New York was surprisingly cold for an early-fall evening. A wind-driven rain snapped at my hands and cheeks. I pulled up the collar of my quilted jacket against the rain and waited. The taxi queue wasn’t long. I was directed to the far lane, where a trunk lid popped as if to signal me. The driver cheerfully helped me with my bag, and I slipped into the cramped backseat. The cab interior was poorly maintained, like the rest of the cabs, but the accommodating driver switched from lane to lane trying to make headway in barely moving traffic. The television news loop kept restarting itself after each attempt to silence it. I finally admitted defeat and lowered the volume. There was plenty of time to answer text messages and e-mails, and I cleared the deck. I made no calls. I was glad to be home and had no interest in telling the tale of my flight. Sometimes living alone is a good thing.
3
Monday morning at the police academy is always a disorienting experience for me. The old building is a mixed-function nightmare, filled with sour-faced, coffee-carrying uniforms and civilians packing the halls and elevators. But mixed in among the crowd are the bright young faces of cadets in novice gray shirts and trousers, buzzing happily to one another and seemingly afraid to speak to anyone outside their ranks. The hopeful young recruits, the academy teaching personnel, and the ancillary function units made it feel lighter than the usual police grind, and almost separate from the human tragedy that drives the police world.
Most of the time, being a police surgeon redefines routine. Seeing sick call is not how I would choose to spend every morning, but increasingly I find it an interesting exercise in understanding the police mentality. Don’t get me wrong about the department. I’m in it, but much as I consider myself part of it, I’m not. I’m still an outsider after eighteen years on the job. Not just me, probably all of us. When we do something brilliant, which happens once in a while, like save a life at a scene or get the best medical team to a bedside, the officer and the family appreciate us, and even the PBA acknowledges our worth. Personally, we feel like heroes. Most of the time, we’re gold badges poking into the private lives of the blue line. Cops don’t like that. The good ones, the ones who want to be left alone to do their job, and that’s most cops, see us as a necessary evil. The others—well, the others are trying to beat the system, and when the job contract allows for unlimited sick leave, you can guess the rest.
At eight thirty, there was a pot of green tea steaming gracefully on a black lacquered tray, which sat on the only clear spot on my huge, messy, old city-issue desk. I knew it would be there and could see it through the open door as I approached.
“How was your trip?”
“It was good, Mrs. Black. An odd end to it, but good.” I could have called my secretary Joyce, but we play a little game. My name is Black as well. No relation. She’s Japanese-American, married to a black cop named, strangely enough, Black. I’m second-generation American Jew with deep German roots on both sides. Over there, our name was Schwartz. Somebody—the immigration officer at Ellis Island, or maybe my grandfather himself—thought the English translation, “black,” sounded more New World or less Jewish. So Black I am. Wendell Black. Sounds American enough. How many Jews were named for the 1940 Republican presidential candidate?
There are a number of my ethnic brothers on the job, but not nearly enough to equal the demographics of the city. Except among the doctors, that is. A good number of police surgeons are Jewish, and every once in a while there’s an anti-Semitic murmur when a cop or two is pissed at us. Despite directives and sensitivity training, it’s not a particularly enlightened atmosphere. Mrs. Black and I do our best to ignore it.
“I’m glad you got away for a few days, doctor. You deserve it. I have tea for you.”
I made my attempt at a bow. “How lovely. What a pleasant surprise.”
Now, all of this may sound dumb to you, but we both are punctual creatures of habit, and the little dance gets the day off to a nice start. The tea is always on my desk at eight thirty.
“You have a message from the medical examiner, and the clinic is already half-full,” she said, following me into my office. Mrs. Black grew up in Flushing, Queens, and by the time she finished Queens College, she was a sociologist and about as Japanese as a candy apple. She was forty-five, five-six, tall for a Japanese woman, and both slim and curvy, with great legs when she showed them. Very elegant. I really liked her. I liked to work with her, I liked to look at her, and under different circumstances, I might have gone the next step. But neither of us wanted that. We had come close to it once and realized it would have broken up a good thing. So we left it alone. A few months later she went back to Billy, and things are more comfortable now.
“What did the ME want?”
“He wants you to call him.”
“Which one?” I asked.
“The chief. Benson.”
“I suppose it’s about the woman that died on the plane.”
“What woman?” she asked, drawing her head up and lifting her eyebrows in question, causing horizontal folds in her beautiful, smooth expanse of forehead.
“Ah, word hasn’t circulated about my airborne heroics.” And I proceeded to tell the story. Rather than acting surprised, she listened closely, all the while standing in front of my desk.
“And I can’t figure out what killed her. I’m sure the ME is making the courtesy call, knowing I’d be interested.”
I circled behind my desk, took a quick look at the stars and stripes by the window, as I always do, and plopped into the beaten-up, old-fashioned leather chair. I watched Mrs. Black pour out green tea for me and thanked her again as she looked down and stepped backward in traditional Japanese fashion. Then she turned, shook her ass in her tight jeans and heels, and said, “I’ll get the ME.”
4
“Dr. Benson, sir, I’m honored that the chief medical examiner of the City of New York has seen fit to call me. Deeply honored.” I had known Benson from medical school. He was a year behind me. Always devoted to his goal, very ambitious and very smart. Not surprisingly, his rise was direct and meteoric. He had his curmudgeon professor act down pat, but in his own way he was a good guy.
“Fuck you, wise ass.” There was a slight echo from the Bluetooth speakerphone Benson used during autopsies.
“Ah.”
“Interesting flight you had, Wendell. Is there anything you can add to the report to help point us in the right direction?”
I had the feeling I was getting set up, but I answered seriously. “Well, I’m not sure what’s in the report. It was the usual failed resuscitation. She was agitated, and then she tanked. There was a rapid, thready pulse before her pressure dropped through the floor and she flatlined. Two unusual things, though, pinpoint pupils and bilateral inframammary dressings, like from breast implants. Could be an OD, but otherwise I’m in the dark. Did I miss something?”
“You got most of the fine points, but perhaps you didn’t notice that she is a he.”
As my face reddened, I could imagine the assistant MEs around the chief getting ready for the big laugh. “Shit. Don’t tell me that. Why do you say that?”
“Why? Simple, big boy, he’s got that thing dangling between his legs.”
What can you say when you feel like a fool. There was no reason to pull her . . . his pants down during CPR, but still I felt well beyond foolish. I said nothing. Defending myself would feed the laughter I could already hear over the speaker. I suffered through ten or fifteen seconds of snickers until Benson spoke again.
“You were half-right, at least.”
“What does that mean?”
“Your patient was a genetic and partially anatomic male with a normal penis and almost no body hair. His testicles have been surgically removed. You were right about the breast implants, three hundred cc silicone bags, but then it gets strange. The implants were in old surgical pockets. The only thing fresh about the site was the healing skin incision. The pockets were lined with a mature capsule, the kind you see with the presence o
f long-standing implants.”
“Interesting.” We were stepping away from making me feel foolish and I wanted to maintain that trajectory. “But why did she die?”
“He. Why did he die. Looks like an OD. You got that one right. The implants were filled with crystalline heroin. The left one broke and I assume the pocket absorbed it like a dry sponge in a hot tub. We don’t have blood levels yet, but they’re going to be high, very high. Interesting. Want to come down here and have a look? This is an odd one, and it’s your case.”
“My case? It’s not my case,” I answered.
“Scientific interest, doctor.”
I was afraid Benson would pull that. I really get creeped out by the morgue. I did my time in pathology, even assisted at autopsies. You learn a lot about disease that way, but everything from the first smell to the casual disregard of the attendants is unpleasant. It’s worse than unpleasant, but you never say no. That’s the whole macho bullshit. You don’t like it, and unless you’re a trained forensic pathologist, you add nothing to the experience, but you go. It’s an old routine pulled on new Homicide detectives all the time. What the hell is a thirty-year-old cop with two years of college going to get from watching a postmortem examination besides acute nausea and losing his lunch? Or even better, her lunch. But that was part of the initiation, another stupid rite of passage.
So I went. My office at the police academy is on Twentieth Street, about ten short blocks from the medical examiner’s office. The weather had improved greatly. It was cool and very sunny, so I opted to walk. That section of First Avenue is a really boring stretch of Manhattan for the sightseer, the east side of the street primarily occupied by Bellevue Hospital and the west dotted with medical-center buildings, the old dental school building, convenience stores, a few apartment buildings, and generally not much to look at. It took me twenty minutes to reach the tile anteroom of the Office of the Chief Medical Examiner of the City of New York, at 520 First Avenue. The city morgue. It’s not quite as gruesome as television shows might make you believe, but it’s sad and foul. Most of the civilians milling about were in small, sorrowful groups, and were managed nicely by understanding intermediaries. Downstairs, in the business end of the building, it was cold and quiet. The place smelled of death and chemicals and futile attempts to freshen the air. Metal doors separated the working areas from the halls, and I followed the directions I had been given to the autopsy room where Benson held court.
The deceased was definitely a man, and it wouldn’t have shocked me if Benson and company had tied a ribbon around his organ, but they’d resisted. I had anticipated him working me over, but he never mentioned it again. The anticipation was bad enough. Giving the office of the ME its due, the proceedings were fully professional and, as Benson had predicted, very interesting.
There were three other men in the room. The oldest man was substantial, but not obese. He had huge hands and a bit of a belly that made a soft curve out of his green rubber apron. He stood close by Benson and seemed to pay no attention to what was being said. Benson referred to him by name, Raymond, when addressing him, which he often did, alternating between Raymond and myself as he spoke. Raymond said nothing. The other two gloved and rubber-aproned men were appreciably younger and seemed not to exist to Benson. I assumed they were residents, but I didn’t ask. Benson did all the work, dissecting and dictating as he went along. Raymond tidied up after him, moving organs, weighing them, and swabbing and hosing as necessary.
Close examination of Azul Capinpin’s face—that was the name on his passport—showed no evidence of a beard. His cheeks were smooth and free of the telltale enlarged pores where hairs had been removed. These days laser hair removal does the job without the ugly side effects of electrolysis. This was smooth, female-looking skin. There were traces of hair follicles on the upper lip that had previously been hidden by makeup. The body was clean. No hair. The pubis had been shaved, or waxed, or lasered clean. The rest of the body was hairless as well. Generally, Asian males don’t have pelts like their Western counterparts. But Capinpin’s body was totally hairless.
Benson talked me through his findings, and doctor or not, I would have missed the boat. The distribution of body fat was feminine, with a fairly soft belly and hips. Even without the implants, which had been removed to a stainless-steel pan hanging from a scale over the table, there were hints of breasts.
“Most of what you see now is hormone supplements at work. It’s a good bet that our man was taking an androgen blocker, probably Aldactone. It’s cheap and it’s been around for decades as a diuretic. That’s the drug of choice for male-to-female transsexuals outside Western Europe and the States. Some use finasteride with it. The trade name is Propecia, more commonly used to treat male-pattern baldness. It does something to block testosterone, but it’s expensive. Then a year of estrogen supplements to grow small breasts and redistribute body fat. Facial hair and body hair is reduced; shape changes, even the timbre of the voice raises a bit. But the pelvis never changes to the wider female configuration.”
He pointed to the pelvic area, but measurements and observation of the skeleton would be necessary to make his point. At least, I couldn’t see it.
“And the hands are a giveaway . . . so is the penis.” There was delayed, restrained laughter following Benson’s levity. He caught us off guard. We all had been listening intently to his lecture and hadn’t expected it. I took it like a man and chuckled.
“Whether or not our victim discontinued the use of testosterone blockers after castration is hard to tell without the chemical assays, but it doesn’t matter. Scars from the surgical castration are mature, and it looks like scrotal skin may have been preserved in place for future vaginal construction.” Here he paused and held the empty, shriveled skin of the scrotal sac in his gloved hand for our inspection. I got the picture without needing closer scrutiny of the evidence.
“And last, the implant pockets.” Here Benson insisted we move in closely to see the smooth, lined pocket between the underside of the breast and the muscles of the chest wall. Benson had separated the skin and breast along the sternum and folded it back for observation. “This smooth capsule is something the modern pathologist has seen a thousand times; our colleagues of a few generations ago would have no idea what to make of it. Under the microscope the white lining you see is made up of a thin fibrous tissue layer spotted with foreign-body giant cells and silicone residue. It effectively separates the implants from the body. That’s its job. It develops quickly and matures over time. Take the implants out and after a time it disappears, or at least dissipates, but as long as implants are in-situ, it remains.”
“What are you telling me? The implants were there until you removed them, weren’t they?” I asked, pointing to the tissue scale alongside the autopsy table.
“Maybe.”
“Maybe? Maybe what?”
“Maybe they were there all the while, and maybe they had been replaced. The old capsule and the new scar don’t go together.”
I know the light bulb should have lit up like Times Square, but it didn’t. Benson kept looking at me like I was thick. And then, finally, the power came on. “You think these implants . . . these bags of heroin . . . were put into an old surgical pocket where other implants used to be. I get it. So that makes our person a professional mule. Is that what you’re saying?”
“Not quite. That’s more of a leap than I’d like to make, but it’s a thought. I can say that the vulcanized silicone sacs of heroin were in old pockets that had held implants in the past. The foreign-body giant cells and the silicone residue make that clear. Whether those prior implants were filled with heroin, I can’t say.”
“Well, one trip or a routine, this is no longer our turf,” I said. “Will your guys call Customs and DEA, or do you pass it on to Narcotics and let them worry? Either way, this is definitely outside my job description.”
5
By the time I hit the street at four twenty, the afternoon had turned colder
. I saw no point in going back to the office for an hour, and there was nothing much to do anyway. The way it works is I do sick call in the morning, hospital visits to inpatients from our command, suffer through piles of bureaucracy in the form of meetings and paperwork, and listen to the ranting union reps when a bad apple has been caught out malingering. The reps are good guys just doing their jobs. The fervor and emotion of their pitch often brings a bit of hydrophobic spittle at the corner of the mouth before they look you in the eye and crack the tiniest smile. We’re all on the same page about this stuff and they have to do what they have to do. I just don’t have to buy it. Deep down, the reps know better than their clients that I’d go to the wall for the good guys—and that’s most of them.
So, barring emergencies, my day was over. I felt lighter being out of the ME building and checked my phone for messages while I walked over to Second Avenue. At the corner, the smell of old beer and frying grease preceded the door to the Waterfront Ale House and beckoned to me. The sun was already low in the west and flooded the entry and the first few feet of the room with a dazzling light that revealed every seedy detail. Beyond that, the room was dark and welcoming. The lunch crowd was long gone and it was too early for after-work socializing. A few sad-looking guys sat at the bar. I found a spot halfway down, where it was dark and empty and wouldn’t encourage conversation. The girl behind the bar greeted me pleasantly and pulled a Sam Adams and a smile after I pointed to the tap. I lifted the glass to her and sipped off the foam, set the glass down on the bar, and stepped over to the carnival machine behind me to scoop a bowl of hot air-popped corn. It managed to have no taste other than salt, and if you’re drinking beer after a confusing hour at the autopsy table, that’s good enough.
Wendell Black, MD Page 2