Together, they walked down the hall, toward the exit leading to the staff parking lot. No small talk, just two parallel travelers, headed toward the same destination.
Louise's husband was waiting in his car, its windshield wipers swinging furiously against the falling sleet. Maura gave a goodbye wave as Louise and her husband drove off, and got a puzzled look from Vernon, who probably wondered who that woman was, waving as though she knew them.
As though she really knew anyone.
She crossed the parking lot, slipping on the glazed blacktop, her head bent under stinging pellets of sleet. She had one more stop to make. One more duty to execute before her day was over.
She drove to St. Francis Hospital to check on the status of Sister Ursula.
Although she had not worked in a hospital ward since her internship years ago, the memories of her final rotation in the intensive care unit remained vividly unpleasant. She remembered moments of panic, the struggle to think through the fog of sleep deprivation. She remembered a night when three patients had died on her shift, and everything had gone wrong at once. She could not walk into an ICU now without feeling haunted by the shadow of old responsibilities and old failures.
The surgical intensive care unit at St. Francis had a central nursing station surrounded by twelve patient cubicles. Maura stopped at the ward clerk's desk to show her identification.
"I'm Dr. Isles, from the Medical Examiner's office. May I see the chart for your patient, Sister Ursula Rowland?"
The ward clerk eyed her with a puzzled look. "But the patient hasn't expired."
"Detective Rizzoli asked me to check on her condition."
"Oh. The chart's in that slot over there. Number ten."
Maura crossed to the row of cubbyholes and pulled out the aluminum cover containing Bed #10's hospital chart. She opened it to the preliminary operative report. It was a handwritten summary, scrawled by the neurosurgeon immediately after surgery:
"Large subdural hematoma identified and drained. Open right parietal comminuted skull fracture debrided, elevated. Dural tear closed. Full operative report dictated. James Yuen, M.D."
She turned to the nurses' notes, and skimmed the patient's progress since surgery. The intracranial pressures were holding steady, with the help of intravenous Mannitol and Lasix, as well as forced hyperventilation. It appeared that everything that could be done was being done; now it was a waiting game, to see how much neurological damage would result.
Carrying the chart, she crossed the unit to Cubicle #10. The policeman sitting outside the doorway gave her a nod of recognition. "Hey, Dr. Isles."
"How is the patient doing?" she asked.
"About the same, I guess. I don't think she's woken up yet."
Maura looked at the closed curtains. "Who's in there with her?"
"The doctors."
She knocked on the doorframe, and stepped through the curtain. Two men were standing by the bed. One was a tall Asian man with a darkly piercing gaze and a thick mane of silver hair. The neurosurgeon, she thought, seeing his name tag: Dr. Yuen. The man who stood beside him was younger—in his thirties, with robust shoulders filling out his white coat. His long blond hair had been pulled back into a neat ponytail. Fabio as M.D., thought Maura, regarding the man's tanned face and deep-set gray eyes.
"I'm sorry to intrude," she said. "I'm Dr. Isles, from the Medical Examiner's office."
"The M.E.'s office?" said Dr. Yuen, looking baffled. "Isn't this visit a little premature?"
"The lead detective asked me to check in on your patient. There is another victim, you know."
"Yes, we've heard."
"I'll be doing that postmortem tomorrow. I wanted to compare the pattern of injuries between these two victims."
"I don't think there's much you'll be able to see here. Not now, after surgery. You'll learn more by looking at her admission X rays and head scans."
She gazed down at the patient, and could not disagree with him. Ursula's head was encased in bandages, her injuries by now altered, repaired by the surgeon's hand. Deeply comatose, she was breathing with the aid of a ventilator. Unlike the slender Camille, Ursula was a woman of large proportions, big-boned and solid, with the plain, round face of a farmer's wife. IV lines coiled over meaty arms. On her left wrist was a Medic Alert bracelet, engraved with "Allergic to Penicillin." An ugly scar tracked, thick and white, over the right elbow—the aftermath of an old injury, badly sutured. A souvenir from her work abroad? Maura wondered.
"I've done what I could in the O.R.," said Yuen. "Now let's hope Dr. Sutcliffe here can head off any medical complications."
She looked at the ponytailed physician, who gave her a nod, a smile. "I'm Matthew Sutcliffe, her internist," he said. "She hasn't been in to see me for several months. I didn't even know she was admitted to the hospital until a little while ago."
"Do you have her nephew's phone number?" Yuen asked him. "When he called me, I forgot to get it from him. He said he'd be talking to you."
Sutcliffe nodded. "I have it. It'll be easier if I'm the one who stays in touch with the family. I'll let them know her status."
"What is her status?" asked Maura.
"I'd say she's medically stable," said Sutcliffe.
"And neurologically?" She looked at Yuen.
He shook his head. "It's too early to say. Things went well in the O.R., but as I was just telling Dr. Sutcliffe here, even if she regains consciousness—and she very well may not—it's likely she won't remember any details of the attack. Retrograde amnesia is common in head injuries." He glanced down as his beeper went off. "Excuse me, but I need to get this call. Dr. Sutcliffe can fill you in on her medical history." In just two quick strides, he was out the door.
Sutcliffe held out his stethoscope to Maura. "You can examine her, if you'd like."
She took the stethoscope and moved to the bedside. For a moment she just watched Ursula's chest rise and fall. Seldom did she examine the living; she had to pause to call back her clinical skills, acutely aware that Dr. Sutcliffe was a witness to just how out of practice she felt when examining a body whose heart was still beating. She had worked so long with the dead that she now felt clumsy with the living. Sutcliffe stood at the head of the bed, an imposing presence with his broad shoulders and intent gaze. He watched as she shone a penlight into the patient's eyes, as she palpated the neck, her fingers sliding across the warm skin. So different from the chill of refrigerated flesh.
She paused. "There's no carotid pulse on the right side."
"What?"
"There's a strong pulse on the left, but not the right." She reached for the chart and opened it to the O.R. notes. "Oh. The anesthesiologist mentions it here. 'Absent right common carotid artery noted. Most likely a normal anatomical variation.' "
He frowned, his tanned face flushing. "I'd forgotten about that."
"So it's an old finding? The lack of a pulse on this side?"
He nodded. "Congenital."
Maura slipped the stethoscope onto her ears and lifted the hospital gown, exposing Ursula's large breasts. The skin was still pale and youthful despite her sixty-eight years. Decades of protection beneath a nun's habit had spared her from the sun's aging rays. Pressing the diaphragm of the stethoscope to Ursula's chest, she heard a steady, vigorous heartbeat. A survivor's heart, pumping on, undefeated.
A nurse poked her head into the cubicle. "Dr. Sutcliffe? X-ray called to say that the portable chest film's ready, if you want to go down and see it."
"Thanks." He looked at Maura. "We can look at the skull films too, if you'd like."
They shared the elevator with six young candy stripers, fresh-faced and glossy-haired, giggling among themselves as they shot admiring glances at Dr. Sutcliffe. Attractive though he was, he seemed oblivious to their attention, his solemn gaze focused instead on the changing floor numbers. The glamour of a white coat, thought Maura, remembering her own teenage years working as a volunteer in St. Luke's Hospital in San Francisco. The doctors ha
d seemed untouchable to her. Unassailable. Now that she herself was a doctor, she knew only too well that the white coat would not protect her from making mistakes. It would not make her infallible.
She looked at the candy stripers in their crisp uniforms, and thought of herself at sixteen—not giggly, like these girls, but quiet and serious. Even then, aware of life's dark notes. Instinctively drawn to melodies in a minor key.
The elevator doors opened, and the girls spilled out, a sunny flock of pink and white, leaving Maura and Sutcliffe alone in the elevator.
"They make me tired," he said. "All that energy. I wish I had a tenth of it, especially after a night on call." He glanced at her. "Do you have many of those?"
"Nights on call? We rotate."
"I guess your patients don't expect you to rush in."
"It's not like your life here in the trenches."
He laughed, and suddenly he was transformed into a blond surfer boy with smiling eyes. "Life in the trenches. That's what it feels like sometimes. The front lines."
The X rays were already waiting for them on the clerk's counter. Sutcliffe carried the large envelope into the viewing room. He slid a set of films under the clips and flipped on the switch.
The light flickered on through images of a skull. Fracture lines laced across bone like lightning strikes. She could see two separate points of impact. The first blow had landed on the right temporal bone, sending a single fine crack downward, toward the ear. The second, more powerful, had fallen posterior to the first blow, and this one had compressed the plateau of cranium, crushing it inward.
"He hit her first on the side of the head," she said.
"How can you tell that was the first blow?"
"Because the first fracture line stops the propagation of an intersecting fracture from a second blow." She pointed to the fracture lines. "You see how this line stops right here, where it reaches the first fracture line? The force of impact can't jump across the gap. That tells me this blow to the right temple came first. Maybe she was turning away. Or she didn't see him, coming at her from the side."
"He surprised her," said Sutcliffe.
"And it would have been enough to send her reeling. Then the next blow landed, farther back on the head, here." She pointed to the second fracture line.
"A heavier blow," he said. "It compressed the skull table."
He took down the skull films and put up the CT scans. Computerized axial tomography allowed one to look into the human cranium, revealing the brain slice by slice. She saw a pocket of collected blood that had leaked from torn vessels. The mounting pressure would have squeezed the brain. It was an injury as potentially devastating as that done to Camille.
But human anatomy and human endurance are variable. While the much younger nun had succumbed to her injuries, Ursula's heart kept beating, her body unwilling to surrender its soul. Not a miracle, merely one of those quirks of fate, like the child who survives a fall from a sixth-floor window, and is only scratched.
"I'm amazed she survived at all," he murmured.
"So am I." She looked at Sutcliffe. The glow of the light box lit half his face, glancing across the strong angles of his cheek. "These blows were meant to kill."
FOUR
CAMILLE MAGINNES HAD YOUNG BONES, thought Maura, gazing at the X rays hanging on the morgue light box. The years had not yet chewed away at the novice's joints, nor collapsed her vertebrae or calcified the costal cartilage of her ribs. Now the years never would. Camille would be placed into the earth, her bones forever arrested in a state of youth.
Yoshima had x-rayed the body while it was fully dressed, a standard precaution to locate loose bullets or other metal fragments that might be lodged in clothing. Except for the crucifix, and what were clearly safety pins over the chest, no other pieces of metal were visible on the X rays.
Maura pulled down the torso views, and the stiff X rays made a musical boing as they bent in her hands. She reached for the skull films, and slid them under the light box clips.
"Jesus," Detective Frost murmured.
The damage to the cranium was appalling. One of the blows had been heavy enough to drive bone fragments deep below the level of surrounding skull. Although Maura had not yet made a single incision, she could already envision the damage inside the cranium. The ruptured vessels, the taut pockets of hemorrhage. And the brain, herniating under the mounting pressure of blood.
"Talk to us, Doc," said Rizzoli, crisp and to the point. She was looking healthier this morning, had walked into the morgue that morning with her usual brisk stride, the warrior woman back in action. "What are you seeing?"
"Three separate blows," said Maura. "The first one hit here, on the crown." She pointed to a single fracture line, running diagonally forward. "The other two blows followed, at the back of the head. My guess is, she was facedown by that time. Lying helpless and prone. That's when the last blow crushed through the skull."
It was a finale so brutal that she and the two detectives fell silent for a moment, imagining the fallen woman, her face pressed to the stone floor. The attacker's arm rising, hand gripping the death weapon. The sound of shattering bone breaking the silence of that chapel.
"Like clubbing a baby seal," said Rizzoli. "She didn't have a chance."
Maura turned to the autopsy table, where Camille Maginnes lay, still clothed in her blood-soaked habit. "Let's undress her."
A gloved and gowned Yoshima stood waiting, the ghost of the autopsy room. With silent efficiency, he had assembled the tray of instruments, angled lights and readied specimen containers. Maura scarcely needed to speak; with only a look, he could read her mind.
First they removed the black leather shoes, ugly and practical. Then they paused, eyeing the victim's many layers of clothing, preparing for a task they had never before attempted: the disrobing of a nun.
"The guimpe should come off first," said Maura.
"What's that?" asked Frost.
"The shoulder capelet. Only I don't see any fasteners on the front. And I didn't see any zippers on X ray. Let's turn her onto her side, so I can check the back."
The body, now stiff in rigor mortis, was light as a child's. They logrolled her sideways, and Maura peeled apart the edges of the capelet.
"Velcro," she said.
Frost gave a startled laugh. "You're kidding."
"The medieval meets the modern age." Maura slid off the capelet, folded it, and set it onto a plastic sheet.
"Somehow, that's really disappointing. Nuns using Velcro."
"You want to keep 'em in the Middle Ages?" said Rizzoli.
"I just kind of figured they'd be more traditional or something."
"I hate to disillusion you, Detective Frost," said Maura, as she removed the chain and crucifix. "But some convents even have their own Web sites these days."
"Oh, man. Nuns on the Internet. That blows my mind."
"The scapular looks like it comes off next," said Maura, indicating the sleeveless overgarment that draped from shoulders to hem. Gently she lifted the scapular over the victim's head. The fabric was soaked with blood, and stiff. She laid this on a separate plastic sheet, followed by the leather belt.
They were down to the final layer of wool—a black tunic, draped loosely over Camille's slim form. Her last barrier of modesty.
In all her years of undressing corpses, Maura had never felt such reluctance to strip a victim nude. This was a woman who had chosen to live hidden from the eyes of men; now she would be cruelly revealed, her body probed, her orifices swabbed. The prospect of such an invasion brought a bitter taste to Maura's throat and she paused to regain her composure. She saw Yoshima's questioning glance. If he was disturbed, he did not show it. His impassive face was a calming influence in that room, where the very air seemed charged with emotion.
She refocused on the task. Together, she and Yoshima lifted the tunic, sliding it up over the thighs and hips. It was loosely fitted, and they were able to remove it without breaking rigor mortis of
the arms. Beneath it were yet more garments—a white cotton hood that had slid down around her neck, the front flaps safety-pinned to a bloodstained T-shirt. The same pins that had appeared on the X ray. Heavy black tights covered her legs. They removed the tights first, revealing white cotton panties beneath. They were absurdly modest briefs, designed to cover as much skin as possible, the underwear of an old lady, not a nubile young woman. A sanitary pad bulged beneath the cotton. As Maura had suspected earlier, from the bloodstained bed sheets, the victim was menstruating.
Next Maura tackled the T-shirt. She unfastened a safety pin, peeled apart more Velcro flaps, and slid off the hood. The T-shirt, however, would not come off so easily due to rigor mortis. She reached for scissors and cut straight up the center of the shirt. The fabric parted, revealing yet another layer.
This one took her aback. She stared at the band of cloth wrapped tightly around the chest, fastened at the front with two safety pins.
"What's that for?" asked Frost.
"It looks like she bound her breasts," said Maura.
"Why?"
"I have no idea."
"Substitute for a bra?" Rizzoli suggested.
"I can't imagine why she'd choose to wear this instead of a bra. Look how tightly it's wrapped. It had to be uncomfortable."
Rizzoli snorted. "Yeah, like a bra's comfortable?"
"It's not some kind of religious thing, is it?" said Frost. "Part of their habit?"
"No, this is just standard Ace wrap. The same wrapping you'd buy at a drugstore to bind a sprained ankle."
"But how do we know what nuns usually wear? I mean, for all we know, under all those robes, they could be dressed in black lace and fishnet."
No one laughed.
Maura gazed down at Camille, and was suddenly struck by the symbolism of bound breasts. Womanly features disguised, suppressed. Squeezed into submission. What had gone through Camille's mind as she'd wound the cloth around her chest, pulling the elastic taut against her skin? Had she felt disgust about these reminders of womanhood? Had she felt cleaner, purer, as her breasts vanished beneath the strips of bandage, her curves flattened, her sexuality denied?
Jane Rizzoli and Maura Isles 03 - The Sinner Page 5