Noelle relaxed to a degree. "I can't say particularly, since cyanosis is a frequent sign seen with severe cardiac illness."
"The ER nurse wrote in the notes the patient had central cyanosis. I mean, she specifically said 'central' cyanosis."
"Listen, when the patient got here, she was close to death, with dilated pupils, completely flaccid body, and a pronounced brachycardia with total AV black. Her heart could not be externally paced. She was on death's door. Cyanosis was just part of the whole picture."
"Well, thanks for talking with me," Jack said. He stood.
"You're welcome," Noelle responded.
As Jack made his way back down to the emergency room, he was even more pessimistic about the outcome of the case than he'd been earlier. Dr. Noelle Everette was going to be a powerful expert witness for the plaintiff, not only because of her expert status as a cardiologist but also because she was articulate and a dedicated physician, and because she had been directly involved in the case. "Times have changed," Jack murmured out loud, thinking that it used to be hard to find a doctor to testify against another doctor. It seemed to him that Noelle was looking forward to testifying, and despite what she'd said, part of her motivation was antipathy toward concierge medicine.
By the time Jack got back to the ER, the shift had changed. Although the ER was still peaceful, Jack had to wait to talk with the nurse and the doctor while they got themselves updated on the patients present who were waiting for test results or for the arrival of their personal physicians. It was close to three thirty when Jack finally was able to sit down with them in a small staff lounge area directly behind the admitting desk. Both were young. Jack guessed early thirties.
Jack said essentially the same thing he'd said to Noelle at the outset, but the emergency-room staff's response was much less emotional or censorious. In fact, Georgina, in her bubbly style, professed to have been greatly impressed by Craig.
"I mean, how many doctors arrive at the ER riding with the patient in the ambulance? I can tell you: not many. The fact that he's being sued is a travesty. It shows how far out of whack the system is when doctors like Dr. Bowman are ambushed by the likes of the ambulance-chaser lawyer on the case. I can't remember his name."
"Tony Fasano," Jack offered. He was enjoying hearing someone who shared his thoughts, although he wondered if Georgina had heard the social side of Craig's tale, especially since Leona had come to the ER that fatal night.
"That was it: Tony Fasano. When he first came snooping around here, I thought he was an extra in one of those gangster movies. I really did. I mean, I couldn't imagine he was for real. Did he really go to law school?"
Jack shrugged his shoulders.
"Well, it wasn't Harvard, I can tell you that. Anyway, I can't imagine him calling me as a witness. I told him exactly what I thought of Dr. Bowman. I think he did a great job. He even had a portable ECG machine and had already tested for biomarkers before they arrived here at the ER."
Jack nodded as Georgina spoke. He'd read all this in her deposition in which she'd fulsomely praised Craig.
When she fell silent, Jack said, "What I wanted to talk to you people about was the cyanosis."
"What about the cyanosis?" Dr. Matt Gilbert asked. It was the first time he'd spoken. His laid-back personality was overwhelmed by Georgina 's vivacity.
"You remember the cyanosis, silly," Georgina said, giving Matt a playful slap on the shoulder before Jack could speak. "She was as blue as a blue moon when they brought her in here."
"I don't think that expression has anything to do with color," Matt said.
"It doesn't?" Georgina questioned. "Well, it should."
"Do you not remember the cyanosis?" Jack asked Matt.
"Vaguely, I suppose, but her general condition trumped everything else."
"You described it as 'central cyanosis' in your notes," Jack said to Georgina. "Was there some specific reason for that?"
"Well, of course! She was blue all over, not just her fingers or legs. Her whole body was blue until they got her on oxygen with the respirator and started doing cardiac massage."
"What do you think might have been the cause?" Jack asked. "Do you think it could have been a right-to-left shunt or maybe severe pulmonary edema?"
"I don't know about a shunt," Matt said. "But she didn't have any pulmonary edema at all. Her lungs were clear."
"One thing I remember," Georgina said suddenly. "She was completely flaccid. When I started another IV line, her arm was like a rag doll's."
"Is that unique, in your experience?" Jack asked.
"Yeah," Georgina said. She looked at Matt for confirmation. "There's usually some resistance. I guess it varies with the degree of consciousness."
"Did either of you see any petechial hemorrhages in her eyes, any strange marks on her face or neck?"
Georgina shook her head. "I didn't." She looked at Matt.
"I was worrying too much about the big picture to see any such details," Matt said.
"Why do you ask?" Georgina questioned.
"I'm a medical examiner," Jack explained. "I'm trained to be cynical. Smothering or strangulation has to be at least considered in any sudden death with cyanosis."
"Now that's a new angle," Georgina said.
"A biomarker assay confirmed a heart attack," Matt said.
"I'm not questioning there was a myocardial infarction," Jack said. "But I'd be interested if something other than a natural process brought it on. Let me give you an example. I once had a case of a woman, arguably a few years older than Mrs. Stanhope, who had a heart attack immediately after being robbed at gunpoint. It was easy to prove a temporal connection, and the perpetrator is sitting on death row to this day."
"My word!" Georgina said.
After giving both individuals a business card that included his cell phone number, Jack headed back to his car. By the time he unlocked the door and climbed in, it was after four o'clock. He sat for a moment, looking out at the small pond. He thought about his conversation with the hospital staff, thinking it was a wash in regard to Craig's cause between Noelle and Georgina, with one avidly for and one avidly against. The trouble was that Noelle was surely going to testify, whereas Georgina, as she expected, probably would not since she wasn't on the defense list. Other than that, he hadn't learned much, or if he had, he was too dumb to recognize it. One thing was for certain: He'd liked and was impressed by all these people, and if he got into an accident and was brought in there, he'd feel he was in good hands.
Jack thought about his next move. What he would have liked to do was drive back to the Bowman house, suit up in his basketball gear, and have a run with David Thomas, Warren 's friend, over on Memorial Drive. But realistically speaking, Jack knew that if there were any chance of his contributing to the case by doing an autopsy on Patience Stanhope's earthly remains, he had to force himself to face Jordan Stanhope with the idea of getting him to sign the exhumation permit. The problem was how to get him to do it short of procuring a pistol and holding it to his temple. Jack could not think of a single reasonable stratagem and ultimately resigned himself to ad-libbing while trying to appeal to the man's sense of justice and fairness.
Jack took out the three-by-five index card that Harold Langley had given him with Harold's cell phone number and Jordan Stanhope's address. Balancing it on the steering wheel, he picked up the trusty Hertz map and tried to find the street. It took a bit of patience, but he located it near both Chandler Pond and Chestnut Hill Country Club. Assuming that the court would have recessed somewhere in the three thirty to four o'clock range, he thought now would be as appropriate a time as any to drop in for a visit. Whether he'd get into the man's house or not he had no idea, but it wasn't going to be for lack of trying.