“That would have been the practice I just left,” Glowa explained. “That certificate was produced by one of my old colleagues drawing from the medical files I left behind.”

“You wouldn’t have certified her death like they did?”

“I don’t know. What did they list as a cause?”

Joe tried to recall. “If memory serves, hypertensive and arteriosclerotic cardiovascular disease, diabetes, obesity, and hypercholesterolemia. I think that was it. Was that wrong?”

“Not necessarily. It sounds about right for a million death certificates. A very common litany of ailments.”

Joe scratched his head. “I’m confused. If that sounds right, why did you imply it wasn’t?”

“I didn’t,” she corrected him. “What were the findings at autopsy?”

“The pathologist found all that, but none of it was severe enough to be an obvious smoking gun.”

Glowa jutted out her chin in a gesture suggesting agreement. “There you have it, then.”

“What?”

The woman took pity on him. “I’m sorry, Joe. Welcome to the real world of medical diagnosis. You must be constantly assaulted by people accusing you of not doing your job and letting guilty people go free, all because of a supposed lack of evidence. Physicians get the same treatment—‘You knew he was sick. Why didn’t you fix him?’ The problem, as in your case, is a matter of degree. How sick is too sick? How guilty is guilty enough to file charges? Lucy Shaw was not a healthy woman. But she wasn’t at death’s door. She was compliant with her medicines, good about coming in for visits, and even eliminated certain behaviors that, over time, were definitely going to shorten her life, like smoking.”

“So you wouldn’t have signed that death certificate like that.”

“I have an academic background, as well as a clinical one,” she answered him. “I would have pushed for an autopsy—a private one if the state’s OCME had demurred. So I’m delighted you ordered one, and I’d love to see the results, if possible.”

“I’ll see what I can do,” Joe said. “The tox results are pending, as usual, so it’ll be a while.”

“I understand. Thank you.”

“Okay,” Joe said. “Let me try this from another angle—call it a more global one. It goes to why I think you attended her wake, which I suspect you don’t do for all your deceased patients.”

She allowed that he was right with a smile and a nod.

“What was it,” he continued, “that merited the extra attention? Friendship or concern?”

“Are you good at your job, Joe?” she asked. “I’m getting the feeling you are.”

He didn’t respond, waiting patiently.

“I would imagine,” she began, “that in your work, you get your fair portion of cases that can’t be landed for one reason or another. Am I right? The hoped-for solution hovers just beyond your reach.”

“No argument.”

“We do, too. Most of the time, it’s diagnostic. Patients come in, complaining of one thing or another, and we simply cannot identify the source or treat its symptoms. Or we know what it is but can’t do anything about it. We live with that. It’s even partly why we do this work. If everything was a laceration, where a Band-Aid would do the trick, things would quickly become stale.”