The Practice Baby Read online

  ‘Dissolve the aspirin in water and get Jean to drink it.’

  Dee concentrated on getting the ECG connected, then she could see what was happening to his heart if Jean Louis lost consciousness. She took the cover off the defibrillator.

  Chris, the registrar, arrived. She set him to insert a cannula, as she did the ECG, which, as she feared, showed a large anterior infarct. The aspirin might help limit the damage.

  Janelle hovered at the door. Dee was on automatic now.

  ‘Janelle, ring triple-O. We’ve got a large anterior infarct, we need a paramedic ambulance with all the sirens, bells and whistles. I’ll talk to them if they give you trouble.’

  Chris had the cannula in; he was just out of hospital training so he was in better practice at it than her.

  ‘Chris, we need IV morphine. Start with 2.5 milligrams and leave the syringe handy. Get adrenaline and lignocaine ready to go. Then make sure the defib’s ready to go.’

  An ambulance arrived but it wasn’t the paramedics. Should she allow Jean Louis to go with them or wait? She decided to wait. An arrest in a conventional ambulance could be fatal.

  The paramedics arrived. They took forever to stabilise him. Finally, they were ready. Dee walked next to the stretcher to the door. Jean Louis held her arm as though physical contact with her would magically protect him.

  She closed the door and looked at the time: 9.05 am. The waiting room was full. At least the spectacle with the ambulance, the trolley and the paramedics in their high-vis uniforms demonstrated she had been involved in a major emergency.

  All she wanted was to collapse into a chair and let her adrenaline level go back down. Instead she walked around to reception and called up the first file.

  ‘Marilyn, come through,’ she called. On with the show.

  *

  Dee’s lunch break had evaporated from ninety minutes down to ten. She remembered her decision to look at the records for Shirley and Ben. That would have to wait.

  Janelle came in with a coffee and salad sandwich for her.

  ‘Thanks.’ Dee took a sip.

  The coffee was still hot. It meant Janelle approved of how Dee had handled the day so far.

  ‘Can you ring the morgue and find out what’s happened to the autopsy report for Tom Harris?’

  ‘Isn’t it here?’

  Janelle walked around to Dee’s inbox. She found an envelope marked ‘Office of the State Coroner’.

  ‘This is it.’

  ‘Oh.’ Dee didn’t want to touch the envelope. ‘Okay.’ She took it and put it back down immediately. ‘I’ll look at it after I sort out the pathology.’

  17.

  ‘Yes, Ken your INR is perfect. Keep on with the current warfarin dose.’

  Dee hung up on her last urgent call of the day. She switched off her computer and heard the whirr as the server kicked in to automatically back up once the last user logged off.

  Outside it was getting dark. She’d be gone soon. The fading light and the quiet after everyone else was gone were her favourite time of day. The path reports and letters were all checked ready for scanning and disposal. The three referral letters and two scripts she’d promised were done. The medico legal report would take at least an hour. It would have to wait—again. Some things were more important than medico legal reports. It usually gave her a buzz, made her feel in control to say no to more work but today there was no relief to be had from the thing she had to face.

  The daylight-saving sun angled in to hit the corner of the desk. The envelope she’d been avoiding all day was there, spotlit, as the sun’s last rays focused directly onto it. She hadn’t turned the lights on and the white envelope glowed in the gloom of the rest of the room.

  It was only the autopsy report, not a sinister portal into another dimension. The glow was the sun, not dangerous radioactivity. Her throat tightened and her stomach churned with grief. She missed Tom. He shouldn’t be dead. There was no sense in it. She reconsidered the idea that he had died of asthma and rejected it again. That was impossible.

  She wasn’t sure she wanted to know the real reason for his death. It was frightening. She was about to open Pandora’s box and there’d be no getting the lid back on.

  She glanced at the clock. Seven twenty-five. If she opened it her reward would be to go home. Get a grip. She opened it.

  Well-nourished Caucasian male of twenty-five years. No signs of recent injury or trauma. No surgical scars or tattoos, no external marks. No evidence of violence. Internal organs, apart from the lungs, healthy.

  Well-established rigor mortis. This together with livedo reticularis, body temperature and the consistent environmental conditions of the corpse, enable an accurate estimate of time of death to within three hours of 11 pm Saturday December 8.

  Stomach contents: gastric juices only, suggesting subject had not eaten within several hours of death.

  Dee skipped to the conclusion.

  The absence of any signs of trauma and a finding of hyper-inflated lungs with mucus plugging of bronchioles is consistent with asthma. Rohypnol at 1.5 times the upper limit of the therapeutic range found in the blood with a smaller concentration in the urine suggests ingestion within an hour of death. The concentration is not sufficient to depress respiratory or cardiac function.

  Cause of death: acute asthma.

  *

  Dee pulled up in front of her house. It was 7.47 pm. She couldn’t remember leaving the surgery or the drive home. All she wanted was to sit in the car and ignore this world that made no sense but the kids could see her from the lounge. If she didn’t go in, they’d be out to get her.

  She walked across the footbridge to her front door and failed in her attempt to slam it. The cantilevered glass door opened and closed silently. God save us; she clenched her teeth. The constipated precision of Rob’s architecture drove her to blasphemy.

  In the lounge, three blobs were sprawled on the couch watching something loud on TV without the lights on. She was wrong to think they’d be aware she was outside. Nothing but the screen in front of them reached consciousness. The coffee table was sticky with takeaway containers, dirty plates and Coke bottles. Their sneaker-clad feet perched amongst the mess.

  No one noticed her in the doorway. Laughter erupted. That was the spark. Dee’s rage flared like a bush fire in a southerly.

  ‘What happened to the steak I defrosted?’

  ‘Hello Mum, good to see you too.’ Ollie was the only one to respond.

  After the day’s news, she wasn’t ready for sarcasm in her own lounge room.

  ‘Move your feet so I can clean up this mess for you.’

  ‘Mum, sit down. There’s a plate in the microwave for you. I’ll heat it up.’ Eleanor got up.

  ‘No, I can’t eat in the middle of this mess.’

  Beatrice and Oliver looked at each other, nodded and stood up.

  ‘I’ve got an assignment,’ said Beatrice simultaneously with Oliver’s ‘Yeah, there’s a physics test in the morning …’

  Both headed to their rooms. ‘What about the Coke?’ Dee asked.

  ‘It was free; a special deal. We saved ten dollars. I thought you wanted us to be more careful.’

  ‘And what about the steak we were supposed to have?’ Dee yelled.

  ‘Still frozen.’

  Then she remembered; she’d been in a rush to get to work early, dinner the last thing on her mind.

  ‘Why’s it always me? You lot eat too.’

  She stopped herself. They were teenagers; she’d brought them into the world, as they often reminded her. There was no winning this argument. It wasn’t even an argument, certainly nothing rational. She was tired and upset. It was just that she didn’t want to be responsible for everything and everyone all the time.

  Dee slammed the empty containers together, picked up a paper bag off the floor and shoved the mess into them. She marched onto the veranda and slammed the lid of the garbage over the lot.

  In the kitchen, Eleanor had set o
ut a napkin, spoon and fork with a plate of green chicken curry and a side plate of fresh rice rolls and peanut sauce.

  ‘Mum, sit down and eat. Please.’

  Dee had barely eaten all day—not since Janelle had handed her the autopsy report. She stood at the sink, rinsed the dishcloth and moved dirty glasses and clattered dirty spoons out of the sink into the dishwasher. Halfway through she realised the dishes in it were clean and she slammed the door so hard a glass broke.

  ‘Mum, I’ll fix it. You need to eat.’ Beatrice was standing in the kitchen door.

  Dee took the dishcloth into the lounge and wiped the coffee table. Under her breath she muttered, ‘Lazy useless slobs, I should send the lot of them to live with their father, see how he’d cope with this shit cluttering up his precious minimalist existence.’

  Out loud she said, ‘I can’t eat in this mess.’

  ‘Sit down and we’ll do it.’ Ollie was back. He took the dishcloth from her and led her to the food.

  She sat and tried to collect herself. ‘The coffee table’s a mess …’

  ‘Sorted,’ said Ollie and went into the lounge room with a bottle of spray cleaner and a roll of kitchen paper.

  Dee looked up. Bea looked anxious and Ellie was ready to cry. She picked up a peanut sauce-covered rice roll and bit it in half. Delicious. The green curry smelt of lime, lemongrass and fish sauce. Dee ate. The girls sat down beside her. Her blood sugar went from ‘let’s chase down and kill a herd of zebra’ to ‘civilised, comfortable, time to look around, rest and digest’.

  ‘Who’s died then?’ asked Ollie from the doorway.

  ‘You don’t want to know. No one died, not today anyway. It was just an autopsy report.’ Dee stopped and looked at him. He was just fifteen; how did he get to be so wise?

  ‘Do you want to tell us about it?’

  ‘No, sorry, I’m okay now. My work isn’t meant to be your problem.’ Dee caught Beatrice and Ollie roll their eyes at each other. ‘No, I mean you don’t need to know the details. It’s better if it stays at work. At home, I’m your mother not other people’s doctor.’

  She reached out and put her arms around the girls.

  ‘Come here, you. You’re not too big for a hug,’ she called to Ollie and turned to hug him around his waist.

  ‘All right, homework and I’ll remember to get the steak out for Monday night. If I’m not here by seven there’ll be salad ready to go and potatoes to microwave—and no more Coke even if it saves you money.’

  *

  In bed, she was wide awake again as soon as she turned off the light. The image of Tom lying on his bed, dead, came to haunt her as soon as her mind was empty. She hadn’t rung Raj like she promised. It absolutely couldn’t be asthma that had killed Tom. If she rang Raj she would have to tell him all about it. Tell him what she was going to do.

  First, she could talk to the pathologist and make sure there wasn’t anything he’d missed.

  18.

  On Tuesday afternoon Dee walked down the ten cracked and steep front steps that kept elderly Thelma Taylor a prisoner in her own home. The state morgue was just around the corner on Parramatta Road. She’d rung this morning to speak to Dr Heinrich Van der Waal who’d performed Tom’s autopsy. It was now 3 pm. No one had phoned her back yet. She could spare half an hour. A person at the front desk was more difficult to ignore than a phone message.

  Reception was in a large modern foyer, aluminium framed pale glass and terrazzo floors. Dee knew that the double doors off to the left led to the courts. She had appeared once as an expert witness at a coroner’s enquiry. Behind the desk, open stairs led up and down. She guessed the morgue and the pathologists’ offices would be downstairs, underground in a windowless basement like in all the movies she’d seen.

  As she asked for Dr Van der Waal, a pale figure in a washed-out green shirt and lilac tie came through the front door, hands full of coffee and takeaway food.

  ‘Heinrich,’ the receptionist called to him. ‘This doctor is here to see you.’

  Pale eyes blinked through blond lashes at the receptionist as Dr Van der Waal carefully avoided looking at Dee.

  ‘I don’t think I’ve got any appointments?’

  ‘No, I’m Dr Flanary. I left you a message earlier and I was just around the corner so took the chance …’ Dee smiled and walked over to put herself between the pathologist and the stairs. ‘But I can see you’re occupied.’

  ‘Yes, a busy morning.’ He gestured with his full hands. ‘I’ve just got to lunch. You’re on my list of people to call.’

  ‘If you have a moment now you won’t have to ring me later. I just wanted to ask about your report on Tom Harris.’

  Van der Waal had the face of a 35-year-old but the posture of someone who’d spent fifty years stooped over a microscope. He gave in and gestured up the stairs. Dee followed him to a messy office with a big window that overlooked Sydney University sports grounds. She sat in a chair opposite his overloaded desk.

  ‘Thanks for making time to see me. I have your report on Tom Harris. He was a patient of mine and I was there when he was found. I wanted to speak to you because I’m concerned that his death may not have been due to natural causes.’

  Heinrich looked for a moment at his lunch, sighed, then looked back at Dee.

  ‘There’s no doubt, Dr Flanary. As I told the insurance company, who also have an interest in the case, your patient, Tom Harris, died of acute asthma.’

  ‘The insurance company?’

  ‘He had a large and recent policy. It’s still in the exclusion period where suicide would mean no payout.’

  ‘There’s no way Tom would kill himself. He was planning on having a baby. I saw him just a few weeks ago. He was excited, happy.’

  ‘I agree, there is no evidence for anything other than an acute severe asthma attack. Young people die of asthma all the time. He had a couple of near misses in the past and this one: well, he didn’t make it this time.’

  ‘From the literature, I understood that a death due to acute anaphylaxis could be indistinguishable from one due to asthma.’ Dee had spent a couple of hours doing research.

  A loud sigh came back to her. ‘Dr Flanary, I don’t know if you noticed in my report that the lungs were hyper-inflated and the bronchioles plugged with mucus. The findings are consistent with acute asthma—end of story.’

  ‘There could be other causes of those findings though, couldn’t there?’

  ‘The pathological findings in acute anaphylaxis are sometimes indistinguishable from asthma because death arrives via the same mechanism as an asthma attack. The reaction to the allergen narrows the terminal bronchioles and fills them with mucus. Essentially it doesn’t change my report. Your patient died because his lungs could no longer take in oxygen due to asthma. And asthma is commonly caused by allergic reactions.’

  ‘Is it possible to tell if there was an acute reaction to an allergen in this case? I know his family would be comforted to know what triggered this after he’d been well so long.’

  ‘There’d have to be additional tests: histamine levels, although they’re unlikely to be reliable when the body was found so late; antigens to specific substances are also possible. I’m sorry though,’ he didn’t look at all sorry, ‘no matter what the result, there’s nothing to indicate foul play.’

  His eyes flicked towards the white paper bags leaking grease onto his desk.

  ‘Surely the insurance payout provides a motive for the beneficiaries? Tom just wouldn’t die of asthma. He was obsessive. He managed it perfectly.’

  ‘Not on this occasion obviously.’ Heinrich paused, possibly aware what he’d said was too harsh. ‘You’re naturally concerned for your patient’ seemed to be the best he could think of to soothe it over.

  Dee guessed that live human beings rarely crossed his path.

  ‘I find it useful sometimes to talk about how we know things,’ he continued. ‘My house is in Surry Hills, on a laneway adjoining the police horse stables and train
ing grounds. When I am sitting in my kitchen and I hear the sound of hooves clomping along the laneway I assume there are horses in the laneway.’

  Dee knew the argument from medical school. Was it just hypersensitivity and loss of self-esteem after the divorce or was she actually being patronised more since menopause?

  ‘You think I heard the sound of hooves and jumped to the conclusion that there’s a herd of zebras passing?’ she interrupted.

  Dee paused long enough for him to feel pressure to reply, then as he started to open his mouth, she let him off the hook.

  ‘In this case though, I know there’s a circus in town and that there are precautions in place to make sure the horses aren’t allowed out for the moment. That increases my odds of zebras a little, doesn’t it?’

  The pathologist screwed up his eyes and rubbed them with his knuckles.

  ‘Dr Flanary, forensic pathology is a science that relies on the balance of probabilities. Many things are possible—a meteor might crash through our roof at any moment but that is so unlikely that it won’t make us stop what we are doing to make a final phone call to our loved ones.’

  Dee knew anger was useless. Her knowledge of Tom and the circumstances of his death couldn’t be seen through a microscope; that meant it didn’t exist for Heinrich. The anger faded. She let the pathologist’s voice wash over her. What he said about allergy was interesting. The extra tests could help. Maybe he could test for prednisone too. Tom would definitely have taken prednisone if he felt an attack coming on.

  She smiled. ‘You’re right of course. And what you said about anaphylaxis is helpful. I remember Tom had an acute admission due to an allergy to echinacea and they’re flowering now.’

  ‘That does fit with my findings.’ Van der Waal tented his fingers together to rest his chin on.

  ‘Is there any way we can absolutely prove you’re right?’

  ‘I’ll order the extra tests. You know it won’t change the conclusion though.’

  ‘Just for completeness, can we test to see if he’d taken his prednisone too? His family might be comforted to know that it was inevitable and nothing further could have been done.’