TEN
Undulating to this side and that, even as a wave receding and advancing.
—Dante
The Melvin Martin autopsy became a crowded affair, and Jessica felt the crunch of others in the room whenever she moved, for at every turn someone stood in the way. Repasi, a man of his word, remained with them. A local physician who acted as the hospital's pathologist also felt compelled to be on hand, as it was his room.
Preliminary tests indicated that some over-the-counter sedative appeared to be present in high levels, that Martin had been sedated, just as Chris Lorentian had. Jessica imagined that in time, it would be proven to be the exact same medication. The fact that the old man had drugs in his system suggested one thing to J.T., who was also present, and another to Jessica and Karl Repasi.
“Maybe it's the one soft spot the killer has,” J.T. had remarked from behind his surgical mask.
The room they were in had a constant flow of air to reduce not only the odor but also the amount of bacteria and decay as they worked over the incinerated flesh.
“Soft spot?” asked Jessica.
“Yeah. He drugs his victims to reduce the pain and suffering he inflicts.”
“A rosy picture, indeed, Dr. Thorpe,” said Repasi. Jessica replied, “J.T., this is the same guy who calls me up so I can listen to their screams.”
Repasi stepped in, saying, “I must agree with Jessica, Thorpe. He only drugs them to control them.”
Jessica, nodding, added, “So he can march them to the secondary crime scene. The first being his assault on their senses with the drug.”
“Yes, the secondary crime scene, the comfort zone for him—the place where he can turn them into so much kindling for his fires,” Repasi agreeably added, his head bobbing in accord.
“Yes, the place where he is in total control and can take his bloody awful time, so he can disrobe them. He doesn't burn them in their clothes, male or female, if you've noticed. Ties them without much of a fight being put up.”
“I feel like a third .. . fourth wheel here,” J.T. told her. “I might do better chasing down the shoeprint we saw.”
Repasi instantly said, “Why don't you do that, Thorpe. Get to the bottom of things, so to speak.” Repasi's little jest left J.T. cold. “I'll see you later,” J.T. told Jessica on his way out.
Jessica took Repasi aside, not wanting the Page people to hear any further dissension between them. She asked, “Do you want to tell me, now, Doctor, why you are here? And just why are you so bloody interested in this case?”
“It's a bloody interesting case, wouldn't you say? Besides, Arizona's my home state, Doctor,” he replied coolly. “And another besides, I'm a board-certified forensic medical examiner, and Page operates under the old coroner system. The coroner here is Doctor Porter, a fine man, yes, but he's not highly trained in forensic science. He's a hospital pathologist with a number of years under his belt, but hardly qualified in forensics.”
Jessica understood this language all too well. In fact, much attention had been placed on the continuing problem of the old coroner system, which still operated in most municipalities in the nation. With two general types of medicolegal investigative systems in the United States, the coroner system and the medical examiner system, there remained a great deal of confusion in the public mind about the differences in the terms “coroner,”
“pathologist,” and “medical examiner.” Twelve states had coroner systems at work that employed politicians and sometimes hospital pathologists to do the work of a medical examiner. Twenty-two states and the District of Columbia employed the medical examiner system, while sixteen states had both systems at work. The coroner system, the older of the two, dated back to a time when kings and dukes employed a man to determine cause in suspicious deaths, in an attempt to confiscate the holdings of suicide victims, who had blatantly wronged Mother Church, and murderers, who had blatantly wronged the Crown by reducing the taxable public by one or more members. To some degree, the coroner system remained a political arm of the legal system, and it was under this undue pressure and conflict of interest that the elected official with the title “coroner” performed his duties. It had for centuries now allowed barbers, butchers, and candlestick makers who ran for the office to pronounce cause of death in cases ranging from suspicious to ordinary, without the coroner having the slightest knowledge of medicine or forensics—medicine as it applied to law. The system had improved over the years, most jurisdictions now insisting that the coroner at least be a board- certified pathologist, but not even an anatomical pathologist—a generalist—had the training the medical examiner took years to acquire. The only training the coroner received for the position still ranged from absolutely none to a few hours to one or two weeks at best. This was an unforgivable sin as far as Jessica Coran was concerned, for therein lay hundreds upon hundreds of people getting away with murder every day. Jessica had heard Karl speak out against the antiquated coroner system on many occasions, and in fact he was scheduled to do so in Vegas today, back at the convention. “I thought you were scheduled to speak at the convention today, Karl.”
“There are more important things than shooting off my mouth on a subject no one in the forensics community wants to hear me fire off on again,” he joked.
“You're sure there's no other reason that you are following . .. this case?” she asked again.
“As I said before, I offered my services to the FBI— Bishop, to be exact, and he encouraged me to help in any way possible. So here I am.”
She pressed it further. “And you're sure there's no other motive at work here?”
“My, but you've become suspicious over the years, Jessica. Look, my office got word of a suspicious fire death here in Page, and they knew of what had happened in Vegas because I was in contact with them. They put it together and called me back. Bishop's office informed me where you were. It was either come here or remain at that dull convention. Which would you have chosen, Jessica?”
“All right, Karl. Let's have the truth now, okay?”
He squirmed, thinking her goddamned persistent. He looked down at his feet, fidgeted with the tails of his surgery gown, and finally admitted, “Phoenix is screwing around with the medical examiner system that / created there. They see it's cheaper to run a coroner's office than a medical examiner's office; they think cheaper is better, even more efficient.”
“Christ,” she moaned in sympathy for Karl.
“My office is being seriously challenged by a referendum on the ballot to make death investigation cheaper in the jurisdiction. Cheaper, do you believe it? You have no idea how close to the bone we run the office as is, but death investigation still doesn't come cheaply enough for the budget cutters.”
It was an all-too-familiar lament among forensics experts. “I'm sorry to hear it, Karl.” She sounded like a person giving condolences to a friend who'd contracted an incurable disease, but she didn't know what else to say.
Repasi shrugged and said, “There's the usual complaint about lack of money, which has led to inadequate staffing and salaries, and we struggle along with antiquated operations and equipment.”
“Resistance to acquiring new technology, resistance to change,” she sounded the mantra. “And a failure to appreciate, even understand, the M.E.'s mission. I got the same nonsense when I was M.E. in Washington, and when I was an assistant M.E. in Baltimore before that.”
Finally, something she did understand. It made sense for Repasi to have shown up uninvited here. “How many ways do we have to show people that the coroner system produces inferior and inaccurate results?” she rhetorically asked. “Non physicians can't make accurate medical decisions, no matter how many weeks of training you give them.”
“Nor can general pathologists in many cases. Sure, they can mull their way through most common cases, but the difficult ones, the cases they often don't even recognize as difficult.... Fools in Phoenix are taking the death
stats to heart, you see. They say only twenty percent of our cases involve suspicious deaths, so a pathologist could handle the eighty percent that we do not need to investigate.”
Jessica understood the enormous hole in this logic, and she nodded knowingly.
“How does a pathologist know which is the twenty percent if he isn't trained to recognize that twenty percent? What judge would take his pregnant wife to a dermatologist for obstetrical care? But the same politician will permit an individual with zero forensic training to testify in a case involving life-and-death decisions.”
“Yeah, agreed,” began Jessica. “A major characteristic of the unqualified expert in forensics is that rare ability to interpret a case in absolute and exquisite detail when there are no forensic details to be had in a case.”
“Worse still is the practice of contract pathologists.”
“Yes, the very notion sets my teeth on edge.” Jessica's mind fumed at the idea of a pathologist paid by the case, so that the more cases he or she put away, the more money the pathologist made. “What about the local coroner here in Page? How does he work?”
“Modified coroner, M.E. system. Sends a lot of his cases up to Salt Lake City, others to me in Phoenix.”
“Oh, so you two know each other well.”
“Yes.”
“So, he's okay with you taking charge, Karl?”
“We've talked at length. He's happy for the interference.”
“That's a refreshing change. I usually meet with resistance with the natives. Good for you.”
“Perhaps I'm better with my people skills than you, Jessica?”
She let this pass, saying, “Well then, let's get to work, shall we?” She returned to the body, what remained of Mel Martin: a greasy, soot-covered, creosoted lump of charred flesh an autopsy could do little or nothing for. This they all knew, but protocol mandated an autopsy be performed.
And so, Jessica, how do you approach a fire victim such as this? She heard Dr. Holcraft's voice, her mentor, now long dead, filling her thoughts.
She inwardly, silently answered, The same way that any physician approaches any patient. In medical school, Jessica was taught that to make a correct diagnosis, she must first take a history, perform an examination, and order relevant laboratory tests. They'd gotten only a smattering of Martin's history, knowing much less about the man than they had Chris Lorentian in Vegas. But there were no family members at hand, and time was fleeting. They were prepared to make their examination now and order necessary tests.
“I suppose you've seen your share of bum cases, Dr .Coran,” said Repasi, “but have you ever seen anything worse than this?”
She paused, considered his question, and replied, “Yes, I have.”
“Oh, really? Explosion victims? Lightning victims?”
“A woman who was scalded to death.” Both doctors appreciated the severe nature of burns from boiling water, knowing that water heated to 158 degrees Fahrenheit caused a full-thickness bum in adult skin in one second of contact.
“Ahhh, bathroom shower injuries I've seen, but nothing approximating this.”
“This was no bathroom shower accident. It was a victim of murder whose body was placed in a scalding hot spring in Yellowstone National Park, held under by her ankles as she thrashed. The scalding was uniform, not showing any bum variation, no multiple splash bums, just all-over fourth-degree bums. The killer hoped to cover up a rape- murder by completely scalding the body in a two-hundred-five-degree hot pool. She was scalded over her entire body, save her ankles and feet, which were only mildly bumed by comparison. Sloppy oversight on the killer's part, but then he didn't know a medical examiner was in the park at the time. The murderer was a young park ranger who'd come up on the victim where she was hiking alone in the park. That was some ten or eleven years ago.”
“Sounds like an interesting case,” he granted.
“It was the first murder case I ever solved.”
While Page's hospital was an adequate, modem facility, the death room and the forensic equipment in Page left a great deal to be desired; still, Jessica was glad to see that they had at least the rudiments for a pathology lab and that it was not placed in the subbasement of the hospital or the back of a funeral home, as was the case in hundreds of thousands of small towns all across America. There was just sufficient enough space along with appropriate lighting, plumbing, and cooling facilities. The instrumentation included an X-ray machine for the pathology lab and coroner's office to share, a luxury, it appeared, despite the fact that an X-ray machine was basic equipment in any autopsy suite. Page also had its own small toxicological lab capable of accurate, precise analysis for the presence of drugs.
In getting the autopsy under way, Jessica spoke into a microphone that recorded her autopsy for later transcription. Back at Quantico, nowadays, the entire autopsy was put on videotape, and Jessica had learned to choose her words with extreme care, for anything said now could come back to haunt the medical examiner. She announced the purpose of their coming together, the name of the deceased, age, height, weight, sex, race, condition of the body upon discovery. This led her to add, “On gross examination of such a victim, it is virtually impossible to distinguish antemortem from postmortem burns. Microscopic examination of the body tissue offers no help, unless the victim has survived long enough to develop an inflammatory response. Wouldn't you agree, Dr. Repasi?”
Repasi promptly agreed, saying, “Yes, lack of such a response doesn't necessarily indicate that the burn was postmortem. I have had occasion to view third-degree burns incurred by Vietnam veterans in which the patients died two and three days later. In some of these cases, there was no inflammatory reaction whatsoever.”
Jessica agreed now, adding, “Due, presumably, to heat thrombosis of the dermal vessels.”
“Such that inflammatory cells could not reach the area of the burn and produce a reaction to begin with,” finished Repasi.
Jessica thought that perhaps J.T. ought to have remained; he might well have learned something about the irregular nature of burn pathology.
“In Mr. Martin's case, it is presumed he was alive when he died due to witness testimony, namely Dr. Coran,” said Repasi for the record.
“It may also be of interest that the skin has split open, revealing exposed muscle across the upper torso and upper extremities, while skin over the back is perfectly preserved. Where the skin is completely burned away, underlying muscles have ruptured due to the intensity of the heat,” added Jessica.
Burned bone shone as gray-white with a fine, superficial network of fractures on the cortical surface. Repasi noted this for the shoulder bone and collarbone as well as the skull. With his gloved hand, he put slight pressure on a section of skull thus discolored, and it crumbled at his touch. He noted this for the record. “The outer table of the exposed cranial vault,” he said, pausing, “reveals a network of fine, crisscrossing heat fractures.”
Both examiners knew that it was extremely hard to bum a body, due to its high water content, and that to do the damage the Phantom had inflicted on Martin required a superheated energy source. Portions of the abdominal wall were burned away as well, exposing the viscera. The internal organs appeared charred, seared.
' in the autopsy on Chris Lorentian, who died from similar inflicted wounds,” Jessica said, “there was evidence of an antemortem epidural hematoma.”
Repasi added, “We find a similar blow to the head before death in Martin; there is a sizable postmortem epidural hematoma present. Not an uncommon sight in severely burned bodies. See here, Jessica, the chocolate brown color, crumbly, with its telltale honeycombed appearance.”
“Yes, I see it. Large, fairly thick, overlying the frontal lobe, extending toward the occipital area.”
He lifted a tiny ruler to it and asked an assistant to snap a picture, and for the record he announced, “Yes, large at one point five centimeters.”
“Good catch, Doctor.” Jessica t
urned off the recorder for a word with Dr. Repasi. “Karl, I didn't know your specialty was burn victims.”
“One of many,” he replied with a grin beneath his surgical mask. “Shall we have a look-see at the larynx and trachea? Examine for carbon monoxide intoxication?”
“I prefer the term smoke inhalation, Doctor, but yes.”
“Semantics,” he parried and scalpeled at the same time, opening up the charred throat and dissecting the larynx and trachea, which, while fire-blackened and fractured on the outside, remained intact.
Too many people in the scientific community, as far as Jessica was concerned, used the terms of the profession too loosely, such as making carbon monoxide poisoning synonymous with smoke inhalation. A number of important factors other than the presence of carbon monoxide in the blood might cause death by smoke inhalation, such as oxygen deprivation due to consumption of oxygen by the fire itself, cyanide, free radicals, and the old standby to fall back on, nonspecific toxic substances. Jessica knew that in cases of self-immolation, carbon monoxide, as a general rule, was not elevated, since it was a flash fire. In cases involving explosives or gasoline fires, carbon monoxide levels in the blood were usually found to be in the so- called normal range. This held true even if the body were severely charred. Every fire, in fact, was unique, and each created its own unique mysteries. Of course, Repasi knew this as well as she.
She spoke again into the recorder, saying, “Smoke inhalation reveals soot in the nostrils and mouth, but this alone is no indication the victim was alive when the fire began. Any further look into the breathing apparatus will not change that fact.”
But Repasi, ever the perfectionist, wanted to see the results of this fire to the windpipe as well. He announced what his scalpel now sliced through and why for the record. The soot had not coated the larynx, trachea, or bronchi, but both doctors took this in stride.
Well, clean as a whistle except for the gristle,” quipped Repasi. “What do you make of that, Dr. Coran?”
Extreme Instinct Page 17