It fills out arteries and veins, and they expand visibly beneath the surface of the skin as if Gail Shipton’s blood is circulating again. She almost looks alive and yet my station in the autopsy room smells like a funeral home.
“Let’s get her back into the scanner.” I take off my gloves and face shield. “We’ll see if something was going on with her vascular structures. Let’s see if she went into cardiac arrest before he had the chance to murder her.”
“What are you thinking killed her exactly?” Lucy asks.
“This likely is going to be a diagnosis of exclusion,” I reply. “Determining what didn’t kill her might help us figure out what did. I know, for example, that at some point her blood pressure went through the roof, causing petechial hemorrhages in the conjunctiva of her eyes.”
I detach the autopsy table from the sink and release the brakes on the swivel caster wheels.
“I’m entertaining the possibility that she died of cardiac arrest while being shocked with a stun gun,” I explain, “or perhaps while he was attempting to smother her with something that left fibers in her nose and mouth. She may have been struggling to breathe but I don’t think she struggled long, not as long as it usually would take to smother someone, especially if the killer does it slowly, sadistically, enjoys drawing it out.”
“Like he waits until they pass out, then loosens the cloth so they can breathe, and does it over and over again,” Anne suggests.
“Possibly, but not with Gail. Not with a pneumothorax. Did she ever complain to you about chest pain, about any cardiac problems?” I ask Lucy.
“Not specifically. I know she complained of being really stressed. As I mentioned, sometimes she said she felt short of breath. She sighed a lot, was tired a lot, but that could have been from anxiety, and she didn’t exercise. The most she’d do was walk on a treadmill.” She stares at Gail Shipton’s face, her own a hard mask that gets more rigid with each minute that passes.
“Are you hanging in there?” I ask her.
“What do you expect?”
“You don’t have to be here.”
“Yes I do. It doesn’t bother me the way you think it would.”
We wheel Gail Shipton across the autopsy room.
“She did this to herself,” Lucy says. “That’s what bothers me.”
“She didn’t do it,” I reply. “Someone else did.”
“I’m not blaming her for what he did. But I’m blaming her for what she set into motion.”
“Let’s not blame her,” I say to my niece. “No one ever deserves to be murdered, I don’t give a damn what they do.”
Back inside large-scale x-ray, we cover the scanner’s table with clean sheets and position the body on its back. I push more embalming fluid through the iliac artery and Anne presses a button and the table slides in with a quiet hum. She angles the gantry, pressing a red button to landmark where the laser lines intersect at the head.
“We’ll start the scan at the carina, the lowest tracheal cartilage, and scan to the top of the orbit,” I instruct.
We retreat to Anne’s console behind glass and turn on the bright red X-Ray in Use warning sign and shut the door. The level of radiation in that room is safe only if you’re dead.
“Virtual 3-D volume rendering from inside out,” I decide. “Thin, thin cuts, one-millimeter, with an increment between them. What do you think?”
“Point-seventy-five by point-five will do.” Anne uses her computer to turn on the scanner.
It begins to pulse. Buzz-buzz-bloop-bloop — warming up. We hear the sounds of the x-ray tube rotating, and she selects Chest on the menu, opening a box on the area of interest, which is the structures of the heart. That’s what we’ll start with. I want to know if Gail Shipton suffered from some vascular defect that might have made her vulnerable to a sudden death that, as Benton suggests, cheated the Capital Murderer.
When he shot her with a stun gun did she go into an arrhythmia and die before he could suffocate her? Did her heart quit while she was struggling violently to breathe and he didn’t get to finish torturing her? I have a suspicion that the pinpoint hemorrhages in the conjunctiva of her eyes might be related to a blood flow constriction, possibly a problem with one or more of her valves. The Washington, D.C., victims had a light scattering of petechiae across the cheeks and eyelids but Gail Shipton’s ruptured capillary vessels are profoundly florid.
What happened to you?
“If you follow the contrast agent through her vessels,” I explain to Lucy, “you can see the structures in exquisite detail, nice and bright like well-lit roads. And here’s the problem. Right here.” I point at the computer display. “In real time we’re seeing a defect she likely had no idea about.”
“Wow, that’s too bad.” Anne moves the cursor, opening a new box and grabbing the image. “It’s always scary to think what might be inside us just waiting to ruin our day.”
I show Lucy the narrowing of a coronary artery that caused an insufficient blood flow to the heart.
“Aortic valvular stenosis, which has caused thickening of the muscle wall of the left pumping chamber,” I note. “Possibly this is a congenital condition or maybe as a child she suffered a bacterial infection that caused inflammation and scarring. Strep throat, for example, that turned into rheumatic fever.” I recall what Bryce said about Gail Shipton’s teeth. “That might be why she had enamel malformation, if she was on an antibiotic such as tetracycline.”
“What would this valve problem do to her?” Lucy asks.
“Over time her heart would have continued to lose its ability to efficiently pump blood, eventually reaching a point when the muscle would no longer expand.”
“Meaning she was a candidate for heart failure. In other words, she wasn’t looking at a healthy long life,” Lucy says as if that’s what she wants to believe.
“Who knows what anybody has to look forward to?” Anne says. “Remember Jim Fixx, the running guru? He goes out for his daily jog and drops dead of a heart attack. Rich people on the golf course get struck by lightning. Patsy Cline went down in a plane crash. Elvis died on the toilet and that sure as hell wasn’t what he had in mind when he got up that morning at Graceland.”
“She would have had fatigue, shortness of breath, heart palpitations. She might have felt faint during exertion, which is consistent with what you’ve described to me,” I say to Lucy as I study the scan. “She may have had swollen ankles and feet.”
“Sometimes she complained about her shoes being tight.” Lucy sounds more entranced than somber or sad. “She liked slip-ons, sandals.”
I envision the green faux-crocodile leather flat Marino found behind the Psi Bar.
“Sounds like she was already decompensating. Did she have routine physicals?” I ask.
“I don’t know except she hated doctors.”
“Her heart had to pump harder than it should have,” I continue to explain.
“She hated people, really,” Lucy says. “She was introverted and antisocial and I should have known better when she tried to pick us up.”
“Pick you up?” Anne turns in her chair, her mouth agape. “She tried to pick you and Janet up in a bar? Well, that’s living dangerously.”
“At the Psi one night last spring,” she says and I recall that in the spring I didn’t yet know Janet was back in Lucy’s life.