Jodi Picoult - Small Great Things

“What were your findings of note during the autopsy?” Odette asks.

“The liver was slightly enlarged. There was slight cardiomegaly and a minimal grade one patent ductus, but other congenital defects were absent-there were no valvular or plumbing abnormalities.”

“What does that mean?”

“The organ was a little large, and there was a small hole in the heart. However, the vessels weren’t hooked up wrong,” he says. “There were no septal defects.”

“Were any of these findings something that suggested the cause of death?”

“Not really,” the medical examiner says. “There was good reason for them. According to the patient’s medical records, the mother had gestational diabetes during the pregnancy.”

“What’s that?”

“A condition that leads to high blood sugar for a mother during pregnancy. Unfortunately, that high blood sugar in mothers also has an effect on their infants.”

“How so?”

“Infants who are born to mothers with diabetes are often bigger than other babies. Their livers, hearts, and adrenal glands may be enlarged. These infants are also often hypoglycemic after birth because of increased insulin levels in the blood. Again, based on the medical records I studied, the patient’s postnatal lab work indicated low blood sugar, as did the femoral stick done during the code. All of the findings of the autopsy, as well as the low blood sugar, would be consistent with an infant born to a diabetic mother.”

“What about the hole in the baby’s heart? That sounds serious…”

“It sounds worse than it is. In most cases, the patent ductus closes up by itself,” Dr. Binnie says, and he glances at the jury. The woman who is a teacher, juror number 12, actually starts fanning herself.

“Were you able to determine how the baby died, then?”

“Actually,” the medical examiner says. “That’s more complicated than most people think. We medical geeks make a distinction between the way a person died and the actual change in the body that causes the termination of life. For example, let’s say there is a gunshot and someone dies. The cause of death is the gunshot wound. But the mechanism of death-the actual physical event that ended his life-would be exsanguination-loss of blood.”

He turns his attention from Odette to the jury. “And then, there’s manner of death-how it came about. Was the gunshot wound an accident? A suicide? Was it a deliberate assault? That becomes important-well-when we’re sitting in a courtroom like this.”

The prosecutor enters another exhibit. “What you’re about to see,” Odette warns the jury, “may be extremely disturbing.”

She sets up on an easel a photograph of the body of Davis Bauer.

I feel my breath catch in my throat. Those tiny fingers, the bow of the legs. The acorn of his penis, still bloodied from the circumcision. If not for the bruises, the blue tint to his skin, he might be asleep.

I had taken this body from the morgue. I had held him in my own arms. I had rocked him toward Heaven.

“Doctor,” Odette begins, “could you tell us-” But before she can finish, there is a crash in the gallery. We all spin around to see Brittany Bauer standing, her eyes wild. Her husband stands in front of her, holding her shoulders. I can’t tell if he’s trying to keep her subdued or keep her upright.

“Let me go,” she shrieks. “That’s my son !”

Judge Thunder raps his gavel. “I’ll have order,” he demands, and not unkindly, “Ma’am, please sit back down…”

But Brittany points a shaking finger directly at me. It might as well be a Taser for the current that runs through my bones. “You fucking killed my baby.” She stumbles into the aisle, approaching me, while I stand caught in the spell of her hate. “I’ll make you pay for this, if it’s the last thing I do.”

Kennedy calls out to the judge as he smacks his gavel again and calls the bailiff. Brittany Bauer’s father tries to calm her down, too, but to no avail. There is a shudder of shock and gossip as she is escorted from the courtroom. Her husband is frozen, caught between comforting her and staying for the testimony. After a moment he turns and runs out the double doors.

When the judge calls order, we all face forward again, riveted by that giant poster of the dead infant. One of the jurors bursts into tears and it takes two others to calm her, and then, Judge Thunder calls a recess.

Beside me, Kennedy exhales. “Oh, shit,” she says.

–

FIFTEEN MINUTES LATER, everyone but Brittany and Turk Bauer has returned to the courtroom. And yet their absence is almost even more visible, as if the negative space is a constant reminder of why we had to break in the first place. Odette leads the medical examiner through a series of photographs of the baby’s body, from every angle possible. She has him explain the different test results, what was standard, what was deviant from the norm. Finally, she asks, “Were you able to determine the cause of death for Davis Bauer?”

Dr. Binnie nods. “For Davis Bauer, the cause of death was hypoglycemia, leading to hypoglycemic seizure, leading to respiratory and then cardiac arrest. In other words, low blood sugar made the infant seize, stop breathing, and that in turn stopped his heart. The method of death was asphyxiation. And the manner was undetermined.”

“Undetermined? Does that mean the defendant’s actions had nothing to do with the baby’s death?” Odette asks.

“On the contrary. It just means that it was not patently clear whether this was a violent or a natural death.”

“How did you go about researching that?”

“I read the medical records, of course, as well as a police report that provided information.”

“Such as?”

“Mr. Bauer told the police that Ruth Jefferson was aggressively beating on his son’s chest. The bruising we found on the sternum could support that allegation.”

“Was there anything else in the police report that led you to fill out the report the way you did?”

“According to multiple accounts, there was an indication that the defendant did not take any resuscitative efforts until other personnel came into the room.”

“Why was that important to the autopsy results?”

“It goes to the manner of death,” Dr. Binnie says. “I don’t know how long that infant was in respiratory distress. If the respiratory failure had been alleviated sooner, it’s possible that the cardiac arrest would never have occurred.” He looks at the jury. “Had the defendant acted, it’s possible that none of us would be sitting here.”

“Your witness,” Odette says.

Kennedy rises. “Doctor, was there anything in the police report that indicated there was foul play or intentional trauma to this infant?”

“I already mentioned the bruising to the sternum…”

“Yes, you did. But isn’t it possible that the bruising might also be consistent with vigorous, medically necessary CPR?”

“It is,” he concedes.

“Is it possible that there might be other scenarios-other than foul play-that might have led to the death of this baby?”

“It’s possible.”

Kennedy asks him to review the neonatal screening results she entered into evidence earlier. “Doctor, would you mind taking a look at exhibit forty-two?”

He takes the file and thumbs through it.

“Can you tell the jury what you’re looking at?”

He glances up. “Davis Bauer’s newborn screening results.”

“Did you have access to this information while you were performing your autopsy?”

“I did not.”

“You work at the state lab where these tests were performed, don’t you?”

“Yes.”

“Can you explain the highlighted section on page one?”