by John Burley
Sam turned to Carl. ‘What’ve you got so far?’
Carl pointed to a spot where the road’s asphalt met the shoulder. ‘She was discovered here.’
The grass in this area was matted down, and in a few places tufts had been pulled from the wet earth. The rain was doing its best to wash the area clean, but Sam could see what he presumed to be bloodstains in several areas. It didn’t take much of an imagination for him to picture the girl lying there weak and exhausted, having pulled herself hand over hand from the dark recesses of the woods. ‘Where was she attacked?’ he asked.
‘It looks like most of the struggle occurred at a spot about two hundred and fifty yards in,’ Carl said. ‘Lots of broken branches and a fair amount of blood.’
‘We need to get a canopy up in that area,’ Sam said. ‘And one here, too. Get these areas protected from the rain as much as possible while there’s still any evidence left worth collecting.’
Carl motioned to one of the deputies standing behind them, who nodded and went to his vehicle.
‘Who found her?’ Sam asked, studying the woods.
‘A motorist on her way to work came across the victim at 6:45 a.m. We got the 911 call at 6:48.’
‘You’ve interviewed her?’
‘Yeah. The lady’s a nurse at Trinity Medical Center, and was heading in for a 7 a.m. shift. She says she assessed the victim’s injuries and rendered what aid she could before placing the call to 911. Said the girl was unconscious, and that her breathing was so slow and shallow that at first the nurse thought she was dead. Fortunately, she checked for a pulse.’
Sam nodded. ‘Where’s the victim now?’
‘They took her to Children’s Hospital of Pittsburgh.’
‘Why not take her to Trinity? It can’t be more than a ten-minute drive from here.’
Carl shook his head. ‘Trinity’s not a trauma center. The girl’s injuries were … severe.’
Sam’s eyes met the detective’s. ‘How severe?’
At first, Carl didn’t answer. The precipitation falling from the sky was really beginning to pick up now, and large drops of water congregated on the edge of his hood before cascading the remaining several feet toward the pavement. He looked down at the grass in front them, imagining what it must’ve been like for the girl as she crawled all that distance through these woods after the attack, as she lay here in the darkness staring up at the rain. ‘I don’t know,’ he said finally. ‘She might not survive.’
The chief considered this for a moment. Behind him, the forensics van arrived and pulled to a stop on the opposite side of the street. Sam glanced over his shoulder as the two technicians emerged from the vehicle, then he turned back to Detective Schroeder. ‘Let them know what we’ve found so far,’ he ordered. ‘Then come with me.’
‘Where are we going?’ the detective asked.
‘Pittsburgh,’ Sam called back, making his way toward the car. ‘I want to go see her.’
Chapter 19
Pittsburgh’s Lawrenceville neighborhood lies along the southeast bank of the Allegheny River. When approached from the Fortieth Street Bridge in the late afternoon, the sun, low in the west, deepens the redbrick exterior of the neighborhood’s buildings to the color of bloodred clay, as if the river’s soil were giving birth to the edifices themselves. Behind them rises the massive structure of Children’s Hospital of Pittsburgh, serving the area’s youngest, most vulnerable citizens.
‘Wow. It’s huge, Dad,’ Joel Stevenson exclaimed from the front passenger seat, his freckled face squinting upward as the Honda turned left on Forty-Fourth Street and came to a momentary halt in front of the hospital.
Ben smiled at his son’s awed exuberance. It doesn’t take much to impress an eight-year-old, he thought. Joel had complained of being bored for most of the hour-long ride from Wintersville, and Ben had been second-guessing his decision to bring him along. Now he was glad to have him here. He’d needed the company, and the boy’s incessant chatter had kept Ben’s mind from lingering on the horridness of what he’d been summoned here to witness.
He turned right at the next intersection and entered the mid-campus garage. They wound their way up several tiers and Ben nosed the Honda into an available spot. He’d received the call from Sam Garston at about 3:30 p.m. this afternoon. The girl had been in surgery for most of the morning and early afternoon. She’d sustained multiple life-threatening injuries and had briefly gone into cardiac arrest twice in the OR, but had managed to make it out of the operating room alive and was now listed in critical condition in the hospital’s pediatric ICU. Could Ben come up and speak with the trauma surgeons? Sam had asked. Maybe take a look at some of the wounds to compare them with those from the first victim?
Ben and Joel descended the garage’s stairwell, then took the enclosed walkway to the hospital’s first-floor information desk. After a brief consultation with the volunteer at the desk, they received visitor ID badges and were directed to the pediatric ICU waiting room, where they found Chief Garston and two detectives conversing quietly with a man and woman whom Sam introduced as the girl’s parents.
‘This is Paul and Vera Dressler,’ he informed Ben. He turned to the couple. ‘Dr Stevenson has been assisting us with the investigation.’
Ben recognized Paul Dressler from a golf tournament they’d played in together a few years back. The man’s arm was wrapped protectively around the shoulder of his wife, who stood among them but looked at no one. Her right hand was clapped tightly across her mouth, as if ready to stifle a scream that threatened to erupt at any moment. Her gaze fixed itself on the front of Ben’s jacket as he stepped forward, offering his hand. ‘I’m so sorry this happened,’ Ben heard himself saying. ‘If there’s anything I can do …’
The woman made a small, indecipherable sound. Her husband nodded his head slightly in appreciation of Ben’s condolences.
Sam gestured toward the man standing to his left. ‘You know Detective Schroeder.’
‘Yes,’ Ben said, shaking hands.
‘And I don’t believe you’ve met Detective Danny Hunt,’ Sam continued. ‘I’ve assigned him to assist us on the case.’
Ben shook the young man’s outstretched hand, as well. ‘Detective.’
Danny nodded. Compared to the rest of the men, he appeared young and baby-faced, as if daily shaving had not yet become a necessary component of his morning ritual. With his button-down brown shirt and beige sport jacket, he looked relaxed and almost casual. But beneath the parted cascade of his light blond hair his eyes were sharp and intelligent, flitting from one face to the next and missing nothing in between.
They were silent for a moment before Sam turned to Ben. ‘The Dresslers would like to return to their daughter as soon as possible. I told them it might help our investigation if you had a chance to look at some of the injuries. They’ve kindly agreed to give us a few minutes to do that, and have consented for some photographs to be taken.’
Ben nodded. He looked down at Joel. ‘I’d like for you to wait out here for us, son. We shouldn’t be more than about fifteen minutes.’
‘We’ll keep an eye on him,’ Paul assured him.
‘I appreciate that,’ Ben said, and he headed through the large double doors with Sam and the two detectives.
The pediatric ICU, Ben noted as they stepped inside, was more tranquil than he recalled. His time as a medical student and resident in such settings had been one of frenzied data gathering, countless procedures, extensive documentation and protracted bedside discussions. It had been a whirlwind of endotracheal tubes and central lines, of ventilators and IV pumps – a seamless blur of medical histories and physical exam findings amid weeks of sleepless nights, as the pager attached to his belt beeped endlessly with its voracious, intractable demands. By comparison, the unit this afternoon seemed hushed, almost silent, as if the patients around them struggled to live or die on their own private battlegrounds, far removed from this physical place in which they lay.
Sam led th
em toward a room in the far corner. Its sliding glass door stood open, and as they approached a technician maneuvered a large portable motor-driven X-ray machine from the room with surprising grace. He smiled politely at the four of them before steering the contraption down an adjacent hallway. Ben and the officers exchanged glances and then proceeded into the room.
Inside, a young girl lay supine on a gurney. A thin blue hospital gown covered her chest, shoulders, and abdomen, her long black hair disappearing beneath the upper ridge of her torso. The remainder of her small frame was obscured beneath the crisp white linen. She lay motionless, except for the slight rise and fall of her chest in step with the measured mechanical pace of the ventilator. A plastic breathing tube protruded from between her pale, cracked lips, and numerous medication lines hung from an assortment of IV pumps attached to two metal poles at the head of her bed. From beneath the gown, an additional two large plastic tubes emerged, one on each side of her body, and descended into multichambered canisters, which bubbled softly. A bulky dressing covered her right ear.
Sam and the two detectives stood near the wall at the foot of the bed. None of them spoke, and the officers now seemed hesitant, as if waiting for something to happen. It took Ben a moment to recognize that they were waiting for him. To these men, this was a foreign place about which they had little understanding, and the young woman lying unconscious in the bed in front of them – held together by a bewildering assortment of tubes and instruments that doggedly sustained her tenuous existence – was an inexplicable enigma. He could sense their tension, their careful restraint, as if the slightest action might inadvertently tip the scales of recovery against her, as if her broken body might suddenly disintegrate and scatter like ash in the wind. This was his world, he realized, or at least it had been at one time in his training. They had asked him to come here to examine her injuries, yes – but they also needed him as a liaison to orient them to what they were seeing and its significance, to broker this space between those who would live and those who would die, and to tell them in which direction to go from here.
He was about to speak when a female voice behind them interrupted the silence.
‘Hard to believe she made it.’
They simultaneously turned to encounter a woman in her mid-thirties dressed in blue scrubs and a white lab coat. Her dark hair was slightly disheveled, as if she’d been wearing a cap for most of the day. A stethoscope had been tucked into a side pocket of her lab coat, its earpieces peeking curiously out at them. The clogs she wore on her feet were enveloped by thin blue shoe covers, and there was a large orange stain – Betadine, Ben presumed – on the front of her left pant leg. A single black pen poked out from the front pocket of her lab coat above a hospital ID badge that dangled from a small metal clasp. She thrust out a hand in Ben’s direction.
‘Karen Elliot,’ she announced. ‘I’ve been in the OR with Ms Dressler for a good part of the morning.’
Ben shook hands with the surgeon. Her skin was cool and dry, her grip firm and assertive. He introduced himself, Sam, and the two detectives. ‘The case is being investigated as an attempted homicide,’ he explained. ‘We’ve received the parents’ consent to examine her injuries … if it’s okay with you, that is.’
‘If her parents are fine with it, then so am I,’ the physician replied. She stepped to the bedside, retrieved the stethoscope from the pocket of her lab coat and listened to the girl’s chest for a moment. She wound the stethoscope into a loose circle, returned it to her pocket, then pulled an otoscope light from its resting place on the wall. As they watched, she pulled back the girl’s upper eyelids to shine the light into first one pupil and then the other, noting the response. The otoscope was returned to its wall mount, and the surgeon bent down on one knee to examine the plastic chambered canister to which each of the tubes exiting the girl’s chest was attached.
‘Could you tell us about her injuries?’ Ben inquired.
Dr Elliot lifted the girl’s hospital gown to expose her abdomen. The skin along a midline surgical incision site had been left open, the wound packed with gauze. Ben spotted three Jackson-Pratt drains exiting the skin from other areas of the abdomen, their small chambers partially filled with a thin reddish fluid.
‘Jesus,’ muttered Detective Schroeder. ‘You haven’t even stitched her up yet.’
‘There’s no point in it,’ the surgeon replied, her eyes remaining on the patient. ‘The first surgery in cases like this is strictly damage control. Get in, do what needs to be done, and get out. The liver and small bowel were lacerated in several places. The spleen was bleeding so badly it had to be removed. The left kidney also took a hit,’ she said, pointing to a urine reservoir bag hanging on the side of the bed. Like the fluid in the abdominal drains, the urine had taken on a bloodied maroon color. ‘Anyway,’ Dr Elliot concluded, ‘we’ll have to go back in at least once more to take a look at things – to make certain the bleeding from the liver is under control, to take another look at the bowel anastomoses, and to be sure nothing else was missed. So there’s no point in closing the abdomen yet.’
Ben nodded. ‘What other injuries did she sustain?’
‘You name it, she’s got it,’ she said. ‘Bilateral hemopneumothoraces, a small right ventricular puncture wound through the pericardium that I have no idea how she survived, multiple small bowel injuries, a grade III liver laceration, grade IV splenic injury requiring splenectomy, left renal laceration, facial bone fractures, tracheal contusion, a left ankle dislocation and medial malleolar fracture that was reduced in the OR, multiple soft-tissue avulsion injuries and traumatic amputations of two fingers on the left hand.’ She sighed, brushing the hair back from her patient’s forehead. ‘Most of her right ear is missing. Whoever did this did not intend for her to live.’
‘How’s her brain?’ Ben asked. ‘Any intracranial injuries?’
The doctor shook her head. ‘That’s one thing her assailant didn’t get around to. She’s pharmacologically sedated now, but provided her blood pressure holds and she survives these other injuries, I have no reason to believe she won’t wake up once she’s weaned off the sedative agents.’
‘When will that be?’ Ben asked.
‘Don’t know yet,’ she said, glancing at the green digital display of the machine monitoring the patient’s vital signs. ‘She’s still hypotensive, despite the vasopressors. A thousand things could happen between now and then. She could go into DIC, and I’m worried about that liver.’
They were quiet for a moment. Then Ben said, ‘Well, thank you for your time, Dr Elliot, and for everything you’ve done for her so far. If it’s okay with you, I’d like to take a few photographs of the injuries. We shouldn’t be long.’
‘Take all the time you need,’ she said. ‘This poor girl …’ She trailed off, her face becoming pinched and hard. She turned away from them for a moment, studying the monitor, one hand on her patient’s shoulder. Her fingers touched the thin plastic tubing of the central line that descended from an IV pump before it entered the girl’s body just beneath the right clavicle. The surgeon exhaled slowly, then her posture straightened as she turned to face them. ‘Take all the time you need,’ she said again, and she strode quickly from the room and disappeared through the swinging double doors at the end of the hallway.
Chapter 20
‘The patient is a Caucasian female, age sixteen, identified by family as Monica Dressler. At the request of the Jefferson County Sheriff’s Department and after consent from the patient’s parents, this examination is being performed at Children’s Hospital of Pittsburgh, where the patient is being treated for her injuries. The patient is currently intubated and on a ventilator, and she is pharmacologically sedated. She has a right subclavian central line, bilateral chest tubes, an open abdominal compartment following recent exploratory laparotomy, three abdominal J-P drains and a Foley catheter in place. Bulky dressings have been applied to the left hand following traumatic amputations to the fourth and fifth digits …
‘… bandaging to the site of the right ear, which was severed during the assault and was discovered at the crime scene by Jefferson County forensic …
‘… large avulsion injury to the region of the left deltoid, and similar soft tissue injuries to the left lateral thigh and upper back. Serrations along the wound margins are consistent with a human dentition pattern …
‘… eight puncture wounds to the anterior chest, resulting in bilateral hemopneumothoraces. According to the operative report, the pericardium and right ventricle were also penetrated, and a hemorrhagic pericardial effusion was discovered, requiring a pericardial window via the subxiphoid approach …
‘… an avulsion injury to the right breast. The lateral portion of the areola and underlying adipose tissue have been severed …
‘… penetration of the peritoneal cavity …
‘… left renal laceration from a penetrating wound to the left flank …
‘… report of multiple lacerations to the small bowel, liver, and spleen …
‘… fracture and dislocation of the left ankle with extensive swelling and ecchymosis …
‘… patient is currently listed in critical condition …
‘… Dr Ben Stevenson, board-certified pathologist. A copy of this report was submitted to the Jefferson County Sheriff’s Department in compliance with Ohio state statutes pertaining to forensic evidence …
‘… End report.’
Chapter 21
The trip back to Wintersville took considerably longer than the day’s earlier journey. After leaving the hospital, Ben had taken Joel to an ice-cream parlor that he’d frequented with Susan during their time in residency training. Ben hadn’t felt much like eating, but he’d promised his son this particular part of the excursion as an enticement for Joel to join him on the trip to Pittsburgh. Watching the boy wolf down two scoops of rocky road topped with hot fudge, whipped cream, peanut crumbles and a maraschino cherry had proven to be too much for Ben’s already tenuous stomach. He’d chosen to distract himself by looking out through the large plate glass window at the passing pedestrian foot traffic. Dusk was beginning to fall on the city now, and Ben was eager to get home. He pulled his cell phone from his pocket and called Susan to tell her they’d be getting back later than expected, advising her not to wait on them for dinner. ‘It’s just leftovers,’ she said. ‘I’ll heat something up for you when you get home.’ Ben looked across the table at his son as the boy twirled his spoon along the inside bottom of the tall glass, meticulously retrieving the last remnants of melted goodness for his consumption. ‘Don’t bother,’ he told his wife over the phone. ‘I don’t think either one of us will be particularly hungry.’