Anne clicks on the icon for tools to take measurements and informs me the width of the wound track before it blows through the diaphragm is .77 to 1.59 millimeters at a depth of 4.2 millimeters.
“So what that tells me…” I start to say.
“How about inches,” Marino complains.
“Some type of double-edged object or blade that doesn’t get much wider than half an inch,” I explain. “And once it penetrated the body up to an approximate depth of two inches, something else happened that caused profound internal damage.”
“What I’m wondering is how much of this abnormality we’re seeing is iatrogenic,” Ollie says. “Caused by the EMTs working on him for twenty minutes. That’s probably the first question we’ll get asked. We have to keep an open mind.”
“No way. Not unless King Kong did CPR,” I reply. “It appears this man was stabbed with something that caused tremendous pressure in his chest and a large air embolus. He would have had severe pain and been dead within minutes, which is consistent with what’s been described by witnesses, that he clutched his chest and collapsed.”
“Then why all the blood after the fact?” Marino says. “Why wouldn’t he have been hemorrhaging instantly? How the hell’s it possible he didn’t start bleeding until after he was pronounced and on his way here?”
“I don’t know the answer, but he didn’t die in our cooler.” I am at least sure of that. “He was dead before he got here, would have been dead at the scene.”
“But we got to prove he started bleeding after he was dead. And dead people don’t start bleeding like a damn stuck pig. So how do we prove he was dead before he got here?” Marino persists.
“Who do we need to prove it to?” I look at him.
“I don’t know who Fielding’s told since we don’t even know where the hell he is. What if he’s told somebody?”
Like you did, I think, but I don’t say it. “That’s why one should be careful about divulging details when we don’t have all the information.” I couldn’t sound more reasonable.
“We got no choice about it.” Marino won’t let it go. “We have to prove why a dead person started bleeding.”
I collect my jacket and tell Anne, “A head and full-body CT scan first. And on MR, full-body coil, every inch of him, and upload what you find. I’ll want to see it right away.”
“I’m driving,” Marino says to her.
“Well, pull it into the bay to warm it up. One of the vans.”
“We don’t want him warming up. Matter of fact, think I’ll put the AC on full-blast.”
“Then you can ride just the two of you. I’ll meet you there.”
“Seriously. He warms up, he might start bleeding again.”
“You’ve been watching too much Saturday Night Live.”
“Dan Aykroyd doing Julia Child? Remember that? ‘You’ll need a knife, a very, very sharp knife.’ And blood spurting everywhere.”
The three of them bantering.
“That was so funny.”
“The old ones were better.”
“No kidding. Roseanne Roseannadanna.”
“Oh, God, I love her.”
“I’ve got them all on DVD.”
I hear them laughing as I walk away.
Scanning my thumb, I let myself into the area that is the first stop after Receiving, where we do identifications, a white room with gray countertops that we simply call ID.
Built into a wall are gray metal evidence lockers, each of them numbered, and I use the key Marino gave me to open the top one on the left, where the dead man’s personal effects have been safely stored until we receipt them to a funeral home or to a family when we finally know who he is and who should claim him. Inside are paper bags and envelopes neatly labeled, and attached to each are forms Marino has filled out and initialed to maintain chain of custody. I find the small manila envelope containing the signet ring, and initial the form and put down the time I removed it from the locker. At a computer station I pull up a log and enter the same information, and then I think about the dead man’s clothes.
I should look at them while I’m down here, not wait until I do the autopsy, which will be hours from now. I want to see the hole made by the blade that penetrated the man’s lower back and created such havoc inside him. I want to see how much he might have bled from that wound, and I leave ID and walk along the gray tile corridor, backtracking. I pass the x-ray room, and through its open door I catch a glimpse of Marino, Anne, and Ollie, still in there, getting the body ready for transport to McLean, joking and laughing. I quickly go past without them noticing, and I open the double steel doors leading into the autopsy room.
It is a vast open space of white epoxy paint and white tile and exposed shiny steel tracks with cool filtered lighting running horizontally along the length of the white ceiling. Eleven steel tables are parked by wall-mounted steel sinks, each with a foot-operated faucet control, a high-pressure spray hose, a commercial disposal, a specimen rinse basket, and a sharps container. The stations I carefully researched and had installed are mini-modular operating theaters with down-draft ventilation systems that exchange air every five minutes, and there are computers, fume hoods, carts of surgical instruments, halogen lights on flexible arms, dissecting surfaces with cutting boards, containers of formalin with spigots, and test-tube racks and plastic jars for histology and toxicology.
My station, the chief’s station, is the first one, and it occurs to me that someone has been using it, and then I feel ridiculous for thinking it. Of course people would have been using it while I’ve been gone. Of course Fielding probably did. It doesn’t matter, and why should I care? I tell myself as I notice that the surgical instruments on the cart aren’t neatly lined up the way I would leave them. They are haphazardly placed on a large white polyethylene dissecting board as if someone rinsed them and didn’t do it thoroughly. I grab a pair of latex gloves out of a box and pull them on because I don’t want to touch anything with my bare hands.
Normally, I don’t worry about it, not as much as I should, I suppose, because I come from an old school of forensic pathologists who were stoical and battle-scarred and took perverse pride in not being afraid of or repulsed by anything. Not maggots or purge fluid or putrefying flesh that is bloated and turning green and slipping, not even AIDS, at least not the worries we have now when we live with phobias and federal regulations about absolutely everything. I remember when I walked around without protective clothing on, smoking, drinking coffee, and touching dead patients as any doctor would, my bare skin against theirs as I examined a wound or looked at a contusion or took a measurement. But I was never sloppy with my work station or my surgical instruments. I was never careless.
I would never return so much as a teasing needle to a surgical cart without first washing it with hot, soapy water, and the drumming of hot water into deep metal sinks was a pervasive sound in the morgues of my past. As far back as my Richmond days—even earlier, when I was just starting at Walter Reed—I knew about DNA and that it was about to be admissible in court and become the forensic gold standard, and from that point forward, everything we did at crime scenes and in the autopsy suite and in the labs would be questioned on the witness stand. Contamination was about to become the ultimate nemesis, and although we don’t make a routine of autoclaving our surgical instruments at the CFC, we certainly don’t give them a cursory splash under the faucet and then toss them onto a cutting board that isn’t clean, either.
I pick up an eighteen-inch dissecting knife and notice a trace of dried blood in the scored stainless-steel handle and that the steel blade is scratched and pitted along the edge and spotted instead of razor-sharp and as bright as polished silver. I notice blood in the serrated blade of a bone saw and dried bloodstains on a spool of waxed five-cord thread and on a double-curved needle. I pick up forceps, scissors, rib shears, a chisel, a flexible probe, and am dismayed by the poor condition everything is in.