Kathy Reichs - Bones Are Forever

When I joined the trio, Leclerc spread his feet and crossed his arms in a posture more characteristic of a bouncer than a physician.

“How many more?” Leclerc’s French hinted at stone gargoyles and arrondissements . I guessed he wasn’t from around these parts.

“We are all here,” LaManche said.

“This must be handled with the greatest of delicacy.”

“Of course.”

Leclerc shook his head, kept shaking it while repeatedly punching the button for an elevator. When the car came, I got in first and moved to the back. As we ascended, I scoped out our host.

Leclerc’s thin brown hair was parted with military precision. His lab coat was eye-blistering white, his khakis creased sharp enough to draw blood. I guessed flexibility was not the guy’s strong suit.

When the doors opened, Leclerc led us down a shiny tile corridor to an X-ray room reminiscent of the one at the LSJML. One difference: no changing rooms at Wilfrid-Derome. Our patients arrived and departed naked.

Through a window, I could see a woman seated beside a machine that looked like a large square donut with a narrow cot projecting from the hole. The woman’s hair was black, her skin the color of walnuts. From her scrubs, I assumed she was a radiology nurse or technician.

“Mrs. Tong will assist you. I have explained”—Leclerc’s lips twisted to one side as he sought the right word—“the situation.”

When Leclerc rapped on the glass, Mrs. Tong looked up. As she rose, set down her magazine, and crossed to the door separating us from the scanning room, Leclerc continued talking.

“I have authorized Mrs. Tong to do full-body MSCTs on both subjects. Each axial scan will be performed with sixteen-by-three-quarter-millimeter collimation. The apparatus is a Sensation 16 unit. I have instructed Mrs. Tong to use two filters, one for bone and one for soft-tissue analysis.”

Leclerc’s delivery was so stiff, he sounded like a recording. “Mrs. Tong has agreed to remain beyond her normal shift. Please do not delay her any longer than necessary. Please follow her directives.”

“Oh, goodness me. I’m happy to help.” Mrs. Tong smiled warmly. “Got no kids to hurry home to. No church tonight. Fact is—”

“Thank you.”

The woman’s smile faded under her boss’s flinty glance.

Leclerc turned to LaManche. “Who will handle the subjects?”

LaManche’s gaze rolled to me. I nodded.

“I think this guy slept with a broom up his ass,” Pomier said under his breath as I took the bags from him.

Three pairs of eyes followed Mrs. Tong and me into the scanning room. She started talking as soon as the door clicked shut.

“I call her Felix the Cat.” She flapped a hand at the scanner. “You know, for CAT scan. That’s what they used to be called. It’s silly, I know. But a lot of patients are nervous as jackrabbits when they get shoved into a big whirring box. Naming the thing after a cartoon character helps ease the jitters.”

“Mrs. Tong—”

“What are we, dining with the queen here? Call me Opaline. You know how Felix works?” As she spoke, she adjusted dials and flipped switches.

“I understand—”

“No magic. The old boy uses a computer and a rotating X-ray device to create cross-sectional images of organs and body parts. I’m talking slices with detail that’ll blow your socks off.”

It was clear that Opaline Tong loved to talk. Or was nervous as hell around dead babies. Her eyes avoided mine as I opened the first tub.

“The T in ‘CT’ stands for ‘tomography.’ You know what that means?”

“Imaging by sections using penetrating waves.” I placed the tiny mummy designated LSJML-49277 on the patient couch, face-up, and secured it by buckling the straps.

“OK, then. You’re a smart one.”

Opaline pushed a button to move the couch up, then forward and backward inside the hole. When the baby was properly positioned, she stepped sideways and slapped the donut.

“The scanner itself is this circular rotating frame. It’s got an X-ray tube on one side and a detector on the other that looks kind of like a banana. The rotating frame will spin the X-ray tube and detector around our poor little fella here, creating a fan-shaped beam of X-rays. The detector will take snapshots called profiles. Typically, about a thousand each time around. So with each complete rotation, we’ll get one cross-sectional slice.”

Opaline’s tone had become a little less kindergarten-teacher sweet.

“The computer will use digital geometry processing to generate three-dimensional images of the inside of the body from the series of two-dimensional images taken around our single axis of rotation. Get it?”

“I do. Thank you.”

“You ready?”

I nodded.

“Let’s do it.”

* * *

Forty-three minutes later, we were all in the anteroom with Mrs. Tong seated at the workstation, the rest of us bunched around her. While entering instructions, she’d explained how the data produced by the scanner would be manipulated through a process known as windowing to demonstrate various bodily structures based on their ability to block the X-ray beam. She said that although images generated were historically in the axial or transverse plane, orthogonal to the long axis of the body, modern scanners now allowed data to be reformatted in various planes or even as volumetric—three-dimensional—representations.

First we’d viewed two-dimensional images produced, according to Mrs. Tong, by MPR, or multiplanar reconstruction. Slice by slice, we’d moved from the window-seat baby’s head to its toes, interpreting pictures that resembled abstracts by Miró.

We’d noted that the skull was deformed due to collapse of both parietal bones. We’d seen that the auditory canals were well defined, that the tiny ossicles—the maleus, incus, and stapes—were present in the middle ear. Leclerc had pointed out the cochlea and vestibule of the inner ear, the labyrinthine segment of the facial nerve canal, the pyramidal process, and other anatomical features.

I’d measured the pars squama and the pars basilaris of the occipital bone and the lengths of the femoral and tibial shafts.

We’d all agreed. The fetus was full-term.

“Switch to three-dimensional?” Mrs. Tong asked.

“Yes,” Leclerc said.

“These images will be produced using the volume-rendering technique and maximum-intensity mode,” Mrs. Tong said.

No abstracts now. The baby appeared in detailed shades of gray and white, angled down, tiny limbs V’ed inward like two sets of wings.

Leclerc used a finger to point out the obvious. “Remnants of the cerebral hemispheres, cerebellum, pons, medulla oblongata, spinal cord.” His finger moved from the skull to the thorax. “Esophagus, trachea, lungs. This is the heart, though I can’t make out the separate cardiac chambers.” He indicated the abdomen. “There’s the stomach, the liver. The rest of the organs are unrecognizable.”

“Is that a penis?” Pomier’s voice sounded husky.

“It is.”

“I see no skeletal malformations or trauma,” I said.

Leclerc and LaManche agreed, then exchanged comments about a few anatomical landmarks.

I didn’t really hear. My attention had shifted to an area of radio opacity in the trachea, partly obscured by superimposition of the tiny jaw.

“What the flip is that?”

LAMANCHE NODDED AS THOUGH I’D ANSWERED A QUESTION, not asked one. Obviously, he saw it, too.

“I noticed that earlier, thought the cloudiness was an artifact,” Leclerc said. “Now I’m not so sure.”