Tess Gerritsen: The Surgeon

The ordeal would have lasted well over an hour. Elena Ortiz was conscious for at least part of that time. The skin on her wrists and ankles was chafed, indicating she had struggled. In her panic, her agony, she had emptied her bladder, and urine had soaked into the mattress, mingling with her blood. The operation was a delicate one, and he took the time to do it right, to take only what he wanted, nothing more.

He did not rape her; perhaps he was incapable of doing so.

When he’d finished his terrible excision, she was still alive. The pelvic wound continued to bleed, the heart to pump. How long? Dr. Tierney had guessed at least half an hour. Thirty minutes, which must have seemed an eternity to Elena Ortiz.

What were you doing during that time? Putting your tools away? Packing your prize in a jar? Or did you merely stand here, enjoying the view?

The final act was swift and businesslike. Elena Ortiz’s tormentor had taken what he wanted, and now it was time to finish things. He’d moved to the head of the bed. With his left hand he’d grasped a handful of her hair, yanking backward so hard he tore out more than two dozen strands. These were found later, scattered on the pillow and floor. The bloodstains shrieked out the final events. With her head immobilized and the neck fully exposed, he’d made a single deep slash starting at the left jaw and moving rightward, across the throat. He had severed the left carotid artery and the trachea. Blood spurted. On the wall to the left of the bed were dense clusters of small circular drops flowing downward, characteristic of arterial spray as well as exhalation of blood from the trachea. The pillow and sheets were saturated from downward dripping. Several cast-off droplets, thrown off as the intruder swung away the blade, had spattered the windowsill.

Elena Ortiz had lived long enough to see her own blood spurt from her neck and hit the wall in a machine-gun spray of red. She had lived long enough to aspirate blood into her severed trachea, to hear it gurgle in her lungs, to cough it out in explosive bursts of crimson phlegm.

She had lived long enough to know she was dying.

And when it was done, when her agonal struggles had ceased, you left us a calling card. You neatly folded the victim’s nightshirt, and you left it on the dresser. Why? Is it some twisted sign of respect for the woman you’ve just slaughtered? Or is it your way of mocking us? Your way of telling us that you are in control?

Moore returned to the living room and sank into an armchair. It was hot and airless in the apartment, but he was shivering. He didn’t know if the chill was physical or emotional. His thighs and shoulders ached, so maybe it was just a virus coming on. A summer flu, the worst kind. He thought of all the places he’d rather be at that moment. Adrift on a Maine lake, his fishing line whicking through the air. Or standing at the seashore, watching the fog roll in. Anywhere but this place of death.

The chirp of his beeper startled him. He shut it off and realized his heart was pounding. He made himself calm down first before he took out the cell phone and punched in the number.

“Rizzoli,” she answered on the first ring, her greeting as direct as a bullet.

“You paged me.”

“You never told me you got a hit on VICAP,” she said.

“What hit?”

“On Diana Sterling. I’m looking at her murder book now.”

VICAP, the Violent Criminals Apprehension Program, was a national database of homicide and assault information gathered from cases across the country. Killers often repeated the same patterns, and with this data investigators could link crimes committed by the same perpetrator. As a matter of routine, Moore and his partner at the time, Rusty Stivack, had initiated a search on VICAP.

“We turned up no matches in New England,” said Moore. “We ran down every homicide involving mutilation, night entry, and duct tape bindings. Nothing fit Sterling’s profile.”

“What about the series in Georgia? Three years ago, four victims. One in Atlanta, three in Savannah. All were in the VICAP database.”

“I reviewed those cases. That perp is not our unsub.”

“Listen to this, Moore. Dora Ciccone, age twenty-two, graduate student at Emory. Victim first subdued with Rohypnol, then restrained to the bed with nylon cord—”

“Our boy here uses chloroform and duct tape.”

“He sliced open her abdomen. Cut out her uterus. Performed a coup de grace — a single slash across the neck. And finally — get this — he folded her nightclothes and left them on a chair by the bed. I’m telling you, it’s too goddamn close.”

“The Georgia cases are closed,” said Moore. “They’ve been closed for two years. That perp is dead.”

“What if Savannah PD blew it? What if he wasn’t their killer?”

“They had DNA to back it up. Fibers, hairs. Plus there was a witness. A victim who survived.”

“Oh yeah. The survivor. Victim number five.” Rizzoli’s voice held a strangely taunting note.

“She confirmed the perp’s identity,” said Moore.

“She also conveniently shot him to death.”

“So what, you want to arrest his ghost?”

“Did you ever talk to that surviving victim?” Rizzoli asked.

“No.”

“Why not?”

“What would be the point?”

“The point is that you might’ve learned something interesting. Like the fact she left Savannah soon after that attack. And guess where she’s living now?”

Through the hiss of the cell phone, he could hear the whoosh of his own pulse. “Boston?” he asked softly.

“And you’re not gonna believe what she does for a living.”

Dr. Catherine Cordell sprinted down the hospital corridor, the soles of her running shoes squeaking on the linoleum, and pushed through the double doors into the emergency room.

A nurse called out: “They’re in Trauma Two, Dr. Cordell!”

“I’m there,” said Catherine, moving like a guided missile straight for Trauma Two.

Half a dozen faces flashed her looks of relief as she stepped into the room. In one glance she took stock of the situation, saw jumbled instruments glittering on a tray, the IV poles with bags of Ringer’s lactate hanging like heavy fruit on steel-rod trees, blood-streaked gauze and torn packaging scattered across the floor. A rapid sinus rhythm twitched across the cardiac monitor — the electrical pattern of a heart racing to stay ahead of Death.

“What’ve we got?” she asked as personnel moved aside to let her pass.

Ron Littman, the senior surgical resident, gave her a rapid-fire report. “John Doe Pedestrian, hit-and-run. Rolled into the E.R. unconscious. Pupils are equal and reactive, lungs are clear, but the abdomen’s distended. No bowel sounds. BP’s down to sixty over zip. I did a paracentesis. He’s got blood in his belly. We’ve got a central line in, Ringer’s lactate wide open, but we can’t keep his pressure up.”

“O neg and fresh frozen on the way?”

“Should be here any minute.”

The man on the table was stripped naked, every intimate detail mercilessly exposed to her gaze. He appeared to be in his sixties, already intubated and on a ventilator. Toneless muscles sagged in folds on gaunt limbs, and his ribs stood out like arching blades. A preexisting chronic illness, she thought; cancer would be her first guess. The right arm and hip were abraded and bloody from scraping across pavement. On his right lower chest a bruise formed a purple continent on the white parchment of skin. There were no penetrating wounds.

She slipped on her stethoscope to verify what the resident had just told her. She heard no sounds in the belly. Not a growl, not a tinkle. The silence of traumatized bowel. Moving the stethoscope diaphragm to the chest, she listened for breath sounds, confirming that the endotracheal tube was properly placed and that both lungs were being ventilated. The heart battered like a fist against the chest wall. Her exam took only a matter of seconds, yet she felt as though she were moving in slow motion, that around her the room full of personnel stood frozen in time, awaiting her next action.