Chapter 25 Chapter Twenty Two

Newtown, Massachusetts Friday, June 9, 2006 three in the morning: twenty-five For the next few seconds, Jack's mind went blank.When he realized that his brother-in-law was not breathing, he jumped forward, trying to get around the corner of the bed and rush to Craig's side as soon as possible, lifted the quilt, quickly judged Craig's condition, and performed artificial respiration if necessary. The sudden rush saved Jack's life.He suddenly realized that there was someone else in the room.The man was dressed in black, making him almost invisible.He was sprinting out of the open bathroom door with a big club in his hand and slammed it at where Jack's head was.

Although it missed Jack's head, it hit him on the left shoulder.Fortunately, the stick was hit sideways, so it wasn't too heavy.But Jack still felt a burning pain all over his body, and his knees went limp. Still holding the flashlight tightly, Jack rushed out from the end of the bed, as far away from the bed as possible, and the beam of the flashlight swayed all over the room.He didn't want to be trapped by intruders.Although he couldn't see clearly, he knew intuitively that the man was rushing towards him, and the big stick was about to fall down.Jack has always believed that the best defense is offense.He squatted down, jumped forward suddenly, and pressed his right shoulder against the man, trying to twist him and fall him.Jack aimed at the man's thigh and kicked repeatedly.He has been mountain biking in New York and has good leg strength.The man was kicked back a few steps, and both of them fell to the ground.

The two were so close that Jack thought it would be an advantage to use the foot-long flashlight as a weapon rather than a stick.Jack let go of the man's thigh, grabbed his shirt, and quickly picked up the flashlight, ready to smash the man's forehead with all his might.But as he raised the flashlight, the beam of light hit the man's face.Fortunately, before he fell down, Jack's mind raced at high speed in an instant, and he recognized that this person was Craig. Craig?Jack couldn't believe it.He quickly lowered the flashlight in his hand and shone it on Craig's face for confirmation.

Jack?Craig asked angrily.He raised his hand to shield his eyes from the glare of the flashlight. OMG!Jack said as he let go of Craig's shirt, put the flashlight away, and stood up from the ground. Craig stood up too.He walked to the wall and flipped on the light switch.What time is it, and you are still sneaking around my house, what on earth are you trying to do?He looked at the alarm clock next to the bed.It's only half past three in the morning! Listen to my explanation, Jack said, feeling a sharp pain in his shoulder, and couldn't help frowning.He tried to feel the place and found that the pain point was at the junction of the collarbone and the shoulder.

Whoops, Craig said, throwing the bat on the bed, and walked over to Jack.God, I hit you, I'm so sorry.I've been ruthless.are you OK? I've had worse injuries than this, Jack said, looking at the bed.Turns out he mistook the pillow and comforter for Craig.can i examine your woundCraig asked with concern. sure. Craig grabbed Jack's arm, put his hand lightly on Jack's shoulder, turned Jack's arm back and forth in the socket of his shoulder, and slowly raised it again.Does it hurt? It hurts a bit, but the pain doesn't get worse with movement. I think the bones should be fine, but it's best to get an x-ray.I can drive you to Newton Memorial Hospital right now if you want.

I think I'll put some ice on it for now, Jack said. good idea!Go downstairs to the kitchen.You can put some ice cubes in the freezer bag. In the hallway on the second floor, Craig said: "My heart is still pounding.I thought you were one of the gangsters who came to terrorize my daughter that day, and wished I could blow you away with a stick. I thought you were one of the gang, too, said Jack.He noticed that Craig was wearing a dark bathrobe, not the black samurai uniform he had imagined.He also felt the gun in his jacket pocket hitting his body.The situation was so urgent just now, he didn't even think about this gun, he thought it was a good thing.

Craig packs an ice pack for Jack.Jack sat at one end of the couch with an ice pack on his shoulder.Craig slumped to the other end, one hand to his forehead. I'm leaving right away so you can go back to sleep, Jack said.But I still want to explain this to you. I'm listening, Craig said.Before going to bed, I went downstairs to inspect the whole house, at which point the bed was already made.I didn't expect it to be you at all, especially at this moment and sneaking around on the second floor. I promised Alexis to come and see you. Did you call her tonight? I did, but it was too late.Honestly, she's worried about you mixing booze with drugs.Her concern is justified.Among the corpses I dissected, several died in this way.

I don't need you to teach me. All right, said Jack.Anyway, she asked me to come and see you.To be honest, I don't think it's necessary either.The reason why I look sneaky is because I am afraid of waking you up and afraid that you will be angry if you see me. Craig took his hand from his forehead and looked at Jack.You are right. I'm really sorry if I offended you.I did it for Alexis.She is afraid that you will be more anxious than ever after today's trial. At least you're being honest, Craig said.I think you really mean well.It's just that the current state is hard to accept.I was forced to re-examine myself.Today I am a pathetic, ridiculous, self-defeating witness.Looking back, I am embarrassed even by myself.

How do you feel about the performance of the expert witnesses this afternoon? fine.Someone finally spoke up for me, but I didn't think it would help.Unless Randolph delivers an Oscar-caliber performance tomorrow when he wraps up his arguments, the jury will definitely vote for that bastard Jordan.Personally, I don't think Randolph is capable of this.Craig looked at the blank TV screen and sighed in frustration. There's another reason why I'm so late, said Jack. oh!what reason?Craig asked.He turned his head to look at Jack, his eyes were moist, as if he wanted to cry but was embarrassed to cry.You haven't told me about the autopsy yet.Has an autopsy been done?

Done, Jack said, and gave Craig a general report of what happened that day, from the exhumation to the meeting with the toxicology examiner.What he told Craig was not as detailed as what Alexis said, but it was roughly the same. Craig became engrossed as he listened, especially to the toxicologist and the possible criminal implications of the case.If the toxicology examiner can find the drug or the poison, that could end the malpractice drama, Craig said, straightening up a little. No doubt, Jack said.But as I just explained, this possibility is very small.But if Patience hadn't suffered a heart attack, many drugs would have been suspect.Another reason I'm here tonight is to see the portable biometric kits in your emergency kit.Can you think of any reason to prove that the positive test result at that time was wrong?

Craig raised his eyebrows and considered the question for a moment.Unable to figure it out, it took him a long time to speak.I also hope that this result is wrong, but I really can't think of a reason. The supervisor of the hospital laboratory asked me whether the kit was used to check troponin I and myoglobin together, or only troponin I? Only myoglobin is checked.I chose this kit for the same reason the lab director mentioned: because the results are available within two hours. Does this equipment have a shelf life? I haven't heard of it anyway. Then we can only narrow the scope of suspicion to drugs that can cause heart attacks. Digitalis checked?Craig asked. Of course I also thought of digitalis, which was part of the test.It was concluded that there was no digitalis in her system. I wish I could be of help, too, Craig said.The worst part about being sued is feeling so helpless. All you can do to help is to think about what kind of heart poisoning drugs Patience and Jordan have access to. She has a lot of medicine in her medicine cabinet, all of which are my partner Ethan.Cohen prescribed it to her before.However, the drug list has been submitted to the plaintiff during the evidence discovery stage. I've been through it, Jack said, standing up.After resting for a while, his legs became a little heavy instead, and his movements were sluggish.Obviously need some coffee to get through the night.I'm going to go back and see if the toxicologist finds anything new, and you better go to bed too.He said and walked towards the door. Are you going to stay up all night tonight?Craig accompanies Jack to the door. Looks like it's going to be a late night, Jack said.Despite all the mishaps I've had and the few times I've been hit, the experience was generally positive and brought back my old relationship with Alexis. They walked to the front door.Craig pointed to the study at the end of the corridor.Shall I bring the emergency kit and show you the test kit?I'm pretty sure this was the box I was using.After this incident, I seldom go out to the clinic. Jack shook his head.No.You've told me all I want to know. Can I see you in court tomorrow? I don't think so.Some personal reasons, very urgent, require me to take the first flight back to New York tomorrow.So all I can say is, good luck! Jack and Craig shook hands.Although the two were not yet friends, they got to know each other better and appreciated each other more and more. I drove into the city after four o'clock in the morning, and the traffic conditions were similar to those when I left the city.There are plenty of cars on Massachusetts highways, but very few on city streets.It took less than twenty minutes for Jack to drive to the Forensic Medicine Department.He parked his car in a private parking space outside the building.Anyway, since he was leaving early in the morning, there should be no problem. The security guard already knew him and let him into the building.He looked at his watch as he climbed the stairs.It's the last minute.Two hours later, his plane will slide slowly onto the runway. Entering the library, Jack was a little surprised.The house is much messier than it was when he left.Latasha seemed to be cramming for the Board of Medicine exam.Spread out on the table were many tomes that she had scavenged around the office, most of which Jack knew, including general internal medicine textbooks, physiology books, toxicology books, and pharmacology books.The case file materials that Jack had sorted out were scattered everywhere, at least he didn't see any order. What are you doing?Jack asked with a smile. Latasha was looking at an open textbook and suddenly raised her head.Welcome back, stranger! There are several books that Jack doesn't know.He turned to the cover to look at the title of the book, then turned to the page that Latasha had read, and sat down opposite her. what happened to your shoulder Jack was still applying an ice pack to the wound.At this moment, the ice in the bag has basically turned into water, but it is still very cold, and it can also start to relieve pain.He told her what had happened.Latasha was sympathetic to him, but very critical of Craig. It wasn't his fault, Jack insisted.For a variety of reasons, I was too invested in the case to ever consider how flippant the idea of ​​sneaking into his house was.You know, some people broke into his house and threatened his children, just to warn him that if I insist on autopsy, they will come back for revenge.Gosh, I just finished my autopsy.What did I think at the time? But you are a guest.He always checks before he hits someone with a bat. I am no longer a guest.Let's not talk about this topic anymore.Thank God he wasn't hurt, I only had a shoulder injury.At least I think it's just a soft tissue contusion, maybe the collarbone needs an x-ray. Look for the good, Latasha said.You at least made sure he wasn't comatose, you know what I mean? Jack couldn't help laughing. What about the physiological index test kit?Did you find anything? It still cannot be determined that the positive test result was wrong.It seems that we can only admit that this result is valid. Maybe a good thing, Latasha said.Many deadly drugs can be ruled out.She glanced at the few books in front of her. It looks like you were busy just now? You can't imagine how busy I am.I drank a few cans of Diet Coke and got my energy back.Felt like taking a toxicology refresher class.I haven't touched any of these things since finishing my Diploma in Forensic Medicine. What about Allen?Did you call? Several times, to be exact. Did he find anything? No.Nothing was found.He was clearly trying to impress me with him.And guess what?He really achieved his goal.I mean, I know he's smart.He excelled in chemistry, mathematics and physics in college.But I didn't know that he later got a Ph.D. from MIT.It takes brains, unlike med school, where persistence is all it takes. Did he say which drugs were excluded? Most commonly used cardiotoxicants not listed on the drug test list were excluded.He also explained to me the tricks he thought of.Heart and lung tissue samples are difficult to examine because of interference from chemicals in preservatives.The sample contamination of body fluids is relatively less, so he focused on this. Then what are you doing with these textbooks? At the beginning, I reviewed cardiotoxic agents, and found that many of them could cause a heart attack, or cause huge damage to the heart muscle, so that the clinical symptoms were very close to a heart attack, and the cardiovascular system would not be blocked.This is consistent with our autopsy results and with what I have observed on stained frozen sections.After you left, I observed a few slices under the microscope.The capillaries appear normal.The slices are still on the microscope in my office, you can take a look if you want to see them. I believe what you say, said Jack.The blood vessels were so clean in the first inspection, and I didn't expect any new findings from the microscopic observation. Now I have expanded from pure heart poisons to nerve agents, because many drugs are harmful to the heart and nerves.Let me tell you, this stuff is interesting, especially the part that involves bioterrorism. Have you read the forensic records?Jack asked.He didn't want to digress. Hey, you haven't been gone long.I think I've done a pretty good job.You have to give me a break! time is limited.concentrate. I'm paying attention, man, Latasha said scornfully.I didn't drive out and wander around. I knew it was impossible and asked around, and I was beaten along the way. Jack rubbed his face vigorously with both hands, trying to drive away the fatigue that would affect his cognition and emotion.He definitely didn't mean to blame Latasha.Is there any more Diet Coke?I need a little caffeine. Latasha pointed to the door leading to the corridor.Go out to the left, there is a vending machine in the dining room. The building was quiet, and Jack was startled by the sound of a Coke can falling into the exit of the vending machine.He was tired, but also tense, and he didn't know why.Maybe it's because the case is closing and time is running out.But it could also be a little anxiety because I'm going back to New York soon, and I don't know what's going to happen in the future.Jack opened the can of Coke, a little hesitant.He was already a little nervous, could the caffeine make it worse?He couldn't care less, drank the Coke in one gulp, and hiccupped.He reassured himself that he needed to be clear-headed at this time, and even doctors would recommend caffeine. Jack returned to the seat opposite Latasha, feeling a buzzing in his head, probably because he didn't usually drink Coke.He plucked Craig and Jordan's forensic records from the pile of papers around Latasha. I didn't read every page of the forensic records, Latasha said.But I skimmed over and made a list of Patience's symptoms. Yeah?Jack is very interested.I'm going to do this. Looks like I guessed right, since you mentioned the idea before driving to the suburbs. Where is the list? Latasha rummaged through the pile of materials in front of her, concentrating so hard that her facial features squeezed together, and finally found a piece of yellow standard writing paper and handed it to Jack. Jack settled himself in the chair.The symptoms on the list are not arranged in order, but simply divided into two columns: morning and evening of September 8th.Morning symptoms include abdominal pain, intensified productive cough, intermittent fever, nasal congestion, insomnia, headache, flatulence, and generalized anxiety.Evening symptoms include chest pain, cyanosis, inability to speak, headache, difficulty walking, difficulty sitting up, numbness, floating sensation, nausea with a small amount of vomiting, and general weakness. that's it?Jack asked, waving the list. Do you think it is not enough?Almost all the symptoms I learned in my third year of medical school. I just want to make sure that the symptoms mentioned in the forensics notes are all here. I wrote everything I could find. Is there any mention of excessive sweating? No.I also searched for it. I did too, said Jack.Excessive sweating is a classic symptom of a heart attack.I didn't find this the first time I watched it and couldn't believe it.I'm glad you didn't find either.I've always felt like I missed it. Jack continued to look at the list.The problem is that most entries have no qualifiers.Items with qualifying components are too broad and not descriptive enough.It makes people feel that all symptoms are equally important, and it is difficult to distinguish the weight of various symptoms in Patience's clinical state.For example, just talking about numbness does not mention the specific location, scope, and duration; nor does it say that numbness refers to no feeling, abnormal sensation, or pinprick sensation.In this case, Jack couldn't tell whether the numbness was caused by a neurological abnormality or a cardiac abnormality. Do you know which part of toxicology is the most interesting?Latasha looked up from a large textbook as she spoke. have no idea!which part?Jack said vaguely.He was preoccupied with considering whether to go through the forensic records again, looking for the qualifiers that preceded the symptoms mentioned on the list. Reptiles, Latasha said.The evolution of their venom and the difference in toxicity is just amazing. It's really strange, Jack said as he opened Jordan's forensic records and quickly flipped through the pages, trying to find the records on September 8th. The venom of some snakes contains a potent cardiotoxin that can cause immediate myocardial necrosis.Can you imagine the effect this has on the physiological indicators of the heart? Yeah?Jack suddenly became interested.which snakes? Latasha sorted out a deep groove in the pile of materials on the table, then turned the textbook around and pushed it in front of Jack.There is a table in the book, which lists two kinds of snakes and compares the toxicity of their venoms. There are several kinds of snakes under each category.Latasha pointed to the watch and said: Mojave rattlesnakes and South Pacific rattlesnakes. Jack glanced at the watch.These two snakes are the most venomous of the snakes listed in the table.Very interesting, said Jack.His interests come and go quickly.He pushed the book back and said: We're not studying venom, though.Patience was not killed by a poisonous snake. I know, Latasha said, taking the book back.The reason I study venom is to know which compounds need to be considered.I mean, if we're looking for heart poisons, we're going to find them in compounds. That's right, Jack said.His interest returned to the forensics records, and he found the part he needed, and began to study it seriously. In fact, the most interesting group of venomous animals is a group of amphibians. Really, Jack wasn't paying attention at all.He found the source of the abdominal pain in forensic records.Jordan said in his testimony that the pain was in the lower abdomen, to the left.He made revisions to the items listed by Latasha and wrote them down on the yellow writing paper. The most poisonous thing is the Colombian poison dart frog. Latasha kept flipping through the book until she found the corresponding chapter in the textbook. Yes, Jack repeated.He skipped part of Jordan's testimony until Jordan started talking about his evening symptoms.He was looking for the part of Patience that felt numb. Their skin secretions contain some of the most toxic substances known to man, Latasha said.Can immediately produce a toxic reaction on the myocardium.Are you familiar with bufotoxin? Know a little, Jack said.He found the source of the numbness.From Jordan's testimony, it was not a loss of sensation, but pins and needles, involving Patience's arms and legs.Jack jotted down all this information on yellow writing paper. Is the most powerful toxin.As soon as the bufotoxin comes into contact with the heart muscle, all cardiac activity stops immediately.Latasha snapped her fingers.In a test tube, the heart muscle cells were still beating normally.After exposure to a few units of bufotoxin, it stopped completely immediately.Can you believe it? It's hard to believe, Jack said.He found Jordan's testimony about the feeling of floating.Interestingly, there was a tingling sensation, but no feeling of floating in the liquid.The testimonies described a feeling of not being able to step on the ground, but of floating in the air.Jack jotted down the information on yellow writing paper. Bufotoxin is a steroidal alkaloid, not a polypeptide.Found in several species of frogs, but the one with the highest concentration of venom is the golden poison dart frog.The name is fitting, as the bufotoxin contained in a tiny poison dart frog can kill a hundred people.It's unbelievable. Jack went back to Jordan's part about Patience's weakness, and found that there was no mention of atrophy of any specific muscle group, but a systemic symptom.At the beginning, it was difficult to walk, and it transitioned to difficulty in sitting up in a short time.Jack added the information to the yellow writing paper. There is one more thing to mention about bufotoxin.From a molecular point of view, its mechanism of action is to depolarize the membrane potential of cardiac muscle and nerve cells.Do you know how?By affecting sodium delivery.You also said that this subject is profound. What did you just say about sodium?Latasha's comment finally caught Jack's attention.When Jack concentrates on thinking about problems, he often forgets the surrounding environment, which is what Latasha just encountered. When bufotoxin enters nerve and muscle cells, it will cause the entrance of sodium ion channels to close, which means that the relevant muscle and nerve activities will be terminated. So, Jack seems a little dazed. Yes, Latasha said.remember we talked about Jack jumped up suddenly, frantically rummaging through the messy files on the desk.What about those papers?He looked a little crazy. What paper?Latasha asked.She leaned back in the chair and had just finished speaking.She was a little taken aback by Jack's sudden madness.In a panic, he knocked the forensics record to the ground. You know!He blurted out, not knowing how to express it.It's those papers! Lots of papers here, big man.God!How much Diet Coke have you been drinking? Oh shit!Jack said angrily.Instead of looking for papers, he reached out to Latasha.Show me that toxicology textbook!He seemed irritable. OK, Latasha said.Jack's transformation confuses her.He turned the pages of the tome like a deck of cards, found the index, and eagerly ran his fingers down the columns of the index.After finding the target, he turned back and quickly turned the pages of the book. Latasha was really worried that the book would fall apart.He found the page he was looking for, and finally fell silent. What are you doing?It's not too much to ask you this question, is it? This is what you call a major discovery, and I call it an epiphany.Jack muttered under his breath as he continued to read.found it!After a while, he yelled and pumped his fists triumphantly in the air.He slammed the book shut and looked across the table at Latasha.I know what to ask Alan to find!It's a bit counterintuitive.If found, it wouldn't explain all the facts we know, but it could explain the most important ones, and it would prove that Craig.Berman did not commit medical misconduct. What is it?Latasha was in a hurry.It annoyed her a little that Jack was so vague.It was almost five o'clock, and she was not in the mood to play games. Look at the strange symptom you wrote down, Jack said, picking up the yellow writing paper, pointing to the record of floating sensation.Not even the most hypochondriac can invent such a symptom.This shows that the patient does have some kind of abnormal situation.If Alan can really find out what I think, it can only show that Patience.Stanhope is either a big fan of sushi or a fanatic of Haitian voodoo.Of course, we know that's not the case. Jack!Latasha said grumpily.I'm too tired to joke with you! I'm sorry, Jack said.The reason why I joke like this is that I am afraid that it will turn out that I am right.In spite of all my efforts, I'd rather I be wrong on this one.He motioned for her to go out with him.hurry up!I'll tell you all on the way to Allen's lab.It's really last minute.