"Oh, God!" Laurie voiced with a shudder. Despite thirteen years as a medical examiner, she still had trouble doing children, especially infants and abuse cases.
"I was in a muddle when I read the investigative report," Riva admitted. "There was no question the child had to be posted, but there wasn't anyone I disliked enough to assign it to."
Laurie tried to laugh because she knew Riva was joking, but she only managed a smile. Riva liked everyone and vice versa. Laurie also knew that Riva would have taken the case herself, had Jack not volunteered.
"Before Jack went downstairs, he mentioned another case," Riva said as she searched through the files before holding one up. "He said he'd had his usual informal tete-a-tete with Janice on his way in, and that she had told him there'd been a case of another young adult at the Manhattan General strikingly similar to McGillan's. He said that you would probably want it, and that I should assign it to you. Are you interested?"
"Absolutely," Laurie said. Her brows knitted as she took the folder. She opened it and rifled through the pages to find the investigative report. The patient's name was Darlene Morgan, age thirty-six.
"She was the mother of an eight-year-old," Riva said. "What a tragedy for the child."
"My word," Laurie voiced as she skimmed the report. "It does sound similar-strikingly similar." She looked up. "Do you know if Janice is still here?"
"I haven't the faintest idea. She was when I passed the PA's office, but that was before six-thirty."
"I think I'll check," Laurie said. "Thanks for the case."
"My pleasure," Riva said, but she was talking to Laurie's back, because Laurie was already on her way.
Laurie moved quickly. Technically, Janice was off at seven, but she frequently stayed later. She was compulsive about her reports and often could be there as late as eight. It was seven-forty as Laurie passed through the clerical room. A minute later, she leaned into the investigator's doorway. Bart Arnold looked up from his desk. He was on the phone.
"Is Janice still here?" Laurie asked.
Bart hooked his thumb over his shoulder to point into the depths of the room. Janice's head popped out from around a monitor. She was sitting at the desk in the far corner.
Laurie walked in and grabbed a chair. She pulled it over to Janice's desk and sat down. She waited until Janice finished a strenuous yawn.
"Sorry," Janice said when she had recovered. She used a knuckle to wipe under her eyes; they were watering.
"You're entitled," Laurie said. "Was it a busy night?"
"Volume-wise it was the usual. Nothing like the night before, although there were a couple of heartbreakers. I don't know what's getting into me. I didn't used to be so sensitive. I hope it's not affecting my objectivity."
"I heard about the infant."
"Can you imagine? How can people be like that? It's beyond me. Maybe I'm getting too soft for this job."
"It's when you stop being affected by such cases that you have to worry."
"I suppose," Janice with an exhausted sigh. She straightened herself up in her chair as if pulling herself together. "Anyway, what can I do for you?"
"I've just scanned your report on Darlene Morgan. The case strikes me as being disturbingly similar to that of Sean McGillan."
"That's exactly what I told Dr. Stapleton when I ran into him this morning."
"Is there anything you can tell me that's not in here?" Laurie said, waving the report in the air. "Like any impressions you might have gotten while talking to the people involved, like the nurses or the doctors or even the family members. You know, a step beyond the facts. Something that you sensed intuitively."
Janice kept her brown eyes glued to Laurie's while she thought. After a minute, she shook her head slightly. "Not really. I know what you mean, kind of a subliminal impression. But nothing came to mind. It was just another hospital tragedy. An apparently healthy, young-to-middle-aged woman whose time was up." Janice shrugged. "When someone like that suddenly dies, it certainly makes you realize we are all living on the edge."
Laurie bit her lip while she struggled to think of what else she should ask. "You didn't talk to the surgeon, did you?"
"No, I didn't."
"Was it the same surgeon who operated on McGillan?"
"No, there were two different orthopedic guys involved, and my impression from the resident was that both are held in high regard."
"It seems that both patients died at about the same time in the morning. Did that seem strange to you?"
"Not really. In my experience, that two-to-four-A.M. time frame is quite popular for deaths to occur. It's my busiest time during my shift. A doctor one time suggested to me it had something to do with circadian hormone levels."
Laurie nodded. What Janice was saying was probably true.
"Dr. Stapleton told me that you did the post on Sean McGillan. Is the reason you are asking these questions because you didn't find much pathology?"
"I found none," Laurie admitted. "What about anesthesia? Any similarities there, like the same personnel or same agents?"
"I have to confess I didn't look into that. Should I have?"
Laurie shrugged. "Both were about eighteen hours postsurgery, so they would still have remnants of the anesthesia on board. I think we're going to have to look into everything, including all the medication they got and in what order and dosage. I asked Bart to get the McGillan chart. I'm going to need the Morgan chart also."
"I can put in the request before I go," Janice said.
Laurie stood up. "I appreciate it. I hope you don't think my coming in here is a negative reflection on your investigative report, because it is quite the contrary. Your reports are always first-rate."
Janice flushed. "Well, thank you. I try. I know how important it can be to have all the information, especially in mysterious cases like these four."
"Four?" Laurie questioned with surprise. "What do you mean 'four'?"
"As I recall, the week before last there were two others, both from the Manhattan General, that were similar from my end."
"How similar? Were they patients who were in their first day postoperative, like McGillan and Morgan?"
"That's my recollection. What I do remember for certain is that they were young and generally in good health, so that it was a big-time unpleasant surprise to everyone that they had cardiac arrests. I also remember both were found by the nurse's aide while doing routine postoperative temperatures and heart rates, which is how Darlene Morgan was found, suggesting they had to have suffered some kind of major medical catastrophe. I mean, there was no warning. At least with Sean McGillan, he'd had a chance to ring his call button. Also, just like with McGillan and Morgan, the resuscitation team had zero luck. I mean, they got nothing but a flat line."
"This could be very important," Laurie said, pleased that she had come to seek out Janice.
"Anyway," Janice said, "I was planning on pulling copies of the investigative reports, but I haven't had time yet."
"Were they orthopedic cases?"
"I don't remember exactly what kind of surgery they had, but it will be easy to find out. If I had to guess, I'd say they were both general surgery cases, not orthopedic. Would you like me to pull the investigative reports?"
"Don't bother. I'm certainly going to want to have the whole folders. Do you remember which doctor posted them?"
"I don't think I ever knew. I don't have much contact with the doctors, besides you and Dr. Stapleton."
"Do you remember what was the final, official cause of death?" Laurie asked.
"Sorry," Janice admitted. "I don't even know if they have been signed out yet. Sometimes I follow up on cases that interest me, but not on the two we're talking about. I have to admit that at the time, they seemed like a couple of pretty routine, unexpected major cardiac problems. I guess saying something is routine and unexpected is an oxymoron, so maybe routine is not the right word. I mean, people die in the hospital, as tragic as that may be, and a lot of times it's not from the problem that brought them into the hospital in the first place. It wasn't until this morning when I was writing up the Morgan case and thinking about the nurse's aide angle that I even remembered them."