"I thought you were scheduled to speak at the convention today, Karl."
"There are more important things than shooting off my mouth on a subject no one in the forensics community wants to hear me fire off on again," he joked.
"You're sure there's no other reason that you are following
… this case?'' she asked again.
"As I said before, I offered my services to the FBI-Bishop, to be exact, and he encouraged me to help in any way possible. So here I am."
She pressed it further. "And you're sure there's no other motive at work here?''
"My, but you've become suspicious over the years, Jessica. Look, my office got word of a suspicious fire death here in Page, and they knew of what had happened in Vegas because I was in contact with them. They put it together and called me back. Bishop's office informed me where you were. It was either come here or remain at that dull convention. Which would you have chosen, Jessica?"
"All right, Karl. Let's have the truth now, okay?"
He squirmed, thinking her goddamned persistent. He looked down at his feet, fidgeted with the tails of his surgery gown, and finally admitted, "Phoenix is screwing around with the medical examiner system that I created there. They see it's cheaper to run a coroner's office than a medical examiner's office; they think cheaper is better, even more efficient."
"Christ," she moaned in sympathy for Karl. "My office is being seriously challenged by a referendum on the ballot to make death investigation cheaper in the jurisdiction. Cheaper, do you believe it? You have no idea how close to the bone we run the office as is, but death investigation still doesn't come cheaply enough for the budget cutters."
It was an all-too-familiar lament among forensics experts. "I'm sorry to hear it, Karl." She sounded like a person giving condolences to a friend who'd contracted an incurable disease, but she didn't know what else to say.
Repasi shrugged and said, "There's the usual complaint about lack of money, which has led to inadequate staffing and salaries, and we struggle along with antiquated operations and equipment."
"Resistance to acquiring new technology, resistance to change," she sounded the mantra. "And a failure to appreciate, even understand, the M.E.'s mission. I got the same nonsense when I was M.E. in Washington, and when I was an assistant M.E. in Baltimore before that."
Finally, something she did understand. It made sense for Repasi to have shown up uninvited here. "How many ways do we have to show people that the coroner system produces inferior and inaccurate results?" she rhetorically asked. "Nonphysicians can't make accurate medical decisions, no matter how many weeks of training you give them."
"Nor can general pathologists in many cases. Sure, they can mull their way through most common cases, but the difficult ones, the cases they often don't even recognize as difficult… Fools in Phoenix are taking the death stats to heart, you see. They say only twenty percent of our cases involve suspicious deaths, so a pathologist could handle the eighty percent that we do not need to investigate."
Jessica understood the enormous hole in this logic, and she nodded knowingly.
"How does a pathologist know which is the twenty percent if he isn't trained to recognize that twenty percent? What judge would take his pregnant wife to a dermatologist for obstetrical care? But the same politician will permit an individual with zero forensic training to testify in a case involving life-and-death decisions."
"Yeah, agreed," began Jessica. "A major characteristic of the unqualified expert in forensics is that rare ability to interpret a case in absolute and exquisite detail when there are no forensic details to be had in a case."
"Worse still is the practice of contract pathologists."
"Yes, the very notion sets my teeth on edge." Jessica's mind fumed at the idea of a pathologist paid by the case, so that the more cases he or she put away, the more money the pathologist made. "What about the local coroner here in Page? How does he work?"
"Modified coroner, M.E. system. Sends a lot of his cases up to Salt Lake City, others to me in Phoenix."
"Oh, so you two know each other well."
"Yes."
"So, he's okay with you taking charge, Karl?"
We've talked at length. He's happy for the interference."
"That's a refreshing change. I usually meet with resistance with the natives. Good for you."
"Perhaps I'm better with my people skills than you, Jessica?''
She let this pass, saying, "Well then, let's get to work, shall we?" She returned to the body, what remained of Mel Martin: a greasy, soot-covered, creosoted lump of charred flesh an autopsy could do little or nothing for. This they all knew, but protocol mandated an autopsy be performed.
And so, Jessica, how do you approach a fire victim such as this? She heard Dr. Holcraft's voice, her mentor, now long dead, filling her thoughts.
She inwardly, silently answered, The same way that any physician approaches any patient. In medical school, Jessica was taught that to make a correct diagnosis, she must first take a history, perform an examination, and order relevant laboratory tests. They'd gotten only a smattering of Martin's history, knowing much less about the man than they had Chris Lorentian in Vegas. But there were no family members at hand, and time was fleeting. They were prepared to make their examination now and order necessary tests.
"I suppose you've seen your share of burn cases, Dr. Coran," said Repasi, "but have you ever seen anything worse than this?"
She paused, considered his question, and replied, ''Yes, I have."
"Oh, really? Explosion victims? Lightning victims?"
"A woman who was scalded to death."
Both doctors appreciated the severe nature of burns from boiling water, knowing that water heated to 158 degrees Fahrenheit caused a full-thickness burn in adult skin in one second of contact.
"Ahhh, bathroom shower injuries I've seen, but nothing approximating this."
"This was no bathroom shower accident. It was a victim of murder whose body was placed in a scalding hot spring in Yellowstone National Park, held under by her ankles as she thrashed. The scalding was uniform, not showing any burn variation, no multiple splash bums, just all-over fourth-degree burns. The killer hoped to cover up a rape-murder by completely scalding the body in a two-hundred-five-degree hot pool. She was scalded over her entire body, save her ankles and feet, which were only mildly burned by comparison. Sloppy oversight on the killer's part, but then he didn't know a medical examiner was in the park at the time. The murderer was a young park ranger who'd come up on the victim where she was hiking alone in the park. That was some ten or eleven years ago."
"Sounds like an interesting case," he granted.
"It was the first murder case I ever solved."
While Page's hospital was an adequate, modern facility, the death room and the forensic equipment in Page left a great deal to be desired; still, Jessica was glad to see that they had at least the rudiments for a pathology lab and that it was not placed in the subbasement of the hospital or the back of a funeral home, as was the case in hundreds of thousands of small towns all across America. There was just sufficient enough space along with appropriate lighting, plumbing, and cooling facilities. The instrumentation included an X-ray machine for the pathology lab and coroner's office to share, a luxury, it appeared, despite the fact that an X-ray machine was basic equipment in any autopsy suite. Page also had its own small toxicological lab capable of accurate, precise analysis for the presence of drugs.
In getting the autopsy under way, Jessica spoke into a microphone that recorded her autopsy for later transcription. Back at Quantico, nowadays, the entire autopsy was put on videotape, and Jessica had learned to choose her words with extreme care, for anything said now could come back to haunt the medical examiner. She announced the purpose of their coming together, the name of the deceased, age, height, weight, sex, race, condition of the body upon discovery. This led her to add, "On gross examination of such a victim, it is virtually impossible to distingui
sh antemortem from postmortem burns. Microscopic examination of the body tissue offers no help, unless the victim has survived long enough to develop an inflammatory response. Wouldn't you agree, Dr. Repasi?"
Repasi promptly agreed, saying, "Yes, lack of such a response doesn't necessarily indicate that the burn was postmortem. I have had occasion to view third-degree burns incurred by Vietnam veterans in which the patients died two and three days later. In some of these cases, there was no inflammatory reaction whatsoever."
Jessica agreed now, adding, "Due, presumably, to heat thrombosis of the dermal vessels."
"Such that inflammatory cells could not reach the area of the burn and produce a reaction to begin with," finished Repasi.
Jessica thought that perhaps J. T. ought to have remained; he might well have learned something about the irregular nature of burn pathology.
"In Mr. Martin's case, it is presumed he was alive when he died due to witness testimony, namely Dr. Coran," said Repasi for the record.
"It may also be of interest that the skin has split open, revealing exposed muscle across the upper torso and upper extremities, while skin over the back is perfectly preserved. Where the skin is completely burned away, underlying muscles have ruptured due to the intensity of the heat," added Jessica.
Burned bone shone as gray-white with a fine, superficial network of fractures on the cortical surface. Repasi noted this for the shoulder bone and collarbone as well as the skull. With his gloved hand, he put slight pressure on a section of skull thus discolored, and it crumbled at his touch. He noted this for the record. "The outer table of the exposed cranial vault," he said, pausing, "reveals a network of fine, crisscrossing heat fractures."
Both examiners knew that it was extremely hard to burn a body, due to its high water content, and that to do the damage the Phantom had inflicted on Martin required a superheated energy source. Portions of the abdominal wall were burned away as well, exposing the viscera. The internal organs appeared charred, seared.
''In the autopsy on Chris Lorentian, who died from similar inflicted wounds," Jessica said, "there was evidence of an antemortem epidural hematoma."
Repasi added, "We find a similar blow to the head before death in Martin; there is a sizable postmortem epidural hematoma present. Not an uncommon sight in severely burned bodies. See here, Jessica, the chocolate brown color, crumbly, with its telltale honeycombed appearance."
"Yes, I see it. Large, fairly thick, overlying the frontal lobe, extending toward the occipital area."
He lifted a tiny ruler to it and asked an assistant to snap a picture, and for the record he announced, ''Yes, large at one point five centimeters."
"Good catch, Doctor." Jessica turned off the recorder for a word with Dr. Repasi. "Karl, I didn't know your specialty was burn victims."
''One of many,'' he replied with a grin beneath his surgical mask. "Shall we have a look-see at the larynx and trachea? Examine for carbon monoxide intoxication?"
"I prefer the term smoke inhalation, Doctor, but yes."
"Semantics," he parried and scalpeled at the same time, opening up the charred throat and dissecting the larynx and trachea, which, while fire-blackened and fractured on the outside, remained intact.
Too many people in the scientific community, as far as Jessica was concerned, used the terms of the profession too loosely, such as making carbon monoxide poisoning synonymous with smoke inhalation. A number of important factors other than the presence of carbon monoxide in the blood might cause death by smoke inhalation, such as oxygen deprivation due to consumption of oxygen by the fire itself, cyanide, free radicals, and the old standby to fall back on, nonspecific toxic substances. Jessica knew that in cases of self-immolation, carbon monoxide, as a general rule, was not elevated, since it was a flash fire. In cases involving explosives or gasoline fires, carbon monoxide levels in the blood were usually found to be in the so-called normal range. This held true even if the body were severely charred. Every fire, in fact, was unique, and each created its own unique mysteries. Of course, Repasi knew this as well as she.
She spoke again into the recorder, saying, "Smoke inhalation reveals soot in the nostrils and mouth, but this alone is no indication the victim was alive when the fire began. Any further look into the breathing apparatus will not change that fact."
But Repasi, ever the perfectionist, wanted to see the results of this fire to the windpipe as well. He announced what his scalpel now sliced through and why for the record. The soot had not coated the larynx, trachea, or bronchi, but both doctors took this in stride.
"Well, clean as a whistle except for the gristle," quipped Repasi. "What do you make of that, Dr. Coran?"
"Absence of soot in these areas in a flash fire is not uncommon, and it does not necessarily mean that Martin was dead prior to the blaze."
"Quite right. I've seen numerous cases in which no soot appeared in these deeper areas, and yet analysis of blood carbon monoxide revealed lethal levels. Unfortunately, blisters or the absence thereof," continued Repasi, "do not indicate that the deceased was alive at the time the burns were incurred either, since they can be produced postmortem."
Jessica knew that many people, medical people included, coroners and pathologists and some medical examiners included, mistakenly believed that if blisters or burns were surrounded by an erythematous-red-rim, then this clearly indicated that the victim was alive at the time the burns were incurred. This was blatantly false. Blisters with such red rims had now been produced on dead bodies at the FBI's famous, or infamous, "Body Farm" in Tennessee. Both she and Repasi knew that heat applied to skin caused contraction of dermal capillaries, and this forced blood to the periphery of the blister, simulating an antemortem hyperemic inflammatory response. An autopsy on such a body proved the worst kind of pathology. Fire did awful things to flesh, creating leathery, wood-grainlike swirls, like some mad tattoo artists had been allowed to go to work on the dead man. Jessica recognized this configuration as the result of actual contact with flame, that they were again dealing with a "flash" burn.
The extent of the burn was indicated as the percent of total surface area involved by the thermal injury, and chemical burns from the gas used caused even deeper, thicker blotches of mottled skin tissue. The percentage of total surface area burned was quickly determined using the rule of nines. Jessica, using the typical conventional thinking, considered the total body surface as 100 percent, meaning the head was 9 percent, as it was completely burned away to the bone, leaving no features. The arms or upper extremities represented 9 percent each. The front of the torso, also extremely badly damaged, counted for an additional 18 percent. The back, which was not burned badly at all, since it was protected by the victim's weight against the bed, also represented 18 percent. Each lower extremity totaled 18 percent apiece, while the neck amounted to 1 percent, equaling an even 100 percent. Martin's body was burned over 82 percent of its surface. His burns were the worst kind, third- and fourth-degree, or as Repasi's nomenclature had it, a combination of partial-and full-thickness burns. In third-degree burns there was coagulation necrosis of the epidermis and dermis with complete destruction to the dermal appendages. Most of Martin's lesions were brown and blackened, the result of charring and eschar formation. If he had survived the fire, the smoke inhalation, the shock, the dehydration, and the bursting blood vessels, this blackened skin would have healed as scar tissue, but at his advanced age, even if he had lived, he would likely be dead within hours or days. Other burns, fourth-degree burns, appeared as ashen white leather. There were no red blisters. The fire was too intense for the cherry-red burns usually associated with fire and skin, for Martin's burns were incinerating injuries extending deeper than the skin.
It was evident to Repasi, J. T., and Jessica that Martin's injuries were the result of a high-intensity flash burn, resulting from an explosion of gases. Jessica kept hearing the whoosh of the explosion in her ears. This explained why 90 percent of the burned areas appeared to have burned uniformly.
The other 10 percent was due to the mattress and clothing burning against the body. When clothing ignited, a combination of flash and flash burn occurred. Hash burns usually resulted in only partial-thickness or second- and third-degree burns and singed hair, but this flash burn was directed by human means directly at the victim, making it third- and fourth-degree about the face, head, and upper torso, with nearly total loss of hair. What hair remained crumbled at the touch, like burned pitch pine.
The severity of the burn was increased by the careful method in which the killer loosely wrapped the clothing about the body. If wrapped tightly and snugly against the body, it would have decreased the degree of burn. But the killer knew that air surrounding the clothing would help fuel his human bonfire.
"Order up at minimum," began Jessica, "blood, vitreous, urine, and bile for toxicological analysis."
"I'll do the blood myself," suggested Repasi, quickly taking the blood from the root of the aorta with needle and syringe. Wise choice, Jessica thought, glad that Karl hadn't incised the vessels and attempted to catch the fluid as it came out.
Repasi next went about placing all body fluids he collected in glass tubes and bottles, no plastic. Once more, Jessica approved.
"Shall we open up the chest? Get liver, kidney, and muscle samples?"
"Ready when you are, Doctor." Repasi was a sure man with a scalpel, and his incision helped the already fractured and split-apart chest open like a melon to reveal the viscera, remarkably but not surprisingly untouched by the fire. Due to its high water content, a body was one of the most difficult items on the planet to use as fuel for a fire-so much so that a body like Martin's, showing great and extreme damage and extensive charring on the outside, often showed perfect preservation of the internal organs, especially those below the rib cage. Household fires generated temperatures seldom exceeding 1,200 to 1,600 degrees Fahrenheit. It took 1,800 to 2,000 degrees Fahrenheit to cremate a body. Ordinary house fires lacked that kind of intensity and the time to incinerate a human body completely. As for a flash fire, involving gasoline and butane and a sudden flashover, the intensity was fleeting. A flash fire could not sustain such temperatures for a long enough period to fully ignite the body and all its water-laden internal organs.
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