Unnatural Selection

NINETEEN

Truro is a venerable cathedral and market town, but the Royal Cornwall Hospital at Treliske, on its western outskirts, is sleek, modern, and well-equipped, with its gleaming basement mortuary being no exception. The waiting room, mercifully unoccupied at the moment by any apprehensive, fearful relatives or friends, was living-room friendly, with plum-colored fabric on the walls, homey furniture, flowers, coffee-table picture books, and up-to-date magazines. Having announced himself to the receptionist, Gideon had finished an article on human cloning (“Another you-the next best thing to teleportation”) in New Scientist and was starting one on a methane-spewing volcano that had been discovered on one of Saturn’s moons, when his host came barreling through the door from the interior.

Wilson Merrill in the flesh, was, if anything, even heartier than he was on the telephone. A ruddy, stocky, country-squireish sort of man who radiated bluff good humor, he stuck out a blunt-fingered hand in greeting. “Well, well, it seems the Dynamic Duo is back in business again.”

“It’s good to see you, Wilson,” Gideon said.

“Come on, old man, let’s get you suited up.”

“Oh, I don’t think I need to put on scrubs,” Gideon said. “I don’t really expect to be doing anything-just observing.” From as great a distance as I can get away with, he might have added.

Merrill laughed as merrily as if Gideon had told an amusing joke. “Nonsense,” he said, taking him by the elbow and shuffling him along the corridor. “Gets a bit splashy in there sometimes. Wouldn’t want to get anything nasty on that pretty shirt.”

Merrill himself was wearing the green, oversized, hand-me-down (from the hospital upstairs) scrubs that were usual in mortuaries around the world, fronted by a plastic apron, and complete with oversize booties. Gideon had noted before this preference of pathologists for roomy scrubs. They needed them, too. Unlike surgeons (other than orthopedic surgeons) who work mostly in small spaces with delicate instruments: scalpel, forceps, probes, retractors-pathologists use implements that look as if they came from a carpenter’s tool chest: hammers, chisels, saws, even pruning shears (for snipping through the ribs). A grizzled, old-school coroner Gideon knew claimed that he bought all his instruments at kitchen shops and hardware stores. “They’re the same damn knives and things, just as good, but if it has ‘autopsy’ in front of it, they charge you an arm and a leg.”

Five minutes later, in the locker room a few yards down the hall, Gideon was getting similarly outfitted in scrubs that must have been made for a professional wrestler. While he was swimming his way into them, Merrill used the time to browse through the file folder of materials that had come with Joey’s body.

“Oh, dear,” he said as Gideon wrapped the drawstring twice around his waist, “did you see what his blood alcohol level was?”

Gideon shook his head. “Pretty high, I imagine.”

“That’s putting it mildly. One hundred and fifty-two milligrams. Not surprising he fell off that catwalk. The wonder is that he was able to get out on it in the first place.”

“You’re inclined to go with the ‘accident’ theory, then?”

“Well, I wouldn’t go quite as far as that. That’s what we’re here to try and determine, isn’t it? But I must say it seems like a reasonable starting hypothesis. At that level of intoxication, one is anything but steady on one’s stumps.”

Gideon slipped into the booties-normal-sized ones-and the two men shuffled down the corridor to the autopsy room, Gideon stolidly, and Merrill practically skipping at his side.

“It’s a pity you weren’t here just two days ago,” the pathologist told him. “We had an astonishing case, really incredible. This chap had committed suicide by turning on his table saw and jamming his head into it. Never seen anything like it. Cleaved his head in half right down the middle, neat as a pin, exactly through the longitudinal fissure, clear down to the vermis of the cerebellum, can you believe it? Like looking at a median sagittal section of the head in an anatomy text.” He sighed. “Gone now, though. Had to release the body.”

“Sorry I missed it,” Gideon mumbled. “My bad luck.”

Merrill brightened. “We have photographs, though.”

“Oh, great. Maybe later if there’s time.”

“Here we are, then,” Merrill said with transparent pride, pulling open the door to a spic-and-span, white-tiled autopsy room. “Hic locus est ubi-”

“-mortui viventes docent.” Gideon finished for him. This is the place where the dead teach the living. A favorite motto of forensic labs. Gideon had it on a plaque on the wall of the anthropology department’s bone room at the university.

The moment the door opened, the mildly unsettling smell of hospital antiseptic was displaced by the more unsettling, though more familiar, mixture of formaldehyde and tissue going bad, l’arome de la morgue. Inside, Joey’s graying body lay faceup on the metal table, naked and pitifully vulnerable under glaring fluorescent light fixtures. Above the foot of the table hung the usual meat-market scale, shocking in its ordinariness, in which his internal organs would be weighed. A tall, somber, long-limbed Indian man, the diener-the autopsy assistant-was finishing up his tasks of preparing the body and the instruments, and taking the preliminary measurements and photographs.

“We are all ready, Doctor,” he said on seeing Merrill.

“Hello, Rajiv. X-rays?”

“Yes, Doctor. The physician from St. Mary’s sent them.” Rajiv nodded toward the wall-mounted viewing box, to which four X-ray plates had been clipped. Merrill walked to the box and, leaning over, peered briefly at the indistinct images. “Fractured spinous processes on these upper thoracic vertebrae, you see?” he said, pointing. “Some damage to the sacroiliac region as well. Both perfectly consistent with a fall onto his back, wouldn’t you say?”

Gideon nodded and placed a finger on a photograph of the left arm. “And I think the olecranon is broken, too; that’d go along with it as well.”

“Yes, I believe you’re right. The cranial photos are ambiguous, though, but then who can read a cranial X-ray? There’s damage to the head, all right, inside and out, but hard to tell exactly what kind.” Merrill straightened up, his eyes alight and already straying toward the saws and knives that Rajiv had set up on a small rolling table. “May as well have a look at the real thing, shall we?”

“May as well,” Gideon said forlornly.

“Well, let’s cover him up, Rajiv,” Merrill said.

“Cover him up?”

“For decency’s sake.”

“Decency’s sake?”

“Yes, we’ll start at the top-”

The top? Gideon said to himself.

Rajiv didn’t disappoint him. “The top?”

“Yes, the top. Dr. Oliver will be most interested in the skull, I believe, so let’s begin there. In the meantime, let’s drape him from the neck down, why don’t we?”

Rajiv was obviously dubious about the correctness of this-pathologists generally began with the trunk; the famous Y-incision-but he did as he was told without even a murmured “Drape him?”, pulling a sheet neatly, even tenderly, up over Joey’s body. Clearly, understanding that Gideon had known Joey, Merrill had had this done out of sensitivity for his feelings, and Gideon very much appreciated it. It was, for whatever reason, easier-less of a violation, less defiling-to open up Joey’s head with the rest of him covered up.

Rajiv handed both men plastic “bouffant-style” operating room caps, which they slipped on over their hair. Gideon was grateful that Clapper wasn’t there to see him.

“You didn’t want gloves, did you?” asked Merrill, who was partial to doing his dissecting bare-handed. “When I’m working with tissue, I find the sense of touch in my bare hands extremely sensitive,” he had once told Gideon-who much preferred gloves, and for exactly the same reason.

“Gloves?” Gideon said now, as if they were the furthest thought from his mind. “No, of course not.” With luck, he wouldn’t have to touch anything.

Many pathologists had their dieners do the gross cutting-the Y-incision, and the ear-to-ear over-the-top-of-the-head incision to get at the skull-but not Merrill, of course. He preferred to do it all himself, so once Rajiv had placed a support block under the back of Joey’s head and turned on the hanging microphone to record their observations, the diener stepped away from the table, awaiting further instructions.

“Well, let’s see what we have,” Merrill said happily. Gideon half expected him to rub his hands together, but with his arms remaining folded, he peered long and hard at Joey’s head. “What do you think?”

Until that moment, Gideon hadn’t looked directly at Joey’s face, but now he did. It helped, he found, that Joey didn’t look much like Joey anymore. In addition to the puffiness and distortion that went with death from cranial blunt-force trauma, on his face had blossomed a pair of bilateral periorbital hematomas-spectacular, purplish, shiny black eyes, which were known in the trade as “raccoon eyes,” and for good reason. Huge and round, blackening both his upper and lower eyelids, swelling them closed, and as dark as stage makeup, they made it look as if he were wearing a strange, pale face mask with black holes cut out for the eyes. His hair, so colorless and fine to begin with, had been rinsed by Rajiv under the faucet at one end of the autopsy table and was still damp, so that it seemed limper and sadder than ever. High on the back of his head, about two inches up from the part of the scalp overlying what anthropologists called “lambda”-the Y-shaped juncture where the two parietals meet the occipital bone-a circular area three or four inches in diameter had been shaved, the better to show a gaping, star-shaped laceration where his scalp had split open.

“You’re the pathologist,” Gideon answered. “What do you think?”

“I think we’re looking at a pretty obvious case of blunt-force trauma to the posterior parietal region, which, of course, goes along with the injuries on the radiograph.” He added a few observations for the microphone and pressed gently against Joey’s cheeks and temples. “No indications of superficial damage around the eyes, and the craniofacial skeleton seems undamaged. I expect we’ll find that the orbital hematomas are not distinct injuries, but a result of the parietal trauma, the force having been transmitted by the brain.”

Gideon nodded. “Contrecoup.”

“Contrecoup,” Merrill agreed.

They were talking about one of the most intriguing and least understood aspects of damage to the human skull and brain: the distinction between coup and contrecoup injuries. Generally speaking, when a moving object hit a stationary head-a blow with a hammer, say-the injury to the brain was going to be directly under the impact point. Whack a man hard enough on the occipital bone at the back of the head, and it will almost always be the occipital lobe of the brain that gets pulped. That was a “coup” injury. But when things were reversed, when a moving head hit a stationary object-in a fall, for example-the brain injury was likely to be at the opposite pole of the brain. Let a man fall off a catwalk onto stone paving and land on that same, rearward occipital bone, for example, and it would be the frontal lobe of the brain that got mashed into red jelly: a “contrecoup” injury.

Why this should be had puzzled scientists for centuries. In 1766 the Royal Academy of Surgeons in Paris had offered a prize for a definitive explanation of contrecoup. They didn’t get one then, and they still didn’t have one that satisfied everybody. Gideon, no expert on the brain, was willing to accept the common theory that, in a fall, the skull is traveling faster than the brain that is cradled inside it, so that when the back of the head hits the ground the brain continues to move, subjecting it to a piling-up of impact forces at the front.

Whether that was really the way it worked or not, contrecoup injuries were a fact, and he agreed with Merrill that they were looking at one now.

“Well!” exclaimed Merrill, and now he really did rub his hands together. “Let’s get on with it!” He stuck out a hand, into which Rajiv slapped the scalpel that he had waiting. Gideon moved a discreet step back. Rajiv, who was already wearing surgical gloves, now pulled up the mask that had been loosely tied around his neck.

Merrill, maskless and gloveless-contrary to both forensic and hygienic protocol-was a quick, sure worker, with no wasted movement. One hand, on Joey’s forehead, steadied his head against the block, while the other placed the scalpel blade behind the left ear. A moment’s pause to align the blade to the path that was to be followed, and the scalpel was deftly whipped over the top of the head, well in front of the scalp wound, and around to the back of the other ear: the standard coronal mastoid incision to expose the skull. With Joey dead so long, there was very little blood, but all the same Gideon’s stomach contracted, almost as if he could feel the blade slicing through his own scalp. This was at least the twentieth autopsy at which he’d been present, and before them he’d dissected two corpses in gross anatomy in graduate school, yet it was always the same. Would he never get used to them?

Probably not, but at least he no longer scandalized the autopsy staff by throwing up in the nearest sink, which he’d done the first time, in the San Francisco city morgue, a place he’d never again had the nerve to show his face.

With the cut made, the scalp was now essentially divided into two flaps. The rear one was pulled back and the front one vigorously tugged forward and down over Joey’s face, hair side down, depersonalizing him yet a little more and helping Gideon toward thinking of what he was looking at simply as a cranium, and not as the cranium of the nice kid he’d had dinner with the night before last. The yellowish, blood-flecked skull, its delicate, meandering coronal and sagittal sutures faintly visible, was now exposed from the ears up, and Gideon, took a step toward it for a closer look, interest overcoming aversion.

“Depressed fracture,” he said.

“Yes, that’s a bit of a surprise, isn’t it?”

Gideon agreed that it was.

The thing was, coup and contrecoup injuries weren’t the only way in which stationary heads that got in the way of moving objects usually differed from moving heads that ran into stationary objects. The skull fracture that was most likely to result from a fall was what is known as a linear fracture-or in common parlance, a crack-that might be anything from a single, relatively straight fissure, to a spiral network, to a maze of large and small cracks that broke the skull into a hundred pieces. A depressed fracture, on the other hand, was one in which the bone directly under the impact point was partially or fully separated from the rest of the skull and driven in, toward the brain, much as a hammer, striking a block of foam, wouldn’t crack it in half, but would leave a sunken imprint of itself in the block. And, naturally enough, such “imprints” were most likely to be the result of blows with instruments-hammers, rocks, ash-trays, or anything else that came to hand in a murderous moment. One didn’t often find depressed fractures in falls onto flat surfaces.

One did, however, occasionally find them in falls directly onto edged or pointed objects.

Which is what Merrill concluded had happened. “His head must have struck something when he fell-something in addition to the paving, I mean. Would there have been any relatively small objects lying on the ground that his head might have hit? Rubble, rocks…?”

“I never did see the body in place, so I don’t know exactly where it landed,” Gideon said, “but yes, there was a lot of stuff lying around in the passageway: tools, construction material, pottery shards-”

“Well, there it is, then. It might have been anything: a rock, or

…” He paused, seeing Gideon’s scrutiny growing more intense. “I say! You can probably tell what it was from the shape of the wound, can’t you?” he asked eagerly. Merrill was something of a fan of Gideon’s, and had been from the first, having earlier read several of his papers in the Journal of Forensic Sciences and some of the more sensational articles in the general media about his work with skeletal remains. And so he tended to expect more than Gideon could always deliver.

“Well, sure, sometimes you can,” Gideon said, shaking his head, “but this one? I don’t know, it’s not a very well-defined imprint. Doesn’t look like anything to me at this point. No, I wasn’t looking at the depressed part, I was looking at the fracture pattern around it, trying to make out…”

His voice faded away, as it frequently did when he was studying bones or thinking about them. And there was something about this one that intrigued him. Sometimes the impacting force of whatever had caused the depressed fracture stressed the surrounding bone enough to create a network of radiating cracks around the depression, and that was what had apparently happened with Joey. The depressed fracture itself was an irregular disk of bone, no more than an inch across, and driven only a couple of millimeters below the rest of the skull, but it lay in a spider-web of cracks that ran jaggedly off in every direction, over much of the skullcap; the calvarium, as it was known. But unless he was mistaken…

Merrill had waited politely for a minute while Gideon stood unmoving, then for a second minute, and then exchanged a what-in-the-world-is-the-man-doing look with Rajiv, who shrugged.

Merrill coughed gently. “I say, Gideon, I’d certainly like to see what the situation is inside the braincase. I have to remove the calvarium anyway. Why don’t I just separate it and give it to you to examine at your leisure while I scoop out the brain, don’t you know?”

Pathologists, Gideon had noticed, were often in a hurry to get through the skeletal architecture, feeling that the “real” information was going to come from the internal organs and structures. Anthropologists, naturally enough, saw it the other way around.

In any case, Merrill’s offer suited Gideon just fine, and he was quick to agree. “You’ll make sure you don’t cut through any of the fracture lines, though?”

Merrill sighed and looked at him.

“Sorry, sorry,” Gideon mumbled.

Merrill held out his hand, into which Rajiv plunked most pathologists’ instrument of choice for skullcap removal: the Stryker saw, a vibrating saw with a small, semicircular blade that oscillated in a narrow arc of about twenty degrees. This limited action ensured that the blade would not cut through to any soft tissue, “such as,” Merrill had laughingly told him last time, “the pathologist’s hand.”

Gideon stepped back again, keeping well clear of the mist of bone tissue that the saw threw up as it circled the outside of the brain case, deeply scoring it. Once that was done, the saw was replaced by a small hammer and a narrow chisel, and then by a miniature pry bar, with which the top part of the skull was delicately pried away from the bottom. For the first time, Gideon closed his eyes, preferring not to watch. If he could have gotten away with it, he would have stuck his fingers in his ears as well, to avoid the sucking sound that came when the top of a skull was pulled off.

When he opened them, the rounded calvarium was on the table near Joey’s head, interior side down, and a concerned Merrill was frowning at him.

“Is anything wrong?”

“Uh, wrong? No, I just had something in my eye. It’s okay now.”

“Good. Would you like me to scrape the dura off, so you can have a look at the underside as well?”

The dura-the dura mater-was the outermost layer of the brain coverings-the meninges-and when the brain was removed it remained behind, stuck to the inside of the skull, making it impossible to see the skull’s interior surface.

“No, don’t,” Gideon said. “The calvarium’s really fragmented. I’m afraid the dura is all that’s holding it together. Anyway, it’s the outside I’m interested in.”

“Yes,” said Merrill, “mm, ha, look at that. Well, now. My word.” He was now as absorbed by Joey’s naked, glistening brain as Gideon had been by the skull, and why not, Gideon thought. Who was he to shake his head in amazement at someone who got enthusiastic about prodding with a finger-an ungloved finger-into a bloody brain? There were plenty of people who had a hard time seeing what it was about bones that so fascinated him.

“Wilson?” Gideon said. “Would there be someplace I could go with this?”

The question was met with raised eyebrows. “You don’t want to stay on for the rest of the autopsy? But we’ve hardly begun.”

“Oh, well, yes of course I do, I’d love to, but I only have a limited time, unfortunately. I do need to get back, so I’d better get on with looking over these fractures. And, really, I’m afraid I’ll be underfoot here. You don’t have that much room. And it would be better if I could examine it someplace quiet, maybe sitting down somewhere.”

It was overkill for a simple request, and Gideon feared that Merrill might read it for what it was-a lame attempt to get the hell out of the autopsy room-but all he could make out on the pathologist’s face were disappointment and surprise, both of which were manfully overcome.

“Certainly,” he said. “Rajiv, take Dr. Oliver to the specimen room. He can use the table there.”

Placing the calvarium on a towel, Rajiv led Gideon a couple of doors down the hall to a tiny room that stank even more of formaldehyde, and with good reason. The shelves that ran around three of the walls were loaded with specimen jars filled with various organs in cloudy formalin, some floating, some sunk to the bottom, some hanging on strings. But specimens in jars, well-separated as they were from their owners’ bodies, didn’t bother Gideon, and he had no trouble concentrating on the cracked, ivory-colored dome in front of him.

Without a word, Rajiv smilingly handed him a set of gloves, and Gideon smiled his gratitude in return.

“Well, Joey,” he said softly, as Rajiv pulled the door shut behind him, “let’s see what you have to tell me.”

At that, he smiled. Maybe Julie was right. Maybe he did talk to bones.

In a way, it was worse than that, because this particular one was talking back to him.