Chapter 15
Essex Falls, New York
“Please accept my apologies yet again for this strange situation,” Bob said as he, Jack, and Laurie stepped out of the changing room back into the autopsy room.
Finally, they were about to commence the autopsy on Stanley Kramer, and all four of them were suited up in surgical gowns with overlying yellow, impermeable aprons, surgical gloves, and face shields.
Bob put his single lens reflex camera on the dissecting table.
“No need for apologies,” Laurie assured their host. “As chief medical examiner in NYC, I am no longer surprised by the strange snafus that can occur in and around morgues.”
“But here in Essex Falls?” Bob questioned with a definite sense of disbelief.
“Anywhere!” Laurie assured him. “I’m convinced it goes with the territory. There’ll be an explanation, despite how incomprehensible it seems at the moment.”
“And the explanation will come as a surprise, something you never thought about,” Jack added.
“I hope you are correct,” Bob said. “And I hope the reveal happens sooner rather than later because I’m going to lose sleep over this.”
Melanie, who was equivalently outfitted, brought the gurney with Stanley Kramer’s body out from the cooler.
She removed the sheet and then positioned the gurney alongside the autopsy table.
Bob went to the head and Jack to the foot.
On the count of three, they lifted the corpse onto the table, while Melanie wheeled away the gurney.
The body was a strikingly pale fifty-year-old man about six feet tall with a few extra pounds around the midriff but otherwise in reasonably good physical condition, with defined musculature of his arms. When Jack commented on this, Bob agreed.
“He was quite active, seemingly healthy, and reasonably athletic,” Bob said.
“Prior to this terminal event, I’d only seen him once professionally and that was years ago.
He even very occasionally showed up at our pickup basketball games and would have been a better player if he’d come more often.
But he was a hard worker before this sudden episode of rapid cognitive decline. ”
“What kind of work did he do?” Jack asked as his trained eye took in all the details that were apparent, the mermaid tattoo on his left forearm and mild varicosities on his lower limbs.
“A plumber who’d learned his trade in the US Navy,” Bob said.
“He’d worked for the Bennet Shoe factory up until the day it closed, but then was one of the few people able to start his own business in town and remain living here.
As such, he’s been a distinct asset in all regards.
We are going to miss him on multiple levels. ”
“And as the only doctor in town, I’m assuming you’d seen him as a patient when this current problem arose,” Laurie said.
“Of course,” Bob responded. “His wife, Darlene, brought Stanley in almost two weeks ago.”
“It was more like a week and a half ago,” Melanie offered.
“Whatever,” Bob said with a bit of apparent frustration at being corrected. But then he quickly apologized. “Anyway, she’d found him wandering in their backyard confused and seemingly lost.”
“Whoa!” Jack said. “So, the problem of cognitive decline started like a bolt from the blue?”
“Well, not exactly,” Bob said. “When Darlene brought him, she said she’d been noticing mounting problems for about a week with Stanley, but the symptoms were initially rather subtle, such as difficulty sleeping, irritability, and forgetfulness.
But on that particular day it had become undeniable that something was definitely wrong, and whatever it was, it was getting worse. ”
“So, what did you do?” Jack asked.
“I examined him, obviously,” Bob said. “Since I’d seen almost a dozen similar cases, I’d become worried I was confronting some kind of strange, possibly contagious outbreak.
Similar to the other cases I’d seen, the only positive findings involved the nervous system: definite confusion and a total inability to count backward, which is a test I use as a quick screen for mental capacity.
I also noticed some superficial muscle spasms in his arms and legs as well as some very mild ataxia.
Anyway, there was nothing I could hang my hat on to suggest a specific diagnosis, so I sent him off to the Clinton Hospital for an emergency MRI brain scan and a neurology consult, which we can get once a week up here in the sticks. ”
“Did the MRI show anything?” Laurie questioned.
“Nothing,” Bob said. “It was read as normal and was confirmed by a second radiologist in Saratoga Springs.”
“What was the neurologist’s impression?” Laurie asked.
“Same as with the other patients,” Bob said.
“He was diagnosed probable early Alzheimer’s, but at this point I can’t help but question it.
If it was early Alzheimer’s, why did he and the two others die so damn quickly, and why did the first two patients test negatively when I sent their samples to NMS Labs?
And the other live patients I currently have with similar stories are all doing progressively poorly.
Alzheimer’s patients don’t go downhill so rapidly or die in a week or two.
“Anyway, I’m mystified and a little scared.
This situation is just like that mysterious episode of fatal brain disease in New Brunswick, Canada, reported in the New York Times in 2024 only it’s happening here, in my Essex Falls, during my watch.
I’m the only doctor in town and I’m supposed to keep people healthy.
Up in Canada they thought they were dealing with a possible weird outbreak of Creutzfeldt-Jakob disease, but the tests came back negative.
Here we think we’re dealing with an outbreak of early-onset Alzheimer’s, but the tests have come back negative.
Up in Canada the cases mysteriously stopped, but so far that doesn’t seem to be what is happening here, so we have to figure this out before more people get sick and more people die. ”
“Well, let’s see what we can learn from this autopsy,” Jack said. “Which brings us to the question of how you would like to handle it. Do you want to do the autopsy while Laurie and I watch and comment, or would you prefer one of us to do it, and you ask questions as we go along? It’s your call.”
“Hmm,” Bob said. “That hadn’t occurred to me. Do you folks have a preference? I’m not sure I do.”
“We think it’s your call,” Laurie said. “Of course, it could also be some mixture of the two.”
“After giving it a quick thought, I believe it would be best for one of you to go ahead and do it rather than I,” Bob said.
“Maybe you could talk it through as you go along, so I understand your reasoning for each step. It will be far more efficient that way. Besides, I’d feel incredibly nervous under the watchful eyes of two experts. ”
“We’d be easy on you,” Jack said with a laugh. “But we’re happy to do it. My suggestion is for Laurie to be in the driver’s seat, as she’s been starved of autopsies ever since she became chief.”
“Fine with me,” Bob said.
“Laurie?” Jack questioned. “Are you okay being the prosector?”
“Is the sky blue?” Laurie humorously retorted.
Immediately taking the lead, she went through a rapid but complete external examination of the body, verbally noting all irregularities, scars, and tattoos.
This portion required rolling the body on its side to inspect the dorsal surface.
She then inspected the inside of the mouth and the condition of the teeth, describing out loud her thought processes.
“So much for the external examination,” she said.
She then asked Melanie for one of the scalpels that had been laid out along with the other instruments.
“I’ll be using the typical Y-shaped autopsy incision,” Laurie announced before doing so, cutting from the points of both shoulders, meeting at the midline, and then incising through the skin all the way down to the pubis so that the omentum and a portion of the intestines were visible.
“Okay, how about you guys create the skin flaps on either side of the thorax while I do the same up to the base of the neck. My idea here is to progress rather rapidly through this part of the autopsy unless we encounter unexpected pathology. Obviously, considering the history, the most critical part will be when we open the cranium to expose the brain. Is that okay with you, Bob, or would you prefer I go slower?”
“It’s fine with me,” Bob said. “I’ve read about doing autopsies but I’ve never seen a professional do one. If there’s something I don’t understand, don’t worry, I’ll certainly speak up.”
As Laurie suggested, she worked quickly but carried on a running commentary as she did so, especially when she got to the point of using the bone shears to cut through the ribs to expose the heart and lungs.
She then increased her commentary as she went through the entire process of exposing the heart, clamping off various vessels before stopping to draw blood samples from the left atrium.
While she was at it, she took other biological samples from the eyes, gall bladder, and kidneys.
After finishing with the thorax, having removed the heart and the lungs and examined them in detail, particularly the coronary arterial system, she went on to the abdomen, first removing the esophagus, stomach, and intestines and showing Bob the best way to open them up and rinse them out to examine their full length.
“I’m impressed with how fast you are able to do this,” Bob commented as he watched Laurie “run the intestines,” meaning check their entire length inch by inch for any abnormality. She did find some polyps, which she sampled.