“Do you know what kind of research Briganti was involved in?” I said.
Dietz’s face lit up. “As a matter of fact I do. Prior to being busted by the police for cocaine possession, Briganti worked on genetics, molecular biology, and stem cell analysis and manipulation.” He paused. “April piqued my curiosity regarding Briganti, so I searched the medical literature on him. I read both papers he coauthored during that time. The research was quite advanced for a grad student, I must say.”
I shifted gears a bit, hoping to catch Dietz off guard. “Why not just kill April and the baby and have it look like an accident instead?”
“Maybe Briganti thought that would arouse more suspicion then a successfully induced abortion. You see, I believe they were simply trying to induce an abortion, not perform one. If they pulled it off, a day or two later the baby would self-abort, making it seem like a natural occurrence and not raising any suspicion.”
“Doesn’t that theory seem a bit far-fetched, Doctor Dietz? I know Briganti had some limited medical training, but these thugs don’t often think in such sophisticated terms.”
“This one does. Briganti is as amoral as he is intelligent,” Dietz said as he grew agitated. “I’m sure he was quite capable of committing this crime.”
“How do you know so much about Briganti? Did April talk about him a lot?”
“She did. But as I’ve said, I also did some research myself. April was a sweet, naïve girl from the Midwest. She was involved in dangerous things she didn’t understand. I wanted to know as much about her world as I could and see if I could help keep her safe.”
My suspicions regarding Dietz were growing: he seemed to be pointing me in a direction of his choosing, perhaps to draw attention away from himself. But what would be his motivation to kill April or the other two women, for that matter? The pieces didn’t all fit.
“That’s rather noble of you, Doctor Dietz, and goes above and beyond what a doctor would be expected to do for a patient.”
I knew what the answer would be to my next question, but I wanted to see what his reaction would be.
“Was there any personal element to your and April’s relationship, Doctor?”
Dietz pulled back as an indignant look spread across his face. “Of course not, Detective,” Dietz insisted. “I just wanted what was best for April and was doing what I could to help.”
“I see.” I looked down at my notepad and jotted a few things down. Without looking up I continued, “Do you know if April was trying to conceal her pregnancy? The police and ER doctor thought she was concealing something; could it have been anything else?”
“April was trying to conceal her pregnancy at work as long as possible. Being pregnant and a stripper, of course, are at odds with one another. But it goes beyond that. April mentioned that the girls were not to fraternize with the bouncers. If it came out that Briganti was the father, she would lose her job. The consequences for him were even worse. He is an up and coming mobster. Such a disregard for protocol would halt his ascension in the organization. That’s why Briganti urged April to abort the baby. April lived in constant fear for herself and her unborn child. That must have been what she was trying to conceal.”
“Did April ever mention a Gerry Buehler to you?”
“No, I’m afraid that name isn’t familiar.”
“I’d like to jump ahead to the murder now,” I said to Dietz. I had to be careful here to not give away too much about what we knew. I wanted to reveal just enough to get a reaction out of the OB/GYN, but not enough to tip him off. If I did it right, Dietz’s reaction would reveal a lot more to me than anything he said.
“As you may have read, Doctor, the murder was brutal. April’s abdominal area and female organs were savagely torn apart. What do you make of that?”
Dietz didn’t hesitate for a moment, he plowed ahead with his agenda as if reading off a mental cue card he had constructed.
“It’s further evidence of Briganti’s guilt,” Dietz said with passion. “As I see it, he was desperate at this point to be rid of the baby, and he realized after the abortion attempt that April was also a threat to him.”
“That’s quite a change in mindset, isn’t it Doctor? We go from Briganti as a masterful manipulator with an elaborate plan to get rid of the baby, to him as a senseless brute hacking away at April and their unborn child.”
“After the attack, the murderer didn’t even attempt to conceal the crime by disposing of the body. The whole attack and murder points to a crime of passion, with Briganti as the logical lead suspect. How do you explain Briganti disregarding caution and so obviously implicating himself?
“Who’s to say what runs through the mind of a cold-blooded killer, Detective? I’m no expert on these people. But you said it yourself, it all points to Briganti. What more could you want? Why aren’t you off arresting Briganti instead of here talking to me, Detective?”
“Well, here’s why: The wounds weren’t what killed April, Doctor Dietz. April was killed in a much subtler manner. The killer threw in the slashing to make it appear like a crime of passion. Seems like Briganti was set up, Doctor. Any idea who might want to do that to him?”
Dietz sat across from me, his mouth agape. Ten, then twenty seconds of stunned silence passed before he could speak. After regaining his composure, Dietz responded in a hurried manner. “Perhaps Briganti simply lost it and the medical examiner was mistaken. Or maybe Briganti sent someone to do his work and they carried out his orders in a different manner than he intended,” Dietz said with feigned conviction.
“I appreciate your help, Doctor, but I don’t think that’s the way it happened,” I replied with cool detachment. “Mind if I take a look at April’s chart now, Doctor?”
§
I sifted through April’s computerized medical records while Dietz sat across from me, shoulders slumped forward, doing paperwork. His wrinkled white lab coat fit tight in some places, loose in others. It fell almost two inches short of reaching his wrists, and had a dull and discolored brownish black hue. It looked like it hadn’t been laundered in quite some time.
April’s chart revealed all the expected physical findings, lab results, and ultrasound reports. Her clinical course confirmed Dietz’s story; she had an uneventful pregnancy until the attacks when things went terribly wrong for her unborn child. Low amniotic fluid levels combined with multiple structural defects led Dietz to the inescapable conclusion: the baby would not survive to term—abort now.
No one could question Dietz’s medical judgment. It was his non-medical judgments that concerned me. Inappropriate comments littered April’s records, beginning with her pregnancy and growing in intensity leading up to the abortion recommendation. The hairs on the back of my neck stood up as I read through the comments:
2/16/15: “β HCG levels confirm my suspicions; the stripper is pregnant.”
3/8/15: “Bothered by morning sickness. Recommended curtailing her early morning lewd behavior at the Golden Garter.”
4/15/15: “Fetus developing well but ultimately it will be doomed by mother’s insistence to continue her sinful behavior, despite counseling by me to the contrary.”
5/23/15: “April’s selfish motivations to bring the child to term once again impair her judgment. She clings to the irrational belief that her horribly maligned fetus, which she calls ‘Rachel’ will be okay. She refuses an abortion. Miracles aside, the stripper intends to raise Rachel as a single mother, without family or the degenerate mobster father Briganti to support her. She and Rachel are utterly hopeless. May God have mercy on their souls.”
I looked over at Dietz, obviously bored as he went through the motions completing paperwork, he was oblivious to the anger I felt towards him at that very moment. I had a strong desire to lunge across the desk, grab him by his shirt, and yell, “What is wrong with you, you sick fuck?” But I didn’t do it. Despite what I read, I had to continue to be cool with Dietz. I knew in the long run I’d get more out of him that way.
<
br /> I put on my most ingratiating smile and called out to Dietz, “You should be commended, Doctor. It seems you did everything in your power to save April and serve her best interests. Could I please take a paper copy of the records with me?”
“Of course, Detective. I’ll have Nurse Halloway prepare that for you,” Dietz said in an upbeat voice, his face filled with a broad smile. “I hope your time here has been well spent.”
It had been. There was strong circumstantial evidence against Dietz, but I couldn’t act on it just yet. I would gather the physical evidence and witnesses needed and make an arrest as soon as possible.
In the meantime, I had a missing baby to find—one I hoped by some miracle was still alive.
Chapter 33
I sat in my car in front of the Medical Arts Building taking notes on April’s OB records. Rain pounded my Firebird as I pondered how to proceed with the investigation. My cell phone buzzed and jumped around on the bucket seat next to me; the number displayed on it indicated a call from the ME.
“Hi, Doctor McGowan. I hope you have some good news for me?” I said with enthusiasm as I slid April’s paperwork on the seat next to me, grabbed the phone, and brought it to my ear.
“Not exactly, Detective. Though we do have a number of tests back already. April Cassidy, along with our second victim, was not killed with Arsenic, Cyanide, Strychnine, or any other poison we routinely test for. Her serum electrolytes, liver and cardiac enzymes, and blood cultures were all normal. A spinal tap and a CT scan of the brain also were normal. I am afraid right now we are no closer to determining a cause of death for any of our victims than when we last spoke.”
“Damn. Any good news, Doc?”
“No. I was hoping your investigation had revealed something that would point us in a new direction.”
“Okay, fair enough. I’ll tell you what we’ve got. Our two suspects at this point are a mobster and an OB/GYN. Kennedy and I still have to interview a pharmacist who may or may not become a suspect. The mobster is no dummy. He spent four years working towards a combined MD/PhD before being kicked out over a drug possession charge. The charge was ultimately dropped, but I guess the administration at NYU Medical School decided to make an example of him anyway. So all of our suspects have a science and/or medical background. If I were you, Doctor McGowan, I’d start looking for an unusual substance that only a scientist or doctor would think of using to kill. Any ideas?”
“None come to mind. But we have ruled out a number of mechanisms of death. By that I mean the pathology that killed as opposed to the substance that triggered the pathology. For example, we’ve ruled out a stroke, so any substance that would kill by causing a stroke is also ruled out. Blood cultures and the spinal tap ruled out infections as the cause of death. The spinal tap and CT scan also ruled out more exotic causes such as increased intracranial pressure and neuromuscular disorders such as myasthenia gravis. Did April’s OB records reveal any significant past medical history, Detective?”
“No, I’m afraid not, Doc,” I said in a loud voice as the unrelenting rain pounded my car like thousands of ball pein hammers. “I think you’re on the right track considering more esoteric causes of death. In med school my professors said when you see hoof-prints, look for a horse, not a zebra. Well, in this case it seems we’re looking for a zebra.”
“And once we find what killed our victims, we may gain valuable insight into the killer’s background or thought process.” McGowan was decidedly more upbeat now than when our conversation began.
“Let’s consider the differential diagnosis for neuromuscular causes of death. It’s been a while since med school and internship, so help me out. There’s myasthenia gravis and Guillian-Barre syndrome. Neither of them can be induced in a patient, right?”
“That’s right. They are both diseases a patient either has or not. The same holds true for Lyme’s disease, Diphtheria, and Polio, and of course, even if you could induce these in a patient, none of these diseases would kill quickly.”
“How about poisoning using substances such as methyl alcohol or carbon monoxide?”
“No, the former would cause a characteristic optic nerve appearance, which our victims lacked. The latter would cause a ruddy complexion and changes to the person’s hemoglobin, both of which were also missing.”
“How about poisoning through ingestion, such as with atropine eye drops in something our victims drank or poisoning them with something they ate?”
“Hmm, those are intriguing theories I had not considered,” McGowan said with excitement. “I am going to check into your ideas further and get back to you when I have more results, Doctor Detective Ravello.”
“Glad I could be of assistance, Doctor McGowan, but I’ll leave the healing arts to board certified physicians who are actively practicing,” I said with a smile. “As for you and I, Doctor, I guess we’re still relegated to working with those who are already dead.”
Chapter 34
Kennedy and I stood with Doctor McGowan over April’s lifeless body. We arrived at the ME’s autopsy room a few minutes earlier after a call from McGowan alerting us to a break in the case. April’s empty chest and abdominal cavities lay splayed open before us, her organs removed for weighing and analysis. I couldn’t help but think that April looked anything but human now.
During my medical training I observed a strange tendency among pathologists to describe what they saw with comparisons to food. Terms such as chocolate cyst abound in pathology texts and always struck me as odd and inappropriate. Over the years I realized such phrases were the doctors’ attempts to humanize and empathize with their patients’ conditions. However twisted the terminology seemed to an outsider, it was one of the pathologists’ tried and true coping mechanisms. Even so, understanding this didn’t make it any easier to accept what happened to me next.
Looking into April’s hollowed-out chest cavity, my mind flashed back to several images from a Thanksgiving feast years before. The images were as powerful as they were unexpected, and hit me with the full force of a combination punch to the head and the gut. First, I saw myself in my parents’ kitchen carving the bird up, removing its meat and stuffing with surgical precision. Next came images of Michelle, Dad, my sister Emily, and brother-in-law Jeff. We were laughing and joking at the table, our faces stuffed with turkey and all the fixings.
I banished the images with a quick but subtle shake of my head as a chill shot up my spine. The Job was having its way with me again, taking what was wholesome and pure in my life and sodomizing it. Not even two weeks into the investigation and already I was being pulled down—hard. Between money problems, the sketchy neighborhood we now lived in, Christine’s issues at school, difficulties with Michelle, my pheo attacks, and trying to catch a serial killer, I was a mess. I was afraid the killer would strike again before we caught him, afraid for my family’s safety and well-being, and afraid my disease was out of control and could soon incapacitate me. Throw in the fear of losing my job and being unable to support my family and it was clear why I was barely holding it together. At this rate, when this case was over, I would need the healing that only comes from a long vacation with Michelle and the kids—or some time in a medical ward. In the meantime, I would try to shut it down emotionally, to deaden myself to the brutality of the killings. Taking this approach had its consequences. I felt less human and became to some extent detached from everything and everyone, including Michelle and the kids. But it was the only survival technique I knew that would save me from the job’s more destructive elements.
“You okay, Chris?” Kennedy said. “You look a bit shaken up.”
“Nah, I’m fine,” I said, embarrassed and angry with myself for allowing my emotions to slip to the surface. I clenched my teeth and swallowed my demons whole, burying them for the moment, deep within me where they belonged. “So what have we got, Doctor McGowan?”
“Well, as you know, Detective Ravello, we finished our last conversation agreeing to consider more esoteric
causes of death for April Cassidy and presumably our other victims, specifically those methods of murder which would require medical and/or scientific training. I checked April and the second victim’s blood for atropine, rechecked their gastric contents for atypical bacteria and rare chemical forms of food poisoning, including the presence of phallotoxins, the group of chemicals that kill within two to five hours of ingestion in mushroom poisoning. All of these came back negative. I must admit, I was quite stumped and a bit discouraged at that point. Then I considered one last variable. What if the route of administration for the toxin was as unusual as the toxin itself? That’s when I found the answer.
“Clostridium Botulinum is an encapsulated, rod-shaped, anaerobic bacterium that causes sickness and death in about one hundred cases a year in the US. It does this via a toxin released into improperly prepared or heated foods. The result is botulism, which becomes manifest an average of twelve to thirty-six hours after ingestion of tainted food. The disease is greatly under-reported, mainly because doctors don’t often consider it in their differential diagnosis. In our case it would not have killed fast enough and none of the bacteria were found in any of the victim’s stomachs.”
“So how is that our answer then, Doc?” Kennedy said impatiently.
“I will tell you right now, Detective. If someone were to take purified toxin and inject a large quantity or a super-concentrated version of it into the patient’s bloodstream, it would kill within minutes and be virtually undetectable. That, gentlemen, is what happened with our last two victims. We confirmed this using the lone method possible, the Mouse Toxicity and Neutralization Bioassay. What we did was inject each victim’s blood into a mouse, which at once displayed signs of botulism: difficulty swallowing, flaccid paralysis, and respiratory dysfunction. Then we administered an antitoxin with complete resolution of the symptoms.”
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