In the House of McDreamy

•February 4, 2012 • Leave a Comment

Note: For the sake of my own sanity, I’m going to apply some more code-names to some of the principal actors involved in this situation. To wit: Detective October is the police detective I (briefly) met during my first call to John Q’s House of WTF — my impression of him was of a man in his mid-to-late fifties, and an experienced crime scene investigator who was, on that night, having visible difficulty coping with what he’d seen and experienced, to the point that it took a considerable amount of effort to get salient details out of him about the scene and what had been found there. Detective Christmas is the police detective I met on — wait for it! — the Christmas Day call, who noticed the repetitive four-pattern and with whom I have been conspiring conferencing since on related issues RE this situation. She is also an experienced investigator, mid-forties if I had to guess and by her own admission has had some dealings with the local DHS Office of Special Operations in the past, for values of “dealings” that mean “having investigations hijacked out from under her by the Men In Black.”

Detective October, according to all the news reports and the official inquest findings, committed suicide by train during the morning commute on 1/14. Unlike the other deaths related to John Q’s House of WTF, this one had actual witnesses. According to their testimony to the ME (in this case, my boss Dr. Weller), Detective October joined the other people waiting on an elevated commuter train platform somewhere between 5:45 and 6:15 AM — no exact time, but the witnesses were all in general agreement about the timeframe. He engaged in some idle chit-chat with two of them. Checked his watch repeatedly. And at 6:35ish, as one of the trains that passed through the station but didn’t stop there was coming through at speed, very calmly and deliberately stepped out in front of it. Everybody was in agreement on that point. He wasn’t behaving oddly. He did not appear to be in any visible signs of distress. He actually spotted the train and watched it coming in. And then he stepped out onto the tracks.

The actual, physical cause of death was massive, nonlocalized blunt trauma to the head, neck, extremities, and trunk. Again, I’m not going to get into the gory details. They’re not particularly salient anyway. The telling detail, in this case, is the presence of the apparently self-inflicted parallel wounds on the interior forearm, identical to the definitely self-inflicted injuries on the Christmas Day victims. I did not, for reasons of being comatose in neurointensive care on the day in question, have the opportunity to examine Detective October. The autopsy report does not deal with these injuries except to describe them as superficial incidental abrasions such as are typically found on a body that has experienced blunt trauma by impact, with incidence of dragging. There were quite a number of abrasion injuries that met that criteria and I don’t have a quarrel with Dr. Weller’s decision to characterize these wounds in that fashion — there’s basically no rational reason to define them otherwise. I do not, however, doubt that they were inflicted well before Detective October’s actual death, having compared Detective October’s autopsy photos to the autopsy photos of the Christmas Day victims. The injuries are identical in length and angle. I shared this information with Detective Christmas, who accepted it with about the equanimity you’d expect, under the circumstances.

The circumstances being, of course, that a lot of people are seriously upset — which is, again, only to be expected. Detective October was a thirty-plus year veteran, more than fifteen years in Homicide, widely known and respected. His wife passed away last year after a long fight with breast cancer. He and his wife raised three good kids. McDreamy spent most of the week after his death triple-scheduled offering aid and comfort to his friends and family, a lot of whom are local. His funeral that weekend was attended by hundreds of people. Neither the family nor the police department disputed the official finding of suicide. Honestly? I don’t actually dispute the official finding, either. I don’t doubt that his death is connected to the others in this case, but unlike the others, his death was…accomplished laterally, I guess is the best way to put it. Which is pretty freaking upsetting all by itself.

Under the cover of checking to make sure the post office was forwarding my mail properly, I wrote a letter summarizing my observations up to that point and left it in my apartment’s mailbox, on the theory that it was still better to drop attempts at indirect communication there than anywhere else. Even though I distinctly remember getting a phone call the night I collapsed, there was no record of it in the recent calls log and my phone hadn’t captured the originating number, so trying to contact the helpful person who told me to stay put just as I was becoming completely incapable of doing anything else was a non-starter. I didn’t want to use McDreamy’s mailbox as a drop-point for, I admit, completely irrational reasons, considering that I was trying to figure out how to tell him about this whole situation without coming across as entirely insane and probably not someone who you want sleeping down the hall from your own unlocked bedroom, and that I didn’t doubt for one second that my contact knew exactly where I was and could reach me any time he/they wanted to do so. My lizard-brain insisted on a layer of mostly illusory disconnection/protection between my increasingly weird existence and McDreamy’s, even though I’m living under his roof, and so I gave it one.

In the meantime, I went back to work and by “went back to work” I mean “drove in with McDreamy every morning and spent the rest of the day doing transcription and assisting with the data entry and processing while waiting to be medically cleared to handle sharp objects again.” The average ME’s office produces a metric fuckton of paperwork, I assure you, as proper and thorough documentation of everything imaginable and a few things only pathologists think about regularly is a significant part of the job. Since nobody wanted to explain to anybody’s grieving loved ones that the ME conducting the autopsy had an unexplained neurological fit and accidentally sawed their  face in half, I became a temporary resident of the office copier room and got the chance to improve my word processing skills at the same time. The office staff, being a largely kindhearted bunch, tolerated my intrusion into their orderly domain with the benign condescension normally only found in pediatric nurses explaining how to properly secure a diaper around a wriggling infant. They were also, for the obvious reason, the first people who were not Dr. Weller to cop to the fact that McDreamy and I were living together — admittedly, McDreamy bringing me lunch more than once probably contributed to the discovery.

This apparently triggered quite a bit of excitement, to which I was generally completely and utterly oblivious. Look, I need to concentrate in order to type with anything resembling speed to begin with and everything you’ve ever heard about doctorate-level crappy handwriting? That is all true. It is even true for doctors who have not one damned excuse, such as the need to see six dozen patients in a four hour period, and so any vaguely legible squiggle on a prescription pad constitutes due diligence. (For the record: my father, who taught me how to write kanji and kana as well as romaji and English, is regularly appalled by my handwriting nowadays, so I’m not disclaiming any guilt on my own part here.) The upshot: I spent a lot of time harassing the other MEs and muttering under my breath about suggesting a remedial calligraphy class for the entire forensics staff.

I realized Something was Up when every single member of the non-medical office staff found the excuse to cruise by my desk at least once in a three day period to ask me some exceedingly casual questions about how I was doing and if I needed anything and was it true that I was going to be looking for a roommate? I seem to recall answering that last one in the affirmative and then innocently mentioning in passing that I was staying with McDreamy until such a time as I could get said roommate, thinking nothing else of it, but this apparently set off quite a bit of speculation. And possibly also resolved a long-running betting pool, thought I’m fairly sure that the deiner who told me about that bit was just fucking with me. Maybe. Apparently, McDreamy’s state of relationship status was a matter of passionate concern to no small portion of the staff, office, medical, and otherwise. He was apparently aware of this but by turns tolerated it or ignored it. The book on when and with whom he’d eventually hook up was apparently two feet thick, and our friendship…thing…whatever…evidently threw off a lot of calculations.

A lot of calculations, people.

My second clue of Upness I found sitting on my desk late one afternoon, after basically the entire office had gone home but I was still hanging out working on a project and poking one of the other ME’s into writing his notes in something other than purple sparkle gel ink. It was an archival file several years old, I hadn’t gotten it out, but the name on it was one I half-recognized. Accident victim — car accident, a drunk driver going somewhere north of eighty miles per hour jumped the center median, triggered a multicar collision with multiple fatalities. This one had been called at the scene, and the late Mrs. McDreamy had died of multiple traumatic injuries consistent with having her car crunched between a drunk doing eighty on the highway and a barrier, and then hit at least twice more before all was said and done. I put the file back.

I’m still not entirely sure how I feel about the whole thing.

More later.


Since you asked, Anonymous…

•January 29, 2012 • 1 Comment

For the record: no, technical error has not been ruled out as a possible origin vis a vis my brain’s Blue Screen of Death. It hasn’t been ruled out for a couple reasons, not the least of which is the fact that it’s physically impossible to survive as long as I did with no detectable brain function. No, really, it’s not possible, regardless of what Congressional representatives who should have their medical licences suspended for diagnosing outside their specialty on the basis of a video tape would like you to believe. It is rendered even more impossible by the fact that there was no meaningful disruption in my body’s autonomic biological functions — I didn’t stop breathing, my heart kept beating, despite the DWI displaying complete brain-stem dysfunction. If my brain had shut down and then I’d coded and required resuscitation, well, that would have been normal. Bad and serious but normal. Nor is this a case of Lazarus Syndrome, which is medically defined as the spontaneous autoresuscitation after failed CPR, in which pulse and respiration restart themselves in patients who have been declared clinically dead, usually some minutes or hours later, and which is usually followed close on by dying again, permanently, because the brain is not intended to go without oxygen for long periods of time.

EDIT: As of 5ish 1/28, no technical error to account for what is now being described as a “highly anomalous” DWI result. None of the other tests done with that particular machine on that day or in the days preceding/following are showing any pattern of wildly divergent results and a mechanical examination declared the machine itself basically free of defects. The official determination — “highly anomalous DWI result” — is basically High Doctorese for “we don’t even freaking know/man that’s weird/can we poke your brain some more?” I have approximately forty million appointments over the next couple weeks with assorted neurologists, at least one of whom is a specialist in the neurology of migraine development and who is very freaking much looking forward to meeting me, I assure you.

I’m going to digress a little bit at this point and talk about migraine headaches — more specifically, my migraine headaches, because every migraineur is just a trifle different from every other migraineur, even though we’ve all got many things in common.

First things first — what migraines are not. Migraines are not “just a bad headache.” Every time I see some dipstick on the internet making this assertion and mocking people for failing to “take an aspirin and get over it,” I am smitten with the ardent wish that I’d gone to school to obtain the technical knowledge required to reach through the computerized ether and punch such people in the face. With an axe. Because that might serve as the ultimate explanation for exactly how it really feels to have a migraine. Nor are migraines “just a woman/a woman on the rag thing.” Nor are migraines an indicator of mental illness/mental retardation. These things are pernicious myths that make people like me wish serious physical and mental harm of those who promote and disseminate them. Okay, maybe not all people like me, because I’ve got this propensity for responding very, very badly to stupidity. But I’m willing to bet that a large cross-section of all migraineurs got tired of being told to suck it up and deal by people who’ve never in their lives dealt at all a long damn time ago. It gets wearying.

Second things — what migraines are.

Migraine headaches are, in technical terms, an idiopathic chronic neurological disorder. Idiopathic does not have anything to do with “idiocy” but actually means arising spontaneously or from an obscure or unknown cause. With the rapid expansion of medical diagnostic technology and sophistication in the 20th and 21st centuries, there are actually very few diseases remaining that are legitimately considered idiopathic any longer, and a few are crossed off the list every year as causes previously undetectable or misunderstood are identified and clarified. Migraines, however, still are in large part because there exists no single, or even multiple, smoking-gun causes/sources that apply consistently across a large enough cross-section of migraineurs to say, with absolute certainty, “this is why your headaches happen.” They are chronic, which means they’re long lasting and recurring. Risk factors are linked to genetics (upwards of 90% of migraineurs have a family history of the disease — my biological mother had migraines, as does one of my great-uncles, and so do several of my cousins), age (most begin experiencing migraines in adolescence though some start earlier), biological sex (women are three times as likely as men to suffer from migraine headaches, though boys are likelier to start having migraines earlier, in pre-adolescence), and hormonal changes (the “rag-induced headache” you see people snarking about can be and frequently is a migraine, which can be triggered by both the hormonal changes of the adolescent body and the hormonal changes of menstruation). They have triggers, much like allergens, that can cause an attack to occur or be more likely to occur if a migraineur is exposed to them and almost everyone’s triggers are different and wildly variable in sensitivity. And since there’s no known singular cause, there’s also no cure, only treatment and management.

So, what happens during a migraine?

There are several different theories. The most medically well-supported is that brain chemical imbalances cause a change in the activity of the brainstem and its interactions with the trigeminal nerve, causing the release of chemicals called neuropeptides. The neuropeptides flood the meninges, triggering widespread vasodilation of the meningal blood vessels, serotonin uptake inhibition, autonomic nervous system involvement, and quite a lot of really moderate-to-severe and biologically unregulated pain. This can occur over a longish period of time, in a series of phases, or quickly and all at once — I’ve experienced both kinds and neither is what can be described as “fun.”

The occurance of a “phased” migraine follows this general pattern: prodrome, aura, the actual headache, and postdrome. Even so, not every migraineur follows this pattern or experiences all aspects of this pattern. I personally, typically have all four stages, so that’s what I’ll talk about next.

Prodrome is a medical term used to describe the precursor symptoms of a disease that manifest prior to the activation of the disease itself. For a generalized example: feeling tired or headachy or not having an appetite just before you really get hammered by a sinus infection or the flu. That “I’m getting sick” feeling is prodrome for infectious diseases. For migraineurs, prodrome can start a day or two before the actual headache itself hits and the vast majority of migraineurs experience precursor symptoms, a great many of them linked to the alterations in brain chemistry we experience during the lead up to a migraine. My own most common prodrome symptom is the fatigue/depression/sleepiness trifecta — and by that, I mean when I’m in prodrome it’s way beyond ordinary day-to-day tiredness and well into the land of watch Dr. Harada become an utterly sessile mass that could not be asked to get out of bed if a smoke alarm is going off. Really. When I was in college I had to be physically removed from bed by my roommate and a residence associate during a fire drill because I was deep in prodrome and I absolutely could not work up any desire to even begin to think about moving. The hyperactive prodrome I experienced before going over to John Q’s House of WTF is almost entirely alien to my adult experience of my condition, though my Dad tells me that my early childhood prodrome symptoms tended to involve being insanely hyper and highly irritable. A great many of the common prodrome symptoms — fatigue, depression, hyperactivity, irritability, mood swings, euphoria — are also symptoms of serotonin deficiency, which occurs during migraines, and others — such as a stiff neck, parasthesia in the hands and face, cravings for sweets/salty foods, assorted digestion upsets — are symptomatic of autonomic nervous system involvement triggered by irritation of the trigeminal nucleus. The vast majority of migraineurs experience prodrome of some variety — it’s a major self-diagnostic method for incipient migraine in sufferers, our friends and family — and the symptoms can start anywhere from days to hours in advance.

Aura is probably the thing most people who’ve never had a migraine have at least heard of before in relation to the condition. “Aura” is the medical term used to describe the neurological phenomena that occur immediately prior to/in conjunction with the migraine itself. The most well-known examples of migraine aura are the visual phenomena — scotomata (blind spots, larger and more physically visible than the naturally occurring blind spot in human vision), scintillating scotomata (flashes of colored light that may or may not arrange themselves into patterns — these are also called fortification spectra or teichopsia, because of their resemblance to physical structures like castle walls and battlements), hemianopsia (partial loss of vision in one or both eyes), photopsia (flashes of black and white light), tunnel vision. Some people experience complete, temporary blindness in one or both eyes during particularly severe auras and the accompanying migraine. Relatively decent examples of what these effects look like can be found here:

Simulations from YouTube:

These effects are all medically classified as hallucinations and they’re generally understood as being caused by the hyper-excited neurological activity that precedes an actual migraine attack. Simply put: a migraineur’s brain freaks out and the retinal nerves interpret that freakout in ways that would probably be a lot more entertaining if they were achieved with recreational chemicals and weren’t followed immediately by skull-cracking pain. Other fun aura related hallucinations are olfactory (phantom smells) and gustatory (phantom tastes), neither of which I’ve personally experienced, though I have a friend who now associates the flavor of Lemon Heads with her migraines, and auditory (phantom sounds), which I have occasionally experienced. Particularly severe auras can produce parasthesia in the hands, arms, face, lips, and tongue, usually on the side of the head that you’re about the experience the migraine, temporary dysphasia (inability to properly speak, read, or write), vertigo, numbness in the extremities, or, alternatively, extreme sensitivity to touch. Point in fact, severe migraine aura and migraines themselves can mimic stroke symptoms to such a degree that misdiagnosis is entirely possible. That being said, the vast majority of migraineurs do not actually experience any form of aura at all, and those that do are prone to growing out of it as they get older — the peak of migraines preceded by aura is statistically about the age of 4 to 5. Most never experience aura at all, some get to have the joy their whole lives. Guess which one of those I am?

There aren’t any visual aids to help describe the headache itself unless I were to ask one of Rin’s friends to get fancy with the Photoshop or possibly to link you to this article from the New York times:

In a more clinical and less artistic description, a migraine is a headache generally characterized by unilateral (one side of the head, either front or back, left or right) moderate-to-severe pain with a throbbing, pulsating quality (think a strobe light made of pure agony), compounded by sensitivity to light, sound, smells, and physical movement, and with the side-effects of nausea/vomiting, blurred/temporarily occluded vision, and lightheadedness/fainting. Sometimes a migraine starts out unilateral and becomes bilateral during the course, sometimes it starts and stays bilateral, sometimes it switches from side to side between attacks — i.e., your first migraine of the month is unilaterally sited on the right side of your head behind your right eye and the second is unilaterally sited on the left side of your head behind the corresponding eye. Intensity of pain is extremely variable from headache to headache, and can last anywhere from a couple hours to a couple days — though there are some people who are afflicted with low-intensity migraines that last for weeks. This is my current personal standard for “obviously being fast-tracked for karmic burn in order to hasten their entry into Nirvana.” The pain is debilitating but frequency of occurrence is also highly variable — some people have multiple migraines a month, some have a migraine every few months, some have migraines once or twice a year — and long periods of “remission” where no migraines occur at all are possible. (My personal longest remission period? Six months.) The clinical description of migraine pain is one of the things I liken to calling the Titanic a big boat: technically correct, but still a massive understatement. The strobe light of pure agony analogy is about as accurate as I can get to an adequate descriptor myself.

Postdrome is the clinical term for the hours/days immediately after the migraine attack, where you can still be feeling some symptoms but in general your ability to function is normalizing again. Some of the physical side-effects tend to linger — soreness, residual nausea, rebound headaches if you’ve taken a lot of meds to interdict the migraine itself, mood swings. Some people I know liken it to feeling hung over. I consider myself lucky to not get the lingering malaise aspects of prodrome, or at least not get them a large percentage of the time. After a migraine, I usually feel good — like you feel better once you’ve thrown up when you’re feeling nauseous — like my endocrine system wants to prove it still loves me by giving me a double-shot of allllllllllll the endorphin, an offer I usually graciously accept.

Like I said further up, there’s quite a bit of debate about the actual root cause of migraine headaches. It’s generally believed that, among other things, they can be triggered by exposure to the chemical constituents present in — guess! — certain foods. You may have noticed that I’m a quasi-vegetarian. (I think the actual persnickety “correct” term is lacto-ovo-piscotarian because I eat milk, eggs, and fish as my major non-vegetable sources of protein and no I don’t give a crap about the horrors of industrial fish farming. I will never give up tilapia. Never.) I made that particular “lifestyle choice” because it simplifies food trigger avoidance rather significantly, because I’m triggered by most of the crap you find in processed food. Sulfites, nitrates, monosodium glutimate, high amounts of just standard sodium. I love salted mango lassi with all my heart, but I don’t drink a gallon-sized cup of it every day and twice on Sundays. When I want Chinese, I cook my own, and only drink alcohol occasionally and in relatively small quantities. Claudio’s Specialty Foods is both my new true love and the bane of my existence because I can get basically all the soft, new cheese that’s safe for me to eat there and have reckless encounters with all the sharp, aged cheese that I should avoid all in one store that is also full of processed meats that are plotting my death. Rin thinks I’m the most desperately deprived person on Earth because I can only eat chocolate if I’m in the mood to take my life into my own hands and have to regulate my caffeine intake pretty exactly, whereas she lives on a diet of theobromine and phenethylamine, canned bacon, and highly caffeinated energy beverages (aka, “liquid migraine in 2 to 16 ounce form”). Sugar and honey are actually better for my brain function than most artificial sweeteners. And those are just my personal triggers. Food and food additives are major triggers across a good chunk of the migraineur population. So are generalized life stress, changes in sleep patterns, physical exertion, hormonal changes, environmental changes.

Most of the major non-pharmacological migraine interventions involve trigger avoidance or mitigation. Eating a diet that avoids or sharply reduces intake of aggravating substances. Moderate exercise taken daily or weekly — back in Cali, I took exercise in the form of swimming and regular biking. I totally need to get another bike. Relaxing through some structured form like yoga or meditation, regular therapeutic massage, or just some low-stress activity like reading (which I do quite a lot) or gardening (black thumb of death, and my grandmother is so, so disappointed by that). Maintaining a regular sleep schedule, which is basically out of the question for me given the realities of my career. Taking rest in a room that’s really dark and really quiet during prodrome. Some people swear by acupuncture and herbal supplements but my results with everything but massage have been only fair to middling. On the other hand, as far as a relaxant goes, pretty much nothing beats forty-five minutes of deep tissue followed by hot stones and a long soak in warm water.

Pharmacological migraine management takes two forms: pain relief and interdiction. Ideally, you’re supposed to take your painkillers as soon as you recognize the symptoms of migraine, which is why it’s a good idea to carry at least a few doses of your med of choice on you at all times. I personally use Imitrex (straight sumatriptan) or Treximet (sumatriptan plus naproxen sodium) for pain relief during the course, plus sound reduction head phones and a sleep mask to help block out light. There are at least a couple OTC pain medications that purport to be specifically for migraine relief and, to give them the credit they deserve, they can help with moderate pain. More severe migraines require more powerful medicines — triptans, which mimic the function of serotonin, ergotomines, specific anti-nausea medications, some opiates, some corticosteroids. If you have frequent, severe migraines over a long period of time, or severe migraines that respond strongly to triggers (such as I do), you’ll likely end up on some sort of long-term interdiction medication, which are usually prescribed for daily intake (to establish maintenance dosage) or (like me) after you’ve been exposed to a known trigger. I take metoprolol in slow-release form for interdiction purposes.

Note: No matter how bad your migraines are, they should not cause your brain to shut down, nor is total brain shut down a side-effect of any medication or combination of medications you could be taking. Yes, I am totally hung up on this.

So, yeah, I woke up in the hospital…

•January 26, 2012 • 3 Comments

My first thought upon waking up and being capable of coherence was, I’m glad my insurance has kicked in, because this room is costing Blue Cross Blue Shield a fuckton of money. My second was, goddamn, I’m thirsty, how long have I been out?

The answer was, of course, “three days” and that information was kindly provided to me when one of the ward nurses came in to check on me. I also learned that I was at the Penn Comprehensive Neuroscience Center at the Hospital of the University of Pennsylvania and that I should probably hold off on food and water until the doctor could talk to me.

Dr. Angstadt, the doctor in question, gave me six kinds of kindly professional Hell because the hospital had had to query my medical records from California, as I’d not yet gotten around to actually visiting the primary care physician I’d picked out. (Ooops. You know what they say about doctors being the worst patients? Broadly true.) He also let me know in that same kindly professional Hell-giving way that he had been in contact with my parents vis a vis treatment directives, as I’d been unconscious and nonresponsive and did not have an advance medical directives document filed anywhere that could be found. (Yeah.) He let me have some water, because I wasn’t nauseous, and then started in on the evaluation. Standard questions first: when was my last migraine, what interdiction meds was I taking, what OTC painkillers I used most frequently, if I’d been experiencing unusual instances of blurred vision, asymmetrical numbness or weakness in my face or limbs, dizziness, more sudden and severe headaches than usual, any recent blunt head trauma. Then the physical examination and, by the time he started listening for carotid atherosclerosis sounds, it finally dawned on me that they thought I had had a stroke. In fact, I said out loud, “Wait — you think I had a stroke?” Which occasioned the application of another six kinds of gently professional Hell, which included a rather pointed reminder that mid-thirties is not, in fact, too young for a stroke especially given my personal medical history of life-long moderate-to-severe migraines plus the stroke-risk inherent in my triptan-based pain control meds and, by the way, hadn’t I graduated from medical school in the last ten years? (Yeah, it was that kind of morning. Afternoon. Day.) They’d already drawn blood and my labs had come back with a normative clotting profile for my age, no significant chemical imbalances, sugar and cholesterol levels good. No blood clots or cholesterol crystallization in the retinal blood vessels. Blood pressure was a little elevated, but we both attributed that to finding myself laying in the stroke unit of a major university hospital with no memory of the last three days to be found. Then he called the nurses in to remove the IVs and get me some real food, because he wanted to continue lecturing me during a time when I wasn’t cranky from hunger.

Food was brought. I asked if I could get out of bed (answer: no) and if I could have a phone (answer: yes), and so I started making calls. Dr. Weller had, unsurprisingly, already been informed where I was and had a broad understanding that my condition was considered “of serious concern” and said she’d have some papers for a temporary medical LOA brought over that day. Then I girded up my loins, did the time zone calculations, and called my Dad.

….There are some conversations you don’t ever want to have with your parents. I finally managed to convince him that it’d be a waste of time and money to fly out right now — I’d probably be out of the hospital before he could even get all the plane tickets lined up. Yes, I was fine — just a bad migraine. He could stop worrying. I’d call again as soon as I was out of the hospital. Give Rin and Mom a hug for me.

He did not sound particularly like he was going to stop worrying.

I’m really not sure I can blame him. I was dozing a bit, because there’s nothing in the universe more boring than a hospital room with no television, when Dr. Angstadt and the rest of the neuro team assigned to my case came back in, with nurses, a ward cart, and a mountain of paperwork. One of the nice things about being a doctor in the hospital is that other doctors will not, in general, treat you like a layperson when it comes to the details and severity of your condition. Dr. Martine Tucker, the doctor who’d been on duty when I was brought in and who did my initial evaluations and treatment, did not even pretend that the situation wasn’t worth my new journal tag. I had been brought to the U of Penn Hospital in the early morning hours of 1/11 by ambulance — my building manager had used her emergency access keys to obtain entry to my apartment after someone had banged on her door complaining of a loud noise coming from inside and promptly called 911 when she found me unconscious and nonresponsive, in mid-seizure, on the floor. The seizure stopped before the EMTs arrived but I remained nonresponsive in the ambulance. The EMTs performed a physical evaluation that included an EKG that displayed the sinus tachycardia and rising-falling T-U waves that characterizes a stroke’s effect on the brain’s sympathetic and parasympathetic control of heart function. That, combined with the medical ID migraine dogtag I wear, led to the decision that subsequently routed me to U of Penn’s neuro center, where I was admitted as acute, possible stroke, and diagnosis and mitigation protocols were immediately enacted. Because severe enough migraines can actually mimic the symptoms of stroke, Dr. Tucker ordered an immediate diffusion weighted image MRI — pretty much the fastest method of identifying areas of abnormal brain function that most hospitals can access.

This is where the superlative form of what the fuck comes into play.

The DWI returned the information that my entire brain was in a state of profound abnormal function. In fact, it was in the process of shutting down. In fact, Dr. Tucker informed me that all electrochemical function in my brain ceased at a little after 0400 hours. I did not, however, code. My heart continued to beat, albeit arrhythmically, spontaneous respiration continued, my autonomic reflexes continued to respond, and, about twenty minutes later, my brain function resumed in a completely normal fashion.

Everyone was, shall we say, pretty surprised. I did not, however, wake up until this morning, which caused quite a bit more surprise and excitement. I’d been under basically continuous monitoring the entire time I was in the hospital and during that time my brain continued to bop along as brains are wont to do, despite having just suffered some sort of trauma sufficient to cause it to shut the fuck down completely, the only sign of any oddity the fact that I wasn’t awake and couldn’t be woken up for love or money. Until, that is, I woke up on my own crabby and in want of coffee.

Yeah. The superlative of what the fuck.

Naturally, the neurology center wanted to do some tests. And by “some” I mean “all the tests ever conceived in the mind of any neurologist anywhere on Earth in the entire history of time.” Given the circumstances — and I would like to emphasize for emphasis that the circumstances were “my brain had shut the fuck down and restarted itself and  nobody had one damn clue how or why” — I was completely okay with this. I spent the rest of the afternoon filling out a vast quantity of paperwork, waivers and informed consent forms and insurance crap and my temporary medical leave request. I called McDreamy and asked him if he could stop by my place and bring some things to the hospital for me, and called my building manager so she would let him in, and shortly thereafter the hospital had copies of my migraine diary, my Do Not Resuscitate Order, my organ donor card, and my Advance Medical Directives. And over the next five days I did, in fact, have every goddamned test under the sun. CT scans. MRIs. Six different kinds of tomography. Just plain angiography. Ultrasounds of probably every major artery in my body. EKGs twice a day. Blood tests for everything up to and including meningitis and encephalitis. The results?

Inconclusive. No signs of aneurysm or arteriovenous malformation. No signs of stenosis in the carotid arteries. No brain tumors, abscesses or bleeds. No infections or inflammations of the brain or meninges. No electrolyte imbalances or hormonal abnormalities. It is not lupus — it is never lupus. For that matter, no signs that my brain had actually suffered any damage from, y’know, completely shutting down. Yes, I’m a little hung up on that. I’ve lived my entire life thus far with a neurological disorder  whose cause is substantially debatable, whose triggers are many and occasionally twitchy, and which can only be managed, not really cured. I have become accustomed to it occasionally punishing my fondness for Pepsi, salted mango lassi, and vegetable curry with blinding agony. Some things you just learn to deal with, because a life without salted mango lassi is a life not worth living. Unexplained total neurological shut down? Not really in the same category of manageable condition. My doctors concurred with this assessment but also couldn’t really give me any answers because, again, inconclusive test results are inconclusive. They finally discharged me with a request that I not drive while they continued trying to figure out what had caused my brain to turn on and off like a light switch and a stern admonishment to actually see my doctor and think about changing to another kind of interdiction medication since what I’m on might be might not be cutting it any longer and the triptan painkillers couldn’t be ruled out as a possible cause of my…episode, and a fuckton of follow-up appointments with an assortment of specialists. Also a request that I make myself available for certain clinical trials and the suggestion that I either get a roommate or develop an action plan with a trusted neighbor to help me monitor my condition at home. My discharge instructions were a half-inch thick but I was cleared to return to work on light duty.

McDreamy, in his continued role as the best human on Earth, picked me up at the hospital and took me home. Or, to be more precise, his home. Admittedly, that was my fault. I complained out loud about the whole ‘get a roommate!’ thing being a perfectly wonderful option if you weren’t sitting on a year-long lease on a one-bedroom apartment with six months remaining. Later that evening we went back to my place and put everything I couldn’t live another minute without in the back of his car. I have since been ensconced in one of his guest rooms where I am residing “until medically cleared.” The building manager and rental company agreed to this arrangement, and to let my car stay in the building lot, on the grounds that I’ll continue paying the stipulated rent until the end of my current lease, at which point I might be able to negotiate a two-bedroom apartment and actually get a roommate. According to McDreamy, I’m paying rent to him in the form of Indian food once a week, intellectual stimulation, gas money for the car pooling we’re going to be doing for the foreseeable future, and exercise partnership. Also teaching him how to play World of Warcraft. It is, I will admit, extremely comfortable being here, not alone.

Less comfortable? While I was in the hospital, the detective that I’d met at John Q’s house in October was killed. Died. The official determination was suicide — threw himself in front of a SEPTA train on the morning of 1/14.

Even less comfortable? The detective in charge of the Christmas day investigation called me. She’d seen his autopsy photos. He had the same parallel-four scratch marks on his arms as the male Christmas day victim.

Rin — you may absolutely not talk about any of this with Dad or Mom.

That Night

•January 18, 2012 • 1 Comment

I went home that night in a state of mind that my grandmother no doubt would have referred to as A State, proper noun, and would have treated with a pot of my favorite tea and a box of Thin Mints kept frozen for just such an occasion. I had no Thin Mints, frozen or otherwise, but I did have good tea and bought a pint of mint chocolate chip ice cream with which to treat my aggravation. I also applied the balm of a series of increasingly passive-aggressive notes that I ultimately didn’t stick in my mailbox, mostly because I couldn’t think of a genuinely cutting way to say nice tie, asshole in a way that came across as properly sarcastic in print.

Once I got that out of my system and my irritation throttled down to manageable levels, I realized a couple things in quick succession.

Firstly, that my presumed contact Delgado was, in all likelihood, sticking his neck out on this matter, as well. If the goal of seizing and sealing the scene at John Q’s house in October was to control the flow of information out of that investigation — and possibly to prevent other investigators from stumbling over the same weirdnesses that I had — they’d succeeded at achieving that objective. Succeeded so well, point in fact, that they might have closed off useful avenues of inquiry for themselves. If I could take the response to my initial inquiry at face value, “they” had no idea where Doe Four was, and that in itself was a matter of significant concern. Doe Four had disappeared and one of the few people who had had verifiable contact with him that night had just been murdered, along with her husband, amid circumstances that recalled the state of John Q’s house, the only differences being quantity of crazy, not so much kind. The other verifiable/possible contacts were the officers in the patrol unit that had found him, the other members of the ambulance crew, the detectives that had responded to the call, any hospital personnel that had been in the emergency room of the hospital he’d been taken to. The ambulance was already gone by the time I arrived, and Delgado had arrived on the scene a quarter-hour after I had.

“They” either couldn’t or wouldn’t approach the police for help with this situation. I lean toward “couldn’t” — the detective in charge of the Christmas day case had indicated that they’d been willing to interject themselves into investigations in the past, which suggests a constraint of some kind that precluded such action. “They” needed an intermediary, someone who was involved-but-not-involved, to function is an information conduit/communications accessory/filtration device. I couldn’t tell the detectives about four anomalous inches of physical space in John Q’s basement without being politely called into my supervisor’s office and remanded to psych evaluation, but I could tell them about the still-disturbing aspects that tied together into the Christmas case, and do so in a way that might point them in the right direction.

Secondly, I realized that the events that unfolded at John Q’s house in October — whatever those events had ultimately been — could not possibly have come as a surprise to “them.” “Their” response was fast — the place was already on “their” radar. By way of contrast, the Christmas day murders were clearly not something “they” had been expecting and the situation was now far outside of “their” control. The crime scene had been processed by people other than their own investigators, the autopsies conducted by someone other than their own coroner/examiner/forensic pathologist, and they either couldn’t or wouldn’t swoop in, seize everything, and tell everyone involved at this point to forget they’d seen anything unusual. “They’d” lost the chance to control that situation from the outset and attempting to assert control after the fact would draw more attention to their activities, which I suspect “they” really didn’t want. So a more oblique approach was required.

Thirdly, it occurred to me that I was under surveillance. That I had, in fact, probably been under surveillance for quite some time. Yes, I really am that slow sometimes. The question was, why me? The best answer I could come up with, beyond my Hardy Boy activities at the site of John Q’s house, was that I’d once been the subject of rather high level security clearance screening by both the FBI and the DHS during the investigation into Pan-Oceanic 332, which I imagine is the sort of thing that’d turn up for Federal employees looking into my recent activities. The thing is, of course, that the Hardy Boying could not possibly have been the trigger for the surveillance. Delgado was close enough during my first trip to the house to render emergency assistance when I caught a double barreled dose of migraine in the face. Either that was an amazingly convenient (for me) coincidence or else…


That is, I confess, where I decided to stop thinking about this stuff for the night, because I was making myself incredibly paranoid. Instead I put down my notebook and did a bunch of perfectly ordinary stuff until I felt a little more normal. Did the dishes. Brewed the coffee for the next morning. Checked and caught up with email. Took my interdiction meds and got ready for bed. My cell started ringing while I was still in the shower. When I checked the messages, there was no mail and since there was no second call, I assumed that it wasn’t the office. Went to bed.

I woke up very suddenly and very completely, startled awake by the silence. I’ve said before that my apartment building isn’t what you’d call the quietest place in the world — it’s a refurbished factory, and those “high, exposed wood beam ceilings” and “original wood floors” that the rental agency uses as selling points actually translate to “lots of cracks in both the floor and the ceiling through which sound and other things can flow almost unimpeded.” It’s never totally quiet, no matter what the hour — even off the ground floor, there’s always street noise or neighbors who work the graveyard shift coming in or going out or the Demon Auffenpinscher spazzing out over something. The closest I come to actual silence is when I’m wearing sound-suppression headphones. Similarly, it’s never totally dark, either. Some of the apartment windows — like the ones in the bedroom and the bathroom — are frosted two-thirds of their length and let in minimal light, and I’ve got blinds on the others, but the ambient level of light in the city isn’t anywhere near the ambient level of, say, my grandparents’ place in Backside of Nowhere, Oregon. The hallway lights leaked around the edges of my front door. I have a socket night light in the kitchen and bathroom so I can make my way around without turning on any other lights. The city sky glows at night, especially when it’s overcast. There’s always light coming from somewhere.

It was absolutely silent when I woke up — I reached up to make sure I wasn’t wearing my phones for some reason, the lack of standard background noise was so complete. I felt it almost like a physical thing — a hand pressed down on my chest so I couldn’t get up, across my mouth so I couldn’t scream. It was dark — too damn dark. My heart was beating like I’d just run a mile, so hard I could feel the pulse of blood in my temples, and knew — I just fucking knew — that I wasn’t alone. I could feel something there in the too-dark and the too-quiet with me. I couldn’t see anything, but I knew something was there, like it was when you were a kid and you knew there’s a monster under your bed or in your closet and if you move or breathe or turn on the light, then it’ll know you’re there, too. Just like that. And I couldn’t move, and I was breathing too loudly, and I wanted to reach over and turn the light on so badly, but I didn’t dare. Because there was something right there and it WANTED me to reach out, to close the gap, so it could reach for me, too.

The worst part is, I almost did it. Almost reached. I was lifting my hand to do it.

And my phone rang.

The silence…broke. I don’t know how else to put it. Almost literally broke — the phone rang, and a huge truck rattled past on the road outside, and the Demon Auffenpinscher started barking its stupid head off, and the light making it through the frosted glass and bedroom blinds speared me in the eyes like a red hot icepick. My vision blurred immediately and my head throbbed, all at once, no prodrome, no aura, just zero to kill me, kill me now in…seconds? Minutes? Not long. Even the dim, dull light from the windows and the numerals on my digital clock were killing me and every ring of the phone brought me closer to heaving up a lung, the nausea and sound sensitivity were that bad. I got it open, just to shut it up.

No phone number on the incoming screen. No bars of connection. I’m not sure what I croaked out around the urge to hurl, but I’m pretty sure it wasn’t a standard greeting. The voice on the other end said: “Dr. Harada, stay where you are. Do not hang up the phone.”

I did not hang up the phone. I do not even remember hanging up the phone. I do not, in fact, remember the rest of that night.

I woke up three days later in the hospital.

Complications Regarding Answers In the Affirmative

•January 10, 2012 • Leave a Comment

That single-word answer presented me with, shall we say, a fairly substantial practical and ethical conundrum.

Practically speaking, I was at that point relatively certain there was a connection between John Q’s House of WTF, the missing Doe Four from that night, and the Christmas Day homicides. I was relatively certain of this because I had received a fat wad of information that I wasn’t supposed to possess from an informant that had thus far declined to formally identify himself to me, despite my suspicions, and because I’d gone poking around in places where I wasn’t actually supposed to be poking, on my own recognizance. Ethically, I had the responsibility to tell the detectives conducting that investigation everything I knew or suspected about it and also a responsibility to the friends and family of the victims, which didn’t end with the determination that their loved ones had been murdered. It never does just end there — what happened is only one half of that answer. Why is the other and I…felt and feel very strongly that why is hanging there right in front of me, just out of reach, waiting to be found.

Why is not usually a question I can answer.

The cheap and easy way out would have been to call the police anonymous tip hotline and strongly suggest looking to a situation involving the female victim and an incident that took place in October. Instead I called the detective in charge and asked if we could meet at some point soon to discuss the case and some concerns I had. She agreed and we met that day for lunch at a place local to her station. As it turns out, some of my concerns were defused almost immediately: she was not unfamiliar with the local DHS Office of Special Operations and their unlovable habit of hijacking investigations that, on first glance, do not look like the sort of thing that DHS would trouble itself with at all, no matter how expansive a definition of “homeland security” you’re using. I did not bring the information concerning the three Does. Instead, I brought copies of my own crappy pictures of John Q’s Basement of WTF, since she had already twigged to the whole fours, fours everywhere thing and might not think me completely insane for suggesting the possibility of a connection there.

On the plus side: she did not think me completely insane. She did, in fact, agree that a connection was possible and was troubled enough by the concept that she called her partner right then and there and asked him to get in touch with the female victim’s co-workers, particularly the other members of her ambulance crew.

On the not-so-plus-side: she did think me relatively crazy for going to the bother in the first place, especially since doing so involved a not insubstantial risk of pissing off a bunch of people who had the theoretical power to have me sent to an undisclosed location until I existed only as a family legend whispered of by my sister’s great-grandchildren. She encouraged me to, for fuck’s sake, not get caught if I was going to play Hardy Boy any further and to keep her posted on what I found out if I did. She would return the favor. I carefully did not mention that, technically speaking, I’d already been caught and was now engaged in something vaguely resembling a conspiratorial backscratching information exchange agreement with somebody who’d stolen evidence of a far more WTF-worthy issue, namely that John Q’s basement violated not just the rules of demonstrable sanity but also the laws of physics.

On my way out, I saw him. He was sitting by himself at a table on the far side of the restaurant from where we’d been — if it hadn’t been for the damned red tie he was wearing, I wouldn’t have noticed him at all, he blent in so well with the rest of the GQ catalog page set that made up the general clientele. The one who’d ordered me off the scene at John Q’s house in October and had me escorted off the porch when I’d argued the point. Same exquisitely tailored black suit, same red tie. Short, wavy dark hair that wasn’t quite a curl, olive skin, striking eyes — incredibly striking, even at a distance and in the thin winter sunlight coming through the windows, his eyes were pale, almost golden. He didn’t even pretend to not know that he’d been made — instead, he smiled the most smackably annoying smile in the history of the known universe and saluted me with his water glass.

I cannot express, in words alone, how much I wanted to go over there and hand him the receipt for my new camera memory card. I heroically restrained myself. Instead I went back to the office, called McDreamy, and invited him over for dinner some time that week — because everything was still pointing back to John Q’s House of WTF and if I was going to go any further in the direction, I was going to need some help.

The Christmas Day Call

•January 8, 2012 • Leave a Comment

I’m not going to go into precise details about the Christmas Day call, mostly because the investigation there is still active and ongoing.

I will say this: I was called to the scene of a multiple homicide to function as the representative of the county medical examiner’s office. What I observed there, besides the bodies, contained a high level of disturbing — an extremely high level. And also a potential link to John Q’s House of WTF.

Every clock in the house was halted at 4:04 — every clock, not just the mechanical ones. The digital channel readout on the cable box: 404. The watch belonging to one of the victims. The time readout on the laptop computer that had been in hibernation mode. The homicide detective on-scene noticed it, too, and remarked on it to me as we were directing the forensic photography, which is pretty much how I know I wasn’t having some advanced four-related psychotic break from reality or suffering from observation bias. And she was also unsettled by it because, seriously, digital clocks don’t work that way.

Both of the victims died of injuries similar to those of the Does at John Q’s house — a combination of blunt force trauma and blunt-object stab wounds. There had been no signs of struggle in the apartment where they’d been found, neither displayed signs of defensive injury. One (female) was found in the bedroom, likely asleep at the time of death; the other (male) in the living room, next to the hibernating computer. No defensive injuries — but the male victim had a four parallel scratches diagonally across the anterior skin on both arms, deep enough to draw blood and cause bruising, not deep enough to damage the veins or muscles, and which appeared to have been self-inflicted. The traces of skin and blood I found under his fingernails were his own.

When I spoke to the detective about my findings, she let slip that there had also been no signs of forced entry and no indications that theft had been a motive. Christmas presents were still under the tree, none of the big-ticket consumer electronics items were taken, money left out on the bedroom furniture was untouched. She came by the office to pick up my report and we ended up talking quite a bit, examining both the autopsy and crime scene photos, discussing particular bits that didn’t make a damn bit of sense. The victims had obviously emptied out their stuff on the bedside bureau when they’d gotten ready to turn in — one of the items was a pocket-sized notebook open to a page marked with four heavy diagonal slashes in a thick, rough circle. The detective wondered if there was any connection with the self-inflicted wounds on the male victim and I demurred, not wanting to bring up any half-baked theories about strange houses and murders committed in October that I wasn’t actually supposed to know anything about. Or at least not yet.

Then, two days later, McDreamy came down to talk to me about the same case. He’d been receiving visitors related thereto — friends and co-workers of the deceased. They’d both been well-like and well-respected in their particular fields of expertise — she was an EMT and he was a nurse-anesthesiologist — and a lot of shaken and disturbed people were coming to him with questions and concerns. One of those concerns was that both of them had been behaving oddly in the last few weeks — “paranoid” was the term that McDreamy said more than one person used and “isolated/not wanting to go out and do anything.” When he pressed for details, at least one of their mutual friends told him they had taken to sleeping in shifts and either staying at work until the other could arrive or else hanging out in more heavily populated staff areas at all times. Another told him that the female victim had been complaining of “unwanted phone calls” and while nobody actually used the term “stalker,” at least a few had the impression that both halves of the couple believed they were being followed. McDreamy was worried there might have been a drug issue involved, a worry I couldn’t assuage at that point, because the toxicology screens had not yet come back. (They ultimately came back clean of both prescribed and recreational drugs.) I made the determination of homicide and Dr. Weller signed off on it at the end of that week.

When I went home that night, I wrote another note to my semi-anonymous “correspondent,” outlining the situation and asking if it was possible that the female victim was an EMT on the ambulance that had responded to the call to John Q’s house. I received my response the Tuesday after New Year.

It was Yes.

And now for the less-than-awesome stuff

•January 6, 2012 • Leave a Comment

* After I left the house ran away from the house like a twelve year old left the house, I drove around for about forty minutes, picking random directions, until I found a place that did one hour photo development. The results were…not quite what I expected. Admittedly, it was dark. But I also had not one but two maglites and the camera flash working to illuminate the scene. And, still, none of the pictures came out. Or, to be more precise, they came out weird: shaky and visually distorted, like the picture I’d snapped with my cell, even though my hands were steady while I was taking the shots. All of the images looked as though someone had put their hands on them and smeared all the way across the paper while it was still developing, or else they were too dark to make out details, particularly the shots of the cellar walls. I’d had the pictures loaded onto a CD, as well, and it wasn’t just the printed photos, so it was no fault of the development process — the shots loaded on the CD are just as severely visually distorted. I was considering going back during the day and trying again, if only to rule out darkness of night being a factor in these results.

* Two days later, I received an anonymous package in my home mailbox. It was an unmarked manila envelope — no delivery address, no origin address, no stamp or postmark or basically any indication that it had been actually sent. The building manager, whose office overlooks the interior courtyard where the mailboxes are located, told me that she hadn’t witnessed anyone but our regular mail carrier come in and drop off, but that she hadn’t been in the office all day. Best part? Our mailboxes are all tiny locked cubicles in a single unit, not the roadside type where anybody can walk up and drop something in at any time. You have to have either the individual key to the box or the post office master key that opens them all.

Inside was the raw autopsy data, complete with photographs and lab reports, for three Does, two Johns and a Jane, their date and time listed as 10/6/2011 between 0130 and 0330 hours, in Philadelphia, Pennsylvania. I am not going to get into the details here, because they’re fairly gruesome, but the reason that the detectives on scene believed they were looking at “at least four and maybe more” is because two of the three bodies were at least partially dismembered post-mortem. Cause of death in all three was a combination of blunt force trauma and stabbing with a relatively blunt object, like a broken metal pipe or crowbar, with the Jane presenting clear evidence of defensive injuries. The dismemberment was not apparently effectuated using the standard implements, such as an axe or a hacksaw — the damage done to the victims’ bodies post-mortem, the tearing of muscles and tendons and the manner in which the bones broke, suggests a manual process, that their bodies were physically twisted and wrenched until they gave way under the stress of repeated action.

The crime scene photos taken inside the house were just as shaky and dark and distorted as my own, but I could still make out that the walls — which had been tagged a couple layers thick with graffiti — were painted over in blood. Numeral 4s, all over the walls, and on the ceiling. I hope whoever they had doing the spatter analysis was a fucking rock star at their job. By way of contrast, the autopsy photos of the victims were perfectly clear, no distortion at all.

Four. It’s becoming a theme, as you’ve probably noticed. Looking for patterns where there aren’t any is a part of the human condition, a part of our psychological makeup, a deeply internalized form of both confirmation bias and observer-expectancy effect. Sometimes, the pattern is real — particularly in cases of patterns that leave physical evidence behind, matching DNA traces on multiple victims, blood spatter patterns, tire tread marks left at the scene, things that can be independently verified as actually existing. A lot of the time, even seasoned investigators see what they want to see, discard what they don’t want to see, and proceed from a point of faulty judgment. I’m trying, very hard, not to fall into that trap but this “four” thing was, at this point, starting to look a little bit too consistent to be totally coincidental. What are the odds of four people being attacked in a house with the number four carved all over the damned basement and then painted all of the walls in their blood? Yeah, that is when I remember there had, in fact, been four victims — the three Does in the house and the fourth Doe that the uniformed patrol had found bleeding in the street and had sent to the hospital just before I’d arrived that night in October.

A cursory review of local online newspaper items from that night and the days following turned up zip about the topic — in fact, the most I found about the whole thing was a couple short articles about “local crackhouse burns down, arson not suspected,” and pretty much nothing more. But there’d been a fourth victim. So I wrote a note (What happened to the fourth Doe?), stuck it back into the envelope, and put it back in my mailbox. Just to see what, if anything, would happen. At worst, I’d get an annoyed note about proper postage and addressing.

* I decided to poke around a bit more at John Q and his background. I’d already done a little research there while contemplating going back to the house. There wasn’t much more I could do to research him personally without making a number of potentially very suspicious phone calls to Norristown State Hospital, so instead I took a look at what appeared to have been the start of his downward spiral: the deaths of his wife and daughter.

Mrs. Q and Mademoiselle Q died together when the plane they were traveling in crashed on approach to Pittsburg International Airport from O’Hare Airport in Chicago, on September 4, 1994. (Bolded emphasis mine.) The plane in question was ConTran 121, a Boeing 737 that flew a regular transcontinental route from SeaTac to O’Hare to Pittsburg. According to the NTSB report, the plane began flying erratically halfway across the Ohio River Valley according to ground-based radar observation, fell out of radio contact with the tower at Pittsburg, and did not respond to the attempts of other planes or smaller, municipal airports to contact the cockpit. At 16:04 hours (which is to say 4:04 PM EST), the plane fell off the radar entirely. Eye witnesses on the ground later reported seeing the plane coming in low and fast, under power, no unusual engine sounds, or visible signs of smoke or fire from any of the engines. It hit the ground at what was estimated to be cruising speed (i.e., several hundred miles per hour), nose-down at an attitude close to full vertical. The NTSB investigation team found no single piece of wreckage, either of the plane or from human remains, larger than hand-sized. The cockpit voice recorder and the flight telemetry data recorder were both recovered, albeit severely damaged. Neither ultimately proved to be much use. The CVR was one of the old models that had only thirty minutes of functional recording time and the first thirty minutes of flight out of O’Hare were entirely without incident, just ordinary workaday radio chatter with assorted towers and the crew going about their in-flight tasks. The information on the flight data recorder was likewise inconclusive, showing no signs of distressed function right up to the point that the plane hit the ground. At no point was an in-flight emergency declared and the crew’s interactions with the towers they contacted were standard in-flight checks and communications with no indicators of distress. The NTSB basically reconstructed almost the entire plane from bits and found, essentially, no single smoking-gun mechanical cause of the crash. The official cause is listed as “unknown,” a designation I know for a fact that they hate handing down for an assortment of practical reasons. ConTran, in a display of corporate handwashing douchery at its finest, pointed at the NTSB report and declaimed any responsibility on the part of their equipment or crew for the crash. That did not stop the families of the people on board from burying them under a mountain of wrongful death lawsuits, which promptly caused them to cease to exist as an entity some years later, with most of those suits still legally unresolved. John Q is named as a plaintiff in one such suit.

About midway through my research on this, I started experiencing a certain sensation of deja vu with regard to the accident details. I might get more into that later but, for now…unless I can find out more information about John Q himself, I might be stalled at this end of things.

* When I checked my mail the next day, the envelope was still there, so I pulled it out. The note inside, however, was not mine. The reply, which was written in that same slanty Catholic school handwriting that I found on the back of Agent Delgado’s business card, was this:

We’d like to know that, too.

More later.