by Jodi Picoult
“Yes. He was a premature liveborn male infant with no congenital abnormalities. There was evidence of acute chorioamnionitis, as well as some meconium aspiration and early pneumonia. There were various indications of perinatal asphyxia. Additionally, there were perioral ecchymoses and intraoral cotton fibers that matched the shirt the infant was found in.”
“Let’s break that down a bit for those of us who didn’t go to med school,” George said, smiling at the jury. “When you say it was premature and liveborn, what does that mean?”
“The baby wasn’t carried to term. Its skeletal age was consistent with a gestational age of thirty-two weeks.”
“And liveborn?”
“As opposed to stillborn. The lungs of the infant were pink and aerated. Representative samples of each lower lobe, with a control sample of liver, were suspended in water. The lung tissue floated, while the liver sank—which indicates that the infant was born and breathed air.”
“How about a lack of congenital abnormalities—why is that important?”
“The baby would have been born viable. There were also no chromosomal defects and no evidence of substance abuse—all significant negative findings.”
“And the chorioamnionitis?”
“Basically, it’s an infection in the mother that led to premature delivery. Additional examination of the placenta ruled out the usual other common causes for premature labor. The cause of the chorioamnionitis was not identified because the fetal tissues and placenta were contaminated.”
“How did you know that?”
“Microbiological studies revealed diphtheroids—common contaminants—in the fetal tissues. The placenta is rarely sterile after vaginal birth, but this one had been sitting in a stable for some time before being retrieved, as well.”
George nodded. “And what is asphyxia?”
“A lack of oxygen, which eventually led to death. Petechiae—small hemorrhages—were visible on the surface of the lungs, thymus, and pericardium. A small subarachnoid hemorrhage was found on the brain. In the liver were patchy zones of necrosis of hepatocytes. These findings sound very exotic, but are seen with asphyxia.”
“What about the ecchymoses and cotton fibers?”
“Ecchymoses are small bruises, in layman’s terms. These were all approximately one to one-point-five centimeters in diameter, all surrounding the mouth. Scrapings of the oral cavity revealed fibers that matched the shirt.”
“What did these two observations lead you to believe?”
“That someone had stuffed the shirt in the infant’s mouth and attempted to cut off his air supply.”
George let that sink in for a moment. “Was the umbilical cord examined?”
“The attached portion of the umbilical cord was twenty centimeters in length, with no tie or clamp present on the cord, although the end was crushed as if a ligature had been present at some time. Fibers present on the cord stump were submitted to Trace Evidence for analysis and matched baling twine found in the barn. The cut surface of the cord was jagged, had bits of fiber on it, and indicated a small demarcation in the center.”
“Is that important?”
The doctor shrugged. “It means that whatever was used to cut the cord, most likely scissors, had a notch in one of its blades and had been used to cut baling twine.”
“Doctor, based on all this, did you determine a cause of death for Baby Fisher?”
“Yes,” Edgerton said. “Asphyxia, due to smothering.”
“Did you determine a manner of death?”
The medical examiner nodded. “Murder.”
* * *
Ellie took a deep breath, stood, and approached the medical examiner. “Dr. Edgerton, are the ecchymoses around the mouth conclusive proof of smothering?”
“The proof of smothering is in the many organs that show signs of asphyxia.”
Ellie nodded. “You mean, for example, the petechiae in the lungs. But isn’t it true that you cannot tell from an autopsy exactly when that asphyxia occurred? For example, if there was a problem with placental blood flow before or during birth, couldn’t it cause a loss of oxygen in the fetus, which would show up in the autopsy?”
“Yes.”
“What if there was a problem with placental blood flow just after birth? Might that result in signs of asphyxia?”
“Yes.”
“How about if the mother were bleeding or having trouble breathing herself during the delivery?”
The medical examiner cleared his throat. “That too.”
“What if the baby’s lungs were immature, or if it were suffering from poor circulation or pneumonia—would that lead to evidence of asphyxia?”
“Yes, it would.”
“And if the baby choked on its own mucus?”
“Yes.”
“So asphyxia may be caused by many things other than homicidal smothering?”
“That’s correct, Ms. Hathaway,” the medical examiner said. “It was the asphyxia, in conjunction with the bruises around the oral cavity and the fibers found within it, that led to my specific diagnosis.”
Ellie smiled. “Let’s talk about that. Does the evidence of a bruise prove that someone held a hand over the baby’s mouth?”
“The bruise indicates that there was local pressure applied,” Dr. Edgerton said. “Make of it what you will.”
“Well, let’s do just that. What if the baby was delivered precipitously, and landed on his face on the barn floor—might that have led to bruises?”
“It’s possible.”
“How about if the mother grabbed for the infant as it was falling after that delivery?”
“Perhaps,” the doctor conceded.
“And the fibers in the oral cavity,” Ellie continued. “Might they have come from the mother wiping mucus from the baby’s air passages, to help it breathe?”
Edgerton inclined his head. “Could be.”
“In any of those alternative scenarios, is the mother of the infant causing it harm?”
“No, she is not.”
Ellie crossed to the jury box. “You mentioned that the cultures were contaminated?”
“Yes. The lapse of time between the birth and the recovery of the placental tissue made it a culture plate, picking up bacteria.”
“The fetal tissue was also contaminated?”
“That’s correct,” Dr. Edgerton said. “By diphtheroids.”
“On what did you base your identification of these . . . diphtheroids?” Ellie asked.
“Colony and Gram’s stain morphology of the placental and fetal cultures.”
“Did you do any biochemical studies to make sure they were diphtheroids?”
“No need to.” The doctor shrugged. “Do you reread your textbooks before every case, Ms. Hathaway? I’ve been doing this for fifteen years. Believe me, I know what diphtheroids look like.”
“You’re a hundred percent sure these were diphtheroids?” Ellie pressed.
“Yes, I am.”
Ellie smiled slightly. “You also mentioned that the placenta showed signs of acute chorioamnionitis. Isn’t it true that chorioamnionitis can lead a fetus to aspirate infected amniotic fluid, and thus develop intrauterine pneumonia—which in turn leads to septicemia and death?”
“Very, very rarely.”
“But it does happen?”
The medical examiner sighed. “Yes, but it’s a real stretch. It’s far more realistic to point to the chorioamnionitis for premature delivery, rather than cause of death.”
“Yet by your own admission,” Ellie said, “the autopsy revealed evidence of early pneumonia.”
“That’s true, but not severe enough to lead to mortality.”
“According to the autopsy report, meconium was found in the air spaces in the lungs. Isn’t that a sign of fetal distress?”
“Yes, in that the fetal stool—the meconium—was passed into the amniotic fluid and breathed into the lungs. It’s very irritating and can compromise respiration.”
&n
bsp; Ellie crossed toward the witness. “You’ve just given us two additional reasons that this infant might have suffered from respiratory distress: early pneumonia, as well as aspirating fetal stool.”
“Yes.”
“By your own testimony, asphyxia was the cause of death for this infant.”
“Yes.”
“Isn’t it true that pneumonia and meconium aspiration—both of which are due to natural causes—would have led to asphyxia?”
Dr. Edgerton seemed amused, as if he knew exactly what Ellie was trying to do. “Maybe, Ms. Hathaway. If the smothering didn’t do the job all by itself.”
* * *
Ellie had always found the concept of a vending machine that sold hot soup and coffee a little upsetting—how long did all that liquid sit around in its insides? How did it know to give you decaf, instead of chicken broth? She stood before one in the basement of the court, hands on hips, waiting for the small Styrofoam cup to shoot out, for the steam to curl and rise.
Nothing.
“Come on,” she muttered, kicking the bottom of the vending machine. She raised a fist and thumped it on the Plexiglas for good measure. “That was fifty cents,” she said, more loudly.
A voice behind her stopped her in mid-tirade. “Remind me to never owe you money,” Coop said, his hands cupping her shoulders, his lips falling on the violin curve of her neck.
“You’d think someone would keep these maintained,” Ellie huffed, turning her back on the machine. As if that was all it took, it began to splash out hot coffee without a cup, spraying her shoes and her ankles.
“Goddamn!” she yelped, jumping out of the way, then surveying the brown stains on her light hose. “Oh, great.”
Coop sat down on a metal bridge chair. “When I was a kid my grandma used to try to make accidents happen. Knock over bottles of milk on purpose, trip over her own feet, splash her blouse with water.”
Blotting at her ankles, Ellie said, “No wonder you went into mental health.”
“Makes perfect sense, actually, provided you’re superstitious. If she had something important to do, she wanted to get the mishap out of the way. Then she’d be free and clear for the rest of the day.”
“You do know it doesn’t work that way.”
“Are you so sure?” Coop crossed his legs. “Wouldn’t it be nice to know that now since this has happened, you can walk into that courtroom and do no wrong?”
Ellie sank down beside him and sighed. “Do you know that she’s shaking?” Folding the soiled napkin in half and then in half again, she set it down on the floor beside her chair. “I can feel her trembling next to me, like she’s a tuning fork.”
“Do you want me to talk to her?”
“I don’t know,” Ellie said. “I’m afraid that bringing it up might terrify her more.”
“Psychologically speaking—”
“But we’re not, Coop. We’re speaking legally. And the most important thing is to get her through this trial without her coming apart at the seams.”
“You’re doing fine so far.”
“I haven’t done anything at all!”
“Ah, now I get it. If Katie’s this nervous just listening to testimony, what’s she going to be like when you get her up as a witness?” He rubbed Ellie’s back gently. “You must have faced skittish clients before.”
“Sure.”
“You—” Coop broke off as another attorney entered the room, nodded, and stuffed a set of quarters into the coffee vending machine. “Careful,” he warned. “It’s not toilet trained.”
Beside him, Ellie swallowed the bubble of a laugh. The attorney kicked the defective machine, cursed beneath his breath, and walked upstairs again. Ellie smiled up at Coop. “Thanks. I needed that.”
“How about this?” Coop asked, leaning forward to kiss her.
“You don’t want to kiss me.” Ellie held him at arm’s length. “I think I’m coming down with something.”
His eyes drifted shut. “I’m in a gambling mood.”
“Oh, there you are.”
At Leda’s voice, Ellie and Coop jerked away from each other. Standing on the staircase was Ellie’s aunt, with Katie in tow. “I told her you were coming right back,” Leda said, “but she wasn’t having any of it.”
Katie walked down the last few steps to stand in front of Ellie. “I need to go home now.”
“Soon, Katie. Just hang on a little longer.”
“We need to be back for the afternoon milking, and if we leave now, we’ll be able to do it. My Dat can’t manage with Levi alone.”
“We’re required to stay in court until it’s adjourned,” Ellie explained.
“Hey, Katie,” Coop interjected, “why don’t you and I go somewhere and talk for a few minutes?” He cast Ellie a sidelong glance, urging her to be compassionate.
Even at a distance, it was possible to see the tremors that ran through Katie. She ignored Coop, staring directly at Ellie instead. “Can’t you make court adjourn?”
“That’s up to the judge.” Ellie set her hand on the girl’s shoulder. “I know this is hard for you, and I—where are you going?”
“To talk to the judge. To ask her to adjourn,” Katie said stubbornly. “I can’t miss my chores.”
“You can’t just go talk to the judge. It’s not done.”
“Well, I’m gonna do it.”
“Get the judge angry,” Ellie warned, “and you’ll be missing your chores forever.”
Katie rounded on her. “Then you ask.”
* * *
“This is a new one for me, counselor,” Judge Ledbetter said. She leaned over her desk, frowning. “You’re requesting that we wrap up early today so that your client can do her chores?”
Ellie straightened her spine, her expression impassive. “Actually, Your Honor, I’m requesting that we adjourn at three P.M. every day this trial goes on.” Gritting her teeth, she added, “Believe me, Judge. If this were not germane to my client’s way of life, I wouldn’t be suggesting it.”
“Court adjourns at four-thirty, Ms. Hathaway.”
“I’m aware of that. I explained as much to my client.”
“I’m just dying to know what she had to say.”
“That the cows wouldn’t wait till then.” Ellie risked a glance toward George, who was grinning like the cat who’d eaten the canary. And why shouldn’t he be? Ellie was doing a splendid job digging her own grave without a single syllable’s contribution from him. “At issue, Your Honor, is the fact that in addition to my client, one of the sequestered witnesses is also a hired hand on the Fisher farm. For both of them to miss the afternoon milking would put undue strain on the economic affairs of the family.”
Judge Ledbetter turned toward the prosecutor. “Mr. Callahan, I assume you have something to say about this.”
“Yes, Your Honor. From what I understand the Amish don’t abide by daylight saving time. It’s one thing to run their own schedules when it doesn’t affect anyone else, but in a court of law they ought to be required to adhere to our clock. For all I know, this is some plot of Ms. Hathaway’s to point out the glaring differences between the Amish and the rest of the world.”
“It’s not a plot, George,” Ellie muttered. “It’s just lactation, pure and simple.”
“Furthermore,” the prosecutor continued, “I have one witness remaining to be questioned, and postponing his testimony would be detrimental to my case. Since it’s Friday, the jury wouldn’t be able to hear it until Monday morning, and by then any momentum that’s been building would be lost.”
“At the risk of being presumptuous, Your Honor, may I point out that in many trials I’ve participated in, schedules have been reworked at the last minute according to the whims of child care, doctor’s visits, and other emergencies that come up in the lives of the attorneys and even judges? Why not bend the rules for the defendant as well?”
“Oh, she’s done a fine job of that by herself,” George said dryly.
“Pipe down, y
ou two,” Judge Ledbetter said. “As tempting as it is to get out of here before Friday-night traffic settles in, I’m going to deny your request, Ms. Hathaway, at least for as long as it takes the prosecution to present their case. When it’s your turn, you’re welcome to adjourn court at three P.M. if it suits you.” She turned to George. “Mr. Callahan, you may call your witness.”
* * *
“Imagine that you’re a young girl,” said Dr. Brian Riordan, the forensic psychiatric expert for the State. “You find yourself involved in an illicit relationship with a boy your parents know nothing about. You sleep with the boy, although you know better. A few weeks later, you find out you’re pregnant. You go about your daily routine, even though you’re a little more tired these days. You think the problem will take care of itself. Every time the thought crosses your mind, you shove it aside, promising you’ll deal with it tomorrow. In the meantime, you wear clothes that are a little looser; you make sure that no one embraces you too closely.
“Then one night you wake up in severe pain. You know what is happening to you, but all you care about is keeping your secret. You sneak out of the house so no one can hear you giving birth. In solitude, in silence, you deliver a baby that means nothing to you. Then the baby begins to cry. You cover its mouth with your hand, because it is going to wake everyone up. You press harder until the baby stops crying, until it is no longer moving. Then, knowing you have to get rid of it, you wrap it up in a nearby shirt and stuff it somewhere out of sight. You’re exhausted, so you go up to your bedroom to sleep, telling yourself you’ll deal with the rest tomorrow. When the police approach you the next day asking about a baby, you say you know nothing about it, just like you’ve been telling yourself all along.”
Mesmerized, the jury leaned forward, caught on the sharp, stiletto edges of the scene Riordan had crafted with words. “What about maternal instincts?” George asked.
“Women who commit neonaticide are completely detached from the pregnancy,” Riordan explained. “For them, giving birth packs all the emotional punch of passing a gallstone.”