Chapter 28
28
“Toxicology came in on the Parker case,” Janice said. “It’ll be uploaded to your electronic files.”
“Thank you,” Cora barely managed to get out before hustling to the computer. She wondered if Janice had purposely held on to the information of the incoming toxicology report, considering that up until a few minutes ago, Cora was elbow-deep in the chest of a patient who died at the nursing home. The family requested the autopsy, but she found nothing suspicious and had just completed the procedures. She was now washed when Janice made her announcement.
It was probably for the best since she would have been distracted during the autopsy while thinking about what was in the toxicology report.
Her fingers flew over the keyboard as she pulled up the report. Once it was in front of her, she shoved her glasses up on her nose and began reading. She fought the desire to scan the results but wanted to understand the entire panel of tests, absorbing all the information to gain the complete picture of what might have caused Roy Parker’s death. She also wanted to review her notations and observations to have a clear memory of her findings.
She’d noted evidence of heart failure, dilated cardiac chambers, and pulmonary edema. She had also detected microscopic damage to heart tissue.
As she continued to study the various reports, she finally found what she was searching for. Mr. Parker’s blood had elevated levels of digoxin. There were also imbalances in the electrolytes, with a potassium level of 8.2, resulting in hyperkalemia.
The air rushed from her body. Swallowing deeply, she continued to study the report. Digitalis metabolites were detected in the stomach and urine. The lab confirmed the results using mass spectrometry and immunoassay.
“Oh God,” she breathed, sitting back in her chair. She slid off her glasses and rubbed her eyes.
Janice and Carl moved to her side. “What?” Janice asked. “What did it find?”
She twisted her neck and looked up at them. “I have to call the sheriff’s department.”
Both of her technicians bugged their eyes at the same time. “Oh no,” Janice whispered as Carl shook his head. “Fucking hell.”
David walked over, his curiosity piqued. “What was it?”
She stood and pointed at the screen. “David, I want you to review the toxicology report. If you work in mortuary medicine or as a medical examiner at some time, you need to understand what you are studying and what will need to be done.”
He nodded and slid into the chair. After a few minutes, he turned the chair around, revealing a furrow between his brows.
“Well?” she asked.
“It says foxglove-derived toxins.”
“And…?” she prompted.
“I… I don’t know what that means. I’m not familiar with foxglove. Did it cause the hyperkalemia? With that level of potassium, he would be dying, but I don’t understand the toxins,” David admitted.
“Then research. Find out what you don’t understand. I have a call to make, but I assure you that once you research, you’ll retain the information much better than me reciting the details.” She turned and caught Janice’s eye roll. Offering a confirming nod, she walked over to a desk with a hospital phone.
She had a direct line to Sheriff Colt Hudson. He wanted to be informed of any suspicious death she found as the medical examiner if the body was discovered in his county. Sheriff Liam Sullivan had the same request from her if it involved his county.
“Colt? This is Cora Wadsworth.”
“Cora. Good to hear from you, but that means you have something for me.”
She chuckled. There was always a downside to being a medical examiner. She was needed but rarely wanted, simply because if she was calling, that indicated she had discovered a suspicious death. “You’re right. I do. I have a man who died in our ER with what appeared to be a heart attack, but his sister voiced her suspicions to the ER doctor who passed them to me.”
“And they turned out to be right, I presume.”
“Yes,” she sighed. “I need to report this to your detectives.”
“Okay,” he agreed. “Let me check my board, and I’ll send two over to you. Will you be around?”
“I’ll be here the rest of the day unless I get called out.”
“Okay, I’ll get right on it. Thanks, Cora,” he said before ending the call.
She leaned back and let out a long sigh. A high followed the acknowledgment she’d made the correct call, but it was followed by the realization that someone had intended Roy Parker’s death. It wasn’t up to her to determine who did what, but knowing that she would play an integral part in finding his killer was one of the reasons she did what she did. Even in death, he deserved that justice. A hand gently landed on her shoulder, and she recognized the touch.
“You did good, boss,” Janice said softly.
“Thank you,” she whispered. She knew she was sometimes curt and straightforward in her speech and mannerisms, but that was only because she couldn’t allow emotions to overshadow what she needed to do as a clinician. But she never wanted to offend her staff, so when they reached out to offer her support, she felt as though they were a team. She demanded a lot from them, but no more than what she demanded from herself.
An hour later, the mortuary receptionist called back to Cora, announcing the detectives there to see her.
“Send them to the interview room two,” she instructed. Picking up the file she had filled with printed reports of Roy Parker’s autopsy findings, including the toxicology report, she looked at David and said, “You need to sit in on this.”
He hesitated, then nodded.
She arched her brow and held his gaze without speaking.
Her expression must’ve been all the prodding he needed. “With all due respect, Dr. Wadsworth. I don’t see myself working as a mortuary clinician.”
“I understand, and that’s fine. But this is part of your rotation. As with any medical profession, you can expect that, at some time, you might have to be interviewed by law enforcement for various reasons. I would like you to join me as an observer. Then you can write down this experience and include it in the report you’re working on concerning Mr. Parker.”
His expression brightened, and she shook her head. At least he followed her dutifully down the hall. As she stepped into the room, she found that the receptionist had just left, and the man and woman inside greeted her warmly, holding out their badges as identification.
She looked at the badges and then nodded. “Detective Perez. Detective Sullivan. I’m Dr. Cora Wadsworth, and this is Dr. David Jenski, my intern. He’s here to observe our proceedings.”
The four quickly sat around the table, and Cora studied the two detectives before her. Elizabeth Perez was attractive, probably in her early thirties. Her thick, dark hair was pulled back into a low ponytail. She wore slacks, a white blouse, and a short leather jacket. John Sullivan was nearly six feet tall, had lean muscles, was mid-thirties, and was dressed in neat, dark jeans, a pale blue shirt, and a gray sports coat.
She cocked her head to the side. “Detective Sullivan, I don’t suppose you’re related to Sheriff Sullivan, are you?”
He smiled and nodded. “Liam and I are cousins.”
“It’s nice to meet you both. I wish the circumstances were better.”
“Agreed,” Elizabeth said. “But then I suppose detectives and medical examiners rarely meet under the best circumstances.”
Cora nodded her agreement. Getting down to business, she opened the file and pushed it gently toward them. She had the same reports opened on her laptop sitting on the table in front of her.
She reviewed the statement from Dr. Lyles, letting them know that he would be available for them to interview that day, too. “Dan Lyles is on duty now in the ER, but he’ll get off shift at four o’clock.”
“Based on the sister’s suspicions, you proceeded with an autopsy?” John said.
She nodded again and explained her reasons. “Dr. Lyles provided me with the patient’s medical history, which did not include any heart issues, and Mr. Parker saw his doctor regularly. The type of heart attack could have been from natural causes, and, in truth, Dr. Lyles admitted that if the sister had not voiced suspicions, he would have signed off on the death certificate as a heart attack.”
She held their gazes. “As the medical examiner, I determine whether an autopsy should be performed. I talked to the sister and had enough suspicion to make that call.” She choked out a laugh and shook her head. “Of course, his wife is furious and is threatening legal action. But that doesn’t bother me. I’m confident in my role.”
Both detectives nodded, their gazes moving over the report. “We will interview Dr. Lyles as soon as we can, and of course, Mr. Parker’s sister,” Elizabeth said, making notes on her report copy.
John held Cora’s gaze and said, “Will you give us a detailed summation of the findings, Dr. Wadsworth?”
Cora adjusted her glasses and gestured to the lab report in her hand. “Detective Sullivan, these results are significant. The toxicology screen shows markedly elevated levels of digoxin, a cardiac glycoside commonly found in foxglove plants. This substance directly affects the heart, and at these levels, it’s fatal.”
She pointed at a specific section of the report. “Take a look here. The blood analysis also shows severely elevated potassium levels, a condition known as hyperkalemia. This is a telltale sign of digoxin toxicity. When digoxin interferes with the sodium-potassium pump in the cardiac cells, it disrupts the balance of electrolytes, leading to dangerous irregularities in heart rhythms.”
Cora paused to let the information sink in, then continued. “The high potassium isn’t just a side effect—it’s a red flag. Combined with the presence of digoxin at these concentrations, it suggests deliberate administration rather than accidental exposure. This isn’t something that happens naturally or by chance.”
Elizabeth cocked her head to the side. “Foxglove? I seem to remember that plant as one suggested when I bought my condo. It was on the list of flowering plants that grow tall, I think.”
“Yes. It’s a common landscaping plant that can grow from two to five feet tall, making it perfect as a backdrop for other plants. Often found closer to the home.” Cora pushed her glasses up on her nose. “At least, that’s what I’ve seen. The blooming stalks are beautiful, often in purple, white, or pink. The leaves are fuzzy, also giving it a distinct appearance.”
“What part of it is toxic?” John asked.
“All parts,” she stated with emphasis. Seeing their raised eyebrows, she elucidated. “The flowers, leaves, stems, and seeds are highly toxic if ingested. It is not a plant that should be in a garden frequented by children or pets. And it is self-seeded.”
“Self-seeded?” John’s pen halted as he looked up.
“It can spread because the seeds drop or blow with the wind, and new plants grow. This makes it desirable for a low-maintenance option for a garden, but can lead to unintended spreading into areas outside the immediate garden.”
She leaned back, her tone more somber. “As for how it was administered, that’s still under investigation. Tea, food, or even medication laced with foxglove extract could have been ingested. If it wasn’t for the elevated digoxin levels, this might have been mistaken for a natural heart attack, especially since the symptoms—irregular heartbeat, dizziness, and cardiac arrest—closely mimic one.”
Cora tapped the report on the table, her expression resolute. “Considering digitalis metabolites were detected in the stomach and urine, I’d conclude the foxglove was ingested. This is no accident, Detectives. Someone intended for this to happen. Now we just need to find out who—and how.”
By the time the two detectives left the conference room, Cora felt a surge of excitement that always accompanied a successful autopsy when a crime had been committed. She knew her findings would help the deceased’s relatives find justice… at least the relatives who weren’t guilty.
Turning her attention to her next task, she grinned as she picked up the hospital’s internal phone and dialed the risk management office to inform them that she was right.