The Skeleton's knee

13

The trip to Burlington took a shade over three hours. I left Gail’s house just before dawn and had settled into the soothing monotony of long-distance travel by the time the sun spread its pallor across the eastern hills of New Hampshire. In that short period between total darkness and when the burgeoning monochromatic daylight reveals a world beyond the headlamps, my mind floated away from the troublesome details surrounding Fred Coyner and Abraham Fuller, focusing instead on the beauty around me.

Interstate 91 is one of only two such roads in Vermont. It shoots straight north toward Canada, paralleling the Connecticut River border with New Hampshire until just below St. Johnsbury, where the border veers off to the northeast. At White River Junction, some sixty miles south, 91 intersects I-89, which takes a diagonal path to Burlington, in the northwest corner of the state.

Combined, the two roads offer one of the best time-compressed tours of Vermont I know of, taking one from the “banana belt” of Brattleboro, through the low hills and river views of the southern valley, along the dramatic forested gaps of the Green Mountains, and finally out onto the rich, flat plains of the Lake Champlain valley. It amounts to a seamless succession of picture-perfect postcards.

Beverly Hillstrom’s lab was located at the rear of the University of Vermont’s Medical Center Hospital, off Colchester Avenue, in an inconspicuous corner not far from the loading docks. I had a little difficulty finding it, even knowing which entrance to use-autopsy areas don’t tend to advertise, especially within hospitals-and the first person I saw when I finally did walk through the metal double doors looked at me as if I’d lost my way. Only my badge and my using Dr. Hillstrom’s name changed his mind.

I was ushered into a small white lab room lined with cabinets, mounted light boxes for X-rays, and several freestanding bulletin boards covered with the photographs Hillstrom had taken the day before. Hillstrom herself was deep in conversation with a small dark-haired woman with half glasses, periodically referring to the mottled dark brown pelvis of the skeleton on which I was pinning so much hope. He-or she-was stretched out on a porcelain table in the middle of the room, looking like a rejected medical-school model that needed reassembling.

Hillstrom looked away from her companion and gave me a wide grin-the most expansive greeting she’d ever bestowed on me. “Lieutenant, good to see you. You must have left at the crack of dawn. I’d like you to meet Dr. Nora Gold, forensic anthropologist. She’s not only agreed to help us out with this case-she’s kept us at it through most of the night.”

Nora Gold and I shook hands. Her warm brown eyes were surrounded by clusters of radiating laugh lines, and she had an engaging, almost mischievous smile. I guessed her to be somewhere in her fifties.

I nodded toward the bones. “Has he confessed yet?”

Dr. Gold chuckled. “To some things, he has.”

I looked at her for a moment, hoping for some good news at last. “How much can he tell us?”

“Have you ever dealt with forensic anthropology before, or someone practicing its particular form of witchcraft?”

“No, but I’ve read or heard about some of the things you can do.”

“Well, one of the things that lots of people find frustrating is the amount we have to equivocate. They think the Ph.D. and the lab coat make us purveyors of the truth. We aren’t. Forensic anthropology is more an interpretive art than it is an exact science. It depends almost entirely on statistical analysis and probability-number crunching, to put it simply. For example, when I say this fellow is a male, I actually mean I’m eighty percent sure of it. There’s an outside chance it’s a female.”

I pushed out my lower lip and sighed gently. The Ph.D. and lab coat had certainly gotten me to expect more.

Nora Gold patted my arm and looked up at me, still smiling. I noticed then that Hillstrom was looking amused, as well. “Lieutenant, that was the limited-warranty speech. I actually do think we can help you out here, but I didn’t want you taking everything you hear from me as gospel. Okay?”

“Okay,” I agreed tentatively.

She gave my arm one last squeeze and then rubbed her hands together, turning toward the photographs and the X-rays covering the wall-mounted light boxes. “Here we go, then. There are six things we can evaluate when we have a specimen as complete as this one: sex, age, height, weight, race, and handedness. Some of those we can nail down pretty well; others are almost flights of fancy. Sex,” she added pointedly, “is pretty solid.

“Now, I won’t give you a postgraduate lecture, but I think you ought to know that the validity of some of these conclusions is based on a massive amount of previous data. A few people over the past hundred years have measured thousands of skeletons they already knew a good deal about. The point of the exercise was that if they could find a set of common physical denominators in skeletons they knew were female, or black, or left-handed, or forty-five years old, or whatever, then later they could apply those denominators to skeletons they knew nothing about.” She turned to the neat pile of bones on the table. “Like our friend here.”

It was nice to hear. “So he’s a male, according to your guidelines.”

She smiled and rested the tips of her fingers on the darkened skeleton, as if feeling for a telltale pulse. “Yes. What Bev and I were doing half the night was measuring almost every square inch of this poor man, taking X-rays and tissue samples, even slicing him here and there to look at him under the microscope. What I can tell you with as much certainty as possible is that he was also Caucasian, almost exactly six feet tall, left-handed, and in his late twenties.”

I understood the amount of effort both these people had put into this case. Not only was their homework decorating the walls all around us, but I could see it in their tired faces. They had brought both their professional and personal interest to bear. And yet, despite that, I was disappointed. The description they’d furnished me could have fit a sizable percentage of the population.

I did my best to keep my ambivalence to myself. “Interesting. What makes you think he’s left-handed?”

“The long bones. Actually, you hit on one of the lesser strengths of this science. A lot of the study skeletons I mentioned came from military conflicts, in which official records supplied the comparative data. Unfortunately, handedness is not recorded as a relevant vital statistic, so we’ve had to establish a standard through other means, mostly by comparing the number of living right- and left-handers to a similar mathematical discrepancy among skeletons. What we found was that living left-handers make up the same percentage of the overall population as the percentage of skeletons with elongated, more torsioned left humerus bones, who also have a distinct beveling of the dorsal margin of the glenoid cavity in their left clavicles.

“Translated into English, it means that if you spend your life throwing balls with one arm instead of the other, the bones and the shoulder blade of that arm show the effects.”

I nodded without comment, causing Dr. Gold to suggest, with the friendliest of smiles, “You expected much more, didn’t you?”

“No, no. I mean, I had nothing before-” She interrupted me. “Well, there is more. I wouldn’t say that in a courtroom, but Bev’s spent half the night singing your praises, so I think I can trust you.”

I laughed and shook my head, realizing I was being thoroughly manipulated. On the other hand, if they did have more to offer, having it fed to me in bits and pieces was a small price to pay for their satisfaction.

“In addition to the six categories of physical appearance I described to you, there are also two other factors that leave their marks on a person’s anatomy-environmental influences and historical landmarks. Examples of each would be a man who worked in a granite quarry all his life, and whose teeth were therefore evenly worn by the stone dust he’d been unconsciously grinding, or a person whose case of childhood rickets left him with a pair of permanently curved legs.”

She moved to the end of the table and picked up a femur. “What we found trespasses into both those areas, although I’d weight it more as historical in origin.” She pointed to a rough rippling at the bottom end of the femur. “See this? It’s where the gastrocnemius-the calf muscle-attaches to the distal head of the femur, or thigh bone, just above the knee joint. That muscle, as you know, tightens up when you stand on your toes. In fact, its major function is to help us pushing off, as you would at the start of a sprint. Of course, all the other muscles of the upper and lower leg play a part, too, but that tiptoe gesture draws most heavily on the calf. Well, over the years, we’ve discovered that a certain repetitive muscular movement sometimes irritates the proximal end of the gastrocnemius, to where it finally scars the bone at the point of attachment.”

“What do you mean?” I asked, a little lost, “Bouncing around on…” I paused and smiled. “A ballet dancer?”

She laughed at my amazement but cautioned me with a hand gesture. “Maybe. I can show you the evidence, and I can tell you how we’ve linked it to a certain activity in the past, but it’s up to you to draw the conclusions.”

She pointed to one of the skeleton’s heels. “There’s something else. Notice how this small bony ledge extends forward from the calcaneus, the heel bone? That’s a spur. He has one on each heel. They don’t look serious, so it’s very possible he never knew he had them, but they are suggestive of another kind of chronic activity.”

“But not ballet?”

“No-remember, the stress there occurs when the dancer’s on his toes. This comes about more often from pounding the heel repetitively.”

“Jogging?”

She straightened with a pleased expression on her face. “Excellent, although the ‘buyer beware’ warning still applies. Other things can cause the same spur to develop.”

“But you’ve connected this thing to jogging more than to anything else,” I persisted.

“I have, and so have others. There definitely is a pattern.”

“Okay. You mentioned you could establish how much he weighed.”

There was no longer any need to control the tone of my voice. Even with her repeated caveats, Nora Gold had done a good deal to rekindle my spirits. As ghostly as his identity still was, the man on the table was beginning to fill out in my mind.

Beverly Hillstrom, who had been sitting on a stool throughout our conversation, wagged a finger at her friend. “I told you he’d hold you to that.”

“All right, all right,” Gold conceded. “You picked the weakest of my magic tricks. I can mutter about probabilities and sliding scales and margins of error on all the rest of this, but I can’t call my estimate of his weight anything other than a pure guess.” She then gave me a theatrically imperious look. “A highly educated guess, of course. It boils down to this: How many fat ballet dancers do you know? None, right? Here was a man in his late twenties, with two historic landmarks indicating strenuous physical activity. I have a tough time imagining him as anything other than fit and muscular, which, if true, would then put him in the 180- to 200-pound category, more or less. That’s the full extent of the science on that one.”

“Reasonable enough, though,” I murmured.

“See?” Gold turned to her friend, “I told you he’d buy it. I have to admit, though, there was another factor that led me to guess that weight, but it has only to do with ego-his, not mine.”

She picked up the skull without the jawbone and held it out to me upside down, so that I was looking at the upper row of perfectly aligned, even teeth. “Look at the right incisor, from the inside.”

I did so and noticed a faint diagonal line separating the crown of the tooth from its base.

“It’s been broken, mostly from the back of the tooth, and replaced with a sort of dental modeling epoxy-a plastic resin that can be molded right on the break, and shaped and colored to look just like the real McCoy. From the front, it’s a perfect match, but dentists usually don’t put the same effort into fixing the posterior side, for obvious reasons.”

“I thought they capped broken teeth.”

“They often do, but this tooth wasn’t so much broken as seriously chipped. It wasn’t dead, and the chip hadn’t exposed its roots to decay. In fact, he might have wandered around with a chipped tooth for years before getting it fixed. The point I’m getting at is that the dentistry is purely cosmetic, and that it was done to an otherwise perfect set of teeth-there’s not a single filling here. That’s both very rare and a natural source of pride in a perfection-driven society.”

I looked at her quizzically, never having given teeth much social significance before, unless they were moss-covered and stinking of rot.

“Remember who we have here: an athlete, who runs enough to cause bone spurs; a dancer, who, despite a recurring muscle tenderness, persists in his art; and a man with perfect teeth, who goes to the trouble of fixing a chipped tooth. I think our friend here kept one eye on the mirror. That’s the other reason I think he was slim and muscular-his ego demanded it of him.”

“What about the metal knee?” I asked finally. “He couldn’t have been a ballet dancer with that.”

“That’s true. I think he was dead before he had a chance to get the knee back to full operational order.”

That sent a tingle down my back. “He died right after surgery?”

“Within a couple of months of it. Bone is dynamic tissue, remodeling itself over the years. That’s how we can gauge things like age-cranial sutures continue to close until we’re eighty years old. That’s what explains how we can recover from a broken leg or arm: The bone reunites, growing back together sometimes to form a bond that’s stronger than before. When a surgeon puts in an artificial knee, he removes the ends of the bones to each side of the joint with a saw, exposing the marrow-filled hollow shaft that he partially fills with bone cement-like pre-drilling screw holes in wood before mounting a door hinge.”

“With a door, though, nothing happens where the metal hinge touches the wood. The metal might rust a bit, and the wood might swell in the dampness, but they remain two separate entities, as does the sawdust, unless you or a breeze removes it. With bone, it’s different; over time, it begins to heal over, removing the rough edges of the cut, along with any residual blood, and also reabsorbing the minute shards of bone dust that were created by the surgeon’s saw blade.”

“Here, however, there was very little healing. The line where the bone ends and the metal begins is only a couple of months old at the most. The residual blood has been reabsorbed, which takes a few weeks, but microscopic remnants of bone dust remain. Also, I could still see the striations left behind by the surgeon’s saw-not fresh, but again, not very old.”

I shook my head, amazed at my luck. “There’s no way you could know why the knee was replaced?”

She smiled regretfully. “’Fraid not, Lieutenant. Could have been any number of things. There was one additional aspect I thought was odd, though.”

I looked at her carefully. “What was that?”

For the first time, she seemed slightly hesitant. “Well, it’s trespassing into an area I really know nothing about, so there’s probably a perfectly mundane explanation for it, but one last indicator that this surgery took place slightly before his death is the amount of leachate surrounding the bone cement. Normally, after an operation like this, the cement, as it sets, leaches out somewhat over the next few months. The leachate is carried away and cleansed by the circulatory system.”

“And here you found some leachate still hanging around?”

I could tell by her tone that there was a little more to it. “Yes, that’s true, and it helped corroborate my time estimate based on the bone fragments, but it was the leachate itself that caught my eye. It looked different from what I’m used to. Now, I admit, it’s not every day that I have a skeleton with a prosthesis implanted, so I’m hardly an expert in the field, but still, it made me wonder. So I did a scraping and had the cement analyzed. The results came back just before you got here. It turns out the cement was a slurry of sorts, heavily impregnated with antibiotics.”

“And that’s not normal?” I asked.

She gave me a rueful smile and shrugged. “That’s just it. I don’t know, and I haven’t had time to check around. Bev’s the only physician I had immediately available, but she didn’t know, either.”

I immediately thought of Michael Brook, Ellen’s old doctor, and the man who had hoped to operate on Abraham Fuller. He was both old enough to have been practicing back in the sixties and experienced enough to at least get me started in the right direction. “Were there any markings on the knee? Something I could use to trace it?”

She pulled a piece of paper out of her lab coat and gave it to me. “Two separate numbers. I have to admit, though, I’m not sure how useful they’ll be. I don’t know if they’re serial numbers or not.”

I glanced at them, one with four digits, a dash, and two more, the other starting with a letter, followed by three digits. I shoved the paper into my pocket; that would make another question to ask Brook. “How about the way he looked? Can’t you reconstruct a face from the skull?”

She shrugged. “You can. Some of the same people who spent their lives measuring bones also took fresh cadavers and stuck pins into their faces, trying to determine if there were any common denominators between peoples’ skin thicknesses. There are reams of figures for chins and foreheads and cheekbones and upper and lower lips. The cadavers must have been wonderful to look at afterward. Needless to say, this was done in the good old days, and not to the aristocracy, either.”

She grabbed a stool at this point and sat, giving a small shrug. “In answer to your question, I can’t really answer. I don’t think much of the technique myself, but others have had success with it. Clyde Snow, one of the giants in the business, once tested how accurate reconstructions could be. He had one done of a male skull, took a photograph of it, and then placed that photo on a poster with seven other head shots, one of which was actually the real guy. People were asked to match the clay reconstruction to the original. Of two hundred guesses, one hundred and thirty-five were right. Pretty good numbers.”

“So why don’t you like the system?”

“How often have you seen two faces that really look the same? Like twins? It’s pretty rare. But can you say the same about two skulls? Even to us, they look pretty similar-we have to work hard just to tell the girls from the boys. I don’t know how you can slap some clay on a bone and make it look like the original; there’re just too many variables, from scars to fat to facial hair. I’ve always felt that reconstructions are expensive and time-consuming shots in the dark.”

I smiled at her conviction. “I guess I won’t ask you to recommend a sculptor.”

She chuckled then. “Oh, I wouldn’t mind. It’s just that you can get so much solid information from remains like these, and still people jump up and down for the Hollywood special effects.”

I waved my hands in protest. “Not me. I’m quite content. I do have to ask the big question, though. What killed him?”

“At last,” Hillstrom exclaimed, throwing up her hands.

Nora Gold began to laugh.

I stared at both of them, nonplussed.

“Nora promised me that if you asked for the cause of death,” Hillstrom explained, “I, as medical examiner, could have the honors. Otherwise, I’d never get to say anything.”

I looked at them both quizzically.

“You’ll have to excuse us. We are old, old friends…”

“And very, very tired,” Gold added.

Over the years, I had become genuinely fond of Beverly Hillstrom, despite a professional coolness that I took merely as her style but that others often misinterpreted as barely veiled hostility. Seeing her cutting up with her small dynamo of a friend reinforced my appreciation of her and marked, I thought, a small turning point in our friendship. I doubted she would have let many people see her so relaxed.

Hillstrom moved to the skeleton’s chest, putting her finger on a neat hole slightly below the center of the sternum. “In my opinion, Lieutenant, a single bullet killed him, or at least could have. This hole fits the bullet we recovered to a tee, and the breakout pattern on the inside is entirely consistent with a bullet wound. Also, bone growth stopped at the time trauma was inflicted; none of the remodeling Nora mentioned earlier happened here. However, since we don’t actually have any soft tissue to consult, I can’t swear that the bullet hit his heart in a lethal fashion. But that’s what I think happened.”

I pointed to several broken ribs. “What about these?”

She pursed her lips. “Those are from last night’s ambush. We didn’t find a single indication of any old trauma beyond the one bullet hole, which encourages me to think the cardiac wound was the culprit. But who can tell? He could have had half his midsection removed by a simultaneous shotgun blast without a scratch left on his skeleton.”

“But you’re not saying he might have died of pneumonia or scarlet fever or something nonhomicidal, are you?”

“My opinion is homicide, and that’s what’s going on the certificate. But anything’s possible when you have this little to work on.”

I turned to Dr. Gold. “How long would you guess he’d been underground?”

She made a face at that. “That’s a tough one-it depends so much on the burial site. Quite a few years, certainly.”

“Closer to five, or twenty-five?”

“Longer rather than shorter. Fifteen to twenty years wouldn’t be out of line-possibly more.”

There was a long pause as we all found ourselves staring at the remains of our now certified murder victim, the stillness of his tarnished bones in violent contradiction to the manner of his death.

Dr. Gold laid her hand on my arm gently. “We’ve told you everything we can. We’ll be giving you the photos and the X-rays and whatever else you need and you’ll be on your own; so I was wondering if I could ask you a favor.”

“Sure-anything…”

“Tell me what happened-tell me who he was.”

I squeezed her hand and looked back at the skeleton, realizing for the first time the bonds she established with each of her “patients” in order to do her work well. It was a startling glimpse at the humanity that underlay professions like hers and Beverly Hillstrom’s-occupations that were at best regarded with ghoulish curiosity.

“If I ever find out, I will.”