“Shit!” Jack yelled at the ceiling in hopes of shocking himself out of his downward-spiraling self-pity. At that point, a head poked in through the open doorway. It was Dr. Chet McGovern, Jack’s former office mate.

“Is that a reflection of your personal state of mind,” Chet joked, “or a general assessment of the current stock-market trend?”

“All of the above,” Jack said. “Come on in and take a load off.” Despite being preoccupied, Jack welcomed the diversion.

“Can’t do,” Chet said, with a lilt to his voice. “I met somebody Saturday night, and we’re meeting for lunch. She might be the one, my friend! She is hot.”

Jack waved him off. He’d become convinced Chet was never going to, find “the one.” Chet loved the chase too much to settle down.

“Hey, Chet,” Jack called to his retreating friend. “Have you ever had a vertebral artery dissection?”

“Yeah, one,” Chet said, returning to lean back into Jack’s office. “It was during my forensic pathology fellowship in L.A. Why?”

“I had one this morning. It stumped me until we opened the skull. There wasn’t much of a history, and there was no apparent trauma.”

“How old?”

“Young. Twenty-seven.”

“Check out if she’d seen a chiropractor in the last three days or so.”

“I think she did,” Jack said, impressed by Chet’s suggestion. “I think she might have seen one last Thursday or Friday. She died last night.”

“It could be significant,” Chet replied. “In my case, the association was easy to make, since the symptoms began moments after the cervical manipulation. But when I looked into the issue in general, I learned the symptoms of VAD can be delayed for days.

“Listen,” Chet added. “I’d love to talk more, but I got to go to meet my new honey.”

“You’re impressing me no end,” Jack said, jumping up and following Chet down the hall. “I vaguely remember reading about a case, but I’d never seen one.”

“I found it interesting,” Chet admitted as he walked, “and I thought I could get some kudos out of it from my chief, so I researched VAD and chiropractic a bit. I found it to be one of those associations which hasn’t sparked much interest, nor did it then for me. It turned out my chief went to the same chiropractor and swore by him, so my hand was forced to sign out the case as merely a therapeutic complication.”

“What is it that certain chiropractors do that makes VAD possible? Do you know?”

“I assume it is the force of their ‘adjustment technique,’” Chet explained. “It’s called a high-velocity, low-amplitude cervical thrust. Though it doesn’t happen often, there are apparently times when it can cause an internal tear in the vetebral artery, and the blood pressure does the rest. Sometimes the dissection extends all the way up into the basilar artery.”

“How often is not often?” Jack asked.

“I don’t remember exactly,” Chet admitted. “It was a few years ago. In the L.A. medical examiner files I think I found only four or five cases of VAD associated with chiropractic visits.” Chet stepped into the elevator, holding the door open with his hand. “Listen, Jack, I gotta go. I’m already late. We can talk more later if you want.” The doors closed, and he was gone.