Genesis – Robin Cook

It was a cold, raw, windy, and heavily overcast March night on the Lower East Side of Manhattan. Although the spring equinox was soon to arrive, winter had not given up. As evidence, a few wayward snowflakes swirled down out of the low cloud cover, which was churning like a witch’s brew. With the temperature hovering in the mid-thirties, these microscopically intricate and strikingly beautiful crystalline structures were immediately metamorphosed into mere droplets of water the instant they touched any terrestrial surface. In sharp contrast to this wanton destruction of nature’s handiwork, the situation was the opposite inside a cozily decorated one-bedroom fourth-floor apartment on 23rd Street. Within the literal and figurative indoor warmth, a cascade of cellular events had begun that was ultimately the absolute antithesis of the dissolution of the snowflakes. Here there was to be a progression of vastly increasing order and complexity initiated by the forcible ejection of more than 100 million eager sperm into a vaginal vault. The individuals involved in this amorous event were blissfully unaware of the miraculous drama they had initiated and of its ultimate dire consequences for both of them. Thoroughly intoxicated by the passion of the moment and forsaking contraception, they had given no thought to the possibility there would be an almost simultaneous release of a receptive ovum from the female’s right ovary. Nor did they consider how determined sperm are in fulfilling their singular desire to fuse with a receptive female equivalent. Two and a half hours later, when the woman was contentedly fast asleep and the man likewise in his own abode, the fastest-swimming sperm, following a perilous and Herculean marathon from the depths of the vagina to the internal end of the right fallopian tube, collided head-on with the passively descending ovum. Powered by an irresistible reflex, this winning sperm rapidly burrowed between the cloud of cumulus cells surrounding the ovum to hit up against the ovum’s tough covering. A moment later he injected his pronucleus into the ovum to allow his twenty-three chromosomes to pair with the ovum’s twenty-three, forming the normal human cell complement of forty-six. The ovum had now become a zygote. Thus, on this nasty New York night, one of the most astounding miracles of the known universe had been initiated: human genesis.

Although such episodes of fertilization currently occur in the staggering neighborhood of 350,000 times a day on a worldwide basis, which clouds people’s appreciation by its repetition, it begins a process of truly wondrous, dumbfounding complexity. As a single cell that can barely be seen by the naked eye, the human zygote contains all the data and instructions in its microscopic DNA library necessary to form and operate a human body. That means without any additional informational input, the single-celled zygote is capable of orchestrating the origin of some 37 trillion cells of two hundred different varieties as well as several billion extraordinarily specific, large-molecule proteins that must be formed according to exacting standards at just the right time, in just the right amount, and at just the right location. The human brain alone, with its 100 billion cells and more than 100 trillion synaptic connections, might be the most complex structure in the universe. By March eleventh, five days after the lovemaking that initiated this particular ongoing miracle of human genesis, the rapidly developing conceptus reached the uterus to begin its implantation in the uterine wall. Soon it would make its presence known, proclaiming that a pregnancy had begun. From then on, all that was needed for the birth of a human infant in approximately nine months was maintenance of basic nutrients, the removal of waste, and physical protection. Unfortunately, that was not to be the case . May 5th 10:05 P.M.

Taking a shower was a Zen experience for twenty-eight-year-old social worker Kera Jacobsen, especially after a tense day, which Saturdays were not supposed to be. Being careful not to fall since her bathtub’s curved, porcelain-coated bottom could be treacherously slippery, she stepped in, yanking the shower curtain closed in the process. She had already adjusted the water temperature to the near-scalding heat she preferred. After wetting her body thoroughly, she began to scrub herself with the help of a fragrant gel and a long-handled shower brush, washing away the stresses of the day and calming her general anxieties. She’d been experiencing more than her share of both lately. Kera had been in New York City for just under eight months. Coming to the Big Apple had been a rather sudden decision. She’d grown up in Los Angeles, obtained her master’s degree at UCLA, and had held a position in social work at the UCLA Mattel Children’s Hospital. Her specialty was working with children with complex medical needs and their families. It was demanding work and often emotionally draining, although ultimately fulfilling.

There was no doubt that her efforts made a big difference and were an important complement to the work of the doctors and nurses who were understandably focused on curing and alleviating immediate symptoms of the disease process rather than the bigger picture of how families and individuals coped. In this capacity she’d been content and professionally satisfied. What ended up rocking her world was the sudden and unexpected end the previous September of a long-term relationship with a medical student named Robert Barlow. Over the course of the two and a half years they had dated, they frequently spent the night at the other’s dwelling. With similar interests, including a shared liberal political orientation, they were never at a loss for conversation, which occasionally included discussions of future plans with the standing assumption it would be together. His intention was to take a surgical residency at one of the wellknown academic medical centers, preferably there in LA or, if not, possibly San Francisco. As a particularly dedicated student, he was hopeful he’d have his choice. Kera had assumed that she would follow if he was to head up to San Fran. With her sterling credentials she was confident she could get a job at any academic medical center. But it wasn’t to be, and Kera still had no idea of exactly what had happened, although she had heard through the UCLA Medical Center grapevine that Robert had been seen frequently in the company of one of the surgical department’s first-year female residents.

Nonetheless, and with zero warning whatsoever, Robert had informed her one hot, smoggy LA afternoon that their relationship was over. Having suffered a big blow to her self-esteem, she felt the urgent need to fly the coop. Mutual friends kept asking what had happened between her and Robert, pretending to be sympathetic but actually loving the drama and gossip. Besides, there were just too many chances of inadvertently running into Robert in and around the medical center. On top of all that, Kera had always had a soft spot for New York City, coupled with being tired of the monotony of Los Angeles weather, its uptick of annual forest fires, and the ever-present threat of San Andreas Fault activity. A few weeks after Robert’s shocking news, she decided to turn an emotional whammy into something positive and made the cross-country move. After rinsing the soap off her body, she squeezed a dollop of shampoo into the palm of her hand and began to wash her hair. This was the part of the shower that she liked the best, and she used considerable force as she worked up copious suds to massage her scalp, trying to blank her mind. At first the move to New York had been positive in all respects except for the continued disappointment voiced by her mother and sister, who claimed they missed her terribly. Kera had managed to get a commitment for a social work job at the NYU Langone Medical Center—specifically with the Hassenfeld Children’s Hospital—before leaving LA, so employment hadn’t been an issue.

As for an apartment, she lucked out by responding to an ad on one of the Langone Medical Center’s bulletin boards that had been posted by a nurse who had opted to join the Peace Corps. The listing was for the sublet of a furnished, rent-controlled one-bedroom on 23rd Street just off Second Avenue. More important, from the standpoint of her self-image, she also found herself involved in a whirlwind affair with an attractive, highly accomplished, and older and more mature man than Robert, whom she met over the December holidays. Unfortunately, her life had taken another unexpected and unpleasant turn, and she had begun to question her judgment as well as her gullibility. Once again, she was experiencing disappointment and self-esteem issues—perhaps not as precipitously as with Robert, yet she was disturbed enough to have started seriously to consider returning to Southern California. As she expected, her mother and sister were absolutely thrilled with the possibility when she’d called them that evening to broach the subject, even though both had immediately questioned what seemed like a sudden change of heart. Only a month earlier in a similar phone call Kera had impressed them with how deliriously happy she was living in the Big Apple. Unprepared to share any details, she merely carried on about having come to the realization of how important close family connections were to her. She felt a twinge of guilt at not having been forthright, but the truth was that she hadn’t completely made up her mind. There was still a vestige of hope that things might improve, although the chances weren’t good.

Kera turned off the shower after making sure all the soap and shampoo had been completely rinsed. With her bath towel in hand, she stepped from the tub. Bending at the waist, she rapidly towel-dried her thick, moderately long hair, which she considered the only contribution her emotionally unavailable father had provided her. As she straightened, she subconsciously glanced at her profile in the full-length mirror attached to the back of the bathroom door. When it occurred to her what she was doing, she laughed at herself. It was far too early to see any change. Finished with drying herself, she was about to hang up her bath towel when her buzzer sounded in the other room, announcing that someone was downstairs at the building’s front door. The sudden raucous sound cut through the quiet apartment like a hot knife through butter, shattering the peacefulness Kera had been experiencing. Tossing her towel over the edge of the bathtub and grabbing her robe from the clothes hook, she dashed out to the tiny kitchen where the ancient intercom was mounted on the wall. As she pressed the talk button and asked who was there, she noticed the time on the microwave oven.

It was 10:23. Since she hadn’t ordered any takeout and there was only one person who would possibly ring her bell at such an hour, although never without a text or call and rarely on weekends, she was reasonably sure who it was. The possibility didn’t thrill her. She’d been trying to calm herself prior to getting into bed. “It’s me,” the expected masculine voice said. “What are you doing?” Kera questioned. She leaned close to the speaker. She had to press the vintage device’s talk button each time she spoke and then let go to listen. “I’m sorry about the hour, but I need to talk with you.” “I’m just getting out of the shower.

How about tomorrow around lunchtime?” “I need to talk with you tonight. I’ve had a change of mind, and I want to share it with you. I need to share it with you.” Kera paused even as her pulse quickened. After everything that had happened and everything that had been said over the previous month, there was no way she could be at all certain what he meant by “a change of mind.” She could guess. But was it wishful thinking? After all, he had been painfully and consistently clear over a period of weeks. Still, if he meant what she thought he might, it would change everything. “What kind of change of mind?” she asked finally, lowering her guard. She didn’t want to get her hopes up only to have them dashed on the proverbial rocks all over again.

“I’ve realized you were right all along, and I was wrong. It just took me some time to figure it out. We need to celebrate!” “Celebrate?” Kera questioned, to be sure she’d heard correctly. “Yes, celebrate. And I’ve brought the makings.” Trying to contain her excitement, she hit the door-open button. Then she fled back to the bathroom, pulling on her robe in the process. She had been standing naked, clutching the robe to her chest the whole time she’d been on the intercom. Once in the bathroom she grabbed her hairbrush and tried to tame the wet mop on top of her head. It wasn’t working.

She felt she looked dreadful, but there was no time to do anything about it. Cinching the tie on her robe, and with a final desperate pat to her hair, she was back out to the door to begin disengaging the panoply of locks and chains the renter of record had installed. Just as she’d finished, there was a furtive knock. With a final check through the peephole, Kera pulled open the door. Her visitor was wearing a dark fedora and a dark overcoat she’d never seen. Before she could greet him, he swooped into the room, closed the door, and enveloped her in an embrace that took her breath away. Only then did he put down the shopping bag he was carrying and remove his hat and coat, which he tossed onto the couch. “As I said, we have to celebrate,” he announced with great fanfare. He then proceeded to take out several impressive cut-crystal fluted champagne glasses, followed by a chilled bottle of rosé prosecco nestled in a thermal sleeve, and finally, a small package of cocktail napkins. “Check this out!” he said, showing the bottle to her as if he were a sommelier.

“Okay,” Kera said while reading the striking black label. “Bortolomiol Filanda Rosé. I’ve never heard of it.” “It’s fabulous,” he said proudly, “and remarkably hard to find.” “What exactly are we celebrating?” she asked hesitantly while he struggled with the wire securing the bottle’s cork. This kind of response from him was what she’d hoped and had expected when she’d originally broken the news. She’d been crushed when it hadn’t happened. “We’re celebrating everything,” he said triumphantly. “The fact is, you were right, and I was wrong. What’s happened is truly a miracle that was meant to be.

I just didn’t see it in the heat of the moment.” Kera could have pointed out that he’d taken far longer than a moment to come to the realization; in fact, there had been nearly a month of confrontation. But she didn’t say anything for fear of breaking the spell his enthusiasm was creating. She heard a resounding pop when the cork came out of the bottle. A bit of foam with a pink blush appeared at the bottle’s mouth. “As you said, life is too precious a miracle not to embrace.” He poured two glasses of the bubbly wine. “What about your wife?” Kera struggled to question. “History,” he said simply, as he handed one of the glasses to her and then hoisted his and extended it toward her. A melodious clink resounded in the otherwise silent room as the glasses touched.

Following his lead, she took a healthy swig of the prosecco, which tasted better than any other wine she had ever had. Almost a month earlier she’d decided to avoid alcohol, but this moment was special. They had had several unpleasant arguments about the future over the previous weeks, and she’d reconciled herself to their being hopelessly miles apart. His sudden 180 elated her. It was most definitely a time for celebration. “Let’s sit and enjoy the wine,” he suggested while gesturing toward the couch. He moved his coat and hat to a side chair. “The company that makes this wine is from the Veneto part of Italy,” he added as he tugged on the sleeve of her robe, urging her over to the couch and to sit. “It is tasty,” Kera said. She had no idea where the Veneto was but assumed it was somewhere near Venice.

She didn’t ask for more of an explanation since she didn’t care. As for the taste of the wine, she was being truthful. As she sat down, she took another healthy swig, enjoying the effervescence as well as the smooth and subtle taste. She’d never been particularly fond of champagne and had always questioned the fuss and the cost, but this was different, making her wonder how much was from the wine and how much from her joyous mindset. Whatever it was, she was savoring the totality of the experience. Of course, she had a million questions, but for the moment they could wait. While he rambled on about prosecco and the Veneto of Italy with no appreciation of her lack of interest, she took another drink of the wine and held it in her mouth for a moment before swallowing. It was truly a delightful experience, and she luxuriated in the wonderfully relaxing feeling that spread over her, a far cry from the depressive thoughts she’d struggled with over the previous month. But then a dizziness intervened that wasn’t so pleasant. Although he was still talking, his words stopped having any meaning.

At the same time her vision blurred. Blinking repeatedly to clear her eyes, she put her glass down and tried to stand, but her legs wouldn’t work. “Are you okay?” he asked while putting his own glass down. “I’m okay, I guess,” she managed, but her words were mumbled. “I’m just suddenly so tired . ” Kera’s voice trailed off as she slowly sank back with her head resting against the back of the couch. Her eyes had closed, and with her mouth agape, her breathing slowed. CHAPTER 1 May 8th 5:49 A.M. Laurie Montgomery-Stapleton’s eyes popped open much earlier than usual and without Jack Stapleton repeatedly nudging her shoulder.

She couldn’t remember the last time she’d spontaneously awakened at such an hour. But her mind was churning because it was going to be an exceptionally busy day. So busy, in fact, that she was going to have to talk Jack, who was still blissfully sleeping next to her, into standing in her stead for at least one of her obligations, and that was not going to be an easy task. A week previous she’d agreed to go into John Junior’s school and meet with his fourth-grade teacher, Miss Rossi, and possibly the school psychologist about JJ’s supposedly recent disruptive behavior. Apparently there had been some aggressive incidents on the playground during recess and other impulse-control episodes. Knowing Jack’s impatience with such issues and his tendency to be less than diplomatic, Laurie hadn’t even broached the subject with him, preferring to handle it herself as she was certain there was nothing wrong with JJ. Now Jack was going to have to deal with the situation on his own because Laurie had newly arisen, pressing work-related obligations down at City Hall that conflicted. By lifting her head and gazing out of the two large, north-facing sixth-floor bedroom windows, Laurie could tell that the sun had just peeked over the eastern horizon. Although there were closable window treatments and even blackout shades, neither she nor Jack bothered to use them. Several blocks away on the top of a significantly taller building, she could see an old water tower.

At the moment it was totally awash with early-morning sunlight, giving the illusion that it was made of gold. Next Laurie’s eyes turned to glance at the digital clock. It was even earlier than she’d suspected—just a smidgen past 5:50—yet she was totally awake. Laurie had never in her life been a morning person and always struggled to wake up and get out from under the warm covers. It had been particularly true since she’d married Jack, because Jack insisted they keep the bedroom cool, almost cold from Laurie’s perspective. But the real reason Laurie had trouble getting up in the morning was that she was a night owl beyond any doubt. On occasion she’d been known to sleep through an alarm only feet away. When she’d been younger, she’d loved to read fiction far into the night, with a predilection for late-eighteenth-century and early-twentieth-century novels. That began to change once she had become a doctor and needed to keep up with the ever-expanding professional literature. These days, she was obsessed with reading not only the current forensic articles but also all the material she was expected to be familiar with as the chief medical examiner of the City of New York.

As the first woman to hold the title and thus a pioneer of sorts, she felt particular responsibility to be the absolute best she could be. To that end she’d had to learn how to read spreadsheets and budgets and all the appropriate reports coming out of the New York City Council, from its various committees, and from the New York City Department of Health and Mental Hygiene. She still sometimes found herself shocked at the sheer volume of documents that landed in her in-box. Despite Laurie’s commitment to doing her job well, the jury was still out in terms of how she personally felt about having accepted the position. Only now did she have a true idea of the extent of the political aspects of the job. It had been her general understanding that the Office of the Chief Medical Examiner, known as OCME, had fought and gained its independence after its founding in 1918, so that it could speak unencumbered for the dead. Although that was mostly true, she was learning the hard way that the mayor, who had appointed her, and the City Council, which held the purse strings, could exert considerable power, which she had to struggle to resist. It was especially hard since the OCME’s $75,000,000 yearly budget was a tempting target in a city continually starving for funds for other worthwhile obligations. On top of that, the morgue itself, where all the autopsies were actually done, was in need of a multimilliondollar replacement. At one time it had been state of the art, but that was no longer the case.

Apart from the political headaches of the job, Laurie found that she missed the intellectual stimulation of being personally immersed in the actual forensics, with the responsibility of determining the cause and manner of death. Objectively she recognized that it was best for her to let the nearly forty highly qualified medical examiners handle all the cases—otherwise, as her predecessor, Dr. Bingham, had learned the hard way, every district attorney, police higher-up, fire chief, city bigwig, and mayor would want the chief to do any case they were interested in simply because she was the Top Dog. But for Laurie, it was a sacrifice to take a step back and settle for frequent, unofficial morning rounds down in the morgue, looking over people’s shoulders and asking questions. The closest she came to being intimately involved was Thursday morning, when she regularly assisted one of the forensic pathology fellows on an autopsy. In partnership with New York University Medical School’s Department of Pathology, the OCME trained a handful of fellows to become board eligible forensic pathologists. With a sense of excitement and no small amount of trepidation, Laurie threw back the covers and stood up. She shivered as her warm feet made contact with the ice-cold floor. Hastily she wiggled her toes into the slippers she dutifully kept at the bedside and pulled on her robe. She always kept both handy in case she had to get up during the night.

Jack had not moved a muscle. He was on his back with his arms outside of the blankets, his hands clasped over his chest, and his mouth slightly ajar, the picture of contented repose. Knowing him as well as she did, Laurie had to smile. Jack was not the calm person he appeared at the moment, but rather someone whose mind never stopped and who had little patience for what he called red tape, meaning rules and regulations he didn’t agree with. He didn’t abide fools, or mediocrity, and he was never one to hide his feelings. From where Laurie was standing, she could see the scar on his forehead and his chipped left front tooth, both remnants of his determination to do what he thought was right despite putting himself at risk and getting pummeled for it. Although she loved him, she knew he was a handful, especially now that she was technically his boss. Although Jack was by far the most productive medical examiner on the entire staff, he was also the one who required the most corralling. Laurie knew, because she’d been rather similar in her day. Closing the door silently behind her, Laurie tiptoed into Emma’s room, which was considerably darker than the master bedroom, thanks to the shades being drawn.

Like Jack, Emma was fast asleep on her back, and appeared angelic in the half-light as only a four-year-old girl can look. Laurie had to restrain herself from reaching out and giving the child a hug. After the initial scare and distress evoked by a diagnosis of autism more than a year ago, Emma had been doing surprisingly well in response to thirty hours of behavioral therapy, five hours of speech therapy, and three hours of physical therapy weekly. It was a complicated, intensive schedule that had all been arranged and monitored by Laurie’s mother, Dorothy, who had turned out to be a lifesaver. After she’d initially caused difficulty between Laurie and Jack by camping out in their home after Emma’s diagnosis, Dorothy had truly stepped up to the plate to take on Emma’s situation as her life’s work, shunning all her previous philanthropic commitments. After corroborating the diagnosis with several acknowledged specialists, Dorothy had researched all the best therapists in the city, interviewed them, hired them, coordinated their schedules, and monitored them. And the effort proved worthwhile. After several months there were some positive signs. Emma’s inclination for repetitive movements appeared to lessen, and she began to lose interest in her compulsion to align her stuffed animals. Perhaps most promising, she showed increased ability to interact with JJ with even a few appropriate words.

There was still a long way to go, but Laurie and Jack both were optimistic that Emma might prove to be in the group of children diagnosed with autism that do make considerable headway in achieving typical developmental milestones. Being even quieter than she’d been when she’d entered, Laurie left Emma’s room, closing the door without the slightest sound. Emma was generally a good sleeper and usually didn’t wake up until after seven, but she could be a bear if disturbed, and sometimes it didn’t take much. On cat’s feet Laurie continued down the hall to JJ’s room. Like Emma, JJ was fast asleep in the room’s semidarkness, but unlike Emma, he looked as if he’d been running a marathon in his bed. His covers and sheets were hopelessly twisted around his nine-and-a-half-year-old body, but with his legs and feet out in the cold. Laurie couldn’t help but smile. Even in sleep the boy was a ball of action, although at that particular moment he was totally still. Without fear of waking him, as he was the opposite of Emma in that regard, Laurie extricated the knot of covers and then spread them back over him, including his legs and feet. Satisfied with what she had accomplished, Laurie turned with the intent of heading downstairs to the kitchen to get some breakfast.

The plan was to use this bonus time in her day to go over the material she’d laboriously prepared the night before and would be presenting during her command appearance that morning at a recently scheduled meeting of the City Council’s Committee on Health. It was this meeting and her long-term anathema to speaking in front of groups that had awakened her so early. But she didn’t get far, and an involuntary yelp escaped her lips as she collided with Jack, who had come into JJ’s bedroom behind her and was about to tap her on the shoulder. Even Jack jumped at Laurie’s apparent shock. “My God!” Laurie managed in a forced whisper. “You scared the hell out of me.” “I can say the same.” Jack pressed an open palm against his chest in the stereotypical sign of distress. In contrast to Laurie, his feet were bare, and he wore only pajama bottoms to ward against the chill. “Was something wrong with JJ?” He looked around Laurie at the sleeping child.

“No, he’s fine. I just covered him up.” “What are you doing up out of bed?” he questioned with obvious concern. “I can’t remember the last time I saw you up and about before six. Are you all right?” “I’m fine. I’m just a little worried about this morning’s City Council Committee meeting,” she said. “I want to go over the material I was working on last night. I told you about it.” “Yeah, I remember,” Jack said with a dismissive wave of his hand. “That’s so much to do about nothing.

You shouldn’t waste your time and emotion on a little mix-up just because a handful of politicians are up in arms.” “I don’t see it that way, not when the City Council has oversight over the OCME budget,” Laurie said. “Keeping them happy is one of my main responsibilities, especially when we’re in dire need of a new Forensic Pathology building and a new autopsy suite.” “But the little body switcheroo was an understandable mistake. No one was hurt, and it was easy to rectify.” “It’s easy for you to say no one was hurt. I heard both families were pretty damn upset and at least one of them is thinking of suing. Dealing with death is hard enough without having to experience the emotional shock of confronting the wrong body in an open-casket wake.” The origin of the problem was the near-simultaneous arrival at the OCME of two cadavers with the same first and last name, Henry Norton. Even though they received unique accession numbers, the night mortuary tech just checked the name and not the number when the first body was released, meaning both bodies ended up at the wrong funeral homes.

To make matters worse, the mistake wasn’t discovered until the family arrived for the first funeral service. “I truly don’t know how you find the patience for this kind of crap,” he said with a shake of his head. “So what are you going to say to the committee?” “I’m going to tell them that I personally apologized to both families, which I did. And then I’ll explain the changes in protocol I’ve made in how bodies are released to make sure it doesn’t happen again. I’ve also asked IT to update the case-management system to call attention to similar-named decedents.” “Well, it sounds like you’ve got the situation well under control.” “Unfortunately, the problem spread. The funeral home where the mix-up was first discovered is on Staten Island. The director added to his complaint that it takes too long for him to get bodies now that we’ve closed the Staten Island morgue and do the autopsies here in Manhattan.” “Yikes! So this mix-up of too many Nortons now forces you to justify closing the morgue on Staten Island?” “It’s worse than that,” Laurie said with a sigh.

“One of the Health Committee members is from the Bronx, where the morgue was also closed. She’s claimed that funeral directors in her district have complained about long delays, too. I’ve had to rush together an extensive report on the turnaround times for bodies from all five boroughs. It’s a PowerPoint presentation, and you know how much I detest talking in front of groups.” “You’ve told me, but it’s a mystery because you always come across like a pro.” “That’s because I overprepare,” she said. “Hey! Aren’t you freezing? I’m cold, and I’m in a robe and slippers.” Jack briefly hugged himself and pretended to shiver. “It is a bit chilly.” “Get your robe and come downstairs,” Laurie said.

“I’ll make some coffee. There’s a favor I need to ask you to do for me this morning.” “Favor?” Jack questioned as he paused at the door to the hallway. “I’m not sure I like the sound of that. What kind of favor?” “Something I was going to do this morning, but now because of this impromptu meeting down at 250 Broadway, I need you to go in my place.” “Was this something you were scheduled to do as the chief medical examiner? I don’t need to remind you that I’m not good at politics.” “No, it’s something I was scheduled to do as a mother. You’ll go as the father, which is totally apropos.” “How long has this been scheduled?” “About a week.” “Are you sure I can handle this?” Jack asked, only half-teasing.

“No, but there’s no choice,” she said with a short laugh. “Get your robe before you freeze to death, and I’ll explain.” Laurie followed him out of JJ’s room and watched him sprint down the hall toward the entrance to their bedroom. With all his pickup basketball and bike riding, he was shockingly fit. Laurie wished he’d stop both and constantly tried to convince him that the family needed him injury-free, but she had to admit that he did look good and wished she had half of his stamina. The trouble was that being the chief medical examiner, a mother, and chief household engineer left her scant time for herself or any kind of exercise routine. A few minutes later and even before Laurie managed to get the coffee water boiling, Jack swept down the stairs and into the kitchen dressed in his white summer robe. His feet were still bare. “Okay, out with it,” he said, pretending to be already irritated. “You have to go to JJ’s school and meet with Miss Rossi and possibly the school psychologist.

The meeting is scheduled for eight, prior to classes. I certainly don’t condone your commuting to the OCME on your bike, but it will make it easy for you since the Brooks School is on your way.” “I already don’t like the sound of this,” he said. “I suspected as much. That’s why I intended to just handle it myself unless it turns out a decision has to be made. I’m of the opinion it’s just a temporary misunderstanding. I mean, kids go through phases.” “JJ is not going through any phase,” Jack said, becoming serious. “What’s this all about?” “I can’t remember the entire litany,” Laurie said. “But there’s been some aggressive behavior on JJ’s part at recess and difficulty sitting still in class, allowing other children to take their turn, and impulse control.

That kind of stuff.” “Oh, for Chrissake,” he snapped. “There is nothing wrong with JJ except he has a Y chromosome, meaning he has a developing male brain that’s trying to prepare him to go out of the cave and hunt mammoths.” “You know that, and I know that. But it behooves us to listen and be supportive of the teacher who has to handle eight young male brains all at the same time.” “That’s what she’s being paid for,” Jack said. “I’m sure it’s not that easy,” she said. “I give teachers all the respect in the world. I don’t think I could do it.” “I know I couldn’t do it,” he said.

“But that’s neither here nor there. What do you think they’re suggesting?” “Obviously they’re concerned about attention deficit hyperactivity disorder.” Laurie concentrated on pouring the boiling water into the coffee maker. “Did they say anything about drugs?” “Miss Rossi raised the issue,” she said. “That’s all.” “Good God.” Jack stared off into the middle distance for a few moments as the smell of brewing coffee enveloped the room. Laurie poured two cups and handed one to him. She could tell his mind was going a mile a minute, and it wasn’t hard to guess the direction. “My plan was just to go and listen,” Laurie said.

“I ask you to do the same. You won’t be required to come to any conclusions today for certain. Just hear what they say and maybe ask a few questions, so you understand their perspective. Mostly listen! Then tonight we can talk about it. It will only take you fifteen or twenty minutes, tops.” “I don’t know,” he said with a shake of his head. “This overdiagnosis-of-ADHD situation is the kind of nonsense that could turn me into a conspiracist. It certainly seems like the pharmaceutical industry and the elementary education industry are in cahoots. There are just too many school-age kids, mostly boys, being prescribed speed to make them easier to corral. And then we wonder why the same kids take drugs as teenagers.

I can tell you now, JJ’s not taking any Adderall. No way.” “That’s certainly my feeling at the moment,” she said. “But I also know medication can be helpful under the right circumstances. And we need to show some respect for the school’s position, whatever it is. It’s not rocket science that we need to stay on friendly terms.” “I’m not the natural-born diplomat you are,” he said. “I know that about myself, and I don’t want to alienate the school, which I might do by being honest. Why don’t you go after your Health Committee meeting?” “I’m sorry, but I’ve got a jam-packed day ahead of me. I’ve got back-to-back obligations all day, including an emergency meeting with Chet McGovern even before I go down to 250 Broadway.

” “What on earth kind of emergency meeting are you having with Chet?” “Ever since I appointed him director of education at the OCME, he’s really taken on the position with inordinate seriousness, to the OCME’s benefit. He’s upped the level of all our teaching efforts across the board.” “I’m sorry to sound negative,” Jack said with a roll of his eyes, “but my guess is he took the position just because there are so many young women applying and being accepted as forensic pathology fellows. He’s an incorrigible Lothario. Chasing women is a sport for him.” Jack went to the refrigerator for fruit and milk while Laurie retrieved the cereal from the pantry. “Maybe that influenced his motivation initially,” Laurie said, knowing Chet’s off-hours inclinations and social history from Jack, “but he’s really put heart and soul into the role of head of education in a way I wouldn’t have expected. This emergency meeting he’s requested is a case in point. He believes one of the NYU pathology residents isn’t acting appropriately on multiple levels. He calls her the Phantom because she isn’t taking her month’s forensic pathology rotation seriously, ignores advice, and often can’t be found.

” All anatomic pathology residents at NYU Medical School were required to spend one month at OCME during their four-to-five-year curriculum. Under the supervision of the OCME director of education, they would assist the medical examiners and learn in the process, but couldn’t sign death certificates. The goal was to introduce them to forensic pathology rather than train them as forensic pathologists. Forensic pathology fellows, on the other hand, had already completed their pathology residency and were required to do autopsies, determine the cause and manner of death, and sign the ultimate death certificate even though officially they were still in training. “What’s the resident’s name?” Jack asked. He occasionally had pathology residents participate on his cases, although he didn’t go out of his way to encourage it. Jack had a reputation of doing the most autopsies by far of any of the medical examiners, which gave him the opportunity and excuse to cherry-pick interesting cases. As a result, many of the more motivated residents sought him out even though Jack hated being slowed down for any reason. Being a workaholic was one of the ways Jack dealt with his demons. “Her name is Dr.

Aria Nichols,” Laurie said. At that point Laurie and Jack were both eating cereal while standing and leaning their hindquarters against the kitchen countertop. “I don’t think I’ve met her. But if Chet is interested in her, she must at least be attractive.” He laughed to indicate he was half kidding. “I think you’re being unfair,” she said. “I don’t think Chet is being personal in the slightest with this woman. My sense is that he’s sincere and truly concerned about her. He even questioned if she should be a pathology resident or even a doctor.” “Wow,” Jack said around a mouthful of cereal.

“She must have brushed him off bigtime.” Laurie waved away his attempt at humor at Chet’s expense and rinsed out her bowl. “I’m impressed that Chet is as concerned as he apparently is, and I’ll be interested in what he has to say. Under Dr. Bingham’s tenure, there was never much attention paid to the NYU anatomic pathology residents. I think that’s got to change, and Chet seems to be doing just that. I want to be supportive.” “Whatever.” He followed her to the sink. “If this school meeting is only going to take fifteen or twenty minutes, are you sure you can’t tackle it? What about you looping back to the Brooks School immediately after your Committee meeting? I want to support you and JJ and pull my weight, but sending me is a risk.

I’m worried that I’ll screw everything up by ruffling feathers. I mean, I feel as strongly about this overdiagnosis of ADHD as I do about the anti-vaccination movement.” “I already told you I won’t have the time,” Laurie said. “As soon as I can get back to the OCME I’ve got a meeting with the chief of staff, the director of human resources, and Bart Arnold about medical-legal investigators’ pay. It’s an important meeting the four of us have been trying to schedule for weeks. The OCME is falling too far behind compared to what physician assistants can make in the private sector, which is making our MLI recruitment almost impossible. And following that, I’m meeting with the architects about the new morgue building. Actually, I’m even going to have trouble fitting both of those in because at eleven I’m scheduled to be over at the Tisch Hospital for my annual breastcancer screening.” After Laurie’s mother, Dorothy, had been diagnosed and treated for breast cancer a number of years previously, Laurie had had herself checked for the BRCA gene. When it was determined she, too, was positive for the BRCA1 mutation, she’d adhered religiously to regular screening.

“Okay,” he said, raising his hands in a gesture of surrender. “Now, that’s important! Why didn’t you just say that right off the bat?”

.

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