“Let’s give it a whirl,” Jack said. He remembered when he had been talking with Lou earlier in the locker room, the thought had passed that if both Sue’s and Cherine’s manner of death were homicides, which they certainly would be if succinylcholine was involved, it probably would have been caused by the same person, raising the specter of a medical serial killer. Succinylcholine certainly wasn’t something available at the local pharmacy.
“Okay,” John said. “We’ll get on it, but don’t be pestering me. Let me call you, okay?”
“Fine,” Jack said agreeably. With his mind in overdrive, he was eager to plan what he was going to do during the single day that he had promised Lou. First off, he needed whatever slides were ready, and then he was going to set up a meeting with Ronnie Cavanaugh. There was no doubt in his mind that he was making significant progress on what was becoming one of his more interesting cases out of an inordinately large repertoire.
After quickly but sincerely thanking John for his help and saying goodbye, Jack took the remaining specimen bottles and made his way to Histology.
“Ah, my favorite ME,” Maureen said with a big smile as Jack came into her office. Her cheeks were noticeably redder from the cooler weather.
“Ah, you say that to all the MEs,” he said, pretending to be dismissive.
“You are wrong!” Maureen said with a laugh. “You’re the only ME who visits us, which I love. It makes us feel appreciated. And now it appears you are bearing gifts.”
“More work, I’m afraid,” Jack said. Just as he had the previous day, he lined up the specimen bottles on Maureen’s desk. There were quite a few more than he’d dropped off in Toxicology, which was the reason he usually made his visits in reverse order, but he’d wanted to give John as much of a head start as possible.
“I’ve got slides from yesterday’s case right here for you,” Maureen said. She turned around in her swivel desk chair to take a slide tray off the countertop behind her. As soon as Jack was finished unloading the specimen bottles, he took the tray from her.
“I appreciate getting this so soon,” Jack said.
“I hope Dr. Montgomery isn’t too devastated by her friend’s death,” Maureen said, becoming serious.
“She’s okay,” he confided. “Luckily she’s got a lot on her plate to keep her mind occupied.”
“I’ve made it a point to keep that little bit of information private.”
“I’m sure the chief appreciates it,” Jack said.
“What’s the story on these new specimens? Any specific staining requests?” Maureen glanced at the labels.
“No,” he said. “But I would appreciate getting slides on this particular specimen ASAP.” Jack found and lifted the specimen bottle containing the slice through the potential nevus or injection site, handing it to Maureen. “Whatever is found histologically will influence what John does up in Toxicology.”
“Okay,” Maureen said agreeably. “I’ll put someone on it right away.” She placed the bottle apart from the others.
“Okay, thanks, Maureen,” Jack said. He raised the slide tray she had given him. “And thanks for this. The chief thanks you, too.”
Exiting the Histology Department, he made his way down to his office using the stairwell to avoid having to wait for an elevator. He put the slide tray that Maureen had just given him next to his microscope before hanging up his jacket on the hook behind his door. Plopping himself down in his desk chair, he pulled out his phone and clicked on Bart Arnold’s name, whom he had called the day before at 6:03 p.m. As the call went through, Jack put his mobile on speaker and placed it on his desk. Then he stripped off the rubber band from around the Sue Passero slide tray and lifted its cover. The numerous slides were arranged in two vertical columns with their origins carefully labeled. He lifted out several from the heart. He’d look at the lungs second and then the rest.
“Bart Arnold here,” Bart said.
As Jack introduced himself, he turned on his microscope light and fitted one of the slides onto the mechanical stage with the stage clip. “Have you had a chance to look into the monthly death rate that we’ve gotten from the Manhattan Memorial Hospital over the previous two years?” Jack was now running the objective down with the coarse adjustment wheel to practically touch the slide.
“Yes, Janice Jaeger was able to spend some time on it last night in the wee hours of the morning because things were slow.”
“Great,” Jack said. He truly appreciated Janice Jaeger’s thoroughness. “What did she find?” He put his eyes to the microscope’s oculars and peered in while backing up with the fine control. Out of the visible blur, sudden pink images emerged of cardiac cellular structure.
“The number of cases referred to the OCME was pretty uniform during the first year,” Bart said. “Then it started to change. At first it was a relatively slow change but then picked up speed.”
“Ouch! I was afraid of that,” Jack said. He sat back, questioning how such a fact could jibe with the hospital’s reported decrease in the mortality ratio. Obviously, it couldn’t, and although indirect, more deaths lent weight to Sue’s concern about a possible medical serial killer. “Exactly how much has it gone up?”
“Gone up?” Bart questioned. “It hasn’t gone up. It’s gone down, and it’s gone down considerably.”
Stunned almost as much as he’d been up in John’s office learning Sue’s drug screen had been negative, Jack tried to adjust to this information that was the opposite of what he’d expected. Although deaths being referred to the OCME from the MMH going down didn’t necessarily eliminate the chances a medical serial killer existed, it certainly and significantly reduced them, especially when it confirmed the mortality ratio, which had also gone down, meaning the two statistics did indeed jibe.
“Are you still there?” Bart questioned when Jack failed to respond.
“Yeah, I’m here,” he said. He felt oddly depressed, as if everyone was working against him. First Cherine died, then John threw him a curveball, and now Bart. It was as if facts and circumstance were mocking him. Of course, he knew such thoughts were ridiculous, but he couldn’t help but feel them at least for the time being.
“Is there anything else you’d like us to do?” Bart asked. “Would any breakdown of the various causes of death help you?”
“No, but thank you,” Jack said. “I’ll be back to you if I think of anything.”
“We’re here when you need us,” Bart said, and then he hung up.
Jack leaned farther back, causing his desk chair to creak, and stared up at the blank ceiling, thinking it was symbolic of his current state of mind. He’d started the day in a fit of excitement, feeling as if he were on the edge of solving the whole mystery, and now he seemed no better off than he’d been the day before when he’d finished Sue’s rather unremarkable autopsy.
Tipping forward again, he eyed his microscope and the open tray of histology slides. He reminded himself that he’d originally thought there was a chance that histology would add some important information. With that thought in mind, he wheeled forward and returned to staring into the microscope’s oculars.
For the next several minutes, Jack carefully scanned multiple sections of the heart. As had been suggested by the totally negative gross examination of the organ, the microscopic sections were also boringly routine. There were a few pockets of errant red blood cells, but he reasoned they were probably artifact due to the slicing of the samples with the microtome. More important, the cellular structures all appeared completely normal, as did the cardiac capillaries and coronary arteries. There was only a tiny bit of possible thickening in one artery cross section, but he knew it wasn’t any more than what might be seen in an adolescent’s heart. There was absolutely nothing that would have supported a diagnosis of a heart attack.