table, and the en bloc dissection of the heart and lungs sloshed into it.
“We do have one drug that we are going to test for specifically,” Jack said to Neil, while he watched Laurie free up the heart. “Again, thanks to the resuscitation effort on the third case, where they encountered hyperpyrexia and surprisingly elevated potassium, we’re going to concentrate our efforts on succinylcholine, which is known to cause both on occasion. At this moment, unless we find something very unexpected, that is the most promising agent.”
“My gosh,” Arun said. “This is fascinating.”
“There’s no heart disease here at all,” Laurie remarked. She’d made a series of slices into the cardiac muscle and along the tracks of the major coronary vessels. “Specifically, there’s no obstructive disease.”
The other three looked over her shoulder. “There is a sprinkling of hemorrhages on the pericardium,” Jack said. “That’s not pathognomonic of succinylcholine poisoning, but it’s consistent.”
“There are some on the pleural surfaces of the lungs as well,” Laurie said.
“Arun, could you take some photos of this with Vijay’s camera?” Jack asked.
“I certainly can.”
After the photos were taken, Laurie prepared to take the samples for toxicology. Using separate syringes, she wanted urine, blood, bile, and cerebrospinal fluid.
“There are two other reasons we’re thinking succinylcholine,” Jack said. “Succinylcholine makes the most sense from a purely diabolical point of view. If the perpetrator is a doctor, as we suspect, he or she would want to use the agent least capable of being detected, and succinylcholine certainly fits the bill. First of all, succinylcholine was probably used during the patients’ anesthesia, so even if succinylcholine happened to be found by the likes of us, its presence could be explained. And second, the body deals with succinylcholine very rapidly, which is why in an overdose situation, all you have to do is breathe for the patient for a short time and there’s a happy ending.”
“But you are still going to run samples?” Arun commented, “even if the body metabolizes succinylcholine rapidly.”
“Absolutely,” Laurie said, filling a syringe with bile. “If someone uses succinylcholine for nefarious purposes, they invariably inject a major amount, worried they might not be injecting enough. With a large dose, the body’s ability to handle it can be overpowered, so not only do you find a host of succinylcholine metabolites in body fluids, you often can find some of the drug itself.”
“Succinylcholine has been used in a couple of high-profile forensic cases in the United States,” Jack said. “There was a nurse by the name of Higgs who killed his wife in Nevada, and an anesthesiologist by the name of Coppolino who killed his wife in Florida. In the Higgs case the drug was found in the wife’s urine, while with Coppolino it was isolated in muscle.”
“Well, it will be interesting to see what our toxicologists can do at the All India Institute of Health Sciences. Our head guy has an international reputation.”
“Is there some way to get those samples over there?” Laurie said, as she finished obtaining the last sample.
“I’m sure there is,” Arun said. “I’ll get Jeet to take care of it. I’d imagine the clinical laboratory here at the Gangamurthy Hospital has a delivery service.”
With two proficient prosectors at work, the autopsy proceeded apace until Laurie got to the kidneys. After checking them and determining them to be normal in situ, she lopped them out with the knife used for gross dissection. Using the same knife, she opened one with a bifurcating coronal slice, exposing the parenchyma and the calyx.
“Jack, look at this!” she said excitedly.
Jack looked over her shoulder. “That looks odd,” he said. “The parenchyma looks sort of waxy.”
“Exactly,” Laurie said, with even more excitement. “I’ve seen this before. You know what it turned out to be?”
“Amyloid?” Jack guessed.
“No, silly. That pink stuff is in the tubules. It’s in the lumen, not in the cells. Maria suffered acute rhabdomyolysis!”
“Arun!” Jack called excitedly, “call Jeet. We want a frozen section. If this is myosin and we’re dealing with an intoxication, as we suspect, this is practically pathognomonic for succinylcholine poisoning.”
A half-hour later, Laurie was the first to get to look at the kidney sections. The autopsy had been finished and dictated. Specimens had been fixed, particularly of the kidney and the heart, and the slides would be made. Finally, the body had been placed in a proper mortuary cooler.
“Well,” Jack demanded impatiently. Laurie seemed to be taking longer than usual peering into the microscope.
“They are definitely pink casts in the tubules,” she said. She leaned back so Jack could look.
“Rhabdomyolysis for sure!” Jack said. He straightened up. “Considering the history, I’d accept that as proof, even without toxicology.”
Laurie got up so that Arun and then Neil could look in and see the myosin blocking the kidney tubules.
“So, what are you going to do now?” Arun asked. He was exhilarated to be part of a forensic pathology case, just what he’d dreamed of when he was in high school, before the realities of the field in India had become known to him.
“We should probably be asking you at this point,” Jack said. “In the United States, medical examiners operating in an independent capacity would approach either the police or the district attorney or both. This is clearly a criminal situation.”
“I don’t know what should be done,” Arun admitted. “Perhaps I should ask one of my lawyer friends.”
“Meanwhile,” Laurie said, “we should move quickly to strengthen the case. Hopefully, we’ll have scientific proof with the urine we sent to the All India Institute of Health Sciences toxicology department, but that’s only with one case. We need to get back to Queen Victoria Hospital and either get a hold of the second body somehow or at a minimum get a urine sample, and we should do the same with the body at the Aesculapian Medical Center. Three cases are much better than one. And we’d better hurry. Jennifer mentioned a noon deadline today.”
“Alright, let’s do that first,” Jack said. “We need proof on more than one body, especially in relation to succinylcholine poisoning. Hell, a body can produce a small amount of succinylcholine just from decomposing.”
“I’ll take a couple of syringes from here so we’ll have them for our samples,” Laurie said.
“Good thinking,” Jack said.
With unmistakable excitement and a strong sense of common purpose, the foursome piled back into the van for the dash back to the Queen Victoria Hospital. Once again Arun was at the wheel.
Neil pulled out his cell phone. “Now that it’s afternoon, I’ll give Jen a call,” he said. “I can’t imagine she could still be sleeping. I know she’s going to be excited about all this.”
“Good idea,” Laurie said. “And let me speak to her as well.”
Neil let the phone ring until voicemail picked up. He left a brief message for Jennifer to call him back. “She’s probably working out or swimming. I’ll try again in a little while.”
“She could be having lunch,” Laurie suggested.
“You’re right,” Neil said, pocketing his phone.
When they pulled into the Queen Victoria, Arun drove immediately around to the rear and backed into same spot.
After eagerly climbing from the van, the group hastily entered the hospital, opening both of the double doors in the process. The elderly man’s chair was vacant.
“Maybe he’s having lunch,” Laurie suggested.
“I hope so,” Jack said. “I’ll feel guilty if he lost his job over our mischievous activities.”
Arun was in the lead. They had to walk single file because the lunchtime cafeteria line snaked all the way out into the hall. They stopped at the cooler where Maria had been stored.
“Should we just ignore everyone and go in?” Arun questioned.
Jack and Laurie exchanged a glance. “You go in, Arun,” Laurie said. “Let’s not make this a scene.”
Laurie, Jack, and Neil moved down the hall a little way. No one paid them any attention.
Arun didn’t even get all the way in before he could tell that Benfatti was gone. The cooler was bereft of corpses. He backed out and shut the door. He told the others the bad news.
“There goes our chances for a trifecta,” Jack said.
