The second was an official hospital message, typed by a clerk and computer-printed: "Dr. D' Anton wishes to extend the courtesy of examining the records of Eden Hale. Please call at your convenience."
Monks rolled the paper up and tapped it against his thigh as he walked down to the morgue. There were such things as changes of heart, but by and large they made him suspicious.
The hospital's cafeteria food was good and usually tempted Monks, but this morning he settled for a scoop of scrambled eggs and toast. He and Roman found a table in a corner. The place was busy, filled with staff in different colored uniforms and a few visitors who were early, or who had spent an anxious night waiting with an ill friend or relative and were not done with their vigils yet.
'The initial tox screen is in," Roman said. "And I had a chance to look at the body before the city took her. This isn't all official, but here's what I'm sure of." He held up his forefinger, ticking off points. "She had a relatively high level of Valium in her system, but nowhere near lethal. There's no direct connection to the death." A second finger appeared. "You were right about the DIC. She bled out. That's what killed her."
Monks felt a measure of relief. His diagnosis had been correct.
But there remained the question of his treatment. "What caused the DIC?"
Roman's ring finger rose to join the other two. "I saw no evidence of surgical infection. No pregnancy, no obvious signs of trauma, carcinoma, any of the other usual causes. It's possible they'll turn up on autopsy, but I doubt it. But there was an infection. We found salmonella in her bloodstream."
"Salmonella," Monks said, laying down his fork. "Salmonella doesn't cause blood clotting. Just the opposite."
Heads at nearby tables turned toward them. Monks lowered his voice.
"She might have had salmonella, but I can't believe that's what did it," he said.
Roman's hand opened, palm out, for patience. "Take it easy, Carroll. I'm just telling you what the tests show."
"Have you ever known salmonella to act like that?"
"Not the common stuff, enteritidis" Roman said. "Which is what this is, or at least what it looked like. There are other kinds."
"You're sure it's not typhoid?" Monks said. "I thought about that." Typhoid fever was caused by a type of salmonella, and he feared that he might have missed it after all.
"Almost positive. I'm doing cultures, so we can verify it. But there are no other indications of typhoid, and it doesn't fit with the DIC."
Monks waited.
"But we've got to keep in mind, there are new strains of everything cropping up all the time," Roman said. "It's possible that this is some form of salmonella that looks like the regular thing, but has a much more severe effect."
"Do you really buy that?"
Roman shook his head. "I'm stumped," he admitted. "Maybe some other factor. Maybe a preexisting condition that's not obvious."
"I'm going to look at her records today," Monks said. But he doubted that D'Anton would have missed something like that.
"There's only one other thing I can think of that might have had that general effect," Roman said. "Some kind of toxic substance."
Monks focused a click. Toxins had been listed as a possible cause of DIC, but he hadn't given it much thought. So soon after the surgery, Eden would have eaten little or nothing.
"Such as?" Monks said.
"I thought about a contaminated drug."
So had Monks. "Everything the paramedics brought in was prescription, or looked that way," he said. "Pharmaceutically stamped pills." A bad batch was possible but highly unlikely. She might have taken something homemade. But both men were very familiar with the effects of street drugs, including those cut with dangerous fillers, like strychnine in heroin. And anything common would have shown up on the tox screen.
"What else?" Monks said.
"Not something you'd find around the house. I'd recognize anything from cleaning fluids to rat poison. Maybe in agriculture, or industry. She wasn't involved in anything like that, was she?"
Monks felt the insane urge to laugh. "Industry, but not that kind."
"What do you mean?"
"She was an adult film actress. Look, she was recovering from surgery. She'd have gone straight home from the clinic. She wouldn't have been out wandering around."
"Any indications that she was suicidal?"
Monks had never spoken with Eden Hale, never seen her really alive. There might have been a dark, despairing side to her. But it didn't jibe with what he knew, and it didn't seem to follow that a woman who had just gone through an expensive, painful treatment to become more beautiful would want to kill herself immediately afterward. Particularly in a protracted, agonizing way.
"No," he said. "Not yet, anyway."
"Well, I'm afraid that's not much help," Roman said. "I can run more tests or request the city coroner to. But it's tough when I don't know what I'm looking for."
"You think anything will turn up on the autopsy?"
"It'll bear out the DIC, Carroll. But I wouldn't hang too much on anything more." Roman hesitated, then said, "Just on the off chance it did turn out to be some particularly virulent strain of salmonella, was your treatment consistent with that?"
Monks pushed his plate away and leaned his elbows on the table, pressing the heels of his hands into his eyes.
'The initial phase was," he said. "Somebody comes in dehydrated and bleeding in an unknown location, you start by replacing fluid volume, then blood. Next step is to locate the source of the bleeding and treat that – if you can. That's where I diverged."
"Diverged how?"
"There was no way to treat it, except to try to break up the clotting. I gave her heparin."
"Seems reasonable to me," Roman said.
"If you look at it that way, yes. But going by the book – about the last thing you want to do with something like salmonella is thin the blood."
Monks took the elevator up to Baird Necker's office. This time he was uninvited.
His mind was stepping up its analysis, reviewing what he knew, eliminating some possibilities and considering others further. It was a little more satisfying with the new information, although still frustrating as hell.
Salmonella was a bacteria, a prime cause of what was generically called food poisoning. There were several exotic strains and modes of infection, but by far the most common cases seen in the States came from ingesting tainted food. Poultry was a major carrier.
Salmonella didn't cause clotting, but the opposite – if it was advanced enough, there was copious intestinal bleeding, discharged via characteristic bouts of bloody diarrhea. Usually there wasn't much that could be done, beyond replacing fluids and blood, and keeping the patient stable until the attack ran its course. With proper treatment, the disease was rarely fatal.
In short, if he had not given Eden Hale the heparin, he would be safely off the hook now. She would have died anyway, and the cause of the DIC might remain forever a mystery. But no one would be able to point a finger at Monks and accuse him of doing the wrong thing.
It was futile to think about whether he could have stood there and let her go, without trying something. That way lay madness.
But he had seen plenty of salmonella, and whether this was some new super mutant or the plain old garden variety, he still couldn't believe it was responsible. Something else, some terrible unseen pump inside her, had driven all her bloodstream's clotting factors into the smaller vessels, leaving the larger ones to bleed unchecked.