Blow Fly (Kay Scarpetta #12)(67)
Mostly, Scarpetta sees a lot of pinks and blues, but there are a perfusion of colors used, depending on the tissue and the cellular structure and possible defects that need to give up their secrets to her at the other end of the lens. Dyes, like diseases, are often named for whoever discovered or invented them, and this is where histology becomes unnecessarily complicated, if not annoying. It isn't enough for dyes or dyeing techniques to be called blue or violet; they must be Cresyl blue, Cresyl violet, or Perl's Prussian blue, or Heidenhain's haematoxylin (purplish red), or Masson's trichrome (blue and green), or Bielschowsky (neutral red), or her favorite mundanity: Jones's methenamine silver. A typical egocentric pathological legacy is a van Gieson staining of a Schwann cell nuclei from a Schwannoma, and Scarpetta fails to understand why German naturalist Theodor Schwann would have wanted a tumor named after him.
She peers into the lens at the contraction bands in the pink-stained tissue shaved from a section of Charlotte Dard's heart at autopsy. Some fibers are missing their nuclei, indicating necrosis, or the death of tissue, and other slides reveal pink-and-blue-stained inflammation and old scarring, and narrowing of the coronary arteries. The Louisiana woman was only thirty-two when she dropped dead at the door of a motel room in Baton Rouge, dressed to go out, keys in hand.
It was suspected eight years ago, at the time of her death, that her family pharmacist illegally gave her the powerful pain medication OxyContin, found in her pocketbook. She didn't have a prescription for the drug. In a letter to Scarpetta, Dr. Lanier suggests that this pharmacist might have fled to Palm Desert, California. Dr. Lanier doesn't indicate what he bases this possibility on or offer further details for his reopening Charlotte Dard's case.
It is a mess for multiple reasons: The case is old; there is no evidence the drug came from the pharmacist, and even if it did, unless he premeditated killing her with OxyContin, he is not guilty of first-degree murder; at the time of Charlotte Dard's death, he would not talk to the police but through his attorney claimed that a family friend with a ruptured disk must have given Charlotte Dard OxyContin, and she accidentally overdosed on it.
Several copies of letters sent eight years ago to Dr. Lanier are from the pharmacist's attorney, Rocco Caggiano.
61
BEYOND THE WINDOW IN FRONT of Scarpetta's desk, shadows crawl over sand dunes as the sun moves.
Palm fronds rattle lightly, and a man walking his yellow lab on the beach leans into a headwind. Far off on the hazy blue horizon, a container ship forges south, probably to Miami. If Scarpetta is too caught up in her work, she will forget the time and where she is and soon will miss another flight to New York.
Dr. Lanier answers his phone and is hoarse as he says, "Hello."
"You sound terrible," Scarpetta says sympathetically.
"I don't know what I caught, but I feel like hell. Thanks for getting back to me."
"What meds are you taking? I hope it's decongestants and a cough suppressant with an expectorant, and that you're staying away from antihistamines. Try the daytime or nondrowsy formulas that don't list antihistamines or doxylamine succinate on the label-unless you want to dry yourself out and get a bacterial infection. And stay away from alcohol. It lowers your immunities."
He blows his nose. "I'm a real medical doctor, just so you know. And an addictionologist, meaning I do know a thing or two about drugs." He says this without a trace of defensiveness. "Thought you might be relieved to hear that."
Scarpetta is embarrassed for making assumptions. Coroners are elected officials and unfortunately, nationwide, many of them are not physicians.
"I didn't mean to insult you, Dr. Lanier."
"You didn't. By the way, your sidekick Pete Marino thinks you walk on water."
"You checked me out." She is nonplussed. "Good. Now hopefully we can get down to business. I've been through Charlotte Dards case."
"An oldie but goodie, and I don't mean that literally. There's nothing good about it. Hold on. Let me get something to write with. Unquestionably, there's a Bermuda Triangle for pens, and in my home it's my beloved wife. All right."
"Mrs. Dard's case is definitely perplexing," Scarpetta begins. "As you know from her tox reports, oxymorphone-the metabolite of OxyContin-is only four milligrams per liter of blood, which puts her in the low lethal range. Her gastric is negative, and the level in her liver's no higher than the level in her blood. In other words, death from an overdose of OxyContin is equivocal. Clearly, her drug level isn't as critical as her clinical findings."
"I agree. My thought all along. If you interpret her tox in light of the histological findings, it's possible she didn't need as high a level for an accidental overdose. Although her reports and body diagrams don't indicate any cutaneous stigmata of past intravenous drug abuse," he adds. "So I'm guessing she was a pill-popper but didn't shoot up."
"Certainly she was a chronic drug abuser," Scarpetta says. "Her heart tells us that. Patchy necrosis and fibrosis of varying age, and chronic ischemia, plus an absence of coronary artery disease or cardiomegaly. Basically, a coke heart."
It is a catch-all phrase that does not necessarily mean the person was a cocaine addict. Drugs such as narcotics, synthetic narcotics, OxyContin, hydrocodone, Percocet, Percodan and whatever else the addict can get his or her hands on will destroy the heart just as completely as cocaine will. Elvis Presley is a sad example.