Kathy Reichs - Deadly Descisions

"In stocking feet."

"Right. These fellows tend to underdress. But Frog wasn't there when the hit went down. It was probably his night for charity work. What about the third guy?"

"The third guy is a girl."

"A girl."

"Yes. What does Frog know about her?"

"Not a thing. But Frog would give nothing up if there wasn't a prize in it for him. What can you tell me about her?"

"She was a white female in her mid to late teens.

"She was that young?"

"Yes."

I could hear traffic in the background and figured Claudel was calling from the road.

"I'll get a list of missing teenage girls. What time frame?"

"Go back ten years.

"Why ten years?"

"I'd say the victim's been dead at least two years, but with what we recovered I can't really pinpoint an upper limit. I have a feeling this was a secondary burial."

"What does that mean?"

"I think she was buried somewhere else, then dug up and moved to the place we found her."

"Why?"

"Another perceptive question, Detective Claudel."

I told him about the surgical implant.

"What does that mean?"

"When I find out I'll let you know"

I'd hardly replaced the receiver when the phone rang again. Carolyn Russell could see me at three. I looked at my watch. If the parking gods smiled I could make it.

I wrote the case number on the lid of a plastic specimen container and sealed the implant inside. Pausing only to tell Bergeron that he could have the girl's skull, I hurried to my car and raced across town.

The Royal Victoria Hospital was built before the turn of the century. A sprawling gray stone complex, it lies in the heart of Montreai, looming over the McGill campus like a medieval castle on a Tuscan hillside.

At the Peel end is the Allan Memorial Institute, infamous for CIA drug experiments conducted there in the late fifties. The Montreal Neurological Institute is located to the east of the Royal Vic, across rue Université. Teaching and research units of McGill University, the MNI, the Neurological Hospital, and the new Brain Tumor Research Institute sit haunch to jowl with the football stadium, a testimonial in mortar and brick to the priorities of the modern university.

The Neuro, as the research institute and hospital are known, dates to the thirties, the brainchild of Wilder Penfield. Though a brilliant scientist and neurosurgeon, Dr. Penfield was not a visionary in traffic control. Parking is a nightmare.

Following Dr. Russell's suggestion, I drove onto the grounds of the Royal Vic, forked over ten dollars, and began cruising the lot. I was on my third pass when I spotted brake lights. An Audi pulled out and I shot forward and into the space, thus avoiding the necessity of tuning to FM 88.5 for a parking update. My watch said two fifty-five.

I arrived at Russell's office sweaty and panting from my dash down avenue des Pins and my trek through the hospital. It had begun to mist, and my bangs lay damp and limp across my forehead. When the doctor looked up, an expression of doubt crossed her face.

I introduced myself and she rose and held out a hand. Her hair was gray, cut short and swept to the side. Her face was deeply creased, but her grip was as strong as that of any man. I guessed she was somewhere in her sixties.

"Sorry I'm late. I had a little trouble finding you." That was an understatement.

"Yes, this building is confusing. Please sit down," she said in English, gesturing at a chair opposite her desk.

"I had no idea this place was so large," I said, seating myself.

"Oh yes. The MNI is engaged in an enormous range of activities.

"I know the institute is world famous for its epilepsy research." I slipped off my jacket.

"Yes, more epilepsy surgeries are performed at our hospital than at any other center in the world. The surgical technique of cortical resection was pioneered at this institution. Studies in the mapping of cerebral function began with epilepsy patients here more than sixty years ago. It was that work that paved the way for the MRI and PET brain mapping going on today."

"I'm familiar with Magnetic Resonance Imaging but what is PET?"

"Positron Emission Tomography. Like MEl, it's a technique used to image brain structure and physiology. Our McConnell Brain Imaging Centre is rated as one of the world's leading facilities."

"What other research do you do?"

"A tremendous amount of groundbreaking work has emanated from the MNI. The development of electroencephalograph', the concept of focal and generalized epilepsies, new methods of frameless stereotactic surgery contributions to postglandin biochemistry in the nervous system, localization of dystrophin skeletal muscle. I could go on and on.

I was certain she could. Dr. Russell was obviously proud of her employer. I smiled encouragement, though I understood only part of what she had listed.

She leaned back and laughed. "I'm sure you are not here for a lecture on the Neuro."

"No, but it's fascinating. I wish I had more time. But I know you're very busy and I don't want to take up any more of your day than necessary.

I took the container from my purse and handed it to her. She looked at it, then unscrewed the cap and slid the implant onto a piece of paper on the blotter of her desk.

"This is an old one," she said, turning it over with a pencil. "I don't think they've made this model for years."

"What is it?"

"It's a ventriculo-peritoneal shunt. They're implanted for the treatment of hydrocephalus."

"Hydrocephalus?" I knew the term, but was surprised to hear her say it. What other misfortunes would I learn about this child?

"It's commonly known as 'water on the brain,' but that's not really accurate, although that's a literal translation from the Greek, hydro being water, and cephalus being head. Cerebral spinal fluid is constantly produced in spaces in the brain called ventricles. Normally it circulates through the four ventricles, and flows over the brain's surface and down the spinal cord. Eventually the CFS is absorbed into the bloodstream, and the amount of fluid and pressure in the ventricles stays within acceptable limits.

"But if drainage is blocked, fluid will accumulate, causing the ventricles to swell and press on the surrounding tissue."

"So hydrocephalus refers to an imbaiance in the amount of CSF produced and the rate at which it drains from the ventricles."

"Exactly."

"And, as the CSF builds up, it causes the ventricles to enlarge and the pressure inside the head to increase."

"You've got it. Hydrocephalus can be acquired or congenital, which is not to say hereditary. The term simply means the condition is present at birth."

"I found the shunt in a normal-looking skull. Doesn't hydrocephalus result in increased head size?"

"Only in infants, and only if left untreated. As you know, with older children and adults the bones of the skull are already formed."

"What causes it?"

"There are lots of reasons for inadequate CSF drainage. Prematurity puts an infant at high risk. And most babies with spina bifida have hydrocephalus."

"Spina bifida involves a neural tube defect?"

"Yes. The problem occurs during the first four weeks of gestation, often before the mother knows she's pregnant. The embryo's neural tube, which develops into the brain, spinal cord, and vertebral column, fails to form properly, leading to varying degrees of permanent damage."

"How common is it?"

"Entirely too common. It's estimated that spina biflda affects one in every thousand babies born in the United States, and about one in seven hundred and fifty born in Canada."

"I recovered no vertebrae, sol have no way to know if my young lady had spina bifida."

Russell nodded in agreement, then continued her explanation.

"There are many other causes of hydrocephalus besides spina bifida." She ticked them off on her fingers. "It can result from brain hemorrhage. The inflammation and debris resulting from brain infections, such as meningitis, can block drainage pathways. Tumors can cause compression and swelling of brain tissues and result in poor drainage. So can certain types of cysts. And hydrocephalus can be familial."