“Good idea,” Jack said. “Meanwhile on my end, I’ll try my darndest to get Toxicology to give us some answers ASAP to confirm or disprove a drug overdose.”
“You do that,” Lou said. “And thanks for letting me observe you guys. It’s been a pleasure as always.” He started to walk away but hesitated and then returned. He looked directly at Jack and pointed a finger. “And remember! One day! You are a superb medical examiner, but you are a piss-poor detective. So be careful!”
“Aye, aye, sir,” Jack said while giving a partial salute.
“I wish I could count on that,” Lou mumbled loud enough for both Jack and Vinnie to hear. Then he left.
“What did he mean by ‘one day’?” Vinnie questioned, watching Lou pass down behind all the autopsy tables, most of which were now occupied. “And what does he mean you are a poor detective?”
“Beats me,” Jack said.
Chapter 26
Wednesday, December 8, 9:17 a.m.
Juggling an armload of specimen bottles just as he had the day before, Jack got off the elevator on the sixth floor and managed to walk into John DeVries’s empty office in Toxicology without dropping any. Carefully he unloaded them, separated the toxicology specimens from those destined for Histology, and then arranged the toxicology bottles like toy soldiers in single file, front and center on John’s desk. Just as he was finishing, John walked in.
“Ah, more care packages!” John declared humorously. He was dressed in a laboratory coat, which he took off and hung up on an antique coatrack. “What do we have here?”
“Probably nothing particularly interesting. It’s a female nurse with a preliminary diagnosis of overdose. A bag of powder was found at the scene, which tested positive for fentanyl.”
“But you bringing the samples up here yourself tells me you suspect otherwise,” John said. He twisted the bottles around to line up the labels, telling him the source of each.
“You’re getting too sharp in your old age,” Jack quipped.
“I wish that were the case,” John said. “Okay, enough flattery. What’s the story here?”
“Detective Soldano was thinking the patient was a victim of homicide, considering aspects of the scene and some testimony. He felt so strongly that he even came in this morning to observe the post. As he explained to me, he’s taking the uptick in homicides personally and was convinced this was another one disguised as an overdose. Unfortunately for him, the post didn’t back him up.”
“I remember Detective Soldano,” John said. “You brought him up here one day and introduced us.”
“I did because he’s a big fan of forensics and particularly toxicology,” Jack explained. “Anyway, the autopsy, as I said, has seemed to confirm it was indeed an overdose with mild pulmonary edema being the only pathology. But because of his interest and because of the demographics of the case, he and I would like to know right away if it indeed was an overdose.”
“Why is it that so many of your cases are toxicological emergencies?” John questioned with a laugh. “All the other MEs seem to be content with the usual week to two-week delay in getting final results.”
Jack laughed in response. “I suppose that is a good question. I guess it’s because I take my job speaking for the dead seriously.”
“I can certainly vouch for that,” John said. “But it is a little late to help them since they are already dead.”
“It’s to prevent more deaths,” Jack explained. “That’s really what we MEs and you toxicologists ultimately hope to do.”
“Well said,” John remarked. “What’s this bottle labeled ‘skin lesion’?”
“Good thing you pointed that out,” Jack said. “I meant to explain it. It is a sample of a skin lesion, which is probably a small nevus, but since this case reminded me of yesterday’s, it occurred to me it might be an injection site. I’ll know once Histology makes some slides. If it is an injection site, it’s going to be key to know what had been injected.”
“Fair enough,” John said. “So, you’ll let me know what Histology tells you?”
“I will,” Jack said. “Now, what can you tell me about results from yesterday’s case?”
“It’s only been twenty-four hours,” John said, rolling his eyes. “Everything is still pending except the general screen, which was negative.”
“No!” Jack blurted. After all the thinking he’d been doing about cyanosis and the physiology of extremis, he’d been progressively sure Sue had taken a lethal drug, which he assumed had been fentanyl as it had become so common in causing overdoses because of its potency.
“You are surprised?” John questioned. “Why? You told me yesterday you thought the chances of the case being an overdose were zero. Obviously, you were correct, so why the surprise now?”
“Because I had rethought everything since I spoke to you, especially that the deceased had been cyanotic and had such characteristic pulmonary edema. The main reason I’d been against the idea was having known the woman personally and, I thought, relatively well, but when it comes down to it, who knows anybody well? Damn!” Jack added with growing emotion. “Now I have to go back and rethink everything all over again. Jesus H. Christ!”
“Sorry to be the bearer of bad news,” John said.
“Don’t be silly, it’s not your fault,” Jack said, while his mind churned with a kaleidoscope of thoughts relating cyanosis, pulmonary edema, and the associated physiology. Suddenly, these thoughts dovetailed in the curious associative fashion that only the human mind can do. As a result, the name Carl Wingate popped unbidden into his consciousness, and Jack knew why... the man was not a fan of Sue or Cherine, was an odd duck in his estimation, but, more important, he was an anesthesiologist, and anesthesiologists used a drug called succinylcholine on a daily basis. Succinylcholine, or SUX as the medical profession frequently called it, paralyzed people almost instantly with just a tiny amount, and unless the anesthesiologists or anesthetists breathed for the patient, the patient would become cyanotic and die.
“All right, thanks for stopping by,” John said agreeably as he started to pick up the specimen bottles. “I’ll have the techs run a general drug screen on this new case. If I crack the whip again, I should have at least a preliminary reading by this time tomorrow.”
“Wait a second!” Jack said. “I’ve just had another thought. What’s the status of detecting succinylcholine? Has that improved of late?” Like any ME, Jack knew that detecting the powerful drug was inordinately difficult because the body very quickly degraded it into compounds that were indigenous to the human body. He also knew that Histology might have something to contribute even if changes weren’t pathognomonic or specific for succinylcholine poisoning.
John paused picking up the sample containers and smiled. “Sounds like you have been reading some recent detective stories. Yes and no, as far as success in detecting it goes. There have been some successes in several recent legal cases by looking for specific metabolites with high-performance liquid chromatography — mass spectrometry, but it isn’t easy and often fails and can be challenged in court. Do you have reason to suspect it in either of these cases?”
“Maybe both,” Jack said, warming to the idea, as Sue certainly had had an injection and even Cherine might have had one combined with both having some degree of cyanosis as well as mild pulmonary edema.
“We can certainly try,” John said. “But that will take real time, probably at least a week, provided I can afford to put someone on it right away.”