Jack felt his face suffuse with color as his blood pressure headed north. Not only was Aria’s language threatening to drive him up the wall, so was her total lack of empathy for this victim of a horrible crime and possibly a therapeutic complication. He was at a definite crossroads: Either he was going to bodily toss this antisocial woman out of the autopsy room, or he was going to have to accept that some of his old beliefs needed to be updated and modified with the times. In his mind he counted to ten as he reminded himself of his promise to Laurie not to make the Aria Nichols situation worse. Throwing her out of the autopsy room would definitely cross that line.
“Somebody must have screwed up over there in the Bellevue ICU big-time,” she continued. For the first time since she’d marched into the room, she looked Jack in the eyes. “I was over there yesterday and was told she was stable and doing well. How the fuck could she die? She was a healthy young woman as far as I know.”
“How she died is what we need to find out,” Jack managed. He had to restrain himself from dashing out of the autopsy room to find something to vent his anger on just to get himself under control.
“Where’s the goddamn folder?” Aria demanded, as if she were in charge, and seemingly totally oblivious of the effect she was having on Jack.
“It’s over on the countertop,” Vinnie said, pointing.
Aria strode over, flipped it open, and rummaged through the contents until she found Bart Arnold’s investigative report. She pulled it out and started reading. Meanwhile Jack and Vinnie exchanged another glance but didn’t speak. Vinnie could tell just by looking at Jack that he was struggling with his self-control, and Vinnie didn’t want to become the spark that ignited a conflagration.
“Ventricular fibrillation!” she called out when she finished reading. She replaced the investigative report in the file and came back to the table. Neither Jack nor Vinnie had moved.
“In my book, ventricular fibrillation is a diagnostic sign, not a diagnosis,” she added. For the first time her voice was calm and reflective, as if her anger had somehow evaporated after reading the MLI report.
“You’re right,” Jack managed to say. Somehow, he was finding the strength to avoid an explosive confrontation with this insensitive, self-centered woman. What helped was her sudden change of tone along with her avoidance of any further vulgarities, making him optimistically wonder if perhaps they had reached a secret bargain. Hoping to start a reasonable conversation, he said, “What are your thoughts about the causes of ventricular fibrillation?”
“Are you gearing up to provide me with another lecture?” Aria asked in a supercilious tone. “If you are, I’d prefer you don’t, if you don’t mind.”
“I’m just trying to understand your thinking before you begin doing the autopsy,” Jack said.
Aria eyed Jack with obvious surprise. “Are you suggesting that you want me to do the autopsy?” she asked hesitantly.
“That’s what I have in mind.” It had been a sudden decision when he remembered Laurie’s comment about the pathology resident’s rotation not being challenging enough. He also recalled Laurie’s compliments about Aria’s prosecting ability. Combining the two by giving her more responsibility had suddenly suggested itself as a way to deal with her aggravating antisocial eccentricities.
“Well, that’s a step in the right direction,” she said. “Okay, here’s what I think. In general, the causes of ventricular fibrillation are usually related to preexisting heart disease of some sort, like a previous heart attack or a congenital heart defect or the history of a channelopathy. Of course, cardiomyopathy could cause VF, too, as well as somedrugs like cocaine or methamphetamine. The only other things I’d keep in mind are the possibility of electric shock from some malfunctioning hardware or electrolyte abnormalities with potassium, magnesium, or calcium.”
“Very well said,” he remarked with surprise. He was actually impressed and for a beat stared at her, thinking she was a piece of work yet clearly medically knowledgeable despite her behavioral issues. “With all that in mind, what might you be expecting to find on this case?”
“Statistically I’d put money on previous heart disease either acquired or congenital,” Aria said. “Probably the most important part of the forensic autopsy will involve the careful examination of the heart. But knowing she was on intravenous fluid in an ICU unit for almost twenty-four hours, I’d want to get electrolyte levels and a toxicology screen. And there is always the possibility of deep vein thrombosis and embolism, especially after the trauma she suffered.”
“Vinnie! Would you mind handing the lady a scalpel?” Jack said. “Time’s a-wastin’. Let’s get this show on the road!”
CHAPTER 28
May 10th
7:52A.M.
Similar to Laurie’s assessment, Jack found Aria to be a talented prosector. She handled the scalpel with confidence and precision. Although he was prepared to offer criticism or suggestions about her technique, he didn’t feel it was necessary. Best of all from his perspective, she became totally engrossed and worked silently, so his ears had a break from the vulgar language. In short order she had the body open with the breastbone, ribs, and intestines in view. Taking bone shears from Vinnie, she quickly cut through the ribs, exactly as Jack would have done, and reflected the breastbone cephalad. Jack generally removed the breastbone, but it wasn’t necessary, and he didn’t interfere. Next Aria reflected the thymic fat pad to expose the pericardium of the heart.
“It all looks normal to me,” she said to no one in particular as she proceeded to run the balls of her fingers over the heart still covered by its pericardium. Without looking up at Jack, she asked him if he wanted to feel it as well.
“It’s not necessary,” Jack said. “I trust your judgment, and it looks normal to me, too.”
Wasting no time, Aria took a couple of clamps and dissecting scissors from Vinnie and opened the pericardium to expose the heart itself. Using her right hand, she palpated the softball-size organ and commented that it, too, seemed entirely normal. After she pulled her hand away, Jack reached in and did the same, with the same conclusion. Taking a large syringe outfitted with a fourteen-gauge needle, Aria lifted the base of the heart high enough to get a look at the posterior aspect of the left atrium. After inserting the needle through the atrial wall, she took a sizable blood sample for Toxicology.
With that job out of the way, she double-clamped all the major cardiac veins and arteries and cut them, freeing up the heart. While she did this, she used the opportunity to look for any large clots, particularly in the veins. “So far no emboli,” she announced. She then lifted the heart out of its bed, where it had been nestled between the two lungs. She weighed it and then put it on a cutting board that Vinnie had brought over along with a standard butcher knife. During the next fifteen minutes Aria carefully opened the heart to peer at the various heart valves. Then using fine dissecting scissors, she began painstakingly tracing out each coronary artery.
Around 8:15 other medical examiners and mortuary techs started to appear in the autopsy room to begin their cases. A number of them detoured to take a peek at the subway case because of its morbid appeal. Those who did asked a few questions, and some even indulged in a bit of dark humor. But each interaction was short-lived as Jack made it plain that he was intent on watching Aria. That was the case until Chet showed up when she was busy with the coronary arteries. Sensing it was an opportune moment, Jack pulled Chet to the side, out of her earshot.
“My God,” Jack said under his breath. “She is a trip!”
“I told you so,” Chet said with apparent satisfaction.
“I almost lost it when we first started,” Jack said. “In retrospect, I’membarrassed my reaction was so over the top. I came close to literally throwing her out of the pit. Her language would make the proverbial sailor blush.”
“Tell me about it.” Chet chuckled behind his hand.
