She'd also carefully reviewed all of Roger's suspect lists, ranking them in order of their potential relevance. She still thought Najah was the most intriguing and most likely suspect, but the other seven individuals from various hospital departments who worked the night shift and who had transferred from St. Francis to the General around the critical time were almost equally interesting, especially since the entire group had easy access to the patient floors. The next list featured eight physicians whose hospital privileges had been canceled during the immediately preceding six-month period. She'd like to find out if possible what each one had done to warrant the disciplinary action.
Between studying Roger's lists and going over the charts for the final time, Laurie had thought about calling Jack. Although she felt her reaction to him earlier was understandable under the circumstances, she regretted it. She'd been far too precipitous and bitter, and she should have at least given him a chance to speak his mind, even if she suspected he was not going to say what she wanted to hear. At the same time, what she had said to him was unfortunately all too true. She was tired of his indecisiveness, which was the reason she'd moved out of his apartment when she had. Ultimately, Laurie decided not to call. It would have been like throwing salt on a wound. Instead, she decided to wait until morning, and if he hadn't called by then, she would call him.
Laurie stacked the hospital charts into two neat piles. Next to them, she put the notepad with her own list of how all the cases resembled one another. She put the CD with the digital records on top of the pad. She looked at her watch. It was quarter to seven, which she thought would be a good time to head back to her apartment. She would make herself a light supper before bed. Whether she would be able to sleep was another issue entirely. She hadn't wanted to go home earlier, for fear of becoming depressed. It had been better to stay busy all afternoon to keep from thinking about Roger's death, Jack's aggravating behavior, and her own looming problems.
Pushing back from the desk, Laurie was about to get up when she looked back at the CD. Suddenly, the idea occurred to her to look and see if there was a difference between the digital record and the hard-copy hospital chart-specifically, in respect to the unknown blood test. Maybe she could find a result, and if so, maybe she could figure out what the test was.
Pulling herself back to the desk, Laurie booted up her computer and inserted the CD, scrolling through the pages until she arbitrarily found herself at Stephen Lewis's laboratory values. The print was very small, and Laurie used her finger to run down the column on the left side of the page. Near the bottom, she found MASNP. Running her finger horizontally, she saw the result. It was "positive MEF2A."
Laurie absentmindedly scratched her scalp as she stared at the recorded result. There was no explanation. MEF2A didn't make any more sense to her than MASNP. It was like looking up the definition of an unknown word and finding an unknown synonym. Laurie took another Post-it from the dispenser and wrote down the result, followed by a question mark. In order to put the new Post-it with the others, which she had stuck to the wall behind her desk, she scooted her chair back and half stood, leaning forward with her hand outstretched.
A muffled cry of pain escaped from Laurie's lips. Instead of pasting the Post-it to the wall, both her hands went down on the surface of her desk to support her weight. She'd gotten a sudden, strong cramp in her lower abdomen, and for a few seconds, she held her position as well as her breath. Thankfully, the pain began to lessen, and Laurie slowly let herself sink back into her chair. She held herself stiffly, lest she aggravate whatever was going on inside her body.
A continuous low-grade discomfort had persisted in Laurie's abdomen following the autopsy on the police custody case. It had waxed and waned to a degree, but it had never entirely gone away. She had characterized it more as pressure than pain until she'd tried to place the new Post-it with the others.
Once the pain had lessened to the point that Laurie could breathe normally, she allowed herself to adjust her weight in her chair by sitting up straighten Thankfully, what had now become an ache stayed at the same tolerable level. Perspiration had appeared on her forehead, and she wiped it off with the back of her hand. She knew she was anxious, but she was surprised that she was anxious enough to perspire so freely. She wondered if she could have a fever, but didn't think so. Gingerly, she palpated her abdomen with a single finger. In contrast to previous occasions, there was now an area of definite tenderness, which seemed ominous to her. As she had noted earlier, it was exactly the location where the pain of appendicitis occurred.
With hesitation, Laurie slowly got to her feet. It had been the sudden motion of half standing a few minutes earlier that had brought on the current episode, and she was eager to avoid a repeat. Luckily, there was no reoccurrence. Her perspiration was another matter. That had actually gotten worse.
Cautiously, Laurie took a few steps out of her office and into the hallway while continuing to support herself with her hand against the wall. The pain remained bearable. With gathering confidence, she walked slowly down the length of the corridor to the ladies' room. Inside, she got some toilet tissue and wiped herself. The spotting had reappeared, and there was more blood than there had been earlier. She knew she didn't have appendicitis.
With gathering anxiety, Laurie retraced her steps back to her office and returned to her chair. She eyed the phone. She was still hesitant to call Dr. Riley, though now she felt she had little choice. The spotting ruled out appendicitis, and along with the location of the pain, suggested a possible ectopic pregnancy, which was far more serious than a mere threatened miscarriage. Finally, she reluctantly picked up the phone and called Laura Riley's office number. When the operator answered, Laurie gave her name and direct-dial number. Thinking it might expedite the callback, she included her M.D. title and said she needed to talk with the doctor. She said it was an emergency.
As Laurie put the receiver back down, she noticed a new sensation: vague shoulder discomfort. It was so mild that she wondered if she was imagining it, yet it added to her already considerable anxiety. If it was real, it suggested the ominous development of peritoneal irritation. To test the possibility, Laurie carefully pushed in on her abdomen with her index finger, then suddenly took her hand away. She grimaced with a fleeting stab of pain. What she had felt was called "rebound tenderness," and it also suggested peritoneal irritation, which now made her worry that not only might she have an ectopic pregnancy, but that it might have already ruptured. If so, it was a true medical emergency for which time could be a critical factor. She could be hemorrhaging internally.
The phone's harsh ring interrupted her obsessing, and she snapped the receiver up to her ear. She was relieved when Dr. Riley identified herself. Laurie could tell she was on a cell phone and in a public place. Loud conversation could be heard in the background.
Laurie began by apologizing for calling on a Saturday night and said that she had resisted because she worried it was a bad way to start out a professional relationship, but she believed she truly had no choice. Laurie went on to describe her symptoms in detail, including the rebound tenderness. She admitted she'd had discomfort prior to speaking with her on the phone the previous day, but had forgotten to mention it and had thought it could wait until her scheduled visit the following Friday.