Having sized up Susan, the taller resident went back to work. He reached into the tangle of organs with his left hand, grasping the liver. His right hand gripped a large, razor-sharp butcher knife. A few strokes freed the liver from the other organs. The liver made a sloshing sound as it oozed into the scale. The resident stepped on a foot pedal on the floor, speaking into the microphone. “The liver appears reddish brown with a lightly mottled surface, period. The gross weight is… a… two point four kilograms, period.” He then reached into the pan and lifted the liver out, dropping it back into the basin.
Susan descended several steps toward the group. The smell was slightly fishy; the air seemed greasy and heavy, like an uncleaned bus depot restroom.
“The liver consistency is more firm than usual but definitely pliant, period.” The knife flashed in the light and the liver surface separated. “The cut surface demonstrates an enhanced lobar pattern, period.” The knife sliced across the liver in four or five more places, then finally cut a piece out of the center. “The cut specimen demonstrates the usual friable character, period.”
Susan moved up to the foot of the table. The sucking drain was directly in front of her. The taller resident on the left reached into the basin for another organ but he stopped when the moustached resident spoke.
“Well, hello…”
“Greetings,” said Susan; “sorry to bother you.”
“No bother. Join the party, except we’ve almost finished.”
“Thanks, but I’m happy to just watch. Is this Crawford or Ferrer?”
“This is Ferrer,” said the resident. Then he pointed at the other body. “That’s Crawford.”
“I was wondering if you’ve determined a cause of death.”
“No,” said the taller resident. “But we haven’t opened the lungs on this case yet. Crawford was clean grossly. Maybe the microscopic sections will shed some light.”
“Do you expect something in the lungs?” asked Susan.
“Well, from the history of apparent respiratory arrest, we were considering pulmonary embolism. But I don’t think we’re going to find anything, though. Maybe there’ll be something in the brain sections.”
“Why don’t you think you’ll find anything?”
“Well, because I’ve posted a few cases like this before, and I’ve never found anything. And the history is exactly the same. Relatively young, somebody comes by and they’re not breathing. There’s a resuscitation attempt but without luck. Then we get them, or at least after the medical examiner turns them over to us.”
“About how many such cases would you estimate?”
“Over what time span?”
“Whatever… a year, two years.”
“Maybe six or seven over the last two years. I’m guessing.”
“And you don’t have any ideas about the cause of death?”
“Nope.”
“None?” asked Susan, a bit surprised.
“Well, I think it’s something with the brain. Something turns off their breathing. Maybe a stroke, but I did brain sections like you wouldn’t believe on two similar cases.”
“And?”
“Nothing. Clean as a whistle.”
Susan began to feel a bit queasy. The atmosphere, the smell, the images, the noises all joined forces to make her feel lightheaded and she shuddered with a mild wave of nausea. She swallowed.
“Are the hospital charts for Ferrer and Crawford down here?”
“Sure, they’re in the coffee room through the lab.”
“I’d like to look at them for a few minutes. If you find anything significant, would you give me a yell? I’d be interested in seeing it.”
The taller resident lifted the heart and placed it on the scale. “These your patients?”
“Not exactly,” said Susan, starting toward the exit, “but they might be.”
The taller resident looked quizzically over at the other as Susan left. His companion was watching Susan exit, trying to figure out a smooth way of getting her name and number.
The coffee room could have been anywhere in the hospital. The coffee machine was an ancient device, the paint on one side burned and the wire frayed to the point of being a real hazard. The countertop desk along both side walls was spread with charts, paper, books, coffee cups, and a welter of ballpoint pens.
“That was quick,” said the resident who had been staining the slides. He was sitting at one of the desks, with a half-filled cup of coffee and a half-eaten doughnut. He was busy signing a large stack of typed pathology reports.
“Autopsies are apparently too much for me,” admitted Susan.
“You get used to it, like everything else,” said the resident, stuffing more doughnut into his mouth.
“Possibly. Where would I look for the charts of the patients they are posting?”
The resident washed down the doughnut with coffee, swallowing with some effort.
“In that shelf marked ‘Post.’ When you finish with them, put them over there in the shelf marked ‘Medical Records’ because we’re finished with them.”
Turning to the rear wall, Susan faced a series of cubic shelves. One of the shelves was marked “Post.” On it she found Ferrer’s and Crawford’s charts. Clearing one of the desks of debris, Susan sat down and took out her notebook. At the top of an empty page she wrote, “Crawford,” on the top of another page she wrote, “Ferrer.” Methodically she began to extract the charts as she had done with Nancy Greenly’s.
17
Tuesday, February 24, 8:05 A.M.
Susan had found it unbelievably difficult to emerge from the warmth and comfort of her bed when the radio alarm went off the following morning. The fact that it was a Linda Ronstadt selection was a big help in that it caused some degree of pleasant association in Susan’s mind and instead of turning the radio off, she lay there and let the sounds and rhythm course through her. By the time the song was over Susan was fully awake, her mind beginning to race over the events of the previous day. The night before, at least until three A.M., had been passed in deep concentration with the large pile of journal articles, the books on anesthesiology, her own internal medicine book, and her clinical neurology text. She had amassed an enormous amount of notes, and her bibliography had increased to some one hundred articles that she planned to drag from the library stacks. The project had become more complex, more demanding, yet at the same time more fascinating, more absorbing. As a consequence Susan had become even more determined, and she realized that she was going to have to accomplish a great deal that day.
Shower, dressing, and breakfast were dispatched with commendable speed. During breakfast, she reread some of her notes, realizing that she would have to reread the last few articles she had read the night before.
The walk to the MBTA stop on Huntington Avenue proved to Susan that the weather had not changed and she cursed the fact that Boston had to be situated so far north. With luck she found a seat on the aging street car and was able to unfold a portion of her IBM printout. She wanted to check once more the number of cases which it suggested.
“Good to see you, Susan. Don’t tell me you’re going to go to lecture today?”
Susan looked up into the grinning face of George Niles, who was holding on to the bar above her head.
“I’d never miss lecture, George; you know that.”
“Looks like you missed rounds. It’s after nine.”
“I could say the same to you.” Susan’s tone hovered between being friendly and combative.
“I was told in no uncertain terms that I had to be seen in Student Health to rule out a comminuted compound skull fracture from yesterday’s gala event in the OR.”
“You are OK, aren’t you?” asked Susan with genuine sincerity and concern.