"I suppose you've seen your share of burn cases, Dr. Coran," said Repasi, "but have you ever seen anything worse than this?"
She paused, considered his question, and replied, ''Yes, I have."
"Oh, really? Explosion victims? Lightning victims?"
"A woman who was scalded to death."
Both doctors appreciated the severe nature of burns from boiling water, knowing that water heated to 158 degrees Fahrenheit caused a full-thickness burn in adult skin in one second of contact.
"Ahhh, bathroom shower injuries I've seen, but nothing approximating this."
"This was no bathroom shower accident. It was a victim of murder whose body was placed in a scalding hot spring in Yellowstone National Park, held under by her ankles as she thrashed. The scalding was uniform, not showing any burn variation, no multiple splash bums, just all-over fourth-degree burns. The killer hoped to cover up a rape-murder by completely scalding the body in a two-hundred-five-degree hot pool. She was scalded over her entire body, save her ankles and feet, which were only mildly burned by comparison. Sloppy oversight on the killer's part, but then he didn't know a medical examiner was in the park at the time. The murderer was a young park ranger who'd come up on the victim where she was hiking alone in the park. That was some ten or eleven years ago."
"Sounds like an interesting case," he granted.
"It was the first murder case I ever solved."
While Page's hospital was an adequate, modern facility, the death room and the forensic equipment in Page left a great deal to be desired; still, Jessica was glad to see that they had at least the rudiments for a pathology lab and that it was not placed in the subbasement of the hospital or the back of a funeral home, as was the case in hundreds of thousands of small towns all across America. There was just sufficient enough space along with appropriate lighting, plumbing, and cooling facilities. The instrumentation included an X-ray machine for the pathology lab and coroner's office to share, a luxury, it appeared, despite the fact that an X-ray machine was basic equipment in any autopsy suite. Page also had its own small toxicological lab capable of accurate, precise analysis for the presence of drugs.
In getting the autopsy under way, Jessica spoke into a microphone that recorded her autopsy for later transcription. Back at Quantico, nowadays, the entire autopsy was put on videotape, and Jessica had learned to choose her words with extreme care, for anything said now could come back to haunt the medical examiner. She announced the purpose of their coming together, the name of the deceased, age, height, weight, sex, race, condition of the body upon discovery. This led her to add, "On gross examination of such a victim, it is virtually impossible to distinguish antemortem from postmortem burns. Microscopic examination of the body tissue offers no help, unless the victim has survived long enough to develop an inflammatory response. Wouldn't you agree, Dr. Repasi?"
Repasi promptly agreed, saying, "Yes, lack of such a response doesn't necessarily indicate that the burn was postmortem. I have had occasion to view third-degree burns incurred by Vietnam veterans in which the patients died two and three days later. In some of these cases, there was no inflammatory reaction whatsoever."
Jessica agreed now, adding, "Due, presumably, to heat thrombosis of the dermal vessels."
"Such that inflammatory cells could not reach the area of the burn and produce a reaction to begin with," finished Repasi.
Jessica thought that perhaps J. T. ought to have remained; he might well have learned something about the irregular nature of burn pathology.
"In Mr. Martin's case, it is presumed he was alive when he died due to witness testimony, namely Dr. Coran," said Repasi for the record.
"It may also be of interest that the skin has split open, revealing exposed muscle across the upper torso and upper extremities, while skin over the back is perfectly preserved. Where the skin is completely burned away, underlying muscles have ruptured due to the intensity of the heat," added Jessica.
Burned bone shone as gray-white with a fine, superficial network of fractures on the cortical surface. Repasi noted this for the shoulder bone and collarbone as well as the skull. With his gloved hand, he put slight pressure on a section of skull thus discolored, and it crumbled at his touch. He noted this for the record. "The outer table of the exposed cranial vault," he said, pausing, "reveals a network of fine, crisscrossing heat fractures."
Both examiners knew that it was extremely hard to burn a body, due to its high water content, and that to do the damage the Phantom had inflicted on Martin required a superheated energy source. Portions of the abdominal wall were burned away as well, exposing the viscera. The internal organs appeared charred, seared.
''In the autopsy on Chris Lorentian, who died from similar inflicted wounds," Jessica said, "there was evidence of an antemortem epidural hematoma."
Repasi added, "We find a similar blow to the head before death in Martin; there is a sizable postmortem epidural hematoma present. Not an uncommon sight in severely burned bodies. See here, Jessica, the chocolate brown color, crumbly, with its telltale honeycombed appearance."
"Yes, I see it. Large, fairly thick, overlying the frontal lobe, extending toward the occipital area."
He lifted a tiny ruler to it and asked an assistant to snap a picture, and for the record he announced, ''Yes, large at one point five centimeters."
"Good catch, Doctor." Jessica turned off the recorder for a word with Dr. Repasi. "Karl, I didn't know your specialty was burn victims."
''One of many,'' he replied with a grin beneath his surgical mask. "Shall we have a look-see at the larynx and trachea? Examine for carbon monoxide intoxication?"
"I prefer the term smoke inhalation, Doctor, but yes."
"Semantics," he parried and scalpeled at the same time, opening up the charred throat and dissecting the larynx and trachea, which, while fire-blackened and fractured on the outside, remained intact.
Too many people in the scientific community, as far as Jessica was concerned, used the terms of the profession too loosely, such as making carbon monoxide poisoning synonymous with smoke inhalation. A number of important factors other than the presence of carbon monoxide in the blood might cause death by smoke inhalation, such as oxygen deprivation due to consumption of oxygen by the fire itself, cyanide, free radicals, and the old standby to fall back on, nonspecific toxic substances. Jessica knew that in cases of self-immolation, carbon monoxide, as a general rule, was not elevated, since it was a flash fire. In cases involving explosives or gasoline fires, carbon monoxide levels in the blood were usually found to be in the so-called normal range. This held true even if the body were severely charred. Every fire, in fact, was unique, and each created its own unique mysteries. Of course, Repasi knew this as well as she.
She spoke again into the recorder, saying, "Smoke inhalation reveals soot in the nostrils and mouth, but this alone is no indication the victim was alive when the fire began. Any further look into the breathing apparatus will not change that fact."
But Repasi, ever the perfectionist, wanted to see the results of this fire to the windpipe as well. He announced what his scalpel now sliced through and why for the record. The soot had not coated the larynx, trachea, or bronchi, but both doctors took this in stride.
"Well, clean as a whistle except for the gristle," quipped Repasi. "What do you make of that, Dr. Coran?"
"Absence of soot in these areas in a flash fire is not uncommon, and it does not necessarily mean that Martin was dead prior to the blaze."