Cursing with a series of particularly offensive expletives he’d learned in the navy, Ronnie pounded his steering wheel several times in frustration. The outburst and the physical activity calmed him, and he was able to regain his composure and think more clearly. He was even able to see a bright side: The situation had awakened him to the reality that he needed to be more careful in the future, perhaps even to the point of cutting down on proving himself with saves, despite how much he enjoyed those episodes. The reason, of course, was that those deaths, if they occurred, were more difficult to pass off as expected, meaning they’d be added to the numerator, thereby raising the mortality ratio. It was also harder to declare them non-ME cases.
Ronnie felt himself smiling as he drove up the ramp leading to the top level of the Queensboro Bridge with its impressive view of lower Manhattan and the burgeoning development of the opposing side in Brooklyn. The situation as he saw it was not unlike the efforts that had to be undertaken to keep a viral outbreak like Covid-19 from becoming an epidemic or even pandemic. Cases had to be diagnosed quickly, isolated, and removed before the disease spread. He’d been able to take care of Sue Passero and Cherine Gardener with comparative ease, although Cherine had been a bit more difficult than expected. That left only Jack Stapleton. There was no question in Ronnie’s mind that the pesky ME had to be eliminated soon, before a possible contagion erupted.
The problem was that Stapleton was not a member of the MMH community, which limited Ronnie’s access to him. On the plus side, he knew that the man wanted to meet with him again and that he foolishly used his bike for traveling around New York City. Like many medical personnel, Ronnie was aware that there were almost twenty thousand bike and vehicle collisions each year with a score or more deaths. It almost seemed as if the man was asking to be eliminated by tempting fate.
Reaching out with his right hand, Ronnie patted the dash of his Cherokee, which he often did because he liked to treat the vehicle as a pet. As he did so he murmured, “You and I will take care of this pest for good tomorrow.”
Chapter 23
Wednesday, December 8, 7:08 a.m.
As Jack rode down 30th Street alongside the OCME, he saw something he didn’t expect. Once again, Lou Soldano’s black Chevy Malibu was parked between two ME Sprinter vans. Having seen him twice yesterday, he didn’t think he’d have the pleasure of seeing him again although Jack knew the supposed suicide of his detective’s wife was weighing on his mind.
After locking his bike in its usual location, he took the stairs heading up to the first floor. He’d arrived later than he had the day before, and in a completely different mindset. Lou’s advice about how he should handle the problematic issues on the home front had been spot-on.
Also affecting Jack’s mood was that he had a forensic case that engrossed him, and one that he was fully motivated to make significant progress resolving. Although it had only been twenty-four hours, he hoped both Maureen in Histology and John in Toxicology were going to come through. Of the two, John was the more questionable, which he fully recognized. At the same time, he was prepared to tell the man that he would be satisfied with a preliminary screen like he’d gotten from Naomi.
After passing the SIDS office, Jack entered the ID room, where Jennifer was again going through the night’s cases. As he expected from seeing the Chevy Malibu, Lou was there but fast asleep in one of the club chairs. Since Jack was arriving almost a half hour later than he had the day before, Vinnie was also already occupying the other club chair, hiding behind his newspaper. Most important, he’d already made the coffee in the common pot, and Jack immediately headed in its direction. He was eagerly anticipating a cup, as much for its warmth as for its stimulant effect. The bike ride that morning had been nippier than it had been the day before when it had been unseasonably springlike.
“I had in mind taking a paper day today,” he called out for Jennifer’s benefit as he poured the coffee. “Unless the lieutenant commander has other ideas.” A paper day in ME lingo meant a day spent completing previously autopsied cases by collating all the material, looking at the histology slides, and signing out death certificates. It was in lieu of doing any additional autopsies.
“Hallelujah!” Vinnie voiced with alacrity from behind his newspaper. Jack was forever making him start cases way before he’d had a chance to go over the sports pages and earlier than any other ME insisted on starting.
“Is that going to be a problem for you if I don’t take any cases?” Jack asked Jennifer while ignoring Vinnie. He added a bit of sugar and cream to his mug and began to stir.
“Not at all,” Jennifer said. “It looks like there’s only going to be dozen or so autopsies today. As far as I am concerned, you’re in the clear if you’d like.”
“I’d like,” he replied. “Any particularly interesting cases I’ll be missing?”
“No, except maybe the one Detective Soldano is here to observe.” She picked up one of the autopsy folders from the desk and held it aloft, thinking that Jack might want to see it. “I haven’t looked at it yet, but he did say before he fell asleep that he hoped you’d be the one doing it.”
Jack groaned. He was one hundred percent eager to get right back to work on Sue Passero’s case and had been since he’d woken up that morning. Overnight he’d given the whole complicated situation a lot of thought, and he’d come to one potentially meaningful conclusion. The fact that Ronnie Cavanaugh had described Sue as being cyanotic when he first found her in the garage and that the cyanosis had improved when he started his CPR made Jack mull carefully over the physiological details in extremis situations. With deadly heart attacks, it’s the heart that is struggling, but whatever blood the faltering organ is able to pump around the body is fully oxygenated because the lungs are functioning fine, at least initially, so the deceased’s coloration is generally rather normal or, if anything, pale. When cyanosis occurs and is evident, particularly in a woman of color where cyanosis is not as apparent as it is in a Caucasian person, it means the lungs are not doing their job oxygenating the blood. That’s what happens with an overdose, severe asthma, drowning, or even strangulation. Obviously, Sue did not have asthma and had not been strangled as there had been no bruising around the neck and, more important, the basic neck dissection he’d done had been normal. Of all the other possibilities, the most probable statistically was certainly an overdose despite how unlikely he’d originally thought it. What all this suggested to Jack was that he had to rethink the whole situation, particularly in regard to toxicology, which was surely going to provide the answer of the cause and manner of death. At this point, he was reasonably certain John was going to confirm the death was an overdose.
All these thoughts rocketed around inside his brain as he stared over at Jennifer, who was still holding up the folder. “What kind of case is it?” he asked hesitantly.
“I don’t really know,” Jennifer said. “It’s listed as a probable overdose by the MLI, which seems a little strange with Detective Soldano involved.”
Jack groaned again. Because of his friendship with Lou, he accepted that he didn’t have a lot of choice whether to do the case, especially if Lou asked him directly. But he wasn’t excited about it, and it wasn’t just because of his eagerness to get back to work on Sue’s case. There was also the issue that he’d done hundreds of overdose autopsies over the last several years, as there had been a virtual epidemic of them, meaning there was minimal forensic challenge. At the same time, if Lou was involved, there had to be a twist, and that idea intrigued Jack to a degree. Resigned and with coffee in hand, he walked over to the desk and took the folder from Jennifer.