Robin Cook – Vital Signs

The patient in this case had been brought to the Memorial by ambulance for a brief resuscitation attempt but the woman had been declared DOA. Then the body had sat in cold storage. It was supposed to have been sent to the medical examiner’s office, but between a rash of shootings and other trauma, the ME had been swamped. Finally, a request had come through for them to do the post at the Memorial and Ken’s chief had gladly agreed.

It was always politically wise to stay on the ME’s good side. You I never knew when a return favor would be needed.

With his gloved. left hand providing counter traction Greg was about to make the typical Y-shaped autopsy incision when Ken told him to hold up.

“Have you gone over the chart?” Ken asked.

“Of course,” Greg said, almost hurt by the implication.

“So you know about this infertility stuff?” Ken asked while he was still reading.

“The in-vitro attempts and the blocked tubes.”

Blocked tubes had rung a bell, and Ken recalled Marissa’s visit.

“Yup, and she looks like a pincushion because of it,” Greg said.

Ken glanced at the body as Greg pointed to the multiple hormone-injection sites as well as the multiple bruises where blood had been drawn to measure estrogen levels.

“Ouch,” Ken said, looking down.

“And here’s a fresh one,” Greg said, pointing to the crook of the left elbow.

“See the heme staining under the skin? She had blood drawn within hours of her jumping out the window.

Couldn’t have been from our ER. She was dead when she arrived.”

Slowly, the doctors’ eyes met. They were thinking the same thought. The patient certainly wasn’t a drug addict.

“Maybe we should extend the toxicology screen,” Greg said ominously.

“Just what I was about to suggest,” Ken said.

“Remember, we’re being paid to be suspicious.”

” You’re being paid,” Greg laughed.

“As a resident, my salary is more like alms.”

“Oh, come on!” Ken said.

“When I was at your stage..

“Spare me,” Greg said, holding the knife aloft. He laughed.

“I’ve already heard what medicine was like in medieval times.”

“What about the evidence of the trauma from the faUT’ Ken asked.

Rapidly, Greg ticked off the external signs of impact. It was apparent that both legs were broken, as was the pelvis. The right wrist was also bent at an abnormal angle. The head, however, was intact.

“All right,” Ken said, “cut away.”

With a few deft strokes, Greg used the razor-sharp knife to cut through the skin, exposing the omentum-covered intestines.

Then, with large clippers, he cut through the ribs.

“Uh-oh!” Greg said, lifting off the manubrium, or breastbone.

“We got some blood in the chest cavity.”

“What does that suggest?” Ken asked.

“I’d say aortic rupture,” Greg said.

“Six stories could have generated the two thousand pounds of force necessary.”

“My, my,” Ken teased, “you must be doing some extracurricular reading.”

“Occasionally,” Greg admitted.

Carefully, the two men extracted the blood from both lung cavities.

“Maybe I’m wrong about the aortic rupture,” Greg said, staring at the graduated cylinder when they were done.

“Only a few hundred cc’s.”

“I don’t think so,” Ken said. He withdrew his hand from inside the chest cavity.

“Feel along the aortic arch.”

Looking up at the ceiling as he concentrated on feel, Greg palpated along the aorta. His finger slipped inside. It was an aortic rupture, all right.

“You have promise as a pathologist after all,” Ken said.

“Thanks, all-seeing, all-knowing Karnak the Magnificent,” Greg joked, though he was obviously pleased with the compliment.

He turned his attention to the evisceration of the corpse.

But as he worked, his forensic mind was beginning to set off alarm bells in his head. There was something wrong with this case; something very wrong.

Having gone through an embryo transfer before, Marissa knew what to expect. There wasn’t much pain involved, especially in comparison with the myriad procedures she’d been enduring over the year, but it was still an uncomfortable and humiliating exercise. To keep her uterus in a dependent position, she had to lie prone with her knees raised to her chest and with her rear end sticking up in the air. Although she had a sheet draped over her, Marissa felt completely exposed. The only people present were Dr. Wingate, his nurse-technician, Tara MacLiesh, and Mrs. Hargrave. But then the door opened and Linda Moore came in. The fact that people could come in and out was part of the reason Marissa felt so vulnerable.

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