Genesis

Chapter 6

May 8th

4:15 P.M.

As far as Laurie was concerned, the first part of the autopsy went rather well, and she began to relax and even enjoy to an extent the nostalgia the experience evoked. Although Aria initially mentioned her disgust related to the mild putrid odor and the ghoulish facial appearance of the deceased, she didn’t dwell on it. And Laurie was relieved that the attitude Aria had displayed in the locker room had seemed to melt away once she focused on the actual tasks at hand — Laurie quickly agreed with Chet that she was no dummy.

“The full-body X-ray can potentially help the identification process and will also pick up any foreign bodies that might have contributed to the cause of death,” Aria had correctly said in answer to Laurie’s question of why the film had been taken. Such a response made Laurie feel that Aria had been listening when she’d observed the forensic autopsies, after all.

Laurie had Aria conduct the external exam verbally and was impressed with Aria’s description. Aria talked about why it was best to leave the clothes on the victim, as Kera Jacobsen was still attired in her bathrobe, exactly the way she had been found. She also talked about why the syringe, still embedded in Kera’s left arm, had been left in place and why it had been carefully covered with paper and tape so that it could be examined for DNA and fingerprints. She also mentioned two other significant findings that Laurie herself had noticed — namely, that there wasn’t much evidence of dried foam around Kera’s mouth and nostrils and that although there were signs of other venous puncture marks, they all seemed relatively new.

“My sense is that she had not been a drug user for long,” Aria had said, and Laurie agreed.

After they had removed the bathrobe and examined the livor mortis of the lower extremities, Laurie had quizzed Aria about livor mortis, rigor mortis, algor mortis, and other methods of estimating time of death and why the time of death was important. Laurie also talked about various signs of the body having been moved, which clearly had not been the case with Kera. In all these arenas, Aria displayed reasonably competent knowledge. Although she might have skipped some of the autopsies she’d been assigned, of the ones she had observed, she’d absorbed a considerable understanding of the forensic process.

It wasn’t until they were ready to begin the internal part of the autopsy that Aria’s personality reverted back to what Laurie now feared was her normal inconsiderate self. What seemed to set it off was Laurie merely asking if Aria was familiar with the difference between the forensic or Virchow autopsy technique, which they used at the OCME to determine the cause and manner of death, compared with the clinical or Rokitansky en bloc method that was done to study the pathological effects of disease.

“Yes, for fuck’s sake!” Aria snapped in a loud, irritated tone of voice. She was holding the scalpel, ready to make the initial incision. “Hell, I’ve been a pathology resident for nearly four years. I’d have to be a dumb ass not to know the difference.”

Laurie was shocked and found herself back to having a staring contest with Aria. They were both wearing surgical masks with plastic eye shields, so Laurie couldn’t see much of her face. The transformation in demeanor had been so sudden that Laurie was momentarily speechless. The only thing that had changed prior to the outburst was that Marvin, who had been hovering in the periphery ready to fetch whatever might be needed, had now joined Aria on the right side of the corpse. Since Laurie had intended for Aria to do the case, she had allowed her to be on the right side while Laurie had gone to the left, where she preferred her assistant to stand.

Before Laurie could reboot her brain, Aria broke off staring at Laurie to direct her attention to Marvin. “I don’t like you standing this close to me,” she snapped.

Marvin appeared as shocked as Laurie. He backed up a step and raised his hands, palms out. “Sorry,” he said.

“What’s the problem?” Laurie demanded, finding her voice. “He was just going to lend a hand if needed.”

“I don’t like men I don’t know crowding me,” Aria said.

Shocked anew at this obviously gender-discriminatory tantrum, Laurie was again speechless.

“It’s not personal, it’s just how I feel,” Aria added.

Laurie was dumbfounded and switched her attention to Marvin. “I’m sorry,” she said. “That was uncalled for, inappropriate, and will not be tolerated.”

“As I said, it’s not personal,” Aria repeated. “I need space, is all. Let’s not make a big deal out of it. Maybe he wouldn’t like it if I crowded him.”

“It’s okay, Dr. Montgomery,” Marvin said magnanimously. “I didn’t realize I was crowding anyone.”

“You were,” Aria insisted. “You actually touched up against me, and I responded. Now it’s over. Let’s get this case finished. Go over on Dr. Montgomery’s side if you want to participate!”

Laurie and Marvin exchanged a prolonged glance. They had worked together on so many occasions in the past that they often didn’t even need to talk to be on the same wavelength. Nonverbally they decided that it was best to get the case over with and deal with the incident later.

Meanwhile, Aria started the case by making a modified Y incision from the point of both shoulders, meeting in over the sternum, and then extending down to the pubis. She handled the knife with confidence. It was quickly apparent she was a skilled anatomical pathologist.

Dismayed at the unpleasant and inappropriate personality that Aria was again demonstrating, Laurie said little as Aria worked although she was prepared to intervene if Aria did anything out of the ordinary. But there was no need. Within minutes Aria had both the chest cavity and the abdominal cavity open with the internal organs in full view. Following Aria’s suggestion, Marvin had moved around to the other side of the table to stand next to Laurie.

“I’m going to do the thorax first,” Aria said. Her voice had reverted to the mild tone she’d used at the beginning of the case. Laurie merely nodded at Aria’s announcement, questioning how this woman got accepted to medical school and then a prestigious Pathology residency with that mercurial temperament. If nothing else, she had to have been a hell of a student.

Aria worked quickly, adroitly, and with great surety. Within minutes she had the heart lifted and angled up toward the head, exposing the left auricle. “Syringe for a blood sample, please,” she said, reaching out with one of her gloved hands while continuing to inspect the underside of the heart. Marvin handed her the syringe he had prepared, and Aria took the sample. Next, she turned her attention to the lungs. First, she carefully felt their surface using the pads of her fingers, then she grasped a lung between her thumb and fingers to feel the consistency. “Not much pulmonary edema,” she said, knotting her brow in surprise. She looked up at Laurie. “You take a feel.”

Laurie did as was suggested, palpating the lung tissue between her thumb and fingers. “I see what you mean,” she said. The lungs were indeed light and fluffy, meaning full of air and not fluid. Normally overdoses had fluid in the lungs, forming what was called pulmonary edema.

“This might have been a cardiac death, not a pulmonary death,” Aria said. “I wonder if the patient ever had an ECG.”

“It wasn’t mentioned in the medical-legal investigator’s report,” Laurie said.

“Maybe it’s a cardiac channelopathy,” Aria said, referring to a relatively new class of heart disease that interrupted the heart’s rhythm. “That could make this an interesting case.”

“I wouldn’t count on it,” Laurie said. “Cardiac channelopathies are rather rare, especially in an otherwise healthy young woman.”

“Yeah, but it’s a fascinating area genetically,” Aria said. “With the terrific DNA lab here at the OCME, this could be one hell of a case. I happen to be interested in channelopathies.”

“When you hear hoofbeats, think of horses, not zebras,” Laurie cautioned.

Aria laughed. “Of course, you’re right,” she said. “Everybody knows fentanyl suppresses breathing, but hell, maybe it also selectively exacerbates channelopathies. You never know. I’d like to know if this patient ever had an ECG or any history of cardiac problems or fainting spells.”

“It will be interesting to learn,” Laurie said. When Aria removed the heart and the lungs from the body, the lungs seemed to be entirely normal, as she’d surmised earlier from feeling the lung consistency. Both together weighed only two point eight pounds, which was well within the normal range.

“Obviously very little edema involved in these babies,” Aria said, taking them out of the scale. “I’m thinking channelopathy all over again.”

“Let’s look at the coronary arteries before we jump to conclusions,” Laurie said. She was again beginning to relax after Aria’s outburst and was once more enjoying herself being back in the pit doing an autopsy. For a few minutes she was able to forget all the stresses of being the chief medical examiner on top of her personal problems.

With the heart out on a cutting board, Aria skillfully traced all the major coronary arteries, confirming they were entirely normal in configuration and patency. When she finished inspecting all the heart’s chambers and valves, she looked up at Laurie, who was watching her every move. “Miss Jacobsen obviously didn’t have a heart attack or a valve prolapse, and she didn’t have pulmonary edema. I’m stoked. The channelopathy idea is starting to sound better and better.”

“Perhaps,” Laurie said. She still thought the chances were pretty small, yet inwardly she was pleased that Aria was raising the possibility and acted enthused. Laurie’s goal with Dr. Nichols had been to first find out if she had learned anything after she’d been at the OCME for a week, which she obviously had, and second, to possibly get her interested in forensics so she’d take her OCME rotation seriously. It seemed that this case, even though most likely a garden-variety overdose despite the lack of pulmonary edema, might do the trick. Laurie could well remember when she’d stumbled onto the attractions of forensic pathology when she was a pathology resident.

Finished with the chest, Aria now turned her attention to the abdomen. She worked quickly, to Laurie’s satisfaction, as it was now going on five o’clock. Within minutes Aria had the entire bowel out of the body. Marvin offered to take it and rinse it out, but Aria said she preferred to do it herself. At one of the sinks lining the far wall, she flushed it out, opened it with dissecting scissors, and then began to carefully inspect its nearly thirty-foot length.

At that moment, Jack and Lou Soldano entered the pit, laughing about something. Laurie wasn’t surprised to see Lou. He was a frequent visitor to the autopsy room. Both men were dressed in scrubs in preparation to do a case. Immediately behind them Vinnie Amendola appeared, pushing a gurney. On it was a toddler whose tiny body made Laurie shudder. Autopsies on children, particularly young children, never failed to bother her even though she’d hoped by this time in her career to have learned to take it in stride.

While Vinnie navigated the gurney next to a neighboring table, Jack and Lou came to Laurie’s. Jack leaned toward Laurie and asked sotto voce if Chet’s resident bête noire was as bad as he claimed.

“Worse,” Laurie whispered back.

“Really?” Jack questioned with surprise.

“We’ll talk about it later,” Laurie said as she saw Aria leave the sink and start back in their direction. “I take it this is the suspicious drowning death Lou called me about earlier?” Laurie asked, even though she didn’t really want to know.

“That’s the one. A scald case and drowning with extensive third-degree burns,” Jack said. “Lou must have told you he’s questioning whether it was an accident as the mother’s boyfriend contends. His gut is telling him it was a homicide.”

“And his intuition is usually spot-on,” Laurie said. She avoided looking at the tiny body as Vinnie moved it over onto the autopsy table. Instead she said hello to Lou, who returned the greeting.

“I’m Dr. Stapleton,” Jack said to Aria when she returned to the table.

“I know who you are.” Aria gave Jack a cursory glance before putting down the bowel she was carrying. Ignoring him further, she proceeded to take samples from various portions of the intestines and place them in specimen bottles.

Jack watched her for a beat, shrugged at being summarily dismissed, and then led Lou to the autopsy table where Vinnie had placed the toddler.

“The bowel is clean,” Aria announced. “Time for the pelvic organs.” Returning to the corpse and using mostly blunt finger dissection with a bit of help from blunt-nosed dissecting scissors, she quickly freed everything up. Then, using a scalpel, she expertly transected what needed to be cut and lifted the pelvic organs including the uterus, the fallopian tubes, and the ovaries out of the pelvic cavity.

“I have to say, you are a talented prosector,” Laurie said, and meant it.

“I’m glad you noticed,” Aria said in a tone of voice that made Laurie wish she’d not made the compliment. After taking a sample of the cervix, Aria forcibly inserted a long-bladed and very sharp scalpel into the cervical os and proceeded to fillet open the uterus to expose the uterine cavity.

“Holy shit,” Aria said. She bent over the specimen to take a closer look. “Do you see what I see?”