The Bone Thief (Body Farm 5)

Garcia next asked me to peel back the chest flap. I did so by pulling the skin upward with my left hand, using the scalpel to extend the incisions from the armpits up to the shoulders so I could peel the skin and breast tissue away from the ribs. Laying the chest flap over the face, I swapped the scalpel for a rib cutter — a sharp stainless-steel cousin of the dull pruning shears in my garage at home — and cut through the ribs on both sides. The chest cavity gaped open, exposing the spongy lungs and the heart in its fibrous sac. Like the abdomen, the chest cavity oozed copious amounts of liquid. “No wonder she had trouble breathing,” I said, “with all this fluid pressing on her lungs.”

“There appears to be considerable edema around the heart, too,” said Garcia. “Let’s open the pericardial sac.”

I used the scalpel to finish cutting out the chest plate — the breastbone and the stubs of the ribs I’d sheared — and laid that aside, then sliced into the tough, grayish-white membrane surrounding the heart. Once again fluid gushed from the incision. Garcia was leaning in, his face practically in the corpse’s chest cavity. “Now let’s check the pulmonary artery,” he said.

I probed the tangle of tubing at the top of the heart, nestled just beneath the arch of the aorta. The pulmonary artery was a thick vessel that branched immediately into a T shape to carry blood to the lungs. Slicing through its fibrous wall, I slid the end of my little finger inside, feeling for a clot that might have choked off the flow of blood.

“I don’t feel anything,” I said.

“I didn’t think you would,” Garcia said. “Her death was rapid, but not rapid enough to be the result of a blood clot.” Next he asked me to check the retropharyngeal area, a cavity deep in the neck, directly in front of the spine. “She had no fever, irregular pulse, plummeting blood pressure — symptoms consistent with hemorrhage. Three or four liters of blood from a bleeding vessel could pool in the retropharyngeal area and nobody would know it unless they did a CT scan. But they didn’t; the ER physician in Crossville says they didn’t have time to scan her. So let’s go in and look. We probably need to Roke out her chest; do you know how to do that?”

Miranda asked the question before I could. “How to do what to her chest?”

“Roke it out,” he repeated. Miranda looked as baffled as I felt.

“Roking out a body is a dissection technique,” he explained. “The Rokitansky technique. Named for Karl von Rokitansky, a pathologist at the University of Vienna a century ago. During his career Rokitansky performed or supervised a hundred thousand autopsies.”

“Wow,” said Miranda. “If practice makes perfect, ol’ Karl must have been damn good. So ‘Roking her out’ is pathologist slang for what, exactly?”

“Gutting the corpse,” he said. “The way a hunter guts a deer. Pulling out all the internal organs, from the chest all the way down the abdomen, in one long string.”

“Yuck,” exclaimed Miranda, who never showed any squeamishness around decayed or dismembered human corpses.

“I’ve never Roked out a body or gutted a deer,” I said to Garcia. “You want me to go up to the hospital lobby and corral a hunter? There’s probably a guy up there who’s field-dressed dozens of deer. He might do a quicker and neater job than I can.”

“You’ll do fine,” he assured me. Following his directions, I cut the carotid artery and tied it off, then did the same with the subclavian arteries, the pipelines carrying blood to the arms. Next, trading the scalpel for the long autopsy knife — the one Jess Carter always called a “bread knife”—I sliced through the windpipe and the esophagus and tugged them downward, peeling the lungs and the heart and other organs out of the body cavity and away from the spine.

As I pulled, the cavity behind the lungs became visible. This space, too, brimmed with watery fluid.

“Interesting,” Garcia murmured again. “Pronounced effusions, but no real bleeding. I’m surprised.” He took in a deep breath and exhaled heavily. “Also concerned.”

I looked at him. “Concerned about what? Why?”

“Hemorrhage was my prime suspect, and it would have been a relatively benign explanation.”

“Not so benign for the dead woman,” Miranda pointed out.

“No, not for her, but for others,” he responded.

I paused, resting the heart and lungs on the corpse’s abdomen. I suspected I knew how he’d answer my next question, and I didn’t much like it. “So if hemorrhage didn’t kill her, what’s the next-best possibility, or the next-worst possibility — infection?”

“Not just infection. Infection leading to toxic shock.”

Miranda’s eyebrows shot up. “Toxic shock? Isn’t that what happens when a woman leaves in a tampon too long? This woman was, what, sixty? Surely she was past menopause.”

“She was,” he confirmed. “And you’re right, tampons are what most people associate with toxic shock. But there are other causes. Toxic shock can occur after normal childbirth, after spontaneous or induced abortion, after injury, after surgery. Sometimes the bacteria that create the toxins are new invaders; sometimes they’re already in the body, but at a harmless level. Then something in the body’s chemistry shifts and they start multiplying like crazy, producing spores by the billions. When they do, they can overwhelm the host within a matter of hours.”

“By ‘host’ I assume you mean the unlucky human,” said Miranda, and he nodded. “But according to the ER chart, this woman got vancomycin,” she persisted. “Isn’t that like the hydrogen bomb of antibiotics?”

“It’s powerful,” he agreed. “It can kill bacteria that are resistant to other antibiotics. But by the time she got it, it was already too late. In cases of toxic shock, it’s not the bacteria themselves that cause death. It’s the poisons they produce — the toxins — that are lethal, and antibiotics can’t destroy the toxins. Once toxic shock sets in, the mortality rate can range between fifty and one hundred percent, depending on which bacterium is involved. Some bacterial toxins are deadly; others are even deadlier.”

“Should I be running away right now?” Miranda tried to make the question sound like a joke, but she couldn’t hide the strain in her voice.

“If you want to leave, I understand,” he said. “You, too, Bill. The face shield and the mask and the gown and the double gloves are good protection, but there are no guarantees. Does either one of you have any open cuts or scrapes?” Miranda and I both shook our heads. Miranda’s eyes widened abruptly as her gaze dropped to Garcia’s left wrist and mangled right hand, both still bandaged.

“Jesus, Eddie, you’re the one who shouldn’t be here,” she said. “Your hands aren’t fully healed, and your immune system’s been compromised.”

He shrugged. “I am at more risk here,” he acknowledged. “I thought about that yesterday, and I decided to accept the risk.”

I wondered if he was doing more than merely accepting the risk; was he actually seeking the risk, intentionally exposing himself to a potentially deadly infection?

“Don’t worry,” he said, “I’m not trying to commit suicide by sepsis.” After a pause he added, “Shall we continue?” This time it was a request, not a question. “I don’t think we need to Roke out the abdomen, though. Let’s look at the neck now, instead.”

I laid the chest flap back down into position. With the chest plate and organs now gone, the flap drooped deeply into the chest cavity.

The Crossville surgeon had made a two-inch cut in the neck, which he’d tied off with about fifteen stitches, around which the skin puckered. The thin black threads, whose clipped ends bristled stiffly at each stitch, reminded me of the legs of ticks, and I shivered at the image of ticks burrowing into the woman’s neck. Odd: I wasn’t at all squeamish about swarms of maggots, but ticks were different, scarier bugs altogether.

The blade sliced easily through the sutures and down through the incision, whose edges had barely begun to adhere to one another. I halfway expected yet another gush of pale fluid as I cut, but there was none. What e

merged instead — and what I’d not expected — was the stench of human decomposition. The woman on the autopsy table had been dead for only two days and had been in the cooler that whole time, but if I’d been guessing from the condition of her neck, I’d have guessed that her corpse had been ripening at the Body Farm for a week or more. The tissue was spongy and mottled, riddled with gray and black patches of decay.

“Ack,” said Miranda.

“Interesting,” said Garcia. He leaned closer and inhaled sharply. “I suspect that localized necrosis began long before she went into toxic shock. Probably immediately after the surgery.”

“So the surgery itself was probably the source of the infection,” I surmised.

“It depends.”

“On what?”

“On the person you ask. If you ask me, I say yes. If you ask the neurosurgeon, he says the procedure went flawlessly and the patient’s death was an unrelated event, a freak coincidence.”

“Well, duh,” Miranda scoffed. “He’s terrified that the woman’s husband is going to sue him, right? Our friend Grease could probably get thirty or forty million for the guy, right Dr. B.?”