Garcia next asked me to peel back the chest flap. I did so by pulling the skin upward with my left hand, using the scalpel to extend the incisions from the armpits up to the shoulders so I could peel the skin and breast tissue away from the ribs. Laying the chest flap over the face, I swapped the scalpel for a rib cutter — a sharp stainless-steel cousin of the dull pruning shears in my garage at home — and cut through the ribs on both sides. The chest cavity gaped open, exposing the spongy lungs and the heart in its fibrous sac. Like the abdomen, the chest cavity oozed copious amounts of liquid. “No wonder she had trouble breathing,” I said, “with all this fluid pressing on her lungs.”
“There appears to be considerable edema around the heart, too,” said Garcia. “Let’s open the pericardial sac.”
I used the scalpel to finish cutting out the chest plate — the breastbone and the stubs of the ribs I’d sheared — and laid that aside, then sliced into the tough, grayish-white membrane surrounding the heart. Once again fluid gushed from the incision. Garcia was leaning in, his face practically in the corpse’s chest cavity. “Now let’s check the pulmonary artery,” he said.
I probed the tangle of tubing at the top of the heart, nestled just beneath the arch of the aorta. The pulmonary artery was a thick vessel that branched immediately into a T shape to carry blood to the lungs. Slicing through its fibrous wall, I slid the end of my little finger inside, feeling for a clot that might have choked off the flow of blood.
“I don’t feel anything,” I said.
“I didn’t think you would,” Garcia said. “Her death was rapid, but not rapid enough to be the result of a blood clot.” Next he asked me to check the retropharyngeal area, a cavity deep in the neck, directly in front of the spine. “She had no fever, irregular pulse, plummeting blood pressure — symptoms consistent with hemorrhage. Three or four liters of blood from a bleeding vessel could pool in the retropharyngeal area and nobody would know it unless they did a CT scan. But they didn’t; the ER physician in Crossville says they didn’t have time to scan her. So let’s go in and look. We probably need to Roke out her chest; do you know how to do that?”
Miranda asked the question before I could. “How to do what to her chest?”
“Roke it out,” he repeated. Miranda looked as baffled as I felt.
“Roking out a body is a dissection technique,” he explained. “The Rokitansky technique. Named for Karl von Rokitansky, a pathologist at the University of Vienna a century ago. During his career Rokitansky performed or supervised a hundred thousand autopsies.”
“Wow,” said Miranda. “If practice makes perfect, ol’ Karl must have been damn good. So ‘Roking her out’ is pathologist slang for what, exactly?”
“Gutting the corpse,” he said. “The way a hunter guts a deer. Pulling out all the internal organs, from the chest all the way down the abdomen, in one long string.”
“Yuck,” exclaimed Miranda, who never showed any squeamishness around decayed or dismembered human corpses.
“I’ve never Roked out a body or gutted a deer,” I said to Garcia. “You want me to go up to the hospital lobby and corral a hunter? There’s probably a guy up there who’s field-dressed dozens of deer. He might do a quicker and neater job than I can.”
“You’ll do fine,” he assured me. Following his directions, I cut the carotid artery and tied it off, then did the same with the subclavian arteries, the pipelines carrying blood to the arms. Next, trading the scalpel for the long autopsy knife — the one Jess Carter always called a “bread knife”—I sliced through the windpipe and the esophagus and tugged them downward, peeling the lungs and the heart and other organs out of the body cavity and away from the spine.
As I pulled, the cavity behind the lungs became visible. This space, too, brimmed with watery fluid.
“Interesting,” Garcia murmured again. “Pronounced effusions, but no real bleeding. I’m surprised.” He took in a deep breath and exhaled heavily. “Also concerned.”
I looked at him. “Concerned about what? Why?”
“Hemorrhage was my prime suspect, and it would have been a relatively benign explanation.”
“Not so benign for the dead woman,” Miranda pointed out.
“No, not for her, but for others,” he responded.
I paused, resting the heart and lungs on the corpse’s abdomen. I suspected I knew how he’d answer my next question, and I didn’t much like it. “So if hemorrhage didn’t kill her, what’s the next-best possibility, or the next-worst possibility — infection?”
“Not just infection. Infection leading to toxic shock.”
Miranda’s eyebrows shot up. “Toxic shock? Isn’t that what happens when a woman leaves in a tampon too long? This woman was, what, sixty? Surely she was past menopause.”
“She was,” he confirmed. “And you’re right, tampons are what most people associate with toxic shock. But there are other causes. Toxic shock can occur after normal childbirth, after spontaneous or induced abortion, after injury, after surgery. Sometimes the bacteria that create the toxins are new invaders; sometimes they’re already in the body, but at a harmless level. Then something in the body’s chemistry shifts and they start multiplying like crazy, producing spores by the billions. When they do, they can overwhelm the host within a matter of hours.”
“By ‘host’ I assume you mean the unlucky human,” said Miranda, and he nodded. “But according to the ER chart, this woman got vancomycin,” she persisted. “Isn’t that like the hydrogen bomb of antibiotics?”
“It’s powerful,” he agreed. “It can kill bacteria that are resistant to other antibiotics. But by the time she got it, it was already too late. In cases of toxic shock, it’s not the bacteria themselves that cause death. It’s the poisons they produce — the toxins — that are lethal, and antibiotics can’t destroy the toxins. Once toxic shock sets in, the mortality rate can range between fifty and one hundred percent, depending on which bacterium is involved. Some bacterial toxins are deadly; others are even deadlier.”
“Should I be running away right now?” Miranda tried to make the question sound like a joke, but she couldn’t hide the strain in her voice.
“If you want to leave, I understand,” he said. “You, too, Bill. The face shield and the mask and the gown and the double gloves are good protection, but there are no guarantees. Does either one of you have any open cuts or scrapes?” Miranda and I both shook our heads. Miranda’s eyes widened abruptly as her gaze dropped to Garcia’s left wrist and mangled right hand, both still bandaged.
“Jesus, Eddie, you’re the one who shouldn’t be here,” she said. “Your hands aren’t fully healed, and your immune system’s been compromised.”
He shrugged. “I am at more risk here,” he acknowledged. “I thought about that yesterday, and I decided to accept the risk.”
I wondered if he was doing more than merely accepting the risk; was he actually seeking the risk, intentionally exposing himself to a potentially deadly infection?
“Don’t worry,” he said, “I’m not trying to commit suicide by sepsis.” After a pause he added, “Shall we continue?” This time it was a request, not a question. “I don’t think we need to Roke out the abdomen, though. Let’s look at the neck now, instead.”
I laid the chest flap back down into position. With the chest plate and organs now gone, the flap drooped deeply into the chest cavity.
The Crossville surgeon had made a two-inch cut in the neck, which he’d tied off with about fifteen stitches, around which the skin puckered. The thin black threads, whose clipped ends bristled stiffly at each stitch, reminded me of the legs of ticks, and I shivered at the image of ticks burrowing into the woman’s neck. Odd: I wasn’t at all squeamish about swarms of maggots, but ticks were different, scarier bugs altogether.
The blade sliced easily through the sutures and down through the incision, whose edges had barely begun to adhere to one another. I halfway expected yet another gush of pale fluid as I cut, but there was none. What e
merged instead — and what I’d not expected — was the stench of human decomposition. The woman on the autopsy table had been dead for only two days and had been in the cooler that whole time, but if I’d been guessing from the condition of her neck, I’d have guessed that her corpse had been ripening at the Body Farm for a week or more. The tissue was spongy and mottled, riddled with gray and black patches of decay.
“Ack,” said Miranda.
“Interesting,” said Garcia. He leaned closer and inhaled sharply. “I suspect that localized necrosis began long before she went into toxic shock. Probably immediately after the surgery.”
“So the surgery itself was probably the source of the infection,” I surmised.
“It depends.”
“On what?”
“On the person you ask. If you ask me, I say yes. If you ask the neurosurgeon, he says the procedure went flawlessly and the patient’s death was an unrelated event, a freak coincidence.”
“Well, duh,” Miranda scoffed. “He’s terrified that the woman’s husband is going to sue him, right? Our friend Grease could probably get thirty or forty million for the guy, right Dr. B.?”
I nodded.
Above his mask, through the face shield, I saw Garcia’s brows furrow. “Even if the surgery opened the door to the infection, it might be impossible to pinpoint the source. It could be improperly sterilized instruments, contaminated saline, strep or staph bacteria floating around in the hospital’s ventilation ducts. But let’s take some samples of tissue from the neck. If we can identify the bacterium that’s responsible, we have a better chance of finding the source.” We took tissue samples from the neck’s tissues, including bone — slivers that required the Stryker saw to cut. Finally I took a sample of fluid, inserting a syringe between the third and fourth vertebrae to draw fluid from the spinal canal.
Garcia leaned down to take another look at the fused section of spine, with its dully gleaming bracket of titanium and the small block of added bone.
“Do you want it?” he asked.
“Want what? The orthopedic hardware?”
“The entire cervical spine. Would it be useful as a teaching specimen, once you’ve cleaned off the soft tissue?”
“Sure,” I said. Gripping the mandible with my left hand, I tipped the head back as far as I could, slicing the ligaments that held the skull to the first cervical vertebra — the washerlike bone called the atlas — and then severing the spinal cord. Then, with the Stryker saw, I cut the seventh cervical vertebra from the first thoracic vertebra. The oscillating blade buzzed easily through the disk, the spinal cord, and the bony prong of the spinous process, which jutted from the back of the vertebral body. The cervical spine was now detached at both ends. Setting aside the saw, I used the scalpel to cut through the last of the tendons that linked the bones to the muscles in the neck. Then, sliding both my hands beneath the five-inch column of bones, I lifted. The cervical spine pulled free of the body with one brief slurp.
An hour later, after cutting slices of Lowe’s major organs for Garcia to inspect and preserve in his “save jar” of formalin, I was nearly finished — and almost done for. Using a curved needle to sew baseball-style running stitches, I closed up her body — her Roked-out, virtually decapitated body — for shipment to a Crossville funeral home, which would doubtless be dismayed by the hollow-hulled, thin-necked, floppy-headed husk they received.
In the morgue’s changing room, I shucked off my blood-and tissue-spattered surgical garb, showered, and put back on my morning’s khakis and soft flannel shirt. On my way out of the morgue, I checked to see if my souvenir was simmering yet. I had set the cervical spine in a steam-jacketed kettle — essentially an oversize Crock-Pot — in the decomp processing room, a lab devoted to removing the last bits of soft tissue from skeletons that had decayed at the Body Farm. The steam-jacketed kettle, its thermostat set slightly below the boiling point, would cook off the tissue without harming the bones. To speed the process and improve the smell of the cleaned bones, I tipped a capful apiece of Biz detergent and Downy fabric softener into the pot.
I turned out the fluorescent lights and closed the door of the decomp room, leaving the hot water, Biz, and Downy to do their work in the dark.
Some people launder money, I thought. I launder bones.
CHAPTER 16
My son answered on the third ring. I hadn’t called Jeff the day I’d learned of Isabella’s pregnancy, not the next, nor the day after that. I’d put it off for a week, in fact. Now, although I was exhausted from the autopsy — or perhaps because I was exhausted from the autopsy — I realized I couldn’t avoid the conversation any longer. “Hey, Dad,” he said, “what’s up?”
“Oh, not much,” I said. “How’s it going?”
“Well, today’s April first. How do you think it’s going?”
“I don’t know,” I said. “That’s why I asked.”
“Christ, Dad, April fifteenth is only two weeks away,” he said irritably. Crap, I thought, I forgot about my taxes. Jeff was an accountant with a small but growing practice in Farragut, an affluent bedroom community twenty miles west of downtown Knoxville.
“So you’re sort of busy.”
“Sort of. The way the pope is sort of Catholic. The good news is, I’ve got ten percent more clients than I had last year. The bad news is, I’ve got ten percent more clients than last year, and some of my new clients have really complicated tax returns. Speaking of which, when do you envision bagging up your financial debris and bringing it to me?”
“Soon, son. Very, very soon. I’m sorry to be such a bad client.”
He sighed wearily. Every year since he’d opened his accounting practice, he’d done my return, and every year he’d had to nag me to gather up my records and bring them in. “I’ve got to have your stuff by Monday, Dad. No kidding.”
“Sure.” I hesitated. “So this probably isn’t a great time to get together for a drink, huh?”
“A drink? You don’t drink. Why would we get together for a drink?”
“Well, I don’t, but I know you do every now and then. I thought maybe you might want to meet somewhere in Farragut on your way home and just catch up a bit.”
“I’ll be working till midnight, Dad. I just called Jenny to tell her that I couldn’t meet her and the boys for pizza. I don’t even have time to breathe, much less to hang out, until April sixteenth.”
“Oh. Sorry. Of course not. I didn’t mean to impose.” They were the same words Eddie Garcia had said to me when I hesitated to perform the autopsy for him. Had he felt as stung by my reaction as I now felt by Jeff’s?
A long silence hung in the air. Finally he said, “Dad, is something wrong? Are you in trouble again?” The “again” made me wince. I’d turned to Jeff for help when I was wrongly accused of murdering Jess Carter. He’d stood by me unquestioningly then, and he’d never made me feel like it had been a burden. But the fact that he’d said “again” just now embarrassed me; I felt like a kid who’s gotten into trouble at school one too many times.
“No, I’m not in trouble,” I said. “I’m not.”
“Are you sick? My God, Dad, are you sick?”
“No, no, nothing like that. I’m fine. Well, not ‘fine,’ exactly, but not sick.”
“What’s on your mind? Is something troubling you?”
“I…” I felt my throat tightening. “It’s just that there’s something important I need to talk to you about, Jeff. Face-to-face.”
There was a pause. “Okay, Dad. Sure. Tell you what. There’s a Panera Bread pretty close to my office, out in Turkey Creek. Do you know it?”
“Is that the one that’s inside the big Target store?”
“No, that’s Starbucks. Panera is across from the movie theaters. Kinda near Borders Books.”
“Oh, I remember,” I said, though I didn’t, actually — Turkey Creek was a huge, sprawling retail development, hundreds of stores and restaurants strung out along a two-mile, traffic-snarled boulevard. I avoided
it whenever possible, which, luckily, was virtually always. I figured I could call Panera on my cell phone for directions if I had trouble spotting them amid the thicket of shops and signs.
“I forgot to bring anything to eat,” Jeff was saying, “and they’ve got decent soups and sandwiches. How about I meet you there in an hour? Well, let’s say fifty minutes; that would be seven-thirty. The dinner crowd will have slacked off by then.”
Forty minutes and two cell-phone calls later, I spotted the striped awnings of Panera and pulled into one of Turkey Creek’s gargantuan parking lots. Turkey Creek my foot, I thought. They should call this place Asphalt Acres. Then, Yeah, and they should call you Grumpy Old Man. I sat in the truck with the radio on — Sirius had a channel with 1940s big-band music I’d gotten hooked on lately — and watched for Jeff. Twenty minutes went by, and I was just about to call and check on him when his hybrid SUV whipped into the parking lot and lurched to a stop. Jeff jumped out, talking rapidly on his cell, and ended the call as we converged at the door.
“Sorry I’m late,” he said. “One of my clients is a surgeon, and, being a surgeon, he assumes he’s my most important client. So when he wants to discuss the draft tax return I e-mailed him, he assumes I’m at his beck and call.”
“No worries. I know you’re scrambling, and I appreciate your taking time to grab a bite with me. Let’s order. I’m starving.”
Jeff, health-conscious guy that he was, ordered a salad with grilled chicken; I got a chicken chipotle sandwich. At its center was grilled chicken like Jeff’s, but it was drenched in a tangy, unhealthy sauce and served on crusty, buttery grilled bread. For his side item, Jeff chose an apple; I chose potato chips. The young cashier handed me what looked like a square plastic coaster. I must have appeared puzzled, because she explained, “It’ll buzz when your order’s ready.” I had barely collected my change when the coaster practically leaped out of my hand, vibrating fiercely and flashing with enough red LED lights to serve as a road-hazard sign.
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