Tess Gerritsen: The Surgeon

Moore swallowed hard. “I see why you called me back from vacation.”

“I’m the lead on this one,” said Rizzoli.

He heard the note of warning in her statement; she was protecting her turf. He understood where it came from, how the constant taunts and skepticism that women cops faced could make them quick to take offense. In truth he had no wish to challenge her. They would have to work together on this, and it was too early in the game to be battling for dominance.

He was careful to maintain a respectful tone. “Could you fill me in on the circumstances?”

Rizzoli gave a curt nod. “The victim was found at nine this morning, in her apartment on Worcester Street, in the South End. She usually gets to work around six A.M. at Celebration Florists, a few blocks from her residence. It’s a family business, owned by her parents. When she didn’t show up, they got worried. Her brother went to check on her. He found her in the bedroom. Dr. Tierney estimates the time of death was somewhere between midnight and four this morning. According to the family, she had no current boyfriend, and no one in her apartment building recalls seeing any male visitors. She’s just a hardworking Catholic girl.”

Moore looked at the victim’s wrists. “She was immobilized.”

“Yes. Duct tape on the wrists and ankles. She was found nude. Wearing only a few items of jewelry.”

“What jewelry?”

“A necklace. A ring. Ear studs. The jewelry box in the bedroom was untouched. Robbery was not the motive.”

Moore looked at the horizontal band of bruising across the victim’s hips. “The torso was immobilized as well.”

“Duct tape across the waist and the upper thighs. And across her mouth.”

Moore released a deep breath. “Jesus.” Staring at Elena Ortiz, Moore had a disorienting flash of another young woman. Another corpse — a blonde, with meat-red slashes across her throat and abdomen.

“Diana Sterling,” he murmured.

“I’ve already pulled Sterling’s autopsy report,” said Tierney. “In case you need to review it.”

But Moore did not; the Sterling case, on which he had been lead detective, had never strayed far from his mind.

A year ago, thirty-year-old Diana Sterling, an employee at the Kendall and Lord Travel Agency, had been discovered nude and strapped to her bed with duct tape. Her throat and lower abdomen were slashed. The murder remained unsolved.

Dr. Tierney directed the exam light onto Elena Ortiz’s abdomen. The blood had been rinsed off earlier, and the edges of the incision were a pale pink.

“Trace evidence?” asked Moore.

“We picked off a few fibers before we washed her off. And there was a strand of hair, adhering to the wound margin.”

Moore looked up with sudden interest. “The victim’s?”

“Much shorter. A light brown.”

Elena Ortiz’s hair was black.

Rizzoli said, “We’ve already requested hair samples from everyone who came into contact with the body.”

Tierney directed their attention to the wound. “What we have here is a transverse cut. Surgeons call this a Maylard incision. The abdominal wall was incised layer by layer. First the skin, then the superficial fascia, then the muscle, and finally the pelvic peritoneum.”

“Like Sterling,” said Moore.

“Yes. Like Sterling. But there are differences.”

“What differences?”

“On Diana Sterling, there were a few jags in the incision, indicating hesitation, or uncertainty. You don’t see that here. Notice how cleanly this skin has been incised? There are no jags at all. He did this with absolute confidence.” Tierney’s gaze met Moore’s. “Our unsub is learning. He’s improved his technique.”

“If it’s the same unknown subject,” Rizzoli said.

“There are other similarities. See the squared-off margin at this end of the wound? It indicates the track moves from right to left. Like Sterling. The blade used in this wound is single-edged, nonserrated. Like the blade used on Sterling.”

“A scalpel?”

“It’s consistent with a scalpel. The clean incision tells me there was no twisting of the blade. The victim was either unconscious, or so tightly restrained she couldn’t move, couldn’t struggle. She couldn’t cause the blade to divert from its linear path.”

Barry Frost looked like he wanted to throw up. “Aw, jeez. Please tell me she was already dead when he did this.”

“I’m afraid this is not a postmortem wound.” Only Tierney’s green eyes showed above the surgical mask, and they were angry.

“There was antemortem bleeding?” asked Moore.

“Pooling in the pelvic cavity. Which means her heart was still pumping. She was still alive when this… procedure was done.”

Moore looked at the wrists, encircled by bruises. There were similar bruises around both ankles, and a band of petechiae — pinpoint skin hemorrhages — stretched across her hips. Elena Ortiz had struggled against her bonds.

“There’s other evidence she was alive during the cutting,” said Tierney. “Put your hand inside the wound, Thomas. I think you know what you’re going to find.”

Reluctantly Moore inserted his gloved hand into the wound. The flesh was cool, chilled from several hours of refrigeration. It reminded him of how it felt to thrust his hand into a turkey carcass and root around for the package of giblets. He reached in up to his wrist, his fingers exploring the margins of the wound. It was an intimate violation, this burrowing into the most private part of a woman’s anatomy. He avoided looking at Elena Ortiz’s face. It was the only way he could regard her mortal remains with detachment, the only way he could focus on the cold mechanics of what had been done to her body.

“The uterus is missing.” Moore looked at Tierney.

The M.E. nodded. “It’s been removed.”

Moore withdrew his hand from the body and stared down at the wound, gaping like an open mouth. Now Rizzoli thrust her gloved hand in, her short fingers straining to explore the cavity.

“Nothing else was removed?” she asked.

“Just the uterus,” said Tierney. “He left the bladder and bowel intact.”

“What’s this thing I’m feeling here? This hard little knot, on the left side,” she said.

“It’s suture. He used it to tie off blood vessels.”

Rizzoli looked up, startled. “This is a surgical knot?”

“Two-oh plain catgut,” ventured Moore, looking at Tierney for confirmation.

Tierney nodded. “The same suture we found in Diana Sterling.”

“Two-oh catgut?” asked Frost in a weak voice. He had retreated from the table and now stood in a corner of the room, ready to bolt for the sink. “Is that like a — a brand name or something?”

“Not a brand name,” said Tierney. “Catgut is a type of surgical thread made from the intestines of cows or sheep.”

“So why do they call it catgut?” asked Rizzoli.

“It goes back to the Middle Ages, when gut strings were used on musical instruments. The musicians referred to their instruments as their kit , and the strings were called kitgut . The word eventually became catgut . In surgery, this sort of suture is used to sew together deep layers of connective tissue. The body eventually breaks down the suture material and absorbs it.”

“And where would he get this catgut suture?” Rizzoli looked at Moore. “Did you trace a source for it on Sterling?”

“It’s almost impossible to identify a specific source,” said Moore. “Catgut suture’s manufactured by a dozen different companies, most of them in Asia. It’s still used in a number of foreign hospitals.”

“Only foreign hospitals?”

Tierney said, “There are now better alternatives. Catgut doesn’t have the strength or durability of synthetic sutures. I doubt many surgeons in the U.S. are currently using it.”