by Radclyffe
Olivia slipped a thin, flexible metal probe into the circular hole in his chest and gently fed it forward into the thorax until only a few inches protruded. “The goal here is maximal exposure in the most efficient manner. We’re not worried about the aesthetics of the wound healing or preserving superficial anatomical planes unrelated to areas of trauma.”
“Should we x-ray the tract?” Jay asked.
“We could, but given the obvious nature of this wound, it’s really not necessary. We should be able to visualize and map the path of the projectile without any difficulty. If there were multiple wounds, we’d need to trace each one individually. With any kind of explosive damage where we expected widespread contamination from foreign matter, imaging would be indicated.”
“Right.” Jay flashed on the bombing during the Boston Marathon and realized that those kinds of mass causalities didn’t just occur on the battlefield any longer.
Olivia outlined a V starting at each shoulder and ending at the upper abdomen. “Go ahead. Full thickness.”
Jay had more or less anticipated where the incisions were supposed to go, everyone having heard of the Y incision, even though she’d never actually witnessed an autopsy before. She made a deeper incision than she would have in the OR and was instantly struck by the absence of blood. The tissue felt different too, thicker and more resistant to her blade, but not the rubbery consistency she remembered from her first-year gross anatomy dissections either. “It’s different.”
Olivia reflected the tissues to either side as Jay deepened the incisions from collarbone down to the lower aspect of the chest, one on each side, exposing the sternum and the ribs.
“These tissues are unlike anything you’ve encountered before,” Olivia said, “still fragile but no longer responsive—fixed, if you will, at the moment of death or shortly thereafter. Technique still matters, and you have the advantage over almost every other trainee. Your surgical skill gives you an affinity for the dissection that is unique.”
Good hands. Jay had always known she’d had good hands. Maybe it still mattered a little. “So what’s our goal here?”
“Good question. We want to document the injuries and rule out other contributing factors. So in addition to the obvious trauma, we’ll examine the rest of the internal organs, run routine tox screens, and submit tissue samples for histo.” Olivia grabbed the hedge clippers. “Now you’ll see why the big shears work so well.” With a few deft turns of her wrist, Olivia neatly snapped through the junction of the ribs and the broad bony plate of the sternum, quickly and efficiently. “Go ahead and lift that off.”
Jay carefully worked the sternum loose from the underlying tissues and placed it in the stainless steel pan Olivia held out for her. When she looked down into the wide-open chest cavity, both lungs and the heart were clearly exposed. She whistled low. “Wow, that’s a lot of damage. The heart’s just flopping around in there.”
“Yes,” Olivia murmured, gently moving some of the clotted blood away from the heart and the great vessels. “See here—the root of the aorta is shredded. The probe passes right through the juncture of the vessel with the heart and out the exit wound on the back. No ricochet.”
“He must’ve bled out quickly.”
“Possibly,” Olivia said. “This massive wound might have caused enough electrical trauma to the heart muscle that the heart simply stopped beating. Note there’s very little blood in the chest cavity. If his heart had continued pumping blood with the aorta severed, I would expect to see some collection in the thorax.”
“I see what you mean.” Jay resisted the urge to press her hand over the scar on her chest left by the defib paddle. She wasn’t even upset she’d gotten a burn when some paramedic shocked her before she was grounded properly. They’d jump-started her heart, and she was alive. A scar was nothing.
“Let’s weigh the heart”—Olivia pointed out where Jay should make the incisions to remove the organ—“and then we’ll section the muscle in a few places. That will tell us if there’s primary tissue damage.”
Jay weighed the fist-sized organ on the scale at the end of the table.
“290 grams. Slightly low for a male, but he’s on the small side in general.” Olivia set the heart on a plastic cutting board and sliced it in half, exposing the inner chambers. “Empty—not even a clot. Conclusion?”
“He bled out from the bullet wound. Most likely his body fell in such a way the blood drained out quickly and nothing accumulated in his chest.” Jay wasn’t positive, but better wrong than uncertain. She smiled to herself. Surgery had taught her to be fearless. She was just remembering that.
“Mmm.” Olivia dropped a small section of muscle into a labeled vial. “Possible. We’ll check the scene photos when we’re done. Let’s move on to the abdomen.”
“Do you sample all the organs in every autopsy?” Jay asked.
Olivia nodded as if the question were a good one. “Not necessarily, no, especially not if we don’t suspect a chemical or toxic component contributing to death. We’ll do a gross exam of all the abdominal contents and section anything that looks abnormal.”
“Okay.”
Olivia indicated where to extend the incision, and once the abdomen was opened completely, Jay removed each of the internal organs, weighed it, and placed it in a labeled container.
“There’s no reason to do a cranial examination in this case,” Olivia said. “We have clear evidence for cause of death. What would you call it?”
If Jay had been filling out a death certificate in the hospital, she’d probably say cardiac arrest, which was the final event, after all. But that wasn’t how Olivia had explained things to her earlier, so she took a stab at the cause and mechanism. “Exsanguination due to gunshot wound.”
Olivia nodded. “Good. Cause is the GSW, the mechanism is hypovolemic shock leading to cardiac arrest. According to the police report, this boy was shot from a passing vehicle, by all witness reports intentionally, making the manner of death clearly a homicide.”
“Got it,” Jay said, experiencing the kind of satisfaction she was used to feeling at the end of a successful case. Not the same, but still, a job done right. Better than she’d imagined feeling doing something like this.
“Why don’t you dictate the final report, and we’ll go over it together before you present it tomorrow.” Olivia stripped off her gloves. “There are forms in the top drawer over there. They’re pretty self-explanatory. Not much different than what you’re used to doing with a routine discharge summary.”
“Okay, I’ll give it a shot.” Jay hesitated. “Can I see your dictation of the external exam?”
Olivia nodded. “I’ll print it out for you. You can pick it up along with the rest of the file in my office.”
Jay glanced down at the body of the boy. “What about him?”
“The night attendant will close the incisions and take care of him now.” Olivia rinsed out the collection tray under the table and hung up the hose. “I think you’ve had a pretty full first day. Let’s meet tomorrow at seven.”
“What about…are you done for the day?”
“I have some paperwork to do. I’ll be here for a while.”
Jay followed her into the scrub room and pulled off her cover gown. “What time are you going to start tomorrow?”
Olivia smiled. “Early.”
“What kind of coffee do you drink?”
Olivia gave her a long look and laughed. “Black, strong.”
“What time should I be here?”
“Is that a bribe?” Olivia countered.
“Absolutely.”
“Five thirty.”
“Great. I can sleep in.”
Olivia shook her head and held the door for Jay. “All right then, Dr. Reynolds. I’ll see you in the morning.”
“Night,” Jay called when she’d collected her jacket and the file Olivia pulled for her.
“Good night.” When the door to her office closed, Olivia settled at her desk and pul
led up the department’s open cases on the computer and quickly scanned the status updates. No problems other than the usual backlog of lab reports waiting to come in. Finally, she reviewed the field notes Bobbi and Darrell had entered on the case that afternoon. Still no ID. They’d need dental records and DNA if nothing turned up in the police, DMV, and NCIC databases in the morning.
Finally she opened Jay’s report from the scene—she’d been thorough in noting standard data and had added some on-scene observations without having been told to. Jay had also done a very nice job on the post. She had a natural affinity for the work, although she might never let herself acknowledge it. Pain had a way of blinding one to the truth.
Olivia sighed, closed the case files, and rose to study the Go array in the corner for a minute, having made up her mind when she’d walked into the office fifteen hours earlier what her move would be. Still satisfied with the strategy, she moved a single stone, took a photo with her phone, and emailed the image.
A minute later an email reply with a familiar avatar appeared, a dragon with jeweled eyes and an oddly mischievous smile. A text message followed. A daring move.
Olivia smiled, knowing her nameless opponent had been baiting her for the last few moves to push her advantage. Now she was ready.
She typed Challenge accepted and turned off her computer. Tomorrow’s response should be interesting.
As she shut off the lights, she thought of Jay’s promise of early-morning coffee—an altogether different sort of challenge, as if Jay was daring her to prove this new direction in her life could match what she’d lost. She wondered if Jay was really ready to find out, and to her surprise, found herself hoping she was.
*
Jay had never been so glad she’d decided on a bare-bones efficiency apartment a block from the University Hospital, sacrificing amenities for expedience. Walking home, more like dragging her ass home, she was more tired than she could remember being after sixty hours straight on call. As much as she hated her cane, she was glad to have it, and glad for the dark that kept anyone she might know from noticing her leaning heavily on it. Her leg throbbed like a mother, and the headache that had been her constant companion for most of the last few months was threatening to bloom behind her eyes. As tired as she was, a buzz she hadn’t experienced in a long time sizzled in the pit of her stomach. She wasn’t ready to go dancing, metaphorically, since dancing probably wasn’t in her future ever again, but the heavy curtain of despair that had clouded every waking moment was lighter tonight. She’d worked, with her hands and with her mind. Even her body, such as it was now, had held up well enough not to embarrass her too much.
She let herself into the tiny foyer with its cracked vinyl floor tiles and tired green-painted walls, checked her mailbox and found it empty, and slowly climbed the worn brown carpeted stairs to the second-floor rear apartment. The place was not much bigger than the room she’d had as a medical student a dozen years before. The hall door opened directly into an afterthought kitchen with just enough room for a narrow pine table and two chairs, a sink, a two-burner stove, and a narrow refrigerator with a freezer barely big enough for two frozen dinners. Beyond that, the single room held a sofa bed pushed up against the windows that looked out onto a postage-stamp yard between the rear of her building and the rear of the ones on the opposite block. The bathroom had a stall shower, a pint-sized corner sink, and a toilet. And that was it. But she didn’t need anything more than that. When she’d moved from Chicago, she hadn’t anticipated spending any time in her apartment, other than to sleep when she wasn’t on call, and even then she knew she’d be sleeping in the hospital most of the time. She had one short year to get every possible experience under her belt, to learn everything Ali Torveau had to teach her, everything the three a.m. trauma calls could challenge her to do. The hospital was the only world she wanted, the place she knew her purpose, where she proved her value, and where she found her greatest satisfaction.
She propped her cane against the kitchen table and draped her jacket over the back of the chair. When she pulled her phone from her pocket and checked the screen, the phone icon indicated a message.
Shower first. She found a yogurt in the back of the refrigerator and ate it while she stripped in the bathroom and threw her clothes into the corner. The hot water beat on her skin like a thousand angry drummers, and she gritted her teeth while she waited for the heat to work its way into her abused tissues. When she finally stepped out and toweled dry, she figured she had ten minutes before she was asleep. The phone rang as she approached the bed, and she dropped down onto the sheets naked.
“Hello.”
“I have to find out from Ali,” Vic said, “that you’ve gone back to work? And why aren’t you answering your voice mail?”
“Because I was working.” Jay covered her eyes against the light coming in the window from someone’s rear porch light and smiled in the dark. “Good to hear you too, sis.”
“So? You decided to be a pathologist?”
“I thought you and Ali decided that for me.”
Vic snorted. “Yeah, right, like we could ever talk you into anything you didn’t want to do.” She paused. “Is it what you want to do?”
“Good question,” Jay muttered. “People have been asking me that all day.”
“Because, listen, I can get you a radiology spot here starting in July.”
“Radiology.” Jay shook her head. “Can you see me spending my life staring at films?”
“There’s always interventional—”
“Vic,” Jay said gently, “I’m not gonna be able to do that kind of work. My hand—”
“You don’t know that,” Vic said adamantly.
“No, you’re right, I don’t. But even if I could, it’s still not what I want to do. They’re technicians—someone else makes all the calls.”
“You don’t have to decide now, you know.”
“I thought you were all for this?”
“I just want you to be…happy.”
Jay didn’t have the heart to say that happy was way down her list. “How about I start with useful. Because I haven’t felt that way in a long time.”
“You don’t have to do anything to be worth something.”
“Hey. You need to stop worrying about me. I’m on the mend. And I had a pretty good day, except I’m beat to shit right now.”
“What do you mean? You okay?”
“Yeah, just a long day,” Jay said. “We had a case in the field, it was…different. Interesting.”
“Yeah?” For the first time, Vic’s voice held a lightness Jay hadn’t heard in a long time. “You serious?”
“Yeah, I mean it,” Jay said. “It’s only the first day, but it was better than I thought.”
“Ali says it’s a good program—one of the best.”
“I haven’t met everyone yet, but Olivia—Olivia Price is the assistant chief medical examiner…I’ll be working with her a lot, I think. She’s good. Really good.”
“You’ll let me know how it’s going, right?” Vic said. “Don’t make me chase you down again.”
“Yeah, sure. I promise.”
“Okay, I gotta go. The OR’s calling.”
A swift pang shot through her chest, but Jay swallowed it down. “Right. Have fun.”
“Always. Love you.”
“Love you,” Jay whispered.
She had meant pretty much everything she’d said—she’d had a good day, better than she’d expected. She still couldn’t see herself in this new life, like trying on a suit of clothes belonging to someone else. When she thought about standing across from Olivia at the table, working with her to get the job done, that part felt right. That was more than enough for now, and maybe she could actually go to sleep looking forward to the morning for a change.
Chapter Ten
Sandy exited the subway just south of City Hall and walked a few blocks from the business district into the border zone between the commercial and residential areas. The
bars, diners, and adult entertainment centers that clustered in the five or six square blocks south of Walnut and east of Broad had resisted gentrification along with the insistent demands of adjacent upscale neighbors for the police to eliminate them. Not many of the street cops had much enthusiasm for rousting working girls or closing down porn shops when the girls would be out on bail by morning and the shops open at sundown the next night, and no one was really sure there was a victim in the picture. As long as the corners were clear of dealers and the alleys weren’t being used to turn tricks, beat cops and narcotics officers had bigger crimes to worry about.
Turning the corner onto Locust and heading toward Twelfth, Sandy slipped her hand into her front pocket and curled her fingers around her badge—more to ward off johns than identify herself to fellow cops. She wasn’t worried about being hassled by uniforms, but she might get some unwanted attention from the hopefuls cruising by. She figured most of the cops she had contact with knew she’d once worked these corners, but the few comments and curious looks she’d gotten in the academy had pretty much stopped. The cutting remarks couched in fake good-natured teasing never bothered her much. She’d never have survived to make it as far as she had if she’d let the opinions of other people shape her own view of herself. Having Frye for a rabbi hadn’t hurt, and she wasn’t too proud to acknowledge it. The cops were a fraternity as old as the Romans, and patronage was part of the tradition. She was lucky to have had Frye and Dell to lend her credibility at the beginning, and she’d earned her place now. She was as solidly blue as any cop on the force.
But no matter how far she’d come, she’d never forget where she’d started, or the women who’d been her first family. In the time she’d been gone, new faces had appeared, but she always knew where to find her friends. Seven p.m. They’d just be emerging from their shared flops and four-to-a-bedroom apartments. They’d be putting on their makeup, doing their hair, sorting through their wardrobe for something to help them stand out, something showy and flashy and skimpy to catch the eye of the johns trolling the streets in their darkened cars, slowing at the corners to look over the merchandise, but something that would keep them halfway warm and let them run if they had to. They’d be thinking about how much they needed to make for the rent, for the food, for the kids, and some of them would be thinking about how much they’d have to give their pimps and how much they might be able to hide away without giving up a cut and risking a black eye or split lip or worse. A dangerous game, played night after night, with no real way to win, but only, with luck, to break even. She knew she’d been lucky—lucky to trust Frye, lucky to find Dell, lucky to risk loving one more time.