The Sisterhood - Michael Palmer [51]
The remainder of the examination was impressive mainly for what it did not show. Pending, of course, microscopic examination of the abdominal lymph nodes, Hadawi announced that he was unable to find any evidence of residual cancer in the woman’s body. The liver cysts, which had been misdiagnosed by the radiologist, Rybicki, were scattered throughout the organ, and similar fluid-filled sacs were found in both kidneys. “Polycystic involvement of hepatic and renal parenchyma,” Hadawi said into his Dictaphone.
Finally the pathologist stepped away from the table. “I have a few remaining things to do on this body,” he said, “but they will have no bearing on my findings. To all intents and purposes, Wally, we are done. Most significant of what I have to tell you is that this woman’s pressure sore was extending beneath her skin to the point where I doubt that even with multiple grafts it ever would have healed. Infection of the sacral bones had already begun and would have been almost impossible to treat.
“She has enough coronary arteriosclerosis so that I feel her final event was probably a cardiac one. I intend to sign her out as cardiovascular collapse secondary to her pulmonary and bedsore infections. An additional stress undoubtedly came from her partial small bowel obstruction, which, as you saw, was due to adhesions from her recent surgery.”
David said, “Dr. Hadawi, Dr. Huttner, if we could sit down over here, there are a few questions that I have.” He could not bear the thought of having to discuss Charlotte’s case over her dissected body. Hadawi responded with a brief, understanding grin and took a seat on one of the risers. Huttner, who still held his arms around himself, followed reluctantly. David gauged the expression on his face as somewhere between disgust and fury. Nowhere in his eyes or manner was there a hint of disappointment or sympathy. Regardless of her underlying disease, Charlotte Thomas had walked into the hospital as Huttner’s patient, had been operated on, and had died. That made her a postoperative mortality. Her operation and the many complications that ensued would be discussed in depth at Surgical Death Rounds. Hardly a prospect that would sit well with this man, David realized. He was far more accus tomed to asking the questions than to answering them.
“Now, David,” Hadawi said, “just what is it that troubles you about what you have seen?”
“Well, most of my concern centers about her heart, which seemed so unresponsive to everything that I tried during her Code Ninety-nine. It may have been simply that too much time elapsed between the moment of her cardiac arrest and the time I started working on her, but it just doesn’t feel like that. I wonder if perhaps her potassium could somehow have risen too high and caused a fatal cardiac arrhythmia.”
“That is always a possibility,” Hadawi said patiently. “I’ve saved several vials of blood. I’ll be happy to have her potassium level checked. However, you must keep in mind the limits of accuracy of such a measurement done in a postmortem patient—especially one who has received prolonged external cardiac compression.”
Finally Huttner spoke. It was no surprise to David that he was unwilling to surrender without a fight. “Look, Ahmed,” he said. His second and third fingers bobbed up and down at the man, but Hadawi showed no outward hint of being offended by the gesture. “I’m not totally satisfied with all this. Dr. Shelton here has a point. Since there’s nothing obvious on gross exam to explain this woman’s sudden death, then we should look further before signing her out as something so nonspecific as cardiovascular collapse. Maybe some nurse made a medication error on her and caused an allergic, anaphylactic reaction of some kind. She was known to be allergic to penicillin.”
Hadawi was obviously used to dealing with Huttner’s ego. He merely shrugged