First, she had gone up to histology to see Maureen, who'd been happy to present her with a tray of McGillan's HE-stained microscopic sections in less than twenty-four hours. With the burden of processing eight thousand autopsies a year, overnight histology-slide service was unheard-of. Laurie had thanked her profusely for her efforts and had immediately taken the slides back to her office to study them painstakingly. As she had suspected, she found no pathology in general, and specifically, she found the heart entirely normal. There were no signs of active or healed inflammation of the cardiac muscle or the coronary vessels, and she saw no abnormalities of the valves or conduction system.
Next, she had gone down to the fourth-floor toxicology lab, where she'd run into a minor setback by bumping into John DeVries. Thanks to the bad blood between them and John's territoriality, he'd demanded to know what she was doing wandering around in his laboratory. Not wishing to get Peter in trouble with his boss, Laurie had to be creative. She happened to have been standing next to the mass spectrometer, so she said she had never completely understood mass spectrometry and was hoping to learn something about it. Mollified to a degree, John had provided her with some printed literature before excusing himself to go down to the serology lab.
Laurie had found Peter in his windowless, Lilliputian office, and his eyes lit up when he saw her. Although Laurie didn't remember Peter from their life prior to the OCME, Peter remembered her when they both had attended Wesleyan University in the early eighties. He had been two years behind her.
"I ran a toxicology screen on McGillan," Peter had said. "I didn't find anything, but I have to warn you that sometimes compounds can hide out in the peaks and valleys on the readout, particularly when the concentration is very low. It would be a big help if you gave me more of a hint of what you are looking for."
"Fair enough," Laurie had said. "Since the autopsies on these patients suggested they suffered a very rapid demise, their hearts had to suddenly stop pumping blood. I mean, one minute everything was fine, and the next minute there was no circulation. That means we have to eliminate cardiac toxins like cocaine and digitalis, and any other drugs that can cause changes in the heart rate, either by affecting the center that initiates the beat or the conduction system that spreads the impulse around the heart. On top of that, we even have to rule out all the drugs that are used to treat abnormal cardiac rhythms."
"Wow! That's a rather big list," Peter had commented. "The cocaine and the digitalis I would have seen, because I know where to look on the readout, and they'd have to be big doses to do what you are talking about. The others, I don't know, but I'll look into it."
At that point, Laurie had asked about Solomon Moskowitz and Antonio Nogueira, whose autopsies had been done several weeks earlier. She told Peter that the cases mirrored McGillan's. Using his keypad in front of his monitor and his password, Peter accessed the laboratory database. Both toxicology screens had been normal, but he offered to run them again now that he had a ballpark idea of what she was looking for.
"One other thing," Laurie had said when she was about to leave. "I did another case this morning whose samples should be on the way up. Again, it was strikingly similar to the others, which tells me there's something weird going on over at the Manhattan General. Since I can't find any pathology, I'm afraid the major burden is going to be on your shoulders to find out what it is."
Peter had said he'd do his best.
After her visit to toxicology, Laurie had gone up to George's office to get a look at Antonio Nogueira's folder. George had surprised her by having copies of the salient portions waiting for her. Kevin had not been so accommodating, but he didn't mind if Laurie made copies. Taking the material back to her office, Laurie had gone over it in detail, filling in her matrix as she went along.
Taking the sheet containing the matrix and twisting around in her chair, Laurie waited for Riva to hang up on a call she was on with a local doctor about her hit-and-run case that morning.
"Check this out!" Laurie said, extending the graph paper to her officemate as she hung up the receiver.
Riva took the sheet and studied it, then looked over at Laurie. "You're being very industrious. This is a great way to organize this information."
"I'm fascinated by this puzzle," Laurie admitted. "I'm also intent on figuring it out."
"I suppose this is why you were pleased when you found no pathology on Morgan, meaning you had yet another case."
"Precisely!"
"So what is your thinking at this point?" Riva asked. "With all this effort, you must have a better idea."
"I think I do. It's become pretty clear to me that the mechanism of death was ventricular fibrillation for all four. The cause is another matter, as is the manner."
"I'm listening."
"Are you sure you want to hear? I mentioned my ideas to Jack, and he was irritatingly dismissive."
"Try me!"
"All right! In a nutshell, since I've decided that the mechanism of death was ventricular fibrillation or cardiac standstill, and since the hearts have been structurally normal, the cause of death has to be some arrhythmia-producing drug."
"That seems pretty reasonable," Riva said. "Now what about the manner of death?"
"This is the most interesting part," Laurie said. She leaned forward and lowered her voice as if she were afraid someone might hear. "I'm thinking the manner of death is homicide! In other words, I think I have stumbled onto the handiwork of a clever serial killer in the Manhattan General."
Riva started to say something, but Laurie held up her hand and moderated her voice. "As soon as I get the hospital charts, I'll be able to fill in the rest of my matrix that will include the preop drugs, the anesthetic agent, as well as the postoperative medication. We'll talk again and see what your response is. Personally, I don't think the extra information is going to make any difference. The occurrence of four cases of fatal ventricular fibrillation unresponsive to resuscitation in young, healthy people undergoing elective surgery in the same hospital using customary protocols within a couple of weeks is too much of a coincidence."
"It is a very busy hospital, Laurie!" Riva said, simply not wanting to argue.
Laurie breathed out forcibly. In her sensitized state, she interpreted Riva's tone as condescending and not all that different from Jack's. Laurie reached out and snatched her matrix from Riva's hand.
"It's just my opinion," Riva said, sensing Laurie's reaction.
"You're entitled to your opinion," Laurie said, swinging back around to face her desk.
"I don't mean to irritate you," Riva said to Laurie's back.
"It's not your problem," Laurie said without looking back. "I'm a bit thin-skinned these days." She turned around again and faced Riva. "But let me tell you this: What made those previous incidences involving serial killers in healthcare facilities go on for so long was a low index of suspicion."
"I think you are right," Riva said. She smiled, but Laurie did not return the peace gesture. Instead, she spun back around and picked up the phone. She might have found it aggravating to share her ideas with Jack and Riva, but the process of vocalizing them had put everything more in focus and had served to make her even more confident that she was correct. Her friends' objections had done nothing to shake her beliefs. She was now even more committed to her serial-killer scenario. As such, she realized that even if it were premature in the sense of having no definitive proof, it was incumbent on her to see that someone over at the Manhattan General was informed. Unfortunately, from bitter experience she knew that such a decision was not hers to make. It had to come from administration and go through public relations. Consequently, she dialed Calvin's extension and asked Connie Egan, Calvin's secretary, for a moment of Calvin's time.