Fatal Reaction (23 page)

“I’m sure you’re wondering why I called,” she said, searching through the clutter on her desk for something. She shifted through the piles until her hand lit upon a file.

“I’m actually surprised you even have the time,” I replied.

“We are a bit stretched, I’ll give you that,” she said, smiling weakly. “The Sarrek case presents a tremendous challenge. The work of identifying his victims is especially painstaking, because so far the inside of the truck is the only crime scene we have. Even though we’re receiving a great deal of help from the FBI, it’s offset by the amount of coordination that must be managed among the various law enforcement agencies. Since it looks as though there’s a good chance the case will be tried in our jurisdiction, we’re anxious not to give up too much control over the investigation. Of course, dealing with the media has been a nightmare in and of itself. The day Sarrek was arrested I actually found a reporter hiding in my garage.”

“They’re jackals,” I said in a simple statement of fact.

“Unfortunately, cases like this have, an appeal, an entertainment value if you will, that somehow manages to transcend the enormity of the taking of human life.”

“I know by comparison Danny Wohl’s death must seem terribly inconsequential,” I said apologetically.

“No death is inconsequential,” replied Dr. Gordon with sudden fierceness. “No matter what the media would like us to believe, the circumstances of a person’s death in no way alters the meaning of their life.” She took a deep breath. “I didn’t mean to serve up a lecture, but I’m afraid that what I’ve seen from the media since Sarrek’s arrest has sometimes made me wonder which of them is the bigger monster.

“Now, about Mr. Wohl. As you know I was not the pathologist who visited the death scene, nor the one who actually performed the autopsy. Under normal circumstances the way it works in our office is that whichever pathologist goes to the scene also performs the postmortem exam. Unfortunately, with our resources spread so thin on account of the Sarrek deaths, one pathologist went to the scene and another actually performed the autopsy. Complicating matters is the fact that neither of the forensic pathologists who examined Mr. Wohl is permanently assigned to this office. Dr. Barrows, who took the unattended-death call and went to Mr. Wohl’s apartment, was on loan to us from the DuPage County coroner’s office. Dr. Breuner, who actually performed the autopsy, is an assistant medical examiner from Lake County in Wisconsin. Both men have subsequently returned to their own jurisdictions, though I have talked to Dr. Breuner several times on the phone.”

“So what killed Danny?” I asked. “How did he die?”

“I don’t know if you realize it, but what you’re asking is actually two separate questions. Before I answer let me explain some things. As a medical examiner I’m actually interested in three things: cause of death, mechanism of death, and manner of death. The cause of death is the event which sets into motion the mechanism of death.”

“I don’t understand.”

“Let me give you an example. Yesterday I performed an autopsy on a thirty-one-year-old, Caucasian male who had been shot at close range in the chest and bled to death before the paramedics could get him to the hospital. The cause of death in this case was a gunshot wound to the chest. The mechanism of death was exsanguination—he bled to death.”

“Like Danny.”

“Yes. Even though the two deaths—your friend’s and the man who was shot—were completely dissimilar in their cause, the mechanism was the same. While there are a huge number of possible causes of death, there are only a handful of mechanisms: respiratory arrest, cardiac arrhythmia, myocardial infarction.”

“What’s the manner of death, then?”

“The manner of death is a description of the circumstances of death. This is indicated on the death certificate by checking off a box at the bottom. The choices are: natural, homicide, suicide, accidental, and undetermined.”

“So what was the manner of death in Danny’s case?” Instead of answering my question, Dr. Gordon reached for a file on her desk and began reading to me from it.

“Daniel Allen Wohlinski, age thirty-two, height one hundred eighty-six centimeters, weight seventy-six kilos. Found in his apartment by the building engineer. The victim had obviously been dead for some time; rigor was already beginning to pass off in the upper extremities so he was pronounced dead at the scene, which, if the photographs are any indication, was pretty grisly.

“Physical examination of the body revealed several indications consistent with AIDS. Kaposi’s sarcoma lesions on the upper thighs, evidence of thrush in the victim’s mouth, and some slight lymphatic abnormalities. Blood-alcohol levels were not taken because the technician was not able to draw an adequate sample. The same for toxicology.” Dr. Gordon turned the page. “Stomach contents were essentially zero, which is not surprising considering he vomited up almost his entire blood supply. Dr. Breuner located evidence of severe arterial erosion caused by a gastric ulcer. In other words, he had a hole in his stomach big enough to stick your finger through. Unfortunately, it was in a place where the wall of an artery was compromised as well.”

“Which is why he bled to death.”

“Yes.”

“So why aren’t you ready to check the box at the bottom of the form that says ‘natural’ and be done with it?” I asked, knowing that if the circumstances of Danny’s death were as clear-cut as that we wouldn’t be having this conversation.

“In reviewing the case I’ve come across some rather unusual findings.”

“Unusual in what way?”

“Well, for one thing, some curious abnormalities have showed up in the microscopic slides of organ tissues.”

“What kind of abnormalities?”

“There are pervasive thrombi in the glomeruli of the kidneys. In lay terms that means that there are lots and lots of blood clots in the filtering apparatus of the kidneys.”

“Big clots?” I asked, without thinking. “I take that back. How big can they be if you have to use a microscope to see them?”

“It’s not the size that’s the issue, but rather their pervasiveness that makes me suspicious.”

“Suspicious of what?”

“Well, for one thing, D.I.C.”

“What’s D.I.C.?”

“It’s short for disseminated intravascular coagulation. It’s a clotting syndrome that’s usually associated with things like massive thrombosis, pulmonary embolism, cardiogenic shock, liver failure due to cirrhosis, snake bite, anaphylaxis. You also see it in some end-stage cancers.”

“Could Danny have had one of those things?”

“Dr. Breuner found no evidence of them at autopsy and these are things that would be hard to miss. Dr. Breuner just assumed that D.I.C. had followed the erosion of a blood vessel by the gastric ulcer. Certainly that is possible, but it would have occurred over a much longer period of time than is consistent with the blood evidence at the scene. However, since Dr. Breuner was not the pathologist who examined the body in situ he had no way of knowing that.”

“I don’t understand.”

“Judging from the condition of the apartment, D.I.C. must have occurred very rapidly—too rapidly to have been the result of an ulcer.”

“And AIDS couldn’t have caused it?” I asked.

“I’ll grant you that AIDS poses some special issues for forensic pathologists. For example, lung cancer can kill in only so many different ways, all of which are recognizable. HIV, on the other hand, offers a seemingly endless range of scenarios depending on which organ system is set upon by the virus and which of a wide array of microbes breaches the immune system first. I think that’s why Dr. Breuner initially discounted the abnormal tissue findings. He sees many fewer cases of AIDS in his jurisdiction than we see here and I think he just assumed that the virus was in some way involved.”

“So what does all this mean?”

“Unfortunately, Ms. Millholland, there is no cookbook that tells us how to figure out how people die. Some things are clear-cut—gunshots, dismemberments, strangulation— but sometimes the footprints that death leaves behind can be very subtle. I don’t usually take my work home with me, but in this case I took the liberty of showing Mr. Wohl’s tissue slides to my husband, who as you probably know happens to be a hematologist.”

“What did he say when he looked at the slides?” I asked.

“He took them back to his lab, where they have a setup that allows them to photograph microscope slides. He took these and suggested that Dr. Azorini have a look at them.” She handed me a manila envelope.

“Why Stephen?”

“I understand that Azor Pharmaceuticals is currently trying to get a new artificial blood product approved by the FDA.”

“So?”

“So Hugh seems to think there’s a good chance that a substance being used at Azor in one of their labs might have been the cause of D.I.C. in Mr. Wohl.”

CHAPTER 18

As soon as I arrived at Azor I went straight to Stephen’s office. I didn’t even bother to take off my coat. I wanted to show him the pictures that Julia Gordon’s husband had made of Danny’s tissue. I needed to know what explanation, if any, he could offer for its appearance.

Blessedly he was in. I found him deep in conversation with Michelle Goodwin. Anxiously I hovered in the doorway, hoping for a good opportunity to interrupt. I didn’t understand a word of what they were saying. Whatever it was must have been important—to Michelle Goodwin, at least. Her entire body sang with intensity as she leaned forward to make a point with the keenness of a runner straining for the finish line. She had shed her customary shyness. Her manner was animated, her skin flushed with excitement. For a moment I thought I caught a glimpse of what the lecherous Nobel prizewinner had seen in her.

I also couldn’t help wondering, once again, where the myth of the cool and unemotional scientist had come from. From my brief experience at Azor it was obvious
that nothing could be further from the truth. I had come to see firsthand that a laboratory is a frustrating place from which to view the world. It took passion, obsession even, to see an investigator through the daily grind of making experiments work.

“I’m so sorry to interrupt,” I said, having no choice but to just break in on them, “but I need a word in private with Stephen.”

“We’ll just be another couple of minutes,” replied Stephen.

“I’ve just come from the medical examiner’s office...” I ventured.

“I’m sorry, Michelle,” said Stephen, turning to the crystallographer. “I’ll stop down in the modeling room for that reprint. We can finish up then.”

For a minute I thought she hadn’t heard him, but finally she rose to her feet. She was a tall woman, with the blocky, squared-off gait of a triathlete. Michelle’s physical assurance stood in strange contrast to her abrupt social mannerisms. Whenever I saw her outside of her lab I got the sense that she felt most at home in the computergenerated world of crystallography and she was eager to get back to it as soon as she could.

“What did the medical examiner want?” demanded Stephen, as soon as the door had closed behind Michelle.

“You, actually. Julia Gordon and I were both trying to reach you last night. Where were you?”

“I was going over our results on Hemasyn with Gus Sandstrom and a couple of the other senior investigators. We worked all night getting them ready to send to the FDA.”

“I tried you at the office.”

“We were upstairs in the hematology conference room. I must have forgotten to switch my line over. What did Julia Gordon want?”

“She wanted you to have a look at these.” I took the photographs out of my briefcase and handed them to Stephen. While he studied them I sat down in the chair Michelle Goodwin had just vacated. It still felt warm. “What am I looking at?”

“They’re photographs of kidney tissue taken under the microscope.”

“Why does Julia want me to look at photomicrographs?”

“It wasn’t Julia Gordon who suggested that you look at them. It was her husband.”

“Why?” he asked, looking closely at the photographs for the first time. “What could I possibly tell Hugh about kidney tissue? Why are there all these thrombi in the small blood vessels?”

“That’s the question. Is there anything at Azor that could have caused that kind of clotting?”

He looked up and his eyes met mine. I saw the weariness in his face and my heart went out to him. As much as he hated to admit it, Danny’s death, his high-wire act with the Japanese, the dissension on the board—they were all taking their toll.

“PAF would do this,” he said, quietly.

“What’s PAF?”

“Platelet activating factor. It’s a powerful procoagulant. They use it upstairs in the Hemasyn labs as a control in clotting studies. But you didn’t tell me where the tissue in this photograph came from.”

“It was taken from Danny.”

Stephen dropped the photograph onto the surface of his desk and leaned back in his chair as if trying to get some distance.

“Is there some way to test for this PAF stuff?” I asked.

“I wouldn’t think so. PAF is metabolized by the body almost instantaneously. It disappears without a trace.”

“So how does it work? What does it do?”

“Just like the name says, it’s a powerful enzyme that makes blood clot, especially in the very high concentrations we use in our labs. Even a tiny dose injected into a person would cause almost immediate D.I.C. The PAF causes the body’s clotting mechanisms to spring into action, which is why you’d see all that microscopic evidence of clotting in the tissues.”

“But then why would you bleed to death?” I demanded. “Wouldn’t all your blood just clot?”

“No. The body’s clotting mechanisms, the platelets and proteins that cause the blood to clot, aren’t sufficient for the body’s entire blood supply. Once they’re exhausted— which would happen almost instantaneously with PAF— the remaining blood wouldn’t clot at all.”

“So tell me, if Danny hadn’t had a perforated ulcer, would the PAF have killed him?”

“Most definitely, but in that case he would have bled to death internally. Compared to what went on in that apartment it would have been a relatively quiet, comfortable death. He might not even have known what was happening to him.”