After stashing his bike in its usual location, Jack hastened to the back elevator. As he zipped past the mortuary office, Vinnie caught sight of him and called out a question. Jack didn’t hear it, but he didn’t care, either. Instead, he jumped on the elevator that happened to be waiting on the basement floor. The back elevator was the slowest of the lot, and Jack had learned over the years to nab it when it was available. Whatever Vinnie’s question was, it could wait, and if it couldn’t, Jack was certain he’d call now that he knew he was in the building.
Jack didn’t even bother to hang up his bomber jacket when he dashedinto his office but rather just tossed it onto his worktable. He sat down at his desk and frantically searched within the surface debris for Nancy Bergmeyer’s mobile phone number. He remembered her giving it to him, and he remembered writing it down, but where? Being in a hurry, he didn’t want to be forced to go back to using the institution’s phone service, which he remembered being a lengthy process. Finally, he came across the scratch pad and there was the number.
Unfortunately, after several rings, he found himself switched to voicemail, forcing him to leave a message. As soon as he hung up, he also texted, to try to cover both bases. It worked. Before Jack even had a chance to hang up his jacket, his phone rang. It was Nancy Bergmeyer.
“Sorry to bother you again today,” Jack began.
“No bother,” Nancy said. “We have no case this week, and last week’s patient is doing exceptionally well.”
“I had an idea I wanted to run by you,” Jack said. “The patient I autopsied yesterday had a very distinct and colorful puzzle-piece tattoo on the volar surface of her right wrist. It would have been hard to miss when she was a patient, especially for anesthesia. What if I were to ask if your transplant program had had such a patient? How would you respond? It’s still a fishing expedition, but only for a very specific fish.”
“That is an interesting question,” Nancy replied. “I don’t think I know the answer to it. I suppose I’d have to run it by the hospital attorneys. And just to be sure, the OCME has subpoena power, doesn’t it?”
“Absolutely,” Jack said. “There’s no question of that.”
“You know, it might work,” Nancy admitted. “The more I think about it, the more I believe that if you just called up out of the blue and asked if we had transplanted during the last four months a young woman with a distinct puzzle-piece tattoo on the right wrist, I might have been willing to ask around and tell you straight off.”
“That’s what I want to hear,” Jack said. “Okay, that clinches it. I’m going to call around at the various heart transplant centers here in themetropolitan area and pose that exact question. Who would you recommend I ask to speak with?”
“My counterpart,” Nancy said. “As far as I know, all programs have a senior nurse coordinator who functions as a program director. We’re the ones who have an overview.”
“Thanks for your help. I really appreciate it.”
“Good luck,” Nancy said. “If I were you, I’d call Columbia-Presbyterian first. They do the most cases by far. I hope it works.”
“Me too,” Jack said. He disconnected, then moved over in front of his monitor. He Googled Maimonides Medical Center to find out if they did heart transplantation. If the subway death patient lived in Sunset Park, Brooklyn, Maimonides was the closest major hospital. To him that seemed a more important qualification than being the medical center that did the most cases. It was also true that somewhere in the back of his mind he recalled that the very first heart transplant done in the United States had been done at Maimonides. But he was in for a disappointment. Maimonides did not do heart transplantation, despite doing just about every other type of cardiac surgery.
Instead of going institution by institution, Jack Googled “heart transplantation in NYC metropolitan area” and then wrote down a list of the centers, along with the phone number of each program. He eliminated, for the time being, Westchester Medical Center, as it seemed just too far out in suburbia for someone who lived in town, and particularly in Brooklyn. That left seven centers that were possibilities, including two that were across the Hudson River in New Jersey. To be systematic, Jack started to the north, with Montefiore Medical Center.
Jack didn’t know what to expect his reception would be, but he was pleasantly surprised. Since he had been involved in clinical medicine, a true sense of competition and customer service had replaced older, unpleasant hospital employee attitudes. It didn’t take long for him to be speaking with Nancy Bergmeyer’s equivalent. His name was CurtisFreehold. He, too, was a certified nurse practitioner and the director of the Montefiore Heart Transplant Program.
After introducing himself as a medical examiner, Jack quickly explained why he was calling, giving all the necessary details about the victim, including a description of the puzzle-piece tattoo. He then asked if such a patient had been seen in the Montefiore program in the last four or five months.
“I personally don’t remember such a patient,” Curtis said thoughtfully. “But most of the day-shift nurse coordinators are here in the unit and I’d be happy to ask around. Our anesthesia team is available as well. I can ask them, too. Do you mind holding on? It won’t take a moment.”
“Not at all,” Jack said. He was encouraged. Not only was Curtis pleasant and helpful, but he didn’t mention HIPAA at all.
While he waited, he thought about calling Aretha back. He knew she said she would call him as soon as she knew something, but he was impatient. As Laurie had reminded him, getting a verifiable diagnosis of a specific virus was key, and probably significantly more critical than the ID. As Laurie had also reminded him, he couldn’t be sure how Aretha intended to proceed if she determined a virus was indeed present from her tissue cultures. Would that take a day or a week or a month? Jack had no idea.
“Looks like I’m striking out,” Curtis said, coming back on the line. “We even have a couple tattoo fans here in the unit, so I’m pretty certain the patient you’re searching for didn’t get her transplant here with us. I’m sure it would have been noticed. Sorry.”
“Thanks for checking,” Jack said.
“Leave me your number,” Curtis suggested. “I’ll put a note on the bulletin board, which we all look at every day. If someone has a different take, I’ll give a shout.”
Jack gave his mobile number and rang off. Going back to his list, he got the number of Columbia-Presbyterian and placed the call. The experience was similar to Jack’s call to Montefiore. It was apparent to Jack thatthe programs were rivals on some level and coached in customer satisfaction. It was certainly a new age. Back when Jack was an ophthalmologist, just calling to schedule surgery at his hospital center had often been unpleasant because of hospital employee attitudes.
Once again, Jack got someone high up in the program’s hierarchy on the line and posed his question. The response was just as helpful as at Montefiore, although in the end the director wasn’t quite as definitive as Curtis had been. She openly said she doubted that a patient that fit the description had been treated, but she couldn’t be certain. Also like Montefiore, she promised to get back to him if the situation changed.
While on hold with Mount Sinai Medical Center, the next hospital on his list, Jack thought again about Aretha and wondered anew what the tissue cultures were showing. The one thing that made him feel reasonably comfortable was that there had not been any similar deaths. He had told Bart he was to be notified immediately if there were. If this subway death was the index case of a new pandemic, it was at least taking its merry time getting going. Reluctantly, he couldn’t help but wonder if Laurie was right after all in holding off on sounding an alarm.
“It doesn’t seem like we’ve had any patients with memorable tattoos,” Harriet Arnsdorf, the Mount Sinai heart transplant director, said when she got back on the line. “Everyone I’ve spoken with insists that they would have remembered what you described.”
“I appreciate your asking around,” Jack said, once more leaving his mobile number just in case.
After disconnecting, Jack sat back and rethought his approach. He was down to his last Manhattan-based heart transplant center, Manhattan General Hospital, before he would be trying the Beth Israel Medical Center in Newark, New Jersey. He couldn’t help but feel a tad let down after the initial excitement of thinking that combining the heart transplant situation with the puzzle tattoo might lead to an ID breakthrough. Perhaps sending a photo of the puzzle tattoo would be more effective in jogging memories than a verbal description. With that thought in mind,Jack took a pic with his phone of the puzzle-piece photo, with the idea of texting it to the rest of the program directors he spoke with.
As the call went through to the MGH Heart Transplant Program, which he noted was advertised as an integral part of the MGH Zhao Heart Center, Jack couldn’t help but remember that MGH was certainly not his favorite hospital. The reason was that it was owned by AmeriCare, a large, publicly traded health insurance and provider organization that in the distant past had played a role in forcing him out of clinical ophthalmology and into forensic pathology. As a medical examiner, Jack did not have to bill health insurance companies, which he had learned to blame for ruining American medicine by turning it into a huge for-profit enterprise, to the detriment of patients and doctors alike.
