“I don’t know,” Vinnie questioned. “I kind of doubt it, considering that skull fracture.”
“You’re right,” Jack said. “I wasn’t being literal because she was probably knocked out cold. But she looks a hell of a lot better than my last subway victim, who appeared as if he’d been practically skinned alive.”
Using one of the digital cameras, Jack took photos of all the injuries. He also drew them on a schematic diagram and indicated their size and location by referencing various anatomical landmarks. As he was finishing taking urine and vitreal samples, he caught sight of Dr. Nichols pushing in through the swinging entrance doors. Jack was surprised. It was only 7:38, an hour earlier than yesterday. He watched her as she approached, noticing even from a distance that she had an aura of confidence, almost arrogance, as if she owned the place. Jack girded himself, sensing that the morning might be more difficult than he’d anticipated.
Without acknowledging either Jack or Vinnie, Aria marched up to the autopsy table, gloved hands and arms akimbo. She stared down at the cadaver. Jack and Vinnie exchanged a glance, during which Vinnie rolled his eyes.
“Holy fuck,” Aria said to no one in particular. Vinnie winced as if he’d been slapped, knowing what Jack’s response was going to be to her choice of words.
“Excuse me?” Jack blurted. He’d heard but wanted to pretend otherwise. He thought he’d prepared himself for this woman, but it was obvious he hadn’t. With great effort he controlled himself and merely said: “Dr. Nichols, such language offends me, and I have to ask you not to use it. I’m old-school, and I find it disrespectful to me, to this patient, and to the institution.”
“I know this woman,” she said, ignoring Jack’s comment. She was still staring at the body on the autopsy table and acting as if she were angry.
“Did you hear what I said?” Jack pressed.
“This is fucking unbelievable,” Aria said, seemingly hypnotized and angered by the sight of Madison Bryant’s body. “I know this woman. She was supposed to help me with the Jacobsen case I did two days ago, since she worked with her and was her goddamn best friend. I don’t believe this! First, she goes and gets herself hit by a train and now she fucking dies. What is this, a conspiracy?”
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 some drugs 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
7:52 A.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.