Although it took somewhat longer than it had with the other three medical centers to get an appropriate person on the line, eventually Jack found himself talking with Bonnie Vanderway, MGH’s Heart Transplant Program’s clinical director. Jack immediately launched into his now practiced spiel, introducing himself professionally, describing the deceased in general terms, including a mention of the heart transplant three or four months ago, and emphasizing the pressing need for the OCME to make an identification. He didn’t bother to explain why. As for the cause of death, he said it was yet to be determined.
“The one thing in our favor is that the body does have some unique identifying markings above and beyond its distinctive thoracotomy scar,” Jack continued. “What I’m talking about are three widely separated tattoos. One of them is rather eye-catching. It’s also on the underside of her right wrist, which would have been in plain sight with an IV. What I’m hoping is that you or one of your colleagues might remember this tattoo if this patient had had a transplant in your program. But rather than describe it, I’d like to send you a pic, provided you’re willing to look at it. You’ve heard the phrase ‘a picture is worth a thousand words.’”
“Of course, everyone has heard that expression,” Bonnie said with a short laugh. “Sure. Send it on!” She gave Jack her mobile number, andJack responded by sending her the photo. A moment later her phone sounded, indicating an incoming message. “I’m opening it now,” she said.
“Take your time,” Jack said.
“Wow,” Bonnie replied almost immediately. “Thisiscolorful and eye-catching. And you know something? I think I remember it.”
“Really?” Jack questioned casually. He didn’t want to get his hopes up.
“I’m not entirely sure,” Bonnie said. It was apparent to Jack that she was still studying the photo. “I think I remember seeing it in the CSR, or cardiac surgery recovery room, but just in passing. It was probably the colorful aspect that briefly caught my attention. When we’re in the CSR we’re pretty focused on our individual patients.”
There was a pause as she gathered her thoughts. “I wish I remember distinctly, but I’m afraid I don’t. But this I can tell you: It wasn’t my patient. I’m also a nurse coordinator, so I have my own patients in addition to my supervisory functions. Let me ask around. Do you want to hold on, or should I call you back?”
“I’ll hang on,” Jack said. Sensing he might be close to success, he didn’t want to let Bonnie figuratively out of his grasp. With the phone pressed up against his ear, he kicked back in his chair. Lifting his feet up and placing them next to his microscope, he tried to decide what he would do if he lucked out. The problem was that he had no idea how cooperative MGH would be. He’d dealt with the hospital on a few difficult cases in the past and had found them less than helpful and had subsequently gotten himself in hot water with Bingham. That was one of the field episodes Laurie was referring to yesterday. AmeriCare was an exceptionally profitable business, and their flagship hospital, Manhattan General, was run accordingly. Jack had had particular difficulty getting information out of the hospital, because bad news, which deaths usually involve, can impact the bottom line. As a consequence, Jack had gotten into a heated clash with the hospital’s president. Making matters particularly dicey, the hospital president was politically tight with the NYC mayor, who was essentially the OCME’s boss.
“Okay,” Bonnie said without preamble when she came back on the line. “I was right. We did have a thirtyish female patient with a tattoo that looked like this pic you sent. I spoke with the nurse coordinator on the case, Tatiana Popov, and showed her the image, and she remembers the tattoo distinctly and thinks there’s a good chance it could have been this individual.”
“Is the time frame correct?” Jack asked.
“Gosh, that I didn’t ask. Hold on!”
Jack could hear Bonnie yell in the background, asking how long ago the case was. He couldn’t hear the muffled response, but Bonnie came back on the line immediately. “That seems to fit as well.”
“Fantastic,” Jack said. “If I give you my email, would you send me all the patient details?”
“Hmmm,” Bonnie said. There was a pause. Then she added: “I don’t think I can do that, not right away.”
“Why not?” Jack questioned, even though he didn’t want to hear.
“Well, we’re specifically told by our executive director not to give out any patient information until we run all requests by the legal department, unless it is for immediate family. You know, with HIPAA and all, our hands are tied. The hospital admin is strict about this, and I don’t want to get fired. Maybe I shouldn’t have even told you about possibly recognizing this tattoo.”
“As a medical examiner investigating a medical examiner case I have subpoena power,” Jack said. Although it was true, Jack didn’t want to be forced into that route as it would invariably take too much time. If the ID was going to have an effect on this subway death case, he needed the information now, not next week. There was nothing speedy about the legal route.
“I know that,” Bonnie said. “Still, there are institutional rules that we have to follow. Besides, this wasn’t what I would call a normal case.”
“Oh?” Jack asked. “How do you mean?”
“It was a direct referral on the day of surgery from a hospital out in New Jersey that has an association with our Zhao Heart Center.”
“A direct heart transplant referral?” Jack questioned. “That sounds unique. Is such a thing a frequent occurrence?”
“No, not to my knowledge,” Bonnie said. “This was the first for me, and I’ve been here for almost two years and at a previous program for five years. But regardless of how she got here, it’s tragic to hear she’s passed away. And I’m sure all the people here associated with her case will feel the same, even though the patient was here for a much shorter time than usual. You can’t help but get to know these people intimately. I know Tatiana couldn’t believe it when I told her why I was asking about the tattoo. She reminded me the patient had done so well. She had been brought in here near death and four or five days later could have walked out if we hadn’t made her use the wheelchair.”
“Interesting,” Jack said. He thought it was more than just interesting, but he didn’t know quite what to say and was racking his brain to think of something. He didn’t want Bonnie to hang up, which worried him as a distinct possibility with her sudden legal concerns. “What exactly do you mean by a ‘direct’ referral?”
“All the patients we operate on have to be accepted into our program and get on the OPTN, or Organ Procurement and Transplant Network, list for a heart. But that didn’t happen in this case. She had been in the program of a New Jersey hospital that was in the process of obtaining its certification as a transplant center. I never knew the clinical details of this woman’s case, like whether she had an implanted left ventricular assist device or not. As I said, she was not my patient. But what I remember hearing is that her clinical situation took a very sudden nosedive to the point that she needed an immediate transplant if she was going to live. And, like a miracle, the hospital where she was being followed came up with a targeted donation that was a good match. Since her hospital lacked certification, the patient and the cleared organ were airlifted here for the surgery.”
“What’s a targeted donation?” Jack asked.
“It is when the donor or, in this case, the donor family stipulates whothe recipient is going to be. It is not very common with hearts, but it happens. It’s usually in situations where the families are either related or know each other. I don’t know what the circumstance was in this case. All I heard was that it was the result of a motorcycle accident. For those of us in the transplant business, motorcyclists are probably our most reliable resource.”
“What you’re saying is that the transplant was done at MGH but none of the preliminary work that’s normally required was.”
“That’s right. All the pre-op preparation for both the patient and the organ, which had been harvested out in the New Jersey hospital, had been done in New Jersey. Everyone here was comfortable with that because their heart center and ours have an association, and their head heart surgeon had been recruited from our program. He’d been our number two heart surgeon. He even came in along with the patient and the heart and assisted during the procedure. He might have actually done it, for all I know.”
“Now I understand why you described this as not a normal case,” Jack said. “Well, if it’s any consolation, it’s not a normal case from our end, either. Not only do we not have an identification, which is extraordinarily rare for someone in her apparent social stratum, but Toxicology determined that there were no immunosuppressants in her system. Does that surprise you, knowing what you do?”
