The undulating sound of the approaching ambulance could be heard in the distance. Jordan left to go downstairs to let in the emergency technicians and direct them up to Patience’s room.
“Is she going to make it?” Leona asked as she continued compressing the Ambu bag. “She doesn’t look quite as blue to me.”
“You’re doing a great job with that breathing bag,” Craig responded. “But I’m not optimistic, since her pupils haven’t come down, and she’s so flaccid. But we’ll know better when we get her over to Newton Memorial Hospital, get some blood work, get her on a respirator and a pacer. Would you mind driving my car? I want to ride in the ambulance in case she arrests. If she needs CPR, I want to do the chest compressions.”
The EMTs were an efficient team. It was a man and a woman who obviously had worked together for some time, since they anticipated each other’s moves. They swiftly moved Patience to a gurney, brought her downstairs, and loaded her into the ambulance. Within just a few minutes of their arrival at the Stanhope residence, they were back on the road. Recognizing a true emergency, they had the siren screaming and the woman drove accordingly. En route, the male EMT phoned ahead to Newton Memorial to advise them of what to expect.
Patience’s heart was still beating, but barely, when they arrived. A staff cardiologist whom Craig knew well had been summoned, and she met them on the unloading dock. Patience was rolled inside with dispatch, and an entire team began to work on her. Craig told the cardiologist what he could, including the results of the biomarker assay confirming the diagnosis of myocardial infarction, or heart attack.
As Craig had anticipated, Patience was first put on a respirator with one hundred percent oxygen followed by an external pacemaker. Unfortunately, it was quickly confirmed that she then had the problem of PEA, or pulseless electrical activity, meaning the pacemaker was creating an image on the electrocardiogram but the heart was not responding with any beats. One of the residents climbed up onto the table to start chest compressions. Blood work came back and the blood gases were not bad, but the acid level was close to the highest the cardiologist had ever seen.
Craig and the cardiologist looked at each other. Both knew from experience that PEA had a dismal outcome with a hospital inpatient, even when caught quickly. The situation with Patience was far worse, since she had come in by ambulance.
After several hours of attempting all possible efforts to get the heart to respond, the cardiologist took Craig aside. Craig was dressed in his formal shirt, complete with bow tie still in place. Blood spatter adorned the upper part of his right arm, and his tuxedo jacket hung on a spare IV pole against the wall.
“It must have been extensive cardiac muscle damage,” the cardiologist said. “It’s the only way to explain all the conduction abnormalities and the PEA. Things might well have been different if we had been able to start on her a bit sooner. From your description of the time course, I imagine the size of the initial infarct significantly grew.”
Craig nodded. He looked back at the team that was still doing cardiopulmonary resuscitation on Patience’s slim frame. Ironically, her color had returned to near normal with the oxygen and the chest compressions. Unfortunately, they had run out of things to try.
“Did she have a history of cardiovascular disease?”
“She had an equivocal stress test a month ago,” Craig said. “It was suggestive of a mild problem, but the patient refused any follow-up studies.”
“To her detriment,” the cardiologist said. “Unfortunately, her pupils have never come down, suggesting anoxic brain damage. With that in mind, what do you want to do? It’s your call.”
Craig took in a deep breath and let it out noisily as a reflection of his discouragement. “I think we should stop.”
“I agree one hundred percent,” the cardiologist said. She gave Craig’s shoulder a reassuring squeeze, then walked back to the table to tell the team it was over.
Craig got his tuxedo jacket and walked over to the ER desk to sign the paperwork indicating the patient was deceased and that the cause was cardiac arrest following myocardial infarction. Then he went out into the emergency room waiting area. Leona was seated among the sick, the injured, and their families. She was flipping through an old magazine. Dressed as she was, she appeared to Craig like a nugget of gold among nondescript gravel. Her eyes rose up as he approached. He could tell she read his expression.
“No luck?” she said.
Craig shook his head. He scanned the waiting area. “Where is Jordan Stanhope?”
“He left over an hour ago.”
“Really? Why? What did he say?”
“He said he preferred to be at home, where he would await your call. He said something about hospitals depressing him.”
Craig gave a short laugh. “I guess that’s consistent. I always thought of him as a rather cold, odd duck who was just going through the motions with his wife.”
Leona tossed aside the magazine and followed Craig out into the night. He thought about saying something philosophical about life to Leona but changed his mind. He didn’t think she’d understand, and he was worried he wouldn’t be able to explain it. Neither spoke until they got to the car.
“Do you want me to drive?” Leona asked.
Craig shook his head, opened the passenger door for Leona, then walked around and climbed in behind the wheel. He didn’t start the car immediately. “We obviously missed the concert,” he said, staring out through the windshield.
“To say the least,” Leona said. “It’s after ten. What would you like to do?”
Craig didn’t have any idea. But he knew he had to call Jordan Stanhope and wasn’t looking forward to it.
“Losing a patient must be the hardest thing about being a doctor,” Leona said.
“Sometimes it’s dealing with the survivors,” Craig responded, without any idea how prophetic his comment would turn out to be.
NEW YORK, NEW YORK
7:10 p.m.
Dr. Jack Stapleton had been sitting in his cramped office on the fifth floor of the Office of the Chief Medical Examiner for more hours than he was willing to admit. His office mate, Dr. Chet McGovern, had deserted him just after four when Chet left for his workout at his posh Midtown gym. As was often the case, he’d badgered Jack to come along with glowing tales of the newest batch of nubile female members in his body-sculpting class with their skintight outfits that left nothing to the imagination, but Jack had begged off with his customary rejoinder that he preferred being a participant rather than an observer when it came to sports. He couldn’t believe that Chet could still laugh at what had become such a hackneyed comeback.
At five o’clock Dr. Laurie Montgomery, Jack’s colleague and soul mate, had poked her head in to say she was heading home to shower and change for the romantic rendezvous Jack had arranged for the two of them that evening at their favorite New York restaurant, Elio’s, where they had had a number of memorable dinners over the years. She had suggested he come along to freshen up as well, but he again begged off, saying he was swamped with work and he’d meet her at the restaurant at eight. Unlike Chet, she didn’t try to change his mind. From her perspective, it was such a rare event for Jack to be so resourceful on a weeknight that she wanted to bend over backward in hopes of encouraging such behavior. His usual evening plans included a death-defying dash home on his mountain bike, a strenuous run on the neighborhood basketball court with his neighborhood buddies, a quick salad at one of the Columbus Avenue restaurants around nine, followed soon after by a mute collapse into bed.
Despite what he had said, Jack didn’t have that much to do and had been scrounging around to keep himself busy, particularly over the last hour. Even before he had sat down at his desk, he had been reasonably caught up with all his outstanding autopsy cases. The reason he was forcing himself to labor this particular afternoon was to keep his mind occupied in a vain attempt to control the anxiety he felt about his secret plans for the evening. The process of submerging himsel
f in either his work or strenuous athletic activity had been his balm and salvation for more than fourteen years, so he wasn’t about to abandon the ruse now. Unfortunately, his contrived work wasn’t holding his interest, especially since he was running out of things to do. His mind was beginning to wander into forbidden areas, which began to torment him into having second thoughts about the evening’s plans. It was at that moment that his cell phone came to life. He glanced at his watch. There was less than an hour to go before D-day. He felt his pulse accelerate. A phone call at that moment was an inauspicious sign. Since the chances of it being Laurie were nil, the chances were huge that it was someone who could throw the evening’s schedule out of whack.
Pulling the phone from his belt clip, Jack eyed the LCD screen. Just as he feared, it was Allen Eisenberg. Allen was one of the pathology residents who was being paid by the Office of the Chief Medical Examiner to cover routine problems after hours, which the forensic investigator on duty thought needed the attention of a medical doctor. If the problem was beyond the pathology resident’s comfort zone, then the medical examiner on call had to be contacted. Tonight, it was Jack.
“Sorry to have to call you, Dr. Stapleton,” Allen said, his voice whiny and grating.
“What’s the problem?”
“It’s a suicide, sir.”
“Okay, so what’s the question? Can’t you guys handle it?” Jack didn’t know Allen very well, but he knew Steve Marriott, the evening forensic investigator, who was experienced.
“It’s a high-profile case, sir. The deceased is the wife or girlfriend of an Iranian diplomat. He’s been screaming at everyone and threatening to call the Iranian Ambassador. Mr. Marriott called me for backup, but I feel like I’m in over my head.”
Jack didn’t respond. It was inevitable: He would have to visit the scene. Such high-profile cases invariably took on political implications, which was the part of Jack’s job that he detested. He had no idea if he’d be able to make the site visit and still get to the restaurant by eight, which only added to his anxiety.
“Are you still there, Dr. Stapleton?”
“Last time I looked,” Jack retorted.
“I thought maybe we’d been cut off,” Allen said. “Anyway, the location is apartment fifty-four-J in the United Nations Towers on Forty-seventh Street.”
“Has the body been moved or touched?” Jack pulled on his brown corduroy jacket, unconsciously patting the square object in its right pocket.
“Not by me or the forensics investigator.”
“What about by the police?” Jack started down the hallway toward the elevators. The hall was deserted.
“I don’t believe so, but I didn’t ask yet.”
“What about by the husband or boyfriend?”
“You should ask the police. The detective in charge is standing next to me, and he wants to talk with you.”
“Put him on!”
“Hey, buddy!” a loud voice said, forcing Jack to pull the phone away from his ear. “Get your ass over here!”
Jack recognized the gravelly voice as that of his friend of ten years, Detective Lieutenant Lou Soldano of the homicide division of the New York City Police Department. Jack had known Lou almost as long as he had known Laurie. It had been Laurie who had introduced them.
“I might have known you’d be behind this!” Jack lamented. “I hope you remember that we’re supposed to be at Elio’s at eight.”
“Hey, I don’t schedule this crap. It happens when it happens.”
“What are you doing at a suicide? You guys think it might not be?”
“Hell, no! It’s a suicide, all right, with a contact gunshot wound to the right temple. My presence is a special request from my beloved captain in appreciation of the parties involved and how much flak they are potentially capable of producing. Are you coming or what?”
“I’m on my way. Has the body been moved or touched?”
“Not by us.”
“Who is that yelling in the background?”
“That’s the diplomat husband or boyfriend. We have yet to figure that out. He’s a little squirt, but he’s feisty and makes me appreciate the silent, grieving type. He’s been yelling at us since we got here, trying to boss us around like he’s Napoleon.”
“What’s his problem?” Jack asked.
“He wants us to cover his naked wife or girlfriend, and he’s madder than hell because we insist on not disturbing the scene until you guys finish checking it out.”
“Hold on!” Jack said. “Are you telling me the woman’s naked?”
“Naked as a jaybird. And to top it off, she doesn’t even have any pubic hair. She’s shaved like a cue ball, which—”
“Lou!” Jack interrupted. “It wasn’t a suicide!”
“Excuse me?” Lou questioned with disbelief. “Are you trying to tell me you can tell this was a homicide without even seeing the scene?”
“I’ll look at the scene, but yes, I’m telling you it wasn’t a suicide. Was there a note?”
“Supposedly, but it’s in Farsi. So I don’t know what it says. The diplomat says it’s a suicide note.”
“It wasn’t a suicide, Lou,” Jack repeated. The elevator arrived. He boarded but kept the door from closing. He didn’t want to lose the connection with Lou. “I’ll even put a fiver on it. I’ve never heard of a case of a woman committing suicide in the nude. It just doesn’t happen.”
“You’re joking!”
“No, I’m not. The thought is that’s not the way women suicide victims want to be found. You’d better act accordingly and get your crime-scene people there. And you know the feisty diplomat husband or whatever he is has got to be your number-one suspect. Don’t let him disappear into the Iranian mission. You might not see him again.”
The elevator door closed as Jack flipped his phone shut. He hoped there wasn’t a deeper meaning behind the interruption of the evening’s plans. Jack’s true běte noire was the fear that death stalked the people he loved, making him complicit when they died. He looked at his watch. It was now twenty after seven. “Damn!” he said out loud and slapped the elevator door a few times with the palms of his hands in frustration. Maybe he should rethink the whole idea.
With rapidity born of repetition, Jack got his mountain bike from the area of the morgue where the Potter’s Field coffins were stored, unlocked it, put on his helmet, and wheeled it out onto the 30th Street loading dock. Between the mortuary vans, he climbed on and cycled out into the street. At the corner, he turned right onto First Avenue.
Once he was on the bike, Jack’s anxieties melted away. Standing up, he put muscle into his pumping and the bike shot forward, rapidly picking up speed. Rush-hour traffic had abated to a degree, and the cars, taxis, buses, and trucks were moving at a good clip. Jack was not able to keep up, but it was close. Once he had achieved his cruising speed, he settled back onto the seat and shifted into a higher gear. From his daily bike riding and basketball playing, he was in tip-top shape.
The evening was glorious, with a golden glow suffusing the cityscape. Individual skyscrapers stood out sharply against the blue sky, the hue of which was deepening with every passing minute. Jack streaked past the New York University Medical Center on his right and, a little farther north, the UN General Assembly complex. When he could, Jack moved to his left so that he was able to turn onto 47th Street, which was one-way, conveniently heading east.
The UN Towers was a few doors up from First Avenue. Sheathed in glass and marble, the structure soared up an impressive sixty-some-odd stories into the evening sky. Directly in front of the awning that stretched from its entrance to the street were several New York City squad cars with their lights flashing. Hardened New Yorkers walked by without a glance. There was also a battered Chevy Malibu double-parked next to one of the squad cars. Jack recognized it as Lou’s. In front of the Malibu was a Health and Human Services mortuary van.
As Jack locked his bike to a no-parking signpost, his anxieties returned. The ride had
been too short to have any lasting effect. It was now seven thirty. He flashed his medical examiner’s badge to the uniformed doorman and was directed to the fifty-fourth floor.
Up in apartment 54J, things had quieted considerably. When Jack walked in, Lou Soldano, Allen Eisenberg, Steve Marriott, and a number of uniformed officers were sitting around the living room as if it were a doctor’s waiting room.
“What gives?” Jack asked. Silence reigned. There wasn’t even any conversation.
“We’re waiting on you and the crime-scene people,” Lou said as he got to his feet. The others followed suit. Instead of Lou’s signature rumpled and slightly disheveled attire, he was wearing a neatly pressed shirt buttoned to the neck, a subdued new tie, and a tasteful although not terribly well-fitted glen plaid sport jacket that was too small for his stocky frame. Lou was a seasoned detective, having been in the organized-crime unit for six years before moving over to homicide, where he’d been for more than a decade, and he looked the part.
“I have to say you look pretty spiffy,” Jack commented. Even Lou’s closely cropped hair looked recently brushed, and his famous five o’clock shadow was nowhere to be seen.
“This is as good as it gets,” Lou commented, lifting his arms as if flexing his biceps for effect. “In celebration of your dinner party, I snuck home and changed. What’s the occasion, by the way?”
“Where’s the diplomat?” Jack asked, ignoring Lou’s question. He glanced into the kitchen and a room that was used as a dining room. Except for the living room, the apartment seemed empty.
“He’s flown the coop,” Lou said. “He stormed out of here just after I hung up with you, threatening all of us with dire consequences.”
“You shouldn’t have let him go,” Jack said.
“What was I supposed to do?” Lou complained. “I didn’t have an arrest warrant.”
“Couldn’t you have held him for questioning until I got over here?”