Night Shift

Chapter 25

Wednesday, December 8, 8:31 a.m.

Cherine Gardener’s X-ray was on the view box, and it was normal, meaning there was no unexpected bullet someplace, which had happened on rare occasions in the past. Her mildly cyanotic, nude body was stretched out on the autopsy table with her head on a wooden block. Her eyes stared unseeing at the ceiling. Running water flowed along her sides and with a mild gurgle disappeared at the base of the table. Although Jack was all too familiar with the sight, seeing her made him pause. Perhaps not with the same degree of discomposure he’d felt with Sue Passero the day before or what he felt autopsying the pathology resident a few years earlier, but he did hesitate for a moment, lamenting the fragility of life. Having directly spoken with her the day before made her passing somehow personal and for a moment reminded him of the death of his first family.

“Okay!” Jack said to reorient his brain away from his emotional centers to his more analytical regions. He was standing on Cherine’s right side, whereas Lou and Vinnie were on her left next to each other. “Do both of you see what I see right off besides her cyanosis?”

“I imagine you are referring to what looks like a small bruise on her cheek,” Lou said.

“Exactly,” Jack said. Using a digital camera, he took several photos. He had already photographed the white powder visible in her nares.

“She was found lying against the wall,” Lou said. “I suppose she could have gotten that when she collapsed.”

“No doubt,” Jack said. “But it should be noted anyway.”

“Could she have been strangled?” Lou asked.

“Doesn’t look like it,” Jack said. “Invariably bruising is seen around the neck, particularly if a ligature was used. But to be sure, we’ll do a brief neck dissection and check the hyoid bone.” He inspected her scalp, then opened her mouth to look at her gums and teeth.

“Wait a second,” Vinnie said. He bent over for a closer look at something that had caught his eye. “What’s that?” He pointed into the left side of Cherine’s mouth.

Against her cheek and her lower molars was a small errant piece of tissue where the coloration and texture were different than the surrounding mucosa.

“Hand me some forceps,” Jack said. He took the instrument from Vinnie and snagged the two-millimeter piece of tissue.

“What is it?” Lou asked.

“I haven’t the slightest idea,” Jack said. “For all we know, it could be possibly left over from her dinner, but who knows. Specimen jar, please.”

Vinnie picked up one of the many specimen jars he had positioned on the instrument tray, opened it, and Jack added the small piece of tissue. “Histology will tell us what it is,” Jack said.

After the head, Jack examined the hands and fingernails before doing a careful full-body inspection. Neither he nor the others found anything of significance. This continued until the body was rolled onto its right side. It was Lou who saw the tiny imperfection first.

“Is this something?” he asked, pointing toward a mere millimeter-round blemish on the lateral side of the left buttock, which was otherwise unremarkable. The spot was darker than the surrounding skin and appeared like a slightly convex period at the end of a sentence.

Both Jack and Vinnie bent over to look. “It’s hard to say,” Jack voiced. He tried to wipe it off with one of his gloved fingers. It didn’t budge. “But it is worth taking a peek. Hand me a scalpel, Vinnie.”

With scalpel in hand, Jack took a two-centimeter circular plug of skin that included subcutaneous adipose tissue and muscle. After slicing the sample into two pieces by cutting through the surface imperfection, he put each in separate specimen jars that Vinnie held out. Remembering all the injection sites on Sue’s thighs and abdomen from insulin injections, Jack thought there was a chance that it, too, represented an injection site, especially since there was a tiny but visible amount of subcutaneous hemorrhage, but he didn’t say anything as it could have been many other things as well, most likely a small nevus.

When the external exam was over, they started the necropsy. By then there were other mortuary techs scurrying about bringing bodies in and making preparations for other cases. The three people at table eight ignored the commotion.

Once Jack had Cherine’s body completely open, he began what he announced was probably the most important part of this particular autopsy, namely taking all the fluid samples of blood from the heart, urine from the bladder, and vitreous from the eyes for toxicology. When that was done, he started removing the organs, beginning with the heart. To his surprise, he detected a slight degree of aortic stenosis. After opening the vessel, he pointed out the valvular pathology to Lou.

“Could that have killed her?” Lou asked.

“I can’t imagine,” Jack said.

“Would it have become a problem as she got older?”

“I doubt it,” Jack said. “It’s mild, and even if it did become symptomatic, it is a condition that can be treated without much trouble since valve replacement and open-heart surgery have come a long way in recent years.”

The next organs were the lungs, and as Jack removed the left lung from the chest cavity, he gauged its weight by lifting it up and down in his hand. “Okay. My guess it’s a bit heavier than expected considering her size, which suggests a fluid-filled lung. Of course, that points toward it being a drug overdose.” Jack put the lung onto the scale hanging over the table. “Yup,” he added, looking at the digital readout, “that’s certainly on the high side considering her size and habitus. But let’s confirm.” Taking the lung from the scale and putting it on a wooden tray, he used a butcher’s knife to make multiple slices into it. Fluid immediately ran out onto the surface to form a puddle. “There you go! Pulmonary edema, a sine qua non of a drug overdose.”

“Really?” Lou said, sounding either exhausted or depressed. He shrugged. “Well, maybe I was wrong. I suppose it isn’t the first or last time, but I’m surprised. I was so sure.”

“We can’t be certain it was an overdose until toxicology confirms it,” Jack said. “There are a few other things that can cause it.” He was thinking about how much the lung in front of him looked like Sue’s, which reminded him of his thoughts last night about Sue’s cyanosis and what it had suggested to him. There was no doubt in his mind that all the same thoughts applied equally to Cherine, as she looked as cyanotic as Sue had or more so. Jack glanced up at Vinnie, wondering if he’d recognized the same thing, but Vinnie didn’t give any indication he was thinking anything besides his normal impatience to get the case done. Looking back down at Cherine’s open body, now missing its heart and one lung, Jack couldn’t help but wonder if whatever had killed this woman was the same as what had killed Sue. Could they possibly have shared the same drug? After all, they were collaborators and apparently friends.

“Yeah, sure, other things can cause it,” Lou said. “The important thing here is that it’s not looking anything like a homicide. Far from it. I don’t know what I was suspecting, but I thought there’d be something to explain the supposed muffled scream and the guy departing. Maybe it was a drug dealer, but we’ll probably never know. Anyway, with that said, I need some shut-eye big-time. If you two gentlemen will excuse me, I think I’ll mosey on home.”

“Good idea,” Jack said. “Meanwhile on my end, I’ll try my darndest to get Toxicology to give us some answers ASAP to confirm or disprove a drug overdose.”

“You do that,” Lou said. “And thanks for letting me observe you guys. It’s been a pleasure as always.” He started to walk away but hesitated and then returned. He looked directly at Jack and pointed a finger. “And remember! One day! You are a superb medical examiner, but you are a piss-poor detective. So be careful!”

“Aye, aye, sir,” Jack said while giving a partial salute.

“I wish I could count on that,” Lou mumbled loud enough for both Jack and Vinnie to hear. Then he left.

“What did he mean by ‘one day’?” Vinnie questioned, watching Lou pass down behind all the autopsy tables, most of which were now occupied. “And what does he mean you are a poor detective?”

“Beats me,” Jack said.