Critical (42 page)

"We've been ready for hours," Marvin joked.

Less than five minutes later, Laurie was suited up and staring down at Ramona's corpse. As with David Jeffries, an endotracheal tube and a number of intravenous lines were still in place. But the most striking thing was the extensive bruising over much of her body from the liposuction.

"You are motivated today," Marvin said, in a reference to how quickly Laurie had gotten down to the basement level, changed into her barrier protective gear, and come into the autopsy room. Besides her case, there was only one other under way, and that was the floater. Laurie hadn't even stopped to see how it was going.

"I want to be as efficient as I can," Laurie admitted. "I promise I won't leave you high and dry like I did yesterday. I apologize again. I got sidetracked and lost all idea of the time."

"No sweat," Marvin said, seemingly embarrassed that Laurie felt she needed to apologize.

Laurie palpated Ramona's skin and looked at it closely. It had a spongy feel, and there were multiple tiny abscesses such that Laurie felt that had she lived, she would probably have sloughed off a large part of her epidermis.

After taking a number of photographs, Laurie began the case. She worked quickly and silently. When Marvin asked questions, she answered as if preoccupied, and he soon stopped. Since they worked together so often, there was little need to talk.

As with David Jeffries, the most notable pathological finding, besides the extensive cellulitis, was in the lungs. Both were fluid-filled and contained innumerable small abscesses that would have coalesced into larger and larger ones had the patient lived. As with Jeffries, the necrosis was substantial.

When the final suture had been placed, closing the autopsy incision, Laurie stepped back from the table. She glanced around the room. Now, all eight tables were being utilized. Looking over near the door, she could see that Jack, Lou, and Vinnie were still involved with the floater.

"That was one of the fastest autopsies I've seen," Marvin commented, as he began to clean up.

"How soon can you have the next case?" Laurie asked.

"Fifteen minutes or so," Marvin said. "Do you have a preference as to which one of the two should be next?"

"It doesn't matter," Laurie said. "I wouldn't fault you if you don't believe me, but I'm going upstairs to make one phone call, and then I'll be back."

Marvin smiled.

Laurie stopped briefly at Jack's table and jokingly asked why he was taking so long. Jack was known to be one of the fastest prosectors.

"Because these two windbags talk like a couple of old ladies," Vinnie said disgustingly.

"We're being thorough," Jack said. "Even before the micro and the lab contribute, we know this young woman was raped rather brutally."

"Which raises the question," Lou said, "was it a rape followed by a homicide, or was it a homicide and an incidental rape?"

"Unfortunately, the autopsy is not going to provide us with an answer to that question," Jack said.

Laurie excused herself and exited via the washroom to ditch her gloves and Tyvek disposable suit. Her face mask she wiped clean with alcohol and left it in her locker. Intent on not keeping Marvin waiting, she dashed upstairs.

Back in her office, Laurie dialed Dr. Silvia Salerno at the CDC. As the call went through, she wedged the phone between her head and shoulder to free her hands. Shuffling through the case files on her desk, she located Chet's case, Julia Francova. She opened it up with the hopes of being able to add the subtyping of the patient's MRSA.

When the phone wasn't answered immediately, Laurie looked at the time. It was now going on nine, and she was certain the CDC had to be open for business. "Come on, come on!" Laurie urged. "Answer the damn phone."

Just when she thought about checking to see if the CDC had a paging system, the line was picked up. It was Silvia, and she was mildly out of breath. She immediately apologized, saying she had been in a neighboring office.

"I hope I'm not bothering you," Laurie said. "I know you said you'd be calling me, but the sooner I have some information, the better."

"Don't be silly," Silvia said. "You certainly aren't bothering me, and I was planning on calling this morning. I did check on those two MRSA cases of Dr. Mehta's. They are the same organism, and I can say that with definite certainty. Because we are adding these strains to the national library of MRSA, we go out of our way to characterize them, and we do this with multiple genetic methods, such as high-throughput amplified fragment-length polymorphism analysis. I could send you a list of the other methods we use."

"Thank you, but I don't believe that will be necessary," Laurie said. She had no idea what Silvia was talking about. "But I do have another case, which had been sent to you people a number of weeks ago for typing. Specifically, it was sent to a Dr. Percy."

"Dr. Percy is a colleague. What was the referring doctor's name?"

"Dr. Chet McGovern. He's a colleague of mine here at the OCME."

"What was the patient's name?"

Laurie spelled out the name to avoid any confusion.

"Hang on for a minute."

Laurie could hear the familiar sound of Silvia's keyboard, making her wonder how anything got done before digital computers.

"Yes, here it is," Silvia said. "Interesting! It's also CA-MRSA, USA four hundred, MWtwo, SCCmecIV, PVL, exactly like the two previous cases. Is it from the same institution?"

"It's from one of the same institutions," Laurie said. "Remember, the first two were from two separate hospitals."

"Yes, I remember. Concerning the two cases at the same institution, are they close to each other in time, maybe even the same date?"

Laurie turned to her unfinished matrix, but she did have the data from Mehta's case from the Angels Cosmetic Surgery and Eye Hospital. The patient's name was Diane Lucente, and like Ramona, she'd had liposuction. Laurie checked the date of Diane's death and Chet's case. "No," Laurie said. "They occurred almost three weeks apart."

"How odd," Silvia said. "I guess you know how genetically versatile staphylococcus is."

"I'm on a rather steep learning curve," Laurie admitted. "But I was informed of that yesterday."

"I find that the exact subtype being separated by institution and time quite amazing. All three must have been in contact with the same carrier."

"Did you have this specific subtype in your collection before Dr. Mehta sent you the isolate?"

"Yes, we did. As I told you last time, it is one of the most virulent subtypes we've seen for all sorts of test animals as well as humans."

"Do you send out cultures of these organisms?"

"We do. We support any number of researchers willing to work with these organisms."

"Have you ever sent this particular organism to New York City?

"I don't know offhand, but I can find out."

"I'd appreciate it," Laurie said. The nagging concern of the bacteria being spread purposefully resurfaced in Laurie's brain, yet the old arguments against such an idea resurfaced as well, each essentially canceling the other.

"I have asked around the center if anyone was aware of the cluster of MRSA cases you are investigating, but no had heard about it."

"Is that odd or not?" Laurie asked.

"No. It's up to the individual institutions if they want to contact us for assistance. There's no mandatory reporting to us, but there probably is to the state or city authorities."

"Did you get the other isolates I had our microbiology department overnight to you?"

"Yes, I did. They are in the works. I shall have some results in two to three days -- four, tops."

Laurie thanked the woman for her help and rang off. For a moment, she sat at her desk and went over the conversation. She had to admit that the call had deepened the mystery, not solved it.

Suddenly remembering the time, she leaped up from her desk and dashed for the elevator. She was afraid she had once again kept Marvin waiting despite her promise not to do so.

CARLO FOLLOWED BRENNAN out of the electronics store on Lexington Avenue in Manhattan. Brennan had purchased a GPS tracking device from a company that specialized in marine as well as terrestrial applications. Once outside, they found that it had started to sprinkle, so they ran for the black GMC Denali.

"I'm glad to see it started to rain," Carlo said, as he revved the engine before pulling out into the traffic.

"How come?" Brennan asked, absorbed in slitting the cellophane wrapping of the box containing the tracking device. He loved electronic contrivances and had had a ball picking out the item. He'd spent such a long time discussing with the salesman the pluses and minuses of the array of tracking devices the store carried that Carlo had become totally bored.

"Because there'll be less chance of people hanging around the marina. I don't want anyone seeing us hiding the thing on the boat. You know what I'm saying?"

Brennan didn't answer. Instead, he was easing the tracking device out of the box's foam interior.

"Hey!" Carlo demanded. He didn't like to be ignored. "Are you listening to me?"

"Sort of," Brennan admitted. He looked into the depths of the molded foam packing material.

"I'm talking about the rain and the marina. I asked you if you agreed it was to our advantage it was raining."

Brennan at last found what he was looking for. It was a packet containing an operating directions booklet but, more important, an online registration code.

"Well?" Carlo questioned with irritation.

Brennan next used his penknife on the packaging for the device itself, but before he could free it from its cellophane mummification, his head snapped forward from an openhanded blow from Carlo.

"What the hell!" Brennan yelled. He turned and glared at Carlo. "What did you hit me for?" he growled.

"I was talking to you," Carlo yelled back. "You were ignoring me. I don't like to be ignored. It pisses me off."

Brennan stared at Carlo. He was in a momentary rage. Luckily, he controlled himself, since Carlo was behind the wheel and they were hurtling down Lexington Avenue in a clot of traffic. Carlo might have been bigger and older, but he sure as hell wasn't wiser. In fact, he was somewhat of a lunkhead, and it was that realization that enabled Brennan to calm down a degree.

"Don't hit me ever again," Brennan voiced slowly, emphasizing each syllable.

"Then don't ignore me when I'm talking to you," Carlo snapped back.

Brennan rolled his eyes, shook his head, and went back to the operating instructions. He was pretty sure how the tracking device worked, but he wanted to read up on registering it for the real-time online services.

"I'm sorry I hit you," Carlo said after a few blocks. "Being ignored is a pet peeve of mine."

"Sorry to hear that," Brennan said.

They drove in silence for a while, to Brennan's relief. He finished reading how to register the device and then skimmed over the operating directions. Armed with all that information, he got his laptop from the rear seat and his cell phone from his jacket pocket. Once the laptop was booted up, he called the company. Not only did he want to register, he wanted to make sure that if the device was lost, it could not be traced back to him. Apparently, it was not an unusual request, because the service individual was able to oblige with ease.

"How long will it take to be online?" Brennan asked.

"Since I just got an okay on your credit card, I'm doing it as we speak."

Brennan thanked the man. Next, he opened the back of the device and inserted the four triple-A Copper Tops he'd bought as well. Going back to the company's website, he clicked on the position icon, then added the password and user name he'd just gotten. With another click, he got an hourglass, and a few seconds later, a query appeared asking him to select the size of the area he wanted to display. Brennan clicked 5 miles by 2.8 miles. A second later, there was a small blinking dot moving slowly along Lexington Avenue.

Turning the laptop screen in Carlo's direction, he said, "It works. It shows us heading south."

"Impressive," Carlo said. "How does it work?"

"It would take too long to explain," Brennan said. "But in essence, it's simple triangulation using satellite signals."

"That's enough," Carlo said. His lack of knowledge of current electronic devices made him feel inadequate.

As usual, the traffic was bad going across town, and the rain, as light as it was, made it worse. The driving was stop-and-go the whole way.

Carlo's cell phone startled both of them. With a bit of a struggle, Carlo got it out and checked the caller ID. Satisfied, he accepted the call, put it on speakerphone, and nestled the phone into a cubby on the center console.

"What's up?" Carlo questioned

"Nothing," Arthur MacEwan said in his high-pitched, shrill voice that drove everybody nuts. "Absolutely nothing. We've been here for over two hours, and Franco Ponti's hog of a car hasn't moved an inch."

Arthur MacEwan and Ted Polowski were parked in the back of Johnny's parking lot and had been there staking out Franco's car since before eight that morning.