Pepe reached for the cranium and shot Isles a mischievous look. “So let’s play pimp time, Dr. Isles. What’s your call on this?”
“Pimp time?‘ asked Korsak.
“It’s a term from medical school,” said Isles. “Pimping someone means to test their knowledge. To put them on the spot.”
“Something I’m sure you used to do to your pathology students at U.C.,” said Pepe.
“Ruthlessly,” Isles admitted. “They’d cringe whenever I looked their way. They knew a tough question was coming.”
“Now I get to pimp you,” he said, with a touch of glee. “Tell us about this individual.”
She focused on the remains. “The incisors, palate shape, and skull length are consistent with the Caucasoid race. The skull is on the small side, with minimal supraorbital ridges. Then there’s the pelvis. The shape of the inlet, the suprapubic angle. It’s a Caucasian female.”
“And the age?”
“There’s incomplete epiphyseal fusion of the iliac crest. No arthritic changes on the spine. A young adult.”
“I concur.” Dr. Pepe picked up the mandible. “Three gold crowns,” he noted. “And there’s been extensive amalgam restoration. Have you done X rays?”
“Yoshima did them this morning. They’re on the light box,” said Isles.
Pepe crossed to look at them. “She’s had two root canals.” He pointed to the film of the mandible. “Looks like gutta percha canal fillings. And look at this. See how the roots of seven through ten and twenty-two through twenty-seven are short and blunt? There’s been orthodontic movement.”
“I didn’t notice that,” said Isles.
Pepe smiled. “I’m glad there’s something left to teach you, Dr. Isles. You’re beginning to make me feel quite superfluous.”
Agent Dean said, “So we’re talking about someone with the means to pay for dental work.”
“Quite expensive dental work,” added Pepe.
Rizzoli thought of Gail Yeager and her perfectly straight teeth. Long after the heart ceased to beat, long after the flesh decayed, it was the condition of the teeth that distinguished the rich from the poor. Those who struggled to pay the rent would neglect the aching molar, the unsightly overbite. The characteristics of this victim were beginning to sound hauntingly familiar.
Young female. White. Well-to-do.
Pepe set down the mandible and shifted his attention to the torso. For a moment he studied the collapsed cage of ribs and sternum. He picked up a disarticulated rib, arched it toward the breastbone, and studied the angle made by the two bones.
“Pectus excavatum,” he said.
For the first time, Isles looked dismayed. “I didn’t notice that.”
“What about the tibias?”
Immediately she moved to the foot of the table and reached for one of the long bones. She stared at it, her frown deepening. Then she picked up the matching bone from the other limb and placed them side by side.
“Bilateral genu varum,” she said, by now sounding quite disturbed. “Maybe fifteen degrees. I don’t know how I missed it.”
“You were focused on the fracture. That surgical pin’s staring you in the face. And this isn’t a condition one sees much anymore. It takes an old guy like me to recognize it.”
“That’s no excuse. I should have noticed it immediately.” Isles was silent a moment, her vexed gaze flitting from the leg bones to the chest. “This does not make sense. It’s not consistent with the dental work. It’s as if we’re dealing with two different individuals here.”
Korsak cut in, “You mind telling us what you’re talking about? What doesn’t make sense?”
“This individual has a condition known as genu varum,” said Dr. Pepe. “Commonly known as bowed legs. Her shinbones were curved about fifteen degrees from straight. That’s twice the normal degree of curvature for a tibia.”
“So why’re you getting all excited? Lotta folks have bow legs.”
“It’s not just the bow legs,” said Isles. “It’s also the chest. Look at the angle the ribs make with the sternum. She has pectus excavatum, or funnel chest. Abnormal bone and cartilage formation caused the sternum-the breastbone-to be sunken in. If it’s severe, it can cause shortness of breath, cardiac problems. In this case, it was mild, and probably gave her no symptoms. The condition would have been primarily cosmetic.”
“And this is due to abnormal bone formation?” said Rizzoli.
“Yes. A defect in bone metabolism.”
“What kind of illness are we talking about?”
Isles hesitated and looked at Dr. Pepe. “Her stature is short.”
“What’s the Trotter-Gleiser estimate?”
Isles took out a measuring tape, whisked it over the femur and tibia. “I’d guess about sixty-one inches. Plus or minus three.”
“So we’ve got pectus excavatum. Bilateral genu varus. Short stature.” He nodded. “It’s strongly suggestive.”
Isles looked at Rizzoli. “She had rickets as a child.”
It was almost a quaint word, rickets. For Rizzoli, it conjured up visions of barefoot children in tumbledown shacks, crying babies, and the grime of poverty. A different era, colored in sepia. Rickets was not a word that matched a woman with three gold crowns and orthodontically straightened teeth.
Gabriel Dean had also taken note of this contradiction. “I thought rickets is caused by malnutrition,” he said.
“Yes,” Isles answered. “A lack of vitamin D. Most children get an adequate supply of D from either milk or sunlight. But if the child is malnourished, and kept indoors, she’ll be deficient in the vitamin. And that affects calcium metabolism and bone development.” She paused. “I’ve actually never seen a case before.”
“Come out on a dig with me someday,” said Dr. Pepe. “I’ll show you plenty of cases from the last century. Scandinavia, northern Russia-”
“But today? In the U.S.?” asked Dean.
Pepe shook his head. “Quite unusual. Judging by the bony deformities, as well as her small stature, I would guess this individual lived in impoverished circumstances. At least through her adolescence.”
“That isn’t consistent with the dental work.”
“No. That’s why Dr. Isles said we seem to be dealing with two different individuals here.”
The child and the adult, thought Rizzoli. She remembered her own childhood in Revere, their family crammed into a hot little rental house, a place so small that for her to enjoy any privacy she had to crawl into her secret space beneath the front porch. She remembered the brief period after her father was laid off, the frightened whispers in her parents’ bedroom, the suppers of canned corn and Potato Buds. The bad times had not lasted; within a year, her father was back at work and meat was once again on the table. But a brush with poverty leaves its mark, on the mind if not the body, and the three Rizzoli siblings had all chosen careers with steady, if not spectacular, incomes-Jane in law enforcement, Frankie in the Marines, and Mikey in the U.S. Postal Service, all of them striving to escape the insecurity of childhood.
She looked at the skeleton on the table and said, “Rags to riches. It does happen.”
“Like something out of Dickens,” said Dean.
“Oh yeah,” said Korsak. “That Tiny Tim kid.”
Dr. Isles nodded. “Tiny Tim suffered from rickets.”
“And then he lived happily ever after, ‘cause old Scrooge probably left him a ton of money,” said Korsak.
But you didn’t live happily ever after, thought Rizzoli, gazing at the remains. No longer were these just a sad collection of bones, but a woman whose life was now beginning to take shape in Rizzoli’s mind. She saw a child with crooked legs and a hollow chest, growing stunted in the mean soil of poverty. Saw that child passing into adolescence, wearing blouses with mismatched buttons, the fabric worn to frayed transparency. Even then, was there something different, something special about this girl? A look of determination in her eyes, an upward tilt to the jaw that announced she was destined for a better life than the one into which she’d been born?