A Case of Need: A Novel (6 page)

There are other examples: severe tuberculosis, tertiary syphilis, gunshot wounds, stabbings, accidents, self-abuse, and personal misfortune. Whatever the category, the City sees more of it, in a more advanced state, than any other hospital in Boston.
³

T
HE INTERIOR OF THE CITY HOSPITAL
is a maze built by a madman. Endless corridors, above ground and below, connect the dozen separate buildings of the hospital. At every corner, there are large green signs pointing directions, but they don’t help much; it is still hopelessly confusing.

As I cut through the corridors and buildings, I remembered my rotation through the hospital as a resident. Small details came back. The soap: a strange, cheap, peculiar-smelling soap that was used everywhere. The paper bags hung by each sink, one for paper towels, the other for rectal gloves. As an economy, the hospital saved used gloves, cleaned them, and used them again. The little plastic name tags edged in black, blue, and red depending on your service. I had spent a year in this hospital, and during that time I had done several autopsies for the medical examiner.

T
HERE ARE FOUR MEDICAL SITUATIONS
in which the coroner claims jurisdiction and an autopsy is required by law. Every pathology resident knows the list cold:

If the patient dies under violent or unusual circumstances.

If the patient is DOA.
⁴

If he dies within twenty-four hours of admission.

If a patient dies outside the hospital while not under a doctor’s care.

Under any of these circumstances, an autopsy is performed at the City. Like many cities, Boston has no separate police morgue. The second floor of the Mallory Building, the pathology section of the hospital, is given over to the medical examiner’s offices. In routine cases, most of the autopsies are performed by first-year residents from the hospital in which the patient died. For the residents, new to the game and still nervous, a coroner’s autopsy can be a tense business.

You don’t know what poisoning or electrocution looks like, for instance, and you’re worried about missing something important. The solution, passed down from resident to resident, is to do a meticulous PM, to take lots of pictures and notes as you go, and to “save everything,” meaning to keep pieces of tissue from all the gross organs in case there is a court action that requires reexamination of the autopsy findings. Saving everything is, of course, an expensive business. It requires extra jars, extra preservative, and more storage space in the freezers. But it is done without question in police cases.

Yet even with the precautions, you worry. As you do the post, there is always that fear, that dreadful thought at the back of your mind that the prosecution or the defense will demand some piece of information, some crucial bit of evidence either positive or negative, that you cannot supply because you did not consider all the possibilities, all the variables, all the differentials.

F
OR SOME LONG-FORGOTTEN REASON
, there are two small stone sphinxes just inside the doors of Mallory. Each time I see them, they bother me; somehow sphinxes in a pathology building smack of Egyptian embalming chambers. Or something.

I went up to the second floor to talk to Alice. She was grumpy; the post hadn’t been started because of some delay; everything was going to hell in a wheelbarrow these days; did I know that a flu epidemic was expected this winter?

I said I did, and then asked, “Who’s doing the post on Karen Randall?”

Alice gave a disapproving frown. “They sent someone over from the Mem. His name, I believe, is Hendricks.”

I was surprised. I had expected someone big to do this case.

“He inside?” I asked, nodding toward the end of the hall.

“Umm,” Alice said.

I walked down toward the two swinging doors, past the freezers on the right which stored the bodies, and past the neatly labeled sign:
AUTHORIZED PERSONNEL ONLY BEYOND THIS POINT
. The doors were wood, without windows, marked
IN
and
OUT
. I pushed through into the autopsy room. Two men were talking in a far corner.

The room was large, painted a dull, institutional green. The ceiling was low, the floor was concrete, and the pipes overhead were exposed; they don’t spend much on interior decoration here. In a neat row were five stainless-steel tables, each six feet long. They were tilted slightly and made with a lip. Water flowed constantly down the table in a thin sheet and emptied into a sink at the lower end. The water was kept running all during the autopsy, to carry away blood and bits of organic matter. The huge exhaust fan, three feet across and built into one frosted-glass window, was also kept on. So was the small chemical unit that blew scented ersatz air-freshener into the room, giving it a phony pine-woods odor.

Off to one side was a changing room where pathologists could remove their street clothes and put on surgical greens and an apron. There were four large sinks in a row, the farthest with a sign that said
THIS SINK FOR WASHING HANDS ONLY.
The others were used to clean instruments and specimens. Along one wall was a row of simple cabinets containing gloves, bottles for specimens, preservatives, reagents, and a camera. Unusual specimens were often photographed in place before removal.

As I entered the room, the two men looked over at me. They had been discussing a case, a body on the far table. I recognized one of the men, a resident named Gaffen. I knew him slightly. He was very clever and rather mean. The other man I did not know at all; I assumed he was Hendricks.

“Hello, John,” Gaffen said. “What brings you here?”

“Post on Karen Randall.”

“They’ll start in a minute. Want to change?”

“No, thanks,” I said. “I’ll just watch.”

Actually I would have liked to change, but it seemed like a bad idea. The only way I could be certain of preserving my observer’s role would be to remain in street clothes. The last thing I wanted to do was to be considered an active participant in the autopsy, and therefore possibly influencing the findings.

I said to Hendricks, “I don’t think we’ve met. I’m John Berry.”

“Jack Hendricks.” He smiled, but did not offer to shake hands. He was wearing gloves, and had been touching the autopsy body before them.

“I’ve just been showing Hendricks a few physical findings,” Gaffen said, nodding to the body. He stepped back so I could see. It was a young Negro girl. She had been an attractive girl before somebody put three round holes in her chest and stomach.

“Hendricks here has been spending all his time at the Mem,” Gaffen said. “He hasn’t seen much of this sort of thing. For instance, we were just discussing what these little marks might represent.”

Gaffen pointed to several flesh tears on the body. They were on the arms and lower legs.

Hendricks said, “I thought perhaps they were scratches from barbed wire.”

Gaffen smiled sadly. “Barbed wire,” he repeated.

I said nothing. I knew what they were, but I also knew that an inexperienced man would never be able to guess.

“When was she brought in?” I said.

Gaffen glanced at Hendricks, then said, “Five
A.M.
But the time of death seems to be around midnight.” To Hendricks he said, “Does that suggest anything?”

Hendricks shook his head and bit his lip. Gaffen was giving him the business. I would have objected but this was standard procedure. Browbeating often passes for teaching in medicine. Hendricks knew it. I knew it. Gaffen knew it.

“Where,” Gaffen said, “do you suppose she was for those five hours after death?”

“I don’t know,” Hendricks said miserably.

“Guess.”

“Lying in bed.”

“Impossible. Look at the lividity.
⁵
She wasn’t lying
flat
anywhere. She was half seated, half rolled over on her side.”

Hendricks looked at the body again, then shook his head again.

“They found her in the gutter,” Gaffen said. “On Charleston Street, two blocks from the Combat Zone. In the gutter.”

“Oh.”

“So,” Gaffen said, “what would you call those marks now?”

Hendricks shook his head. I knew this could go on forever; Gaffen could play it for all it was worth. I cleared my throat and said, “Actually, Hendricks, they’re rat bites. Very characteristic: an initial puncture, and then a wedge-shaped tear.”

“Rat bites,” he said in a low voice.

“Live and learn,” Gaffen said. He checked his watch. “I have a CPC now. Good to see you again, John.” He stripped off his gloves and washed his hands, then came back to Hendricks.

Hendricks was still looking at the bullet holes and the bites.

“She was in the gutter for five hours?”

“Yes.”

“Didn’t the police find her?”

“Yes, eventually.”

“Who did it to her?”

Gaffen snorted. “You tell me. She has a history of a primary luetic oral lesion, treated at this hospital, and five episodes of hot tubes, treated at this hospital.”

“Hot tubes?”

“P.I.D.”
⁶

“When they found her,” Gaffen said, “she had forty dollars in cash in her bra.”

He looked at Hendricks, shook his head, and left the room. When we were alone, Hendricks said to me, “I still don’t get it. Does that mean she was a prostitute?”

“Yes,” I said. “She was shot to death and lay in the gutter for five hours, being chewed by sewer rats.”

“Oh.”

“It happens,” I said. “A lot.”

The swinging door opened, and a man wheeled in a white-shrouded body. He looked at us and said, “Randall?”

“Yes,” Hendricks said.

“Which table you want?”

“The middle.”

“All right.” He moved the cart close, then swung the body over onto the stainless-steel table, shifting the head first, then the feet. It was already quite stiff. He removed the shroud quickly, folded it, and set it on the cart.

“You gotta sign,” he said to Hendricks, holding out a form.

Hendricks signed.

“I’m not very good at this,” Hendricks said to me. “This legal stuff. I’ve only done one before, and that was an industrial thing. Man hit on the head at work and killed. But nothing like this …”

I said, “How did you get chosen for this one?”

He said, “Just lucky, I guess. I heard that Weston was going to do it, but apparently not.”

“Leland Weston?”

“Yes.”

Weston was the chief pathologist of the City Hospital, a great old man and probably the best pathologist in Boston, bar none.

“Well,” Hendricks said. “We might as well get started.”

He went to the sink and began a long and thorough scrub. Pathologists who scrub for a post always annoy me. It makes them too much like parodies of surgeons: the idiotic reverse of the coin, a man dressed in a surgical uniform—baggy pants, V-neck short-sleeve blouse—cleaning his hands before operating on a patient who was past caring whether he received sterile treatment or not.

But in Hendricks’ case, I knew he was just stalling.

A
UTOPSIES ARE NEVER VERY PRETTY
. They are particularly depressing when the deceased is as young and as attractive as Karen Randall was. She lay nude on her back, her blonde hair streaming down in the water. Her clear blue eyes stared up at the ceiling. While Hendricks finished scrubbing, I looked at the body and touched the skin. It was cold and smooth, the color gray-white. Just what you’d expect for a girl who had bled to death.

Hendricks checked to see that there was film in the camera, then waved me aside while he took three pictures from different angles.

I said, “Have you got her chart?”

“No. The old man has that. All I’ve got is a summary of the OPD discharge.”

“Which was?”

“Clinical diagnosis of death secondary to vaginal hemorrhage complicated by systemic anaphylaxis.”

“Systemic anaphylaxis? Why?”

“Beats me,” Hendricks said. “Something happened in the OPD, but I couldn’t find out.”

“That’s interesting,” I said.

Hendricks finished with his pictures and went to the blackboard. Most labs have a blackboard, on which the pathologist can write his findings as he makes them—surface markings of the body, weight and appearance of organs, that sort of thing. He went to the board and wrote, “Randall, K.” and the case number.

At that moment, another man entered the room. I recognized the bald, stooping figure of Leland Weston. He was in his sixties, about to retire, and despite his stoop he had a kind of energy and vigorousness. He shook hands with me briskly, then with Hendricks, who seemed very relieved to see him.

Weston took over the autopsy himself. He began, as I remembered he always did, by walking around the body a half-dozen times, staring at it intently, and muttering to himself. Finally he stopped and glanced at me.

“Observed her, John?”

“Yes.”

“What do you make of it?”

“Recent weight gain,” I said. “There are striation marks on her hips and breasts. She is also overweight.”

“Good,” Weston said. “Anything else?”

“Yes,” I said. “She has an interesting hair distribution. She has blond hair, but there is a thin line of dark hair on her upper lip, and some more on her forearms. It looks sparse and fine to me, new looking.

“Good,” Weston said, nodding. He gave me a slight, crooked grin, the grin of my old teacher. For that matter, Weston had trained most of the pathologists in Boston at one time or another. “But,” he said, “you’ve missed the most important finding.”

He pointed to the pubic area, which was cleanly shaven. “That,” he said.

“But she’s had an abortion,” Hendricks said. “We all know that.”

“Nobody,” Weston said sternly, “knows anything until the post is completed. We can’t afford to prediagnose.” He smiled. “That is a recreation reserved for the clinicians.” He pulled on a pair of gloves and said, “This autopsy report is going to be the best and most accurate we can make. Because J. D. Randall will be going over it with a fine comb. Now then.” He examined the pubic area closely. “The differential of a shaved groin is difficult. It may imply an operation, but many patients do it for purely personal reasons. In this case, we might note that it was carefully done, with no nicks or small cuts at all. That is significant: there isn’t a nurse in the world who can do a pre-op shave on a fleshy region like this without making at least one small slip. Nurses are in a hurry and small cuts don’t matter. So …”