Remembering the reporters in reception, Jack called back to Lou, asking which of the three cases had brought the reporters to the OCME so bright and early. Short of possibly the floater, Jack had a hard time imagining any of the three being particularly newsworthy. In a city the size of New York, sad, violent events were all too common.
"None of the ones I've talked about," Lou called back. "The media is salivating about a death in police custody in the Bronx of a man called Concepcion Lopez. It's going to be one of those excessive-force brouhahas, I'm afraid. What I was told was that the guy went ballistic with an overdose of cocaine."
Jack merely nodded, thankful Lou wasn't encouraging Jack to do it. Police custody cases invariably were political disasters, which Jack found trying. No one was ever satisfied with the report, always claiming a cover-up.
"I'll see you downstairs," Lou said, getting up out of his chair with some effort. "I want to stop in Sergeant Murphy's cubbyhole and see if a missing-person complaint has been filed for John Doe."
"Have you come across Lou's John Doe floater?" Jack asked Riva.
Riva was immediately able to put her finger on the case file, since it was on top of the pile of apparent homicides. She handed it to him.
"How about two blunt-injury cases?" Jack asked. "The names are Thomas and Barlow."
Riva had to hunt for these cases in the stack, which was uncharacteristically high.
"Ugly night in the Big Apple," Jack commented. "You'd think people could solve their differences more amicably."
Riva smiled politely at Jack's weak attempt at humor. It was too early in the morning to respond verbally. She found the folders, and handed them over as well.
"Mind if I do these cases?" Jack asked.
"Not at all," Riva said in her soft, silky voice. She was a petite, gentle Indian American with dark skin and even darker eyes.
"Who is going to do the police custody case?" Jack asked.
"The chief called and said he wanted to do it," Riva said. "Since I was on call, I guess I'll have to be the one to assist him."
"My condolences," Jack said. Although Dr. Harold Bingham had an encyclopedic knowledge of forensics, helping him on a case was always an exercise in frustration control. No matter what you did as the assistant, it was never right, and the case invariably dragged on interminably.
Jack was about to wake Vinnie up from his sports statistics-induced trance when Laurie looked up from her reading. In contrast to Jack, who was content to skim-read the case material prior to the autopsy, she liked to go over it in exquisite detail. Jack felt that too much attention to detail initially prejudiced his ability to keep an open mind, while Laurie felt that not going over the history increased the chances she'd miss something. They'd argued over the issue but had finally agreed to disagree.
"I think you should read this," Laurie said in a serious tone, extending a case toward Jack. "I think you will find it personally disturbing."
"Oh?" Jack questioned. He read the victim's name, David Jeffries, which he did not recognize. His brows knitted in confusion over Laurie's comment and tone as he slid out the contents of the envelope. "What do you mean, 'personally disturbing'?"
"Just read the PA's investigator's note," Laurie suggested. PAs were physician assistants who worked as forensic investigators. It was the OCME's policy that PAs visited the scenes when indicated rather than forensic pathologists. The Chief Medical Examiner, Dr. Harold Bingham, felt strongly that it wasn't an efficient use of the M.D.'s time, despite his recognition that in some cases a site visit was crucial to determine the mechanism and manner of death.
It took only a few sentences for Jack to understand. David Jeffries had died of a fulminant postoperative staphylococcus infection following an anterior cruciate ligament repair, due to a particularly nasty type of staph called methicillin-resistant staphylococcus aureus, or MRSA. Considering the argument he and Laurie were having over Jack's upcoming surgery, it seemed coincidentally relevant, even if it involved another hospital. "I know what is going through your mind," Jack said, "but it ain't going to change my mind. I've already taken into consideration the risk of postoperative infection. Fearmongering is not going to work."
"But this coincidence has to give you pause," Laurie said. She knew it would certainly give her more than pause if the situation were reversed and she was slated to have the surgery.
"Frankly, it doesn't," Jack said. "First, I'm not superstitious, and second, I specifically asked Dr. Anderson what his postsurgical infection rate was. He told me that the only postoperative infections he'd had over his entire career involved compound-fracture repairs, which are a totally different situation. Besides, this case you're showing me involved University Hospital." Jack tried to return the file to Laurie, but she wouldn't take it.
"If you'd read further, you'd see that's not the case."
"What do you mean?" Jack asked. He felt himself getting irritated about the surgery issue all over again. Laurie could be like a dog with a bone, which he found frustrating at times, although he knew people often accused him of having the same trait.
"The patient had had his surgery eleven hours earlier at Angels Orthopedic Hospital, not University Hospital. The reason he ended up at the University Hospital was to treat his septic shock and fulminant staphylococcal pneumonia."
"Really?" Jack's eyes went back to the PA's note. Although he trusted that Laurie would never make such a thing up he had to read it himself.
"This has to worry you," Laurie said. "The fact that they had to transfer a critically ill patient at all doesn't speak very highly for the Angels Orthopedic Hospital. What kind of hospital outsources its dirty laundry? The patient apparently died in the ambulance. That's crazy!"
"New treatments for septic shock require specialized personnel," Jack said. He was distracted by what he was reading. The rapidity with which the patient's infection progressed was shocking. Jack, as the OCME's putative infectious-disease guru, from having made several -- what he called lucky -- diagnoses on cases of infectious disease ten years ago, couldn't help but be impressed. In fact, he started to wonder if Mr. Jeffries had had a more truly infectious disease like Rocky Mountain spotted fever.
"Was the infectious agent unequivocally proved to be staph aureus?" Jack asked. He tried to remember what other known diseases caused such a rapidly fulminant course.
"Not by culture but by a monoclonal-based automate diagnostic system. Both the incision site and the lungs tested positive for methicillin-resistant staph, and interestingly enough, it was a strain associated with what they call 'community-acquired staph,' not the kind of antibiotic-resistant staph that has been plaguing hospitals over the last ten or fifteen years."
"Which means the patient probably brought the bug in with him rather than acquired it in the hospital."
"Could be," Laurie agreed. "But there's no way to know. Doesn't this bother you at all? I mean, the victim was roughly your age, had suffered the same injury, and was going to have the same operation at the same hospital. It would sure make me think twice. That's all I can say."
"To be honest, a postoperative infection had been one of my concerns," Jack said. "Maybe even the biggest, which is why I asked Dr. Anderson about his record and why I have been using antibacterial soap ever since the accident. I'm going to be damn sure I'll not be bringing any bacterial hitchhikers into the hospital if I can help it."
Jack flicked the back of Vinnie's newspaper hard enough to startle the man.
"Quit it!" Vinnie groused when he'd recovered from his shock and saw who was the culprit. "Please, God, don't let the self-proclaimed super forensic sleuth insist on breaking the rules by starting early," Vinnie added sarcastically and with seeming disrespect. In point of fact, there was enough mutual respect between Vinnie and Jack to allow for such teasing banter, and technically they were breaking the rules. By decree from Chief Bingham, autopsies were supposed to start at seven-thirty sharp, although they never did. Jack was always early, thanks in part to Vinnie's willingness to cut short his coffee break while all the other medical examiners, including Laurie, were always late because Bingham or the deputy chief, Calvin Washington, were rarely there to enforce the edict.
"The supersleuth wants the super mortuary tech down in the pit," Jack said to the back of Vinnie's paper. Defiantly, Vinnie had gone back to his reading.
Laurie asked Riva if she could do David Jeffries's autopsy.
"Of course," Riva said. "But it's going to be a busy day. You'll have to take at least one more. Do you have a preference?"
"Sure," Laurie said absently. She was back to rereading David Jeffries's history.
"Come on, Vinnie," Jack called, leaning on his crutches at the doorway leading into the communications room. Vinnie had become reabsorbed in his paper.
"I'm here!" a voice called out. "The day can now officially begin."
All eyes turned to the door leading out to the main part of the ID room. Even Vinnie, who was passive-aggressively avoiding Jack, lowered his paper to see who had arrived. It was Chet McGovern, Jack's office mate. "Have you guys left anything mildly interesting? Hell, I'd have to camp here overnight to avoid getting your rejects." After ditching his coat on an empty chair, he stepped behind Riva to paw through some of the folders. Jokingly, as if a schoolmarm, Riva hit his hand using a foot-long wooden ruler.
"You're in a good mood, sport," Jack said. "What's the occasion? How come you're here so early?"
"I couldn't sleep. I met a woman last night at my health club who's an impressive businesswoman. I had the feeling she's a CEO or something. I woke up this morning early, trying to figure out how to get her to go out with me."
"Ask her," Laurie suggested.
"Oh, sure, in case I hadn't thought of that."
"And she said no?"
"Sort of," Chet said.
"Well, ask her again," Laurie said. "And be direct. Sometimes you men can be rather vague to protect your fragile egos." Chet saluted, as if Laurie were his superior officer.
"Come on! You lazy good-for-nothing," Jack said after returning to where Vinnie was sitting and snatching his paper out of his hands. Vinnie scrambled after Jack, who managed to keep the newspaper away from Vinnie until they reached the clerical room beyond communication. There was a brief tug-of-war amid laughter.
The battle for the newspaper over, Jack gave Vinnie the John Doe case file and asked him to put up the body, meaning prepare the body for the autopsy. Meanwhile, Jack stuck his head into Sergeant Murphy's closet-like NYPD office. The aging, amiable cop looked up from his computer screen. He'd been assigned to the OCME forever. Jack was fond of the man, as was everyone else. Murphy was one of those rare individuals who managed to get along with everyone. Jack admired the trait and wished some of it could rub off on him. Over the years, he'd become progressively intolerant of perfunctory bureaucrats with mediocre administrative or professional skills, and he was unable to hide his feelings, as much as he tried. In his mind, there were too many such tenured people hiding out in the OCME.
"Have you seen Detective Soldano?" Jack asked.
"He was here earlier but left to go down to the morgue," Sergeant Murphy said.
"Did he ask you about the unidentified floater that came in last night?"
"He did, and I told him the only missing-person report filed overnight was for a woman."
Jack thanked the sergeant and managed to catch up to Vinnie, who'd summoned the back elevator. Downstairs, Jack found Lou in the locker room, already suited up in a Tyvek coverall, which had replaced the far more bulky protective moon suits except for known exceptionally infectious cases.
As Jack quickly changed into scrubs, Lou couldn't help but notice the swelling and discoloration of Jack's injured knee.
"That doesn't look so good," Lou commented. "Are you sure you should be doing these posts?"
"Actually it's gotten better," Jack said. "I just have to baby it until Thursday, when it's scheduled to be repaired. That's what the crutches are for. I could do without them, but using them is a constant reminder."
"You're having it operated on so soon?" Lou questioned. "My ex-brother-in-law had an ACL tear, and he had to wait six months before having it fixed."
"The sooner I have it, the better, as far as I am concerned," Jack said as he climbed into a Tyvek coverall. "The quicker I get back to my bike and, hopefully, my b-ball, the saner I'll be. The competition and the physical exercise keep my demons at bay."
"Now that you remarried, are you still tormented by what happened to your family?"
Jack stopped and stared at Lou as if he couldn't believe Lou had asked such a question. "I'm always going to be tormented. It's just a matter of degree." Jack had lost his wife of ten years and two daughters, aged ten and eleven, to a commuter plane crash fifteen years earlier.
"What does Laurie think of you having surgery so soon?"
Jack's lower jaw slowly dropped open. "What is this?" he questioned with obvious irritation. "Is this some kind of conspiracy? Has Laurie been talking to you about this behind my back?"