Bloodstream

by Tess Gerritsen

  Roman and his colleagues unzipped the LES and stripped the corpse. The fabric was fire-retardant, too tough to cut through. They had to peel it off. They worked efficiently, their comments matter-of-fact and without even a hint of emotion. When they had removed her clothing, she looked like a broken doll. Both her hands were deformed by fractures, reduced to masses of crushed bone. Her legs, too, were broken and akilter, the shins bent at impossible angles. The tips of two broken ribs penetrated her chest wall, and black bruises marked the strap lines of her seat restraint.

  Jack felt his breaths coming too fast, and he had to quell his rising horror. He had witnessed many autopsies, on bodies in much worse shape. He had seen aviators burned into little more than charred twigs, skulls exploded from the pressure of cooking brains. He had seen a corpse whose face had been sliced off from walking into a chopper’s tail rotor. He had seen a Navy pilot’s spine broken in half and folded backward from ejecting through a closed canopy.

  This was far, far worse because he knew the deceased. He remembered her as a living, breathing woman. His horror was mingled with rage, because these three men viewed Jill’s exposed body with such cold dispassion. She was a slab of meat on the table, nothing more. They ignored her injuries, her grotesquely fractured limbs. The cause of death was only of secondary concern to them. They were more interested in the microbiological hitchhiker harbored within her corpse.

  Roman began his Y incision. In one hand he gripped a scalpel; the other hand was safely encased in a steel mesh glove. One slash ran from the right shoulder, diagonally through the breast, to the xiphoid process. Another diagonal slash ran from the left shoulder and met the first slash at the xiphoid. The incision continued straight down the abdomen, with a small jag around the umbilicus, ending near the pubic bone. He cut through the ribs, freeing the sternum. The bony shield was lifted to reveal the chest cavity.

  The cause of death was immediately apparent.

  When a plane crashes, or an automobile slams into a wall, or a despondent lover makes a suicide leap from a ten-story building, the same forces of deceleration apply. A human body traveling at great speed is abruptly brought to a halt. The impact itself can shatter ribs and send missiles of bone shards into vital organs. It can fracture vertebrae, rupture spinal cords, crush skulls against dashboards or instrument panels. But even when pilots are fully strapped in and helmeted, even when no part of their body makes contact with the aircraft, the force of deceleration alone can be fatal, because although the torso may be restrained, the internal organs are not. The heart and lungs and great vessels are suspended inside the chest by only tissue attachments. When the torso comes to an abrupt halt, the heart continues to swing forward like a pendulum, moving with such force it shears tissues and rips open the aorta. Blood explodes into the mediastinum and pleural cavity.

  Jill Hewitt’s chest was a lake of blood.

  Roman suctioned it out, then frowned at the heart and lungs. “I can’t see where she bled out,” he said.

  “Why don’t we remove the entire block?” said his assistant. “We’d have better visibility.”

  “The tear is most likely in the ascending aorta,” said Jack. “Sixty-five percent of the time, it’s located just above the aortic valve.”

  Roman glanced at him in annoyance. Up till then, he’d managed to ignore Jack; now he resented this intrusive comment. Without a word, he positioned his scalpel to sever the great vessels.

  “I advise examining the heart in situ first,” said Jack. “Before you cut.”

  “How and where she bled out is not my primary concern,” Roman retorted.

  They don’t really care what killed her, thought Jack. All they want to know is what organism might be growing, multiplying, inside her.

  Roman sliced through the trachea, esophagus, and great vessels, then removed the heart and lungs in one block. The lungs were covered with hemorrhages. Traumatic or infectious? Jack didn’t know. Next Roman examined the abdominal organs. The small bowel, like the lungs, was splotchy with mucosal hemorrhages. He removed it and set the glistening coils of intestines in a bowl. He resected the stomach, pancreas, and liver. All would be sectioned and examined microscopically. All tissue would be cultured for bacteria and viruses.

  The body was now missing almost all its internal organs. Jill Hewitt, Navy pilot, triathlete, lover of J&B scotch and high stakes poker and Jim Carrey movies, was now nothing but a hollow shell.

  Roman straightened, looking vaguely relieved. So far, the autopsy had revealed nothing unexpected. If there was gross evidence of Marburg virus, Jack did not see it.

  Roman circled behind the corpse, to the head.

  This was the part Jack dreaded. He had to force himself to watch as Roman sliced the scalp, his incision running across the top of the crown, from ear to ear. He peeled the scalp forward and folded the flap over the face, a fringe of chestnut hair flopping down over her chin. With a rongeur, they cracked the skull. No saws, no flying bone dust, could be allowed in a Level 4 autopsy. They pried off the cap of bone.

  A fist-sized mass of clotted blood plopped out, splattering the stainless steel table.

  “Big subdural hematoma,” said one of Roman’s associates. “From the trauma?”

  “I don’t think so,” said Roman. “You saw the aorta—death would have been nearly instantaneous on impact. I’m not sure her heart was pumping long enough to produce this much intracranial bleeding.” Gently he slid his gloved fingers into the cranial cavity, probing the surface of gray matter.

  A gelatinous mass slithered out and splashed onto the table.

  Roman jerked back, startled.

  “What the hell is that?” his assistant said.

  Roman didn’t answer. He just stared at the clump of tissue. It was covered with a blue-green membrane. Through the glistening veil, the mass appeared irregular, a knot of formless flesh. He was about to slit the membrane open, then he stopped himself and shot a glance toward Jack. “It’s a tumor of some kind,” he said. “Or a cyst. That would explain the headache she reported.”

  “No it wouldn’t,” Jack spoke up. “Her headache came on suddenly—within hours. A tumor takes months to grow.”

  “How do you know she hasn’t been hiding her symptoms these past months?” countered Roman. “Keeping it a secret so she wouldn’t get scrubbed from the launch?”

  Jack had to concede that was a possibility. Astronauts were so eager for flight assignments they might well conceal any symptoms that would pull them from a mission.

  Roman looked at his associate standing across the table from him. The other man nodded, slid the mass into a specimen container, and carried it out of the room.

  “Aren’t you going to section it?” said Jack.

  “It needs to be fixed and stained first. If I start slicing now, I could deform the cellular architecture.”

  “You don’t know if it is a tumor.”

  “What else would it be?”

  Jack had no answer. He had never seen anything like it.

  Roman continued his examination of Jill Hewitt’s cranial cavity. Clearly the mass, whatever it was, had increased pressure on her brain, deforming its structures. How long had it been there? Months, years? How was it possible that Jill had been able to function normally, much less pilot a complicated vehicle like the shuttle? All this raced through Jack’s head as he watched Roman remove the brain and slide it into a steel basin.

  “She was close to herniating through the tentorium,” said Roman.

  No wonder Jill had gone blind. No wonder she hadn’t lowered the landing gear. She had already been unconscious, her brain about to be squeezed like toothpaste out the base of her skull.

  Jill’s corpse—what remained of it—was sealed into a new body bag and wheeled out of the room, along with the biohazard containers holding her organs.

  A second body was brought in. It was Andy Mercer.

  With fresh gloves pulled over his space suit gloves, and a clean scalpel, Roman set to wo
rk on the Y incision. He was moving more quickly, as though Jill had just been the warm-up and he was only now hitting his stride.

  Mercer had complained of abdominal pain and vomiting, Jack remembered as he watched Roman’s scalpel slice through skin and subcutaneous fat. Mercer hadn’t complained of a headache, as Jill had, but he’d had a fever and had coughed up a little blood. Would his lungs show the effects of Marburg virus?

  Again, Roman’s diagonal cuts met below the xiphoid, and he sliced a shallow line down the abdomen to the pubis. Again he cut through the ribs, freeing up the triangular shield that covered the heart. He lifted the sternum.

  Gasping, he stumbled backward, dropping his scalpel. It clanged onto the table. His assistants stood frozen in disbelief.

  In Mercer’s chest cavity was a cluster of blue-green cysts, identical to the cyst in Jill Hewitt’s brain. They were massed around his heart, like tiny translucent eggs.

  Roman stood paralyzed, his gaze fixed on the gaping torso. Then his gaze shifted to the glistening peritoneal membrane. It was distended, full of blood and bulging out through the abdominal incision.

  Roman stepped toward the body, staring at the outpouching of peritoneal membrane. When he’d made his incision through the abdominal wall, his scalpel had nicked the surface of that membrane. A trickle of blood-tinged fluid leaked out. At first it was barely a few drops. Then, even as they watched, the trickle turned into a stream. The slit suddenly burst open into a gaping rent as blood gushed out, carrying with it a slippery flood of blue-green cysts.

  Roman gave a cry of horror as the cysts plopped onto the floor in splatters of blood and mucus.

  One of them skittered across the concrete and bumped against Jack’s rubber boot. He bent down, to touch it with his gloved hand. Abruptly he was yanked backward as Roman’s associates pulled him away from the table.

  “Get him out of here!” Roman ordered. “Get him out of the room!”

  The two men pushed Jack toward the door. He resisted, shoving away the gloved hand now grasping his shoulder. The man stumbled backward, tipped over a tray of surgical instruments, and sprawled to the floor, slippery with cysts and blood.

  The second man wrenched Jack’s air hose from its connection and held up the kinked end. “I advise you to walk out with us, Dr. McCallum,” he said. “While you’ve still got breathable air.”

  “My suit! Jesus, I’ve got a breach!” It was the man who’d stumbled into the instrument tray. He was now staring in horror at a two-inch-long tear in his space suit sleeve—a sleeve that was coated with Mercer’s body fluids.

  “It’s wet. I can feel it. My inner sleeve is wet—”

  “Go!” barked Roman. “Decon now!”

  The man unplugged his suit and went running in panic out of the room. Jack followed him to the air lock door, and they both stepped through, into the decon shower. Water shot out of the overhead jets, pounding down like hard rain on their shoulders. Then the shower of disinfectant began, a torrent of green liquid that splattered noisily against their plastic helmets.

  When it finally stopped, they stepped through the next door and pulled off their suits. The man immediately peeled off his already-wet scrub suit and thrust his arm under a faucet of running water, to rinse away any body fluids that had leaked through the sleeve.

  “You have any breaks in your skin?” asked Jack. “Cuts, hangnails?”

  “My daughter’s cat scratched me last night.”

  Jack looked down at the man’s arm and saw the claw marks, three scabbed lines raking up the inner arm. The same arm as the torn space suit. He looked at the man’s eyes and saw fear.

  “What happens now?” said Jack.

  “Quarantine. I go to lockup. Shit . . .”

  “I already know it’s not Marburg,” said Jack.

  The man released a deep breath. “No. It’s not.”

  “Then what is it? Tell me what we’re dealing with,” said Jack.

  The man clutched the sink with both hands and stared down at the water gurgling into the drain. He said softly, “We don’t know.”

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