“Keep your head just like that,” Rivera told him.
Jack’s chin was raised slightly, but with a little effort he was able to see what was going on at shoulder level. Rivera held an eight-by-ten photograph below Jack’s chin for comparison. The tone of the discussion changed, as if Jack was no longer in the room, Rivera and Andie talking cop to cop.
Rivera said, “You see the bruising pattern that is emerging here, right along his carotid artery?”
“Definitely,” said Andie.
“Now look at the photograph.”
Andie paused, seeming to study it. “Bruising is virtually in the same spot,” she said.
“Same spot as who?” asked Jack.
Andie touched his hand, as if to reassure. “Celeste Laramore.”
Jack took a minute to absorb the comparison, but his skepticism bore out. “This is junk science, folks. Wouldn’t anyone who gets choked have a bruise like mine?”
“No,” said Rivera. “That’s the interesting thing. I asked our medical examiner to take a look at Celeste Laramore’s photos. He says the bruising pattern on her neck is more like a hanging, where the rope jerks up higher on the neck. It’s the simple force of gravity, the weight of the body pulling the victim down. Choking someone with your bare hands tends to produce a bruising pattern much lower than this. Unless you were lifting them up by the neck.”
“He didn’t lift me up. I was on the ground.”
“That’s my point. No one saw Celeste Laramore’s feet leave the ground, either.”
“You’re suggesting we had the same attacker?”
“It’s an assumption based on the M.O.”
“Strangulation?”
“More than that. It’s the way he strangles his victim. He seems to be trying to simulate the effects of a hanging with his bare hands.”
Jack gave it some thought. “Well, I don’t necessarily agree that you can ascribe an M.O. to someone in a mob who reached out and grabbed Celeste Laramore by the throat. But for the sake of discussion, let’s say you’re on to something. Why would anyone try to simulate a hanging?”
The doctor spoke up. “Possibly to involve the carotid sinus.”
“The what?” asked Jack.
“The carotid sinus is a dilatation of the lower end of the internal carotid artery,” Dr. Cohen said, gently putting her hand to Jack’s neck. “It functions as a baroreceptor, which is complicated, but basically it plays a key role in short-term blood pressure control.”
The doctor no longer seemed like a teenager to Jack. “So. . you’re saying what? The carotid sinus comes into play in hanging but not in other forms of strangulation?”
“Not exactly. But there have been studies on this, partly out of morbid fascination with what actually causes death in a hanging, which isn’t fully understood. It’s safe to say that a hanging would more likely involve pressure above the carotid sinus-like your injury. Other forms of manual strangulation might involve pressure on or below the carotid sinus.”
“Above or below-what’s the difference?” asked Jack.
“Pressure above the carotid sinus can interrupt parasympathetic pathways between the brain and heart, which can result in anything from fainting to instantaneous death.”
“To coma,” said Jack, thinking of Celeste Laramore.
“Yes. Coma is possible. Depending in part on the duration and force of the compression. Don’t get me wrong. You can get the same end result with pressure on or below the carotid sinus. But there are researchers who posit that pressure above it-as in a hanging-is more, shall we say, efficient. Or maybe ‘expedient’ is the right word.”
The doctor refastened Jack’s neck brace, but Jack was watching Andie, almost able to feel her next question coming.
“Doctor,” said Andie, “how difficult is it for someone to know how much force and compression are needed to achieve a specific result along the continuum you described?”
“Are you asking me if someone could learn how to squeeze a person’s neck just long enough to make him pass out, how to apply enough pressure to make sure he’s dead, how to stop just short of death and induce a coma?”
“Yeah, that’s what I’m asking.”
“Virtually impossible.”
“Well, you’re the doctor,” said Jack. “But isn’t controlled deprivation of oxygen the whole idea behind erotic asphyxiation?”
Andie’s mouth opened, but the words were on a few-second delay. “Not that he learned that from me.”
The detective snickered. “Henning, I knew you had a wild side.”
“No, no,” Jack said nervously. “I wasn’t implying. . Actually, this was another woman I dated who used to like to-”
Jack stopped, frozen by a glare from his fiancee that said, Way too much information.
An awkward silence hung between them. Finally, the doctor bailed Jack out.
“Mr. Swyteck raises a good point,” said Dr. Cohen. “The notion that oxygen deprivation is something you can manipulate with precision is a myth. Even when the participants know each other intimately, and the strangulation is intended only to enhance sexual gratification, mistakes happen. So you can only imagine what a guessing game it is when the victim is a stranger. There’s absolutely no way to know how far you can push it without fatal results. Too many different variables come into play. One person’s fainting episode is another person’s cardiac arrest.”
Jack was reluctant to say more on the subject, but it was worth pursuing. “There’s always someone who thinks he’s smart enough, who thinks he can play God and get whatever result he wants.”
Andie picked up on Jack’s point, apparently having forgiven his faux pas. “I see this in my criminal profiling. Predators with enough experience to fancy themselves experts on such matters.”
The doctor considered it. “That would be one very sick human being.”
Andie took Jack’s hand, her eyes clouding with concern. “I’ve known a few of them.”
Jack would have nodded, if not for the neck brace. “You and me both,” he said.
Chapter Twelve
Jack left the ER just after midnight. He could have walked out on his own power, but the nurse insisted that “hospital policy” required him to remain in a wheelchair until they were through the doors and were completely outside the building. It was standard procedure for patients who have experienced any loss of consciousness.
“And for lawyers,” the nurse told him.
Jack did a double take.
“Kidding,” she said, only half smiling.
Andie held his hand a little tighter than usual as they started toward the stairs, making sure he was stable. From the top step Jack could see all the way across the parking lot to the bay. Not many hospitals shared a breathtaking stretch of shoreline with some of the most expensive waterfront homes in Miami, and the sparkle of the moon on Biscayne Bay reminded him why, year after year, the New Times survey of south Florida attractions rated Mercy Hospital as “best view from a death bed.” Jack stopped at the base of the stairs. A certain aspect of their conversation in the ER was weighing on his mind.
“Andie, when Dr. Cohen and I started talking about erotic asphyxiation-”
“Jack, let’s not go there.”
“Please. I want you to know-”
“I don’t need to know anything about it. Really.”
“But I don’t want you to think that-”
“Jack, just stop.”
“It’s not that we were into strangling each other. She would just hang her head off the edge of the mattress when we-”
“La-la-la-la-la-la-la-la,” she said with her hands over her ears. “I can’t hear you.”
A camera flashed. Jack turned so quickly that not even the neck brace could stop him from hurting himself. Another flash blinded him. His vision returned in time for him to see the photographer leap over a small hedge and jump into the passenger side of a car that was waiting at the curb with the motor running. The tires squealed as it sped away.