It kept coming back to the feet. The removal of the feet was not logical.
She retrieved Rat Lady’s X-ray envelope and slid the ankle films onto the light box. Once again, the abrupt demarcation of severed flesh shocked her, but she saw nothing new here, no clues that would explain the killer’s motive for the amputation.
She took the films down, replaced them with the skull films, frontal and lateral views. She stood gazing at the bones of Rat Lady’s face, and tried to envision what that face might have looked like. No older than forty-five, she thought, yet already you have lost your upper teeth. Already, you have the jaw of an elderly woman, the bones of your face rotting from within, your nose sinking into a widening crater. And scattered across your torso and limbs are ugly nodules. Just a glance in the mirror would be painful. And then to step outside, into the eyes of the public . . .
She stared at the bones, glowing on the light box. And she thought: I know why the killer took the feet.
It was only two days before Christmas, and when Maura walked onto the Harvard campus, she found it almost deserted, the Yard a broad expanse of white, scarcely marred by footprints. She tramped along the walkway, carrying her briefcase and a large envelope of X rays, and could smell, in the air, the metallic tang of a coming snowfall. A few dead leaves clung, shivering, to bare trees. Some would view this scene as a holiday postcard with a Season’s Greeting caption, but she saw only the monotonous grays of winter, a season she was already weary of.
By the time she reached Harvard’s Peabody Museum of Archaeology, cold water had seeped into her socks and the hems of her pant legs were soaked. She stomped off the snow and walked into a building that smelled of history. Wooden steps creaked as she went down the stairwell to the basement.
The first thing she noticed, as she stepped inside the dim office of Dr. Julie Cawley, were the human skulls—at least a dozen of them, lining the shelves. A lone window, set high in the wall, was half covered by snow, and the light that managed to seep through shone down directly on Dr. Cawley’s head. She was a handsome woman, with upswept gray hair that looked pewter in the wintry light.
They shook hands, an oddly masculine greeting between two women.
“Thank you for seeing me,” said Maura.
“I’m rather looking forward to what you have to show me.” Dr. Cawley turned on a lamp. In its yellowish glow, the room suddenly seemed warmer. Cosier. “I like to work in the dark,” she said, indicating the glow of the laptop on her desk. “It keeps me focused. But is hard on these middle-aged eyes.”
Maura opened her briefcase and removed a folder of digital prints. “These are the photos I took of the deceased. I’m afraid they’re not very pleasant to look at.”
Dr. Cawley opened the folder and paused, staring at the photo of Rat Lady’s mutilated face. “It’s been a while since I’ve attended an autopsy. I certainly never enjoyed it.” She sat down behind the desk and took a deep breath. “Bones seem so much cleaner. Somehow less personal. It’s the sight of flesh that turns the stomach.”
“I also brought her X rays, if you’d rather look at those first.”
“No, I do need to look at these. I need to see the skin.” Slowly she flipped to the next photo. Stopped and stared in horror. “Dear god,” she murmured. “What happened to the hands?”
“They were removed.”
Cawley shot her a bewildered look. “By whom?”
“The killer, we assume. Both hands were amputated. So were parts of the feet.”
“The face, the hands, the feet—those are the first things I’d look at to make this diagnosis.”
“Which could be the reason why he removed them. But there are other photos in there that might help you. The skin lesions.”
Cawley turned to the next set of images. “Yes,” she murmured, as she slowly flipped through them. “This certainly could be . . .”
Maura’s gaze lifted to the row of skulls on the shelf, and she wondered how Cawley could work in this office, with all those empty eye sockets staring down at her. She thought of her own office, with its potted plants and floral paintings—nothing on the walls to remind her of death.
But Cawley had chosen to surround herself with the evidence of her own mortality. A professor of medical history, she was a physician as well as an historian, a woman who could read a lifetime’s worth of miseries etched in the bones of the dead. She could look at the skulls on her shelf and see, in each, a personal history of pain. An old fracture or an impacted wisdom tooth or a jawbone infiltrated by tumor. Long after the flesh melts away, the bones still tell their stories. And judging by the many photos of Dr. Cawley taken at archaeological dig sites around the world, she had been mining these stories for decades.
Cawley looked up from a photo of one of the skin lesions. “Some of these do bear a resemblance to psoriasis. I can see why it was one of the diagnoses you considered. These could also be leukemic infiltrates. But we’re talking about a great masquerader. It can look like many different things. I assume you did skin biopsies?”
“Yes, including stains for acid-fast bacilli.”
“And?”
“I saw none.”
Cawley shrugged. “She may have received treatment. In which case there’d be no bacilli still present on biopsy.”
“That’s why I came to you. Without active disease, without bacilli to identify, I’m at a loss as to how to make this diagnosis.”
“Let me see the X rays.”
Maura handed her the large envelope of films. Dr. Cawley carried them to a viewing box mounted on her wall. In that office cluttered with artifacts from the past—skulls and old books and several decades’ worth of photos—the light box stood out as a starkly modern feature. Cawley rifled through the X rays and finally slid one under the mounting clips.
It was a skull film, viewed face-on. Beneath the mutilated soft tissues, the bony structures of the face remained intact, glowing like a death’s head against the black background. Cawley studied the film for a moment, then pulled it down and slid on a lateral view, taken of the skull’s profile.
“Ah. Here we go,” she murmured.
“What?”
“See here? Where the anterior nasal spine should be?” Cawley traced her finger down what should have been the slope of the nose. “There’s been advanced bone atrophy. In fact, there’s almost complete obliteration of the nasal spine.” She crossed to the shelf of skulls and took one down. “Here, let me show you an example. This particular skull was exhumed from a medieval grave site in Denmark. It was buried in a desolate spot, far outside the churchyard. You see here, where inflammatory changes have destroyed so much bony tissue that there’s just a gaping hole where the nose would be. If we were to boil off the soft tissues from your victim there—” She pointed to the X ray “—her skull would look very much like this one.”
“It’s not postmortem damage? Could the nasal spine have been cracked off when the face was excised?”
“It wouldn’t account for the severity of changes I see on that X ray. And there’s more.” Dr. Cawley set down the skull and pointed to the film. “You’ve got atrophy and recession of the maxillary bone. It’s so severe that the front upper teeth have been undermined and have fallen out.”
“I’d assumed it was due to poor dental care.”
“That may have contributed. But this is something else. This is far more than just advanced gum disease.” She looked at Maura. “Did you do the other X-ray projections I suggested?”
“They’re in the envelope. We did a reverse Waters shot as well as a peri-apical series to highlight the maxillary landmarks.”
Cawley reached inside and pulled out more X rays. She clipped up a peri-apical film, showing the floor of the nasal cavity. For a moment she said nothing, her gaze transfixed by the white glow of bone.
“I haven’t seen a case like this in years,” she murmured in wonder.
“Then the X rays are diagnostic?”
Dr. Cawley seemed to
shake herself from her trance. She turned and picked up the skull from her desk. “Here,” she said, turning the skull upside down to show the bony roof of the hard palate. “Do you see how there’s been pitting and atrophy of the alveolar process of the maxilla? Inflammation has eaten away this bone. The gums have receded so badly that the front teeth fell out. But the atrophy didn’t stop there. Inflammation continued to chew away at the bone, destroying not just the palate, but also the turbinate bones inside the nose. The face was literally eaten away, from the inside, until the hard palate perforated and collapsed.”
“And how disfigured would this woman have been?”
Cawley turned and looked at the X ray of Rat Lady. “If this were medieval times, she would have been an object of horror.”
“Then this is enough for you to make a diagnosis?”
Dr. Cawley nodded. “This woman almost certainly had Hansen’s disease.”
THIRTEEN
THE NAME SOUNDED INNOCUOUS enough to those who did not recognize its meaning. But the disease had another name as well, a name that rang with ancient echoes of horror: leprosy. It conjured up medieval images of robed untouchables hiding their faces, of the shunned and pitiful, begging for alms. Of leper’s bells, tinkling to warn the unwary that a monster approaches.
Such monsters were merely the victims of a microscopic invader: Mycobacterium leprae, a slow-growing bacillus that disfigures as it multiplies, rippling the skin with ugly nodules. It destroys nerves to the hands and feet so that the victim no longer senses pain, no longer flinches from injury, leaving his limbs vulnerable to burns and trauma and infection. With the passage of years, the mutilation continues. The nodules thicken, the bridge of the nose collapses. The fingers and toes, repeatedly injured, begin to melt away. And when the sufferer finally dies, he is not buried in the churchyard, but is banished far beyond its walls.
Even in death, the leper was shunned.
“To see a patient in such an advanced stage is almost unheard of in the U.S.,” said Dr. Cawley. “Modern medical care would arrest the disease long before it caused this much disfigurement. Three-drug therapy can cure even the worst cases of lepromatous leprosy.”
“I’m assuming this woman has been treated,” said Maura. “Since I saw no active bacilli in her skin biopsies.”
“Yes, but treatment obviously came late for her. Look at these deformities. The loss of teeth and the collapse of facial bones. She was infected for quite some time—probably decades—before she received any care.”
“Even the poorest patient in this country would have found treatment.”
“You’d certainly hope so. Because Hansen’s disease is a public health issue.”
“Then the chances are this woman was an immigrant.”
Cawley nodded. “You can still find it among some rural populations around the world. The majority of cases worldwide are in only five countries.”
“Which ones?”
“Brazil and Bangladesh. Indonesia and Myanmar. And, of course, India.”
Dr. Cawley returned the skull to the shelf, then gathered up the photos on her desk and shuffled them together. But Maura was scarcely aware of the other woman’s movements. She stared at the X ray of Rat Lady, and thought of another victim, another death scene. Of spilled blood, in the shadow of a crucifix.
India, she thought. Sister Ursula worked in India.
Graystones Abbey seemed colder and more desolate than ever when Maura stepped through the gate that afternoon. Ancient Sister Isabel led the way across the courtyard, her L. L. Bean snow boots peeking out incongruously from beneath the hem of her black habit. When winter turns brutal, even nuns rely on the comfort of Gore-Tex.
Sister Isabel directed Maura into the Abbess’s empty office, then she vanished down the dark hallway, the clomp-clomp of her boots trailing a fading echo.
Maura touched the cast-iron radiator beside her; it was cold. She did not take off her coat.
So much time passed that she began to wonder if she had been forgotten, if the antique Sister Isabel had simply shuffled on down the hall, her memory of Maura’s arrival fading with each step. Listening to the creaks of the building, to the gusts rattling the window, Maura imagined spending a lifetime under this roof. The years of silence and prayer, the unchanging rituals. There would be comfort in it, she thought. The ease of knowing, at each dawn, how the day will go. No surprises, no turmoil. You rise from bed and reach for the same clothing, kneel for the same prayers, walk the same dim corridors to breakfast. Outside the walls, women’s hems might rise and fall, cars might take on new shapes and colors, and a changing galaxy of movie stars would appear and then vanish from the silver screen. But within the walls, the rituals continue unchanging, even as your body grows infirm, your hands unsteady, the world more silent as your hearing fades.
Solace, thought Maura. Contentment. Yes, these were reasons to withdraw from the world, reasons she understood.
She did not hear Mary Clement’s approach, and she was startled to notice the Abbess was standing in the doorway, watching her.
“Reverend Mother.”
“I understand you have more questions?”
“About Sister Ursula.”
Mary Clement glided into the room and settled in behind her desk. On this bitterly cold day, even she was not immune to winter’s chill; beneath her veil, she wore a gray wool sweater embroidered with white cats. She folded her hands on the desk and fixed Maura with a hard look. Not the friendly face that had greeted her on that first morning.
“You’ve done all you can to disrupt our lives. To destroy the memory of Sister Camille. And now you want to repeat the process with Sister Ursula?”
“She would want us to find her attacker.”
“And what terrible secrets do you imagine she has? Which sins are you now fishing for, Dr. Isles?”
“Not sins, necessarily.”
“Just a few days ago, you were focused only on Camille.”
“And that may have distracted us from probing more deeply into Sister Ursula’s life.”
“You’ll find no scandals there.”
“I’m not looking for scandals. I’m looking for the attacker’s motive.”
“To kill a sixty-eight-year-old nun?” Mary Clement shook her head. “There’s no rational motive that I could imagine.”
“You told us that Sister Ursula served a mission abroad. In India.”
The abrupt change in subject seemed to startle Mary Clement. She rocked back in her chair. “Why is that relevant?”
“Tell me more. About her time in India.”
“I’m not sure what you want to know, exactly.”
“She was trained as a nurse?”
“Yes. She worked in a small village outside the city of Hyderabad. She was there for about five years.”
“And she returned to Graystones a year ago?”
“In January.”
“Did she talk much, about her work there?”
“No.”
“She served five years there, and she never spoke of her experiences?”
“We value silence here. Not idle chatter.”
“I’d hardly consider it idle chatter to talk about her mission abroad.”
“Have you ever lived abroad, Dr. Isles? I don’t mean in a nice tourist hotel, where maids change the sheets every day. I’m talking about villages where sewage runs in the street, and children are dying of cholera. Her experience there wasn’t a particularly pleasant topic to talk about.”
“You told us there’d been violence in India. That the village where she worked was attacked.”
The Abbess’s gaze dropped to her hands, the skin chapped and red, folded on the desk.
“Reverend Mother?” said Maura.
“I don’t know the whole story. She never spoke of it to me. What little I do know, I heard from Father Doolin.”
“Who is that?”
“He serves in the archdiocese in Hyderabad. He called from India, right after it hap
pened, to tell me that Sister Ursula was returning to Graystones. That she wished to rejoin cloistered life. We welcomed her back, of course. This is her home. Naturally, this was where she came to find solace, after . . .”
“After what, Reverend Mother?”
“The massacre. In Bara village.”
The window suddenly rattled, buffeted by a gust. Beyond the glass, the day was leached of all color. A gray wall, topped by gray sky.
“That was where she worked?” asked Maura.
Mary Clement nodded. “A village so poor it had no telephones, no electricity. Nearly a hundred people lived there, but few outsiders dared to visit. That was the life our sister chose, to serve the most wretched people on earth.”
Maura thought of Rat Lady’s autopsy. Of her skull, deformed by disease. She said, softly: “It was a leper’s village.”
Mary Clement nodded. “In India, they’re considered the most unclean of all. Despised and feared. Cast out by their families. They live in special villages, where they can retreat from society, where they don’t have to hide their faces. Where others are as deformed as they are.” She looked at Maura. “Even that didn’t protect them from attack. Bara village no longer exists.”
“You said there was a massacre.”
“That’s what Father Doolin called it. Mass slaughter.”
“By whom?”
“The police never identified the attackers. It could have been a caste massacre. Or it could have been Hindu fundamentalists, angry about a Catholic nun living in their midst. Or they could have been Tamils, or any one of half a dozen separatist factions at war there. They killed everyone, Dr. Isles. Women, children. Two of the nurses in the clinic.”
“But Ursula survived.”
“Because she wasn’t in Bara that night. She’d left the day before to fetch medical supplies from Hyderabad. When she returned the next morning, she found the village in ashes. Workers from the nearby factory were already there, searching for survivors, but they found none. Even the animals—the chickens, the goats—were slaughtered, and the corpses burned. Sister Ursula collapsed when she saw the bodies, and a doctor from the factory had to keep her in his clinic until Father Doolin arrived. She was the only one from Bara who survived, Dr. Isles. She was the lucky one.”
The Sinner Page 18