After replacing the sheet, Jack maneuvered the gurney out of the cooler, across the hallway, and into the autopsy room, which had been upgraded to an extent since his arrival at the OCME but still held remnants of its outdated self. There was no doubt that the largest, oldest medical examiner institution in the United States was in dire need of a new autopsy suite.
Vinnie had made great strides in getting ready with his usual efficiency, and Jack’s favorite autopsy table was ready with everything laid out. It was table number eight at the far end of the room, and Jack headed in its direction. He much preferred this table because its location far from the entrance meant he was less casually interrupted by fellow MEs coming in to do their cases. Jack wasn’t asocial in any way. Far from it. It was just that he liked to maintain his concentration with the fewest interruptions as possible. As Laurie had suggested, he was the fastest prosector on staff.
After the gurney came alongside the table, Vinnie pulled off the sheet. He then helped Jack lift the body onto the table.
“Wow!” Vinnie said with a grunt. “She is one solid lady.”
“She was quite an athlete in her day,” Jack said. He walked over to the X-ray view box and glanced at Sue’s film, which Vinnie had already put up.
“X-ray is all clear,” Vinnie called out. Over the years he’d become expert at reading X-rays to the point of occasionally catching small details that Jack might miss.
Jack nodded, then returned to table eight. Vinnie had a camera ready, and Jack took a few initial photos, and while he was doing so, he noticed what looked like a small bloodstain on the dress near Sue’s right hip. Pointing to it he asked, “Does this look like blood to you?”
“Could be,” Vinnie agreed after bending over to take a closer look. “It wouldn’t be surprising, either.”
“Get me some scissors anyway,” Jack said. He knew that body fluid stains, including blood, were certainly an occupational hazard for a doctor during a normal day in the clinic, but Sue was meticulous. Once he had a pair of dissecting scissors, he cut out a square of fabric containing the stain. He put it in a sample bottle that Vinnie held out. With that accomplished, they removed both the black Burberry winter coat whose arms had been cut open lengthwise during the resuscitation attempt, and then the red dress. Next to go were the underclothes. For thoroughness, all of it would be saved for a period of time as standard practice.
Once the body was completely naked, Jack and Vinnie together did a thorough external examination that included the entire body, talking as they did so to point out everything and anything abnormal. The only things of note were multiple injection sites on her abdomen and both thighs, some obviously older than others, as would be expected with an insulin-dependent diabetic. One on the right thigh appeared to be the most recent, with even a small amount of surrounding bruising. Jack took several close-up photos in his usual obsessive-compulsive, detail-oriented fashion. Later, when they removed the endotracheal tube after ascertaining it indeed was in the proper position in the trachea, Vinnie noted a laceration of the upper frenulum between the gum and the lip.
“It probably occurred during the intubation in the ED,” Jack said. “But good pickup!”
While Vinnie held the upper lip away from the teeth, Jack took a photo of the defect. Then, after removing the intravenous catheters, they were ready to go.
“Let’s not dillydally,” Jack said as he reached out toward Vinnie while glancing up at the wall clock. The tray with the instruments and all the sample bottles was on Vinnie’s side of the table. On Jack’s side was the camera and a pad for notes and diagrams. Picking up the scalpel, Vinnie jokingly slapped it into Jack’s hand the way he’d seen it done in movies during operations on live patients. They both laughed at the routine nature of what they were about to do, a procedure that normal people would find ghoulishly cringeworthy.
Chapter 4
Tuesday, December 7, 7:55 a.m.
Now that the autopsy proper had started, Jack and Vinnie worked efficiently and silently. Since they could anticipate each other’s moves and instinctively knew what had to be done, there was little need for conversation. With the scalpel in hand, Jack made the usual Y-shaped incision, starting at the points of both shoulders, connecting over the sternum, and then running all the way down to the pubis. It was done in two rapid, decisive strokes. When Jack was finished freeing up the margins, Vinnie exchanged the scalpel for the bone shears, so Jack could cut through the ribs to free up and remove the sternum. With the body open like a book, exposing most of the major organs, Jack proceeded to take the usual fluid samples from the aorta, the gallbladder, the urinary bladder, and the eyes with a variety of syringes that Vinnie silently handed over.
“Okay,” he said, more to himself than to Vinnie, when all the toxicology samples had been obtained and he was looking down at the heart nestled between the lungs. “Let’s see what went wrong with the ticker.”
With forceps and scissors, Jack opened the pericardium. So far everything appeared entirely normal, yet he wasn’t surprised. Often fatal heart attacks, even massive ones, weren’t grossly visible, nor were sudden ruptures of heart valves until the organ was opened. Back to using the scalpel, he freed up the heart by cutting through all the attached great vessels and lifted it out of the chest cavity. Gingerly he placed it on a tray Vinnie presented. Stepping down to the foot of the autopsy table while carrying the tray, Jack used a combination of large dissecting scissors and a long-bladed knife to open all the chambers.
“Looks pretty damn normal,” Vinnie commented. He had joined Jack, watching intently.
“You got that right,” Jack agreed. “The pathology is going to be in the coronary vessels.” Meticulously he began tracing out the complicated arborization of the heart’s arteries using more delicate dissecting tools. He worked quickly but painstakingly, looking for the telltale signs of atherosclerosis or plaque lining the interior of the vessels, a condition frequently suffered by diabetics, which could cause the vessel to occlude suddenly, thereby denying a segment of the heart its needed oxygen and nutrients. When it happened, it was called a heart attack.
“My word!” Jack said with surprise as he continued working. “I don’t see any plaque whatsoever. The vessels look like those of a normal teenager.” In the recesses of his forensically oriented mind, faint alarm bells began to sound. With no cardiac pathology, the idea that Sue’s death was natural was being seriously called into question, thereby awakening the possibility of it being accidental or, worse still, homicidal.
“You said she was athletic,” Vinnie said.
“True enough. She was also chief of internal medicine at an academic medical center. She knew how to take care of diabetes and her general health, and she practiced what she preached.”
When Jack was finished with the dissection of the heart and Vinnie had bottled and labeled all the histology samples, Jack returned to his position on the right side of the patient. Moving on, he palpated the lungs before removing them. As he did so, he sensed they were a bit heavier than expected, which was confirmed when he weighed them. “Curious,” he mumbled.
“How much?” Vinnie asked.
“Two-point-four pounds,” Jack said.
Stepping back down to the foot of the autopsy table, Jack made use of the same tray he’d used to dissect the heart to make a series of slices into the lungs. “Mild pulmonary edema,” he commented as he looked more closely.