The Cobra Event (7 page)

“But I came here to observe.”

“I think your insights into this case could be interesting,” Nathanson said. “Ben, she’ll need a chain-mail glove. You’ll use your own knife, I assume.”

She nodded.

Kly got her a chain-mail glove. She put it on her left hand and replaced the yellow rubber glove. She opened her prosection pack and removed her steel knife.

“Glenn will help you with the forensics, and he’ll sign the documents,” Nathanson said.

Nathanson left to make his rounds in the Pit. He passed by the autopsy tables one by one, stopping to chat with pathologists, having a look at each of the day’s cases. As she watched him walk away, Austen felt that he had been sizing her up from the moment they met. From the beginning, he had been thinking of turning the autopsy over to her, but he had held off making the decision until the last possible moment. She watched him out of the corner of her eye.

Dudley said to Austen in a low voice, “I never saw the point of Lex’s calling the C.D.C. It was something he wanted to do, not me. You will follow my direction. Is that clear?”

“Yes.”

“The last thing we need around here is a C.D.C. trainee who’s carrying on her education in public.”

Ben Kly pretended not to hear a word of this. He took up a rubber hose and rinsed the girl’s body gently with running water.

Across the tables, the day’s work had gotten under way. A flash went off on the other side of the room. A photographer was standing on a ladder, taking pictures of a shooting victim, a young Hispanic man who had been caught in a heroin deal gone bad. They had peeled off his bloody clothes and hung them to dry on a hat stand, and a pathologist was writing on tags with a Magic Marker and tying the tags to the clothes, while a New York City homicide detective stood by and watched. Another table was getting a lot of attention. On it lay a naked woman. She was marked with bruises about the chest and head, she appeared to have a fractured skull, and there were deep stab wounds in her belly, which was very large. Eight months’ pregnant, she had been beaten and stabbed to death by her husband. A fetus had apparently died of stab wounds inside her. Someone at another table said, “Who’s got the loppers?” A hot smell of intestinal contents filled the air, a smell that resembled the foulest diarrhea. There was the murmur of voices, as pathologists chatted with one another across the tables. The Pit was one of the beating centers of life in New York City, essential to its daily existence, yet unseen and unimagined by most people who lived in the city. The case of the girl who had collapsed in school was not getting much attention from the other pathologists.

Dudley called over the photographer, who took a few pictures of Kate Moran. Then Austen and Dudley together did an external examination.

In the bright fluorescent light, they looked at the skin. They rolled the body sideways and examined the girl’s back, then rolled her so that she was resting on her back again. When a baby is born, the attending pediatrician examines the baby’s genitalia, to check for malformation. At the other end of life, the pathologist performs a similar examination. Austen parted the girl’s legs and looked carefully there. She saw a string and some blood. The girl had been having her menstrual period. Pulling the string, she removed the tampon and looked at it, turning it over in her gloved hands. It bore a few spots of bright red blood.

An experienced morgue attendant, or diener, can help find things. Ben Kly pointed to the girl’s nose. “Lot of mucus there.”

Austen looked. Coming out of the girl’s nose, along with the blood, was a slick watery fluid, a fair amount of it. “You’re right,” she said. “It looks like she had a cold.”

“She
has
a cold,” Kly commented.

“What?” Alice said, looking at him.

“You know how a cold survives in a dead body?” Kly said. “I’ve caught colds from bodies. Cadaver colds are the worst. I think that cold gets mean sitting in that body, saying, ‘This guy is dead.
Get
me out of here.’ ”

“I wonder what else you guys catch,” Dudley said to him.

“Hey, I’ve worked in the morgue for seven years,” Kly replied, “and my immune system is like a rock by now. Nothing can get past it. Except every October I get my cadaver cold, as regular as an alarm clock.”

Austen wanted to inspect the girl’s mouth and tongue. She opened the mouth and grasped the tongue firmly with a forceps, and pulled the tongue partway out of the mouth.

Her mouth was stained with partly coagulated blood. Austen moved the tongue sideways. “She bit her tongue and lips,” she said. “There are molar cuts toward the back of the tongue.” She had shredded her lips with her front teeth, it seemed, and a portion of lip was missing. But that was not all. The inside of the mouth had the wrong texture and color, but the blood obscured it. Austen bent over and looked very closely, and now she saw something. The inside of the mouth was shining with blisters. They were very dark. They were blood blisters, it seemed.

Next came the examination of the eyes. Gripping the eyelids delicately with a small forceps, Austen rolled them back one at a time.

The inside of the eyelid was peppered with small red dots.

“She’s got inflammation of the conjunctiva,” Austen said.

Now she looked at the eye. The iris was blue-gray, but with a hint of golden yellow. Austen bent down until her face was inches from Kate’s, and she stared into the pupils, left and right. In the cornea was reflected the blue glare of the overhead fluorescent lights and her own face, with the mask over her mouth and nose, and the safety glasses over her eyes. Pathology, above all, is the act of seeing. Seeing with understanding leads to diagnosis. Austen continued to stare into Kate’s eyes, trying to understand what she was seeing, trying to recognize a pattern. Her eyes had an abnormal color, she thought. There seemed to be a ring of yellowish shiny pigment inside each iris—a pupillary ring, with flamelike offshoots. It had formed a kind of iridescent circle fringing the black dot of the pupil. The ring had a metallic sheen, like the wing of a tropical butterfly, with a predominantly yellowish cast, and it made the pupil look as if it had caught fire.

“These eyes seem unusual, Dr. Dudley. What do you think of the color in the iris?”

“Huh.” Dudley bent over to look. “It’s natural color. The conjunctiva’s inflamed.”

“But she has pupillary rings in the iris. Like some kind of crystalline or metallic deposit. I wonder if this is copper. She could have copper poisoning. These rings in the iris could be Kayser-Fleischer rings. That’s a copper deposit in the eyes. It’s a sign of Wilson’s disease—”

“I
know
what that is,” he said, looking at her. “Nope—no way. Rings from copper poisoning, Dr. Austen, would appear on the
outside rim
of the iris. This golden coloration is on the
inside
of the iris, near the pupil. It’s normal eye color.”

The girl had had a bloody nose. Austen decided that she wanted to look inside the nose. “Do you have an exam light?”

Kly found a standard examination light and handed it to Austen. She pointed the light into Kate’s nostril and looked.

The nasopharynx is like a cave inside the head. This cave was clogged with congealed blood. Then Austen saw it: blood blisters in the cavity. They gleamed in the light.

“Wow,” Austen said. “There’s a blistering process.” She thought: the bloody nose could be a broken blister.

“Let me look,” Dudley said. He took the light. “Yeah. What the hell is that?”

“She has similar blisters in her mouth. This looks like an infectious-disease process, I think.”

“Yeah. Or hemorrhages. This could be a toxin, a poison of some kind. Go ahead and open her,” Dudley said to Austen.

Ben Kly prepared a fresh scalpel, snapping a clean blade onto the handle, and he handed it to Austen. She inserted the scalpel into Kate Moran’s right shoulder. With a quick, careful, deft motion she ran the scalpel down from the shoulder and underneath the young woman’s breast, then across her rib cage, bumping over the ribs. She reached the point of the sternum, where the ribs come together at the top of the abdomen, and from that point she cut straight down the abdomen, heading for the navel. She made a detour around the navel, still cutting. She stopped the cut when it reached the pubic bones of the pelvis, at the top of the pubic hair. As the skin of the abdomen parted, a strong whiff of feces filled the air.

Now Austen made a second cut, starting at Kate’s other shoulder and running down and across her chest to her sternum, where the cut joined the first cut. The two cuts thus formed a Y. The points of the Y were in the shoulders, and the joint of the Y was at the bottom of the rib cage. The shaft of the Y ran down over the abdomen to the pubis. Her skin gaped open, the yellow body fat revealed.

“
Ephaphtha
,” Ben Kly said softly.

“What was that?” Austen said, glancing at him.

“
Ephaphtha
. It’s a good-luck word. It’s what Jesus said when he threw a demon out of a deaf-and-dumb man. He stuck his finger into the guy’s ear, and he put a dab of his spit on the guy’s tongue. Then he said, ‘
Ephaphtha
.’ It means, ‘Be opened.’ And the demon came out.”

“The Lord guides our diener’s hand,” Dudley remarked.

“He guides our prosector’s hand,” Kly said quietly.

Using the scalpel to cut away fat and tissue, Alice Austen gently pulled back the underlying tissue of the girl’s chest. She reflected (laid back) the large flaps of skin, exposing her rib cage. She laid the skin of the chest backward and inside out, like a blanket, over the girl’s face. The breasts were turned inside out, the breast tissue seen from the inside, white and milky in color, while the outside of the breasts lay upon Kate’s face.

Kly handed Austen a pair of lopping shears—the kind gardeners use to trim branches—and she cut the girl’s ribs. The ribs gave off cracking sounds as they broke. Then she lifted away the chest plate, the central section of the rib cage. She laid the chest plate on the table.

Austen reached into the chest cavity with her fingers and gently pulled the lungs away from the heart, which was encased in a membrane. “I want to get a blood sample,” she said.

“You’re going to take a blood sample from the
heart
?” Dudley said sharply. “If you’re testing for infective agents, you’ll want to take blood from the leg, not the heart. Don’t you know that?” He went on to say that the heart would be contaminated with many kinds of bacteria, and thus it would not give a reliable biological sample of blood.

Austen turned red. “Okay,” she said.

Dudley had a look of satisfaction on his face. He handed Austen a syringe. She slid it into the femoral vein of the girl’s leg in the groin area. She found the vein on the second try and withdrew a small amount of blood and squirted it into two jars of blood-culture fluid, which is the color of beer. Any bacteria in Kate’s blood would grow in the liquid and could be observed and tested.

Then she lifted out the heart and lungs. She laid them on a white plastic cutting board. She sliced open both lungs with her knife. The lungs were heavy and dark. Kate had inhaled blood from her nosebleed. But the blood in her lungs was not enough, Austen thought, to be the cause of death. Not enough blood to drown the lungs.

With blunt scissors, she cut open the heart and examined the chambers, and she snipped open the coronary arteries. Kate Moran’s coronaries and heart were normal, unremarkable.

She cut away one-inch chunks of heart tissue and lung tissue, and dropped them into a large glass jar full of formalin preservative, a clear, poisonous fluid that looks like water. This jar was known as the stock jar. It would be sent to the O.C.M.E. histology lab, where slices of the tissue in the jar would be prepared for viewing through a microscope. Austen also prepared a separate toxicology container, a plastic container with no preservative in it. The O.C.M.E.’s toxicology lab would test the samples in this container for toxins and drugs. She dropped raw pieces of lung into the tox container.

Now Austen reached into the abdomen, feeling around among the intestines. She removed the small intestine, pulling it out like rope, foot by foot, cutting the membranes that held the masses of intestines together. There was a sour reek, and a quantity of chyme squeezed out of the small intestine, like toothpaste coming out of a tube. Chyme is a soft gray paste that looks like oatmeal. It is partly digested food from the upper intestine, food that has not yet met the bile and darkened. She placed the small intestine in a cylindrical steel wash tank full of running water that sat at the end of the autopsy table. The tissue seemed healthy and normal.

She found the liver and pulled it up to look at it. The liver appeared normal in color: dark reddish brown. She removed the liver and weighed it on a scale over the table. “Liver’s thirteen hundred and fifty grams.” She put it down on the cutting board and sliced it quickly, then dropped a sample of liver into the stock jar, and another piece of liver into the tox container. She cut open the stomach and looked inside at the contents. Kate Moran had not eaten in a while.

Austen lifted the bowel out, holding it in both hands, loosely folded. This she handed to Ben Kly. He placed the bowel in the wash container and squeezed it and rinsed it, like hand laundry. Masses of feces floated away in the wash water and swirled down the drain. A stench of feces filled the air.

The body cavity was open and almost empty now, a red gaping cave of ribs. The girl’s face was not visible. It was still covered with the blanket of chest skin.

Kly was standing close to Austen, looking into the body cavity.

“Find her soul, Ben?” Dudley said.

“It’s gone to a better place, Doctor,” Kly answered.

There were still the pelvic organs to remove. These are the organs that are tucked inside the pelvis (the hip bones). The pelvic organs open out through the natural openings between the legs.

Austen reached down through the abdomen, low inside the girl’s pelvis, and grasped the vagina and rectum with her left hand (her chain-mail hand). With her right hand, she inserted a scalpel deep down into the pelvic area. Working delicately, by sense of touch, she cut through the base of the rectum, through the vagina, and she cut away the bladder at the base of the urethra. As she was cutting, she pulled steadily. Nothing happened. She pulled harder. The bundle of organs were suddenly freed, and they came out of the body with a bubbling squelch. The sound is known as the pelvic slurp, and it is caused by a suction drawing air inward as the organs are pulled out of the pelvis.