The Killing Room

I

The body is apparently that of an adult Asian woman that has been mutilated. The head and extremities have been amputated and the body has been incised along its chest and abdomen.

Margaret spoke clearly for the microphone. Experience had taught her that the Chinese who transliterated the tape would be easily confused by any lapse by her into slang or dialect. The vocabulary was arcane and difficult enough.

The body lay on the cold stainless steel of the autopsy table, its amputated pieces assembled in a grotesque parody of the complete human form they had once comprised. The head lay at an odd angle, black holes where the eyes should have been gazing into nothing. One foot was missing. Deterioration was more advanced in some pieces than in others. Parts of the dismembered limbs had become purple-black and slimy, and blisters filled with decompositional juices were forming on the skin. The sweet smell of rotting human flesh filled the room, like luncheon meat that has been left in the refrigerator and discovered two weeks too late.

The body is nude, unembalmed, and is cold to the touch. Rigor mortis is not appreciated. The body is in an early to moderate stage of decomposition characterised by areas of red and green-black discoloration of the abdomen and legs, drying of the face and digits, and patchy drying of the body surfaces. There are also discernible areas of adipocere.

‘What is that?’ Li asked, and Margaret glanced up at him through the plastic of her goggles.

She enjoyed the anonymity of the pathologist during autopsy. She could hide beneath the shower cap, behind the goggles and surgeon’s mask. She could conceal her vulnerability under the surgeon’s pyjamas, plastic apron and long-sleeved gown. Barely any part of her was exposed to scrutiny. Gloves, steel mesh, latex and waterproof sleeves cloaked every inch of exposed flesh. Even her shoes were shrouded in plastic.

Today she felt particularly exposed to scrutiny. She knew that Li was watching her closely wondering if, perhaps, their relationship had reached its end. Mei-Ling, too, was carefully examining her every move. Perhaps she was also wondering about the state of Margaret’s relations with Li, and what might have passed between them last night. And, of course, Dr Lan was waiting for the first slip, the first wrong move, the first ambiguity, to justify his previous findings. The autopsy assistants were courteous and professional, but they were Lan’s men and made that clear to Margaret by their exaggerated deference to her Chinese counterpart. At the back of the room a green-uniformed forensics expert stood watching with interest. He was a young man, with round, gold-rimmed spectacles. Unusually for a Chinese there was stubble on his jaw. He could have done with a shave. Margaret felt the heat building beneath all her layers, and glanced up at the closed-circuit TV camera on the wall. Somewhere, she knew, in another room, other eyes were also watching.

‘Adipocere …’ she said, but paused and glanced at Dr Lan. ‘Perhaps you would like to explain to the Deputy Section Chief, Doctor.’ She could not tell what his expression was beneath his mask. He nodded curtly.

‘Adipocere,’ he said, ‘is a white-tan waxy deposit, especially over the face, breasts and buttocks. It is formed by conversion of the oily fats in the body fat to solid fats during slow decomposition, suggesting that a body has been dead for at least three months. In addition, in this case, there are patchy white dry spots which would suggest direct exposure to cold air, probably in a freezer.’

Margaret nodded, raising an eyebrow in approval, and then turned her attentions to an examination of the head.

The head has been separated from the neck at the third cervical vertebra. It is normocephalic. The hair is partially sloughing, but the remaining hair is coarse, straight, black, and measures fourteen inches on the top of the head. The skin is dry and there is adipocere over the face. The eyes are not identified, and there is brown, waxy and pasty material in the orbits.

She worked the mouth open with her fingers.

The lips are dry, darkened, but apparently free of trauma. The oral mucous membranes are sloughing, but also free of trauma. The teeth are natural and in fair repair, except for the identification of shallow grooves on the occlusal surfaces of the incisors.

Margaret examined the neck and moved down to the chest where an entry wound extending in a ‘Y’ shape from each shoulder, meeting at the breastbone and carrying straight down to the pubic bone, had been roughly sutured with a coarse, black, braided waxed twine.

Dr Lan said, ‘The same twine appears to have been used to suture the wounds in all the victims.’ Margaret nodded.

There is mottled drying of the skin of the chest and abdomen, patchy areas of mould, freezer burn and adipocere.

She leaned over to examine the wound more closely.

There is also a faint yellow-brown discoloration of the skin of the chest and abdomen.

The colour rose high on Dr Lan’s face, and he also leaned over to make a closer examination of the wound. Margaret said, ‘Were you aware of this during the other two autopsies?’

Lan shook his head. ‘The bodies were still quite muddy. It is possible I overlooked it.’

‘Is it significant?’ Li asked.

‘We’ll discuss that later,’ Margaret said coldly, and returned her attentions to the torso. She was afraid to speak directly to Li in case the emotion was apparent in her voice. She had slept for only a couple of hours before her body clock had wakened her, and she had lain for the rest of the night thinking about Mei-Ling, and about Li, and about their argument. Was it really just her paranoia and insecurity that made her distrust Mei-Ling? She had determined that today she was going to be only what she was good at — a professional pathologist.

The breasts are those of an adult female and are free of masses or trauma. The abdomen likewise bears the sutured incision but is otherwise free of trauma.

She pressed the flat of her hands on the soft, giving abdomen and then felt around with her fingers.

The abdomen is flat and on palpation appears to be missing organs. The external genitalia are those of an adult female and are free of trauma. The anus is patulous and atraumatic.

She moved on to the severed limbs, examining them for signs of trauma, other than amputation. But when she couldn’t find any, she turned the body to examine the buttocks and the spine, and then moved back to where the head had been severed, for further external examination of the wound.

The amputation edge of the head is sharp, bloodless, and passes through the third cervical vertebra. The bone bears several deep sharp tool marks, with the appearance of having been chopped. There is a small amount of clotted blood adherent to the surface, but the tissues are otherwise pale and bloodless. The amputation wounds of the upper extremities are similar to the head amputation wound. They are cleanly cut, bloodless and pale. There are no saw marks and they, likewise, have the appearance of having been chopped at the level of the upper third of the humerus. The leg amputation edges at mid-femur have the same appearance.

‘Is that important?’ Li asked. ‘The lack of blood at the amputation edges?’

Mei-Ling said, ‘All it means is that they were not hacked to death. They were chopped up afterwards.’

Margaret glanced at her and wondered why she was surprised. After all, Mei-Ling must have attended many autopsies. Why shouldn’t she understand the significance of the bloodless wounds? Mei-Ling shifted self-consciously under her piercing gaze and said, ‘We had a murderer here in the nineties who liked to hack up his victims.’

Margaret nodded, and then said, ‘Before going internal, perhaps we should take her fingerprints. It’s unlikely that any of these women have criminal records, but it is a possibility. And since identification is paramount here …’

Lan looked at her, surprised. ‘But that is not possible.’

‘Why?’

Lan lifted the fingers of the right hand. ‘The degree of decay, Dr Campbell. It would be impossible to take clean prints.’

Carefully, Margaret took the hand from him and examined it minutely, noting for the record an area of callus between the top knuckle and the tip of the third finger. Then she started easing the wrinkled skin away from the rotting flesh of the fingers. ‘The process of degloving has already begun,’ she said. ‘All we have to do is help it on its way.’ And slowly, delicately, she eased the skin of the whole hand free from the decaying muscle and tissue inside. The fingernails came away also, so that she was left holding what looked much like a very thin, discoloured latex glove with neatly trimmed fingernails. It hung limp in her hand. Everyone around the table watched with fascinated horror a technique which was new to them. ‘If someone would bring an inkpad and card …’ Margaret left the request hanging.

Lan nodded towards the uniformed forensics man, who hurried out and returned a few moments later with an inkpad and several fingerprint cards. The young man looked perplexed when Margaret handed him a pair of latex gloves and asked him to put them on. Again he looked to Dr Lan for guidance and again was given the nod. He pulled on the gloves and Margaret said, ‘Now slip your right hand inside the degloved skin.’

There was something close to panic in his eyes now, and Margaret saw perspiration beading across his forehead. He hesitated, but a sharp word in Chinese from Lan prompted him to do as he was told, and he carefully slipped on the skin of the dead woman’s hand like another layer of glove. ‘Now,’ Margaret said, ‘take a set of fingerprints as if they were your own.’

The tension in the young man was apparent as one by one he rolled the ‘gloved’ fingers of his right hand across the inkpad, and then repeated the process on the white card, creating a perfect set of the dead woman’s prints.

Apart from a faint humming of the lights, there was complete silence in the room and Margaret said, ‘After we have finished here, and before we carry out any further autopsies, we should examine the hands of all the victims for signs of trauma or other evidence, and then repeat this process. It will speed up any possible identification.’

Lan looked at her, and she saw in his eyes for the first time, a glimmer of respect. He nodded his solemn agreement. ‘I agree, Doctor,’ he said.

Margaret’s standing in the room had suddenly risen, and she returned to the body of the poor woman on the table to begin the internal examination.

There is a twenty-three inch ‘Y’-shaped sutured incision of midline anterior torso, running from each shoulder to the breastbone and down to the symphysis pubis.

She turned to Lan. ‘In my experience, Doctor, Chinese pathologists normally employ a single post-mortem incision running in a straight line from the laryngeal cartilage to the pubic bone. Similar to the practice of pathologists in Europe.’

Lan nodded. ‘That is correct.’

‘The “Y” incision is peculiarly American. The cut that I would make during autopsy.’

Lan nodded again, but added, ‘I have made a “Y” cut myself on occasion. But I agree, in China it is the exception rather than the rule.’

Margaret carefully began unpicking the suture to ease open the chest cavity.

Upon removal of the suture, the edges of the incision are seen to be oily with decompositional change, but are otherwise erythematous, and there are multiple areas of clotted blood on the incision’s edges.

She glanced up at Lan, and again the colour rose on his face. The exchange of looks was brief and wordless, but Li did not miss it. He decided to save any questions for later.

There are several areas of black gritty material in areas of haemorrhage of the incision edges of the abdominal wall. The sternum has been cut vertically and bears no sternotomy wires. The heart, lungs, kidneys, liver and pancreas are absent.

‘What are sternotomy wires?’ Li asked.

Again, before Margaret could answer, Mei-Ling said, ‘They are loops of wire that are used to close the sternum after open chest surgery.’

Margaret inclined her head slightly. ‘You know your surgery, Miss Nien.’ And Mei-Ling blushed.

Margaret returned to a systematic examination of the internal organ systems, working her way through the remains of the pericardial sac and the various arteries and pulmonary vessels left by the removal of the heart. Suddenly she stopped as she uncovered the ends of what looked like two very small sutures of blue-coloured thread. She examined them for a moment, a frown of puzzlement on her face, and glanced at Dr Lan. His dark eyes gave no clue as to his thoughts.

The major pulmonary vessels each bear a knot of suture, appearing to be a monofilament polypropylene, approximately half an inch in length.

She detailed the missing lungs and sectioned the neck before moving down to the stomach and intestine, noting the absence of the liver, gallbladder and pancreas, finding nothing abnormal until she began pawing her way through the retroperitoneal fat to make sure that the kidneys really were absent. There she found further suture knots on the renal arteries, and for a moment lost her scalpel as it slipped through fingers made greasy by the fat.

The spleen is normal size, shape and position … She stopped and thought about that for a moment. The capsule is grey-purple and wrinkled. Sectioning reveals an oozing red-purple, autolytic cut surface with no recognisable follicular pattern.

She moved, then, down to the pubic area and said, ‘Virgin territory. No one’s been down here before us. At least, not with a scalpel.’ With the bladder exposed, she stuck a needle into it to try to draw out some fluid. None was forthcoming, and she made a small incision with her scalpel so that she could look inside. Satisfied that there was, indeed, a small amount of fluid there, she twisted the needle off the syringe and drew out about 10 cc of cloudy amber urine with the syringe alone, and handed it to an assistant for dispatch to the lab.

Now she cut out the bladder to expose the uterus which was pink-tan in colour, and shaped like an upside-down, flattened pear. At its lower end it opened into the cervix, a small tough ring which was pale tan in colour and shaped like the lips of a carp. ‘Looks like someone’s lost their mom,’ Margaret said grimly.

‘How can you tell?’ Li asked, peering more closely.

‘The cervix is normally round in nulliparous women — that is, a woman who hasn’t had kids. When a woman has had children, the cervix is stretched and takes on the shape of a fish mouth. Like a carp. See it?’

Li nodded. This woman had probably delivered a child who would never see her again, who might not even know what had become of his or her mother. It was too easy to forget that these slabs of rotting meat on a table had once been living human beings just like them.

Margaret pulled the body of the uterus up, away from the vagina, felt for the cervix and cut across the vagina just below, leaving a small cuff of vagina around it. The fallopian tubes with their attached ovaries were connected to the uterus at the opposite top corners. She smiled to herself and said, ‘I always see this picture of a kind of homely, faceless bald kid. See …? His ears would be the tubes and ovaries, and the cervix would be where his neck is.’

If any of the others saw what she saw, they did not find it amusing, and there was an embarrassed silence. Margaret shrugged and sighed. People never recognised the need for some kind of relief from this constant exposure to death and decomposition, the ceaseless reminder of your own mortality. No matter how absurd, humour was at least some kind of escape. She caught Lan’s eye and for a moment there was a twinkle in it. ‘I took up smoking,’ he said. And only Margaret understood the allusion.

She turned back to the womb, removing the tubes and ovaries and serially sectioning each to ensure that they were normal. Then she took a long set of forceps and tried to slide them up through the cervix into the body of the womb. It was a trick she often employed, using the forceps as a guide for her knife so that she could draw it up through the womb and cut it neatly in half. But in this case, she was unable to slide the forceps in. She tutted with irritation, and when she had finally bivalved the uterus, saw that adhesions on the inside wall had scarred it closed.

The uterus is grossly unremarkable, with the exception of a two by one centimetre area of scarring of the endometrium.

‘What caused the scarring?’ Mei-Ling asked.

Margaret looked up briefly. ‘Who knows? Probably some complication during childbirth. It is not uncommon. Certainly not as the result of sexual abuse, if that’s what you’re thinking. There is no indication that this woman has been sexually abused in any way.’

One of the assistants held the head in place while the other cut through the top of the skull with an oscillating saw, allowing Margaret to ease out the brain.

The scalp, skull and dura are intact and free of trauma. The dura is thin and translucent. The brain is apparently symmetric, but softened and pale green with decompositional change. The convolutional pattern cannot be evaluated due to decomposition. Serial sectioning and palpation of the brain, brainstem and cerebellar material shows no gross evidence of haemorrhage or mass lesion.

‘So nobody smacked her over the head,’ Margaret said.

When she had completed her examination of the musculoskeletal system, and examined the x-rays, she moved away from the table, perspiration gathering in her eyes, and removed her mask and goggles with a sense of relief. Off came the gloves and the steel mesh that protected her non-cutting hand, and as she removed her shower cap, her hair, damp with sweat, fell free over her shoulders. Only then did her sense of vulnerability return, and she steeled herself to mask it.

‘Well …?’ Li asked impatiently.

But she ignored him and turned to Dr Lan. ‘A few questions, Doctor, about your other autopsies.’ He nodded acquiescence. ‘Have you had the results of the urine tests back from toxicology yet?’

‘They came in this morning.’

‘Did the lab do a gas chromatography urine acidic drug screen?’

‘They did.’

‘And did they by any chance detect traces of succinic acid?’

Lan stared at her for a moment, a frown of confusion or perhaps disbelief was etched on his brow. ‘How did you know that?’ he asked.

‘And a benzodiazepine?’

Lan was astonished now. ‘Well … yes.’

‘In both victims?’

‘But, Doctor, how can you—?’

She raised a hand to cut him off. ‘Bear with me, I’m indulging in some intelligent guesswork here,’ she said. ‘It could save us some time.’ She thought for a moment. ‘I would suggest a search for succinylcholine in the brain tissue, and that we get the lab to do a mass spectrograph of the urine to confirm the possible presence of midazolam.’ She stripped off her apron and gown and crossed to the sink to wash her hands.

‘Well?’ Li asked.

‘Well what?’

‘What do you think?’

Margaret looked at Lan. ‘I think we should re-autopsy the first two victims, don’t you, Doctor?’ And she added quickly, before he was forced to lose face, ‘We very often see what we expect to see, and when the bodies have been in the ground and decomposed to this degree … well, I think comparisons would be invaluable.’ He nodded, aware of her consideration, and grateful for it.

‘Do you wish to conduct all the autopsies?’ he asked.

‘No.’ She shook her head. ‘It would be far too much for one person.’ She flicked her head towards the camera on the wall. ‘I presume we had an audience. Your people?’ He acknowledged with an almost indiscernible nod. ‘Then they’ll know what to look for. Pick your best pathologists and we’ll share the load. If you’ll permit me to supervise, we could have them all done by tomorrow night.’ She dried her hands on a towel. ‘Now, I could do with a coffee.’

They sat in a room at the end of an upstairs corridor. White leather settees on a polished wooden floor, brown curtains drawn on large windows. Two monitors set on tables pushed against a half-panelled wall showed camera-eye views of the autopsy rooms downstairs. The viewing room was still filled with the cigarette smoke of the pathologists who had watched Margaret at work. She sipped on a mug of hot green tea as the leaves rehydrated and sank to the bottom. She had forgotten that the Chinese rarely, if ever, drank coffee, and she could have done with a caffeine hit right now.

Li and Mei-Ling, and Lan and the forensics officer, sat sipping tea also, and watching her expectantly.

‘Okay,’ Margaret said. ‘What do we know?’ She drew a deep breath. ‘We know that she was an Asian woman, probably in her early thirties. We know that she was probably the mother of one or more children.’ She tilted her head slightly towards Mei-Ling. ‘Although with the enforcement of the One Child Policy, no doubt just the one.’ Mei-Ling did not react, fixing Margaret instead with a long, cold stare. Margaret continued, unaffected, ‘I would hazard a guess that she might have been a seamstress or a tailor’s assistant.’ And she took pleasure in seeing a frown furl Mei-Ling’s brow.

‘How do you know that?’ Li asked, astonished.

‘There were tiny grooves on the occlusal surfaces of her front teeth. The kind of grooves that might be worn over many years of holding pins between them, as a seamstress does when she’s pinning a pattern or fitting pieces on a tailor’s dummy. I’ve often seen grooves like them, only bigger, in the teeth of joiners, where they hold nails between the incisors.’

There was a small gasp from Dr Lan. ‘Of course,’ he said. ‘The callus above the knuckle at the top of the middle finger. It would be caused by a sewing ring.’

‘A sewing ring?’ Margaret asked. ‘You mean a thimble?’

‘Not a thimble. In China a seamstress wears a ring at the top of her third finger to protect it as she pushes the needle through the material. It often leaves a callus, like a normal ring does at the root of the finger.’

‘Which makes it just about conclusive, then,’ Margaret said. ‘This woman almost certainly worked in the rag trade.’ She paused and chose her next words with care. ‘What I cannot say with any certainty is whether or not the poor woman had been experimented on by medical students or researchers …’ This to let Lan off the hook. ‘But I can say with absolute certainty that she was not the subject of a post-mortem.’

Li frowned and glanced at Dr Lan. ‘But I understood Dr Lan to have concluded that all these women had had autopsies performed on them.’

Margaret said, ‘Dr Lan was not entirely incorrect in that conclusion, Deputy Section Chief. The difference is that the woman I examined this morning had had an ante-, as opposed to a post-, mortem performed on her. In other words, she was very much alive when they cut her open.’ She looked at Lan. ‘Am I right, Doctor?’

He nodded gravely.

‘How do you know?’ Mei-Ling asked.

‘The yellow-brown colour of the skin around the long central wound. Caused probably by betadine, an iodine tincture used to disinfect the skin before making an incision. You don’t need to disinfect the skin of a dead person.’

‘And that is conclusive?’ asked Li.

‘No. But there were plenty of other clues. There was blood clotting around the chest and abdominal wounds. Doesn’t happen if the person’s dead. Also, the black gritty material I described along the incision edges was caused by an electrocautery device used to heat-seal small bleeders that aren’t big enough to suture. Miss Nien made the point herself when she described to you why the wounds were bloodless where the limbs and head had been severed. The woman was certainly dead when they hacked her up.’ She took a sip of her tea. ‘And then there were those sutures inside, tying off bleeding arteries where organs had been removed. Like I said, dead people don’t bleed.’

Mei-Ling flicked her hair back from her face and said, ‘You mentioned something about succinic acid and midazolam found in the urine.’

Margaret nodded. ‘I’m pretty sure the lab will find succinylcholine in the brain tissue. I would suspect that it was used, in conjunction with the midazolam, to keep the victims compliant. The midazolam sedates. It is often used in the induction phase of anaesthesia. It would need to be injected in small doses every few minutes to keep the victim riding on the edge of unconsciousness. The succinylcholine is a neuromuscular blocker. It would have paralysed the victims so that an ambu bag would have been required to force air into the lungs and keep the blood oxygenated. It sounds complicated, but it’s quicker and easier to apply than full anaesthesia.’

There was a long silence as everyone in the room took in the implications of Margaret’s findings. Eventually Li said, ‘It looks like I am going to have to revise my initial thoughts on organ theft.’

Margaret frowned. ‘What were those?’

Li said, ‘The reason I was brought in on this case is because of a body we found in Beijing last winter. A young woman, cut open and then dismembered. Identical in almost every detail to the Shanghai victims. I dismissed the thought that she might have been murdered for her organs because, although they had been removed, they were found with the body in a separate bag.’

Margaret shook her head. ‘I don’t think you can look for a motive in organ theft.’

‘Why not?’

‘Well, for a start the lady I examined today appeared to me to have had a partial autopsy performed on her, albeit a “live” one. And, as you know, the organs are always removed during autopsy to be sectioned.’

‘Why would anyone want to perform a “live” autopsy?’ Mei-Ling asked.

‘I have no idea. But it certainly helps to establish cause of death. After all, if you remove someone’s heart it is going to kill them. So the victim would die halfway through the procedure. Perhaps that’s why the ante-mortem was not completed, why the spleen and the lower organs were left intact. Who knows?’ She looked around the faces watching her, hanging on her every word, her every thought. ‘But more compelling still,’ she said, ‘there would be no need to keep someone alive in order to remove their organs for transplant. You would simply kill them and remove the organs afterwards. Cleaner, quicker, easier. I cannot think of a single reason why you would want to keep the person alive.’ She took another gulp of her tea. ‘The facts are these. Our seamstress was murdered by sterile surgical procedure. Her legs, arms and head were then crudely hacked off with some kind of heavy chopping instrument. The pieces were stored in a freezer for at least three months, and then dumped across the river anything up to a week ago, the process of thawing having increased the rate of decomposition. These are the facts. And other than indulging in wild speculation about it being the work of some kind of psycho surgeon, I’m afraid I can’t offer you a single clue as to why.’