Michael Palmer: The fifth vial

Vincent helped him to stand. Then Dr. Prouty opened the door. It was the first time Lonnie went to the front of the van since the day it had stopped for him. Things there had completely changed. A bright saucer light was attached to the ceiling, and beneath it was a narrow bed covered with a green sheet. Beside the bed stood a tall doctor, wearing a blue mask over his mouth and nose.

"Get him up there while I scrub in," Dr. Prouty said.

Lonnie looked toward her voice and saw that she, too, had a mask on. He felt wobbly, barely able to stand. Vincent helped him to lie facedown on the bed and pulled a strap across his back. A sheet was lowered over him. Then the tall doctor put a needle into his arm and left it there. Lonnie's eyes closed and refused to open. His fear subsided.

"Now, Lonnie," the tall doctor said, "I'm going to put a special breathing mask over your face…Perfect. Okay, just breathe in and out. In and out. This won't hurt a bit."

"The body is that of a well-nourished white male in his twenties. Height five feet nine inches? weight one hundred ninety-seven pounds. Hair brown, eyes blue. No tattoos or…"

Pathologist Stanley Woyczek used a foot pedal and overhead mike to dictate as he worked. He was in his second term as medical examiner for Florida District 19, which included St. Lucie, Martin, Indian River, and Okeechobee counties, all located north and west of West Palm Beach. He loved the intricacies and puzzle-solving that went along with the job, but was still not at all inured to the human tragedy. Cases often stayed with him for weeks, if not years. He had no doubt that this would be one of them. A young man, carrying no identification, had run out of a grove of trees and onto a sparsely populated stretch of Route 70, where he was blasted out of existence by a tractor-trailer. The driver of the semi estimated he was going sixty-five when the man suddenly appeared as if out of nowhere, right between his headlights. Gratefully, Woyczek reasoned, the pain of the impact couldn't have lasted more than a second or two.

Preliminary screens for alcohol and drugs of abuse were already back, and were negative. Assuming the more extensive toxicology was also going to be unrevealing, there would probably still be two glaring questions when this postmortem was completed: Who? And why?

"There is a well-healed scar over the left inguinal canal, presumably from the surgical repair of a hernia. There is a seven inch laceration and compound fracture of the skull above the left ear, and a twelve inch long vertical tear through the left chest, through which a severed portion of the aorta can be seen."

Woyczek motioned to his assistant that it was time to turn the victim over. They did so with care.

"Posteriorly, there is a deep abrasion across the right scapula, but no other — "

The pathologist stopped speaking and peered down at the top of the man's buttock, just above his right hip…then at an identical area on the left.

"Chantelle, what does that look like to you?"

The assistant studied both areas.

"Puncture wounds," she said.

"No doubt about it."

"No, Dr. Woyczek. There are six on each side, maybe more."

"We'll do a microscopic on some of them to set the age, but these punctures are recent. I'm sure of it. I think we have something here." He stepped back and stripped off his gloves. "Hold the fort for a couple of minutes, Chantelle. I want to get the detectives to come over. I might be wrong, but I don't think so. Sometime in the last day, two at the most, John Doe here was the donor for a bone marrow transplant."

Go ahead and sew him up, Ms. Reyes."

Natalie stared at the slice down Darren Jones's forehead, across his eyebrow, and down his cheek. Until this moment, the largest knife wound she had ever seen was one she had accidentally inflicted on her own finger. Treatment then had been a couple of Band-Aids. She forced herself not to make eye contact with Cliff Renfro, the surgical senior resident in charge of the ER, and followed him out to the hallway.

In her three years and one month as a medical student, she had sutured countless pillows, several varieties of fruit, some ragged stuffed animals, and recently, at what she considered great peril, the seat of a pair of her favorite jeans. Renfro's order didn't make much sense. She was only two hours into her second day on the ER rotation at Metropolitan Hospital of Boston, and although Renfro had checked her diagnostic skills out on several patients, he had yet to see her sew.

"Dr. Renfro, I…um…think maybe I should go over things with you before — "

"Not necessary. When you're finished, write a scrip for him for some antibiotic — any one. I'll sign it."

The resident turned and was gone before she could respond. Her classmate and good friend, Veronica Kelly, who had already finished her surgical rotation at Metropolitan, had told her that Renfro was in his final year before taking over as chief surgical resident at White Memorial, the flagship of the medical school's many famous teaching hospitals. After years of training, he had the air of one who had seen it all and was burnt out on what he considered the lowlife patient population of Metro.

"Renfro's smart and damn competent," Veronica had said, "and he'll take the really messy trauma cases. But he couldn't care less about the routine stuff."

Apparently he considered a black teenage loser in a gang fight to be routine. Natalie hesitated outside the boy's room, wondering what the fallout would be if she chased Renfro down and asked for a demonstration of his skill.

"You okay, Nat?"

The nurse, a gravel-voiced veteran of years in the ER, had given a portion of yesterday's student orientation, including the tradition that in a hardscrabble place like Metro, almost all the staff used first names. Hers was Bev — Bev Richardson.

"I asked for this rotation because I heard the students got to do a lot of procedures, but sewing up a kid's face on my second day is a bit more than I had expected."

"Have you sutured before?"

"Nothing that was ever alive, except a few unfortunate oranges." Bev sighed.

"Cliff's a darn good doc, but he's a little immature at times and can be hard on people. And the truth is, I don't think he cares all that much for our clientele."

"Well, I do," Natalie said, stopping short of a litany of the many times earlier in her life when she had been wheeled or carried or dragged into this very ER.

"We like having people working around here who care. The patients have it hard enough everyplace else. Their hospital ought to be something of a sanctuary."

"I second that. Well, Dean Goldenberg has told me that he's heard I'm going to be accepted into the White Memorial surgical residency. Maybe Dr. Renfro has heard the same thing and he's just testing me."

"Or maybe he senses that you're not like him and he wants to see if you'll back down from the challenge."

"He wouldn't be the first," Natalie replied, already setting her jaw and mentally ticking through the pages of the plastic surgery text she had reviewed during the week before this rotation.

"You're the runner, aren't you?"

The question didn't startle Natalie in the least. Her tragic accident during the Olympic trials was chronicled on the local and national news and the cover of Sports Illustrated. From the day she started med school as a thirty-two-year-old first-year student, people knew who she was.

"Past tense," she said, her terse response requesting a change in subject.

"Think you can do this boy's face?"