Jodie Picoult - Plain Truth

“Does your sister know you have these letters?”

Jacob shook his head. “I was going to tell her last night. But she was so upset already, about the trial coming up so fast, that it seemed like one extra heartache.” He grimaced, flexed his hands on the edge of the table. “I suppose I should give them to her today.”

Ellie stared at the neat, block type that formed the letters of Katie’s name. At the thin-skinned blue airmail stationery, folded and stamped and sealed. “Not necessarily,” she said.

• • •

Technically, Ellie should have dragged Katie into Philadelphia with her, but at this point she’d managed to screw up the legal process so much that bending the requirements for Katie’s bail couldn’t possibly get her into any greater trouble. She didn’t even know why she was driving toward Philly, actually, until she pulled into the parking lot of the medical complex where Coop’s office was located.

The address was familiar, but Ellie had never been there before. She found herself standing in front of the directory, touching her finger to the brass plate stamped with Coop’s name. In his office, when a pretty young secretary asked to help her, a stab of jealousy took Ellie’s breath away. “He’s with a patient,” the woman said. “Would you care to wait?”

“Please.” Ellie took a seat and began to leaf through a magazine that was six months old, without seeing a single page.

After a few minutes there was a buzz on the secretary’s intercom, a muted conversation, and then Coop opened the door to the inner sanctum. “Hi,” he said, his eyes dancing. “I hear this is an emergency.”

“It is,” Ellie replied, feeling better than she had since Katie had turned the world upside down. She followed Coop in and let him close the door. “I need urgent medical attention.”

He took her into his arms. “Well, you know, I’m a psychiatrist. I treat the mind.”

“You treat all of me,” Ellie said. “Don’t sell yourself short.”

When Coop kissed her, Ellie clung to him, rubbing her cheek against the crisp flat of his shirt. He eased her onto his lap in one of the overstuffed armchairs.

“Now, what would Dr. Freud have to say about this?” she murmured.

Coop shifted, his erection strong beneath her legs. “That a cigar isn’t always a cigar.” He groaned, then tumbled her into the chair as he stood up to pace. “I’ve only got a ten-minute window before the next patient arrives, and I’d rather not tempt fate.” He stuffed his hands in his pockets. “To what do I owe this visit?”

“I was hoping for a freebie,” Ellie confessed.

“Well, I’d be happy to take you up on that later-”

“I meant a clinical consult, Coop. My head’s a mess.” She buried her face in her hands. “I’m no longer using an insanity defense for Katie.”

“How come?”

“Because it goes against her code of morality,” Ellie said sarcastically. “I’m just so glad I get to defend the first alleged murderer in history with an unshakable sense of ethics.” She got up and walked to the window. “Katie told me who the baby’s father was-a professor friend of Jacob’s who never knew about the pregnancy. And now that she’s turned over this new leaf of honesty, she won’t let me get up there and say she dissociated and killed the baby, since she swears it’s not the truth.”

Coop whistled. “You couldn’t convince her-”

“I couldn’t say anything. I’m not dealing with a client who understands the way courts operate. Katie believes with all her heart that she can say her piece and she’ll be pardoned. Why shouldn’t she? That’s the way it works in her church.”

“Let’s assume that it’s the truth, that she didn’t kill the baby,” Coop said.

“Well, there are some other unalienable truths, too. Like the fact that the baby was born alive, and that it somehow was found dead and hidden.”

“Okay. So what does that leave you with?”

Ellie sighed. “Someone else killed it-which, as we’ve already discussed, is virtually impossible to use as a defense.”

“Or else the baby died on its own.”

“And walked, postpartum, to the tack room to bury itself under a stack of blankets?”

Coop smiled faintly. “If Katie wanted that baby, and woke up to find it dead, maybe that was the point when she lost touch with reality. Maybe she got rid of the corpse in a dissociative state, and can’t remember now.”

“Concealment of death is still a crime, Coop.”

“But not of nearly the same proportion,” he pointed out. “There’s a pathos to trying to keep from consciously admitting a loved one’s death that doesn’t come into play if you also caused that death.” He shrugged. “I’m no lawyer, El, but it looks to me like you’ve got one thing to go with-that the baby died on its own, and that was what Katie’s mind tried to cover up. And you’ve got to have some expert you can pull out of your hat who’ll twist the autopsy report, right? I mean, she gave birth early. What premature infant is going to make it without an incubator and lights and the services of a neonatal ICU?”

Ellie tried to turn that strategy over in her mind, but her thoughts kept snagging on something that stuck out as sharp and as stubborn as a splinter. It had been accepted, from the autopsy report forward, that Katie had delivered at thirty-two weeks. And no one-Ellie included-had bothered to question that. “How come?” she asked now.

“How come what?”

“How come Katie, a healthy eighteen-year-old girl in better physical shape than most women her age, went into premature labor?”

Dr. Owen Zeigler looked up as Ellie distracted him for the tenth time with a tremendously loud crunch of pork rinds. “If you knew what those did to your body, you wouldn’t eat them,” he said.

“If you knew when the last time I ate was, you wouldn’t bother me.” Ellie watched him hunch over the autopsy report again. “So?”

“So. In and of itself prematurity isn’t an issue. Preterm labor is a fairly frequent occurrence, there’s no good treatment for it, and OBs don’t know what causes it most of the time. In your client’s case, however, the preterm labor was most likely caused by the chorioamnionitis.” Ellie stared at him blankly. “That’s a pathological diagnosis, not a bacteriological one. It basically means that there was marked acute inflammation of the amniotic membranes and villi.”

“Then what caused the chorioamnionitis? What does the ME say?”

“He doesn’t. He implies that the fetal tissues and the placenta were contaminated, so the cause wasn’t isolated and identified.”

“What usually causes chorioamnionitis?”

“Sexual intercourse,” Owen said. “Most of the infectious agents that cause it are bacteria living in the vagina on a regular basis. Put two and two together-” He shrugged.

“What if intercourse wasn’t a viable option?”

“Then an infectious agent entering by another route-like the mother’s bloodstream or a urinary tract infection-would have caused it. But is there evidence to support that?” Owen tapped a page of the autopsy. “This keeps catching my eye,” he admitted. “The liver findings were overlooked. There’s necrosis-cell death-but no evidence of inflammatory response.”

“Translation for those of us who don’t speak pathologese?”

“The ME thought that the liver necrosis was based on asphyxia-a lack of oxygen-his assumed cause of death. But it’s not-those lesions just don’t make sense; they point to something other than asphyxia. Sometimes you see hemorrhagic necrosis due to anoxia, but pure necrosis is unusual.”

“So where do you see that?”

“With congenital heart abnormalities, which this baby didn’t have-or with an infection. Necrosis might occur several hours before the body can mount an inflammatory response to an infection that a pathologist is able to see-and it’s possible the baby died before that happened. I’ll get the tissue blocks from the ME and do a Gram’s stain to see what I come up with.”