“Death is coming for us all,” Jordan once said to Lucy during his performance review. “I just hope whoever gets my body treats it with respect. That’s what’d I’d want, so I guess that’s what I do.”
He got a raise.
Jordan had the broad shoulders and thick neck of a football player, though he had never played any organized sport.
“Living in Dorchester is sport enough,” Jordan once said.
Lucy sometimes let Jordan watch her perform autopsies. He found it endlessly fascinating.
“Who’s our new houseguest?” Lucy asked.
Jordan lifted back the bedsheet and squinted his big brown eyes to read the toe tag. “Tommy Grasso. He’d been on life support, but they just pulled the plug. Funeral home will receive him tomorrow, so he’s going to storage, no autopsy needed, at least according to the paperwork here.”
Lucy glanced at the documents Jordan handed her and gave a nod. “Okay, wheel him and seal him,” she said.
“What’s happening in here?” Jordan asked. “It’s not my business, I know, but I usually don’t see you in the lab these days, Dr. Abruzzo.”
It was true. Lucy’s Sunday shifts had lately been less about the lab and more about that catch-up paperwork.
“Oh, Dr. Stinson and I are talking about doing some tests that aren’t officially sanctioned.”
“Hospital stuff, huh?” Jordan said with a shrug. He had an innocent, boyish-looking face, though quite handsome, and kept his dark hair cut short. The patch of hair on his chin helped him look closer to his true age, twenty-six.
“Yeah, Jordan, hospital stuff.”
Jordan wheeled Tommy away, and Lucy’s attention returned to Mr. Anderson’s case.
“I feel bad that you’re going to take some heat on this,” Becca said, “but I really think it’s the right thing to do.”
“I’m fine with it. Honest.”
At that moment, Jordan returned to the lab, no longer wheeling Tommy Grasso, but holding a slip of paper in his hand. “Hey, I found this in the hallway. I think it dropped out of one of your file folders, or something.”
Jordan handed the paper to Lucy. It was a test result for Cliff Anderson. Odd, because the only lab work Becca had done was that temporal artery biopsy. At first Lucy thought it might be a result from one of the tests Becca wanted to run. Maybe she’d already ordered them, and was doing the “ask forgiveness before permission” thing. But this was a heavy metal test, specific for cobalt, and the result was quite puzzling.
“Becca, who ran this test?” Lucy handed the sheet to Becca.
Becca stammered, “I-I don’t know.”
“Something wrong?” Jordan asked. He sounded genuinely concerned.
“No, nothing you did. It’s just this paper-this test result you found.”
“What is it?” Jordan asked.
“Well, according to these findings, Cliff Anderson has a cobalt level of twenty-four micrograms per liter of blood. It’s not enough to kill him, but it could certainly make him very ill,” Lucy said.
“Loss of motor coordination, memory troubles, tissue death, headaches, anxiety,” Becca added, sounding excited. “Sound familiar?”
“Has he had a hip replacement?” Lucy asked.
“I’d have to look up his full medical record. Give me a second.”
Becca left and Lucy reviewed the lab result again. The line that would normally indicate the doctor who requested the test was blank, as was the field for the technician who ran it.
“Guess it’s a good thing I found that paper,” Jordan said.
“Yes, it could be a very good thing,” Lucy said.
Becca returned soon after, with a surprised look on her face.
Lucy’s eyes went wide with anticipation. “And?” she asked.
“And seven years ago, it appears Mr. Anderson got a hip replacement from Aberdeen Hip Replacement Systems.”
“You know it?” Lucy asked.
“No,” Becca said. “But does the company matter?”
“Some hip replacements have been known to cause cobalt poisoning,” Lucy said.
“Is there a part number or something?” Jordan asked.
Becca showed him the tablet.
Jordan used his smartphone to run a search query for the part number displayed on Anderson’s medical record.
“It says here that the product was discontinued, but never recalled.”
“Why was it discontinued?” Lucy asked.
Jordan squinted to focus. “Says overuse. Metal-on-metal construction was supposed to help with failure rates, but instead caused an increase in met… metall… metallosis, if that’s the right word.”
Lucy’s expression was one of stunned disbelief. “Well, well, well. Cliff Anderson doesn’t have Alzheimer’s, he has cobalt poisoning.”
“Guess we’re not going to have to battle with the insurance companies after all,” Becca said.
“Glad I found that piece of paper,” Jordan said, with the proud smile of someone who had just done something important.
“Yeah, but the question remains,” Lucy said. “Who knew enough about Cliff Anderson to request we run this test?”
“And who the heck ran it?” Becca added.
CHAPTER 10
The siren’s persistent wail rattled Julie’s nerves and made it impossible to concentrate. Ashley, more accustomed to the noise, appeared unfazed by the racket as she conducted a thorough secondary trauma survey on Sam.
Julie had ridden in the back of ambulances before, but only as part of her training. She did not remember them being so claustrophobic. She found the constant jostling unnerving.
To put an exclamation mark on that thought, the ambulance lurched forward. Julie, occupied with Sam’s heart rate and pulse oximeter readouts, tumbled to the floor.
“Are you all right?” Ashley asked.
Julie quickly got back to her feet. Her gaze went to the heart rate monitor, which showed a jump from 97 to 125 in less than a minute.
“What’s going on with that?” Ashley said, and began to reassess Sam anew.
Sam’s heart rate continued to tick upward: 125, 130, 145…
Julie had a gut feeling it had everything to do with those distended jugular veins. Through one of the windows between the hard plastic struts that made up the cervical collar, Julie could see those veins were even more grotesquely engorged than before. Blood filled them from Sam’s sternum to his jawline. It was a clear sign of impaired blood return to the heart.
His breath sounds were still solid, though, and the pulse oximeter read 96 percent, which was in line with the ten liters of oxygen flowing into Sam’s face mask.
Julie recalled all of the anatomy she knew about the heart. It was an ingenious circulatory system that regulated blood flow from areas of high pressure, with less space for the blood to flow, to areas of low pressure, which included the body’s veins. In a healthy person those jugular veins should be flat, with no noticeable bulge.
The bulge on Sam’s neck was a clear indication that the whole system was in disarray. If pressure built up in the heart’s right atrium, the first chamber to receive blood returning from the body, blood could begin to back up into the veins leading to it. That included those jugular veins, which drained the head and arms.
Julie centered her thoughts.
“His heart rate is still climbing,” Ashley announced. “One fifty-five. His pulse is thready. I’m really worried he’s going to arrest.” Her calm exterior seemed to be fraying.
“It’s those veins,” Julie said, softly, almost to herself. “Something is causing the pressure to increase in his circulatory system. It’s not building from inside the heart, but from outside of it.”
The ambulance shimmied and shook. Its siren screamed. All of it combined to make it difficult for Julie to focus on a differential diagnosis. She fought the distractions, churning through the limited possibilities. Topping the list was a tension pneumothorax, common in chest trauma. A collapsed lung, pushing against the heart, could squeeze the vessels and the heart itself toward the opposite side of the chest. If enough air pressure built, blood could not enter the heart and it would back up into Sam’s veins. But those breath sounds simply did not support the theory. What then?