Jack's ophthalmology career had ended abruptly in 1990, when his practice had been gobbled up by the aggressively expanding managed-care giant AmeriCare. AmeriCare's offer to hire Jack as an employee was another slap in the face. The experience forced Jack to recognize that old-school, fee-for-service medicine based on close doctor-patient relationships, where decisions were based solely on patients' needs, was rapidly disappearing. That epiphany led to his decision to retrain as a forensic pathologist, hopefully freeing himself from managed care, which he felt was more of a euphemism for "denial of care." The final irony was that AmeriCare had resurfaced to haunt Jack despite his efforts to distance himself. Thanks to a low bid for its premiums, AmeriCare had recently won a competitive contract for city employees. Jack and his colleagues now had to look to AmeriCare for their own healthcare needs.
Wishing to avoid the throng of media, Jack set off on the back route to the ID office, where the morgue's workday began. On a rotating basis, one of the more senior medical examiners arrived early to review the cases that had come in during the night, decide which ones needed to be autopsied, and make the assignments. It was Jack's habit to get to work early as well, even if it wasn't his turn to be the scheduler, so he could snoop through the cases and get the most challenging ones assigned to him. Jack had always wondered why other docs didn't do the same thing until he realized that the majority of the others were more interested in avoidance. Jack's curiosity invariably caused him to end up with the largest caseload. But he didn't mind; work was Jack's opiate for taming his demons. While he and Laurie had been practically living together, he'd gotten her to come in early with him, which had been no mean feat, considering how hard it was for her to get up in the morning. The thought made Jack smile. It also made him wonder if she had already arrived.
Jack suddenly stopped in his tracks. Until now, he had deliberately kept the morning's confrontation from his mind. Thoughts of his relationship with Laurie as well as memories of horrific events of his own past flooded into his consciousness. Irritably, he wondered why she had felt compelled to end a beautiful weekend on such a downer note, especially since things had been going so well between them. In general, he almost felt content, a remarkable state of mind, considering he didn't feel he deserved to be alive, much less happy.
A wave of anger spread through him. The last thing he needed was to be reminded of his smoldering grief and guilt about his late wife and daughters, which happened with any talk of marriage or children. The idea of commitment and the vulnerability it entailed, especially starting another family, was terrifying.
"Get a grip," Jack murmured to himself under his breath. He closed his eyes and roughly massaged his face with both hands. Behind his irritation and frustration with Laurie, he felt the stirrings of melancholy, an unwelcome reminder of his past struggles with depression. The problem was, he truly cared for her. Things were great, except for the gnawing issue of children.
"Dr. Stapleton, are you all right?" a woman's voice asked.
Jack peeked out through his fingers. Janice Jaeger, the petite night-shift forensic investigator, was staring up at him while pulling on her coat, on her way home and apparently exhausted. Her legendary dark circles made Jack wonder if she ever slept.
"I'm fine," Jack said. He took his hands away from his face and shrugged self-consciously. "Why do you ask?"
"I don't think I've ever seen you standing still, especially in the middle of the corridor."
Jack tried to think of a witty retort, but nothing came to mind. Instead, he changed the subject by lamely asking if she had had an interesting night.
"It was wild around here!" Janice said. "More so for the tour doctor and even Dr. Fontworth than me. Dr. Bingham and Dr. Washington are already here doing a post, with Fontworth assisting."
"No kidding!" Jack said. "What kind of case?" Harold Bingham was the chief, and Calvin Washington was the deputy chief. Generally, neither appeared until well after eight in the morning, and it was rare for them to do an autopsy before the normal day began. There had to be political ramifications, which explained the media presence. Fontworth was one of Jack's colleagues, and had been on call for the weekend. Medical examiners didn't come in at night unless there was a problem. Pathology residents were hired as "tour doctors" to cover routine calls requiring a physician.
"It's a gunshot wound, but it's a police case, which is why Font-worth had to take it. As I understand it, the police had surrounded a suspect in his girlfriend's care. When they tried to arrest him, a barrage of shots was fired. There's the question of unreasonable force. You might find it interesting."
Jack inwardly winced. GSW cases could be tricky with multiple shots. Although Dr. George Fontworth was Jack's senior by eight years at the Office of the Chief Medical Examiner, or OCME, he was, in Jack's opinion, perfunctory. "I think I'll stay clear with the chief involved," Jack said. "What'd you handle? Anything of note?"
"The usual, but there was one at the Manhattan General that stood out. A young man who'd just been operated on yesterday morning for a compound fracture after a fall while in-line skating on Saturday in Central Park."
Jack winced anew. With his sensitivities aroused, thanks to Laurie, he had a negative response at the mere mention of the Manhattan General Hospital. Once an acclaimed academic center, it was now an AmeriCare flagship hospital after having been targeted and taken over by the cash-rich managed-care giant. Although he knew that the overall level of medicine practiced at the institution was good, such that if he took a bad flop on his bike and ended up in their trauma unit, which is where they would probably take him with the new city contract, he'd be well taken care of. At the same time it was still a managed-care establishment run by AmeriCare, and he had a visceral hatred for the company. "What made the case stand out?" Jack asked, trying to conceal the emotion he felt. Reverting to sarcasm, he added: "Was it a diagnostic conundrum, or was there some sort of scurrilous hanky-panky involved?"
"Neither!" Janice sighed. "It was just the way the case struck me. It was just… rather sad."
"Sad?" Jack questioned. He was taken aback. Janice had been working as a forensic investigator for more than twenty years and had seen death in all its inglorious permutations. "For you to say it's sad, it's got to be really sad. What's the scoop in a nutshell?"
"He was only in his late twenties and had no medical history- specifically, no heart trouble. The narrative I got was that he'd rung his call button, but by the time the nurses got around to him five to ten minutes later-that's according to the nurses-he was dead. So it must have been cardiac."
"There was no resuscitation attempt?"
"Oh, they definitely tried to resuscitate him, but with no success whatsoever. They never even got a blip on the EKG."
"What made it so sad? The man's age?"
"The age was one factor, but it wasn't the whole story. Actually, I don't know why it bothered me so much. Maybe it has something to do with the nurses not responding quickly enough and my thinking the poor guy knew he was in trouble but couldn't get help. We can all relate to that kind of a hospital nightmare. Or maybe it has something to do with the patient's parents, who are very sympathetic. They came in from Westchester to go to the hospital, then came over here to stay near the body. They're really broken up. I get the impression their son was their whole life. I think they're still here."