The Multnomah County DA was a rail-thin bachelor with thinning brown hair and blue eyes. His deputy was a big-boned, ample-breasted, African-American woman with arms as wide around as a steel worker’s. Delilah dwarfed her boss and Dr. Ralph Karpinski, a dapper dresser in his early sixties, who brought up the rear. As they walked toward the library, Delilah took in the artwork and museum-quality antiques that decorated the hallway. The library was what she expected, another massive space with a huge stone fireplace, more wood-paneled walls, and floor-to-ceiling bookshelves. Henry Van Meter was sitting in a high-backed armchair next to the fireplace, which had a fire roaring in it despite the summer weather. Miles Van Meter walked over as soon as they entered the room. He was wearing a navy blue pinstripe suit, a maroon tie, and a white silk shirt with French cuffs secured by gold cufflinks. Miles shook Stamm’s hand.
“Thank you for coming, Jack,” he said.
The Van Meters had always been big contributors to Jack Stamm’s political campaigns and there was never any question that he would respond to Miles’s request for a personal update on the Maxfield case.
“It’s no trouble, Miles. I can only imagine how hard this has been on both of you.” Stamm turned toward his companions. “This is Dr. Ralph Karpinski, an expert on comas. We’ve been consulting with him about how to proceed with our indictment. And this is Delilah Wallace. She’ll be prosecuting Joshua Maxfield.”
“Do you have any experience with murder cases?” Henry Van Meter asked, eying the black woman suspiciously. The question was really a challenge, but Delilah simply smiled.
“Yes, sir, I do. My brother was killed in a drive-by when I was in high school, so I take my murder cases personally. They’re my specialty and I haven’t lost one yet. And I’m definitely not what you’d call soft on crime. I’ve tried five death cases and there are five men sitting on death row today because I asked the jury to put them there. I intend to make Mr. Maxfield number six.”
“Delilah won’t let you down, Henry,” Stamm assured him. “She’s the best I’ve got and she’s already putting in long hours on the case.”
Everyone sat down and Stamm continued the conversation. “I wanted Dr. Karpinski to update you on Casey’s condition so you’ll understand why we’re going ahead with her case now as an assault instead of waiting to see if she passes away so we can try Maxfield for murder. Then Delilah has some questions she wants to ask.”
Karpinski had a head of white hair and a patrician air. He dressed as elegantly as Miles Van Meter. The doctor straightened his cuffs as he began to speak.
“Mr. Van Meter, your daughter is in a coma. That means that she is alive but unaware of herself and her surroundings. To be blunt, a coma is a type of living death.”
Henry took a deep breath and closed his eyes for a moment.
“So you can better understand what’s wrong with Casey, let me explain why a coma occurs. The cerebral cortex is the part of the brain that is ultimately responsible for processing all sensory input, motor output, and integrative functions of the nervous system. The reticular activating system, or RAS, is the core of neurons in the center of the brainstem that projects into the cerebral cortex and wakes up the cortex so it can process the information it’s getting and do something about it. To put it another way, the RAS is like an alarm clock. If it doesn’t go off, the cerebral cortex stays asleep and doesn’t do its job, so you stay unconscious.”
“Will Casey come out of her coma?” Miles asked.
“That’s hard to say. There is a slim chance that she will. More likely, she will probably stay asleep for years. She may never regain consciousness.”
“But there is a chance that she’ll come back to us?” Henry asked.
“That’s not something you can count on. Let me explain. There are three types of coma. In the first category, widespread areas of the cortex are damaged by causes such as severe trauma, absence of blood flow for more than seven to ten minutes, or advanced meningitis. In the second category, processes like prolonged seizure activity, intoxication and alcohol withdrawal, or liver and renal failure alter the ability of the brain tissue to function normally. In the third category, things like tumors, strokes, or compression of the brainstem damage the RAS.
“When a coma falls into the first two categories, meaningful neurologic recovery isn’t possible. With the first type, even if the patient regains consciousness, they’re severely incapacitated because of the widespread brain damage. In the second, say where there’s liver failure or prolonged seizures, the patient dies if the metabolic cause of the coma isn’t corrected quickly.
“Fortunately, Casey became comatose because of trauma damage to the brainstem RAS that occurred when she struck her head with a lot of force against one of the timbers that support the roof of the Academy’s boathouse. Traumatic damage was done to the lower posterior portion of the skull just above the top of the neck. This covers the brainstem and cerebellum. The area that was damaged was the locus ceruleus, a section of the RAS. What’s good about this is that people in a prolonged comatose state caused by damage to the RAS can spontaneously recover consciousness. In theory, recovery can also be induced pharmaceutically, though no one has done it yet.”
“Are you saying that a drug exists that can wake up my sister?” Miles asked.
“No, but scientists are working to develop one. Theoretically, yohimbine, which has been around for years, should do the trick. The problem is that it causes extreme elevations of blood pressure even at relatively small doses. There have been attempts to develop a drug that will block the peripheral effect of yohimbine on the heart and blood vessels. That would allow us to administer high doses to the locus ceruleus and reverse the coma. The greatest success has been achieved by using a drug that is similar to carbidopa, which is used to treat Parkinson’s disease, but the pharmaceutical companies are far from the point where the FDA will approve such a drug for use on living patients.”
Miles struggled to maintain his composure.
“If I understand you correctly, Dr. Karpinski, Casey will wake up spontaneously, or a miracle drug, which does not currently exist, will bring her out of her coma. Otherwise she will stay a vegetable for the rest of her life. There is no other alternative.”
Karpinski nodded. “Unfortunately, under the present state of our knowledge, those are the alternatives.”
“That’s why we’re going after Maxfield for assault, Miles,” Stamm said. “But we’re also prosecuting him for Terri Spencer’s murder, so he will receive the severest punishment the law allows.”
Miles’s hands curled into fists. He glared at Jack Stamm. “I want that bastard dead, Jack. I want him dead.”
“We’re going to convict him, Miles. We’re going to send him down,” Stamm assured him.
“Mr. Van Meter,” Delilah asked Miles in a calm voice that sought to defuse his hatred, “can you help us with any information about Joshua Maxfield or your sister that could help my prosecution?”
Miles took a deep breath and regained his self control.
“I don’t think so. The night Casey was attacked, I was in New York City with two other members of my firm negotiating a deal for a client.”
“How well did you know Joshua Maxfield?”
“Not well at all. I’m an attorney with Brucher, Platt and Heinecken. I don’t have much to do with the Academy. I did meet Maxfield briefly at a fund-raiser for the school, and I had dinner with him when he was hired. Casey wanted me to meet him. She thought we might get along, but we really had little in common.”
Delilah turned to Henry Van Meter. “Sir, did you have any contact with Joshua Maxfield?”