Interesting . . . Whatever had afflicted Walter Baldwin had apparently caused the lining of his digestive tract to slough.
Entering the autopsy room a few minutes later, the first things he sensed were the odor and the sound of the exhaust fans laboring on their highest setting. Needing only masks and eye protection to complete their attire, Guy and Natalie were dressed out and waiting, standing as far from the bloated corpse of Walter Baldwin as the relatively small room allowed.
“We get time and half for this one, right?” Guy said.
“We can do that,” Broussard replied, reaching into the box of booties. “But we’ll have to start keepin’ track of things like those two hours you took off Friday to meet your plumber.”
“Good point,” Guy said. “I vote for continuation of the old policy. Natalie, what do you think?”
“Old policy,” Natalie said with less than her usual energy.
Natalie had short, curly hair the shade of the tan leather reading chair in Broussard’s study and fair skin, so her tortoiseshell glasses always made her look a little on the pale side, but with enough color in her cheeks to seem in robust health. Today, as Broussard slipped his plastic apron over his head, he noticed that her color seemed a bit off, tending toward the yellow range. Thinking she was probably just trying out a new makeup, he said nothing.
After tying on her mask and donning her eye shield, Natalie moved to the stereo and stopped at the CD rack. “I’d like some Strauss today.”
Guy turned and looked at her, wide-eyed. Broussard paused in his attempt to tie the knot of his apron strings.
This was a major departure from long-standing autopsy protocol. Broussard chose the music. Everyone knew that.
Puzzled, Broussard looked at Natalie, who was already selecting the Strauss disc. He rarely chose Strauss and from time to time had thought he should remove that disc from the stereo. Waltzes and polkas were just too frenetic for careful work.
As the lilting strains of “Thunder and Lightning” filled the room, Guy glanced at Broussard in horror.
“Yes,” Broussard said, “Strauss today.” And Guy relaxed.
Broussard picked up the Polaroid camera and checked it for film. Empty, and there was none on the counter where it should be.
He glanced again at Natalie, who’d joined Guy at the table bearing Walter Baldwin’s body. It was her responsibility to make sure each autopsy began with film in the camera and several packs nearby on the counter. This was the first time she’d dropped the ball. He noticed that her eyes were focused on a distant point while her head bobbed slightly in time to the music.
He pulled the drawer with the extra film farther out than was necessary, hoping the noise would call her attention to her failure. But she didn’t seem to notice. Not wishing to criticize her in front of Guy, he made a mental note to speak to her later about it.
He moved to the body, glanced approvingly at the red grease pencil circles around the punctures where fluids had been drawn, and took a facial shot that wouldn’t rank as one of the victim’s better pictures. He then began a careful inspection of the body, which, though they were difficult to see, exhibited a large number of ecchymoses that he noted on his superficial-exam forms. Wishing to document them photographically, he again picked up the camera.
“Guy, hold this hand up for me so I can get a picture of the skin on the back, will you? Natalie, I’ll need a marker.”
Guy came around the table, lifted the arm, and turned the hand to an appropriate angle. Natalie hadn’t moved. “Natalie . . . a marker, please.”
She came back from wherever her mind had been and reached into the pocket of her smock, then into the other pocket. Not finding the roll of ruler tape there, either, she began to search the countertops. Finding it finally, she went over to where the two men were waiting.
“Natalie, is anything wrong?” Broussard asked.
“No . . . Just a little headache,” she said, peeling a small ruler from the roll of tape. “Where did you want this?”
Broussard showed her and she stuck it onto the corpse’s skin.
They photographed several more ecchymoses, then turned the body so Broussard could examine the back. A few minutes later, after noting the last of the ecchymoses there, Broussard asked Natalie to bring him the camera.
As Broussard made his final entry on the superficial-exam form, there was a crash from Natalie’s direction. Looking up from his clipboard, Broussard saw that she’d dropped the camera. Above her mask, her eyes were filled with confusion. Though the room wasn’t particularly warm, there was a film of perspiration on her forehead.
“I don’t know what happened,” she said. “I had it in my hand and then I didn’t.”
She bent at the waist and closed her eyes. “Jesus, do I feel lousy.” When she stood up a moment later, there was a red stain on the upper part of her mask.
“Natalie,” Guy said, pointing. “I think your nose is bleeding.”
As Broussard watched this unfold, the bubble enclosing the autopsy results of Jack Doe came bouncing over his mental horizon. “Natalie, I want you to leave now, get out of that autopsy gear, and go up to see Dr. Seymour in Internal Medicine . . . suite seven twenty-seven. I’ll let him know you’re comin’. Guy . . . go with her.”
Natalie raised a hand in protest. “That’s okay . . . I can manage myself.”
“I’d prefer he go with you.”
“No,” she said ferociously. “I don’t want help.”
The two men watched her walk slowly to the dressing alcove, where she stripped off her gear and headed for the door, holding a clean mask to her nose. Before she reached the door, Guy sprinted ahead of her and pulled it open. She shambled through without thanking him.
Broussard went to the phone and punched Seymour’s number into the plastic sheet covering the phone’s buttons.
“Mornin’, this is Dr. Broussard. One of my assistants is ill and I’d like for Dr. Seymour to examine her soon as possible. Could that be right now? . . . Good. She’ll be there in just a few minutes. Tell him I appreciate the special attention.”
Broussard hung up and looked at Guy, who was picking the camera off the floor.
“I sure hope she’s gonna be okay,” Guy said.
“Me, too.”
Broussard went to the stereo and exchanged the Strauss CD for Mozart. Trying to put his concern for Natalie aside, he returned to Baldwin’s body.
Guy showed him a developing picture he’d just taken of the counter. “Camera seems all right.”
He handed it over and Broussard took the shots he’d wanted before Natalie had become ill.
Because of the time that had elapsed before the body had been found, the blood and the organs were surely so overgrown with bacteria they would be useless for most of the tests routinely done to determine if he’d picked up an unusual bug. There was, therefore, no need to draw more blood.
“Ready to move him?” Guy asked.
“Yeah.”
Guy wheeled the table with the body into the adjoining alcove and lined it up with the autopsy platform. Together, they slid the body over. Guy then made the first two slanting scalpel cuts. As he opened the abdomen with the third, the foul smell in the room grew far worse. Acknowledging that with a war whoop, Guy began reflecting the chest flaps, his scalpel snicking away the restraining connective tissue.
Broussard turned his attention to sharpening his long knife and arranging his sample containers, aware that most of the organs would be so putrid, they wouldn’t be worth sectioning. Hearing Guy’s scalpel slice through the rib cartilages, he walked to the body, eager to get his first look inside.
Guy removed the breast plate and put it on the cadaver’s legs.
The first thing Broussard noticed was how much fluid there was in the chest, far more than he’d anticipated. The lungs were black, as expected, but in places he could see purple, which meant . . . He pressed on one lung and found that beneath the sponginess produced by decomposition gas
es, there was an underlying firmness.
“Okay for me to take the chest organs?” Guy asked.
“Go ahead.”
While Guy bent to his work, Broussard parted the abdominal slit and peered into the peritoneal cavity, where he saw a large amount of dark bloody fluid.
In short order, Guy delivered the chest organs into a stainless pan and carried them to the sink. With his suspicions aroused, Broussard transferred the organs into the sink rather than onto the cutting board. When he cut the tip off the left lung, dark bloody fluid poured out.
The bleeding was far more extensive then he’d imagined. In addition to his gastrointestinal tract and skin, this man had bled into his lungs and most likely into and out of most of his other organs.
Over the next few minutes as he worked on the thoracic and then the abdominal contents, Broussard found further support for that view. As would have occurred in most bodies in such a state of decomposition, they found that the brain had turned to soup.
While Broussard watched Guy clean out the cranial cavity, Jack Doe’s bubble bounced into his field of conjecture and collided with the bubble containing all he’d learned about Walter Baldwin’s death. This time, the two bubbles came to rest side by side, pulsing and shimmering, separated by the narrowest of spaces. From the neglected periphery, another, smaller bubble wafted into the picture and settled onto the two large bubbles, straddling them.
Ecchymoses.
Broussard shivered, feeling as though someone had poured a beaker of cold formalin down the back of his shirt. He went to the body on the table, leaned down, and peered at the roof of its mouth through the gaping angle of its lower jaw. The epithelium of the palate had sloughed in places, but he could still see that it was dotted with small hemorrhages.
Where there had been three bubbles, there was now only one.
Natalie . . .
He hurried to the phone. Seymour should be told what he’d found. The phone rang and rang, until he was considering going up there in person. But then the voice he’d spoken to earlier came on the line.
“This is Dr. Broussard. I need to talk to Dr. Seymour about my assistant.”
“We were just about to call you regarding that Dr. Broussard. Dr. Seymour has an appointment at Tulane in about fifteen minutes. So if your assistant doesn’t get here soon . . .”
“She’s not there?”
“We haven’t seen her.”
“I’ll check on it.”
Heart pounding, he dropped the receiver and crossed the room, moving as fast as Guy had ever seen him go. He threw the door open and charged into the hallway, where he stepped into a pool of black blood.
7
In the light from the row of wire-caged bulbs overhead, Broussard saw bloody footprints leading to a second pool glistening darkly in front of the door to the room where the morgue assistants had their desks. Beyond that, the floor was clean.
Broussard could remember only a few times in his life when he’d been gripped by the kind of fear he now felt for Natalie. He took a big step to get out of the pool at his feet and rushed to the next one, where he circled around it and pushed the heavy green door to the assistants’ room open.
There were four desks in the room, all facing forward, two on the left, two on the right. No one was at any of them. He glanced at the floor and saw it was not bloodied.
So where was she?
Natalie’s desk was the one in the rear, to his left. She liked that one because the wall space behind it gave her room to display the winter scenes she’d collected from old calendars. Having grown up in New Orleans, she’d rarely seen snow and was infatuated with it.
Maybe she’d gone home. . . .
He couldn’t remember her number, but Margaret, the senior secretary in his office, would have it. He stepped to the wall phone and punched in the number for the office.
“Medical examiner . . .”
Before he could answer, he heard a sound from the direction of Natalie’s desk. He noticed now that her chair was pushed carelessly to the side.
He hung up and moved slowly down the aisle. Reaching Natalie’s chair, he pulled it out of his way and peered under her desk. There, knees pulled to her chest, was Natalie, her clothes soaked with black blood.
“STOP RIGHT THERE. WHEN I say stop, I mean stop. Hand your end to him. . . . No. You stand right where you are. I don’t want you tracking blood out of here.”
Ruth Lamm, the hospital’s infection-control officer, stood only a hair over five feet tall, and in her protective gear, she looked like a kid playing doctor. But tiny as she was, she left no doubt who was in charge.
“Careful.”
The stretcher bearing Natalie D’Souza was passed from the two masked, gowned, and gloved men who’d brought her into the hall to the three similarly dressed men waiting well clear of the blood on the hall floor.
“You know where you’re going?” Lamm asked in an accusatory tone.
“Tuberculosis isolation ward, twelfth floor,” one of the men answered.
“That’s right. They’re waiting for you. And when you’re finished, all your protective gear goes in a biohazard container. That’s ready up there, too. And don’t just take any elevator—use the one we’ve set aside.”
The three men moved off down the hall.
“And your gear”—she gestured to the other two men— “goes in here.” She rapped the biohazard box beside her with her fist.
Then her voice suddenly became more gentle. “Think of it like a dance,” she said as they undid the straps to their booties. “You never let your bare shoes touch a part of the floor where your booties have been. Lovely, Mr. Carter. . . .”
The other man was having trouble getting his off. “It’s those shoes, Mr. Marcus. You really should get another pair—one without such flared soles.”
The change in her manner was so striking Broussard wondered if her Prozac had just kicked in.
The two men stepped up to the box and deposited their shoe covers.
“Now, the first pair of gloves. . . .”
The hall echoed with the snap and ripple of rubber, and four gloves were added to the container.
“Garments now. . . . No, Mr. Marcus, not your mask,” she said sharply, destroying Broussard’s Prozac theory, “your garment.”
Following the other man’s lead, Mr. Marcus simply tore his way out of his smock and stuffed it in the biohazard box.
“Next . . . gloves, and then your mask and head protection. Good. Thank you, gentlemen. You may go back to your other duties.”
The two men headed for the elevators, talking in low tones, most likely about Ruth Lamm.
She turned to Broussard. “You said she cut herself . . . working on a body that showed the early stages of whatever she’s got?”
About all Broussard could see of her face was sharp gray eyes behind a pair of silver-framed glasses, things that made him think of bullets. “I don’t think there’s any doubt that’s the cause of her illness.”
“Where’s that body now?”
“In our refrigerator.”
“You’re through with it?”
“Yes.”
“I’d like it double-bagged.”
“We’ll do that.”
“Where are his—it’s a he?”
“It was.”
“Where are his organs?”
“Parts of most of ’em are fixed in formalin. The rest have been incinerated.” Broussard found that he did not like being questioned this way. The morgue was his territory . . . his responsibility. She was merely a visitor. So it was with more than a little reluctance he said, “There’s another case on the table right now. An advanced one that’s pretty well decomposed.”
“Are you finished with him?”
“Yes. We’ll double-bag his remains, too.”
“Will you be sending any fluids from that body upstairs for analysis?”
“Toxicology already analyzed some. But that’s all we’re gonna do on him.
We also sent samples from the first case to Toxicology, as well as to the Blood Bank and to Laboratory Medicine, where I’m sure they were relayed to Immunology, Micro, and Virology.”
“Were any of those samples labeled as hazardous?”
“We didn’t know then what we know now.”
Clearly, she was displeased with his answer. “I’ll have to talk with everyone who worked on those samples. Have them examined, warn them. I guess they didn’t identify any organisms.”
“I sure would have told you if they had.”
“Any idea how the two victims you autopsied acquired the disease?”
He shook his head, far more unhappy over having no answers to her questions than he was at her asking them.
“Knowing the mode of transmission would be a big help,” she said. “If it requires exchange of bodily fluids or some other type of intimate contact, we’ll be a hell of a lot better off than if the causative agent can be transmitted through the air by a cough or a sneeze. When did your assistant cut herself?”
“Last Thursday.”
She held up her gloved fist and ticked off the days by extending her fingers one at a time. “Friday, Saturday, Sunday, Monday . . . it has an incubation period of only three or four days when the organism is passed by direct contact. If it can also be transmitted through the air, the incubation period could be longer.” She looked at Guy, who had been standing quietly behind Broussard, still dressed in his autopsy gear. “Did you work on either of the two cases we’ve been talking about?”
Loyal to Broussard and sensing his unreceptive attitude to her questioning, he glanced at Broussard for guidance. Broussard nodded.
“I worked on both of them.”
“How are you feeling?”
“I’m upset over what’s happened to Natalie, but I’m not physically ill.”
“Pay close attention to your health. If you feel the least bit nauseous or start to run a fever—anything at all—get yourself up to Internal Medicine.” She looked at Broussard. “Anyone else work on those cases?”
Louisiana Fever Page 8
