overdose of that drug."
Dr. Strack took a minute to describe phenelzine, which was used to treat atypical depression, often in conjunction with other compounds. It worked by inhibiting production of an enzyme called MAO that broke down various mood-altering neurotransmitters. The effect on the brain often improved emotional states, but limiting the enzyme could have fatal side effects in other parts of the body, especially when foods or drugs containing a substance called tyramine were ingested.
"There's a whole list of things you shouldn't eat when you're being treated with phenelzine," Strack said. "Red wines. Aged cheeses. Beer. Yogurt. Pickled meat or fish. Any kind of dry sausage. They all increase the drug's toxicity."
"Where would she have gotten this stuff?"
"It was in her medicine cabinet. If it wasn't, American Medical would never have identified it." Dr. Strack explained how the mass spectrograph on the blood sample worked. Initially, it produced a virtual forest of color bars. All the spectrographic patterns for the one hundred or so drugs surveyed as part of a routine tox screen were then eliminated, because they had already been covered. The small number of remaining colors could represent thousands of ions. So the lab referred to the inventory of Barbara's medicine cabinet, matching against those knowns. Phenelzine was identified almost at once.
"So this could have been an accidental overdose?" asked Molto.
"Well, if you just look at the blood levels, you'd have to say probably not. The concentration is about four times a normal dose. Assuming that's a true result, then you'd ask if she could have forgotten and taken a pill twice. I suppose. Four times? That would be unusual. Patients who take this stuff are usually warned up and down about how dangerous this drug can be."
"So it wasn't accidental?"
"I'd say no, offhand, but there's a phenomenon called 'postmortem redistribution' that causes certain antidepressants to migrate to the heart after death, giving you inflated concentrations in cardiac blood. That's particularly true of tricyclics. Whether MAO inhibitors act the same way hasn't been defined in the literature. I don't know if phenelzine migrates, and neither does anybody else, not for sure. If we'd realized what we were looking for at the time of the autopsy, we could have done a blood draw from the femoral artery, because there's no postmortem redistribution that far from the heart, but a femoral draw's not standard practice in this county, and obviously, we can't do that now. So no toxicologist will be able to say for sure that the high concentration of phenelzine in her blood means she actually ingested a lethal dose of the drug, as opposed to it being a redistributive effect after her death."
Brand would never say I told you so, but Tommy realized that if he had let Jim treat this as a murder investigation from the jump, they might have those answers. Lost in himself for a second, Molto felt a sigh escape. Sometimes when Tomaso roused them in the middle of the night and Tommy rocked his son back to sleep, he would try to figure out which of a day's decisions was going to come back to bite him. He always went back to bed thinking, You can only do your best. Making mistakes was part of being in charge. You could only hope they turned out to be small.
He looked back at Dr. Strack. "So this redistribution thing means maybe she didn't get an overdose? Maybe she just took a pill and cheated a little and had a pepperoni pizza?"
"That could have happened."
"And what about suicide? Is this one of those drugs that has a tendency to make depressives even more suicidal?"
"That's what the literature says."
"No note," said Brand, trying to discount the possibility Barbara killed herself. "Cops didn't find a note."
Tommy raised a hand. He didn't want a debate right now.
"So maybe it's suicide. Maybe it's murder. Maybe it's an accident. That's all you can say?" Molto asked her.
"Assuming phenelzine caused the death. You'll need the pathologist to say that definitively."
This Dr. Strack looked okay, but by now Tommy had a feel for her. She'd gotten bumped around on cross-examination often enough that she'd rather not go to court at all. He thought science was about investigating the unknown, but experts like Strack seemed to prefer that the unknown remain that way. He really didn't get it.
In the wooden-armed chair next to Strack, Brand was easy to read. His chin was lowered and he was making a face like he was biting back on heartburn. Tommy could see that Dr. Strack had spun Jim, gone soft when she sat down to talk to the PA himself.
Jim wouldn't have trotted her in here unless she'd been a lot more positive with him in his office. In the unlikely event this case went to trial, they'd have to insert a steel bar in her spine or find another expert.
"What about time?" Brand asked. "If you let a day pass after the death, what impact would that have on identifying the phenelzine overdose in the autopsy?"