The Rizzoli & Isles Series 10-Book Bundle

by Tess Gerritsen

  “The skin is markedly pale,” they heard Gruber say over the intercom speaker. “I see absolutely no residual flush.”

  “Is that significant?” Detective Pasternak asked Maura.

  “Cyanide poisoning can sometimes cause the skin to appear bright red,” she answered. “But this body has been frozen for days, so I don’t know if that would affect it.”

  “What else would you find in cyanide poisoning?”

  “If it’s ingested orally, it can corrode the mouth and lips. You’ll see it in the mucous membranes.”

  Gruber had already slipped a gloved finger into the oral cavity and he peered inside. “Membranes are dry, but otherwise unremarkable.” He glanced through the window at his audience. “You getting a good view of this on the monitor?”

  Maura nodded at him. “There are no corrosive lesions?” she asked over the intercom.

  “None.”

  Jane said, “Isn’t cyanide supposed to smell like bitter almonds?”

  “They’re wearing respirators,” said Maura. “They wouldn’t be able to smell it.”

  Gruber carved the Y-incision and picked up the bone cutters. Over the intercom, they heard the crack, crack as he split the ribs, and Maura noticed several of the officials suddenly turn away and stare at the wall. Gruber lifted up the shield of sternum and ribs, exposing the chest cavity, and reached into the chest to resect the lungs. He lifted out one wet and dripping lobe. “Feels pretty heavy to me. And I’m seeing some pink froth here.” He sliced into the organ, and fluid oozed out.

  “Pulmonary edema,” said Maura.

  “What does that signify?” Pasternak asked her.

  “It’s a nonspecific finding, but it can be caused by a number of drugs and toxins.”

  As Gruber weighed the heart and lungs, the camera remained fixed on a static view of the torso, gaping open. No longer were they staring at a nubile young girl. What once might have titillated had been transformed to butchered flesh, a mere carcass of cold meat.

  Gruber once again picked up his knife and his gloved hands reappeared on the monitor. “This damn face shield keeps fogging up,” he complained. “I’ll dissect the heart and lungs later. Right now, I’m most concerned about what we’re going to find in the stomach.”

  “What is your sensor showing?” Maura asked.

  The assistant glanced at the GasBadge monitor. “It’s not registering anything. No cyanide detected yet.”

  Gruber said, “Okay, here’s where things could get interesting.” He looked through the window at his audience. “Because we could be dealing with cyanide, I’m going to proceed a little differently. Normally I’d just resect, weigh, and open up the abdominal organs. But this time I’m going to clamp off the stomach first, before I resect it in toto.”

  “He’ll place it under the fume hood before he slices it open,” Maura explained to Jane. “Just to be safe.”

  “Is it really that dangerous?”

  “When cyanide salts are exposed to gastric acid, they can form toxic gas. Open that stomach and you release the gas into the air. That’s why they’re wearing respirator hoods. And why he’s not going to cut into that stomach until it’s under a fume hood.”

  Through the window, they watched Gruber lift the clamped and resected stomach out of the abdomen. He carried it to the fume hood cabinet and glanced at his assistant.

  “Anything showing up on the GasBadge?”

  “Not a blip.”

  “Okay. Bring that monitor closer. Let’s see what happens when I start cutting.” Gruber paused, staring down at the glistening organ, as though bracing for the consequence of what he was about to do. The fume hood blocked Maura’s view of the actual incision. What she saw was Gruber’s profile, his head craned forward, his shoulders hunched in concentration as he sliced. Abruptly he straightened and looked at his assistant.

  “Well?”

  “Nothing. It’s not reading cyanide, chlorine, or ammonia gas.”

  Gruber turned to the window, his face obscured by the fogged mask. “There are no mucosal lesions, no corrosive changes in the stomach. I have to conclude that we’re probably not dealing with cyanide poisoning.”

  “Then what killed her?” asked Pasternak.

  “At this point, Detective, I’d be guessing. I suppose they could have ingested strychnine, but the body shows no lingering opisthotonos.”

  “What?”

  “Abnormal arching and rigidity of the back.”

  “What about that other finding, in the lungs?”

  “Her pulmonary edema could be due to anything from opiates to phosgene. I can’t give you an answer. I’m afraid this is all going to come down to the tox screen.” He pulled off his fogged respirator hood and heaved out a sigh, as though relieved to be free of that claustrophobic mask. “Right now, I’m thinking this is a pharmaceutical death. A drug of some kind.”

  “But the stomach’s empty?” said Maura. “You didn’t find any capsule remnants?”

  “The drugs could have come in liquid form. Or death could have been delayed. Sedation, followed by assisted asphyxiation.”

  “Heaven’s Gate,” Maura heard someone say behind her.

  “Exactly. Like the Heaven’s Gate mass suicide in San Diego,” said Gruber. “They ingested phenobarbital and tied plastic bags over their heads. Then they went to sleep and never woke up.” He turned back to the table. “Now that we’ve ruled out any danger of cyanide gas, I’m going to take my time. You’ll all have to be patient. In fact, some of you may find the rest of this tedious, if you’d like to leave.”

  “Dr. Gruber,” one of the officials said, “how long is this first autopsy going to take? There are forty other bodies waiting in the deep freeze.”

  “And I’m not thawing any more of them until I’m satisfied I’ve done justice to this young lady.” He looked down at the girl’s corpse, and his gaze was mournful. Entrails glistened in her gaping abdomen, and her freshly thawed flesh dripped pink icemelt into the table drain. But it was her face that seemed to hold his attention. Staring up at the monitor, Maura, too, was transfixed by the face, so pale, so innocent. A snow maiden, frozen on the threshold of womanhood.

  “Dr. Gruber?” the assistant said. “Are you okay? Doctor?”

  Maura’s gaze shot back to the viewing window. Gruber swayed and put his hand out to catch himself against the table, but his legs seemed to dissolve away beneath him. A tray toppled and steel instruments clattered across the floor. Gruber collapsed, his body landing with a sickening thud.

  “Oh my God!” The assistant knelt down beside the body. “I think he’s having a seizure!”

  Maura grabbed the nearest telephone and dialed the operator. “Code Blue, autopsy lab,” she said. “We have a Code Blue!” As she hung up, she saw to her dismay that three observers had already pushed through the door into the lab. Jane was about to follow them when Maura grabbed her arm and stopped her.

  “What the hell?” Jane said.

  “You stay right here.” Maura snatched an autopsy gown off a shelf and thrust her arms into heavy rubber dissecting gloves. “Don’t let anyone else into that room.”

  “But the guy’s having a seizure in there!”

  “After he took off his hood.” She glanced around frantically for another respirator, but she saw none in the anteroom. No other choice, she thought. I have to be quick. She washed out her lungs with three deep breaths and pushed through the door, into the lab. Gruber had left his respirator lying on the fume hood cabinet. She snatched it up and pulled it over her head. Heard a clang and turned to see one of the men sag against the sink.

  “Everyone, get out of here!” she yelled as she grabbed the wobbling man and helped him toward the door. “This room is toxic!”

  The morgue assistant shot her a stunned look through his mask. “I don’t understand! The GasBadge monitor didn’t register a thing!”

  She bent down to grab Gruber under his arms, but he was too heavy, an immovable deadweight. “Take his f
eet!” she ordered.

  Together she and the morgue assistant dragged Gruber away from the table and across a floor littered with instruments. By the time they pulled him into the anteroom, the Code Blue team had arrived and was strapping oxygen masks onto three pale-looking men.

  Maura looked down at Gruber, whose face was tinged with blue. “This man’s not breathing!” she yelled.

  As the code team converged on the patient, Maura backed away to let them do their jobs. Within seconds they were forcing oxygen into his lungs, slapping cardiac leads on his chest. On the monitor, an EKG tracing appeared.

  “He’s got a sinus rhythm. Rate of fifty.”

  “I’m not getting a blood pressure. He’s not perfusing.”

  “Start compressions!”

  Maura said, “He was exposed to something. Something in that room.”

  But no one seemed to hear her through her respirator hood. Her head was pounding. She pulled off the hood and blinked against lights that suddenly seemed too bright. The medical team was in full Code Blue mode now, and Fred Gruber’s torso was completely bared, his bloated abdomen humiliatingly exposed and jiggling with each cardiac compression. The stench of urine rose from his soaked scrub pants.

  “Do we have any history on this man?” the doctor called out. “What do we know about him?”

  “He collapsed while doing an autopsy,” Jane said.

  “He looks about a hundred pounds overweight. I’m betting he had an MI.”

  “He wet himself,” said Maura.

  Again, her voice went ignored. She was like a ghost hovering at the periphery, unheard and unheeded. She pressed a hand to her head, which was pounding even worse, and struggled to think, to focus. Somehow she managed to push her way into the throng of personnel and kneel down near Gruber’s head. Lifting one of his eyelids, she stared at the pupil.

  It was barely a pinprick of black against the pale blue iris.

  The stench of urine wafted up from his body, and she looked at his soaked scrub pants. Suddenly aware of the sound of retching, she glanced across the room and saw the morgue assistant was vomiting into a sink.

  “Atropine,” she said.

  “I got the IV in!” a nurse called out.

  “I’m still not getting a blood pressure.”

  “You want a dopamine drip?”

  “He needs atropine,” said Maura, louder.

  For the first time, the doctor seemed to notice her. “Why? His heart rate’s not that slow.”

  “He has pinpoint pupils. He’s soaked with urine.”

  “He also had a seizure.”

  “We all got sick in that room.” She pointed to the morgue assistant, who was still leaning over the sink. “Give him the atropine now, or you’re going to lose him.”

  The doctor lifted Gruber’s eyelid and stared at the constricted pupil. “Okay. Atropine, two milligrams,” he ordered.

  “And you need to seal that lab,” said Maura. “We should all move into the hallway now, as far from that room as possible. They need to call in a hazmat team.”

  “What the hell is going on?” said Jane.

  Maura turned to her, and just that sudden movement made the room seem to whirl. “They’ve got a chemical hazard in there.”

  “But the GasBadge readings were negative.”

  “Negative for what it was monitoring. But that’s not what poisoned him.”

  “Then you know what it is? You know what killed all those people?”

  Maura nodded. “I know exactly why they died.”

  “Organophosphate compounds are among the most toxic of pesticides used in the agricultural industry,” said Maura. “They can be absorbed by almost all routes, including through the skin and by inhalation. That’s how Dr. Gruber probably got exposed in the autopsy room. When he removed his respirator and breathed in the fumes. Fortunately, he received the appropriate treatment in time, and he’s going to recover.” She looked around the table at the medical and law enforcement personnel who had gathered in the hospital conference room. She did not need to add the fact that she was the one who’d made the diagnosis and saved Gruber’s life. They already knew it, and although she was an outsider, she heard a tone of respect when they addressed her.

  “That alone can kill you?” said Detective Pasternak. “Just doing an autopsy on a poisoned corpse?”

  “Potentially it can, if you’re exposed to a lethal dose. Organophosphates work by inhibiting the enzyme that breaks down a neurotransmitter called acetylcholine. The result is that acetylcholine accumulates to dangerous levels. That causes nerve impulses to fire off like crazy throughout the parasympathetic nervous system. It’s a synaptic storm. The patient sweats and salivates. He loses control of his bladder and bowels. His pupils constrict to pinpoints, and his lungs fill with fluid. Eventually, he’ll start convulsing and lose consciousness.”

  “I don’t understand something,” said Sheriff Fahey. “Dr. Gruber got sick within half an hour of starting that autopsy. But the coroner’s recovery team dug up forty-one of those corpses, put them in body bags, and moved them into an airport hangar. None of those workers ended up in the hospital.”

  Dr. Draper, the county coroner, spoke up. “I have a confession to make. It’s a detail that was reported to me yesterday, but I didn’t realize it was significant until now. Four members of our recovery team came down with the stomach flu. Or that’s what they thought it was.”

  “But no one keeled over and died,” said Fahey.

  “Probably because they were working with frozen bodies. And they were wearing protective garb, plus heavy winter clothes. The body in the autopsy room was the first one to be thawed.”

  “Would that make a difference?” asked Pasternak. “Frozen versus a thawed corpse?”

  Everyone looked at Maura, and she nodded. “At higher temperatures, toxic compounds are more likely to aerosolize. As that body defrosted, it started to release gases. Dr. Gruber probably sped up the process when he sliced it open, exposing body fluids and internal organs. He wouldn’t be the first doctor to fall ill from exposure to toxins in a patient.”

  “Wait. This is starting to sound familiar,” said Jane. “Wasn’t there a case like this out in California?”

  “I think you’re referring to the Gloria Ramirez case, in the mid-1990s,” said Maura. “That was discussed quite a bit at forensic pathology conferences.”

  “What happened in that case?” asked Pasternak.

  “Gloria Ramirez was a cancer patient who came into the emergency room complaining of stomach pains. She suffered a cardiac arrest. As the medical team worked on her, they began to feel ill, and several of them collapsed.”

  “Was it due to this same pesticide?”

  “That was the theory at the time,” said Maura. “When they performed the autopsy, the pathologists donned full protective gear. They never did identify the toxin. But here’s the interesting detail: The medical personnel who collapsed while treating her were successfully resuscitated with intravenous atropine.”

  “The same drug used to save Gruber.”

  “That’s right.”

  Pasternak said, “How sure are you that this organophosphate stuff is what we’re dealing with?”

  “It will need to be confirmed by the tox report. But the clinical picture is classic. Gruber responded to atropine. And a STAT blood test showed a significant drop in cholinesterase activity. Again, that’s something you’d find with organophosphate poisoning.”

  “Is that enough to say it’s a slam dunk?”

  “It’s pretty damn close to one.” Maura looked at the faces around the table and wondered how many of these people, aside from Jane, were ready to trust her. Only days ago, she had been a possible suspect in the shooting of Deputy Martineau. Surely doubts about her still lingered in their minds, even if no one voiced them aloud. “The people who lived in Kingdom Come were most likely poisoned by an organophosphate pesticide,” she said. “The question is, was it mass suicide? Homicide? Or an
accident?”

  That was met with a sound of disbelief from Cathy Weiss. The social worker had been sitting in the corner as if aware she was not fully accepted as a member of this team, although Detective Pasternak had invited her to attend the briefing.

  “An accident?” Cathy said. “Forty-one people are dead because they were ordered to drink pesticide. When the Prophet tells his followers to jump, their only possible response is to ask how high, sir?”

  “Or someone could have dumped it in their well water,” said Dr. Draper. “Which makes it homicide.”

  “Whether it’s homicide or mass suicide, I have no doubt it was the Prophet’s decision,” Cathy said.

  “Anyone could have poisoned the water,” pointed out Fahey. “It could have been a disgruntled follower. Hell, it could have been that Perkins boy.”

  “He’d never do that,” said Maura.

  “They kicked him out of the valley, didn’t they? He had every reason to get back at them.”

  “Oh right,” said Cathy, not bothering to hide her disdain of Fahey. “And then that lone sixteen-year-old boy single-handedly drags forty-one bodies into the field and buries them with a bulldozer?” She laughed.

  Fahey looked back and forth at Maura and Cathy, and he gave a dismissive snort. “You ladies obviously don’t know what sixteen-year-old boys are capable of.”

  “I know what Jeremiah Goode is capable of,” Cathy shot back.

  Pasternak’s ringing cell phone cut off the conversation. He glanced at the number and quickly rose from his chair. “Excuse me,” he said, and left the room.

  For a moment there was silence, the tension from the last exchange still hanging in the air.

  Then Jane said, “Whoever did it needed access to the pesticide. There must be a record of its purchase. Especially since we’re talking about a large enough supply to kill an entire community.”

  “The Plain of Angels compound in Idaho grows its own food,” said Cathy. “They’re a completely self-sustaining community. It’s likely they’d keep this pesticide on hand for farming.”