“Are you looking forward to doing this autopsy?” Laurie asked as she pulled into the Bennet Clinic’s parking lot. She’d insisted on driving.
“I am,” Jack admitted. “Are you?”
“Without doubt,” Laurie said. “You know me. I’ve been starved for intellectual forensic challenge with all the politics I’ve been smothered with. But how do you think we should handle this? Should we essentially do the case to show him how it should be done or let him do it and make comments?”
“That’s a good question, but I think it’s six of one, half a dozen of the other. Maybe we should ask him what he thinks would be the most helpful for him. I don’t care however we do it.”
“Good point,” Laurie said as they climbed out of the Jeep. “I notice Bob’s car is not here yet.”
“I noticed that, too, but he warned us he’d be making hospital rounds on his inpatients, which he does every morning. I give him a lot of credit. I don’t know how he does all this solo, meaning he’s on call twenty-four seven. And with the state of clinical medicine thanks to the inroads of private equity along with the ungodly power of health insurance companies, it’s a constant challenge just to stay afloat. All I can say is that I am so thankful I’m not still caught up in that rat race, which I had been back when I was a practicing ophthalmologist.”
“I’m glad to have never had to deal with it,” Laurie said as she pulled open one of the Bennet Clinic’s double doors and gestured for Jack to enter ahead of her. “Even as a medical student I could see the writing on the wall about what was happening to clinical medicine.”
They were moderately surprised not to find Melanie Hopkins at her reception desk in the waiting room as she had told them thatshe generally arrived about 8:00a.m. Instead they found her back in the autopsy room busily setting up for the morning by laying out the tools and specimen bottles. She was already dressed for the autopsy with a surgical gown over her street clothes. Bob had told them that he and she had been learning to do autopsies together and that she was a quick study thanks to her extensive and varied nursing background. He’d fully admitted there was no way he could possibly do all he did without her invaluable input.
“How would you people like to outfit yourselves?” Melanie asked. “We have scrubs if you so desire. Bob and I usually just use heavy surgical gowns and impermeable aprons over our street clothes, plus face shields and booties.”
“That will be fine for me for the kind of case we’ll be doing,” Laurie said, glancing at Jack. Both were in casual summer shirts and jeans.
“Ditto,” Jack said.
“Actually, we’ll be doing two cases this morning not just one, provided it’s okay with you guys,” Melanie said apologetically. “Last evening one of the recent, rapid dementia patients Bob has been following passed away, and he hopes you’ll be willing to do it after Ethan Jameson.”
“No problem,” Laurie said. She looked at Jack and he nodded a definite yes.
“I just spoke with Bob a few minutes ago,” Melanie added. “He’s finished his rounds and on his way. He’ll be here momentarily. Also, there’s coffee back in his office, and it’s fresh. I make it every morning when I arrive.”
“We’ve had our coffee,” Laurie said. “In fact, thanks to Bob’s welcoming efforts we’ve had wonderfully full breakfasts.”
“Perfect,” Melanie said. “As you can see, I’ve laid out the usualautopsy tools that we use.” Melanie gestured toward the wheeled instrument tray. “Please let me know if there’s anything special you might want.”
“It looks to me like you have the basics,” Laurie said, glancing over the instruments.
“Let me show you where the gowns and aprons are,” Melanie said, waving for Jack and Laurie to follow her into the changing room, but she only got a few steps before Bob and his commanding presence swept into the room.
“Good morning! Good morning,” he repeated loudly with great enthusiasm. “How is everyone this glorious Essex Falls day and how was your night’s rest at the Hiram House?”
“It couldn’t have been better,” Jack said. “Seriously! We slept like a couple of logs, as the saying goes, and you’re spoiling us rotten with the marvelous breakfast makings you provided, not to mention the fabulous double-thick lamb chops last night. I didn’t know I was such a lamb fan.”
“I didn’t either until I had lamb loin chops,” Bob said. “Leg of lamb not so much. But switching gears: Did Melanie fill you in about the potential second autopsy this morning?”
“She did indeed,” Laurie said. “We’re happy to do it.”
“Terrific,” Bob said. “I was hoping you wouldn’t mind, and I didn’t want the news to spoil our evening. It’s sad to lose yet another Essex Falls resident to these curious and disturbing recent cases of early-onset and rapidly progressive dementia, but the timing in relation to your visit is too opportune to pass up. I was going to be consulting with you later today about the previous two deaths and the autopsies Melanie and I did on them, but this way you will be able to see for yourselves firsthand.
“I’ve been at a total loss of how to explain this apparentoutbreak, if it is an outbreak; I mean, it is possible they are just a series of unrelated, sporadic dementia cases. But if they’re not, I question what I should be doing in my dual roles as the only doctor here in Essex Falls as well as the Hamilton County coroner. I’ve already officially reported the situation in writing to the state health authorities in both capacities, but they have yet to advise me on what they are going to do or what I should do. So far I’ve had a total of about a dozen cases of what seems to be an early and unusually rapidly progressive Alzheimer’s-like dementia. Isn’t that true, Melanie?”
“A dozen exactly,” Melanie confirmed. “But just yesterday I scheduled upcoming appointments this afternoon for what sounds like might be yet two more cases. So, the total might rise to fourteen.”
“My word! It all sounds intriguing,” Laurie said. “The two previous autopsy cases were the ones you thought were Alzheimer’s, but NMS Labs reported them to be negative.”
“That’s right,” Bob said. “Grossly and microscopically they looked to me like Alzheimer’s.”
“When you say ‘early’ do you mean the patients are young?” Laurie asked.
“Correct,” Bob said. “Today’s autopsy is forty-eight years old.”
“That’s definitely young for Alzheimer’s,” Laurie agreed. “And what exactly do you mean by ‘rapidly progressive’? What’s the time frame?”
