Chapter 23 Chapter Twenty

Newtown, Massachusetts Thursday, June 8, 2006 9:05 p.m. After four rings, Alexis finally picked up the phone.Just now Jack dialed her number, then turned on the speaker, and put the phone on the co-pilot's seat.He had left Langley Pearson Funeral Home and was driving to Newton Memorial Hospital.He decided to call on the day doctor before he closed at eleven, to see if he could run into Matt.Gilbert and Georgina.O'Keeffe.It was a sudden decision when he and Latasha left the funeral home after the autopsy.She said she was going to stop at the apartment and feed the dog first; then put the liquid sample in the toxicology lab and write a note asking Allen to call her as soon as he got to the lab; Grab some pizza from the small store that's open; finally meet up with Jack in the Forensics Department's parking lot.Originally, she wanted Jack to be with her, but Jack wanted to take advantage of this spare time to go to the hospital.

I was waiting for your call, Alexis said, hearing Jack's voice. Can you hear me clearly?Jack asked.I have the speaker on. I can hear you clearly.Where are you? I keep asking myself the same question, joked Jack.Just now Patience's autopsy found nothing, his emotions fell to the bottom, and now it seems to have rushed to the top again.Latasha's enthusiasm was contagious, and with the possible help of a toxicology examiner tonight, his mood was getting better and better, like an old steam locomotive speeding up.Countless thoughts flashed through his mind, like a flock of excited sparrows flapping their wings.

You're in a weird mood.What happened? I was driving that rental car to Newton Memorial Hospital. are you OK? I am fine.I wanted to sneak in and find Patience, who was in the emergency room that day.Stanhope folks, ask a few questions. Have you had an autopsy done? Yes. Did you find anything? Nothing was found except an unrelated colon cancer. Didn't find anything?Alexis asked.She sounded very disappointed. I know exactly what you're thinking because I think so too.I was also depressed just now.But now I think it was an unexpected gift. how do I say this? Of course I hope to find some kind of magical cause of death, but a more realistic idea is to find ordinary coronary heart disease.But if it was really coronary heart disease, I would give up and admit that she had a heart attack and died of a heart attack, so I will not pursue it.However, the autopsy found that she had no heart disease, which is difficult to explain.Of course, it's been eight months since it happened, and it's also possible that she died of some rare heart condition, which we can't find out now.But now I am more willing to believe that there are other problems.Otherwise, why did Fasano prevent me from doing an autopsy?Why is Franco trying to drive me off the highway?More importantly, why would someone threaten several children?By the way, how are they now?

very good.They feel safe and are having a dance at Grandma's.She pampered them as always.Going back to your earlier point: what exactly are you trying to say? can not say it clearly.That's what I think, listen to see if it makes sense.Patience.Stanhope's death and obstructing my autopsy may be two different things at all.It is possible that Fasano could order his men to threaten the children, but purely for financial reasons.But there is one thing I don't understand.Since he did not hesitate to break into your house and threaten the child, why didn't he interfere with my autopsy?I think these three things are independent and not connected to each other.The reason Fasano threatened me, as he said, was because he had advanced money for the case.Franco because I kneed his pussy, his pride couldn't stand it, and Patience.Stanhope has nothing to do.Now only break into your home with no reasonable explanation.

Too complicated, Alexis complained.If it wasn't for Tony.Fasano ordered someone to do it, who did it? I don't know either.I also wondered, if not Fasano and money, what was the motive?There is clearly something that doesn't want me to find out.So what can an autopsy reveal?One possibility is Patience.Stanhope may have overdosed in the hospital, or had taken the wrong medicine.Hospitals are also large institutions with many shareholders, involving large sums of money. The idea is crazy, Alexis said emphatically.Hospitals don't scare my kids. Alexis, you invited me to Boston to make me think outside the box.I did as you asked.

Don't doubt the hospital then, Alexis complained.You go to the hospital now just to investigate this? Yes, Jack admits.I still see people very accurately.I spoke to two people in the ER on Tuesday and I was very impressed by the two.Quite frankly, no tricks at all.I want to talk to them again. What can we talk about?Alexis asked contemptuously, asking if they made a major mistake in the rescue?So much so that the hospital is trying to cover up the truth by scaring my child?It's outrageous. To put it this way, it does sound a bit far-fetched.I still want to try it though.The autopsy is not over yet.The initial inspection is indeed done, but there is also a toxicological checksum and a microscopic examination.I also want to make sure to save Patience.What drugs did Stanhope take when the time came and he could tell the toxicologist.

Well, that's about the same, much better than accusing the hospital of covering up the truth. My thoughts go beyond overdoses and wrong medications.Do you want to hear it? want to hear.But I hope your next thoughts will be a little more normal. Jack thought of several dark humorous ways of answering, but he still didn't say anything after thinking about it.The reason why he doubts the hospital is because he thinks Patience.Stanhope having a heart attack and blocking my autopsy are two different things.What if two things involve the same person? Jack paused deliberately, allowing the impact of the sentence to be fully felt.

I don't quite understand what you mean, Alexis finally spoke.You mean to say someone made Patience.Stanhope had a heart attack and then tried to thwart the autopsy so that no one would find out? I mean it. I don't know, Jack.It still sounds crazy.I assume you mean Jordan? My first thought was Jordan.Craig said Jordan and Patience were not a loving couple at all.Once she dies, Jordan is the biggest winner.He didn't have time to mourn his dead wife.Who knows, he and his girlfriend might have been together while Patience was alive. How can you make someone else have a heart attack?

Just use digitalis. I don't know, Alexis said hesitantly.It also sounds far-fetched.Had Jordan been guilty, he certainly would not have taken the lead in the malpractice lawsuit, and he certainly would not have signed the permit to open the casket. I've thought about that, too, Jack said, pulling into the parking lot of Newton Memorial Hospital.It's kind of unreasonable, but maybe we're dealing with an unreasonable person.Maybe Jordan found it exciting, to prove that he was smarter than the rest of us.It is too early to make such assumptions.First of all, the toxicology test must be able to detect the ingredients of digitalis.If we can find out, we have to reason back step by step.

This is the second time you've said the word us.Are you referring generically or what? A coroner at the Boston Medical Examiner offered to help. You told Laurie, Alexis said.Does she agree with you to stay here? She wasn't too happy, but agreed anyway. I can't believe you're getting married tomorrow. I can't believe it either, Jack said.He pulled into a parking lot overlooking a pond, his headlights illuminating a flock of waterfowl swimming by.How was the court hearing this afternoon? Randolph sent two expert witnesses to testify, one from Yale and one from Columbia.Both are believable, but neither is brilliant.Tony tried to knock them out, but it didn't bother them at all.I think Tony wanted Randolph to send Craig to court again, but instead of doing that, Randolph announced that he would voluntarily stop presenting evidence.that's all.Tomorrow morning is the closing statement, Randolph first.

Has your view on the final outcome of the lawsuit changed now? Nothing has changed.Defense witnesses are really good, but not local.Boston is a medical mecca, and the jury did not take kindly to these expert witnesses from distant universities.Tony's expert witnesses are more convincing. I have to admit, you might be right. Only in Patience.Only by finding criminal evidence on Stanhope's body will it be possible to restore Craig's defeat.But this possibility is too small. I think so too.To be honest, that's my main motivation.How is Craig feeling? Frustrated as usual.It seems that it is not as good as before.I'm a little concerned that he's home alone.What time will you be home? Maybe, Jack said.Thinking of his reluctance to go back to Boman's house, he suddenly felt a little ashamed. Can you visit him when you get home?I don't really like the fact that he mixes hard liquor with sleeping pills. All right, I'll go and see, said Jack.I'm at the hospital and I'm going to call. No matter what happens, I appreciate everything you do, Jack.You have no idea how much your support has meant to me these past few days. It was because of my meddling that the children were threatened. I will never blame you for this incident. Before the two said their goodbyes, they continued to say a few words of affection between brother and sister, and Jack felt that he would cry if he continued.He turned off his phone and sat in the car for a while, thinking about how relationships between people change over time.Over the years he wallowed in his own pain and alienated his sister.Now he feels that the relationship between the two is as close as before, which makes him feel warm in his heart. Jack got out of the car, and the enthusiasm that Latasha had sparked came back with a jerk.Alexis' comment does hit a bit.But even if she didn't say it, he knew that his thoughts were a little ridiculous.As he said himself, he was unconventional thinking, and the evidence in his hands was unbelievable. Contrary to his first visit, the emergency room was overwhelmed.The waiting room is full, almost every seat is occupied.Several people stood outside in the ambulance reception area.It's a little hot and humid outside, like summer is here. Jack had to line up in front of the reception desk.The woman ahead of him in line held a feverish baby in her arms.The kid leaned on his mother's shoulder, staring at Jack blankly.When the queue reached Jack, he was about to ask Matt.When Dr. Gilbert was away, Matt showed up.He tossed a filled-out emergency room admissions record, along with the clipboard, on the reception desk.Then he saw Jack. I've seen yours, he said, pointing to Jack.Apparently he was recalling Jack's name. Jack.Dr Stapleton. Yes!Forensic officer interested in attempted artificial respiration. Good memory, Jack remarked. The biggest achievement of medical school is to practice memory.What do we need to do? I want to take two minutes of your time to find Georgina.O'Keeffe is even better.is she there tonight She is always in charge, the receiving nurse said with a smile.She's at. I know this is not the right time for you, Jack said.But we've dug up the body and just finished the autopsy.I thought you might want to know the results of the autopsy. Of course, Matt said.The timing is also good.We are busy, but they are all routine projects, and the outpatient department and specialists can handle them. There is no emergency right now.Let's talk in the lounge.I'm calling Georgina. Jack sat alone for a few minutes.He took the time to go over Patience's two pages of emergency room records.During the phone call with Alexis just now, he pulled these two pages out of the case file. Welcome back, Georgina smiled as she entered the room, followed by Matt.Both of them were wearing green overalls and white coats. Matt said you dug up Mrs. Stanhope's body and did an autopsy.Cool!What did you find?No one has ever given us such feedback before. Interestingly, her heart appeared to be completely normal.No degenerative changes at all. Georgina crossed her hips and smiled wryly in disappointment.I thought I was going to hear some amazing discovery. In fact, this result is also surprising, Jack said.It is indeed rare to die suddenly from a heart attack without pathological signs. You made a special trip just to tell us we didn't find anything?Georgina asked puzzledly, and then looked at Matt's reaction. In fact, I came here to ask you if there was an overdose of some kind, or a wrong drug. What kind of medicine are you referring to?Georgina's smile disappeared, replaced by confusion and alertness. Either way, Jack said.Especially the new fibrinolytics and anticoagulants.I don't know, are you doing a randomized study of heart attacks?I'm just curious.None of the doctor's order execution sheets I mentioned were there.Jack handed the execution order to Georgina.She glanced at it, and Matt leaned over to take a look, too. Here are all the medicines we gave her, said Georgina, holding up the order sheet.She looked at Matt, wanting to confirm. Yes, Matt said.She was in critical condition when she was sent in, and the EKG was basically a straight line.All we could do was give her artificial respiration, and we didn't deal with the myocardial infarction at all.What do you want to ask? Never used digitalis? No, Matt said.I have tried dual-chamber sequential pacing, but the heartbeat still cannot be detected.Her heart was completely unresponsive. Jack's eyes flicked from Georgina to Matt and back again.It seems impossible to overdose or use the wrong medicine!The emergency room rescue record only shows the test results of blood oxygen content.Did you not do other checks? When blood was drawn for oxygenation test, we also added routine blood test and electrolyte test.And because it was a heart attack, a physiological index test was added. Now that the inspection has been done, why is there no trace on the doctor's order execution form?Why is the test result not written in the emergency room rescue record?The blood oxygen content is written. Matt took the slip from Georgina, scanned it quickly, and shrugged.I don't know, maybe these should have been included in the medical records.But she died soon after, before a medical record could be created.He shrugged again.The reason why it was not written on the doctor's order execution form may be that patients with suspected myocardial infarction must undergo these tests.I did mention that the sodium and potassium levels were normal in the admissions notes, maybe someone called the ER desk with the results. It's not like an emergency room in a big city, Georgina explained.Very few people die in emergency rooms.Even if the patient is in a bad condition, we will admit it. How about calling the lab and seeing if I can find the test results for the day?Jack asked.He didn't know what to make of this unexpected discovery, or what it meant, but he felt the need to try to see if the path would work. All right, Matt said.We're going to have the nurse contact the lab right now.We're getting back to work, though.Thank you for making the trip.It is indeed strange that the autopsy did not find a pathological explanation, but we are very happy to know that the rescue steps have not been overlooked. Five minutes later, Jack was in the office of the evening lab manager.The house is small and has no windows.The administrator was a large man with thick eyelids that gave the impression of not getting enough sleep.He was staring at the computer screen, his head tilted back slightly, and the badge read: Hello, I'm Wayne.Marsh. There is no Patience here.Stanhope's record, Wayne said.When he got the call from the emergency room, he was so enthusiastic that he asked Jack to go upstairs to the office to find him.Jack's status made him take it seriously, and he might have noticed that the forensic badge said New York instead of Massachusetts, but he didn't say anything. You need a serial number to find it, Wayne explained.But if she is not admitted, there is no number. Or check the bill?Jack reminded him.Someone has to pay the check. There must be no one in the account room right now, Wayne said, didn't you just say that you have a copy of the emergency room rescue record, with the emergency room entry number on it.May try that. Jack handed him the ER slip.Wayne dialed in the number.Found it, a record popped up on the screen.Dr. Gilbert was right.Indeed, a routine blood test was done, including platelets, electrolytes, and common cardiac physiological indicators. Which indicators? Creatine kinase isoenzyme test and cardiac troponin T test will be done as soon as you arrive in the emergency room, and they will be repeated six hours later and twelve hours later. Are all the test results normal? Depends on how you define normal, Wayne said.He turned the monitor around so Jack could see it too.He pointed to the column for routine blood tests.Mild to moderately high blood protein levels indicate a heart attack.His finger moved to the column for electrolytes.Potassium concentration reaches the upper limit of normal.If she survives, definitely track this down for obvious reasons. Mentioning the potassium concentration made Jack tremble involuntarily.Although it has been more than a year, the scene of Laurie's rescue due to high blood potassium concentration during ectopic pregnancy is still vivid in my memory.Then his eyes fell on the column of physiological indicators.To his surprise, the test came back negative.He immediately brought this to Wayne's attention.Jack's pulse quickened slowly.Did you discover the answer by accident? It's very common, Wayne said.It takes three to four hours for a heart attack patient to see a rise in physiological indicators.With the speed of response to 9/11 calls, we're usually in the emergency room before that happens.This is one of the reasons why the check is repeated every six hours.Jack nodded as he considered what this new information meant.He didn't know whether he forgot, or never knew, that there was a lag of three to four hours for physiological indicators to become positive.In order not to make himself appear too ignorant, he chose his words carefully for the next question.But don't you think it's strange that the result of the portable physiological index test kit was positive earlier? Not surprising, Wayne said. Why? There are many variables.First, about 4 percent of negative results and 3 percent of positive results were false.Although the test is based on specific monoclonal antibodies, it is not foolproof.Second, the portable kit is based on troponin I, not T, and there are many types of portable kits on the market.The kind you said is to check only troponin I, or also check myoglobin? No idea, Jack admitted.He tried to recall what was written on the box in Craig's emergency kit, but couldn't. This is an important point.The speed of myoglobin positive is faster, generally within two hours.What is the time period of this case?He picked up the emergency room notes and read them aloud, and Patience's husband said that around five or six in the afternoon, closer to six, the patient developed chest pains and other symptoms.Wayne looked up at Jack.She was sent to the emergency room at about eight o'clock, with an interval of less than four hours, which coincided with our examination results.Do you know when it's time to check in with a portable kit? No idea, Jack said.But if I had to guess, it would be about half past seven. Oh, that's hard to say.However, as I have explained just now, there are many manufacturers of portable sets with different sensitivities.There are also certain requirements for the storage of the box, and there is a shelf life.To be honest, this is also the reason why there are no sets of boxes in the hospital.We prefer to use troponin T because only one manufacturer can make it.Provides reproducible and verifiable inspection results in a very short time.Would you like to see our Abbott tester?Amazing.Absorbance at 450 nm can be measured spectrophotometrically.It's just across the lab, if you want to see it. Thanks, but I don't think I'll watch it, said Jack.The technical jargon was too esoteric for him, and his stay in the hospital was twice as long as he expected.He really didn't want Latasha to wait any longer.He thanked Wayne for his help, and quickly took the elevator downstairs.On the way down the elevator to the first floor, he began to suspect that there might be something wrong with Craig's portable test kit, either stored improperly or expired, so the test result was wrong.If Patience.Didn't Stanhope die of a heart attack?Suddenly, he found a whole new line of investigation, relying on tonight's toxicology test results.There are far more drugs that can harm the heart than drugs that can cause a heart attack. Jack got in the car and dialed Latasha's number.As with Alexis, he turned on the speaker and put the phone on the passenger seat.After he drove out of the hospital parking lot, Latasha answered the phone. Where are you?she asked.I'm in the office.I bought two hot pizzas and two large bottles of Coke.Where are you? I just left the hospital.Sorry for the long delay, but I found an important clue.The hospital's analyzer showed that Patience.Stanhope's biomarkers came back negative. But you told me it was positive. That's the result of the portable test kit, Jack said.He carefully explained to Latasha what the lab administrator had told him. At the end of the day, Latasha said, we can't say for sure that she suffered a heart attack, which is consistent with the autopsy findings. Completely correct.If so, the results of the toxicology tests are key. I've sent the samples to the toxicology lab and left a note for Alan to call me. Very well, said Jack.He couldn't help but sigh how lucky he was to find Latasha for help.If it weren't for her, I might have given up when the autopsy found no heart problems. It was equivalent to targeting the husband who claimed to be devastated, Latasha added. There are still some things that don't make sense, and Jack thinks of Alexis's point that Jordan may be innocent, but I basically agree with you, even if it sounds a little sinister. When can you come over? as soon as possible.I'm on Route 9 now.You should be more familiar with the roads here than I am.Eat your pizza while it's hot. I'll wait for you, Latasha said.I'm busy getting ready for the heart cryosection right now. I don't think I can eat much, said Jack.I'm so excited right now, it feels like I've had ten cups of coffee. Jack turned off his phone and checked the time.It was almost half past ten, which meant that Latasha's friend was going to work in the toxicology laboratory soon.Jack wants this person to have a lot of free time tonight, because there are many projects to be done, and it may take most of the night.Jack didn't expect the toxicology test to detect the poison.This process is not as simple as it appears in TV dramas.There is probably nothing wrong with detecting high levels of commonly used drugs.More toxic compounds often require only tiny amounts to kill.Trying to detect such compounds through toxicological testing is, as the saying goes, looking for a needle in a haystack. Jack stopped at a red light, drumming his fingers impatiently on the steering wheel.The hot and humid evening wind blew in through the window.He was glad he took the time to go to the hospital.But thinking that he had suspected that the hospital was trying to cover up the truth, he felt a little embarrassed.But this thought made him indirectly suspect Patience.Whether or not Stanhope really had a heart attack, it can be regarded as wrong. When the light turned green, he continued on.The problem is that she could still be having a heart attack.Wayne also admitted that even with the absorbance analyzer he was proud of, the error rate of negatives was higher than that of positives.Jack sighed.Nothing in this lawsuit is straightforward.Patience.Stanhope remained a problem patient after his death.It reminds Jack of his favorite lawyer joke: What's the difference between a lawyer and a whore?The whore will not pester you after death.In Jack's opinion, Patience was indeed a bit of a bad lawyer. As Jack drives, he considers whether to go back and see Craig.At this moment, he might have drunk, taken medicine, and passed out.Jack really didn't want to go back, and didn't feel the need to go back.In his view, Craig was absolutely not suicidal.And as a smart physician, Craig knows just how powerful these drugs can be.But on second thought, when I go back, I can see what kind of portable box Craig is using and whether it has expired.Only with this information can he judge whether the positive test result is reliable.