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Why does something like this always have to happen on a weekend?
Laurie silently lamented.

She'd like to ask Laura Riley the significance but was reluctant to call her on a Saturday.

Laurie took a fresh piece of toilet tissue and again blotted herself. The blood didn't reappear, which provided a bit of consolation, yet combining the fact that there had been any blood with the right lower quadrant discomfort she'd been having lately seemed inauspicious at best.

Out at the sink, while she was washing her hands, Laurie looked at herself in the mirror. The last few nights of restless sleep had taken their toll. Although hardly in Janice's league, her eyes had dark circles and looked tired, and her face was drawn. She had a bad feeling that she might be facing yet another upheaval and prayed that if it were to happen, she'd find the emotional reserve to deal with it.

NINETEEN

IT DIDN'T TAKE LAURIE AS long as she'd feared to get back to the OCME, but once again, the ride in the taxi markedly aggravated her abdominal distress. Marvin had been waiting for her, and she immediately posted the police custody case, which turned out to be therapeutic. By the time she finished the autopsy, the pain had vanished and in its stead was a vague sensation of pressure. As she changed out of her scrubs, she pressed the area with her fingers. In contrast to what had happened that morning, palpating the area made it feel worse. As confused as ever, she went into the toilet stall to see if she was spotting, but she wasn't.

Laurie went up to her office and stared at her phone. Once again, she thought about calling Laura Riley but had the same reluctance. She didn't even know the woman, and she hated to start out the relationship by bothering her on a weekend with a problem that could probably wait until Monday. After all, Laurie had been having the symptoms for a number of days. The sudden appearance of the few drops of blood was the only aspect that was truly different, and that seemingly had stopped.

Annoyed with herself for her indecisiveness, Laurie switched to thinking about calling Calvin. She could update him on Roger and give him a heads-up on the police custody case. She'd found extensive trauma to the prisoner's larynx, with the implication that excessive force had been used. Such cases were invariably politically challenging and Calvin would need to be apprised. Yet there was no apparent pressure from the media, and the toxicology had yet to be done. Laurie decided it could all wait until Monday unless Calvin took it upon himself to call.

Instead of making any phone calls, Laurie decided to spend some serious time with the charts from Queens and then Roger's lists. She felt she owed it to him, since he had, in a way, sadly given his life for the cause.

The first thing that she noticed was that the St. Francis charts were significantly different from the General's. Whereas the Manhattan General was a tertiary teaching hospital, St. Francis was a mere community institution. There were no interns or residents writing notes, so the charts were much skimpier. Even the attending doctor's notes and the nurses' notes were shorter, which made them much easier to go through.

As she expected from having read the forensic investigators' reports on each of the cases, the demographics matched those of the General. The victims were all relatively youthful, and had died within twenty-four hours of elective surgery. They were also all healthy, compounding the tragedy.

Laurie then remembered Roger saying that he'd discovered that the General cases were all relatively recent subscribers to AmeriCare. Turning to the biographical data section of the chart she was currently examining, Laurie saw that it was the same. She quickly checked the other five Queens charts. All of the patients had been AmeriCare subscribers for less than a year. Two of them had been subscribers for only two months.

Laurie pondered this curious fact and wondered if it was significant. She didn't know, but she took out a ruled pad of paper and wrote: all victims recent AmeriCare subscribers. Beneath that, she wrote: all victims within twenty-four hours of anesthesia; all victims on IV's; all victims young to middle-aged; all victims healthy.

Laurie looked at her list and tried to think of any other ways the victims had been related. Nothing came to mind, so she put the pad aside and went back to the charts.

Although she knew the General cases had occurred in various parts of the hospital with many on the surgical floor, she didn't know about the Queens cases. Quickly, she determined that it was similar, with cases spread around the hospital.

Since the Queens charts were considerably thinner, Laurie was more tempted to look at every page, and with one chart, she found herself even reading the admission orders, which were standardized on a printed form. They described prepping the operative site, proscribing anything by mouth after midnight, and various routine laboratory studies.

As Laurie's eyes ran down the list, she stopped on a test she didn't recognize. It was grouped with blood tests, so she assumed it was a blood test. It was called MASNP.

She'd never heard of a test called MASNP. She wondered if NP stood for nuclear protein, but if it did, what did MAS stand for? She didn't know, but if she was right about the meaning of NP, then the test might be some kind of immunological screen.

Switching to the back of the chart where all the laboratory test results were appended, Laurie searched for the result. She didn't find it. Although she found all the other test results, there was no MASNP result.

With her curiosity piqued, Laurie looked in the other Queens charts. Each one had an order for an MASNP, but no result. It was exactly the same with the charts from General: Each chart had the order, but no results.

Laurie reached for her ruled pad and wrote: All victims had an MASNP ordered but no MASNP result; what's an MASNP?

Thinking about laboratory tests reminded Laurie of the short run of EKG in Sobczyk's chart taken by the resuscitation team. She shuffled through the charts until she found the right one. It was easy, since it still had her ruler sticking out. Laurie opened the chart, unfolded the segment, and reread the Post-it note she'd written to herself to show the segment to a cardiologist. Putting Sobczyk's chart aside but open to the EKG, she then checked to make sure none of the other charts had any EKG associated with the resuscitation attempts. She hadn't remembered seeing any, but she wanted to be certain.

"I hope I'm not interrupting anything," a voice said.

Laurie turned around. Jack was standing in the doorway. Instead of his usual mildly sardonic expression, his face reflected concern.

"You look awfully busy," he added.

"It's best I stay busy," Laurie responded. She reached over for Riva's chair and pulled it over next to her desk. "I'm glad to see you. Come on in and sit down."

Jack lowered himself into the seat and scanned Laurie's desk. "What are you doing?"

"I wanted to make certain the Queens cases were the equivalent of those at the General. They are, to a surprising degree. I also found something curious. Are you acquainted with a blood test called MASNP? I assume it is an acronym, but I've never heard of it."

"Me neither," Jack said. "Where did you see it?"

"It's part of the standardized preoperative orders in all these cases," Laurie said. She picked up a chart at random and showed the order form to Jack. "It's in every chart. I guess it's part of AmeriCare's established routine, at least at these two hospitals."

"Interesting," Jack commented. He shook his head. "Did you look in the back to see what kind of units the results are recorded in? That might be a clue."

"I tried that, but I couldn't find any results."

"Not in any one of the charts?"

"Nope. Not one!"

"Well, I'm sure we can clear that up on Monday by asking one of the forensic investigators to look into it."

"Good suggestion," Laurie said. She made herself another Post-it note. "There is something else curious about all these victims. Without exception, every one of them is a relatively new subscriber to AmeriCare, having joined the plan within the last year."

"Now that's a cheery thought, considering that's what we are."

Laurie gave a half laugh. "I hadn't thought of that."

"The plan is growing so fast, I imagine a fair percentage of subscribers falls into that group."

"True, but it still seems odd to me."

"Anything else of note?" Jack asked.

Laurie glanced around at the charts scattered across her desk. "There is one other thing." She picked up Sobczyk's chart with the short run of EKG recording folded out, and handed it to Jack. "Does this tracing ring any bells with you? It was taken by the resuscitation team the moment they got to the patient and just before the patient flatlined."

Jack glanced at the squiggles, too embarrassed to admit he'd never been much good at EKG interpretation in even the best of circumstances. He had decided early in medical school that he was going into ophthalmology, and he didn't pay too much attention to skills that he wasn't going to need.

With a shake of his head, Jack handed the chart back to Laurie. "If I was forced to say something, I'd say that it looks to me as if the conduction system of the heart is failing, but that's obvious with the way the complexes are spread out. But you shouldn't be asking me. My advice would be to show it to a cardiologist."

"That's my plan," Laurie said, taking the chart back and putting it with the others.

"What about Roger's lists?" Jack asked. "Have you had time to go over them?"

"Not yet. I had to do the police custody case first, so I've only been here for half an hour or so. I'll spend some time with the lists when I finish the charts. It's with the charts that I feel I can make the biggest contribution. There's got to be some piece of the pie I'm not seeing."

"You don't think it's random?"

"No. There's something that links these patients together, beyond what we already know."

"I'm not so sure. I think the cases are opportunistic with the victims being at the wrong place at the wrong time."

"Did you guys have any luck with Najah?"

"Yes and no," Jack said. "They picked him up all right, but he's not cooperating. He claims he's being discriminated against and victimized by racial profiling. They've got him in custody, but he won't talk. He's insisting on waiting for his attorney, who'll be up from Florida tomorrow for the arraignment."

"And the gun?"

"It's been sent to ballistics. But results won't be available for a while. In the meantime, I'm sure he'll be given bail."

"What's Lou's take on whether he's the man?"

"He's optimistic, especially given his behavior. Lou says if someone is innocent, they're happy to cooperate. Of course, Lou is only concentrating on who shot the nurse and Rousseau. He's not thinking about your series."

"What about you?"

"As I said, I like the idea he's an anesthesiologist. Given his training, he could be knocking these patients off in a way that would be hard for us to figure out. As for him shooting the nurse and Rousseau, that's equally circumstantial, since it's based merely on knowing he owned a nine-millimeter handgun. The problem is that there are a lot of those weapons out there."

"You don't think that whoever is killing the patients killed the nurse and Roger?"

"I'm not sure."

"I am," Laurie said. "It stands to reason. The nurse probably saw something suspicious. Her death occurred the morning after there were two additions to my series.

As for Roger, he'd gone up in the hospital specifically to talk to people he thought were potential suspects. He could have confronted Najah. Maybe he even saw him in Pruit's room."

"Very good points," Jack conceded.

"I'm glad they arrested Najah," Laurie said. "If he's the one, he'll think twice about any more shenanigans while Lou is breathing down his neck, which means I'm going to sleep a little better tonight. In the meantime, I'm going to go over Roger's lists very carefully, in case he doesn't pan out."

Jack nodded several times that he agreed with Laurie's plan. There was a brief pause until Jack said, "I know it's a bit off-topic, but can we pick up where we left off last night?"

Laurie eyed Jack warily. As they had been talking, she'd noticed that his typical sardonic expression had gradually reappeared, which she couldn't help but feel was a bad sign now that he was suggesting turning the conversation to personal issues. Deep down, a combination of frustration and irritation begin to brew. With everything else going on, from guilt about Roger's death to the pressure in her lower abdomen, she was uninterested in weathering any more disappointment.

"What's the matter?" Jack asked, in response to Laurie's silence. Misinterpreting her hesitancy, he raised his eyebrows questioningly and superciliously added, "Is this still not the time or the place?"

"You got that right!" Laurie blurted, struggling for control in the face of Jack's tone.

"The city morgue is hardly the place to discuss starting a family. And furthermore, to be honest with you, I suddenly realize I'm finished discussing it. The facts are pretty damn plain. I've made it clear how I feel, up to and including the new development of my pregnancy. What I don't know is how you feel, and I've got to know whether you're interested and capable of abandoning your self-absorbed grieving role. If that is what you want to tell me, then fine! Tell me! I'm sick and tired of discussing it, and I'm sick and tired of waiting for you to make up your mind."

"I can see this is definitely not the time or the place," Jack said with equal irritation.

He stood up. "I think I'll wait until a more opportune circumstance."

"You do that," Laurie snapped.

"We'll be in touch," Jack said before walking out the door.

Laurie turned to her desk, cradled her head in her hands, and sighed. For a brief second she considered running after Jack, but even if she did, she wouldn't know what to say when she caught him. It was obvious he wasn't about to tell her what she wanted to hear. At the same time, Laurie questioned if she was being too pushy and demanding, especially since she'd not told him about her latest symptoms and the fear that she had yet to voice even to herself: the fear of a miscarriage, which would change everything all over again.