Deadly Decisions

by Kathy Reichs

  “She was that young?”

  “Yes.”

  I could hear traffic in the background and figured Claudel was calling from the road.

  “I’ll get a list of missing teenage girls. What time frame?”

  “Go back ten years.”

  “Why ten years?”

  “I’d say the victim’s been dead at least two years, but with what we recovered I can’t really pinpoint an upper limit. I have a feeling this was a secondary burial.”

  “What does that mean?”

  “I think she was buried somewhere else, then dug up and moved to the place we found her.”

  “Why?”

  “Another perceptive question, Detective Claudel.”

  I told him about the surgical implant.

  “What does that mean?”

  “When I find out I’ll let you know.”

  I’d hardly replaced the receiver when the phone rang again. Carolyn Russell could see me at three. I looked at my watch. If the parking gods smiled I could make it.

  I wrote the case number on the lid of a plastic specimen container and sealed the implant inside. Pausing only to tell Bergeron that he could have the girl’s skull, I hurried to my car and raced across town.

  The Royal Victoria Hospital was built before the turn of the century. A sprawling gray stone complex, it lies in the heart of Montreal, looming over the McGill campus like a medieval castle on a Tuscan hillside.

  At the Peel end is the Allan Memorial Institute, infamous for CIA drug experiments conducted there in the late fifties. The Montreal Neurological Institute is located to the east of the Royal Vic, across rue Université. Teaching and research units of McGill University, the MNI, the Neurological Hospital, and the new Brain Tumor Research Institute sit haunch to jowl with the football stadium, a testimonial in mortar and brick to the priorities of the modern university.

  The Neuro, as the research institute and hospital are known, dates to the thirties, the brainchild of Wilder Penfield. Though a brilliant scientist and neurosurgeon, Dr. Penfield was not a visionary in traffic control. Parking is a nightmare.

  Following Dr. Russell’s suggestion, I drove onto the grounds of the Royal Vic, forked over ten dollars, and began cruising the lot. I was on my third pass when I spotted brake lights. An Audi pulled out and I shot forward and into the space, thus avoiding the necessity of tuning to FM 88.5 for a parking update. My watch said two fifty-five.

  I arrived at Russell’s office sweaty and panting from my dash down avenue des Pins and my trek through the hospital. It had begun to mist, and my bangs lay damp and limp across my forehead. When the doctor looked up, an expression of doubt crossed her face.

  I introduced myself and she rose and held out a hand. Her hair was gray, cut short and swept to the side. Her face was deeply creased, but her grip was as strong as that of any man. I guessed she was somewhere in her sixties.

  “Sorry I’m late. I had a little trouble finding you.” That was an understatement.

  “Yes, this building is confusing. Please sit down,” she said in English, gesturing at a chair opposite her desk.

  “I had no idea this place was so large,” I said, seating myself.

  “Oh yes. The MNI is engaged in an enormous range of activities.”

  “I know the institute is world famous for its epilepsy research.” I slipped off my jacket.

  “Yes, more epilepsy surgeries are performed at our hospital than at any other center in the world. The surgical technique of cortical resection was pioneered at this institution. Studies in the mapping of cerebral function began with epilepsy patients here more than sixty years ago. It was that work that paved the way for the MRI and PET brain mapping going on today.”

  “I’m familiar with Magnetic Resonance Imaging but what is PET?”

  “Positron Emission Tomography. Like MRI, it’s a technique used to image brain structure and physiology. Our McConnell Brain Imaging Centre is rated as one of the world’s leading facilities.”

  “What other research do you do?”

  “A tremendous amount of groundbreaking work has emanated from the MNI. The development of electroencephalography, the concept of focal and generalized epilepsies, new methods of frameless stereotactic surgery, contributions to postglandin biochemistry in the nervous system, localization of dystrophin skeletal muscle. I could go on and on.”

  I was certain she could. Dr. Russell was obviously proud of her employer. I smiled encouragement, though I understood only part of what she had listed.

  She leaned back and laughed. “I’m sure you are not here for a lecture on the Neuro.”

  “No, but it’s fascinating. I wish I had more time. But I know you’re very busy and I don’t want to take up any more of your day than necessary.”

  I took the container from my purse and handed it to her. She looked at it, then unscrewed the cap and slid the implant onto a piece of paper on the blotter of her desk.

  “This is an old one,” she said, turning it over with a pencil. “I don’t think they’ve made this model for years.”

  “What is it?”

  “It’s a ventriculo-peritoneal shunt. They’re implanted for the treatment of hydrocephalus.”

  “Hydrocephalus?” I knew the term, but was surprised to hear her say it. What other misfortunes would I learn about this child?

  “It’s commonly known as ‘water on the brain,’ but that’s not really accurate, although that’s a literal translation from the Greek, hydro being water, and cephalus being head. Cerebral spinal fluid is constantly produced in spaces in the brain called ventricles. Normally it circulates through the four ventricles, and flows over the brain’s surface and down the spinal cord. Eventually the CFS is absorbed into the bloodstream, and the amount of fluid and pressure in the ventricles stays within acceptable limits.

  “But if drainage is blocked, fluid will accumulate, causing the ventricles to swell and press on the surrounding tissue.”

  “So hydrocephalus refers to an imbalance in the amount of CSF produced and the rate at which it drains from the ventricles.”

  “Exactly.”

  “And, as the CSF builds up, it causes the ventricles to enlarge and the pressure inside the head to increase.”

  “You’ve got it. Hydrocephalus can be acquired or congenital, which is not to say hereditary. The term simply means the condition is present at birth.”

  “I found the shunt in a normal-looking skull. Doesn’t hydrocephalus result in increased head size?”

  “Only in infants, and only if left untreated. As you know, with older children and adults the bones of the skull are already formed.”

  “What causes it?”

  “There are lots of reasons for inadequate CSF drainage. Prematurity puts an infant at high risk. And most babies with spina bifida have hydrocephalus.”

  “Spina bifida involves a neural tube defect?”

  “Yes. The problem occurs during the first four weeks of gestation, often before the mother knows she’s pregnant. The embryo’s neural tube, which develops into the brain, spinal cord, and vertebral column, fails to form properly, leading to varying degrees of permanent damage.”

  “How common is it?”

  “Entirely too common. It’s estimated that spina bifida affects one in every thousand babies born in the United States, and about one in seven hundred and fifty born in Canada.”

  “I recovered no vertebrae, so I have no way to know if my young lady had spina bifida.”

  Russell nodded in agreement, then continued her explanation.

  “There are many other causes of hydrocephalus besides spina bifida.” She ticked them off on her fingers. “It can result from brain hemorrhage. The inflammation and debris resulting from brain infections, such as meningitis, can block drainage pathways. Tumors can cause compression and swelling of brain tissues and result in poor drainage. So can certain types of cysts. And hydrocephalus can be familial.”

  “It can be inherited?”

&
nbsp; “Yes. Though that’s rare.”

  “So where does the shunt come in?”

  “There is no way to cure or prevent hydrocephalus. For the past forty years the most effective treatment has been the surgical insertion of a shunt. The one you’ve brought is a bit outdated, but it’s really pretty typical.

  “Most shunts are just flexible tubes placed into the ventricles to divert the flow of CSF. They consist of a system of tubes with a valve to control the rate of drainage and to prevent back flow. The early ones diverted the accumulated CSF into a vein in the neck, then into the right atrium of the heart. Those are called ventriculo-atrial, or VA shunts. Some VA shunts are still used, but there are problems associated with them, including infection, and, though rare, heart failure due to blockage of blood vessels within the lungs by particles of blood clot flaking off the shunt’s catheter tip. Most shunts now drain into the peritoneal cavity. They’re called VP shunts.”

  She indicated the device I’d pulled from the skull.

  “This is a VP shunt. In the living patient you would have been able to feel the bottom tube running under the skin that overlies the ribs. That part of the device is missing.”

  I waited for her to go on.

  “The peritoneal cavity is large and can usually handle any amount of fluid delivered by the shunt. Another advantage of draining into the abdomen is that the rhythmic contractions of the intestinal organs move the tip of the catheter around. That motion prevents its becoming blocked or sequestered in scar tissue.”

  “When do these things go in?”

  “As soon as hydrocephalus is diagnosed. As much as thirty-six inches of tubing can be placed in the abdomen of a neonate. As the child grows, the tubing unwinds to accommodate the increased length of the torso.”

  “I found a small hole in the skull, near the parieto-temporal junction.”

  “That’s a burr hole. It’s drilled during surgery to insert the upper end of the shunt into the brain. They’re usually made behind the hairline, either at the top of the head, behind the ear, or in the back.”

  Russell’s eyes flicked to a round metal clock on her desk, then back to mine. I was anxious to learn what difficulties might be caused by hydrocephaly, but knew the woman’s time was limited. That research would be up to me.

  I gathered my jacket and she returned the shunt to its jar, curling the paper and allowing the device to slide gently into place. We rose simultaneously and I thanked her for her help.

  “Do you have any idea who your young lady is?” she asked.

  “Not yet.”

  “Would you like me to send you some reading material on hydrocephalus? There are problems associated with the condition that you might find helpful.”

  “Yes, very much. Thank you.”

  I LEFT THE NEURO AND WENT DIRECTLY TO CARCAJOU HEAD-quarters for the second of Roy’s review sessions. The meeting was already in progress, so I slipped into a back seat, my brain still processing what I’d learned from Carolyn Russell. Our conversation had raised as many questions as it had answered.

  How had the hydrocephaly affected my unknown girl? Had she been sickly? Disabled? Retarded? How did a teenager with that condition end up buried near a biker headquarters? Was she a willing participant, or another innocent, like Emily Anne Toussaint?

  This time Roy was using transparencies, and a bulleted list filled the screen. I forced myself to focus.

  “Outlaw motorcycle clubs are characterized by a number of common elements. Most OMCs are organized according to the Hells Angels model. We’ll come back and look at that structure in some detail.”

  He indicated the second item.

  “All clubs have membership which is very selective, and ‘prospects’ or ‘strikers’ are required to prove themselves to earn their colors.”

  He moved down the list.

  “The colors, or club patch, are the member’s most valued possession. Not everyone wears colors, however. Individuals who are useful to the gang are allowed to interact as associates without actually joining.

  “The primary focus of an OMC is criminal activity. Each club has rules that condone violence to further the interests of the club and its members. Intelligence gathering is intensive, including the monitoring of other gangs and of law enforcement personnel.”

  Roy pointed his pen at the last item on the list.

  “The clubhouse, which is often strongly fortified and elaborately outfitted, is the meeting place for club activities.”

  I thought of the Vipers’ house in St-Basile, and wondered what activities could have included a sixteen-year-old girl with hydrocephaly.

  Roy removed the transparency and replaced it with another, this one a tree titled “Political Structure of an OMC: National.”

  Roy explained the hierarchy, starting at the bottom.

  “The basic element of the OMC structure is the chapter. An independent outlaw motorcycle club becomes part of a larger organization, such as the Hells Angels, only after a charter has been approved by vote of the national membership. This involves a long process that we can discuss later if we have time.

  “Each chapter operates in a specific local area and maintains a certain degree of autonomy, but must live by the rules set out by the organization. These rules, either in the form of bylaws or a constitution, define the rights and obligations of the members and the gang.”

  Roy slid a new transparency onto the projector. This chart was labeled “Political Structure of an OMC: Chapter.”

  “Each chapter has its own controlling body, or executive, elected by the members. Typically there’s a president, vice president, secretary-treasurer, and sergeant at arms. These are the guys responsible for maintaining order within and peace outside the group.”

  “Guess none of our local morons will make the Nobel short list this year.” Kuricek was up to form.

  Roy waved down the laughter.

  “There’s also an elected road captain who takes charge of the runs. Then there are the rank-and-file members—”

  “And he does mean rank.” Kuricek held his nose.

  “—who have a say in matters affecting the group, but the president makes the final decisions. Some of the larger clubs also have a security officer whose duty it is to keep up-to-date information on rival gangs, reporters, lawyers, judges, public officials, witnesses, and, of course, on yours truly.”

  Roy swept his arm across the room.

  “What kind of information?”

  “Personal, financial, family members, girlfriends, boyfriends, phone numbers, birth dates, addresses, vehicle descriptions, license plates, places of employment, daily habits, you name it, these guys get it. Their photo collections make the National Portrait Gallery look sparse. If there’s an intended victim, his dossier may include tips on the best places to kill him.”

  “Merde!”

  “Esti!”

  Roy worked his pen from left to right across three boxes on the next to lowest line of the diagram.

  “At the bottom of the chapter hierarchy are the prospects, the hang-arounds, and the women.”

  Roy pointed to the box marked “Probationary Member.”

  “The ‘prospect’ or ‘striker’ must be nominated by a full patch member. He does all the shitwork around the clubhouse and during runs. Prospects can’t vote and they can’t attend church.”

  “Church?” Today the ponytailed investigator wore a silver skull in his ear.

  “The mandatory weekly chapter meeting.”

  “How long does it take to get in?”

  “The prospect period averages six months to one year. You can spot these guys because they wear only the bottom rocker of the patch.”

  “Which gives the chapter location.” Ponytail.

  “C’est ça. There are several pages showing club colors in the manuals I gave you. Some of them are true artistic marvels.”

  Roy’s pen moved sideways to the box marked “Associates.”

  “A hang-around must also be spo
nsored by a full patch member. Some go on to prospect, others never do. Hang-arounds do all kinds of menial jobs, and act as a support structure for the club in the community. They are excluded from all club business.”

  Two boxes hung from the one at the far right marked “Female Associates.”

  “Women are at the lowest level of the hierarchy and fall into one of two categories. The ole ladies are wives, either common-law or legal, and are off-limits to other gang members, except by invitation. The club ‘mamas’ or ‘sheep’ are a different story. How shall I put it?” He raised eyebrows and shoulders. “They mingle freely.”

  “Warm-hearted ladies, all.” Kuricek.

  “Very. Mamas are fair game to any color-wearing member. While the ole ladies enjoy a certain degree of protection, have no doubt about it, outlaw motorcycle gangs are male-dominated and highly chauvinistic. Women are bought, sold, and swapped like hardware.”

  “The biker’s idea of women’s lib is to take the cuffs off after he’s through. Maybe.” Kuricek.

  “That’s pretty close. Women are definitely used and abused.” Roy.

  “Used how?” I asked.

  “Aside from sex, there’s what we might call wage sharing. They get the women into exotic dancing, drink hustling, street-level drug trafficking, prostitution, then rake back the earnings. One hooker from Halifax claimed she had to turn over forty percent of her take to the Hells Angel who pimped for her.”

  “How do they find these women?” I felt a knot forming in my stomach.

  “The usual. They pick them up in bars, hitchhiking, runaways.”

  “Wanna ride my Harley, sweet thing?” Kuricek.

  I pictured the skull and shunt.

  “Amazingly, there’s never a shortage,” Roy continued. “But don’t get me wrong. While many are victimized, some held against their wills, a good number of these ladies embrace the lifestyle with gusto. Macho men, drugs, alcohol, guns, round-the-mountain sex. It’s a wild ride and they go along gladly.

  “The women also make themselves useful in ways not strictly sexual or economic. Often it’s the ladies who carry concealed drugs or weapons, and they’re very good at ditching when a bust comes down. Some make very effective spies. They hire on with government agencies, the phone company, records offices, any place they might have access to useful information. Some ole ladies have guns or property registered in their names, either because hubby is prohibited, or to protect his assets from seizure by the government.”