“Thank you for coming out here again today,” Stephen said in his commanding voice. Han merely broadly smiled in apparent agreement. Stephen made a production out of shaking hands with Jack and didn’t immediately let go. “We are pleased you could make it. We were all sorry to hear about that huge screwup in New York this morning that you got caught up in.”
Jack inwardly cringed.Here it comes,he thought.
“That kind of ridiculousness is the reason I’m so happy to be out of there and here in the sticks,” Stephen continued, still clutching Jack’s hand. “We don’t have the layers of bureaucracy you people have to put up with. One thing it does show is that under certain circumstances there can be too much planning and training. Is that your take?”
“That and the dangers of a disgruntled employee,” Jack said. He started to relax. Stephen was immediately seeing Jack as the victim, not the cause, which was certainly how Jack viewed the event.
“Well, we’re glad you haven’t let the episode slow you down. We’reexcited to have your help on our problem,” Stephen said. He let go of Jack’s hands before rubbing his own hands together in apparent anticipation of the upcoming autopsy. “Let me tell you exactly why we are thrilled you’re here. Since you had the opportunity to see Carol Stewart’s transplanted heart in situ, which we unfortunately were unable to do not being there with you, you’ll be able to give us valuable information. From a technical point of view, we are interested in comparing Carol’s heart with the transplanted heart in Margaret Sorenson, and you will be the only person who can do it from having seen both hearts in situ.”
“Are you thinking from a surgical point of view?” Jack asked. He remembered being impressed with what he had seen.
“I’m talking about the totality of the situation,” Stephen said. “The surgical technique being one of them, but also how the heart appears in its orientation in the chest and how the healing of the pericardium has progressed, along with the anastomoses with the great vessels. There were some technical differences in the two cases whose details I won’t bore you with, but the unfortunate fact that these two patients passed away within months of their procedures offers us a rare opportunity to analyze their progress and decide which was best, Carol’s or Margaret’s. We’d like to try to get something positive out of these two tragedies. Am I making sense here?”
“I think I might be able to reasonably compare them,” Jack said. In his mind’s eye, he tried to remember exactly what he’d seen and what he’d thought when he’d first opened Carol’s chest, and then later, when he’d removed the heart and lungs en bloc, and finally when he exposed the heart by cutting through the scarred pericardium. Most of it came back to him, so he thought he’d be able to make a comparison without too much trouble.
“All right, then,” Stephen said, clapping his hands. “Dr. Lauder will take you into the locker room to change into scrubs. We’ll meet you in the personal protective equipment room. Has Dr. Lauder asked you about your druthers regarding personal protection?”
“We went over that,” Harvey said. “He’s comfortable with standard precautions.”
“Excellent,” Stephen said. “So are we.”
The locker room was as posh as the autopsy room was up-to-date. Harvey gave Jack scrub pants and a shirt. Jack used one of the lockers for his clothes. As he was pulling on the shirt, Harvey returned and asked if there were any special tools he required.
“That I require?” Jack questioned. “I thought I was observing, not performing.”
“They want you to do the case,” Harvey said. “I’ll be assisting, if you need me. We’ll also have two mortuary technicians to help us. Are you okay with that?”
“No problem,” Jack said. Actually, he preferred to handle the case. Sometimes when he observed others, he got antsy that they were taking too long or being clumsy or, worse yet, incompetent. Jack’s prior life as an eye surgeon had honed his hand-eye coordination and made him efficient with his time. He had no idea of Harvey’s skill or lack thereof, but Jack had been mildly concerned Harvey might perform as haphazardly as he dressed. For Jack it was a comfort to know the scalpel and scissors and other instruments would be in his hands.
36
THURSDAY, 11:30 A.M.
As far as Jack was concerned, the Dover Valley Hospital autopsy room was not only a joy to look at, it was a pleasure to use. There was even classical music piped in quietly in the background, reminiscent of how Jack had liked to perform eye surgery in his former life. Having it during an autopsy was a first for Jack. He hadn’t even thought of piped music at the OCME, but now he considered making a suggestion to the design committee responsible for coming up with the plans for the new autopsy room.
There were seven people in the room, which included the two mortuary techs Harvey had mentioned and whom Jack had not formally met. Everyone was dressed in the same light green impervious gowns with full face shields. Jack was on the patient’s right, which was his choice, along with Stephen. Directly across from Jack was Harvey, along with Ted. Dr. Han Lin was standing at the head of the table. The two mortuary techs floated. Jack had the instrument tray brought over to his side, as he preferred to pick up instruments himself rather than having them handed to him by Harvey. It was his strong belief that handing off instruments was a source of accidents, which Jack made a point to avoid.
Once he’d finished the external exam with Beethoven’s Piano Concerto No. 3 playing almost subliminally in the background, Jack picked up the scalpel. After asking Stephen if it mattered to him if Jack cut through the woman’s well-healed thoracotomy scar, Jack carried out a modified Y autopsy incision just as he had done on Carol Stewart.
Jack worked quickly and efficiently. Although he knew everyone present was interested exclusively in the heart, he followed his usual routine and first did the abdomen. Jack never varied the order he followed in his autopsies, to make sure he never forgot any step. He explained this to his audience, and they all said they understood. Stephen and Ted acted subdued as the case progressed, which was understandable, as autopsies were not part of their normal routine, and to the uninitiated they were brutal.
After checking the entire length of the digestive tract in situ, Jack removed the intestines and handed them off to one of the techs to wash out. He then inspected the rest of the abdominal contents. The only pathology he found were the signs of mild inflammation with extravasated blood in the gallbladder, spleen, and kidneys. He informed the group that Carol Stewart had the same findings, which he explained were later determined by microscopic section to have a mild amount of disseminated intravascular coagulation.
“Was it about the same amount of inflammation with Carol?” Ted asked, as Jack held up the cut surface of the kidney so it could be more clearly seen.
“I’d say nearly identical,” Jack said. “When I first saw it, I thought of hantavirus, as it’s a typical finding in those particular organs in fatal hantavirus pulmonary syndrome. But rapid tests for hantavirus were negative, as were tests for all the other respiratory viruses.”
“Can we move along here?” Stephen said. “Han and I have a case on a live person pending at noon.”
Jack didn’t respond. He was already working significantly faster than he knew most prosectors functioned. In his current sensitive state, hecouldn’t help but be mildly annoyed at Stephen’s increasingly impatient and condescending air, which was becoming progressively apparent and which hadn’t been present yesterday.
Taking the heavy-duty wire cutters he’d requested at the outset of the case, Jack proceeded to cut through the wires holding Margaret’s sternum together. They made a distinctive metallic snap as each one was cut. Harvey then participated by pulling each wire out with a pair of pliers. When the last wire was cut, the sternum split apart with an audible pop.
Using a couple of towels against the jagged cut surfaces of the sternum, Jack yanked them apart with a decisive cracking noise, which he knew was the sound of breaking ribs. The thorax was now completely exposed and mostly filled by the pale, swollen lungs. Shielded by its scarred pericardial cover, the heart was not yet in view. Jack left the towels in place to avoid anyone cutting themselves on the sharp edges of bone.
Stephen leaned over the open wound. “Do you mind if I palpate the pericardium?” he asked.
“Be my guest,” Jack said. He was surprised the surgeon had asked. It seemed out of character with his controlling personality.
