Робин Кук - Genesis

Aria worked quickly, adroitly, and with great surety. Within minutes she had the heart lifted and angled up toward the head, exposing the left auricle. “Syringe for a blood sample, please,” she said, reaching out with one of her gloved hands while continuing to inspect the underside of the heart. Marvin handed her the syringe he had prepared, and Aria took the sample. Next, she turned her attention to the lungs. First, she carefully felt their surface using the pads of her fingers, then she grasped a lung between her thumb and fingers to feel the consistency. “Not much pulmonary edema,” she said, knotting her brow in surprise. She looked up at Laurie. “You take a feel.”

Laurie did as was suggested, palpating the lung tissue between her thumb and fingers. “I see what you mean,” she said. The lungs were indeed light and fluffy, meaning full of air and not fluid. Normally overdoses had fluid in the lungs, forming what was called pulmonary edema.

“This might have been a cardiac death, not a pulmonary death,” Aria said. “I wonder if the patient ever had an ECG.”

“It wasn’t mentioned in the medical-legal investigator’s report,” Laurie said.

“Maybe it’s a cardiac channelopathy,” Aria said, referring to a relatively new class of heart disease that interrupted the heart’s rhythm. “That could make this an interesting case.”

“I wouldn’t count on it,” Laurie said. “Cardiac channelopathies are rather rare, especially in an otherwise healthy young woman.”

“Yeah, but it’s a fascinating area genetically,” Aria said. “With the terrific DNA lab here at the OCME, this could be one hell of a case. I happen to be interested in channelopathies.”

“When you hear hoofbeats, think of horses, not zebras,” Laurie cautioned.

Aria laughed. “Of course, you’re right,” she said. “Everybody knows fentanyl suppresses breathing, but hell, maybe it also selectively exacerbates channelopathies. You never know. I’d like to know if this patient ever had an ECG or any history of cardiac problems or fainting spells.”

“It will be interesting to learn,” Laurie said. When Aria removed the heart and the lungs from the body, the lungs seemed to be entirely normal, as she’d surmised earlier from feeling the lung consistency. Both together weighed only two point eight pounds, which was well within the normal range.

“Obviously very little edema involved in these babies,” Aria said, taking them out of the scale. “I’m thinking channelopathy all over again.”

“Let’s look at the coronary arteries before we jump to conclusions,” Laurie said. She was again beginning to relax after Aria’s outburst and was once more enjoying herself being back in the pit doing an autopsy. For a few minutes she was able to forget all the stresses of being the chief medical examiner on top of her personal problems.

With the heart out on a cutting board, Aria skillfully traced all the major coronary arteries, confirming they were entirely normal in configuration and patency. When she finished inspecting all the heart’s chambers and valves, she looked up at Laurie, who was watching her every move. “Miss Jacobsen obviously didn’t have a heart attack or a valve prolapse, and she didn’t have pulmonary edema. I’m stoked. The channelopathy idea is starting to sound better and better.”

“Perhaps,” Laurie said. She still thought the chances were pretty small, yet inwardly she was pleased that Aria was raising the possibility and acted enthused. Laurie’s goal with Dr. Nichols had been to first find out if she had learned anything after she’d been at the OCME for a week, which she obviously had, and second, to possibly get her interested in forensics so she’d take her OCME rotation seriously. It seemed that this case, even though most likely a garden-variety overdose despite the lack of pulmonary edema, might do the trick. Laurie could well remember when she’d stumbled onto the attractions of forensic pathology when she was a pathology resident.

Finished with the chest, Aria now turned her attention to the abdomen. She worked quickly, to Laurie’s satisfaction, as it was now going on five o’clock. Within minutes Aria had the entire bowel out of the body. Marvin offered to take it and rinse it out, but Aria said she preferred to do it herself. At one of the sinks lining the far wall, she flushed it out, opened it with dissecting scissors, and then began to carefully inspect its nearly thirty-foot length.

At that moment, Jack and Lou Soldano entered the pit, laughing about something. Laurie wasn’t surprised to see Lou. He was a frequent visitor to the autopsy room. Both men were dressed in scrubs in preparation to do a case. Immediately behind them Vinnie Amendola appeared, pushing a gurney. On it was a toddler whose tiny body made Laurie shudder. Autopsies on children, particularly young children, never failed to bother her even though she’d hoped by this time in her career to have learned to take it in stride.

While Vinnie navigated the gurney next to a neighboring table, Jack and Lou came to Laurie’s. Jack leaned toward Laurie and asked sotto voce if Chet’s resident bête noire was as bad as he claimed.

“Worse,” Laurie whispered back.

“Really?” Jack questioned with surprise.

“We’ll talk about it later,” Laurie said as she saw Aria leave the sink and start back in their direction. “I take it this is the suspicious drowning death Lou called me about earlier?” Laurie asked, even though she didn’t really want to know.

“That’s the one. A scald case and drowning with extensive third-degree burns,” Jack said. “Lou must have told you he’s questioning whether it was an accident as the mother’s boyfriend contends. His gut is telling him it was a homicide.”

“And his intuition is usually spot-on,” Laurie said. She avoided looking at the tiny body as Vinnie moved it over onto the autopsy table. Instead she said hello to Lou, who returned the greeting.

“I’m Dr. Stapleton,” Jack said to Aria when she returned to the table.

“I know who you are.” Aria gave Jack a cursory glance before putting down the bowel she was carrying. Ignoring him further, she proceeded to take samples from various portions of the intestines and place them in specimen bottles.

Jack watched her for a beat, shrugged at being summarily dismissed, and then led Lou to the autopsy table where Vinnie had placed the toddler.

“The bowel is clean,” Aria announced. “Time for the pelvic organs.” Returning to the corpse and using mostly blunt finger dissection with a bit of help from blunt-nosed dissecting scissors, she quickly freed everything up. Then, using a scalpel, she expertly transected what needed to be cut and lifted the pelvic organs including the uterus, the fallopian tubes, and the ovaries out of the pelvic cavity.

“I have to say, you are a talented prosector,” Laurie said, and meant it.

“I’m glad you noticed,” Aria said in a tone of voice that made Laurie wish she’d not made the compliment. After taking a sample of the cervix, Aria forcibly inserted a long-bladed and very sharp scalpel into the cervical os and proceeded to fillet open the uterus to expose the uterine cavity.

“Holy shit,” Aria said. She bent over the specimen to take a closer look. “Do you see what I see?”

May 8th

5:05 P.M.

For several beats, the two women were transfixed by their unexpected discovery. Nestled inside the uterus was a tiny embryo. Although both women were professionally accustomed to death, one more than the other, discovering that the dead woman was pregnant momentarily yanked them out of their comfort zone.

“Oh, dear,” Laurie said. “This makes this overdose a double tragedy.”