"It seems that both patients died at about the same time in the morning. Did that seem strange to you?"
"Not really. In my experience, that two-to-four-A.M. time frame is quite popular for deaths to occur. It's my busiest time during my shift. A doctor one time suggested to me it had something to do with circadian hormone levels."
Laurie nodded. What Janice was saying was probably true.
"Dr. Stapleton told me that you did the post on Sean McGillan. Is the reason you are asking these questions because you didn't find much pathology?"
"I found none," Laurie admitted. "What about anesthesia? Any similarities there, like the same personnel or same agents?"
"I have to confess I didn't look into that. Should I have?"
Laurie shrugged. "Both were about eighteen hours postsurgery, so they would still have remnants of the anesthesia on board. I think we're going to have to look into everything, including all the medication they got and in what order and dosage. I asked Bart to get the McGillan chart. I'm going to need the Morgan chart also."
"I can put in the request before I go," Janice said.
Laurie stood up. "I appreciate it. I hope you don't think my coming in here is a negative reflection on your investigative report, because it is quite the contrary. Your reports are always first-rate."
Janice flushed. "Well, thank you. I try. I know how important it can be to have all the information, especially in mysterious cases like these four."
"Four?" Laurie questioned with surprise. "What do you mean 'four'?"
"As I recall, the week before last there were two others, both from the Manhattan General, that were similar from my end."
"How similar? Were they patients who were in their first day postoperative, like McGillan and Morgan?"
"That's my recollection. What I do remember for certain is that they were young and generally in good health, so that it was a big-time unpleasant surprise to everyone that they had cardiac arrests. I also remember both were found by the nurse's aide while doing routine postoperative temperatures and heart rates, which is how Darlene Morgan was found, suggesting they had to have suffered some kind of major medical catastrophe. I mean, there was no warning. At least with Sean McGillan, he'd had a chance to ring his call button. Also, just like with McGillan and Morgan, the resuscitation team had zero luck. I mean, they got nothing but a flat line."
"This could be very important," Laurie said, pleased that she had come to seek out Janice.
"Anyway," Janice said, "I was planning on pulling copies of the investigative reports, but I haven't had time yet."
"Were they orthopedic cases?"
"I don't remember exactly what kind of surgery they had, but it will be easy to find out. If I had to guess, I'd say they were both general surgery cases, not orthopedic. Would you like me to pull the investigative reports?"
"Don't bother. I'm certainly going to want to have the whole folders. Do you remember which doctor posted them?"
"I don't think I ever knew. I don't have much contact with the doctors, besides you and Dr. Stapleton."
"Do you remember what was the final, official cause of death?" Laurie asked.
"Sorry," Janice admitted. "I don't even know if they have been signed out yet. Sometimes I follow up on cases that interest me, but not on the two we're talking about. I have to admit that at the time, they seemed like a couple of pretty routine, unexpected major cardiac problems. I guess saying something is routine and unexpected is an oxymoron, so maybe routine is not the right word. I mean, people die in the hospital, as tragic as that may be, and a lot of times it's not from the problem that brought them into the hospital in the first place. It wasn't until this morning when I was writing up the Morgan case and thinking about the nurse's aide angle that I even remembered them."
"What were the names?" Laurie asked. She felt a shiver of excitement. This curious, unexpected yet potentially important snippet of information was exactly the reason she had wanted to talk with Janice. It made her feel more strongly that her medical-examiner colleagues who ignored the experience and expertise of the forensic investigators and the mortuary techs did so at their professional peril.
"Solomon Moskowitz and Antonio Nogueira. I wrote them down with their accession numbers." Janice handed the paper to Laurie.
Laurie took the paper and looked at the names. Whether she was actively seeking a major diversion from her own personal problems she didn't know. What she did know was that she had found one.
"Thanks, Janice," Laurie said sincerely. "I've got to hand it to you. Associating these cases might be important." One of the problems of there being eight medical examiners at the OCME is that such associations could slip through the cracks. There was a Thursday-afternoon conference where cases were vetted in an open forum, but it usually involved only the more academically interesting or even macabre ones.
"Don't mention it," Janice said. "It makes me feel good when I think I'm really part of the team and contributing."
"You most certainly are," Laurie responded. "Oh, and by the way, when you put in the request for Morgan's chart, will you also ask for Moskowitz's and Nogueira's as well?"
"I'll be happy to," Janice said. She made a notation on a Post-it and put the reminder on the side of her monitor.
With her brain in a twitter, Laurie hustled out of the forensic investigator's office and took the elevator up to the fifth floor. Concerns about BRCA1 and even Jack were pushed to the back of her mind. She couldn't take her eyes off the two names on the paper that Janice had given her. Going from one curious case to four was a huge leap. The question was simply whether these four cases were indeed related. For her, this was what being a medical examiner was all about. If the cases were related by a common drug or procedure, and if she could figure it out, then she would have the rewarding opportunity to prevent more deaths. Of course, such information would also tell her if the deaths were accidental or homicidal, and that thought gave Laurie a shiver.
Entering her office, Laurie quickly hung up her coat behind the door, then sat down at the computer. She typed in the accession numbers of the two cases, learning that neither had been signed out as of yet. Mildly disappointed, she did get the names of the two doctors who had done the autopsies: George Fontworth had posted Antonio Nogueira, and Kevin Southgate had posted Solomon Moskowitz. Having seen Southgate down in the ID office earlier, she picked up her phone and dialed his extension. She let it ring five times before hanging up.
Returning to the elevator, Laurie descended to the first floor and wended her way back to the ID room. She'd hoped Kevin would still be there, talking with Arnold, and she wasn't disappointed. She waited patiently for a break in their animated conversation. The two incessantly argued about politics: Kevin, the inveterate liberal Democrat, and Arnold, the equivalent conservative Republican. Both had been at the OCME for almost twenty years and had come to resemble each other. Both were overweight with ashen complexions and were haphazard about their hygiene and dress. In Laurie's mind, they were the stereotypical coroners in old Hollywood movies.
"Do you remember posting a Solomon Moskowitz about two weeks ago?" Laurie asked Kevin after apologizing for interrupting. As usual, he and Arnold seemed to be just shy of exchanging blows. They frustrated each other, since neither had a snowball's chance in hell of changing the other's entrenched opinions.
After joking that he couldn't remember the cases he did yesterday, Kevin's doughy face screwed up in thought. "You know, I think I remember a Moskowitz," he said. "Do you happen to know if it was a Manhattan General case?"