“Sorry to bother you,” Jason said, sitting down. Once again he marveled how small and feminine Margaret seemed in light of her job.
“No bother,” she said. “I did the post on Dr. Hayes this morning.” She leaned back in her chair, which squeaked softly. “I was a little surprised. It wasn’t cancer.”
“What was it?”
“Aneurysm. Aortic aneurysm that broke into the tracheobronchial tree. The man never had syphilis, did he?”
Jason shook his head. “Not that I know of. I’d kinda doubt it.”
“Well, it looked strange,” Margaret said. “Do you mind that I continue eating? I have another autopsy in a few minutes.”
“Not at all,” Jason said, wondering how she could. His own stomach did a little flip-flop. The whole building had a slightly fishy odor. “What looked strange?”
Margaret chewed, then swallowed. “The aorta looked kind of cheesy, friable. So did the trachea, for that matter. I’d never seen anything quite like it, except in this one guy I’d posted who was one hundred and fourteen. Can you believe it? It was written up in The Globe. He was forty-four when the First World War started. Amazing.”
“When will you have a microscopic report?”
Margaret made a gesture of embarrassment. “Two weeks,” she said. “We’re not funded for adequate support personnel. Slides take quite a while.”
“If you could give me some samples, I could have our path department process them.”
“We have to process them ourselves. I’m sure you understand.”
“I don’t mean for you not to do it,” Jason said. “I just meant we could too. It would save some time.”
“I don’t see why not.” Standing up, Margaret took another large bite out of her hamburger and motioned for Jason to follow her. They used the stairwell and went up a floor to the autopsy room.
It was a long rectangular room with four stainless steel tables oriented perpendicular to the long axis. The smell of formaldehyde and other unspeakable fluids was overpowering. Two tables were occupied, and the two others were in the process of being cleaned. Margaret, perfectly at home in the environment, was still chewing her last bite of lunch as she led Jason over to the sink. After scanning through a profusion of plastic-capped specimen bottles, she separated a number from the rest. Then, taking each in turn, she fished out the contents, placed them on a cutting board, and sliced off a piece of each with a blade that looked very much like a standard kitchen carving knife. Then she got new specimen bottles, labeled them, poured in formaldehyde, and dropped in the respective samples. When she was done, she packed them in a brown paper bag and handed it to Jason. It had all been done with remarkable efficiency.
Back at GHP, Jason headed to pathology, where he found Dr. Jackson Madsen at his microscope. Dr. Madsen was a tall, gaunt man who at sixty was still proudly running marathons. As soon as he saw Jason, he commiserated with him about Jason’s experience with Hayes.
“Not many secrets around here,” Jason said a little sourly.
“Of course not,” Jackson said. “Socially, the medical center is like a small town. It thrives on gossip.” Eyeing the brown paper bag, he added, “You have something for me?”
“In a manner of speaking.” Jason went on to explain what the specimens were, and added that since it was going to take two weeks for the slides to be processed at the city lab, he wondered if Jackson would mind running them at the GHP lab.
“I’d be happy to,” Jackson said, taking the bag. “By the way, are you interested in hearing the results of the Harring case now?”
Jason swallowed. “Of course.”
“Cardiac rupture. First case I’ve seen in years. Split open the left ventricle. It appeared as if most of the heart had been involved in the infarct, and when I sectioned the heart, I had the impression that all of the coronary vessels were involved. That man had the worst coronary heart disease I’ve seen in years.”
So much for our wonderful predictive tests, Jason thought. He felt defensive enough to explain to Jackson that he’d gone back and reviewed Harring’s record and still couldn’t find any evidence of the impending problem on an EKG taken less than a month before Harring’s death.
“Maybe you’d better check your machines,” Jackson said. “I’m telling you, this man’s heart was in bad shape. The microscopic sections should be ready tomorrow if you’re interested.”
Leaving the pathology department, Jason considered Jackson’s comment. The idea of a defective EKG machine hadn’t occurred to him. But by the time he got to his office, he discarded the notion. There would be too many ways to tell if the EKG machine wasn’t functioning properly. Besides, two different machines were used for the resting EKG and the stress EKG. But in thinking about it, he remembered something. Like Jason himself, on joining the GHP staff, Hayes would have been given a complete physical. Everyone was.
After Claudia had given Jason his phone messages, he asked her to see if Dr. Alvin Hayes had a patient chart, and if he did, to get it. Meanwhile, he avoided Sally and headed up to radiology. With the help of one of the department secretaries, he located Alvin Hayes’s folder. As he’d expected, it contained a routine chest X ray taken six months previously. He looked at it briefly. Then, armed with the film, he sought out one of the four staff radiologists. Milton Perlman, MD, was emerging from the fluoroscopy room when Jason buttonholed him, described Hayes’s death and the results of the autopsy, and handed Milton the chest film. Milton took the film back to his office, placed it on the viewing box, and flipped on the light. He scanned the film for a full minute before turning to Jason.
“There ain’t no aneurysm here,” he said. He was from West Virginia and liked to talk as if he’d left the farm the day before. “Aorta looks normal, no calcification.”
“Is that possible?” Jason asked.
“Must be.” Milton checked the name and unit number on the film. “I guess there’s always a chance we could have mixed up the names, but I doubt it. If the man died of an aneurysm, then he developed it in the last month.”
“I never heard of that happening.”
“What can I say?” Milton extended his hands, palms up.
Jason returned to his office, mulling over the problem. An aneurysm could balloon quickly, especially if the victim had a combination of vessel disease and high blood pressure, but when he checked Hayes’s physical exam, his blood pressure and heart sounds were, as he suspected, normal. With no signs of vascular disease, Jason realized that there was little he could do at that point besides wait for the microscopic sections. Maybe Hayes had contracted some strange infectious disease that had attacked his blood vessels, including his aorta. For the first time, Jason wondered if they were seeing the beginnings of a new and terrible disease.
Changing his suit jacket for a white coat, Jason left his office, practically bumping into Sally.
“You’re behind schedule!” she scolded.
“So what else is new?” Jason said, heading for exam room A.
By a combination of hard work and luck, Jason caught up to his schedule. The luck involved not having any new patients that needed extensive workups or old patients with new problems. By three there was even a break. Someone had canceled.
The whole afternoon, Jason could not get the Hayes affair out of his mind. And with a little extra time on his hands, he headed up to the sixth floor. That was where Dr. Alvin Hayes’s lab was located. Jason thought perhaps Hayes’s assistant would have some idea if the big breakthrough Hayes had mentioned had any basis in fact.