“But the surgery lasted more than two hours, Dr. B. Do you really want to watch it all in real time? Can’t we fast-forward till we see something interesting?”
“How will we know what’s interesting if it zooms past in a nanosecond?”
“Tell you what,” she offered. “If we get to the end and we haven’t seen anything interesting, I’ll back it up and we can watch it in slo-mo. Deal?”
“Deal.” On the screen, two pairs of hands converged on the neck, steel instruments glistening in the light, and then withdrew. Once they were out of the frame, I saw that the incision in the neck had been spread apart with clamps; the opening was now as wide as it was long. “Slow down; this is getting interesting.”
“Yeah, fascinating,” she said, but her heart wasn’t in the sarcasm, and once the speed slowed to normal, she leaned closer to the screen, drawn into the drama as the woman’s trachea and esophagus were pulled to the side and the front of her spine was exposed to view. The surgery was accompanied by a sound track — country music, turned up loud — with an occasional indecipherable murmur of human voices underneath the drawling, twanging music.
With a series of tools — forceps, scissors, scalpel, forceps again — the surgeon attacked the disk, yanking and snipping and gouging out the crumbling cartilage that separated the third cervical vertebra from the fourth. The surgeon’s gloves and the surgical drapes were soon spattered with blood and tissue. “Wow, I hadn’t fully appreciated how much an orthopedic surgeon has in common with a butcher,” Miranda remarked, adding, “Not much elbow room there in the neck.”
“Not much,” I agreed. “Back when I was teaching anatomy, the surgery residents used to put pieces of tissue down in the bottom of Styrofoam coffee cups. They’d practice cutting and suturing without touching the sides of the cup.”
She paused the video. “Like that doctor game for kids? Operation? The one where it buzzes if the tweezers touch the board while you’re lifting out the funny bone or the brain or whatever?”
“Like that. The name of the patient was something-Sam, I think. Yosemite Sam? No, that was a cartoon character. Cavity Sam, maybe. Kathleen and I gave Jeff that game one year for Christmas.”
“Did he like it?”
“Not so much. I thought it was fun, but Jeff was disappointed. What he really wanted was a BB gun.”
Miranda snorted. “He wanted a BB gun, and he got Operation? Poor Jeff — he’ll probably need therapy the rest of his life to get over the pain.”
“We didn’t want him to shoot his eye out, you know? But I felt so bad when I saw how sad he looked that Christmas morning that I got him a BB gun two months later, for his birthday.”
“Did he shoot his eye out?”
“He never did. Not yet anyhow. I do seem to remember replacing a window or two, though.” I laughed. “Oh, and the neighbor’s cat stopped coming over and eating our cat’s food. Which wasn’t such a bad thing.”
“Just think of all the money you could’ve saved on cat food if you’d gotten him the BB gun two months sooner,” she said. “You ready to watch surgery again?” Without waiting for an answer, she hit “play,” and the bloody fingers and tools resumed their assault on the spinal disk. The scraps of cartilage grew smaller and smaller; then, after a pause, I heard a high-pitched whine, like a dentist’s drill. Gripping a small grinder, not unlike the Dremel tool I’d bought at Home Depot, the surgeon angled the tool into the opening in the patient’s neck. “Yikes,” said Miranda. “This is when you really don’t want your spine surgeon to have the shakes. One twitch and you’re a quad.”
He laid aside the grinder and then, with a pair of forceps, held a small, white peg — a short, squat bone graft, roughly twice the diameter of a pencil eraser — in the neck, measuring it against the gap between the two vertebrae whose surfaces he’d just smoothed. The back of the surgeon’s head leaned into the frame, bending down for a closer look, and then he withdrew the forceps and reamed out the gap between the vertebrae a bit more. After another inspection he reinserted the peg into the opening in the neck, wedged it between the vertebrae, and then tapped it deeper into the intervertebral gap, using a small hammer and punch, creating a snug fit: a fit whose snugness I’d noticed when I removed the section of spine from the neck of the corpse. Finally he took a silvery metal bracket and screwed it to the bones. The procedure he’d just performed was an anterior decompression and fusion; the “fusion” part would be completed by the patient herself — or would have been, if she hadn’t died — as new bone grew from her vertebrae to surround and incorporate the grafted piece.
On the monitor the surgeon removed the retractors and clamps from Lowe’s neck; once released, the skin contracted and the gaping incision half closed itself. With a curved needle and stiff black thread, the surgeon took fifteen neat stitches in the neck: the fifteen stitches that had so readily parted, only hours before, under the blade of the scalpel in my hand.
A different, smaller pair of hands entered the video frame. With brisk efficiency they scrubbed the dried blood off the patient’s neck, then swabbed on iodine and applied a gauze dressing. The surgeon’s hand reappeared; it waved to the camera, then gave a cheery thumbs-up.
Clarissa’s surgery was finished.
Her swift death spiral was starting, and no inventor’s high-tech video system could rewind that.
CHAPTER 18
Culpepper paused between bites of egg salad. “So here’s another wild-ass guess. You think there’s any chance Willoughby’s dismemberment could’ve been cult-related?” The KPD detective had called just as I’d finished watching the video with Miranda. He’d offered to swing by a deli and pick up sandwiches so he could chat with me about postmortem mutilation over lunch.
I didn’t answer the cult question right away — I’d just taken in a mouthful of smoked turkey and provolone cheese — so I shook my head to buy time. “You remember the Job Corps murder,” he said as I chewed. I did. It had been committed by a teenage girl, who’d repeatedly stabbed and bludgeoned another girl, a classmate at the job-training center where they were enrolled. “That involved missing parts,” Culpepper persisted, “and there was a cult connection there, right? Didn’t she carve a pentagram into the chest of the victim?”
I nodded, wiping a stray blob of mayonnaise from my lip. “She did,” I conceded. “She also kept a piece of the skull as a souvenir. But I don’t think it counts as a cult killing. I think it was mostly about jealousy over a boy they both liked. I think the pentagram and the souvenir were drunken, stoned-out afterthoughts. And anyhow, Willoughby’s limbs were amputated with surgical precision. Crazy cultists wouldn’t have done such a neat job of it.”
Culpepper chewed on this as he chewed on his egg-salad sandwich. For a man who chomped gum with such ferocity, Culpepper ate with surprising daintiness. He’d begun by nibbling the fringe of lettuce, pruning it to a neat, straight line, even with the edges of the white slices of loaf bread. From there he’d nibbled into the sandwich proper, starting at one corner and working his way around the perimeter of the crust. I watched in fascination as he spiraled slowly toward the center, one mincing bite at a time. He noticed me watching and stopped, the sandwich a few inches from his mouth. “What?”
“Nothing,” I said. “I’ve just never seen anybody eat a sandwich like that.”
“The egg salad squishes a little bit with every bite,” he explained. “So if you start at one side and just go straight across, by the time you get to the other side, it’s all squishing and dripping out the edge. This keeps it corralled.”