Tess Gerritsen: The Surgeon

Moore turned to the crime scene photos. On the bedroom floor, Andrew Capra lay dead, flat on his back. He had been shot twice, once in the abdomen, once in the eye, both times at close range.

For a long time he studied the photos, noting the position of Capra’s body, the pattern of the bloodstains.

He turned to the autopsy report. Read it through twice.

Looked once again at the crime scene photo.

Something is wrong here, he thought. Cordell’s statement does not make sense.

A report suddenly landed on his desk. He glanced up, startled, to see Rizzoli.

“Did you get a load of this?” she asked.

“What is it?”

“The report on that strand of hair found in Elena Ortiz’s wound margin.”

Moore scanned down to the final sentence. And he said: “I have no idea what this means.”

In 1997, the various branches of the Boston Police Department were moved under one roof, located inside the brand-new complex at One Schroeder Plaza in Boston’s rough-and-tumble Roxbury neighborhood. The cops referred to their new digs as “the marble palace” because of the extensive use of polished granite in the lobby. “Give us a few years to trash the place, and it’ll feel like home” was the joke. Schroeder Plaza bore little resemblance to the shabby police stations seen on TV cop shows. It was a sleek and modern building, brightened by large windows and skylights. The homicide unit, with its carpeted floors and computer workstations, could have passed for a corporate office. What the cops liked best about Schroeder Plaza was the integration of the various BPD branches.

For homicide detectives, a visit to the crime lab was only a walk down the hallway, to the south wing of the building.

In Hair and Fiber, Moore and Rizzoli watched as Erin Volchko, a forensic scientist, sifted through her collection of evidence envelopes. “All I had to work with was that single hair,” said Erin. “But it’s amazing what one hair can tell you. Okay, here it is.” She’d located the envelope with Elena Ortiz’s case number, and now she removed a microscope slide. “I’ll just show you what it looks like under the lens. The numerical scores are in the report.”

“These numbers?” said Rizzoli, looking down at the long series of scoring codes on the page.

“Correct. Each code describes a different characteristic of hair, from color and curl to microscopic features. This particular strand is an A01—a dark blond. Its curl is B01. Curved, with a curl diameter of less than eighty. Almost, but not quite, straight. The shaft length is four centimeters. Unfortunately, this strand is in its telogen phase, so there’s no epithelial tissue adhering to it.”

“Meaning there’s no DNA.”

“Right. Telogen is the terminal stage of root growth. This strand fell out naturally, as part of the shedding process. In other words, it was not yanked out. If there were epithelial cells on the root, we could use their nuclei for DNA analysis. But this strand doesn’t have any such cells.”

Rizzoli and Moore exchanged looks of disappointment.

“But,” added Erin, “we do have something here that’s pretty damn good. Not as good as DNA, but it might hold up in court once you nail a suspect. It’s too bad we don’t have any hairs from the Sterling case to compare.” She focused the microscope lens, then scooted aside. “Take a look.”

The scope had a teaching eyepiece, so both Rizzoli and Moore could examine the slide simultaneously. What Moore saw, peering through the lens, was a single strand beaded with tiny nodules.

“What are the little bumps?” said Rizzoli. “That’s not normal.”

“Not only is it abnormal, it’s rare,” said Erin. “It’s a condition called Trichorrhexis invaginata , otherwise known as ‘bamboo hair.’ You can see how it gets its nickname. Those little nodules make it look like a stalk of bamboo, don’t they?”

“What are the nodules?” asked Moore.

“They’re focal defects in the hair fiber. Weak spots which allow the hair shaft to fold back on itself, forming a sort of ball and socket. Those little bumps are the weak spots, where the shaft has telescoped on itself, making a bulge.”

“How do you get this condition?”

“Occasionally it can develop from too much hair processing. Dyes, permanents, that sort of thing. But since we’re most likely dealing with a male unsub, and since I see no evidence of artificial bleaching, I’m inclined to say this is not due to processing, but to some sort of genetic abnormality.”

“Like what?”

“Netherton’s Syndrome, for instance. That’s an autosomal recessive condition that affects keratin development. Keratin is a tough, fibrous protein found in hair and nails. It’s also the outer layer of our skin.”

“If there’s a genetic defect, and the keratin doesn’t develop normally, then the hair is weakened?”

Erin nodded. “And it’s not just the hair that can be affected. People with Netherton’s Syndrome may have skin disorders as well. Rashes and flaking.”

“We’re looking for a perp with a bad case of dandruff?” said Rizzoli.

“It may be even more obvious than that. Some of these patients have a severe form known as icthyosis . Their skin can be so dry it looks like the hide of an alligator.”

Rizzoli laughed. “So we’re looking for reptile man ! That should narrow down the search.”

“Not necessarily. It’s summertime.”

“What does that have to do with it?”

“This heat and humidity improves skin dryness. He may look entirely normal this time of year.”

Rizzoli and Moore glanced at each other, simultaneously struck by the same thought.

Both victims were slaughtered during the summertime.

“As long as this heat holds up,” said Erin, “he probably blends right in with everyone else.”

“It’s only July,” said Rizzoli.

Moore nodded. “His hunting season’s just begun.”

John Doe now had a name. The E.R. nurses had found an ID tag attached to his key ring. He was Herman Gwadowski, and he was sixty-nine years old.

Catherine stood in her patient’s SICU cubicle, methodically surveying the monitors and equipment arrayed around his bed. A normal EKG rhythm blipped across the oscilloscope. The arterial waves spiked at 110/70, and the readings from his central venous pressure line rose and fell like swells on a windblown sea. Judging by the numbers, Mr. Gwadowski’s operation was a success.

But he’s not waking up, thought Catherine as she flashed her penlight into the left pupil, then the right. Nearly eight hours after surgery, he remained in a deep coma.

She straightened and watched his chest rise and fall with the cycling of the ventilator. She had stopped him from bleeding to death. But what had she really saved? A body with a beating heart and no functioning brain.

She heard tapping on the glass. Through the cubicle window she saw her surgical partner, Dr. Peter Falco, waving to her, a concerned expression on his usually cheerful face.

Some surgeons are known to throw temper tantrums in the O.R. Some sweep arrogantly into the operating suite and don their surgical gowns the way one dons royal robes. Some are coldly efficient technicians for whom patients are merely a bundle of mechanical parts in need of repair.

And then there was Peter. Funny, exuberant Peter, who sang earsplittingly off-key Elvis songs in the O.R., who organized paper airplane contests in the office and happily got down on his hands and knees to play Legos with his pediatric patients. She was accustomed to seeing a smile on Peter’s face. When she saw him frowning at her through the window, she immediately stepped out of her patient’s cubicle.