Life Support (14 page)

Mrs. Lacy hesitated only a few seconds. Softly she said, "If you think one is necessary. Yes."

Toby hung up. She started to call the Pathology Department next, then decided against it. Even with the family's permission, no Springer pathologist would perform the postmortem�not when the attending physician objected.

Why is Wallenberg so determined to avoid an autopsy? What is he afraid they'll.find?

She looked at the telephone. Decide. You have to decide now. She picked it up and dialed directory assistance. "City of Boston," she said. "The office of the medical examiner."

It took a moment to obtain the phone number, another few moments to get through to the right extension. While she waited, she could picture the progress of Angus Parmenter's body toward the morgue.

The ride down the elevator. The door whishing open to the basement level. The corridor with its groaning water pipes.

"Medical examiner's office. This is Stella."

Toby snapped to attention. "I'm Dr. Harper at Springer Hospital in Newton. May I speak to the chief medical examiner?"

"Dr. Rowbotham is on vacation, but I can connect you with our deputy chief, Dr. Dvorak."

"Yes, please."

There were a few clicks, and then a man's voice, flat and weary, said, "This is Dr. Dvorak."

"I have a patient who just expired," she said. "I think an autopsy is indicated."

"May I ask why?"

"He was admitted here a week ago. I saw him in the ER when he came in by ambulance�"

"Were there traumatic injuries?"

"No. He was confused, disoriented. There were cerebellar signs. Early this morning he nod a respiratory arrest and died."

"Do you suspect foul play of any kind?"

"Not really, but�"

"Then your own hospital pathologist can certainly perform the autopsy.

You don't have to report a death to our office unless the patient dies within twenty-four hours of being admitted."

"Yes, I realize it's not your usual coroner's case. But the attending physician refuses to order a postmortem, which means our pathologist won't do it. That's why I'm calling you. The family has already agreed to it."

She heard a long sigh and the shuffle of papers, could almost see the man at his desk, tired and overworked, surrounded by countless reminders of death. A joyless profession, she thought, and Dr. Dvorak had the voice of an unhappy man.

He said, "Dr. Harper, I don't think you're quite clear on the role of our office here. IJnless there's a question of foul play or public health�"

"This could be a public health issue."

"How so?"

"It's the second case I've seen in my ER this month. Two elderly men, both presenting with acute confusion, cerebellar signs, and focal seizures. And here's what troubles me, these two patients lived in the same retirement complex. They drank the same water, ate in the same dining room. They probably knew each other."

Dr. Dvorak said nothing.

"I don't know what we're dealing with here," said Toby. "It could be anything from viral meningitis to garden pesticides. I would hate to overlook a preventable illness. Especially if other people are at risk."

"You say there were two patients."

"Yes. The first one was in my ER three weeks ago."

"Then the autopsy on that first patient should provide your answers."

"There was no autopsy on the first patient. He vanished from the hospital. His body's never been recovered."

The man's silence gave way to a soft exhalation. When he spoke again, she could hear the new undertone of interest. "You said you're at Springer Hospital? What's the patient's name?"

"Angus Parmenter."

"And is the body still there?"

"I'll make sure it is," she said.

She ran four flights down the stairwell and emerged in the basement.

One of the overhead fluorescents was flickering like a strobe light, and her legs seemed to move in a jerky click-click-click of freeze frames as she hurried down the hall to a door labeled, AtJTEIORiZED PERSONNEL ONLY. She stepped into the morgue.

The lights were on, and a radio on the attendant's desk was playing, but there was no one in the anteroom.

Toby entered the autopsy lab. The stainless steel table was empty. Next she checked the cold room, the refrigerated locker where bodies were stored prior to autopsy. A chill vapor, faintly malodorous, swirled out of the locker. The smell of dead meat. She flipped on the light and saw two gurneys. She went to the first one and unzipped the shroud, revealing the face of an elderly woman, eyes open, the sclerae shockingly red from hemorrhages. Shuddering, she closed the shroud and went to the second gurney. It was a large corpse, and a foul odor rose up as she slid the zipper open. At her first sight of the man's face, she jerked away, fighting nausea. The flesh of the corpse's right cheek had melted away.

Necrotizing streptococcus, she thought, the flesh devoured by bacteria.

"This area is off limits," a voice said.

Turning, she saw the morgue attendant. "I'm looking for Angus Parmenter. Where is he?"

"They wheeled him out to the loading bay."

"They're taking him already?"

"The hearse just arrived."

"Shit," she muttered and dashed out of the morgue.

A quick jog down the hall brought her to the loading bay doors. She pushed through, and the morning sunlight caught her full in the face.

Blinking against the glare, she quickly took in the situation, the orderly, standing by the empty gurney. The hearse, as it pulled away.

She dashed past the orderly and ran alongside the moving hearse, rapping at the driver's window.

"Stop. Stop the car!"

The driver braked and rolled down his window. "What is it?"

"You can't take the body."

"It's been authorized. The hospital released it."

"It's going to the medical examiner."

"No one told me. As far as I know, the family's already made arrangements with the mortuary."

"This is now a medical examiner's case. You can check with Dr. Dvorak at the ME's office."

The driver glanced back at the loading bay, where the orderly stood watching in puzzlement. "Gee, I don't know . . ."

"Look, I'll take full responsibility," she said. "Now back up. We have to unload the body."

The driver shrugged. "Whatever you say," he muttered and shifted into reverse. "But someone's gonna catch hell for this. And I sure hope it isn't me."

Lisa was flirting with him again. It was one of the daily irritations that Dr. Daniel Dvorak had learned to tolerate, his female assistant's eyelash-batting glances through the protective goggles, her insatiable curiosity about his private life, and her obvious frustration that he chose to ignore her advances. He didn't understand why she should find him so interesting, he suspected her attraction to him was nothing more than the challenge of a silent man.

An older man, he admitted to himself with resignation as he eyed his youthful assistant. Lisa had no wrinkles, no gray hairs, no sagging epidermis. At twenty-six she was, in the immortal words of his own teenage son, a blond babe. And what does my boy call me behind my back?

he wondered. Old fart? Fuddy duddy? To a fourteen-year-old like Patrick, forty-five must seem as distant as the next ice age.

But we're all closer to death than we realize, thought Dvorak, gazing at the naked body on the morgue table. The overhead lights shone down, harsh and unforgiving, emphasizing every wrinkle and mole on the corpse's skin. The gray hairs on the chest. The black seborrheic keratoses on the neck. The inevitable changes of aging. Even blond and buff Lisa would someday have liver spots.

"Looks like we have an outdoorsman," he commented, running a gloved finger across a rough patch of skin on the corpse's forehead. "Actinic keratoses. He has sun damage here."

"But pretty nice pectorals for an old guy." Lisa, of course, noticed such details. She was a health club addict, had started the gym craze two years ago, and her quest for physical perfection had reached the point where she talked incessantly about abs and lots and reps. It was the code of the muscle obsessed, who seemed to prefer one-syllable words. Often Dvorak would see Lisa glancing at her own reflection in the mirror over the sink. Was the hair perfect? Did that blond forelock curl just so? Was the tan holding, or would she need another twenty minutes on her apartment rooftop? Dvorak found her youthful preoccupation with good looks both amusing and bewildering.

Dvorak seldom looked in a mirror anymore, and that was only to shave.

When he did look at himself, he was always surprised to see that his hair was now as much silver as black. He could see the passage of years in his face, the deepening lines around his eyes, the permanent frown etched between his eyebrows. He also saw how tired and drawn he'd become. He'd lost weight since his divorce three years ago, had lost even more weight since his son, Patrick, had left for boarding school two months ago. As layers of his personal life had peeled away, so had the pounds.

This morning, Lisa had commented on his new gauntness. lookin' good t*ese day.s, Doc! she'd chirped, which only confirmed how blind the young were. Dvorak didn't think he looked good. When he looked in the mirror, what he saw was a candidate for Prozac.

This autopsy was not going to improve his mood.

He said to Lisa, "Let's turn him over. I want to examine his back first. " Together they log-rolled the corpse sideways. Dvorak redirected the light and observed dependent mottling, consistent with the postmortem pooling of blood, as well as pale areas on the buttocks where the weight of the body had compressed the soft tissues. He pressed a gloved finger against the bruiselike discoloration. It blanched.

"Livor mortis not fixed," he noted. "We've got an abrasion here, over the right scapula. But nothing impressive."

They rolled the corpse onto its back again.

"He's in complete rigor mortis," said Lisa.

Dvorak glanced at the medical record. "Time of death recorded at five-fifty-eight. It's consistent."

"What about those bruises on the wrists?"

"Looks like restraints." Dvorak flipped through the record again and saw the nurse's note, Patient remains agitated and in fourpoint restraints. If only all his postmortems came with the circumstances of death so well documented. When a body was wheeled into his autopsy room, he felt fortunate just to have a positive identification, even more fortunate if the body was both intact and free of odors. To deal with the worst odors, he and his assistants donned protective suits and oxygen units. Today, though, they were working with standard gloves and goggles, on a cadaver that had already been screened in the hospital for HIV and hepatitis. While autopsies were never pleasant, this one would be relatively benign. And probably unrewarding.

He redirected the light straight down on the table. The corpse had pincushion arms�typical for a hospital death. Dvorak counted four different puncture sites on the left upper extremity, five on the right.

There was also a needle puncture wound in the right groin�probably from an arterial blood gas draw. This patient had not gone peacefully into that good night.

He picked up the scalpel and made his Y incision. Lffling the sternum in one piece, he exposed both the chest and abdominal cavities to view.

The organs looked unremarkable.

He began to remove them, dictating his findings as he worked.

"This is the body of a well-nourished white male, age eightytwo . . ."

He paused. That age couldn't be right. He flipped to the front of the chart and checked the birth date. The age was correct.

"I would've guessed sixty-five," said Lisa.

"It says here, eighty-two."

"Could that be a mistake?"

Dvorak studied the corpse's face. The variability of aging was a matter of both genetics and lifestyle. He had seen eighty-year-old women who could pass for sixty. He had also seen a thirty-fiveyear-old alcoholic who'd appeared ancient. Perhaps Angus Parmenter was merely the beneficiary of youthful genes.

"I'll confirm the age later," he said, and continued dictating.

"Decedent expired today at five-fifty-eight in Springer Hospital, Newton, Massachusetts, where he was admitted as a patient seven days ago." Once again, he picked up the scalpel.

Dvorak had gone through these motions so many times before that much of it was automatic for him. He severed the esophagus and trachea, as well as the great vessels, and removed the heart and lungs.

Lisa slid them onto the scale and called out the weights, then placed the heart on the cutting board. Dvorak sliced along the coronary vessels.

"I don't think we have an MI," he said. "Coronaries look pretty clean."

He resected the spleen, then the small intestine. The seemingly endless coils of bowel felt chill and slippery. The stomach, pancreas, and liver were resected in one block. He saw no signs of peritonitis, nor did he detect the odor of anaerobic bacteria. The joys of working on a fresh corpse. No foul smells, only the butchershop scent of blood.

On the cutting board, he sliced open the stomach and found it was empty.

"Hospital food must've sucked," said Lisa.

"He wasn't able to eat, according to the record."

So far, Dvorak had seen nothing on gross inspection that would point to the cause of death.

He circled around to the cadaver's head, made his incision, then folded the scalp forward over the face like a rubber mask. Lisa had the Stryker saw ready. Neither of them spoke as the saw whined, opening up the skull.

Dvorak Iffled off the cap of bone. The brain looked like a mass of gray worms under its delicate covering of meningeal membrane.

The meninges did not appear in any way unusual, which argued against infection. Neither did Dvorak see any signs of epidural bleeding.

The brain would have to be removed for closer inspection. He picked up the scalpel and worked quickly, severing optic nerves and blood vessels.

As he reached deeper, to free the brain from the spinal cord, he felt a sharp bite of pain.

At once he withdrew his hand and stared at the cut glove. "Shit," he muttered and crossed to the sink.